Hosp Pediatr. 2026 Jul 17:e2025009094. doi: 10.1542/hpeds.2025-009094. Online ahead of print.

ABSTRACT

BACKGROUND: Illicitly manufactured fentanyl (IMF) is the predominant opioid in the US drug supply and is a major contributor to morbidity and mortality during pregnancy. While prenatal opioid exposure is an established risk factor for neonatal opioid withdrawal syndrome (NOWS), the differential effects of IMF vs other opioids on outcomes are largely unknown. Therefore, we aimed to evaluate the associations between prenatal IMF exposure and fetal, perinatal, and neonatal health outcomes.

METHODS: We conducted a retrospective cohort study of pregnant women with opioid use disorder (OUD) and their infants who were born between January 2024 and December 2024. Maternal and infant participants were stratified into 2 groups based on the opioids, IMF vs medications for OUD (MOUDs), identified on urine drug testing at delivery. Descriptive statistics were used to describe the characteristics of cohort participants, while χ2 and t tests were used to evaluate for differences in outcomes between the groups.

RESULTS: Among 125 infants, 34 were categorized as IMF exposed, and 91 were categorized as MOUD exposed. Fetal growth restriction, preterm birth, and abnormal growth parameters, including low birth weight and very low birth weight, were more frequently identified among IMF- vs MOUD-exposed infants. In addition, IMF-exposed infants were significantly more likely to require neonatal intensive care unit admission, have a longer neonatal hospital length of stay, and require pharmacologic treatment for NOWS.

CONCLUSIONS: Prenatal IMF exposure was associated with significant neonatal morbidity compared with MOUD exposure, highlighting the importance of engagement in maternal substance use treatment during pregnancy to both maternal and neonatal health outcomes.

PMID:42463150 | DOI:10.1542/hpeds.2025-009094

JAMA Netw Open. 2026 Jul 1;9(7):e2623280. doi: 10.1001/jamanetworkopen.2026.23280.

ABSTRACT

IMPORTANCE: Buprenorphine-naloxone and extended-release (XR) naltrexone are both efficacious medications for opioid use disorder that reduce unregulated opioid use and improve opioid cravings and treatment retention. While prior comparative effectiveness studies demonstrated superiority of buprenorphine-naloxone over XR naltrexone for relapse and treatment retention, the comparative effectiveness of both treatments for all-cause mortality and nonfatal opioid overdose outcomes has not been rigorously tested.

OBJECTIVE: To compare the effectiveness of buprenorphine-naloxone vs XR naltrexone after medically managed opioid withdrawal (MMOW) treatment.

DESIGN, SETTING, AND PARTICIPANTS: This observational comparative effectiveness study using a target trial emulation framework leveraged individually linked administrative data from the Massachusetts Public Health Data Warehouse to emulate the protocol of the Extended-Release Naltrexone vs Buprenorphine for Opioid Treatment randomized clinical trial. Participants included adults 18 years or older who were discharged from MMOW in Massachusetts between January 1, 2014, and December 31, 2018. Individuals could meet eligibility criteria more than once. Data were analyzed from December 22, 2023, to January 30, 2025.

EXPOSURES: Initiation of buprenorphine-naloxone or XR naltrexone therapy within 28 days of MMOW discharge.

MAIN OUTCOMES AND MEASURES: Estimated 24-week cumulative incidence of all-cause mortality and nonfatal opioid overdose using inverse probability weighting to adjust for baseline and time-varying confounding.

RESULTS: A total of 36 752 unique individuals who met eligibility criteria were identified and contributed 106 052 MMOW discharge episodes; 79 089 (74.6%) episodes were among individuals who were male and 44 463 (42.1%) were among individuals aged 18 to 29 years. By 28 days after MMOW discharge, initiation of buprenorphine-naloxone was observed among 14 194 discharge episodes (13.4%) and initiation of XR naltrexone was observed among 4734 (4.5%) episodes. The adjusted 24-week cumulative incidence of all-cause mortality after MMOW discharge was 1.4% (95% CI, 1.2%-1.7%) for buprenorphine-naloxone and 1.4% (95% CI, 1.1%-1.8%) for XR naltrexone, corresponding to a risk difference of 0.0 percentage points (pp) (95% CI, -0.4 to 0.4 pp). The adjusted 24-week cumulative incidence of nonfatal opioid overdose after MMOW discharge was 11.6% (95% CI, 10.8%-12.3%) for buprenorphine-naloxone and 13.9% (95% CI, 12.9%-15.0%) for XR naltrexone, corresponding to a risk difference of 2.3 pp (95% CI, 1.2-3.6 pp).

