J Palliat Med. 2026 Oct 19:10966218261499456. doi: 10.1177/10966218261499456. Online ahead of print.

NO ABSTRACT

PMID:42897829 | DOI:10.1177/10966218261499456

J Subst Use Addict Treat. 2026 Oct 18:210140. doi: 10.1016/j.josat.2026.210140. Online ahead of print.

ABSTRACT

The National Institute on Drug Abuse Clinical Trials Network (CTN) was established in 1999 to bridge the persistent divide between addiction research and clinical practice through partnerships between researchers and community treatment providers. This editorial examines the evolution of the CTN over its first 25 years and considers priorities for its future. Drawing on the historical development of the Network and articles in this 25-year special collection, we examine changes in the populations and settings represented in CTN research, the incorporation of implementation science, the evolution of community partnerships, the scientific value of accumulated CTN data and experience, and emerging clinical and methodological priorities. Over 25 years, the CTN has developed from a network focused principally on clinically relevant effectiveness trials into a broader national infrastructure for clinical trials and translational addiction research. Its research has expanded beyond specialty addiction treatment programs into primary care, emergency departments, hospitals, community health centers, pharmacies, and other settings in which people with substance use disorders receive care. The Network has also increasingly addressed populations historically underrepresented in addiction research, incorporated implementation questions into clinical research, strengthened community engagement, and used accumulated trial data and emerging analytic methods to generate new scientific knowledge. These developments demonstrate that the value of a clinical research network extends beyond individual trial outcomes. Clinical trials should remain at the core of the CTN’s scientific mission. However, trial designs and complementary research methods should be determined by the scientific questions being addressed. The CTN’s future impact will depend on its ability to conduct rigorous multisite trials while incorporating implementation, representation, community partnership, and accumulated data and responding rapidly to changes in the drug supply and addiction care environment. These capabilities can help the Network generate evidence that is rigorous, relevant, timely, and more likely to improve addiction care.

PMID:42893770 | DOI:10.1016/j.josat.2026.210140

J Gen Intern Med. 2026 Oct 14. doi: 10.1007/s11606-026-10924-3. Online ahead of print.

ABSTRACT

BACKGROUND: Addressing the opioid crisis requires an interdisciplinary approach. Pharmacists may provide medication expertise to primary care addiction teams.

OBJECTIVE: To determine whether implementing a pharmacist-integrated model of care for opioid use disorder (PrIMO) was feasible and acceptable.

DESIGN: Nonrandomized mixed-methods longitudinal feasibility/implementation trial conducted from March 2022 to October 2024.

PARTICIPANTS: Four primary care sites with retail pharmacies and clinical pharmacists. Participants were adults employed by the clinics and adult patients receiving medications for opioid use disorder (MOUD) exposed to PrIMO for at least 2 weeks. Site staff (provider, pharmacists, leadership) were surveyed for 15 months (80.6% follow-up completion) and patients for 6 months (75.5% follow-up completion).

INTERVENTION: Pharmacist-integrated MOUD.

MAIN MEASURES: Primary: Feasibility (PrIMO launch). Secondary: acceptability (survey and interview data) and impact (electronic health record data).

KEY RESULTS: All sites launched PrIMO (100%) and maintained it for at least 1 year. From 3 months pre- to 1 year post-launch, site staff reported fewer barriers to providing MOUD (m [SD] 2.2 [0.8] to 1.8 [0.5], 1-4-point scale), increased knowledge of MOUD (3.8 [0.4] to 4.0 [0.5], 1-5-point scale), and steady acceptability by providers/pharmacists (2.1 [0.3] to 2.0 [0.4], 0-3-point scale) and leadership (2.1 [0.3] to 2.0 [0.4], 0-3-point scale). Patients reported less stigma (3.1 [1.1] to 2.8 [1.1], 1-5-point scale) and steady acceptability (2.2 [0.4] to 2.2 [0.4], 0-3-point scale). Electronic health records data demonstrated increases in the rate of patients retained in MOUD (m [SD] 59.5 [34.81] to 60.2 [35.35] proportion of days covered), adherence to MOUD (38.6 to 40.9%), clinic visits for MOUD (+ 100 encounters), and total patients treated per prescriber (m [SD] 12.9 [32.49] to 13.7 [35.07]) 1 year pre- vs 1 year post-launch, although statistical significance was not assessed.

CONCLUSIONS: Integrating pharmacists into MOUD care teams may improve feasibility and acceptability of MOUD in primary care.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT05310786, March 14, 2022.

PMID:42875616 | DOI:10.1007/s11606-026-10924-3

J Pain Symptom Manage. 2026 Oct 12:S0885-3924(26)01033-X. doi: 10.1016/j.jpainsymman.2026.10.008. Online ahead of print.

