Pub Date : 2025-11-07DOI: 10.1016/j.josat.2025.209832
Bridget Freisthler , Daniel J. Feaster , Charles Knott , Marc LaRochelle , John McCarthy , Svetla Slavova , Sharon L. Walsh , Jennifer Villani
Introduction
Efforts to reduce opioid overdose deaths in the United States have been stymied by the lack of timely and standardized population-level data for local, state, and national levels. The U.S. has a strong national need for linking opioid and other drug overdose surveillance data to service utilization data for overdose prevention and treatment to inform resource allocation and response planning.
Methods
We provide insight on the challenges of identifying, obtaining, and harmonizing administrative outcome data across four states using the collective experience from the HEALing Communities Study to test a community-engaged, data-driven, population-level intervention to reduce opioid overdose deaths. We also discuss the opportunities that arose from those challenges, as well as the relationships across state agencies that were strengthened.
Results
Challenges experienced by the research sites on obtaining administrative outcome data included issues around who owned the data, what level of data access and use was allowed, and difficulties related to the timeliness of the data, ability to harmonize the data elements, and lack of demographic data available for stratification. Opportunities arose from these challenges whereby research sites developed new partnerships with state agencies (including a key governmental official in the state administration), provided an additional layer of quality control for these data, and facilitated democratizing data so local communities could access them.
Conclusions
The overall lessons show the importance of adapting to external changes and maintaining strong partnerships to pursue shared goals. The HCS serves as an exemplar of how local and state jurisdictions can create comprehensive data systems for monitoring and responding to the opioid overdose epidemic.
{"title":"Establishing a public health surveillance system for the opioid crisis: The experience of the HEALing Communities Study","authors":"Bridget Freisthler , Daniel J. Feaster , Charles Knott , Marc LaRochelle , John McCarthy , Svetla Slavova , Sharon L. Walsh , Jennifer Villani","doi":"10.1016/j.josat.2025.209832","DOIUrl":"10.1016/j.josat.2025.209832","url":null,"abstract":"<div><h3>Introduction</h3><div>Efforts to reduce opioid overdose deaths in the United States have been stymied by the lack of timely and standardized population-level data for local, state, and national levels. The U.S. has a strong national need for linking opioid and other drug overdose surveillance data to service utilization data for overdose prevention and treatment to inform resource allocation and response planning.</div></div><div><h3>Methods</h3><div>We provide insight on the challenges of identifying, obtaining, and harmonizing administrative outcome data across four states using the collective experience from the HEALing Communities Study to test a community-engaged, data-driven, population-level intervention to reduce opioid overdose deaths. We also discuss the opportunities that arose from those challenges, as well as the relationships across state agencies that were strengthened.</div></div><div><h3>Results</h3><div>Challenges experienced by the research sites on obtaining administrative outcome data included issues around who owned the data, what level of data access and use was allowed, and difficulties related to the timeliness of the data, ability to harmonize the data elements, and lack of demographic data available for stratification. Opportunities arose from these challenges whereby research sites developed new partnerships with state agencies (including a key governmental official in the state administration), provided an additional layer of quality control for these data, and facilitated democratizing data so local communities could access them.</div></div><div><h3>Conclusions</h3><div>The overall lessons show the importance of adapting to external changes and maintaining strong partnerships to pursue shared goals. The HCS serves as an exemplar of how local and state jurisdictions can create comprehensive data systems for monitoring and responding to the opioid overdose epidemic.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209832"},"PeriodicalIF":1.9,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-03DOI: 10.1016/j.josat.2025.209829
Steven Klein , Juan Franco , Adam Scioli
Despite overwhelming evidence supporting Medications for Opioid Use Disorder (MOUD) for substance use disorders (SUDs), stigma persists within recovery communities—particularly in some circles of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA)—that view Medications as incompatible with sobriety. This perspective piece explores the tension between life-saving pharmacologic interventions such as MOUD and deeply held beliefs within 12-step fellowships. Through the lens of a clinically grounded, narrative-driven, and first-person perspective we examine the origins of this stigma, including the historical ambivalence toward psychiatric medication in AA's founding literature. We also examine contemporary NA literature especially as it relates to the term “clean.” While many 12-step programs have increasingly accepted medications like antidepressants, MOUD remains stigmatized despite its proven effectiveness in reducing cravings, relapse, and overdose deaths. We argue that this resistance—often reinforced by sponsors, literature, and group norms—places patients at risk and undermines recovery. We use our personal experience as physicians and people in long-term recovery to call for a renewed interpretation of fellowship principles that embrace evidence-based treatment and affirms each individual's path to recovery. True sobriety should not require choosing between medication and belonging.
