Abstract Introduction Sleep deficiency is common among individuals with opioid use disorder (OUD) and may contribute to psychiatric distress, substance use, and poor retention in treatment. Sex-specific differences in sleep health and their relationship to OUD outcomes remain poorly understood. We sought to characterize sex differences in sleep deficiency, psychological symptoms, and treatment outcomes in a large community-based opioid treatment program (OTP). Methods Validated measures of sleep—including the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), the first two items of the Cambridge-Hopkins Restless Legs Syndrome questionnaire (CH-RLSq), and the STOP Questionnaire—were administered to all patients at a Connecticut OTP in August 2023. Psychological symptoms were assessed using the 24-item Behavior and Symptom Identification Scale (BASIS-24). Chart-derived variables included methadone dose, number of take-home days, and treatment duration. One-year outcomes assessed in August 2024 included retention, urine toxicology, and mortality. Group differences by sex were evaluated using t-tests and chi-square tests. Results Methadone dose (81.62 mg men vs. 81.9 mg women, p = 0.87), take-home days (12.55 vs. 13.13, p = 0.31), and treatment duration (7.12 vs. 7.02 years, p = 0.74) did not differ by sex. Women reported significantly poorer sleep: higher PSQI scores (8.18 vs. 6.89, p < 0.0001), greater insomnia severity (ISI 9.27 vs. 7.67, p = 0.0001), and more restless-legs symptoms (0.68 vs. 0.52, p = 0.0011). STOP and ESS scores did not differ. Women also demonstrated higher BASIS-24 Depression (1.13 vs. 0.87, p < 0.001). Over one year, women were more likely to test positive for benzodiazepines (30.0% vs. 24.8%, p = 0.046), whereas men were more likely to test positive for fentanyl (34.99% vs. 28.48%, p = 0.0185). Treatment retention was similar (p = 0.86). Thirteen participants died (9 women, 4 men). Conclusion In this large community-based cohort of patients receiving methadone for OUD, women exhibited markedly poorer sleep quality and more depressive symptoms than men despite comparable treatment duration and retention. Over one year, more women tested positive for benzodiazepines, while more men tested positive for fentanyl. Support (if any)

Chronic pain (CP) and opioid use disorder (OUD) are common and interrelated chronic medical conditions. Currently, there is a paucity of evidence-based integrated treatments for CP and OUD among individuals receiving medication for opioid use disorder (MOUD). Wearable devices have the potential to monitor complex patient information and inform treatment development for persons with OUD and CP, including pain variability (e.g., exacerbations of pain or pain spikes) and clinical correlates (e.g., perceived stress). However, the application of large language models (LLMs) with wearable data for understanding pain spikes, remains unexplored. Consequently, the aim of this pilot study was to examine the clinical correlates of pain spikes using a range of AI approaches. We found that machine learning models achieved relatively high accuracy (>0.7) in predicting pain spikes, while LLMs were limited in providing insights on pain spikes. Real-time monitoring through wearable devices, combined with advanced AI models, could facilitate early detection of pain spikes and support personalized interventions that may help mitigate the risk of opioid relapse, improve adherence to MOUD, and enhance the integration of CP and OUD care. Given overall limited LLM performance, these findings highlight the need to develop LLMs which can provide actionable insights in the OUD/CP context.

We examined the perceived importance of counseling and its correlates among patients receiving methadone treatment (MT). Participants were 345 patients attending MT who completed 7-point Likert-type scales from 1 ("Strongly Disagree") to 7 ("Strongly Agree") to rate agreement with perceived importance of counseling, opioid use disorder (OUD) illness models, and OUD treatment beliefs. We examined predictors of perceived importance of counseling using hierarchical linear regression; steps 1, 2, and 3 were demographics, OUD illness models, and OUD treatment beliefs, respectively. Most (76%) agreed counseling was important (Mean = 5.6, SD = 1.7). Demographics did not contribute significantly to the regression model, F(4, 340) = 0.88, p > .05). R2 was significant for Step 2 (F = 2.89, p < .05) but individual OUD illness model variables did not make a significant contribution (F(3, 337) = 1.76, p > .05). The addition of OUD treatment beliefs on Step 3 (positive overall treatment expectation, importance of daily methadone, life-saving benefit of methadone medication, and importance of mutual aid) explained an additional 51% of the variation in perceived importance of counseling and this change in R2 was significant, F(4, 333) = 31.17, p < .001. We conclude that most participants perceived counseling to be important and OUD treatment beliefs independently predicted perceived importance of counseling.