ABSTRACT

Patients who present after suicide attempts (SA) may experience a wide range of clinical trajectories, from full medical recovery to irreversible neurologic injury, multiorgan failure, or death. Although suicide prevention, risk assessment, and psychiatric treatment after a SA are well represented in the literature, comparatively little guidance exists for palliative care (PC) clinicians consulted after an SA. Care after SA lies at the intersection of critical care, psychiatry, and ethics, and raises distinctive challenges in prognostication, decisional capacity, decisions about life-sustaining treatment, and support for families and clinicians. This manuscript uses the case of Mr. A, a patient with a self-inflicted gunshot wound and uncertain neurologic prognosis, to describe a PC-informed framework for PC clinicians caring for patients after SA. In collaboration with psychiatry, ethics consultants, and the primary team, PC clinicians can help integrate medical and psychiatric prognosis, avoid anchoring on the attempt as evidence of stable values, support families struggling with guilt and stigma, manage distressing symptoms, and guide ethically grounded decision-making.

PMID:42863590 | DOI:10.1016/j.jpainsymman.2026.10.008

Subst Use Addctn J. 2026 Oct 8:29767342261489216. doi: 10.1177/29767342261489216. Online ahead of print.

ABSTRACT

BACKGROUND: Xylazine, a veterinary sedative, has become a prevalent adulterant in the unregulated opioid supply and can lead to chronic ulcerative wounds among people who use drugs (PWUD). Without regular care, these wounds can progress and result in infectious and limb-threatening complications. Despite this, PWUD face many barriers to wound self-management and medical treatment. Using the Rhodes’ Risk Environment framework, we investigated factors that influence wound care practices and healing among PWUD with xylazine-associated wounds in Pittsburgh, Pennsylvania.

METHODS: From March to April 2024, we conducted semi-structured interviews with 20 PWUD with at least one xylazine-associated wound and past-90-day xylazine exposure confirmed by laboratory urine testing or self-reported xylazine test strip results. Using content analysis guided by the Rhodes’ Risk Environment framework, we categorized individual-level, micro-level, and macro-level factors influencing wound care and outcomes and defined care practices shaped by these factors.

RESULTS: At the individual level, xylazine-associated wound care and healing were shaped by participant knowledge, prior experience, and resourcefulness. Pain, withdrawal, ongoing substance use, and emotional responses like fear and guilt also strongly influenced wound care practices and care-seeking behaviors. At micro and macro levels, multiple factors across the physical, economic, social, and health care environments further impacted wound outcomes, including environmental hazards, resource scarcity (eg, wound supply availability and affordability), health care and public stigma, social support networks, punitive policies, and quality of medical care and access.

CONCLUSION: Overall, xylazine-associated wound care practices and healing are modified by various individual and structural factors within the risk environment that may lead to disruption in consistent wound care. To improve clinical outcomes, health care systems should prioritize low-barrier strategies that minimize gaps in care, support timely reentry to facilitate wound self-management, and foster continued engagement by addressing the underlying factors that drive treatment hesitation and interruptions.

PMID:42851032 | DOI:10.1177/29767342261489216

J Pain. 2026 Oct 6:106457. doi: 10.1016/j.jpain.2026.106457. Online ahead of print.

ABSTRACT

Moderate-to-severe cancer pain is frequently managed with prescription opioids. However, there are many barriers to guideline-concordant prescription opioid management, including stigma surrounding prescription opioids. The goal of this concept mapping study was to work directly with patients to identify actionable treatment targets to inform future behavioral intervention development that can ultimately improve cancer pain management. Investigators were particularly interested in exploring patient perspectives on opioid stigma interventions, given the lack of existing strategies in this area. Investigators conducted concept mapping with 20 patients with advanced cancer pain who endorsed at least one aspect of opioid stigma. Participants responded to a broad focal prompt: “What kinds of supports and problems should people know about when using prescription opioids to treat cancer pain?” Findings revealed 5 “clusters”: 1) pain and opioid management; 2) prescription opioid stigma; 3) clinician attitudes about prescription opioids; 4) support and resources; and 5) insurance and pharmacy issues. Salient discussion focused on strategies to improve internalized stigma and reducing stigmatizing clinician attitudes. Future research should develop and test easily accessible multicomponent, contact-based, and/or internalized stigma interventions that integrate psychoeducation and shared decision-making. PERSPECTIVE: This article presents important, actionable intervention targets for improving cancer pain management, with a specific emphasis on addressing opioid stigma. Findings can be used to inform future intervention development efforts that improve patient and clinician skills, including multicomponent, contact-based, and/or internalized stigma interventions, improved psychoeducation, and shared decision-making.

PMID:42838401 | DOI:10.1016/j.jpain.2026.106457

J Pain Symptom Manage. 2026 Oct 5:S0885-3924(26)01011-0. doi: 10.1016/j.jpainsymman.2026.09.029. Online ahead of print.

