Journal of Addiction Medicine最新文献

{"title":"Association Between Buprenorphine Adherence Trajectories, Health Outcomes, and Health Care Costs Among Medicaid Enrollees.","authors":"Olajumoke A Olateju, Chijioke Okeke, Mina Shrestha, Douglas Thornton","doi":"10.1097/ADM.0000000000001458","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001458","url":null,"abstract":"<p><strong>Objectives: </strong>To identify distinct buprenorphine adherence trajectories among patients with opioid use disorder (OUD) and evaluate their associations with health events and health care costs.</p><p><strong>Methods: </strong>A retrospective longitudinal cohort study was conducted using the Merative Multi-state Medicaid database. The study analyzed 12,244 Medicaid enrollees aged 18-64 years who were diagnosed with OUD and initiated buprenorphine treatment between July 1, 2017 and June 30, 2019. Group-based trajectory models were used to identify adherence patterns during the first 180 days of treatment. Cox proportional hazard models were used to evaluate the associations between adherence trajectories and time to opioid overdose, substance use disorder-related hospitalization, and all-cause hospitalization. Generalized linear models were used to compare health care costs across trajectories.</p><p><strong>Results: </strong>Four buprenorphine adherence trajectories were identified: completely adherent (50.8%), initially adherent with later decline (13.6%), increasing adherence with later decline (9.9%), and continuously declining nonadherence (25.8%). Compared to the completely adherent group, patients in other groups had a higher risk of opioid overdose, hospitalization and increased health care costs. The continuously declining nonadherent group demonstrated the highest risks, with an opioid overdose hazard ratio (HR) of 1.92 (95% CI, 1.46-2.39), all-cause hospitalization of HR of 1.71 (95% CI: 1.58-1.85), and substance use disorder (SUD)-related hospitalization HR of 2.01 (95% CI: 1.82-2.15). Additionally, healthcare costs were notably higher compared to the completely adherent group, with an increase of $1482.45 (95% CI: $745.45-$2756.01) in the increasing adherence with later decline group and $1698.46 (95% CI: $432.57-$3087.78) in the continuously declining nonadherence groups.</p><p><strong>Conclusions: </strong>Almost half of Medicaid beneficiaries with OUD exhibited varying degrees of nonadherence to buprenorphine within 180 days of treatment initiation. This nonadherence was associated with adverse clinical outcomes and increased health care costs. Health care providers should consider adherence challenges when designing therapeutic interventions with buprenorphine.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Privacy, Care-seeking, and Stigma: A Qualitative Investigation of Patient Perspectives on Sharing Substance Use Disorder Treatment Records.","authors":"James Aluri, Evelyn Gurule, Tulha Dobler Siddiqi, Camryn R Upson, Adam D'Sa, Eric C Strain, Denis G Antoine","doi":"10.1097/ADM.0000000000001460","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001460","url":null,"abstract":"<p><strong>Objectives: </strong>To examine, among persons with substance use disorders (SUDs), how their decision-making to seek care is influenced by concerns about the privacy of their treatment records, how they weigh the risks and benefits of record sharing, and their awareness of how records are shared and regulated.</p><p><strong>Methods: </strong>This qualitative study followed the Standards for Reporting Qualitative Research and analyzed semi-structured interviews of 13 men and 14 women recruited from inpatient and residential SUD treatment programs. Due to the onset of the COVID-19 pandemic, recruitment took place over an extended period (between May 2020 and July 2023). Interview transcripts were analyzed using qualitative thematic analysis. Saturation was checked using established quantitative methods.</p><p><strong>Results: </strong>Most participants reported that privacy concerns about their records were not a significant factor in the decision to seek treatment. Participants identified many benefits to record sharing, and stigma was viewed as a primary risk. Several women reported that health care professionals, particularly in emergency or perinatal care contexts, treated them differently or negatively after learning about their substance use history. Most participants were unaware of how their substance use treatment records were protected or who had access to their records.</p><p><strong>Conclusions: </strong>Sharing of SUD treatment records with health care professionals was generally viewed positively and privacy concerns did not appear to deter participants from seeking care. Stigma was a concern among participants, especially women. The unawareness of how records are shared highlights the need to better engage persons with SUDs in clinical conversations about their records.