{"title":"Shattering the STIGMA: Talking openly about MOUD in 12-step recovery programs","authors":"Steven Klein , Juan Franco , Adam Scioli","doi":"10.1016/j.josat.2025.209829","DOIUrl":"10.1016/j.josat.2025.209829","url":null,"abstract":"<div><div>Despite overwhelming evidence supporting Medications for Opioid Use Disorder (MOUD) for substance use disorders (SUDs), stigma persists within recovery communities—particularly in some circles of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA)—that view Medications as incompatible with sobriety. This perspective piece explores the tension between life-saving pharmacologic interventions such as MOUD and deeply held beliefs within 12-step fellowships. Through the lens of a clinically grounded, narrative-driven, and first-person perspective we examine the origins of this stigma, including the historical ambivalence toward psychiatric medication in AA's founding literature. We also examine contemporary NA literature especially as it relates to the term “clean.” While many 12-step programs have increasingly accepted medications like antidepressants, MOUD remains stigmatized despite its proven effectiveness in reducing cravings, relapse, and overdose deaths. We argue that this resistance—often reinforced by sponsors, literature, and group norms—places patients at risk and undermines recovery. We use our personal experience as physicians and people in long-term recovery to call for a renewed interpretation of fellowship principles that embrace evidence-based treatment and affirms each individual's path to recovery. True sobriety should not require choosing between medication and belonging.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209829"},"PeriodicalIF":1.9,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01Epub Date: 2025-07-31DOI: 10.1016/j.josat.2025.209768
Laura J Cremer, Ayana L Miles, Miranda E Gali, Nida Ali, Marissa Roberts, Minda Reed, Donjanea F Williams, Cherie R Rooks-Peck
Background: According to the Centers for Disease Control and Prevention (CDC), there was a 480 % increase in overdose deaths among all women from 1999 to 2021 (Jones et al., 2024). Women are uniquely impacted by substance use and overdose due to biological and cultural differences compared to men. CDC launched the Overdose Data to Action (OD2A) cooperative agreement in 2019 with the goal of helping to mitigate the opioid overdose crisis across the United States by supporting state and local health departments.
Methods: This study focused on a review of programmatic data submitted by OD2A jurisdictions that detail their prevention activities to identify how jurisdictions implemented activities to address the unique needs of women. The team conducted systematic content analysis using multiple rounds of coding.
Results: Most activities were tailored for pregnant women or women who had recently given birth and focused on expanding capacity to meet their needs. The most common activities were capacity-building activities to enhance efforts to address overdose needs for women (specifically pregnant women), resource development/sharing, and implementation/evaluation of best or promising practices for women.
Conclusion: While it is important that activities tailored for pregnant women continue, our study showed a gap in activities tailored to other populations of women where the problem may be the greatest, such as women who are incarcerated, women who engage in sex work, and other female sub-populations. To address overdose rates in women, future efforts would benefit from continuing activities for pregnant women but also attempting to reach other at-risk female populations.