CONCLUSIONS AND RELEVANCE: In this comparative effectiveness study of buprenorphine-naloxone vs XR naltrexone, initiating buprenorphine-naloxone after MMOW discharge was associated with a lower risk of nonfatal opioid overdose at 24 weeks than initiating XR naltrexone, but a similar risk of all-cause mortality.

PMID:42446876 | DOI:10.1001/jamanetworkopen.2026.23280

Subst Use Addctn J. 2026 Jul 10:29767342261463988. doi: 10.1177/29767342261463988. Online ahead of print.

ABSTRACT

BACKGROUND: Opioid treatment programs (OTPs), the only outpatient settings authorized to dispense methadone for opioid use disorder in the United States, often operate within compliance-focused frameworks that do not reflect the complex realities of substance use or the needs of many patients with the evolving opioid crisis. Given their unique infrastructure, OTPs are well-positioned to provide risk reduction services including naloxone, wound care supplies, and other safer use tools.

OBJECTIVES: Describe the implementation and early outcomes of a pragmatic pilot program integrating safer use kit distribution within a large OTP in Western Pennsylvania.

METHODS: Our team worked with the OTP to develop a workflow for safer use kit distribution. Staff offered interested patients a menu of safer use kits from which they could select up to one of each kit type. Prepackaged kits included fentanyl/xylazine test strips and safer injection, smoking, snorting, and wound care supplies. Kit distribution was tracked over a thirteen-month period. Postimplementation, we sampled patient-facing OTP staff on their perspectives of the program.

RESULTS: From November 2024 to November 2025, 643 kits were distributed during 266 encounters with 142 unique patients. High-demand items included test strips and safer smoking kits. Staff reported improved patient engagement, reduced stigma, and stronger therapeutic relationships after implementing on-site kits.

CONCLUSION: Integrating safer use kits into OTPs is both feasible and impactful, demonstrating consistent patient uptake and positive staff perceptions. These findings suggest such models have the potential to support more inclusive, patient-centered care, though future research is needed to determine downstream effects on retention, safety, and clinical outcomes.

PMID:42427185 | DOI:10.1177/29767342261463988

BMJ Qual Saf. 2026 Jul 7:bmjqs-2025-019297. doi: 10.1136/bmjqs-2025-019297. Online ahead of print.

ABSTRACT

INTRODUCTION: Physician burnout is related to patient safety and quality of care. Female physicians face unique challenges which may contribute to higher physician task load (PTL). We investigated the association of gender and PTL, and if gender differences in PTL contribute to burnout, professional fulfilment and intent to leave in medicine.

METHODS: A retrospective observational study using secondary data was conducted in June 2019-June 2021. Physicians at eight large US academic-affiliated medical centres completed a survey assessing PTL using four NASA-TLX items, burnout and professional fulfilment using the Professional Fulfilment Index (PFI), and intent to leave using a standardised single-item measure; demographic items were included. Descriptive statistics characterised the participant sample. χ² tests examined differences across participant characteristics and PTL, PFI and ITL by gender. Logistic regressions assessed associations between PTL and well-being variables. Analysis of indirect association explored the association of PTL and the relationship between gender and well-being variables.

RESULTS: Females had higher mean PTL as compared with males (6.67 (1.82) vs 6.45 (1.96), p<0.001). Higher levels of PTL were associated with lower PFI by PTL quintile (p<0.001), higher burnout by PTL quintile (p<0.001) and greater ITL in the highest PTL quintile (p<0.001). Despite higher burnout and PTL, females had lower odds of ITL than males. Analyses of indirect associations suggested PTL may partially account for the relationship between gender and PFI and burnout, with an opposite-direction (suppression) effect for ITL.

CONCLUSIONS: Higher mean PTL scores were observed in females compared with males. Findings suggest that both gender-specific and gender-agnostic interventions for addressing cognitive burden may be relevant for supporting well-being for all physicians.

PMID:42414091 | DOI:10.1136/bmjqs-2025-019297