Importance:Previous research has shown neighborhood environmental interventions can improve health and safety for residents. It is unknown whether these interventions impact opioid overdose outcomes. Objective:To evaluate the association of neighborhood environmental interventions with opioid overdose rates. Design, Setting, and Participants:This quasi-experimental nonrandomized trial used a continuous treatment difference-in-differences design and was conducted in a single neighborhood of Philadelphia, Pennsylvania, between January 1, 2019, and December 31, 2021. The quasi-experimental design used nonrandomized comparator groups to evaluate the associations of neighborhood environmental interventions with opioid overdose rates since randomization was not possible. Data analysis took place between May 2022 and February 2025. Interventions:Community trash pickups, vacant lot cleanups, and abandoned house remediation. Main Outcomes and Measures:Outcomes of interest were nonfatal and fatal opioid overdoses. Results:Of 1667 individual blocks (median household income, $37 821) included in the study geography, 622 blocks (37.3%) received at least 1 intervention during the study period. Among 59 590 residents in the study area, there were 1179 Asian residents (2.0%), 9951 Black residents (16.7%), 23 261 White residents (39.0%), 5016 residents (8.4%) who identified as 2 or more races, and 19 903 residents (33.4%) who identified as another race; 30 286 residents (50.8%) were Hispanic or Latinx. A total of 763 community trash pickups, 483 abandoned house remediations, and 855 vacant lot cleanups were included in analysis. In aggregate, the interventions were associated with a significant reduction in fatal opioid overdoses (change, -6.6%; 95% CI, -10.5% to -2.4%), with no measurable association for nonfatal opioid overdoses (change, -0.0%; 95% CI, -3.4% to 3.5%). Abandoned house remediation was associated with a significant reduction in both fatal (change, -17.6%; 95% CI, -26.2% to -7.9%) and nonfatal (change, -11.5%; 95% CI, -19.0% to -3.3%) opioid overdoses. Community trash pickup was not associated with rates of fatal or nonfatal overdoses. Vacant lot cleanup was not associated with rates of fatal overdoses but was associated with a significant increase in nonfatal overdoses (change, 11.7%; 95% CI, 4.0% to 20.0%). No significant displacement associations were found in other locations. Conclusions and Relevance:In this study of the association of neighborhood environmental interventions with opioid overdose rates, interventions analyzed in aggregate were associated with reduced fatal opioid overdoses outcomes, with no association with nonfatal outcomes. Abandoned house remediation was significantly associated with reduced fatal and nonfatal opioid overdose rates and should be considered along with other essential interventions that provide treatment and harm reduction to individuals with substance use disorder.

Medetomidine is a veterinary α2-adrenergic agonist that has been an adulterant of illicitly manufactured opioids since 2022. We review its pharmacology, detection, intoxication, withdrawal, and management, and assess why severe withdrawal has emerged in some regions but not others. Medetomidine has spread through North American drug markets yet evades most toxicology testing. Roughly two hundred times more potent than xylazine, with greater α2 selectivity and imidazoline-1 activity, it causes intoxication resembling other α2 agonists: sedation and bradycardia. The dominant clinical problem is withdrawal: autonomic dysregulation, intractable vomiting, and encephalopathy frequently requiring intensive care. Treatment requires multimodal α2-agonist therapy, often escalating to parenteral dexmedetomidine. Where it is established, withdrawal encounters and hospital admissions have risen. We hypothesize that both local prevalence and drug concentration determine where withdrawal appears. This syndrome exposes gaps in both assessment and treatment; prospective multicenter research, a validated withdrawal instrument, and integrated addiction-critical care models are needed.