{"title":"Overdose Data to Action: A qualitative analysis of funded activities tailored for women.","authors":"Laura J Cremer, Ayana L Miles, Miranda E Gali, Nida Ali, Marissa Roberts, Minda Reed, Donjanea F Williams, Cherie R Rooks-Peck","doi":"10.1016/j.josat.2025.209768","DOIUrl":"10.1016/j.josat.2025.209768","url":null,"abstract":"<p><strong>Background: </strong>According to the Centers for Disease Control and Prevention (CDC), there was a 480 % increase in overdose deaths among all women from 1999 to 2021 (Jones et al., 2024). Women are uniquely impacted by substance use and overdose due to biological and cultural differences compared to men. CDC launched the Overdose Data to Action (OD2A) cooperative agreement in 2019 with the goal of helping to mitigate the opioid overdose crisis across the United States by supporting state and local health departments.</p><p><strong>Methods: </strong>This study focused on a review of programmatic data submitted by OD2A jurisdictions that detail their prevention activities to identify how jurisdictions implemented activities to address the unique needs of women. The team conducted systematic content analysis using multiple rounds of coding.</p><p><strong>Results: </strong>Most activities were tailored for pregnant women or women who had recently given birth and focused on expanding capacity to meet their needs. The most common activities were capacity-building activities to enhance efforts to address overdose needs for women (specifically pregnant women), resource development/sharing, and implementation/evaluation of best or promising practices for women.</p><p><strong>Conclusion: </strong>While it is important that activities tailored for pregnant women continue, our study showed a gap in activities tailored to other populations of women where the problem may be the greatest, such as women who are incarcerated, women who engage in sex work, and other female sub-populations. To address overdose rates in women, future efforts would benefit from continuing activities for pregnant women but also attempting to reach other at-risk female populations.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209768"},"PeriodicalIF":1.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-31DOI: 10.1016/j.josat.2025.209831
Blake T. Hilton , Mia A. Haidamus , Victoria R. Votaw , Gerardo Gonzalez , Roger D. Weiss , Margaret L. Griffin , R. Kathryn McHugh
Introduction
Despite demonstrated effectiveness, medications for alcohol use disorder (MAUD) are underutilized. While studies have considered structural and provider-level barriers, little is known about patient-level factors associated with MAUD initiation. We aimed to examine stigma, knowledge, and beliefs about MAUD and their associations with intention to take them among a sample with severe AUD.
Methods
Adults receiving treatment for alcohol use disorder at an inpatient withdrawal management and treatment initiation program completed a cross-sectional survey (N = 171). MAUD knowledge (i.e., correctly identified medications for AUD), beliefs (i.e., perceived effectiveness), and stigma (i.e., internalized and perceived) in general and by medication type (i.e., naltrexone, acamprosate, and disulfiram) were assessed using a measure developed for this study.
Results
Knowledge about which medications are indicated for AUD was low, with the highest awareness for naltrexone (61 % of participants correctly identified this medication). Most (55 %) participants believed MAUD helps people recover, however approximately half were uncertain about the effectiveness of each specific medication type. Participants with greater MAUD knowledge and more positive beliefs about effectiveness reported greater intention to take MAUD (ps < 0.05). Stigma was low across all medications (mean scores <3 on a scale of 10), though a substantial portion of participants endorsed uncertainty about stigma.
Conclusions
Greater knowledge and positive beliefs about MAUD were significantly associated with intentions to pursue MAUD, yet many participants reported uncertainty in these domains. MAUD knowledge was low overall, as was stigma. Targeted efforts to enhance patient knowledge of MAUD could be a promising strategy for increasing medication uptake.
