BACKGROUND:Illicit drug use among older adults (aged 45+ years) is increasing globally. Despite the growing impact on older adults, studies examining illicit drug use in this population remain limited. METHOD:Data were drawn from Wave 21 (2021) of the Household, Income and Labour Dynamics in Australia (HILDA) longitudinal cohort survey. The analysis included 7862 participants aged 45+ years, representing a weighted population of 8 713 896 individuals. The primary outcome was any illicit drug use in the past 12 months and was coded as a binary variable (yes/no). A series of Survey-weighted logistic regression (svy: logistic) was used to examine associations between illicit drug use and a range of explanatory variables, including individual-level, lifestyle behaviours, and social and mental health factors. RESULT:Illicit drug use prevalence among older adults was 42% (95% CI: 40-43). Illicit drug use was significantly higher among participants born in main English-speaking countries (adjusted odds ratio [aOR] = 1.47; 95% CI: 1.08-1.99), in Australia (aOR = 1.47; 95% CI: 1.16-1.87), and those living in Inner Regional areas (aOR = 1.93; 95% CI: 1.07-3.47). Participants with moderate psychological distress (K10) had 1.24 times higher odds (aOR = 1.24; 95% CI: 1.03-1.50), and those with high or very high distress had 1.57 times higher odds (aOR = 1.57; 95% CI: 1.22-2.04) of reporting illicit drug use. Lower scores on the SF-36 Mental Health scale (moderate or low mental health status) were significantly associated with increased odds of illicit drug use. Those who experienced traumatic life events were more likely to report illicit drug use (aOR = 1.22; 95% CI: 1.05-1.42). CONCLUSION:Illicit drug use among older adults is associated with smoking, high-risk alcohol use, psychological distress, and trauma exposure. These findings highlight the need for integrated interventions addressing both substance use and mental health.
BACKGROUND:Cannabis marketing and regulation have rapidly evolved. This study examined online cannabis marketing across different regulatory contexts. METHODS:In 2022 and 2025, we assessed cannabis retailer websites from 5 US cities: Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas (LV), Nevada; and Los Angeles (LA), California. We assessed age verification, online sales, products, marketing, and warnings, and compared by city in 2025 (N = 171) and by year (N = 130). RESULTS:In 2025, most verified age (83.6%) and offered online sales (96.5%). Frequently promoted health benefits included sleep (58.5%) and pain (48.5%), most often by Denver, LV, and LA retailers (P's < .05). Targeted populations included veterans/military (40.9%) and racial/ethnic minorities (24.0%), especially in LV and LA (P's < .05), as well as seniors (29.2%), women (25.7%), LGBTQ+ (13.5%), young adults (13.5%), and underage (7.6%). Price promotions included daily/weekly/monthly specials (78.9%) and membership/loyalty programs (75.4%). Most (73.7%) displayed health/safety warnings (range: 57.6% in Portland to 96.9% in LV, P = .003), commonly adults-only (57.9%) and keep from children (46.8%). Most (58.5%) displayed regulation-related warnings (range: 41.9% in LA to 71.9% in Seattle, P = .011), common purchase/amount restrictions (49.1%) and no public use (27.5%). There were increases (P's < .05) from 2022 to 2025 in beverage offerings (74.6% in 2022 vs 90.0% in 2025), membership/loyalty programs (64.6% vs 78.5%), and targeting veterans/military (28.5% vs 40.0%), seniors (4.6% vs 27.7%), LGBTQ+ (5.4% vs 13.1%), and racial/ethnic minorities (4.6% vs 19.2%). CONCLUSIONS:Stronger regulations and enforcement are needed to address online retail, including limiting product access, price promotions, and marketing practices targeting specific populations.
