Search Results (76)

Pregnant people in U.S. jails experience high rates of opioid use disorder (OUD), yet access to medications for opioid use disorder (MOUD) remains inconsistent. This mixed-methods study examines how jail policies, treatment infrastructure, and political context shape MOUD provision for pregnant incarcerated individuals. We conducted a secondary analysis of a national survey of 2885 U.S. jails (analytic sample = 836). Logistic regression models assessed associations between MOUD provision and telemedicine capacity, community MOUD availability, state Medicaid expansion, and 2020 presidential voting outcomes. Qualitative responses characterized barriers to care. Findings confirm that MOUD access for pregnant incarcerated individuals remains limited and structurally patterned. Fewer than half of jails continued methadone or buprenorphine for pregnant individuals already in treatment, and initiation was uncommon. MOUD provision was more likely in Democrat-won states, jails with telemedicine capacity, and jails located in communities with MOUD providers, while limited community availability reduced odds of provision. Qualitative themes highlighted restrictive jail policies, provider discretion, diversion concerns, and misconceptions regarding fetal harm. These findings underscore persistent structural barriers to evidence-based perinatal OUD treatment in carceral settings and highlight the importance of telemedicine expansion, community treatment capacity, and standardized correctional policies to advance perinatal health equity. Full article

Substance use disorder (SUD) is a chronic and clinically complex condition, frequently complicated by significant organic and psychiatric comorbidities. Most patients are polymedicated and require opioid substitution programs (OSPs). This complexity is further exacerbated by drug–drug interactions, therapeutic duplication, and fragmentation of the healthcare system. This retrospective observational study analyses the prevalence of polypharmacy and associated pharmacotherapeutic risks in a cohort of 1050 patients with SUD treated at Drug Care Units (DCUs) in Tenerife (Canary Islands, Spain). Prescriptions were dominated by methadone (62%), antidepressants, and antipsychotics, often in combination with benzodiazepines. Significant polypharmacy (>10 active prescriptions) was observed in 2.3% of patients, while 8.1% received 6–10 medications and 37.2% were using 2–5 medications. Women showed a higher pharmacological burden, with 3.5% experiencing significant polypharmacy (>10 different prescriptions) compared with 1.1% of men. Overall, 31% of patients received antidepressants, 31% were treated with antipsychotics—frequently with concurrent use of multiple agents—and 6.4% received opioids outside the OSP. Therapeutic duplication was observed in 15.6% of patients for psycholeptics, 14.2% for psychoanaleptics, and 3.2% for antiepileptics. Additionally, 25.2% of patients reported self-medication, predominantly with benzodiazepines. These findings underscore the need for integrated pharmaceutical care programs incorporating individualized therapeutic review and deprescribing strategies to enhance the safety and efficacy of SUD treatment. Full article

The global opioid crisis necessitates innovative non-pharmacological interventions for pain management and addiction recovery. This comprehensive narrative review synthesizes evidence from approximately 75 studies supporting manual therapy’s modulation of endogenous opioid systems and explores potential applications in addiction treatment. Manual therapy interventions, including massage and joint manipulation, demonstrate significant neurochemical effects, with controlled studies showing 16% increases in plasma β-endorphin levels (p = 0.025) persisting approximately one hour following treatment. These effects appear mediated through periaqueductal gray-rostral ventromedial medulla descending pathways, with naloxone reversibility studies confirming opioid-mediated mechanisms. The endogenous opioid system undergoes profound dysregulation during addiction, creating therapeutic opportunities for interventions capable of stimulating natural opioid release without exogenous substances. Clinical applications in addiction recovery may include withdrawal symptom management, craving reduction, and restoration of dysregulated reward pathways. Manual therapy’s demonstrated safety profile, accessibility, and compatibility with existing treatment modalities position it as an ideal complementary intervention for comprehensive addiction programs. However, significant methodological limitations in existing studies necessitate cautious interpretation. Rigorous randomized controlled trials specifically examining manual therapy’s effects in addiction recovery populations represent the highest research priority. Manual therapy as an endogenous opioid modulator represents a promising frontier in addiction medicine but warrants rigorous scientific investigation before potential clinical integration into evidence-based treatment protocols. Full article