Addiction consult services (ACSs) are a growing hospital-based care model that increases quality of care for patients with substance use disorders (SUDs). One implementation barrier has been concern about negative financial impacts for health systems. To examine whether starting an ACS changes hospital length-of-stay and 30-day readmissions for patients with opioid use disorder (OUD) served in a large academic health system. Quasi-experimental difference-in-differences study of opioid-related hospital admissions from January 2018 to December 2024, comparing one hospital that implemented an ACS to three hospitals in the same urban, academic system in Philadelphia, PA without ACSs. Adults (≥ 18 years) with opioid-related hospitalizations. A fully staffed, hospital-based, multidisciplinary ACS launched in July 2023. Primary outcomes were hospital length-of-stay and 30-day readmissions. Secondary outcomes were receipt of any medication for opioid use disorder (MOUD) during hospitalization, discharge on a therapeutic MOUD dose, emergency department visits within 6 months of discharge, and discharges before medically advised. In unadjusted analyses, ACS implementation was associated with a 5 percentage point increase in MOUD receipt (95

INTRODUCTION:Novel psychoactive substances (NPSs), due to rapid emergence and evolving use patterns, pose a significant public health surveillance challenge. Traditional surveillance lags street-level reality, necessitating the exploration of novel strategies and data sources like Reddit for continuous NPS trend monitoring and presenting a public dashboard. METHODS:We mined data from 60,601 subreddits between January 2015 and June 2025 for seven NPSs (kratom, xylazine, medetomidine, nitazenes, tianeptine, bromazolam, and 2C-B) using keyword-variants. We performed Mann-Kendall trend tests to assess temporal patterns, computed correlations to compare post volumes with National Forensic Laboratory Information System (NFLIS) drug report counts (2015-2024), conducted cross-correlation analyses at ±2-year lags to identify lead-lag relationships, and created a public dashboard for data visualization. RESULTS:The dataset comprised 328,223 posts from 139,901 accounts. We observed moderate to strong correlations between Reddit volumes and three out of five NPSs with NFLIS reports: bromazolam (ρ = 0.81, p < 0.001), tianeptine (ρ = 0.48, p = 0.04), xylazine (ρ = 0.60, p < 0.001). Cross-correlation analyses indicated Reddit discussions preceded NFLIS reports for medetomidine (ρ = 0.93, lag = -2 years), bromazolam (ρ = 0.86, lag = -1year), tianeptine (ρ = 0.81, lag = -2years), and xylazine (ρ = 0.62, lag = -2years), suggesting Reddit discussions as a potential leading indicator. Co-mention of other substances with NPSs often matched known trends from retrospective data. CONCLUSION:Reddit-based surveillance provides timely and complementary signals to traditional forensic systems for NPS monitoring. Interactive visualizations and downloadable aggregated statistics are available via our dashboard.

