Addiction. 2026 Jun 22. doi: 10.1111/add.70504. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Individuals who engage in illicit or nonmedical opioid use may have elevated risk of health and social consequences, including progression to opioid use disorder (OUD). Preventive interventions to reduce this risk are lacking. This trial tested the impact of a primary care-integrated collaborative care approach for reducing risky opioid use, defined as nonmedical use of prescription opioids or any use of illicit opioids.

DESIGN: Cluster-randomized controlled trial randomized primary care providers (PCPs) and their patients into the Subthreshold Opioid Use Disorder Prevention (STOP) intervention or enhanced usual care (EUC).

SETTING: Primary care clinics at 5 U.S. sites.

PARTICIPANTS: PCPs and their patients were recruited January 2021-May 2023. A total of 119 PCP clusters (STOP = 48, EUC = 51) and 202 patients (STOP = 88, EUC = 114) enrolled. Eligible patients were adults (≥18 years) having current risky opioid use, without moderate-severe OUD. Patient participants were majority female (63.4%), white (70.8%) and non-Hispanic (96.5%), with a mean age of 55.7 [standard deviation (SD) = 12.7] years. At baseline, 63.4% of participants had moderate-severe pain (Brief Pain Inventory) and below average physical (79.2%) and mental (62.4%) health (SF-12).

INTERVENTIONS: The STOP collaborative care intervention consisted of brief advice from the PCP about reducing risky opioid use, meetings with a clinic-embedded nurse care manager over 12 months and remote health coaching (2-6 sessions). Both groups received primary care treatment as usual and overdose risk reduction materials.

MEASUREMENTS: The primary outcome was total days of risky opioid use, recorded from 6 monthly electronic surveys. A key secondary outcome was moderate-severe OUD at 6 and 12 months.

FINDINGS: A total of 77 (87.5%) STOP and 107 (93.9%) EUC participants completed the 6-month assessment period. The primary outcome analysis used the Intention-to-Treat sample with multiple imputations of missing data. Mean days of risky opioid use at 180 days were lower in STOP than EUC [12.2 (SD = 27.73) vs. 15.5 (SD = 32.64)]; the difference between groups adjusted for baseline risky opioid use was not statistically significant (rate ratio 0.95, 95% confidence interval = 0.52-1.74). One STOP participant (1.1%) and 13 EUC participants (11.4%) developed moderate-severe OUD at 6 months, and 3 (3.4%) STOP and 6 (5.3%) EUC participants had moderate-severe OUD at 12 months (P < 0.001).

CONCLUSIONS: This cluster-randomized controlled trial did not find evidence that the STOP intervention for reducing risky opioid use produced greater reductions over 6 months compared with enhanced usual care, though fewer intervention participants progressed to moderate-severe opioid use disorder. Patients had a high burden of pain and comorbidities that may present challenges to reducing opioid use.

PMID:42331724 | DOI:10.1111/add.70504

Harm Reduct J. 2026 Jun 17. doi: 10.1186/s12954-026-01486-y. Online ahead of print.

ABSTRACT

BACKGROUND: As xylazine-adulterated opioids become more prevalent in the U.S., people who use drugs (PWUD) face growing risks from sedation, withdrawal, and wounds. This study explores PWUD perceptions on recognizing xylazine exposure including its physical effects and clinical harms and how these factors shape their drug use practices.

METHODS: In August 2023, we surveyed adult PWUD clients reporting at least one past-year drug use-related wound across three Massachusetts syringe service programs with high xylazine prevalence. We compared demographics, drug use factors, physical effects, and clinical symptoms between those with and without self-reported past-90-day xylazine exposure and conducted content analysis of open-ended responses.

RESULTS: Of the 171 respondents, 80% (n = 136) reported past-90-day xylazine exposure. The majority of respondents were male, white, non-Hispanic, and aged 36-45 years, with no significant differences by xylazine exposure. Xylazine-exposed participants commonly reported sedation (77%), loss of consciousness (52%), and wounds (91%). Most participants were afraid and frustrated, seeing xylazine as an unwanted contaminant but were often unable to avoid it due to financial constraints, withdrawal symptoms, and limited alternative options.

CONCLUSION: Syringe service program clients in Massachusetts commonly reported xylazine-adulterated fentanyl exposure, recognized through heavy sedation and skin wounds. Their experiences highlight the urgent need for real-time xylazine detection, safer supply, overdose and sedation risk mitigation, and improved wound prevention and care.

