Abstract Background and Objectives Although medications are effective treatments for opioid use disorder (OUD), they are highly stigmatized. Our objectives were to (1) compare patient‐reported stigma across medication types and (2) determine whether intention to take each medication was associated with stigma and perceived effectiveness. Methods Adults with OUD ( N = 58) were enrolled from inpatient treatment. Results Stigma toward naltrexone was significantly lower than buprenorphine and methadone. Perceived effectiveness was strongly associated with intention to take each medication, whereas stigma was only associated with intention to take methadone. Conclusions and Scientific Significance Patients reported higher stigma for agonist medications, however perceived effectiveness was more strongly associated with intention to take medication. Both knowledge about MOUD effectiveness and stigma may be valuable targets for improving MOUD uptake.
BACKGROUND AND OBJECTIVES Cychlorphine is an emerging synthetic opioid with limited clinical data. METHODS We describe a patient's reported cychlorphine use and its's clinical effects. RESULTS Thirty-five years old male with opioid use disorder reported purchasing cychlorphine online. He described marked sedation and respiratory depression. Standard toxicology did not detect cychlorphine. Patient died 2 months later from a drug poisoning event. DISCUSSION AND CONCLUSION Clinicians should ask about online drug purchases and manage suspected opioid intoxication based on clinical symptoms. SCIENTIFIC SIGNIFICANCE This case highlights the risk associated with emerging NSOs, the limitations of standard and even sophisticated toxicology screening.
Background and Objectives Hospitalization offers a limited but important opportunity to address medical and psychiatric needs among incarcerated adults, who have high burdens of substance use disorder (SUD), mental illness, and suicide-related risk. National comparative data by SUD status remain sparse. Methods We conducted a retrospective study using the National Inpatient Sample (2016-2021) of hospitalized adults with ICD-10 codes indicating incarceration to evaluate the association between SUD and psychiatric comorbidity, suicidality, and hospitalization outcomes in the United States. Results Among 92,715 (N) hospitalized incarcerated adults, 40.4% had SUD. Patients with SUD were younger (40.7 +/- 11.4 vs. 48.4 +/- 13.9 years) and more frequently female (22.2% vs. 12.6%). SUD was strongly associated with suicidal ideation (75.4% vs. 38.6%; adjusted odds ratio [aOR] 3.73; p < .001). Multivariable analyses demonstrated higher odds of major depressive disorder (aOR 1.43), schizophrenia-spectrum disorders (aOR 1.61), bipolar disorder (aOR 1.66), anxiety disorders (aOR 2.07), trauma-related disorders (aOR 1.90), and personality disorders (aOR 1.63) (all p < .001). Despite this, SUD was associated with lower in-hospital mortality and total charges, with no significant difference in length of stay. Discussion and Conclusions SUD is highly prevalent and independently associated with increased psychiatric burden and suicide-related risk in hospitalized incarcerated adults. These findings support prioritizing integrated inpatient approaches to address co-occurring addiction and mental health conditions in this vulnerable population. Scientific Significance These findings identify SUD as a significant factor associated with psychiatric morbidity and suicidality among incarcerated patients, highlighting hospitalization as an important opportunity for integrated screening, assessment, and care delivery.
BACKGROUND AND OBJECTIVES Prolonged fentanyl detection may complicate urine drug testing (UDT). We describe norfentanyl detection after negative confirmatory testing. METHODS Two patients (N = 2) entering residential treatment after heavy illicitly manufactured fentanyl exposure underwent clinically indicated serial UDT with confirmatory LC-MS/MS. RESULTS Both had negative confirmatory results followed by subsequent low-level urinary norfentanyl detection. Recurrent exposure could not be excluded. DISCUSSION These findings demonstrate diagnostic uncertainty rather than a defined pharmacokinetic mechanism. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Low-level norfentanyl after negative confirmatory testing should prompt longitudinal assessment rather than automatic attribution to recurrent use or prolonged detection.