{"title":"Stigma and knowledge about medications for alcohol use disorder among treatment-seeking adults","authors":"Blake T. Hilton , Mia A. Haidamus , Victoria R. Votaw , Gerardo Gonzalez , Roger D. Weiss , Margaret L. Griffin , R. Kathryn McHugh","doi":"10.1016/j.josat.2025.209831","DOIUrl":"10.1016/j.josat.2025.209831","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite demonstrated effectiveness, medications for alcohol use disorder (MAUD) are underutilized. While studies have considered structural and provider-level barriers, little is known about patient-level factors associated with MAUD initiation. We aimed to examine stigma, knowledge, and beliefs about MAUD and their associations with intention to take them among a sample with severe AUD.</div></div><div><h3>Methods</h3><div>Adults receiving treatment for alcohol use disorder at an inpatient withdrawal management and treatment initiation program completed a cross-sectional survey (<em>N</em> = 171). MAUD knowledge (i.e., correctly identified medications for AUD), beliefs (i.e., perceived effectiveness), and stigma (i.e., internalized and perceived) in general and by medication type (i.e., naltrexone, acamprosate, and disulfiram) were assessed using a measure developed for this study.</div></div><div><h3>Results</h3><div>Knowledge about which medications are indicated for AUD was low, with the highest awareness for naltrexone (61 % of participants correctly identified this medication). Most (55 %) participants believed MAUD helps people recover, however approximately half were uncertain about the effectiveness of each specific medication type. Participants with greater MAUD knowledge and more positive beliefs about effectiveness reported greater intention to take MAUD (<em>p</em>s < 0.05). Stigma was low across all medications (mean scores <3 on a scale of 10), though a substantial portion of participants endorsed uncertainty about stigma.</div></div><div><h3>Conclusions</h3><div>Greater knowledge and positive beliefs about MAUD were significantly associated with intentions to pursue MAUD, yet many participants reported uncertainty in these domains. MAUD knowledge was low overall, as was stigma. Targeted efforts to enhance patient knowledge of MAUD could be a promising strategy for increasing medication uptake.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"180 ","pages":"Article 209831"},"PeriodicalIF":1.9,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-30DOI: 10.1016/j.josat.2025.209828
Avik Chatterjee , Rachel P. Chase , Rouba A. Chahine , Jill Davis , Nishi Dsouza , Sylvia Ellison , Sarah M. Bagley , Tiarra Fisher , LaShawn Glasgow , Miriam T.H. Harris , Terry T.-K. Huang , JaNae Holloway , David W. Lounsbury , Emmanuel Oga , Kat Asman , Sara M. Roberts , Nasim Sabounchi , Hilary L. Surratt , Lisa M. Lines , Henry W. Stadler , Alissa Davis
Introduction
Evidence-based practices (EBPs) tailored to reduce opioid-related fatalities among minoritized populations may help reduce inequities, but research elucidating the relationship between local-level inequities in social determinants of health (SDH) and selection and implementation of tailored EBPs.
Methods
The HEALing Communities Study was a multisite, wait-listed, community-level cluster-randomized trial with the objective to reduce opioid overdose deaths. Community coalitions selected and partner organizations implemented EBP strategies to increase access to Overdose Education and Naloxone Distribution (OEND) and Medications for Opioid Use Disorder (MOUD). The research team utilized negative binomial and zero-inflated Poisson models to assess whether the relationship between (a) communities' need for tailored OEND and MOUD strategies, as indicated by opioid overdose death rates among minoritized groups; and (b) the selection, implementation, and reach of those strategies was moderated by local-level inequities in SDH, quantified by the Local Social Inequity in Drug Overdoses (LSI-DO) index. The analysis included data from 33 communities across four states.
Results
Eleven of 33 communities implemented tailored OEND and MOUD strategies. Adjusted analysis revealed that LSI-DO scores moderated the relationship between 2021 opioid overdose death rates among minoritized groups and the proportion of community-implemented tailored strategies (p = 0.015). The research team found no moderation for the number of strategies selected or number of individuals reached by EBPs.
Conclusion
Few communities selected EBPs tailored to minoritized populations. For those that did, higher local-level social inequity was associated with decreased implementation of tailored strategies. Continued research on how to address overdose inequities—and local-level social inequity—is vital. Findings highlight the need for policy approaches that pair overdose prevention strategies with investments to reduce local-level social inequities that impede equitable implementation.