PMID:42310644 | DOI:10.1186/s12954-026-01486-y

J Am Pharm Assoc (2003). 2026 Jun 17:103469. doi: 10.1016/j.japh.2026.103469. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with opioid use disorder encounter challenges obtaining buprenorphine (BUP) at pharmacies, increasing their risk of treatment non-adherence and illicit drug use.

OBJECTIVES: The purpose of this quality improvement (QI) initiative was to implement and evaluate a multi-component intervention to ensure continuous BUP access.

METHODS: Using a quasi-experimental study design, the initiative was developed and a convenience sample was recruited from an outpatient BUP treatment program and a pharmacy affiliated with the West Virginia University health system between November 20, 2023, to November 29, 2024. The QI intervention consisted of education, use of pharmacy-integrated electronic medical record (EMR), BUP delivery and adherence support and/or assistance with BUP dispensing. Participants selected the intervention or wait-list control group based on their choice of pharmacy. The intervention was offered to the intervention group over a 3-month period. Proportion of days covered was the primary outcome measure for continuous BUP access. Clinical data were extracted from participants’ EMR and electronic satisfaction surveys were administered to all participants following the intervention.

RESULTS: Study participants included 56 patients prescribed sublingual BUP, 14 pharmacy staff, and 19 clinic staff. Nine patient participants (16.07%) received medication delivery, and 8 patient participants (14.28%) received medication adherence support and/or assistance with BUP dispensing. There was no significant difference in the mean proportion of days covered (PDC) for BUP between the intervention (97.31%) and control group (94.90%) (p=0.32). Compared to the control group, the intervention group had lower retention rates (76.92 % vs. 97.37%, p=0.02) and was more likely to report satisfactory waiting time to receive BUP (X²=4.85; 100 % vs. 64.50%, p=0.028).

CONCLUSION: The intervention was successfully implemented and highly rated; however, it did not significantly increase the PDC of BUP. Challenges with BUP dispensing persist and future research addressing these multi-level barriers are urgently needed.

PMID:42309279 | DOI:10.1016/j.japh.2026.103469

Kidney360. 2026 Jun 2. doi: 10.34067/KID.0000001198. Online ahead of print.

ABSTRACT

BACKGROUND: Legalization of cannabis across several US states may increase its use by individuals on hemodialysis, particularly among those with chronic pain. Contemporary data on frequency or factors associated with cannabis use by this population are limited.

METHODS: We conducted a secondary analysis of the HOPE Consortium Trial to Reduce Pain and Opioid Use in Hemodialysis, a randomized trial that tested whether a cognitive behavioral therapy intervention lowered pain interference in people with chronic pain receiving hemodialysis at 103 US dialysis facilities. We analyzed baseline demographic characteristics, social and medical history, pain intensity, pain interference, and cannabis use. Multivariable logistic regression was used to examine associations of baseline data with cannabis use. Linear regression was used to examine whether cannabis use modified the response to the intervention.

RESULTS: Among 643 participants, 102 (16%) reported current cannabis use, 133 (21%) reported former use, and 408 (63%) had never used. Current users were younger than never or past users combined (median age 54 vs. 63 years) and more likely to be disabled (79% vs. 66%), to have received dialysis for >5 years (40% vs. 30%), and to self-report depression (41% vs. 31%), anxiety (28% vs. 20%), or any psychological disorder (51% vs. 38%), and less likely to be married (16% vs. 34%). Current cigarette smoking (odds ratio [OR]=3.22, 95% confidence interval (CI) 1.61-6.46) and alcohol use (OR=2.82, 95% CI 1.37-5.80) were independently associated with cannabis use, as were age, relationship status, neighborhood segregation index, and cocaine/heroin use. Cannabis use did not modify response to the intervention.

CONCLUSIONS: Current cannabis use was reported by 16% of HOPE participants and was more common among younger, unmarried individuals who use other substances, but did not alter response to our intervention. More research is needed on the consequences of cannabis use among people receiving hemodialysis.

PMID:42228518 | DOI:10.34067/KID.0000001198

Hepatol Commun. 2026 May 22;10(6):e0955. doi: 10.1097/HC9.0000000000000955. eCollection 2026 Jun 1.

ABSTRACT

BACKGROUND: Chronic pain is common and uniquely challenging to manage in people with cirrhosis. The purpose of this pilot study was to evaluate the feasibility and acceptability of a tailored pain self-management (PSM) intervention for people with cirrhosis and chronic pain.