Background: Opioid use disorder (OUD) and associated overdose deaths have reached epidemic proportions worldwide over the past two decades, with death rates for men consistently reported at twice the rate for women. We have recently reported sex-specific differences in electrocortical activity in persons with OUD in a visual object recognition task. The mesolimbic dopamine (DA) system is implicated in OUD but also plays a critical role in some disorders of visual attention and a modulatory role in the processing of visual stimuli in the blue cone pathway of the retina. We hypothesized that electrocortical responses to color stimuli would be affected differentially in men and women with OUD. Methods: Using a controlled, cross-sectional, age-matched (18–56 years) design, we evaluated color processing in male and female subjects recruited from a community-based, high-intensity residential substance abuse and detoxification treatment program. We evaluated electroencephalogram (EEG) event-related potentials (ERPs) and reaction time (RT), in male and female participants with OUD (n = 38) vs. sex- and age-matched non-OUD control participants (n = 37) in a simple color recognition Go/No-Go task, as well as perceptual and behavioral responses in physiological and neuropsychological tests. Results: N200, P300, and late potential (LP) Relevant stimulus-induced ERPs were evoked by the task and were well-differentiated from Irrelevant distractor stimuli. P300 amplitudes were significantly greater and N200 and LP latencies were significantly shorter in male vs. female non-OUD controls in this task. There were significant sex differences in N200, P300, and LP amplitudes and latencies between male vs. female non-OUD subjects and OUD differences with blue color as the Relevant stimulus. In the Binocular Rivalry Test, there were shorter dwell times for perceiving a blue stimulus in male OUD subjects and there were significant sex and OUD differences in neuropsychological tests including Finger Tapping, Trails A/B, and Symbol Digit Modalities Test. Conclusions: These findings suggest that there are significant sex-related physiological, perceptual, and cognitive differences in color processing that may result from deficits in DA production in the retina that mirror deficits in mesolimbic DA transmission correlating with OUD, suggesting that blue color processing has the potential to be an effective biomarker for brain DA and for diagnosis and monitoring of treatment efficacy in substance use disorders. Full article

Community-level overdose prevention interventions often require collaboration among organizations from various sectors including emergency medicine, criminal justice, harm reduction, and drug treatment organizations, yet little is known about ways to foster interorganizational collaboration among organizations with very different missions and in different socio-political contexts. This paper presents results from interviews with key informants involved in overdose prevention coalitions in two counties in Wisconsin (n = 45). Key informants were purposively selected from 31 different organizations in sectors including harm reduction, drug treatment, emergency medicine, and law enforcement. Interviews asked participants to describe the overdose crisis in their communities and the work they do, including any partnerships or coalitions formed with other organizations. We conducted thematic analysis using inductive and deductive coding. Participants’ experiences illuminate strategies and actions that facilitated coalitions’ work (interorganizational processes) and changed the context in which they worked to be more accepting of harm reduction efforts and less stigmatizing and punitive toward people who use opioids (PWUO). These included getting the word out in community-facing events to educate the public and destigmatize harm reduction, working with representatives across the CoC in various sectors, and actively working with them to create shared missions. Key people acted as bridges while others had the power to convene multiple agencies to a common cause. Overdose Fatality Reviews (OFRs) were found to be particularly helpful in identifying gaps in the current Opioid CoC and developing programs in collaboration with other organizations to address them. Organizational empowerment offers a useful framework for understanding how to facilitate IOC at the intra- (e.g., community education to reduce stigma, inter- (bridging roles by key actors), and extra-organizational levels (e.g., policy changes supporting naloxone access). These strategies can be used by coalition members and tested in future community-level overdose responses. Full article

Background/Objectives: Patient satisfaction is increasingly recognized as a key indicator of the effectiveness of substance use disorder (SUD) treatment. While some studies suggest disparities in satisfaction across treatment settings, there remains limited research examining these differences, particularly among vulnerable populations. This study aimed to assess patient perceptions of satisfaction with opioid use treatment services and explore how demographic and socioeconomic factors influence these experiences. Methods: Conducted between 1 February and 31 March 2025, the study took place at a longstanding Opioid Treatment Program in Philadelphia. A total of 217 participants receiving treatment were recruited through convenience sampling during routine clinic visits. Data collection involved an electronically administered survey using the validated Client Satisfaction Questionnaire-8, with both quantitative and qualitative components. Quantitative data were analyzed using SAS 9.4, while qualitative responses underwent thematic analysis in Excel. Results: Findings revealed an average satisfaction score of 27.16, with employment status emerging as a significant predictor; employed individuals reported lower satisfaction (β = −1.118, p = 0.040), and race showed a marginal association. Qualitative analysis highlighted themes such as supportive staff, financial struggles, and personal growth. Conclusion: The results emphasize the need for equitable, culturally responsive treatment approaches that account for socioeconomic disparities in patient experience and care quality. Full article