{"title":"Local level of social inequity moderates implementation of evidence-based practices tailored to minoritized populations to reduce opioid overdose deaths","authors":"Avik Chatterjee , Rachel P. Chase , Rouba A. Chahine , Jill Davis , Nishi Dsouza , Sylvia Ellison , Sarah M. Bagley , Tiarra Fisher , LaShawn Glasgow , Miriam T.H. Harris , Terry T.-K. Huang , JaNae Holloway , David W. Lounsbury , Emmanuel Oga , Kat Asman , Sara M. Roberts , Nasim Sabounchi , Hilary L. Surratt , Lisa M. Lines , Henry W. Stadler , Alissa Davis","doi":"10.1016/j.josat.2025.209828","DOIUrl":"10.1016/j.josat.2025.209828","url":null,"abstract":"<div><h3>Introduction</h3><div>Evidence-based practices (EBPs) tailored to reduce opioid-related fatalities among minoritized populations may help reduce inequities, but research elucidating the relationship between local-level inequities in social determinants of health (SDH) and selection and implementation of tailored EBPs.</div></div><div><h3>Methods</h3><div>The HEALing Communities Study was a multisite, wait-listed, community-level cluster-randomized trial with the objective to reduce opioid overdose deaths. Community coalitions selected and partner organizations implemented EBP strategies to increase access to Overdose Education and Naloxone Distribution (OEND) and Medications for Opioid Use Disorder (MOUD). The research team utilized negative binomial and zero-inflated Poisson models to assess whether the relationship between (a) communities' need for tailored OEND and MOUD strategies, as indicated by opioid overdose death rates among minoritized groups; and (b) the selection, implementation, and reach of those strategies was moderated by local-level inequities in SDH, quantified by the Local Social Inequity in Drug Overdoses (LSI-DO) index. The analysis included data from 33 communities across four states.</div></div><div><h3>Results</h3><div>Eleven of 33 communities implemented tailored OEND and MOUD strategies. Adjusted analysis revealed that LSI-DO scores moderated the relationship between 2021 opioid overdose death rates among minoritized groups and the proportion of community-implemented tailored strategies (<em>p</em> = 0.015). The research team found no moderation for the number of strategies selected or number of individuals reached by EBPs.</div></div><div><h3>Conclusion</h3><div>Few communities selected EBPs tailored to minoritized populations. For those that did, higher local-level social inequity was associated with decreased implementation of tailored strategies. Continued research on how to address overdose inequities—and local-level social inequity—is vital. Findings highlight the need for policy approaches that pair overdose prevention strategies with investments to reduce local-level social inequities that impede equitable implementation.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"180 ","pages":"Article 209828"},"PeriodicalIF":1.9,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-30DOI: 10.1016/j.josat.2025.209830
Jodie M. Dewey , Kathryn R. Gallardo , Meenakshi S. Subbaraman , Amy A. Mericle
Introduction
This paper provides an in-depth examination of examines four recovery residences, that serve individuals prescribed medications for opioid use disorder (MOUD). The study has two primary aims: first, to deepen understanding of how recovery residences adopt and operationalize Social Model of Recovery principles; and second, to identify gaps in staff integration of residents receiving MOUD—gaps that may either support or undermine the integrity of the social model within these settings.
Methods
We conducted semi-structured interviews with 17 residents receiving MOUD living in four participating recovery homes. The interviews were conducted between August 2022 and January 2024 using a semi-structured interview guide designed to explore residents' experiences upon entering and living in the recovery home. Qualitative software was used to organize and qualitatively analyze transcripts through multiple rounds of coding. Themes were discussed across the research team and grouped across each of the various principles of the Social Model of Recovery.
Results
Residents reported feeling supported in safe, structured environments that promoted accountability and community, while staff with lived experience played a central role in fostering trust and modeling long-term recovery. Structured programming, peer coaching, and access to essential resources further reinforced recovery-supportive conditions. However, inconsistent staff attitudes toward MOUD revealed underlying stigma, which some residents found intrusive or isolating.
Conclusion
This study addresses key gaps in recovery science by offering qualitative insights into Level 3 recovery residences, emphasizing the perspectives of residents navigating staff relationships, organizational policies, and recovery programming. Despite increasing MOUD acceptance, recovery homes rarely address MOUD-related stigma formally, creating tension between medical and social models of recovery and contributing to judgment or marginalization of MOUD recipients. These findings highlight the urgent need for evidence-based MOUD integration strategies, staff education, and stigma reduction efforts to ensure that recovery homes fully support all residents' recovery pathways.