QuestionDoes 7-day extended-release injectable buprenorphine compared with sublingual buprenorphine improve treatment engagement at 7 days?FindingsIn this multicenter randomized trial of 1994 adult patients presenting to the emergency department with untreated opioid use disorder and a Clinical Opiate Withdrawal Scale (COWS) score of 4 or higher, 40.5% in the extended-release group and 38.5% in the sublingual buprenorphine group were in treatment at 7 days, demonstrating no significant difference between groups.MeaningA 7-day extended-release injectable preparation of buprenorphine does not improve treatment engagement. ImportanceExtended-release injectable buprenorphine may expand the reach of initiating medications for opioid use disorder in high-risk and hard-to-reach individuals who visit the emergency department (ED) and can be administered in low levels of withdrawal.ObjectiveTo compare the effect of ED-initiated 7-day extended-release injectable buprenorphine vs sublingual buprenorphine on treatment engagement at 7 days.Design, Setting, and ParticipantsMulticenter randomized clinical trial enrolling adult patients presenting to the ED with untreated opioid use disorder and a Clinical Opiate Withdrawal Scale (COWS) score of 4 or higher across 29 EDs in the US from July 12, 2020, to August 21, 2024. Final follow-up was completed on October 24, 2024.InterventionsPatients were randomized to receive a 24-mg injection of extended-release buprenorphine (equivalent to 16 mg/d) or sublingual buprenorphine, which included either self-administration instructions if the COWS score was less than 8 or administration of 8 mg of sublingual buprenorphine in the ED if the COWS score was 8 or higher. All sublingual buprenorphine group patients received a 7-day prescription for 16 mg/d. Both groups were provided referral for ongoing medication with a scheduled appointment within 7 days.Main Outcomes and MeasuresEngagement in opioid use disorder treatment on day 7 was the primary outcome. Secondary outcomes included engagement at 30 days, precipitated withdrawal and overdose events, craving scores, days of illicit opioid use, and patient satisfaction with treatment.ResultsAmong 2000 patients randomized, 6 who were enrolled twice were excluded, resulting in 991 in the extended-release group and 1003 in the sublingual group. The median age was 37 (IQR, 30-47) years, 68% were male, 31% had an initial COWS score of 4 to 7, and 76% tested positive for fentanyl. The adjusted proportion of engagement in opioid use disorder treatment at 7 days was 40.5% with extended-release buprenorphine vs 38.5% with sublingual buprenorphine (adjusted difference, 1.6%; 95% CI, -2.8% to 6.0%). Engagement at 30 days was similar, with adjusted proportions of 43.8% with extended-release buprenorphine vs 44.9% with sublingual buprenorphine (adjusted difference, -1.5%; 95% CI, -6.2% to 3.2%). Precipitated withdrawal was rare: 6 (0.6%) with extended-release buprenorphine and 8 (0.8%) with sublingual buprenorphine. Overdose events within 30 days occurred in 18 participants (2.3%) in each group. Patients receiving extended-release buprenorphine reported lower mean craving scores at 7 days vs those receiving sublingual buprenorphine (scale, 0-100; mean score, 26.5 vs 30.2, respectively; adjusted mean difference, -3.85; 95% CI, -7.08 to -0.63), fewer days of illicit opioid use in the past 7 days (adjusted ratio of means, 0.77; 95% CI, 0.68-0.95), and better treatment satisfaction scores (scale, 1-5; adjusted mean difference, 0.13; 95% CI, 0.01-0.25).Conclusions and RelevanceNo difference was detected in opioid use disorder treatment engagement on day 7 between the 7-day extended-release and sublingual buprenorphine groups. Both buprenorphine formulations were well tolerated; precipitated withdrawal was rare despite a high prevalence of fentanyl.Trial RegistrationClinicalTrials.gov Identifier: NCT04225598 This randomized clinical trial assesses the effect of emergency department (ED)-initiated 7-day extended-release injectable buprenorphine vs sublingual buprenorphine on treatment engagement at 7 days among patients with opioid use disorder.

Hospital-based Addiction Consult Services (ACS) are increasingly implemented to improve care for patients with substance use disorders (SUD). While ACS are generally well-regarded, healthcare professionals of various roles may hold different perceptions of their impact. We conducted a web-based survey of physicians, advanced practice providers (APP), and nurses at a Philadelphia academic hospital from August-September 2024, 16 to 17 months after ACS implementation. The survey assessed attitudes and perceptions of the ACS with 6 questions using a 5-point Likert scale. These data were integrated with results from semi-structured interviews with physicians, advanced practice providers (APPs), and nurses from November 2023-January 2024, 7–9 months after ACS implementation, to provide a richer understanding of provider perspectives on the impact of the ACS. We used descriptive statistics to characterize the samples and analyzed survey data by healthcare professional group chi-squared tests. Interviews were analyzed using thematic content analysis. Of 793 healthcare professionals surveyed, 311 responded (39