Objectives: Prolonged opioid use leads to tolerance and hyperalgesia in patients with chronic pain. Apart from an increase in pain, opioid use also leads to several other adverse effects. Nevertheless, the prevalence of opioid use as a treatment for chronic pain remains high, and opioid withdrawal interventions deserve more attention. This study evaluates the effects of a guideline for an opioid withdrawal intervention method that is nested in cognitive behavioral treatment (CBT) and is specifically for patients with a history of long-term opioid use and chronic pain. Methods: We conducted a clinical, exploratory, and mixed-methods study involving pre- and post-measurements on opioid use and health-related quality of life (SF-36), as well as a qualitative analysis of patient experiences (interviews) to evaluate the program. Results: A total of 29 patients were included in the study; 23 of these patients no longer used opioids, and some continued withdrawal under the guidance of their general practitioner. Quality of life improved in all domains, including the amount of pain experienced. No patients reported increased pain levels, and most experienced significantly fewer adverse side effects. Patient satisfaction was high, with no negative long-term side effects of the intervention reported. Conclusions: In light of the results of this study, it is important to address opioid use in patients with chronic pain. There are strong arguments in favor of motivating patients to withdraw from using opioids to treat chronic pain, which can be achieved in combination with CBT. Full article

Substance use during pregnancy is an increasingly important yet under-recognized threat to maternal and child health. This narrative review synthesizes the current evidence available on the epidemiology, pathophysiology, clinical management, and policy landscape of prenatal exposure to alcohol, tobacco, opioids, benzodiazepines, cocaine, cannabis, methamphetamines, and other synthetic drugs. All major psychoactive substances readily cross the placenta and can remain detectable in breast milk, leading to a shared cascade of obstetric complications (hypertensive disorders, placental abruption, pre-term labor), fetal consequences (growth restriction, structural malformations), and neonatal morbidities such as neonatal abstinence syndrome and sudden infant death. Mechanistically, trans-placental diffusion, oxidative stress, inflammatory signaling, and placental vascular dysfunction converge to disrupt critical neuro- and cardiovascular developmental windows. Early identification hinges on the combined use of validated screening questionnaires (4 P’s Plus, CRAFFT, T-ACE, AUDIT-C, TWEAK) and matrix-specific biomarkers (PEth, EtG, FAEE, CDT), while effective treatment requires integrated obstetric, addiction, and mental health services. Medication for opioid use disorders, particularly buprenorphine, alone or with naloxone, confers superior neonatal outcomes compared to methadone and underscores the value of harm-reducing non-punitive care models. Public-health strategies, such as Mexico’s “first 1 000 days” framework, wrap-around clinics, and home-visiting programs, demonstrate the potential of multisectoral interventions, but are hampered by structural inequities and punitive legislation that deter care-seeking. Research gaps persist in polysubstance exposure, culturally tailored therapies, and long-term neurodevelopmental trajectories. Multigenerational, omics-enabled cohorts, and digital longitudinal-care platforms represent promising avenues for closing these gaps and informing truly preventive perinatal health policies. Full article

Background/Objectives: Rates of receiving opioid use disorder (OUD) treatment among adolescents and young adults (AYA) aged 16–25 are low. The current study qualitatively analyzed informants’ perspectives regarding the availability of, developmental considerations relevant to, and barriers associated with OUD treatment for AYA. Methods: Thirty key informants involved with OUD treatment in the northeastern United States completed individual, semi-structured interviews, including treatment providers (N = 11) and clinic leaders in programs that provide medication and psychosocial treatments for AYA with OUD (N = 10), as well as opioid-related policymakers (N = 6) and patient advocates (N = 3). Interviews were transcribed and independently double coded. Template-style thematic analysis methods were used and revealed seven themes. Results: The first theme highlighted limited treatment program availability for adolescents (aged < 18 years) with OUD. Four themes related to developmentally optimizing OUD treatment for AYA, describing the importance of caregiver involvement, AYA peer connections, wraparound services, and early intervention. Two themes described barriers to AYA OUD treatment, including stigma and knowledge gaps about medications for OUD as well as deficits in AYA’s access to basic resources (e.g., housing, food security) that prohibit effective participation in treatment. Conclusions: Results highlight concerns from systems-level key informants regarding gaps in OUD treatment options for youth under the age of 18 and a high need for OUD treatment that is developmentally tailored to AYA. Findings point toward potential modifications and additions to existing adult treatment programs to make OUD treatment more accessible, relevant, and engaging for AYA. Full article