IMPORTANCE Opioid use disorder (OUD) impacts millions of people worldwide. Prior studies investigating its underpinning neural mechanisms have not often considered how brain signals evolve over time, so it remains unclear whether brain dynamics are altered in OUD and have subsequent behavioral implications. OBJECTIVE To characterize brain dynamic alterations and their association with cognitive control in individuals with OUD. DESIGN, SETTING, AND PARTICIPANTS This case-control study collected functional magnetic resonance imaging (fMRI) data from individuals with OUD and healthy control (HC) participants. The study was performed at an academic research center and an outpatient clinic from August 2019 to May 2024. EXPOSURE Individuals with OUD were all recently stabilized on medications for OUD (<24 weeks). MAIN OUTCOMES AND MEASURES Recurring brain states supporting different cognitive processes were first identified in an independent sample with 390 participants. A multivariate computational framework extended these brain states to the current dataset to assess their moment-to-moment engagement within each individual. Resting-state and naturalistic fMRI investigated whether brain dynamic alterations were consistently observed in OUD. Using a drug cue paradigm in participants with OUD, the association between cognitive control and brain dynamics during exposure to opioid-related information was studied. Variations in continuous brain state engagement (ie, state engagement variability [SEV]) were extracted during resting-state, naturalistic, and drug-cue paradigms. Stroop assessed cognitive control. RESULTS Overall, 99 HC participants (54 [54.5%] female; mean [SD] age, 31.71 [12.16] years) and 76 individuals with OUD (31 [40.8%] female; mean [SD] age, 39.37 [10.47] years) were included. Compared with HC participants, individuals with OUD demonstrated consistent SEV alterations during resting-state (99 HC participants; 71 individuals with OUD; F-4,F-161 = 6.83; P < .001) and naturalistic (96 HC participants; 76 individuals with OUD; F-4,F-163 = 9.93; P < .001) fMRI. Decreased cognitive control was associated with lower SEV during the rest period of a drug cue paradigm among 70 participants with OUD. For example, lower incongruent accuracy scores were associated with decreased transition SEV (rho(58) = 0.34; P = .008). CONCLUSIONS AND RELEVANCE In this case-control study of brain dynamics in OUD, individuals with OUD experienced greater difficulty in effectively engaging various brain states to meet changing demands. Decreased cognitive control during the rest period of a drug cue paradigm suggests that these individuals had an impaired ability to disengage from opioid-related information. The current study introduces novel information that may serve as groundwork to strengthen cognitive control and reduce opioid-related preoccupation in OUD.

Objectives:Opioid use disorder (OUD) and its treatment (MOUD) are associated with altered sleep health. The purposes are to (1) describe profiles of sleep health among adults using medication for opioid use disorder (MOUD) and (2) examine the associations between multi-level individual, family, neighborhood, and social characteristics and sleep profiles. We hypothesized that poor quality of life, adverse life experiences, addiction behavior, dysfunctional family and social interactions, and negative neighborhood characteristics are associated with negative profiles of sleep health. Methods:This study comprised baseline analyses of the NIH/HEAL-funded CLOUDS study (Collaboration Linking Opioid Use Disorder and Sleep). We obtained self-report measures of sleep health and indicators of multi-level individual, family, and neighborhood factors. We identified sleep health profiles with K-means cluster analysis and examined the associations between these multi-level factors and sleep health profiles. Results:The sample included 165 participants (M age = 42, SD =11.4 years; N = 73/42.2% female; N = 37/22.4% Black or more than one race). We identified four sleep health profiles: Healthy sleep (Profile A; 30.3%); mild insomnia/late sleep timing (Profile B: 20%); clinical insomnia/long sleep (Profile C: 25.5%); and insomnia with excessive daytime sleepiness (Profile D: 23.6%). There were statistically significant differences across sleep profiles in physical and psychological health, addiction use and risk, family function, neighborhood esthetic quality, and perceptions of community support, with more adverse factors associated with poorer sleep health. Conclusions:Research is needed to understand the causal directions of these relationships and promote multi-level interventions to promote sleep health.

BACKGROUND:People experiencing homelessness (PEH) with opioid use disorder (OUD) are at high risk of overdose yet less likely to enroll and stay engaged in standard-of-care treatment for OUD, opioid agonist medication for OUD (MOUD), particularly methadone treatment. Engaging this group in treatment is a public health priority, yet little is known about the experiences of PEH enrolled in MOUD. We sought to understand the housing experiences and perspectives of PEH engaged in methadone treatment using mixed quantitative and qualitative methods. METHODS:We recruited individuals with past or present experiences of homelessness who were engaged in methadone treatment at a low-barrier opioid treatment program (OTP) in Connecticut between December 2022 and May 2023. Participants completed surveys about their demographics, resource needs, and housing and healthcare experiences. One-to-one qualitative interviews using a semi-structured interview guide queried participants' experiences with homelessness. Descriptive statistics summarize study variables using Python. The interviews were transcribed and analyzed using thematic analysis. RESULTS:Of 50 participants (19 women, 31 men, mean age 44 years), 80 % reported experiencing homelessness for over a year. Participants reported experiencing a mean of 56.6 months without permanent, stable housing and a mean of 2.4 periods of homelessness in the past 3 years. Thematic analysis yielded three primary themes that described the intersectional identity of an individual with OUD and experiencing homelessness: 1) Challenges created by homelessness (e.g., transportation barriers limiting access to the OTP); 2) Personal barriers to exiting homelessness (e.g., struggling with continued substance use); and 3) Structural barriers to exiting homelessness (e.g., difficulty navigating the housing system). CONCLUSIONS:PEH enrolled in methadone treatment face substantial barriers related to their OUD and housing status as well as many structural, social, and health-related vulnerabilities. Future efforts to address these vulnerabilities in clinical settings may enhance treatment engagement and should be examined to potentially attenuate the very high risk of overdose that PEH face. Challenges created by homelessness, personal barriers to exiting homelessness, and structural barriers to exiting homelessness are potential targets for methadone treatment programs to better tailor treatment and improve engagement and outcomes.