Fentanyl concentrations are typically interpreted in forensic contexts using postmortem and driving under the influence data, both of which have important limitations. This study describes fentanyl and norfentanyl concentrations measured in an acute, clinical setting among patients presenting to the emergency department with a suspected opioid overdose. A prospective observational study was performed utilizing the Toxicology Investigators Consortium (ToxIC) Drug Overdose Toxico-Surveillance (DOTS) Reporting Program enrolling patients ≥ 13 years old from April 2023 to July 2024 following a life-threatening overdose treated at 17 EDs within the United States. Fentanyl and norfentanyl concentrations were determined by liquid chromatography tandem quadrupole mass spectrometry (lower limit of quantification (LLOQ) 1 ng/mL). Fentanyl and norfentanyl concentrations were summarized using descriptive statistics and stratified by time of ED presentation to blood collection. Fentanyl concentrations were also stratified by norfentanyl concentrations. Three hundred and thirty-one patients presented with a clinical presentation consistent with an opioid overdose and were included in the study. Of these, 248 (74.9

OBJECTIVES:Accurate identification of xylazine-associated wounds (XAWs) is critical to providing timely and optimal management; however, discerning the etiology of wounds by appearance alone poses a clinical challenge. This study sought to develop an accessible and accurate approach for XAW diagnosis using a deep learning tool applied to wound photographs. METHODS:Publicly accessible wound photographs were curated from academic publications, Reddit, and news media to develop, train, and test the deep learning tool. XAWs were defined by provided clinical confirmation or self-reported descriptions associated with each image. The data set included images of 114 xylazine-associated and 1710 nonxylazine wounds from 17 distinct pathologies. Four deep learning models (DenseNet121, EfficientNetB0, ResNet34, and SENet154) were trained on 1185 images (65%) and 163 for validation (9%) to predict xylazine exposure and tested using 476 unseen wound images (26%). RESULTS:All 4 deep learning models achieved consistent diagnostic performance on 476 unseen wound images (accuracy: 97.5%-98.5%; AUROC: 96.8%-99.7%; weighted F1 score: 97.2%-98.5%). High specificity, reaching 100.0%, was observed across the 4 models. Sensitivity ranged from 60.0% to 80.0% across the 4 models, with SENet154 demonstrating robust performance across all metrics. Qualitative assessment demonstrated accurate identification of XAWs with high-confidence exclusion of xylazine exposure in wounds attributed to trauma, surgery, pressure, or venous ulcers. CONCLUSIONS:This novel deep learning tool can enable accurate identification of XAW. With further validation, this tool may offer an accessible and automated approach to guide wound care, augment bedside clinical medicine assessments, and equip public health efforts to monitor xylazine's geographic distribution.

Importance:Extended-release injectable buprenorphine may expand the reach of initiating medications for opioid use disorder in high-risk and hard-to-reach individuals who visit the emergency department (ED) and can be administered in low levels of withdrawal. Objective:To compare the effect of ED-initiated 7-day extended-release injectable buprenorphine vs sublingual buprenorphine on treatment engagement at 7 days. Design, Setting, and Participants:Multicenter randomized clinical trial enrolling adult patients presenting to the ED with untreated opioid use disorder and a Clinical Opiate Withdrawal Scale (COWS) score of 4 or higher across 29 EDs in the US from July 12, 2020, to August 21, 2024. Final follow-up was completed on October 24, 2024. Interventions:Patients were randomized to receive a 24-mg injection of extended-release buprenorphine (equivalent to 16 mg/d) or sublingual buprenorphine, which included either self-administration instructions if the COWS score was less than 8 or administration of 8 mg of sublingual buprenorphine in the ED if the COWS score was 8 or higher. All sublingual buprenorphine group patients received a 7-day prescription for 16 mg/d. Both groups were provided referral for ongoing medication with a scheduled appointment within 7 days. Main Outcomes and Measures:Engagement in opioid use disorder treatment on day 7 was the primary outcome. Secondary outcomes included engagement at 30 days, precipitated withdrawal and overdose events, craving scores, days of illicit opioid use, and patient satisfaction with treatment. Results:Among 2000 patients randomized, 6 who were enrolled twice were excluded, resulting in 991 in the extended-release group and 1003 in the sublingual group. The median age was 37 (IQR, 30-47) years, 68% were male, 31% had an initial COWS score of 4 to 7, and 76% tested positive for fentanyl. The adjusted proportion of engagement in opioid use disorder treatment at 7 days was 40.5% with extended-release buprenorphine vs 38.5% with sublingual buprenorphine (adjusted difference, 1.6%; 95% CI, -2.8% to 6.0%). Engagement at 30 days was similar, with adjusted proportions of 43.8% with extended-release buprenorphine vs 44.9% with sublingual buprenorphine (adjusted difference, -1.5%; 95% CI, -6.2% to 3.2%). Precipitated withdrawal was rare: 6 (0.6%) with extended-release buprenorphine and 8 (0.8%) with sublingual buprenorphine. Overdose events within 30 days occurred in 18 participants (2.3%) in each group. Patients receiving extended-release buprenorphine reported lower mean craving scores at 7 days vs those receiving sublingual buprenorphine (scale, 0-100; mean score, 26.5 vs 30.2, respectively; adjusted mean difference, -3.85; 95% CI, -7.08 to -0.63), fewer days of illicit opioid use in the past 7 days (adjusted ratio of means, 0.77; 95% CI, 0.68-0.95), and better treatment satisfaction scores (scale, 1-5; adjusted mean difference, 0.13; 95% CI, 0.01-0.25). Conclusions and Relevance:No difference was detected in opioid use disorder treatment engagement on day 7 between the 7-day extended-release and sublingual buprenorphine groups. Both buprenorphine formulations were well tolerated; precipitated withdrawal was rare despite a high prevalence of fentanyl. Trial Registration:ClinicalTrials.gov Identifier: NCT04225598.