BACKGROUND:Despite the widespread prevalence and health impacts of substance use (including alcohol), policies and services remain anchored in diagnostic criteria, overlooking people whose substance use does not fit clinical categories. This structural emphasis on meeting diagnostic thresholds often means people wait until crisis to seek help rather than engaging with support earlier. Substance use health frameworks instead encourage understanding substance use as an aspect of health that occurs along a continuum rather than a simple binary between "healthy" and "disordered" making visible a wider range of experiences and outcomes. While there is early adoption of this framework, little is known about how people understand their place on this spectrum or how it shapes their relationships with substances, identity, and stigma. METHODS:Semi-structured focus groups were conducted with men and women across the substance use health spectrum (n = 18). Codebook thematic analysis was used to identify dominant narratives about substance use, identity, and stigma. RESULTS:Participants described diverse and shifting relationships with substances, including individuals who do not currently or have never used substances (n = 7), who have a relationship with one or more substances (n = 8), and who notice a change in their health with regard to their substance use (n = 3). Analysis generated four themes: spectrum identity negotiation and fluidity; social contexts, norms, and hierarchies; negotiating stigma across public, self, and structural levels; and gendered patterns in substance use discussions. CONCLUSION:The substance use health spectrum offers language for describing substance use as a dynamic aspect of health and identity rather than a fixed diagnostic status. By exploring how people across the continuum understand and negotiate stigma, our findings show how the spectrum can inform public health messaging, services, and research that reflect substance use across the population and move stigma reduction beyond disorder‑focused approaches.
BACKGROUND:Hepatology specialty clinics present a unique opportunity to provide alcohol-related care (brief counseling, treatment referral, medications for alcohol use disorder [MAUD]). We used practice facilitation to implement alcohol-related care in 3 distinct Veterans Health Administration hepatology clinics in the western U.S. and conducted a mixed-methods summative evaluation assessing documented alcohol-related care (adoption) and patient experiences (acceptability/fidelity). METHODS:Three sources of data were triangulated. Electronic health record (EHR) data extracted for patients receiving care at the 3 clinics pre-, during, and post-implementation measured patient characteristics and trends in documented alcohol-related care (adoption). Structured chart reviews for a random sample of 137 patients with documented unhealthy alcohol use assessed documentation of 3 additional adoption measures: (1) alcohol-related discussions, (2) discussion of/referral to treatment, and (3) discussion/receipt of MAUD. Qualitative interviews with 12 patients (4/clinic) with documented alcohol-related discussions during the implementation/post-period were conducted to assess patients' perspectives (acceptability/fidelity). RESULTS:Five thousand four hundred three unique patients were seen during the study; 2566 at Site 1, 2428 at Site 2, and 409 at Site 3. EHR data showed dynamic but little overall change in alcohol use or alcohol-related care over time. In chart reviews during pre-implementation, 74% had documented alcohol discussions, 23% of those with alcohol discussions had discussion of/referral to treatment, and 15% had discussion/receipt of MAUD. During/post-implementation, 75% had alcohol discussions, 59% of those with alcohol discussions had discussion of/referral to treatment, and 25% had discussion/receipt of MAUD. Interview participants generally remembered and were satisfied with alcohol-related discussions. Patients appreciated when clinicians described how liver damage can reverse with abstinence and expressed confidence in their ability to abstain. CONCLUSIONS:Practice facilitation may have supported adoption of alcohol-related care in hepatology clinics, which patients generally appreciated. Clinicians in hepatology specialty clinics should encourage honesty, emphasize the benefits of abstinence, and provide patient-centered messaging.
BACKGROUND:Despite declines in opioid overdose deaths, stigma toward individuals with opioid use disorder (OUD) among clinicians remains a critical barrier to high-quality care. Stigma compromises therapeutic relationships, discourages care-seeking, and negatively affects clinical decision-making. This review aimed to: (1) identify clinician groups targeted by stigma-reduction interventions; (2) describe stigma measurement tools used; and (3) examine the types and effectiveness of interventions designed to reduce OUD-related stigma. METHODS:A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and CINAHL were searched for studies published between 2020 and 2025. Studies were included if they evaluated interventions explicitly aimed at reducing stigma toward individuals with OUD among U.S. clinicians or trainees. Study quality was assessed using the Johns Hopkins Nursing Evidence-Based Practice guidelines. RESULTS:Nineteen studies met inclusion criteria, predominantly single-group pretest-posttest designs, with sample sizes ranging from 5 to 1842 participants. Thirteen studies targeted students or trainees, while 6 focused on practicing clinicians. Interventions were categorized as didactic, contact-based, or experiential. Didactic interventions produced modest improvements in attitudes, particularly among students, but were less effective for practicing clinicians. Contact-based interventions, involving exposure to individuals with lived experience, were generally more effective among students, with mixed results among clinicians. Experiential interventions, including simulation, virtual reality, and supervised clinical experiences, consistently reduced stigma across student and clinician populations. CONCLUSIONS:Experiential and contact-based interventions appear most effective for reducing stigma toward individuals with OUD, particularly among practicing clinicians. Future research should prioritize practicing clinicians, employ theory-informed designs, standardize stigma measures, and evaluate long-term and scalable effects to optimize stigma reduction in healthcare settings.
