Limited access to medications for opioid use disorder (MOUD) is a major driver of the opioid overdose crisis. Jails have been slow to implement MOUD treatment, especially agonist medications (methadone, buprenorphine). Massachusetts mandated certain county jails pilot-test delivery of all FDA-approved MOUD treatments, stipulating jails continue MOUD, or initiate it prior to release, and facilitate MOUD continuation in the community post-release. The Massachusetts Justice Community Opioid Innovation Network (MassJCOIN) partnered with seven pilot jails, the Massachusetts Department of Public Health, and community treatment providers to conduct a Type 1 hybrid effectiveness-implementation study of this carceral MOUD program. Drawing from selected MassJCOIN evidence on MOUD treatment program implementation, outcomes, and costs, we consider how findings can inform more effective, humane public health and clinical responses to treating incarcerated individuals. MOUD treatment in jail improves treatment engagement, reduces recidivism, and saves lives. MOUD program implementation facilitators included: policies and processes to offer universal MOUD access; transformative and adaptive leadership; appropriate staffing capacity and capabilities; proactive prevention of MOUD diversion; and consideration of patient preferences for MOUD treatment and co-occurring mental health conditions. MOUD program success was influenced by the legislative mandate and other major statewide changes and a community-based treatment system conducive to MOUD implementation. MOUD treatment continuity post-release was facilitated by re-entry planning and preparing individuals for post-release risk environments. Site-specific costs of implementing and sustaining MOUD programming provide information for decisions about program design, budgetary needs, and resource allocation. Carceral MOUD programming is a compelling strategy to advance public safety and public health. Lessons learned provide a playbook for broader diffusion of carceral MOUD programs and can help carceral leadership, healthcare providers, and policymakers make carceral healthcare improvements. Within a harm reduction framework, carceral MOUD treatment can provide substantial opportunities to fill gaps in public health prevention efforts and clinical care to reduce opioid overdose and other concomitant risks. Carceral MOUD programming offers ways for carceral systems to work for the common good, garner trust in public institutions, and increase their legitimacy and value as public institutions.
The opioid epidemic remains a critical public health crisis in the United States, with New York State (NYS) experiencing persistently high overdose mortality despite recent declines. Community-based naloxone distribution programs are a core, cost-effective overdose prevention strategy, equipping people at-risk individuals and their social networks with naloxone and overdose response training. This study examined the patterns of reported community naloxone administrations in New York State to better understand overdose response trends across demographic groups and settings. We conducted a descriptive analysis of naloxone kit distribution and reported community-administered naloxone events from 2016 to 2023 using data collected through the New York State Department of Health Opioid Overdose Prevention Program electronic ordering and reporting system. Analyses examined trends in distribution and overdose reversals, demographic characteristics, settings, naloxone administration characteristics, and survival outcomes across the years. Between 2016 and 2023, over 1.4 million naloxone kits were distributed and over 1 million individuals were trained statewide through more than 1,300 organizations operating nearly 6,000 distribution sites. A total of 18,690 community naloxone administrations were analyzed. Adults aged 25–44 accounted for 63
Under the World Anti-Doping Code, pharmacists are formally recognized as Athlete Support Personnel, yet their role in preventing unintentional doping in routine practice remains poorly understood. This study examined how pharmacists operationalize anti-doping responsibilities when confronted with a real-world counselling scenario involving a conditionally prohibited medication. A simulated-patient telephone study was conducted in July 2024 across 99 randomly selected community pharmacies in Croatia. A trained professional athlete enquired about the permissibility of continued inhaled salbutamol use in international competition. Pharmacists’ responses were assessed for clinical information gathering, accuracy of anti-doping advice, and reliance on referral. Group differences were analysed using χ²/Fisher tests, and exploratory predictors of adequate advice were examined using binary logistic regression. Valid interactions were completed with 80 pharmacies. Only 10
Abstract Background Gambling disorder, the first non-substance-related addictive disorder to be recognized, can have a severe impact on health and psycho-social well-being, but treatment seeking is often low, and the documentation of clinical needs and medical comorbidities is sparser than for substance use disorders. The present study protocol describes a large clinical and register study which aims to describe physical and psychiatric comorbidities in patients seeking treatment at a regional gambling disorder treatment unit within addiction health care, and how comorbidity, routes of referral, and psychiatric medications are associated with problem gambling patterns, self-exclusion from gambling, gambling despite self-exclusion, gender, age, psycho-social living conditions, and over-indebtedness. In addition, the study aims to map out prior contacts of care in treatment-seeking patients, aiming to lay the ground for improved and earlier detection of gambling problems in diverse clinical settings. Methods Health care documentation will be studied for all patients seeking treatment for gambling-related problems (estimated N around 1,200) for the entire 10-year period since the opening of a specialized treatment unit in the Skåne region, Sweden, in December, 2015, through November, 2025. In addition to data from health care records, treatment episode data will be run against a regional health care register describing all other primary care and specialized care contacts in the region, including out-patient and in-patient episodes and diagnoses, for both physical and mental health disorders. Discussion The present project can describe – over time – the full range of socio-demographic conditions and comorbidities, not only regarding mental health but also physical disorders, in clinical patients with gambling disorder. Results can therefore guide efforts for detection of gambling problems in other types of social service or health care settings. User perspectives are ensured through the collaboration with a patient and peer support organization, and public implementation is ensured through continuous collaboration with political decision makers and coordinating leading stakeholders in social services and health care in the region and elsewhere. Trial registration ClinicalTrials.gov, Clinical Trials identifier number NCT07488871, date of registration March 9, 2026.
Substance use disorder (SUD) in American Indian and Alaska AI (AI/AN, or “AI”) communities remains a persistent public health concern. AI/AN men experience high rates of substance use, along with related health conditions, mental health challenges, and premature mortality. Despite these concerns, research and public health efforts addressing AI/AN men’s health, particularly through culturally grounded approaches, remain limited. To address this gap, a culturally adapted secondary prevention intervention, Hastiin Bidziil (Strong Man), was developed for AI men to reduce substance use. The intervention is based on the Common Elements Treatment Approach (CETA), a transdiagnostic mental health intervention. The AI/AN-led study team facilitated a formative process where the evidence-based CETA model was adapted for rural AI men through the ADAPT-ITT approach, resulting in the Strong Man intervention. The randomized controlled trial will evaluate the effectiveness of the Strong Man intervention among 160 adult AI men. Participants are randomly assigned to either the Strong Man intervention or a basic vehicle maintenance control group. The intervention consists of a 6-lesson skill-building curriculum (minimum 5, maximum 8 sessions) incorporating cognitive behavioral therapy, motivational interviewing, and harm reduction components. The control group receives four workshops on basic vehicle maintenance, with the option to access the intervention as a service after study completion. Assessments occur at baseline, post-intervention, or control completion (or 6 months post-baseline, whichever comes first), and at an 8-month follow-up. The primary outcome is substance use frequency over the past 14 days. Secondary outcomes include substance use involvement, depression, anxiety, and post-traumatic stress disorder. Mixed-effects models will be used to evaluate intervention effects. This trial represents one of the first rigorous evaluations of a culturally adapted secondary prevention program for rural AI men. By intervening before substance use escalates, Strong Man has the potential to reduce substance-related harms, strengthen protective behaviors, such as culturally grounded coping strategies, community, connectedness, and mental well-being. Findings will inform scalable, community-driven strategies that reduce substance-related harm in tribal communities. ClinicalTrials.Gov NCT06559774.