METHODS: This single-arm, single-site pilot study recruited patients with a diagnosis of cirrhosis and chronic pain to a virtual, health coach-led, modular PSM intervention. After 6 weekly one-on-one sessions, patients were invited to attend 6 weekly group sessions. Outcomes were measured at baseline, 6 weeks, 12 weeks (end of intervention), and 24 weeks (maintenance). The primary outcomes were acceptability, defined by a 4/5 rating on the Treatment Acceptability Questionnaire, and feasibility, defined as the ability to retain patients in 80% of the intervention sessions. Secondary outcomes of pain and function were measured using the Pain intensity, Enjoyment of life, and General activity (PEG) scales, and a rating of percent improvement with the intervention.

RESULTS: Among 21 participants who started the intervention, 16 (76%) attended ≥80% of sessions. Acceptability thresholds were met at all time points. On a scale of 0-100, where 30 is considered to be a meaningful change, participants rated their improvement in pain symptoms an average of 50 ± 25. The average PEG score decreased from 6.1 at baseline to 5.3 at 24 weeks. Participants reported increases in PSM behaviors, including cognitive and stress-reduction methods, physical activity, healthy sleep behaviors, and changes in diet.

CONCLUSIONS: This pilot identified a reduction in pain and an increase in PSM activities and demonstrated the acceptability of a health coach-led PSM intervention for adults with chronic pain and cirrhosis.

PMID:42172501 | DOI:10.1097/HC9.0000000000000955

JAMA Netw Open. 2026 May 1;9(5):e2611514. doi: 10.1001/jamanetworkopen.2026.11514.

ABSTRACT

IMPORTANCE: Due to the impact of high-potency synthetic opioids on medication for opioid use disorder (MOUD) initiation, hospital-based addiction clinicians adapted their practice to improve care, with decisions often guided by limited evidence.

OBJECTIVE: To derive expert consensus on best practices for hospital-initiated MOUD among patients with OUD using high-potency synthetic opioids.

DESIGN, SETTING, AND PARTICIPANTS: This survey study used a 2-round Delphi process conducted from January to April 2025. National experts were hospital-based physicians or advanced practice clinicians who treated at least 100 hospitalized patients with OUD in the last 2 years and self-identified as an expert in methadone and buprenorphine initiation. Experts were purposively sampled based on practice location and addiction board certification. Data were analyzed from April 2025 to March 2026.

MAIN OUTCOMES AND MEASURES: The main outcome was consensus on the appropriateness of specific practices. Appropriateness was evaluated using a 9-point Likert scale from 1, indicating very inappropriate to 9, very appropriate. The presence of consensus was determined using the RAND/UCLA appropriateness method; if consensus was obtained, it was stratified into inappropriate (median 1-3), uncertain (median 4-6), or appropriate (median 7-9).

RESULTS: Of 48 experts, 42 (87.5%; median [IQR] age, 41 [36.0-45.8] years; 25 [59.5%] female) completed round 1 and 41 of these (97.6%) completed round 2. Most were physicians (36 participants [85.7%]); of those, 30 (83.3%) were board certified in addiction medicine, 3 (14.3%) in addiction psychiatry, 2 (5.6%) in both, and 1 (2.4%) in neither. Experts treated a median (IQR) of 200 (100-315) hospitalized patients with OUD in the past year. There was consensus that buprenorphine and methadone initiation were appropriate, while the appropriateness of naltrexone initiation was uncertain. Consensus was reached that rapid methadone initiation was appropriate. Regarding buprenorphine initiation practices, experts reached consensus that high- and low-dose initiation were appropriate, traditional initiation was of uncertain appropriateness, and rescue was inappropriate. There was consensus that provision of non-MOUD full agonist opioids was appropriate to treat opioid withdrawal during methadone initiation, as a bridge during buprenorphine initiation, and to treat withdrawal among patients declining MOUD.

CONCLUSIONS AND RELEVANCE: In this survey study of hospital-based addiction specialty clinicians, consensus was reached on hospital-initiated MOUD and treatment of opioid withdrawal. These best practices can inform current clinical approaches and reflect the need for more robust research to evaluate effectiveness and safety.

PMID:42096208 | DOI:10.1001/jamanetworkopen.2026.11514

J Palliat Med. 2026 May 4:10966218261447000. doi: 10.1177/10966218261447000. Online ahead of print.