{"title":"“If he did it, I can do it, too. I can change my life around”: The social model of recovery within the context of recovery homes accepting residents prescribed medications for opioid use disorder","authors":"Jodie M. Dewey , Kathryn R. Gallardo , Meenakshi S. Subbaraman , Amy A. Mericle","doi":"10.1016/j.josat.2025.209830","DOIUrl":"10.1016/j.josat.2025.209830","url":null,"abstract":"<div><h3>Introduction</h3><div>This paper provides an in-depth examination of examines four recovery residences, that serve individuals prescribed medications for opioid use disorder (MOUD). The study has two primary aims: first, to deepen understanding of how recovery residences adopt and operationalize Social Model of Recovery principles; and second, to identify gaps in staff integration of residents receiving MOUD—gaps that may either support or undermine the integrity of the social model within these settings.</div></div><div><h3>Methods</h3><div>We conducted semi-structured interviews with 17 residents receiving MOUD living in four participating recovery homes. The interviews were conducted between August 2022 and January 2024 using a semi-structured interview guide designed to explore residents' experiences upon entering and living in the recovery home. Qualitative software was used to organize and qualitatively analyze transcripts through multiple rounds of coding. Themes were discussed across the research team and grouped across each of the various principles of the Social Model of Recovery.</div></div><div><h3>Results</h3><div>Residents reported feeling supported in safe, structured environments that promoted accountability and community, while staff with lived experience played a central role in fostering trust and modeling long-term recovery. Structured programming, peer coaching, and access to essential resources further reinforced recovery-supportive conditions. However, inconsistent staff attitudes toward MOUD revealed underlying stigma, which some residents found intrusive or isolating.</div></div><div><h3>Conclusion</h3><div>This study addresses key gaps in recovery science by offering qualitative insights into Level 3 recovery residences, emphasizing the perspectives of residents navigating staff relationships, organizational policies, and recovery programming. Despite increasing MOUD acceptance, recovery homes rarely address MOUD-related stigma formally, creating tension between medical and social models of recovery and contributing to judgment or marginalization of MOUD recipients. These findings highlight the urgent need for evidence-based MOUD integration strategies, staff education, and stigma reduction efforts to ensure that recovery homes fully support all residents' recovery pathways.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"180 ","pages":"Article 209830"},"PeriodicalIF":1.9,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-29DOI: 10.1016/S2949-8759(25)00199-7
{"title":"C2: editorial board","authors":"","doi":"10.1016/S2949-8759(25)00199-7","DOIUrl":"10.1016/S2949-8759(25)00199-7","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"179 ","pages":"Article 209820"},"PeriodicalIF":1.9,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-29DOI: 10.1016/S2949-8759(25)00200-0
{"title":"TOC (update)","authors":"","doi":"10.1016/S2949-8759(25)00200-0","DOIUrl":"10.1016/S2949-8759(25)00200-0","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"179 ","pages":"Article 209821"},"PeriodicalIF":1.9,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-28DOI: 10.1016/j.josat.2025.209812
Noel Vest, Christina E Freibott, Kelly E Dunn, Landhing Moran, P T Korthuis, Joshua D Lee, Edward Nunes, Christine Timko
Objectives: People receiving medications for opioid use disorder often continue to experience opioid withdrawal, creating barriers to improved outcomes. Emerging evidence suggests the existence of distinct opioid withdrawal subtypes characterized by high and low levels of withdrawal severity, highlighting the need for personalized treatment approaches. To inform clinical practice, we identified subgroups of adults based on levels of opioid withdrawal over time during opioid use disorder (OUD) treatment.