Physical exercise may affect drug use by balancing neurohormonal system mechanisms. Cortisol and β-endorphin, associated with stress, mood, and pleasure feelings, can be affected by exercise and act as regulators of withdrawal symptoms associated with drug use during short-term abstinence. The present study investigated the effect of a supervised, two-month moderate-intensity aerobic exercise program on salivary cortisol and β-endorphin levels in patients with an opioid use disorder (OUD) and on a substitution treatment during a short-term, 24–36 h withdrawal phase from methadone/buprenorphine medication. Ninety opioid users (41 females) in methadone and buprenorphine substitution treatment were randomly divided into four groups: (a) buprenorphine exercise (BEX) (n = 26; age (mean ± SD): 41.9 ± 6.1 yrs), (b) buprenorphine control (BCON) (n = 25; age: 41.9 ± 5.6 yrs), (c) methadone exercise (MEX) (n = 20; age: 46.7 ± 6.6 yrs), and (d) methadone control (MCON) (n = 19; age: 46.1 ± 7.5 yrs). The exercise intervention groups (BEX and MEX) followed a training program on a treadmill for 20 min at 70% HRmax, 3 days/week for 8 weeks. The responses of cortisol and β-endorphin were measured before (t0) and immediately after an exercise session (t20) on different days (i.e., the 1st, 12th, and 24th session) corresponding to the beginning, middle, and end of the training program. A significant increase in β-endorphin levels was observed after the completion of the training intervention (24th exercise session) in both exercise groups (BEX before: 63.8 ± 33; BEX after: 185.6 ± 182.8 pg/mL; MEX before: 115 ± 211; MEX after: 262.3 ± 505.7 pg/mL), whereas β-endorphin was decreased in the control groups (BCON before: 34.7 ± 20.1; BCON after: 24.2 ± 8.8 pg/mL; MCON before: 129.7 ± 185.7; MCON after: 84.9 ± 104.3 pg/mL) (p < 0.05). Inversely, cortisol decreased in both exercise groups post-intervention (BEX before: 9.5 ± 5.9; BEX after: 2.8 ± 1.5 ng/mL; MEX before: 9.3 ± 6.6; MEX after: 3.1 ± 1.5 ng/mL) and increased in control groups (BCON before: 6.3 ± 2.5; BCON after: 10.1 ± 5.4 ng/mL; MCON before: 7.5 ± 3.2; MCON after: 12.5 ± 4.3 ng/mL) (p < 0.05). Moderate-intensity aerobic exercise can beneficially influence β-endorphin and cortisol levels in individuals undergoing treatment for OUD. By increasing endogenous opioid levels and reducing stress hormones, exercise emerges as a promising adjunctive strategy for alleviating withdrawal symptoms, enhancing emotional regulation, and potentially reducing the risk of relapse. The inverse relationship between β-endorphin and cortisol highlights the role of physical activity as a long-term modulator of neuroendocrine function in the context of substance use recovery. Future research should prioritize longitudinal studies extending beyond two months and involving larger, more diverse populations. Additionally, investigating the integration of exercise with non-pharmacological interventions—and its effects on relapse rates, mental health outcomes, and overall quality of life—would provide further insight into its therapeutic value in addiction recovery. Full article

Background: This study examined shifts in the productivity and efficiency of Opioid Substitution Treatment (OST) units in Greece from 2019 to 2022. OST units address withdrawal symptoms in individuals discontinuing psychoactive substances. They also offer mental health care, primary healthcare, psychosocial support, and other integrated services, aiming to provide holistic addiction treatment and promote social reintegration. Methods: We assessed the contributions of 54 OST units addressing opioid addiction using non-parametric Malmquist Data Envelopment Analysis (DEA). Data were collected from all OST units operating in Greece during this period, with a focus on key external factors such as the COVID-19 pandemic and rising global trends in stimulant and synthetic opioid use. Results: The analysis revealed a productivity decline in 2020, followed by improvements in the next two years. However, technical efficiency declined, suggesting a decrease in resource utilization. Conclusions: This dip in efficiency likely reflects the impact of emerging drug trends, particularly stimulants and synthetic opioids, which lack standardized treatment protocols. These findings highlight the urgent need for new treatment options to address evolving addiction trends. The study also underscored the need for improved data collection and monitoring to optimize resource allocation and enhance operational efficiency in OST units. Strengthening evidence-based policies and expanding access with low-threshold treatment services could improve patient outcomes and the overall effectiveness of OST programs. Full article