ABSTRACT

CONTEXT: With increased survival in cancer and other serious illness, palliative care clinicians are increasingly facing decisions about the benefits versus burdens of opioid therapy in individuals with longer prognoses. When a patient who is prescribed opioids develops an opioid use disorder, guidelines recommend transitioning to a medication for opioid use disorder (MOUD) such as buprenorphine. However, how best to communicate this transition is unknown.

OBJECTIVE: We developed a framework for these conversations based on our clinical experience, and, using directed content analysis, we sought to qualitatively evaluate the framework in clinician and non-clinician interviews.

METHODS: We first created a 13-minute demonstration video of a physician-patient interview in which the physician used our proposed skills, and an interview guide. Participants (10 clinicians with experience caring for patients with cancer, 11 individuals with lived experience) reviewed the video, and then were asked to comment on the skills used, and bring up additional skills. We used coding and thematic analysis to identify themes.

CONCLUSION: We identified six themes which refined our initial communication framework: raising a concern directly, balancing boundaries with shared decision-making, expressing empathy, embedding these conversations within a long-term clinician-patient relationship, countering stigma, and preserving positive regard. When a patient prescribed opioid therapy for pain has developed an addiction, clinicians should balance setting clear limits on opioid prescribing with expression of concern. Further, clinicians should work to develop awareness around their own attitude towards the patient with chronic pain and substance use disorder, and actively repudiate stigma in these conversations.

PMID:42833598 | DOI:10.1016/j.jpainsymman.2026.09.029

PLOS Glob Public Health. 2026 Sep 29;6(9):e0007355. doi: 10.1371/journal.pgph.0007355. eCollection 2026.

ABSTRACT

People with multiple long-term conditions (MLTC) in low-resource settings face high treatment burdens, influenced by healthcare access and quality disparities. The study aimed to compare the treatment burden among patients with MLTC across geographical locations and healthcare providers in Peru. We conducted a cross-sectional study conducted between June-October 2023 among outpatients aged ≥40 years with type 2 diabetes and ≥1 additional chronic condition, recruited from public and private healthcare facilities in urban Lima and semi-urban Tumbes, Peru. Treatment burden was assessed using the Multimorbidity Treatment Burden Questionnaire (MTBQ). Differences in median MTBQ scores by setting and healthcare provider were analyzed using regression models adjusting for capacity- and workload-related variables. Among 555 participants (55% female, mean age 62.4 ± 10.5 years), median MTBQ score was 27.1 (IQR 14.6-41.7). After adjustment, patients in semi-urban Tumbes had higher treatment burden than those in urban Lima (adjusted median difference 6.1 points; 95% CI 2.9 to 9.3), while patients receiving care in private facilities had lower treatment burden than those in public settings (-6.6 points; 95% CI -9.3 to -3.9). These findings highlight substantial inequalities in treatment burden by place and provider type, with implications for efforts to improve care delivery and reduce disparities for people living with MLTC.

PMID:42809550 | PMC:PMC13623086 | DOI:10.1371/journal.pgph.0007355

Int J Drug Policy. 2026 Sep 21;157(Pt A):105480. doi: 10.1016/j.drugpo.2026.105480. Online ahead of print.

ABSTRACT

Internationally, compliance with program rules and the earning of privileges is common to cultural understandings of treatment for opioid use disorder (OUD). One long standing and striking example of such a culture is methadone maintenance treatment within US opioid treatment programs. This compliance-based model, established by a mix of regulation and culture, has shaped decades of clinical practice and policy within the US-and it is precisely what new federal rules in the US now aim to challenge. The opportunity now is to prioritize programs that expand or embed meaningful participation among people who use opioids in individual, organizational, and policy decisions, and we believe this challenge extends to other healthcare settings. In this commentary, we define meaningful participation by people who use opioids, outline why meaningful participation by people who use opioids is essential, examine barriers to adoption, and propose initial strategies to integrate it effectively into individual healthcare, organizational, and policy decisions. Meaningful participation means that people who use opioids are recognized as the experts in their own lives, needs and preferences, have input in decisions, and this input has impact. Barriers to participation of people who use opioids include gaps in perceptions of participation between people who use opioids and healthcare professionals; cultural inertia; social vulnerability of people who use opioids; assumptions that people who use opioids are not rational decision-makers; imbalances in social standing and power; restrictive institutional policies; and survivorship bias among those who participate. We review examples in Canada, Australia, and the US to illustrate both the promise and challenges to institutionalizing participation of people who use drugs. Strategies to integrate participation by people who use opioids into individual healthcare, organization, and policies decisions are reviewed.

PMID:42767088 | DOI:10.1016/j.drugpo.2026.105480