Methods: We conducted a secondary analysis of the Clinical Trials Network (CTN-0051) Extended-Release Naltrexone versus Buprenorphine for Opioid Treatment trial using latent class growth analysis to identify subgroups of withdrawal. Four hundred and seventy-four participants in an OUD trial were randomized to receive extended-release naltrexone (XR-NTX) or sublingual buprenorphine-naloxone (BUP-NX). Withdrawal symptoms were measured using the Subjective Opiate Withdrawal Scale (SOWS) at 10 timepoints. We identified classes and compared their predictors of withdrawal and time to return to opioid use.
Results: Two distinct trajectories - low and high sustained opioid withdrawal - were identified in each treatment arm. Most participants were in the low withdrawal class (n = 176; 86 % XR-NTX and n = 241; 89 % BUP-NX) with fewer in the high sustained withdrawal class (n = 28; 14 % XR-NTX and n = 29; 11 % BUP-NX). Differences in lifetime history of anxiety and depression and in quality of life domains (mobility, usual activities, and pain/discomfort) were primarily observed among XR-NTX participants, with only one baseline mobility difference emerging between BUP-NX classes. In the XR-NTX arm, time to return to use was significantly shorter in the high sustained withdrawal class compared to the low withdrawal class, whereas BUP-NX classes did not differ on time to return to use.
Discussion and conclusions: Our findings demonstrate the existence of distinct high and low opioid withdrawal subtypes among individuals receiving XR-NTX and BUP-NX. These results underscore the importance of personalized withdrawal management strategies and highlight the need to consider individual withdrawal trajectories when optimizing treatments. Future research should focus on identifying predictors of withdrawal severity to improve clinical outcomes.
{"title":"Identifying patterns of withdrawal among patients in treatment for opioid use disorder: A secondary latent class growth analysis of the CTN XBOT trial.","authors":"Noel Vest, Christina E Freibott, Kelly E Dunn, Landhing Moran, P T Korthuis, Joshua D Lee, Edward Nunes, Christine Timko","doi":"10.1016/j.josat.2025.209812","DOIUrl":"10.1016/j.josat.2025.209812","url":null,"abstract":"<p><strong>Objectives: </strong>People receiving medications for opioid use disorder often continue to experience opioid withdrawal, creating barriers to improved outcomes. Emerging evidence suggests the existence of distinct opioid withdrawal subtypes characterized by high and low levels of withdrawal severity, highlighting the need for personalized treatment approaches. To inform clinical practice, we identified subgroups of adults based on levels of opioid withdrawal over time during opioid use disorder (OUD) treatment.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the Clinical Trials Network (CTN-0051) Extended-Release Naltrexone versus Buprenorphine for Opioid Treatment trial using latent class growth analysis to identify subgroups of withdrawal. Four hundred and seventy-four participants in an OUD trial were randomized to receive extended-release naltrexone (XR-NTX) or sublingual buprenorphine-naloxone (BUP-NX). Withdrawal symptoms were measured using the Subjective Opiate Withdrawal Scale (SOWS) at 10 timepoints. We identified classes and compared their predictors of withdrawal and time to return to opioid use.</p><p><strong>Results: </strong>Two distinct trajectories - low and high sustained opioid withdrawal - were identified in each treatment arm. Most participants were in the low withdrawal class (n = 176; 86 % XR-NTX and n = 241; 89 % BUP-NX) with fewer in the high sustained withdrawal class (n = 28; 14 % XR-NTX and n = 29; 11 % BUP-NX). Differences in lifetime history of anxiety and depression and in quality of life domains (mobility, usual activities, and pain/discomfort) were primarily observed among XR-NTX participants, with only one baseline mobility difference emerging between BUP-NX classes. In the XR-NTX arm, time to return to use was significantly shorter in the high sustained withdrawal class compared to the low withdrawal class, whereas BUP-NX classes did not differ on time to return to use.</p><p><strong>Discussion and conclusions: </strong>Our findings demonstrate the existence of distinct high and low opioid withdrawal subtypes among individuals receiving XR-NTX and BUP-NX. These results underscore the importance of personalized withdrawal management strategies and highlight the need to consider individual withdrawal trajectories when optimizing treatments. Future research should focus on identifying predictors of withdrawal severity to improve clinical outcomes.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209812"},"PeriodicalIF":1.9,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12604569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145411073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-22DOI: 10.1016/j.josat.2025.209811
Sophia T Gonzalez, Viviana E Horigian, Hannah Cheng, Hildi J Hagedorn, Dikla Shmueli-Blumberg, Cynthia I Campbell, Chunqing Lin, Erin Rogers, Jure Baloh, Rachel Hilton, Ashley Vena, Jennifer McNeely, Joseph E Glass
Background: The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) has supported clinical trials of substance use disorder (SUD) interventions for 25 years. This review describes the use of implementation outcomes across CTN trials, characterizes outcomes included, and identifies gaps and potential opportunities to strengthen implementation research within the CTN and the field of SUD treatment.