The United States continues to grapple with the shifting substance use landscape among the emerging concurrent use of opioids and stimulants. Polysubstance use (PSU) of opioids and stimulants, whether intentionally or unintentionally, has increased substance use related morbidity and mortality. Changes at the policy level are needed to effectively curb overdose and other adverse outcomes. This article outlines 3 policy changes that are particularly relevant to opioid-stimulant PSU: (1) reforms in opioid agonist treatment policy, (2) reforms in payment for evidence-based treatment, and (3) reforms of drug paraphernalia laws. The current overdose crisis requires a multidimensional paradigm shift toward patient-centered and harm reduction focused policies that will expand access to comprehensive evidence-based treatments and services for individuals engaged in opioid and stimulant PSU.
BACKGROUND:Standardized screening tools are widely used to support early identification and triage in mental health and substance use (MHSU) services. However, little is known about how clinicians experience such tools in high-pressure community settings, where structural vulnerability and clinical complexity are common. METHODS:We conducted in-depth interviews with 13 clinicians at a centralized MHSU intake center in British Columbia using interpretive description and reflexive thematic analysis. The aim was to examine how a locally adapted Global Appraisal of Individual Needs-Short Screener-based screener was used and understood in real-world practice. FINDINGS:Clinicians expressed mixed understandings of the screener's purpose, noting tensions between administrative and clinical roles. Most valued structured tools in principle but found the screener misaligned with relational care because its structured fields did not consistently preserve narrative context or connect clearly to referral actions. Training and implementation support varied, and several participants wanted clearer communication, follow-up, and better workflow integration. Clinicians proposed improvements including narrative fields, embedded referral actions, and collaborative implementation. CONCLUSIONS:Effective implementation of MHSU screeners requires more than tool design. Contextual fit, relational alignment, and sustained clinician engagement are also required. Findings underscore the need for collaborative implementation, iterative learning, and integration that supports rather than disrupts clinical reasoning and client-centered care.
Opioid use disorder (OUD) treatment needs continue to outpace the capacity of existing treatment systems, with access to buprenorphine particularly constrained in many communities. Pharmacist involvement in medications for OUD (MOUD), including buprenorphine initiation and longitudinal management, has demonstrated feasibility and acceptability in select settings, yet widespread implementation remains limited by regulatory variability and fragmented care models. Pharmacies are highly accessible health care sites, and pharmacists' scope of practice can be expanded through mechanisms such as collaborative pharmacy practice agreements (CPPAs)-a term used interchangeably in the literature with "collaborative practice agreement" and related variants-to support buprenorphine initiation and ongoing management. The CTN-0151 PharmValue project aims to develop a scalable, pharmacist-led CPPA model for MOUD that can be adapted across diverse state regulatory environments and pharmacy settings. Using a community-engaged research approach and a 50-state legal and regulatory review supplemented by a national expert survey, PharmValue will (1) engage community stakeholders to codevelop a model CPPA and care pathway for pharmacist-managed buprenorphine and (2) identify existing legal authorities and advocacy opportunities to expand pharmacist-managed MOUD care nationally. This protocol commentary describes the rationale, guiding frameworks, and key design decisions underlying the PharmValue model and outlines anticipated implementation challenges and future directions for evaluation and scale-up.
BACKGROUND:Wearable technologies enable objective measurement of physical activity (PA) and sleep in substance use disorder (SUD) treatment research, yet the feasibility of deploying wearables in real-world SUD service settings is poorly understood. Given high rates of treatment discontinuation (30%-50%), housing instability, and transience among individuals with SUDs, wearable loss may be substantially higher than in other populations. METHODS:We prospectively tracked SENS Motion wearables deployed to 63 participants across 8 SUD treatment and recovery service sites in Western Australia, spanning residential, continued-care, and community-based services, as part of an ongoing longitudinal study. Wearable loss was treated as a key feasibility outcome. An advisory group comprising individuals with lived experience of SUD recovery (n = 2), treatment service stakeholders (n = 3), and researchers (n = 4) contextualised observed challenges. Advisory group data were analysed using inductive qualitative content analysis. FINDINGS:Thirteen wearables (20.6%) were permanently lost, compared with approximately 1% in general population studies. Loss occurred almost exclusively in residential care settings (14.3%-42.9% across facilities) and coincided with participant exit from treatment. No losses were attributable to technical malfunction or deliberate non-compliance. Five higher-order categories were identified: treatment transitions as drivers of loss, diffuse responsibility for wearable return, ethical tensions around accountability, impact on future research, and practical mitigation strategies. CONCLUSIONS:Wearable-based PA and sleep measurement in SUD treatment settings is feasible but requires structural and procedural safeguards, including integration of wearable retrieval into discharge workflows and clarification of responsibility between research teams and service partners that explicitly anticipate high rates of unplanned treatment discontinuation.