Nonmedical opioid use is an urgent public health challenge, with far-reaching clinical and social consequences that are often underreported in traditional healthcare settings. Social media platforms, where individuals candidly share first-person experiences, offer a valuable yet underutilized source of insight into these impacts. In this study, we present a named entity recognition (NER) framework to extract two categories of self-reported consequences from social media narratives related to opioid use: ClinicalImpacts (e.g., withdrawal, depression) and SocialImpacts (e.g., job loss). To support this task, we introduce RedditImpacts 2.0, a high-quality dataset with refined annotation guidelines and a focus on first-person disclosures, addressing key limitations of prior work. We evaluate both fine-tuned encoderbased models and state-of-the-art large language models (LLMs) under zero- and few-shot in-context learning settings. Our fine-tuned DeBERTa-large model achieves a relaxed tokenlevel F1 of 0.61 [95% CI: 0.43-0.62], consistently outperforming LLMs in precision, span accuracy, and adherence to task-specific guidelines. Furthermore, we show that strong NER performance can be achieved with substantially less labeled data, emphasizing the feasibility of deploying robust models in resource-limited settings. Our findings underscore the value of domain-specific fine-tuning for clinical NLP tasks and contribute to the responsible development of AI tools that may enhance addiction surveillance, improve interpretability, and support real-world healthcare decision-making. The best performing model, however, still significantly underperforms compared to inter-expert agreement (Cohen's kappa: 0.81), demonstrating that a gap persists between expert intelligence and current state-of-the-art NER/AI capabilities for tasks requiring deep domain knowledge. The dataset, annotation guidelines, appendix, and training scripts are publicly available to support future research.**https://github.com/SumonKantiDey/Reddit_Impacts_NER.