Methods: This systematic review included active or completed studies listed on the CTN Dissemination Library webpage as of August 18, 2021, and approved by the CTN for development by January 1, 2022. Study summaries and protocols were reviewed if they: 1) measured at least one implementation outcome and 2) examined a practice change, intervention, or process. Extracted data elements included trial design characteristics, implementation frameworks, and outcome assessment domains informed by the RE-AIM and Proctor Implementation Outcomes Frameworks.
Results: 114 protocols were considered, 42 full-text protocols were screened, and 25 were included for data extraction. Start dates of trials spanned a 20-year period (2004-2024) with latter studies including more implementation outcomes. Fidelity (n = 29) and reach/penetration (n = 26) were the most included implementation outcomes. Equity was not identified in any protocols. Methods of defining, capturing, and evaluating outcomes data varied across trials and outcomes.
Conclusion: The inclusion of implementation outcomes increased over time, perhaps reflecting a growing emphasis on implementation research. Incorporating measures of equity could advance knowledge about differential receipt or effectiveness of SUD interventions. Future research should seek to improve the consistency and comprehensiveness in descriptions of implementation science elements.
{"title":"Implementation outcomes included in NIDA Clinical Trials Network (CTN) studies: A systematic review of studies conducted over 20 years.","authors":"Sophia T Gonzalez, Viviana E Horigian, Hannah Cheng, Hildi J Hagedorn, Dikla Shmueli-Blumberg, Cynthia I Campbell, Chunqing Lin, Erin Rogers, Jure Baloh, Rachel Hilton, Ashley Vena, Jennifer McNeely, Joseph E Glass","doi":"10.1016/j.josat.2025.209811","DOIUrl":"10.1016/j.josat.2025.209811","url":null,"abstract":"<p><strong>Background: </strong>The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) has supported clinical trials of substance use disorder (SUD) interventions for 25 years. This review describes the use of implementation outcomes across CTN trials, characterizes outcomes included, and identifies gaps and potential opportunities to strengthen implementation research within the CTN and the field of SUD treatment.</p><p><strong>Methods: </strong>This systematic review included active or completed studies listed on the CTN Dissemination Library webpage as of August 18, 2021, and approved by the CTN for development by January 1, 2022. Study summaries and protocols were reviewed if they: 1) measured at least one implementation outcome and 2) examined a practice change, intervention, or process. Extracted data elements included trial design characteristics, implementation frameworks, and outcome assessment domains informed by the RE-AIM and Proctor Implementation Outcomes Frameworks.</p><p><strong>Results: </strong>114 protocols were considered, 42 full-text protocols were screened, and 25 were included for data extraction. Start dates of trials spanned a 20-year period (2004-2024) with latter studies including more implementation outcomes. Fidelity (n = 29) and reach/penetration (n = 26) were the most included implementation outcomes. Equity was not identified in any protocols. Methods of defining, capturing, and evaluating outcomes data varied across trials and outcomes.</p><p><strong>Conclusion: </strong>The inclusion of implementation outcomes increased over time, perhaps reflecting a growing emphasis on implementation research. Incorporating measures of equity could advance knowledge about differential receipt or effectiveness of SUD interventions. Future research should seek to improve the consistency and comprehensiveness in descriptions of implementation science elements.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209811"},"PeriodicalIF":1.9,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12785561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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