BACKGROUND:Intimate partner violence (IPV) victimization is a serious public health issue linked with negative mental health, including substance use disorder (SUD). Yet little is known regarding patterns of IPV victimization among people with SUD. This study used a person-centered approach to characterize heterogeneous IPV victimization experiences and their association with behavioral health outcomes among individuals enrolled in SUD treatment. METHODS:Latent class analysis (LCA) classified IPV patterns in adult participants (N = 359) enrolled in SUD treatment in Missouri. IPV was measured using the 15-item Composite Abuse Scale-Revised Short Form and assessed on 3 levels: never, lifetime (ie, not within the past 12 months), and current (ie, within the past 12 months). Multinomial logistic regression analyses examined the associations between latent class membership and outcomes of interest, adjusting for demographics. RESULTS:Most study participants (65.5%) reported any IPV-including past and current. The strongest fit to the data was a five-class solution. Classes characterizing IPV experience included Never (34.5%), Current Multiple (24.8%), Past Multiple (19.8%), Current Emotional (12.5%), and Past Emotional (8.4%). Polyvictimization classes (ie, Current Multiple and Past Multiple) were significantly correlated with greater odds of endorsing moderate/severe depression and anxiety, compared to the Never class. IPV class membership was not associated with past-30-day non-medical drug use. CONCLUSIONS:IPV victimization among adults enrolled in SUD treatment programs is heterogeneous. Unlike prior studies characterizing IPV in general adult community samples, emotional abuse emerged as the most prevalent type of IPV in this clinical sample. Experiencing multiple types of IPV was linked to more severe mental health problems, illustrating that complex IPV histories may be a barrier to SUD recovery success. Findings highlight the need for comprehensive IPV screening and trauma-informed mental health support within SUD treatment settings.
BACKGROUND:Harmful substance use affects millions of people, producing health and social consequences that require both professional support and effective self-management. This study piloted a self-management program targeting the consequences of substance addiction in adults enrolled in medication-based program. METHODS:A parallel-group pilot trial compared the Self-Management Substance Addiction Consequences Program (ADS Program) with treatment as usual (TAU) to assess the program's effectiveness and identify the need for adjustments to the intervention or the trial design. Seventy-two randomly selected adults enrolled for at least 5 weeks in medication-based program for alcohol or other drugs participated. Data were collected at baseline and after 8 to 21 weeks to assess effects on substance addiction consequences (SAC) and positive mental health (PMH). RESULTS:Of the 236 patients screened, 72 were randomized: 38 to the ADS Program and 34 to TAU. Twenty-five participants completed the ADS Program (34.2% attrition), and 16 completed TAU (52% attrition). ADS participants attended more sessions (6 vs 2), although still fewer than planned. Participants in the ADS Program demonstrated significant reduction in SAC (paired t(24) = -5.718, P < .001, d = -1.169). Similar improvements were observed in the TAU group (paired t(15) = -6.357, P < .001, d = -1.580), with no significant differences between groups (P > .05). PMH also improved in both groups. The ADS group showed a statistically significant increase (paired t(20) = -3.945, P < .001, d = -0.861), whereas the TAU group demonstrated marginally non-significant improvement (paired t(11) = -2.170, P = .053, d = -0.626). No significant between-group differences were identified (P > .05). CONCLUSIONS:This pilot trial indicates that the ADS Program is feasible, safe, and potentially effective in supporting self-management of SAC. Findings suggest an adjusted duration of 6 to 18 weeks may be beneficial. Given the substantial dropout rate, further research with larger samples is needed to confirm effectiveness and improve retention.