This study sought to examine demographic, treatment-related, and diagnosis-related correlates of substance use disorder (SUD)-related perceived discrimination among patients receiving methadone maintenance treatment (MMT). Participants were 164 patients at nonprofit, low-barrier-to-treatment-access MMT programs. Participants completed measures of demographics, diagnosis-related characteristics (Brief Symptom Inventory (BSI-18) and Depressive Experiences Questionnaire (DEQ)), and treatment-related characteristics. Perceived discrimination was measured on a seven-point Likert-type scale ranging from 1 ("Not at all") to 7 ("Extremely") in response to the item: "I often feel discriminated against because of my substance abuse." Given the variable's distribution, a median split was used to categorize participants into "high" and "low" discrimination groups. Correlates of high and low discrimination were analyzed with bivariate and logistic regression models. Ninety-four participants (57%) reported high SUD-related perceived discrimination. Bivariate analyses identified six statistically significant correlates of SUD-related perceived discrimination (P < .05): age, race, age of onset of opioid use disorder, BSI-18 Depression, DEQ Dependency, and DEQ Self-Criticism. In the final logistic regression model, those with high (versus low) SUD-related perceived discrimination were more likely to report depressive symptoms and be self-critical. Patients in MMT with high compared to low SUD-related perceived discrimination may be more likely to report being depressed and self-critical.

We examined the perceived importance of counseling and its correlates among patients receiving methadone treatment (MT). Participants were 345 patients attending MT who completed 7-point Likert-type scales from 1 ("Strongly Disagree") to 7 ("Strongly Agree") to rate agreement with perceived importance of counseling, opioid use disorder (OUD) illness models, and OUD treatment beliefs. We examined predictors of perceived importance of counseling using hierarchical linear regression; steps 1, 2, and 3 were demographics, OUD illness models, and OUD treatment beliefs, respectively. Most (76%) agreed counseling was important (Mean = 5.6, SD = 1.7). Demographics did not contribute significantly to the regression model, F(4, 340) = 0.88, p > .05). R2 was significant for Step 2 (F = 2.89, p < .05) but individual OUD illness model variables did not make a significant contribution (F(3, 337) = 1.76, p > .05). The addition of OUD treatment beliefs on Step 3 (positive overall treatment expectation, importance of daily methadone, life-saving benefit of methadone medication, and importance of mutual aid) explained an additional 51% of the variation in perceived importance of counseling and this change in R2 was significant, F(4, 333) = 31.17, p < .001. We conclude that most participants perceived counseling to be important and OUD treatment beliefs independently predicted perceived importance of counseling.

Background and Aims:Many jurisdictions are experiencing opioid epidemics. Opioid use disorder (OUD) often co-occurs with other psychiatric disorders including behavioral addictions like gambling disorder. However, little is known regarding the frequency and correlates of problematic pornography use (PPU) among people seeking treatment for OUD. Here we aimed to investigate PPU and its correlates in people seeking OUD treatment. Method:From October 2018 to March 2020, 1,272 individuals seeking OUD treatment were screened for PPU by completing the Brief Pornography Screen (BPS), a 5-item instrument validated for assessing PPU. Self-reported data were used. Results:Among the sample there were 707 (60%) males and 565 (40%) females. The mean age of participants was 37.9 ± 10.5 years (range 18-73), there were 707 (60%) males and 565 (40%) females, 9.9% (n = 126) exhibited low positive BPS scores (1 ≤ score < 4), and 4.5% of the sample (n = 57) screened positive for PPU (BPS score ≥4). Individuals screening positive for PPU versus negative were mostly male (77%), scored higher on measures of impulsivity in the domains of positive urgency, negative urgency, and sensation-seeking and demonstrated more psychopathology on measures of substance use, psychotic symptoms, emotional lability, depression/functioning and self-harm. Discussion and Conclusion:A minority of individuals seeking treatment for OUD screened positive for PPU. Among individuals with OUD, those screening positive (versus negative) for PPU were more impulsive and experienced more psychiatric symptoms, suggesting the need for additional investigation and screening for and addressing PPU in people with OUD.