BACKGROUND:Substance use treatment and harm reduction strategies are vital tools in addressing the overdose crisis, however, effectiveness depends on access and uptake. Little is known about perceptions of harm reduction and substance use treatment efforts among people who use drugs (PWUD) in minoritized communities and how to enhance acceptability and uptake of evidence-based care. Our aim was to explore perceptions of drug use, PWUD and approaches to harm reduction and treatment in an urban, predominantly Black neighborhood heavily impacted by overdose. METHODS:We conducted one-on-one, semi-structured interviews with a purposive sample of participants living or working in West and Southwest Philadelphia, focusing on factors influencing uptake of substance use services. Interviews were recorded, transcribed, and analyzed using thematic analysis. RESULTS:We completed 19 interviews. Mean participant age was 46, 79% of the sample were women; 83% were Black/AA. Half of participants worked with PWUD in health or social service roles (50%), and the majority had lived experience of substance use personally or with a close friend or family member (83%). Participants reported several factors of attitudes toward substance use, PWUD, and addiction care in the community. First, participants frequently referenced the legacy of the punitive drug policies regarding current community apprehension about substance use services. Participants reported a high degree of community stigma towards PWUD, as well as a view of harm reduction as an endorsement of drug use rather than a public health effort. Stigma also shaped cultural norms, limiting acceptability of care-seeking among PWUD. In addition, participants highlighted the toll of systemic racism, noting that it contributed to generational trauma, substance use, and overall vulnerability to addiction and overdose. Finally, participants emphasized the importance of community-driven initiatives, culturally appropriate services, and expanded outreach to actively address and dismantle the structural inequities. CONCLUSION:Overall, participants from West and Southwest Philadelphia described how the combined impact of the war on drugs, systemic racism, and medical system mistrust has shaped the experiences of Black PWUD and their communities. Participants highlighted the need for equitable, culturally responsive public health policies that safeguard the provision of harm reduction services for Black PWUD.

Study objective To examine the effectiveness and implementation of a multicomponent strategy to increase emergency department (ED) initiation of evidence-based treatment for patients with alcohol misuse. Methods Setting was an academic health system with 6 hospitals. Interventions occurred in the ED at 4 of the hospitals, with the other 2 serving as controls. We launched interventions in 2 phases: (1) ED discharge order set with clinical decision support (May 20, 2024); (2) screening for patient concerns about alcohol use and facilitating treatment conversations (August 21, 2024). Multivariate logistic regression assessed changes relative to baseline in the primary outcome, proportion of ED patients with an alcohol-related discharge diagnosis who were discharged with a naltrexone prescription. A difference-in-difference analysis compared intervention hospitals to controls. Results Across the 43-month study period, there were 8,909 (2.0%) ED patients discharged with an alcohol-related diagnosis code. At intervention hospitals, there were 13 (0.2%) discharged with a naltrexone prescription at baseline, 18 (2.7%) during phase 1, and 81 (3.2%) during phase 2. At control hospitals, the rate of naltrexone prescribing was flat across these periods (0.0%, 0.0%, and 0.3%, respectively). In the multivariate model, patients with alcohol-related diagnoses at intervention hospitals were more likely to be discharged with naltrexone in phase 1 (odds ratio [confidence interval] = 12.3 [6.0 to 25.7]) and phase 2 (14.6 [8.4 to 27.4]) compared to baseline. The difference-in-difference analysis showed a 2.9% [2.4% to 3.5%] greater absolute increase in naltrexone prescribing among intervention hospitals. Conclusion A triage-based ED protocol that integrated universal screening, electronic health record banners, and clinical decision support increased initiation of naltrexone to treat alcohol misuse and alcohol use disorder.

Unlabelled:This study, using natural language processing and manual thematic analysis of Reddit posts, revealed a rapid rise in discussions about tianeptine, with posts frequently reporting dependence, withdrawal, and coingestion with other unregulated substances, highlighting tianeptine as an emerging public health concern.