BACKGROUND:Treatment for alcohol and opioid withdrawal when managed independently is well-established; however, specific guidance on their concurrent management is lacking. This review evaluated the relationship between buprenorphine initiation and time to initiation on key substance use disorder outcomes for inpatients at risk for both alcohol and opioid withdrawal. METHODS:This single-center retrospective cohort study included patients admitted to the acute psychiatry unit from January 1, 2019 through September 30, 2023 and at risk for concurrent opioid and alcohol withdrawal. Patients were divided into 4 cohorts depending on time to buprenorphine initiation from admission: 0 to 24 hours (n = 85), 24 to 72 hours (n = 44), >72 hours (n = 16), and those who did not receive buprenorphine (n = 187). The primary outcome compared the patient-directed discharge (PDD) rate among the 4 cohorts. Secondary outcomes compared the overall length of stay, inpatient readmission rates at 30 and 90 days, and buprenorphine medication retention at 90 days. Descriptive statistics were used for analysis. RESULTS:Of all psychiatric admissions meeting inclusion criteria (N = 332), 43.7% (n = 145) received buprenorphine. PDD rates were higher in those who did not receive buprenorphine compared to those who did (15.5% [n = 29] vs 6.9% [n = 10]) and in those who initiated buprenorphine between 24 and 72 hours versus 0 to 24 hours of admission (11.4% [n = 5] vs 5.9% [n = 5]). Absence of buprenorphine initiation also resulted in higher inpatient readmission rates at both 30 (25.1% [n = 47] vs 11.0% [n = 16]) and 90 days (46% [n = 86] vs 24.1% [n = 35]). CONCLUSIONS:Patients who did not receive buprenorphine had the highest rate of PDD and readmission. Buprenorphine initiation within 24 hours of admission was associated with a lower rate of PDD. Results highlight the importance of the timely initiation of evidence-based medications for opioid use disorder in patients with concurrent alcohol withdrawal, leading to more favorable outcomes for patients and the facility.
BACKGROUND:Psychosis is a complex neuropsychiatric state which can be induced by methamphetamine. How methamphetamine-associated psychosis (MAP) is perceived by those who experience it, and whether it increases or reduces motivation for recovery is unclear. OBJECTIVE:Using qualitative methods, our study explored the relationships between MAP and subjective changes in methamphetamine use among individuals with a history of MAP. We sought to identify salient experiences of MAP and relationships between these experiences and methamphetamine use patterns, to inform intervention development for persons with MAP. METHODS:As part of a larger observational study on MAP, we conducted semi-structured interviews with participants (n = 21) who had recently recovered from an episode of MAP. Interviews queried experiences with MAP, use of methamphetamine in relation to psychosis, and treatment experiences. We developed a codebook based on the interview guide, which was iteratively tailored using emergent data from the transcripts and field notes and applied to all data. RESULTS:In response to MAP, participants increased, decreased, or did not change their use. Participants reported a variety of reasons for their change in use patterns. As expected, some participants reduced their use to reduce psychosis, but this was far from universal; some participants did not find psychotic symptoms motivating enough to change their use. Some participants increased their use to stay safe from perceived threats, and others increased or decreased their use in an idiosyncratic manner, depending on the content of the psychosis. CONCLUSIONS:Despite the common perception of psychosis as an undesirable experience, participants described a variety of changes in methamphetamine use patterns in response to MAP. Reported changes in use were complex and idiosyncratic, and many participants even reported increasing their use. Our findings add depth and nuance to our understanding of the relationship between psychosis and methamphetamine and may inform future clinical intervention research.
Artificial intelligence (AI) is embedded in addiction scholarship, not only as a methodological tool in research but also as a tool for manuscript preparation. In addiction research and clinical care, AI is already used to analyze data and support clinical decision-making. In parallel, AI tools are increasingly used to summarize literature, revise prose, generate outlines, draft text, and assist with interpretation and presentation of findings. These developments create an urgent need for addiction journals to clarify how AI use should be governed and disclosed. In this editorial, we argue for a principled, proportionate framework for AI disclosure grounded in materiality. We distinguish AI used in the conduct of research from AI used in manuscript preparation and propose a practical taxonomy of assistive, intermediate, and generative AI mapped onto 6 escalating levels of involvement. We identify intermediate AI as a key governance challenge because it may appear to provide editorial assistance while materially shaping scholarly content. We argue that disclosure should be required when AI materially contributes to the conduct of research or to the intellectual content, interpretation, argument, or presentation of a manuscript, while routine low-risk assistive uses should not require disclosure. Transparent governance, organized around materiality rather than specific technologies, is the appropriate response to AI in addiction publishing.