ABSTRACT

Eating disorders (ED), particularly anorexia nervosa (AN), represent high-morbidity, high-mortality psychiatric illnesses with multisystem medical complications, frequent relapse, and substantial caregiver burden. As palliative care (PC) clinicians increasingly encounter patients with severe and enduring ED, they may be asked to help manage complex symptom distress, navigate treatment refusals, support families, and participate in values-based goals of care discussions amid prognostic uncertainty. At the same time, the emerging and contested discourse around “terminal anorexia nervosa” underscores the need for careful clinical reasoning, nuanced capacity assessment, and ethically rigorous, interdisciplinary deliberation. In this article, an interdisciplinary group of PC, psychiatry, psychology, and eating-disorder specialist clinicians presents a practical “Top Ten Tips” framework to support real-world care. Tips emphasize early recognition of countertransference and moral distress, medical severity assessment and refeeding risk, trauma-informed and harm-reduction approaches, task-specific decision-making capacity evaluations, communication strategies that prioritize values and meaning over labels, and collaboration with eating-disorder specialty teams, ethics consultation, and community resources. We aim to provide actionable guidance that strengthens PC clinicians’ confidence and consistency when caring for patients with severe EDs.

PMID:42080350 | DOI:10.1177/10966218261447000

J Subst Use Addict Treat. 2026 Apr 28:209986. doi: 10.1016/j.josat.2026.209986. Online ahead of print.

ABSTRACT

INTRODUCTION: Higher buprenorphine maintenance doses (>24 mg daily) may be more effective in improving opioid use disorder (OUD) treatment outcomes in the era of fentanyl predominance. Evidence on maintenance dose trends remains limited, especially among vulnerable populations, who are disproportionately affected by opioid overdose deaths. The objective of this study was to describe trends in maintenance dose of buprenorphine for OUD and the association of social vulnerability with maintenance dose.

METHODS: We identified buprenorphine treatment episodes initiated between January 2019 and June 2021 using the IQVIA Longitudinal Prescription database. Episodes were assigned to a maintenance dose category of <16, 16-24, or >24 mg, to reflect dosages lower than, consistent with, or higher than the guideline-recommended target dose range, respectively. County-level social vulnerability was measured with the Minority Health Index (MHI). We used multinomial logistic regression with generalized estimating equations to test the association between MHI (stratified into quartiles) and maintenance doses <16 mg and >24 mg (with 16-24 mg as the reference group), adjusting for patient, geographic, and time characteristics.

RESULTS: Of 1,044,460 treatment episodes among 543,326 individuals (mean [SD] age 41.9 [12.6] years, 43% female), the most common buprenorphine maintenance dose category was 16-24 mg (62.7%), followed by <16 mg (34.5%), then >24 mg (2.8%). The median (IQR) episode duration was 64 (109) days. The proportion of episodes in the <16 mg category increased from 34.1% in 2019 to 39.2% in 2021, whereas prevalence of the remaining categories decreased. A greater proportion of episodes in the >24 mg category were in rural versus urban counties; the magnitude of this difference increased over time. Relative to 16-24 mg, maintenance dose >24 mg was more likely among individuals in the most vulnerable MHI quartile compared to the least vulnerable quartile (aOR 1.28, 95% CI 1.19-1.38).

CONCLUSION: During a period of growing evidence supporting higher buprenorphine maintenance doses, the prevalence of treatment episodes with maintenance dose <16 mg increased. Individuals in the highest social vulnerability quartile tended to receive higher doses, suggesting that some higher-risk groups may receive more intensive treatment, even as important gaps remain. These results can inform efforts targeting equitable, high-quality buprenorphine prescribing.

PMID:42061723 | DOI:10.1016/j.josat.2026.209986

J Subst Use Addict Treat. 2026 Apr 24:209998. doi: 10.1016/j.josat.2026.209998. Online ahead of print.

ABSTRACT

Despite comprising one-fifth of the population, individuals living in rural areas are underrepresented in clinical trials on substance use disorders (SUD). The inclusion of rural residents is critical to reducing disparities in health outcomes and improving adoption of evidence-based interventions for SUDs. The current commentary provides five guiding principles to assist researchers in including rural populations in trials. These principles emphasize including rural communities in the study design phase and throughout the research process, understanding the local rural context, consideration of operationalization of rural in research, suggested adaptions for research, and embracing opportunities for bi-directional and sustainable partnerships. When approached thoughtfully, research funding can catalyze rural capacity, foster durable partnerships, and enrich scientific inference to assist in establishing the evidence-base for SUD research.

PMID:42035881 | DOI:10.1016/j.josat.2026.209998

JAMA Intern Med. 2026 Apr 20. doi: 10.1001/jamainternmed.2026.0428. Online ahead of print.

NO ABSTRACT

PMID:42008248 | DOI:10.1001/jamainternmed.2026.0428