Background Few studies have examined illness models among people with addiction. We investigated illness models and their associations with demographics and treatment beliefs among patients receiving methadone treatment for opioid use disorder. Methods From January 2019 to February 2020, patients receiving methadone treatment at outpatient opioid treatment programs provided demographics and rated using 1 to 7 Likert-type scales agreement with addiction illness models (brain disease model, chronic medical condition model [CMCM], and no explanation [NEM]) and treatment beliefs. Pairwise comparisons and multivariate regressions were used to examine associations between illness models, demographics, and treatment beliefs. Statistical significance was set at P < 0.05. Results A total of 450 patients participated in the study. Forty percent self-identified as female, 13% as Hispanic, and 78% as White; mean age was 38.5 years. Brain disease model was the most frequently endorsed illness model (46.2%), followed by CMCM (41.7%) and NEM (21.9%). In multivariate analyses, agreement with brain disease model was significantly positively associated with beliefs that methadone treatment would be effective, counseling is important, and methadone is lifesaving, whereas agreement with CMCM was significantly positively associated with beliefs that methadone treatment would be effective, counseling is important, 12-step is the best treatment, taking methadone daily is important, and methadone is lifesaving. In multivariate analyses, agreement with NEM was negatively significantly associated with beliefs that methadone would be effective, counseling is important, taking methadone daily is important, and methadone is lifesaving. Discussion Many patients in methadone treatment endorsed medicalized addiction models. Agreement with addiction illness models appear to be related to treatment beliefs.

Stigma and discrimination create barriers to care among people receiving medication for opioid use disorder (MOUD). We report qualitative findings from a mixed methods study guided by three aims: to explore (1) intersecting identities of people receiving MOUD (2) how individuals experience stigma and discrimination and (3) helpful resources in addressing cumulative experiences of multiple forms of disadvantage. We conducted interviews with 25 individuals in three treatment centers in the Northeast United States and identified six themes: (1) Living with multiple socially marginalized identities and addiction; (2) Loss; (3) "It's everywhere": Discrimination and stigma; (4) A "damaged" identity, (5) Positive responses to negative experiences: Facing reality and becoming accountable, and (6) Experiencing treatment and identifying supportive interventions. Findings highlight the complexity of intersecting, marginalized social positions. Future work should look beyond one-size-fits-all approaches to care and recognize individual vulnerabilities and strengths for improving outcomes among those experiencing OUD.

Resting-state functional MRI (rs-fMRI) analysis in individuals with Opioid Use Disorder (OUD) has been predominantly analyzed using seed-based methods that rely on a priori information. To overcome this limitation and the need for an arbitrary connection threshold, we used a data-driven voxel-based method that compares the functional connectivity of each brain voxel to every other voxel. To comprehensively understand brain alterations across different modalities in OUD, we also structurally assessed voxel-wise volume differences between individuals with OUD and healthy controls (HCs).

Background/ObjectivesThere is a great unmet need for accessible adjunctive interventions to promote long-term recovery from substance use disorder (SUD). This study aimed to iteratively develop and test the initial feasibility and acceptability of Mindful Journey, a novel digital mindfulness-based intervention for promoting recovery among individuals with SUD.Patients/MaterialsTen adults receiving outpatient treatment for SUD.MethodsPhase 1 (n = 5) involved developing and testing a single introductory digital lesson. Phase 2 included a separate sample (n = 5) and involved testing all 15 digital lessons (each 30- to 45-minutes) over a 6-week period, while also receiving weekly brief phone coaching for motivational/technical support.ResultsAcross both phases, quantitative ratings (rated on a 5-point scale) were all at or above a 4 (corresponding with 'agree') for key acceptability dimensions, such as usability, understandability, appeal of visual content, how engaging the content was, and helpfulness for recovery. Additionally, in both phases, qualitative feedback indicated that participants particularly appreciated the BOAT (Breath, Observe, Accept, Take a Moment) tool for breaking down mindfulness into steps. Qualitative feedback was used to iteratively refine the intervention. For example, based on feedback, we added a second core mindfulness tool, the SOAK (Stop, Observe, Appreciate, Keep Curious), and we added more example clients and group therapy videos. In Phase 2, 4 out of 5 participants completed all 15 lessons, providing initial evidence of feasibility. Participants reported that the phone coaching motivated them to use the app. The final version of Mindful Journey was a smartphone app with additional features, including brief on-the-go audio exercises and a library of mindfulness practices. Although, participants used these additional features infrequently.ConclusionsBased on promising initial findings, future acceptability and feasibility testing in a larger sample is warranted. Future versions might include push notifications to facilitate engagement in the additional app features.