Buprenorphine and methadone are widely used as medication for addiction treatment (MAT) in patients with opioid use disorders. However, there is no compelling evidence of their impact on the immune–endocrine response. Therefore, the aim of this study was to examine the effects of the aforementioned medications on craving and on biomarkers of inflammation and cortisol, approaching the dose issue concurrently. Sixty-six patients (thirty-four under methadone and thirty-two under buprenorphine) who had just entered a MAT program and were stabilized with the suitable administered doses after a two-week process were divided into four groups based on medication dose (i.e., methadone high dose, buprenorphine high dose, methadone medium dose, and buprenorphine medium dose). The heroin craving questionnaire for craving assessment was completed, and the blood biomarkers were measured on Days 1 and 180. According to the results, high doses of both medications were accompanied by low levels of craving, cortisol, and inflammation on Day 1, and no alterations were observed on Day 180. On the contrary, medium doses reduced the tested psychosocial and biochemical parameters in terms of time, indicating a positive action for the patients. Concludingly, modifications in MAT doses are needed soon after the stabilization process to prevent inflammation and avoid relapse, thus helping opioid-addicted patients toward rehabilitation. Full article

The limitations of pharmacological treatments for chronic pain have become increasingly evident: dependency, side effects, resistance, and diminishing efficacy. The urgent need for innovative solutions has become a compelling focus for improving patient outcomes. Innovative non-pharmacological approaches, such as sleep management, as a strategy to reduce opioid consumption and pain control are needed. The aim was to evaluate the impact of a Sleep and Circadian Intervention Program (SCIP) in the control of chronic musculoskeletal pain (CMP). This was a randomized clinical trial (NCT03646084), in which 49 CMP patients were assigned to SCIP (n = 15, mean age 51 years and 40% women) or non-SCIP groups (n = 26, 53 years and 61.5% women). Outcomes were evaluated after 6 months through self-reported questionnaires (pain intensity, physical function, depression/anxiety, and quality of life (QoL)). The SCIP group was assessed by polysomnography and specific questionnaires and was treated for diagnosed sleep disorders according to clinical guidelines. This population showed a moderate pain intensity at baseline, important deterioration of QoL and pathological anxiety/fear related to pain. Fifty percent of them presented restless leg syndrome, 60% moderate/severe insomnia, and 62.5% sleep apnea. During the follow-up, the SCIP group presented a greater reduction in the abnormal risk group for anxiety (from 73.3% to 46.7%) and depression (from 53.3% to 33.3%) on the Hospital Anxiety and Depression Scale compared to the non-SCIP group (from 40% to 29.2% and 33.3% to 29.2%, respectively). Also, a positive significant effect on anxiety/fear related to pain was found in the Pain Anxiety Symptoms Scale multivariable model, with an important improvement in symptoms. The application of SCIP in CMP patients improved anxiety and controlled associated sleep disorders, highlighting the impact on insomnia. Larger studies are needed for better understanding of the sleep intervention in CMP control. Full article

Background/Objectives: Public health administrators are entrusted to oversee the fair and efficient implementation of public health policy. Professional standards rooted in social justice add an additional ethical standard beyond what is required by procedural equality, reinforcing a service culture of creativity and doing more with less when resources are restrictive. This study explores this phenomenon within the context of government-subsidized opioid use disorder programming in Pennsylvania. Methods: Twenty-three agencies responsible for opioid treatment referrals in Pennsylvania were surveyed about the effects of meeting social equity needs on their operational and procedural outcomes. Univariate frequencies, cross-tabulations, and percentage comparisons were employed in a descriptive–analytic induction approach to analyze the online survey responses. Results: The survey results showed that 91.4% of administrators identified transportation equity as an important programmatic concern, with 91.3% developing transportation support for their clients although not required or funded by the grant program. Conclusions: Equity-focused interventions necessitated operational creativity and sacrifice to maintain compliance while meeting the unique needs of populations, especially when taking geographical differences into account. Full article

The primary aim of this study was to establish the feasibility of implementing a larger RCT designed to evaluate the effect of financial incentives on HCV treatment initiation among persons receiving opioid agonist therapy and/or who have injected drugs in the prior six months. ETHOS Engage is an observational cohort of participants recruited from drug treatment and needle and syringe programs in Australia. Among 11 drug and alcohol clinics, participants who were HCV RNA-positive were randomized (1:1) to receive standard of care or a AUD $60 gift card at treatment initiation. Regarding feasibility, 100% (57/57) of eligible participants enrolled to take part. Twenty-eight participants were randomised to the financial incentive arm (AUD $60 gift card) plus standard of care and 29 participants to the standard of care arm. In this pilot RCT (n = 57), median age was 42 years (IQR 37–49), 63% were male (n = 36), 35% Indigenous (n = 20) and 36% (n = 21) reported injecting drugs daily in the past month. Twelve weeks post-study enrolment, 11 (39%) participants in the financial incentive arm and 17 (59%) participants in the standard of care arm initiated HCV treatment. Findings indicate high feasibility among people who inject drugs to be randomised to receive financial incentives to initiate HCV treatment. Full article