BACKGROUND:The relationship between menopausal transition, alcohol use and women's health remains poorly understood despite its relevance in psychiatry and women's health. Alcohol and menopausal symptoms can overlap, which can lead to misattribution and a barrier to access appropriate care. The objectives are to map the existing literature on the relationship between menopause, perimenopause and alcohol use. We also aim to synthesise current evidence and identify knowledge gaps across 3 domains: alcohol and impact on menopausal physiology and symptoms; menopausal transition and impact on alcohol use patterns; and psychosocial context and mental health. METHODS:A scoping review was conducted using the Ovid MEDLINE, PubMed, Embase, Cochrane and PsycINFO databases. Studies were included if they involved perimenopausal, menopausal or postmenopausal women and addressed any kind of alcohol use. Data were synthesised thematically. RESULTS:Fifty-seven studies were included, predominantly prospective cohorts (n = 18) and cross-sectional studies (n = 15). Most focused on postmenopausal populations, with perimenopausal women under-represented. Moderate alcohol consumption was associated with higher oestradiol and lower follicle-stimulating hormone levels, though effects on menopausal timing were inconsistent. Findings on vasomotor symptoms, sleep disturbance and sexual function varied considerably. No consistent evidence demonstrated that the menopausal transition independently increases alcohol consumption. Mental health outcomes were reported in fewer than one-quarter of studies, with moderate drinking showing neutral effects while heavy consumption correlated with worse mood and cognitive complaints. CONCLUSIONS:The literature provides only a partial understanding of the menopause-alcohol relationship, with conflicting results across vasomotor symptoms, sleep, sexual function and psychological outcomes.
BACKGROUND:People with (vs without) disabilities may be at greater risk for substance use, but limited research has explored the use of various substances among people with disabilities. This study examined differences in substance use among U.S. young adults with versus without disabilities. METHODS:Survey data were derived from an internet-based, purposive national sample of U.S. young adults (aged 18-34; N = 3458; Mage = 26.4; 61.2% female, 63.2% White). Multivariable regression analyses examined disability status, subtype (hearing, vision, cognitive, mobility), and number of disabling limitations in relation to: past 30-day cannabis and tobacco use frequency (ordinal logistic regression, adjusted odds ratios [aOR]); past 30-day binge drinking (negative-binomial regression, adjusted incidence rate ratio); and past 6-month non-medical stimulant and opioid use (logistic regression, aOR). RESULTS:One-third of participants (30.2%) reported having at least 1 disability. 40.5%, 37.8%, and 33.1% participants reported past 30-day cannabis use, tobacco use, and binge drinking, respectively. 8.7% and 5.3% of participants reported past 6-month non-medical stimulant and opioid use, respectively. Participants with (vs without) disability had greater odds of more frequent cannabis use (aOR: 1.44, 95% confidence interval: 1.23-1.69), more days of tobacco use (1.61, 1.33-1.93), and 3 times higher rates of both non-medical use of stimulants (3.02, 2.23-4.09) and opioids (3.00, 2.11-4.28). Mobility/complex activity limitations were associated with more days of binge drinking (1.55, 1.08-2.21). Compared to participants without disabilities, a greater number of disability subtypes was associated with higher likelihood of using all substances studied, except for binge drinking. CONCLUSIONS:Young adult substance use patterns differ by disability status, disability subtype, and number of disabling limitations, as well as by specific substances. Future research should prioritize tailored prevention and treatment strategies to address substance use within this underserved population with disabilities.
BACKGROUND:Previous research indicates that opioid overdose risk is significantly higher during community reentry following incarceration, particularly for women. However, there is a limited understanding of factors specifically associated with women's overdose risk post-jail release. This study examines the relationship between individual risk factors, structural vulnerabilities, and nonfatal overdose during the 3 months following jail release among a sample of women with opioid use disorder (OUD). METHODS:Women (N = 900) in this study were randomly selected from 9 Kentucky jails, screened for OUD, and interviewed as part of the Justice Community Opioid Innovation Network trial (NCT04069624) funded by the National Institute on Drug Abuse. The sample consisted of women who completed the 3-month follow-up interview post-release and had complete data on all variables of interest (n = 754). Bivariate analyses assessed relationships between post-release nonfatal overdose and individual-level factors (eg, demographic characteristics) and structural vulnerabilities (eg, unstable housing and food insecurity). Firth logistic regression was then used to further examine independent correlates of nonfatal overdose during community reentry. RESULTS:According to analyses, 31 women (4.1%) reported a nonfatal overdose during the 3 months post-jail release. Regression results indicated that odds of overdosing post-release were higher for women who had overdosed previously in their lifetime (P = .004). Injection drug use (P < .001) and unstable housing (P = .048) during the follow-up period also increased the odds of overdose. CONCLUSIONS:These results suggest that both individual risk factors and structural vulnerabilities may contribute to increased overdose risk for women with OUD returning to the community post-incarceration. Overdose prevention interventions should include strategies for mitigating these reentry challenges. CLINICAL TRIALS INFORMATION:ClinicalTrials.gov ID NCT04069624; https://clinicaltrials.gov/study/NCT04069624.