OBJECTIVES:Medetomidine is an alpha-2 adrenoreceptor agonist approved only for veterinary sedation and was reported in the US illicit drug supply starting in 2022. Our aim was to determine the prevalence of medetomidine exposure and associated clinical characteristics among emergency department patients presenting with opioid and/or stimulant overdoses. METHODS:The Toxicology Investigators Consortium (ToxIC) Drug Overdose Toxico-Surveillance (DOTS) Reporting Program included 17 US medical centers. Emergency department (ED) patients with acute opioid and/or stimulant overdose were enrolled between April 2023 and September 2024. Blood was obtained for toxicological analysis, and chart reviews and structured patient interviews were conducted. RESULTS:Among 964 cases, medetomidine was detected in 2.8% (n = 27). After adjusting for confounders, medetomidine exposure was associated with an increased odds (odds ratio: 4.03; 95% CI: 1.35, 10.58) of bradycardia (<50 beats per minute) within 24 hours of presentation. Patients with medetomidine exposure had significantly higher rates of BVM (20.5%) than those without medetomidine exposure (3.7%; P=0.03) but did not require more intubation, BiPAP/CPAP, or naloxone than medetomidine-unexposed patients. No differences between medetomidine-exposed and unexposed groups were found for length of stay, critical care unit disposition, hypotension (<50 mmHg), or sedation. No patients completing an interview (n = 24) reported medetomidine use. CONCLUSIONS:Medetomidine exposure among ED patients with overdose was associated with increased bradycardia but not greater sedation, respiratory support, or need for higher level of care. Sentinel toxico-surveillance can identify emerging drug trends not captured through routine clinical data.

Despite being a life-saving opioid antagonist used to reverse opioid overdose, public understanding of naloxone access, use, and effects remains limited. Social media websites such as Reddit can provide unique insights into what information might be sought on naloxone in real-world contexts. Our objective was to characterize naloxone-specific information-seeking behavior on Reddit and identify knowledge gaps among two distinct querent groups: laypersons and healthcare providers. For this cross-sectional study, we collected a dataset of 11,085 original and publicly available Reddit posts from June 23, 2005, to December 31, 2023, using an artificial intelligence-assisted approach for thematic analyses. Among a subset of 376 subreddits where health-related information is discussed, posts containing naloxone-specific keywords were included in the study. We summarized knowledge gaps pertaining to naloxone, as seen from questions extracted from original posts on Reddit. We used a transformer-based question classifier to extract naloxone-related questions. Expert-guided thematic analysis was performed using a few-shot large language model (LLM) classifier to stratify the questions by underlying themes, substances of interest in addition to naloxone, and querents. We adopted a self-supervised summarization strategy using the open-source LLM Llama-3 to obtain insights into information-seeking discussions and knowledge gaps among laypersons and healthcare providers. Of 11,085 Reddit posts, 5,118 contained questions related to naloxone; 9,789 questions were extracted from 376 subreddits, across 8 overlapping themes, 6 distinct substance categories, and 3 querent classes. Drug use (36.6

CONTEXT:Not-for-profit hospitals are required to provide community benefits (CB) in exchange for tax-exempt status, yet CB spending remains the predominant measure for assessing whether hospitals meet these obligations. Newly available hospital price transparency data offer an opportunity to evaluate whether hospitals' stated CB health priorities align with their financial practices. OBJECTIVE:To examine whether not-for-profit hospitals that prioritize opioid use disorder (OUD) in CB planning are more likely to comply with price reporting for medications commonly prescribed for OUD treatment (OUD medications) and offer lower self-pay prices for OUD medications. DESIGN:Mixed-methods cross-sectional study. SETTING:United States not-for-profit hospitals. PARTICIPANTS:A nationally representative sample of 534 not-for-profit hospitals. MAIN OUTCOME MEASURES:Hospital compliance with OUD medication price reporting and median self-pay prices for medications commonly prescribed for OUD treatment. RESULTS:Hospitals that prioritized OUD (n = 217; 40.6%) were located in counties with higher overdose mortality and greater levels of poor mental health. However, hospitals that prioritized OUD were neither significantly more likely to report self-pay prices for OUD medications nor more likely to offer lower self-pay prices for these medications. Overall, we found limited evidence that hospitals identifying OUD as a community health priority translated these stated priorities into pricing practices that may improve affordability for uninsured and underinsured patients. CONCLUSIONS:Identifying OUD as a community health priority may not be sufficient to ensure alignment between hospitals' stated commitments and financial practices affecting affordability and access to treatment. As calls for stronger hospital accountability grow, integrating price transparency data into CB oversight may help policymakers and hospital leaders strengthen accountability, transparency, and alignment between community health priorities and patient financial protections.