Abstract 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.
Abstract 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.
BACKGROUND AND OBJECTIVES:Managing substance use disorders (SUDs) is limited by the lack of longitudinal clinical data during active use and recovery. Wearable devices may help address this gap by capturing physiological and behavioral data in real-world settings. This review evaluated the feasibility and acceptability of wearable devices among individuals with SUDs. METHODS:A systematic search of PubMed, PsycINFO, and MEDLINE identified peer-reviewed studies published between 2000 and 2023 examining wearable devices that passively measured physiological data among adults with SUDs or at-risk substance use. RESULTS:Thirty-three studies met inclusion criteria and were grouped into feasibility and acceptability outcomes, sleep-related outcomes, and other clinical outcomes including craving, stress, and detection of substance use or overdose events. Most studies used wrist-worn devices and focused on opioid and alcohol use. The literature was heterogeneous and predominantly observational, with few experimental designs, and several studies included individuals with at-risk use rather than diagnosed SUDs. Short-term wearable use was generally feasible and acceptable when privacy and safety concerns were addressed. Wearables captured indicators such as sleep disruption, stress, and overdose risk. However, none of the included studies evaluated whether wearable use was associated with improved substance use outcomes over time. DISCUSSION AND CONCLUSIONS:Wearable devices show promise as adjunct tools for monitoring clinically relevant indicators in SUDs, but evidence remains limited. Future research should prioritize longitudinal outcomes, validate clinically meaningful thresholds, and support equitable, patient-centered implementation. SCIENTIFIC SIGNIFICANCE:This review provides a structured synthesis of an emerging and fragmented literature, offering a foundation to guide future hypothesis-driven, longitudinal, and implementation-focused research.
BACKGROUND AND OBJECTIVES:Cannabis withdrawal symptoms can be severe and protracted, significantly impeding the ability to abstain from cannabis use, resulting in failed quit attempts and relapse. This clinical trial evaluated safety and efficacy of PP-01, a novel dual‑mechanism of action, investigational agent, for mitigating cannabis withdrawal symptoms in patients with cannabis use disorder (CUD). METHODS:This Phase 1b/2a randomized, double-blind, placebo-controlled, crossover, 5-night, inpatient study evaluated efficacy and safety of PP-01 (nabilone and gabapentin) in 14 adults with moderate to severe CUD. Participants with daily/near daily use of ≥1 gram/day of cannabis and a history of cannabis withdrawal were randomized to PP-01 or placebo. Severity and bothersomeness of withdrawal symptoms were evaluated by patient daily diary. Mixed model repeated measures analysis of variance was used to compare mean differences between PP-01 and placebo. RESULTS:PP-01 significantly reduced severity (p = .0222) and bothersomeness (p = .0063) of cannabis withdrawal symptoms within 10 and 4 h post-first dose of PP-01, respectively. Sleep quality and cannabis cravings significantly improved following first dose through discharge. Objective withdrawal measures also statistically significantly improved. PP-01 was well tolerated; adverse events (AEs) were mild in severity with no serious AEs. DISCUSSION AND CONCLUSIONS:Investigational PP-01 mitigated cannabis withdrawal symptoms in participants with moderate to severe CUD, was safe and well-tolerated in this proof-of-concept study. SCIENTIFIC SIGNIFICANCE:PP-01 is intended as a potential treatment for cannabis withdrawal syndrome (CWS)/CUD, a serious and unmet need for which there is no Food and Drug Administration (FDA)-approved medication.