BACKGROUND:Cocaine use disorder (CUD) presents high relapse rates and limited treatment options. Repetitive transcranial magnetic stimulation (rTMS) has shown promise, but evidence in clinical practice is scarce. METHODS:We conducted a naturalistic retrospective study using medical records of patients with CUD (n = 93) who received rTMS treatment in a private clinic between October 2018 and 2021. Thirty-two (rTMS) sessions were administered: 2 daily sessions in the first week and 2 sessions per week at a high-frequency (10 Hz) stimulation at 120% motor threshold to the left dorsolateral prefrontal cortex. Sociodemographic data, cocaine use, and treatment dropout were recorded, along with psychopathological assessments at 5 time points. RESULTS:Baseline abstinence predicted lower relapse risk at days 5, 30, and 90 (OR range = 1.42-1.95, all P < .05). At study end, abstinence probability was 58.6% for baseline abstinent versus 33.6% for active users. Intensive treatment (day 5) increased abstinence by 18.8%. Treatment completion was 44.6%, higher among baseline abstinent (70.3% vs 25.0%; P < .001). Age predicted relapse (OR = 1.06, P = .003), while sex and baseline craving did not. Craving decreased significantly over time (F = 56.4, P < .001), with higher scores in active users and a significant time × consumption interaction (P < .05). Sleep quality, depressive symptoms, and anxiety also improved (all P < .001). No side effects were described. CONCLUSIONS:rTMS was associated with reduced craving and improved clinical outcomes. Baseline abstinence and younger age were associated with lower relapse rate and increased retention. rTMS may be a safe and promising adjunctive treatment for CUD.
Machine learning (ML) models have been commonly utilized to predict various opioid-related outcomes and risks, including post-operative opioid use, opioid use disorder (OUD), misuse, or overdose. Despite their promising performance, the clinical utility and cross-study comparability of ML models are constrained. This is mainly due to variability in outcome definitions, data heterogeneity, class imbalance and analysis concerns, inadequate external or prospective validation, and limited real-world deployment and ethical concerns. Herein, we present an updated overview of these challenges in predicting opioid-related outcomes and outline strategies to improve the clinically meaningful applications of ML in this domain.
BACKGROUND:Medications for opioid use disorder (MOUD) are underused by problem-solving court (PSC) clients, despite their treatment efficacy. Prior qualitative work suggests PSC staff make case-by-case decisions about whether clients can use MOUD, with decisions influenced by the type of MOUD desired and the presence of PSC-MOUD provider partnerships. This study tests these qualitative findings using an experimental survey. METHODS:A national convenience sample of 53 PSC staff was randomly assigned 8 of 32 hypothetical vignettes with varying court client factors in a factorial online survey experiment. For each vignette, staff were asked whether their court would allow MOUD. Decision factors tested included client race, client gender, type of MOUD, history of client MOUD misuse, and whether the MOUD would come from an MOUD provider who partners with the court. Client race and gender were made to vary across surveys, while the remaining factors varied within surveys. Hierarchical ordinal modeling tested the effects of factors on decisions. RESULTS:PSC staff were significantly less likely (P < .05) to allow MOUD if hypothetical clients (a) were prescribed methadone rather than buprenorphine, (b) desired medication from a non-partnering treatment provider versus a partner, or (c) had a history of MOUD misuse versus no history. CONCLUSION:Findings affirm prior qualitative work indicating the PSC's relationship to the MOUD provider and MOUD type affect case-by-case PSC staff decisions about MOUD. Interventions to promote development of court-MOUD provider partnerships could help increase MOUD utilization among PSC clients. Partnerships with methadone providers might help address methadone misconceptions.