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individuals Dispensed Buprenorphine in the United States Before and After Federal Policy Changes Aimed at Increasing Access.","authors":"Gery P Guy, Christopher M Jones, Michaela Rikard, Andrea E Strahan, Kun Zhang, Yngvild Olsen","doi":"10.1097/ADM.0000000000001457","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001457","url":null,"abstract":"<p><strong>Objectives: </strong>Buprenorphine can decrease opioid use disorder and mortality risk but remains underutilized. This study evaluates changes in monthly buprenorphine dispensing associated with federal policy changes in the United States from 2018 to 2023.</p><p><strong>Methods: </strong>This study used interrupted time series analysis comparing the monthly rate of patients dispensed buprenorphine after the implementation of telehealth flexibilities in March 2020, relaxation of training requirements in April 2021, and removal of waiver requirements in December 2022. Buprenorphine formulated for opioid use disorder was included from the IQVIA Total Patient Tracker.</p><p><strong>Results: </strong>Before March 2020, the monthly rate of individuals dispensed buprenorphine was increasing. The rate of increase slowed after each policy change: -0.69 (95% CI=-1.00 to -0.39) after telehealth flexibilities were initiated, -0.60 (95% CI=-0.92 to -0.27) after relaxing training requirements, and -0.49 (95% CI=-0.73 to -0.24) after waiver elimination. After the elimination of the waiver, declines were observed across several specialty groups, including pain medicine, emergency medicine, and primary care, while the rate increased among addiction medicine specialists.</p><p><strong>Conclusions: </strong>After each policy change, the rate of individuals dispensed buprenorphine increased at a slower rate than before each policy change. These findings suggest that the removal of the waiver, while important, may not be sufficient on its own to meaningfully expand buprenorphine prescribing. Individual and systems-level strategies may be needed to fully optimize the impact of these policy changes focusing on reducing patient, clinician, and institutional stigma, addressing clinician barriers, implementing systems-level improvements, and strengthening payment policies that incentivize prescribing.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient Alcohol Withdrawal Management in a Substance Use Disorder Bridge Clinic: An Opportunity for Low-barrier Engagement and Shared Decision-making.","authors":"Alyssa F Peterkin, Jordana Laks, Natalija Farrell, Karrin Weisenthal, Jessica L Taylor","doi":"10.1097/ADM.0000000000001463","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001463","url":null,"abstract":"<p><strong>Objective: </strong>To describe the implementation of outpatient alcohol withdrawal management in a low-barrier substance use disorder (SUD) bridge clinic and short-term clinical outcomes.</p><p><strong>Methods: </strong>A bridge clinic in Boston, MA implemented outpatient benzodiazepine tapers for alcohol withdrawal in patients at low risk of alcohol withdrawal seizures or delirium tremens. We conducted a retrospective chart review of patients who received one or more benzodiazepine doses between April 2021 and January 2023. We described patient characteristics and evaluated rates of taper completion, clinical complications, and medication for alcohol use disorder (AUD) initiation.</p><p><strong>Results: </strong>Forty-six patients with alcohol withdrawal were treated during the study period. Their mean age was 43 years and the majority identified as male (76%); ∼30% were Black/African American and 30% Hispanic/Latinx, and 24% spoke a primary language other than English. Most had severe AUD (76%), and 30% had a history of complicated withdrawal, counter to typical clinical eligibility criteria. Over a third of patients (19/46, 41.6%) completed their planned withdrawal treatment course, 18 (39.1%) patients did not follow up in the bridge clinic within the first 3 days, and 1 (2%) experienced a documented seizure during treatment. Twenty-four patients (52%) initiated medication for AUD.</p><p><strong>Conclusion: </strong>Outpatient alcohol withdrawal management in a bridge clinic provides an opportunity to engage patients from marginalized groups, including those at higher risk for complicated alcohol withdrawal who decline inpatient care. More work is needed to improve patient follow-up and assess treatment outcomes.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Risks of Major Cardiac Adverse Events in Stimulant Use Disorder as Compared With Other Substance Use Disorders: A Propensity-score Matching Cohort Study.","authors":"Nicolas Garel, Kyle T Greenway, Paola Lavin, C William Pike, Rebecca Hyde, Didier Jutras-Aswad, Steven D Tate, Anna Lembke","doi":"10.1097/ADM.0000000000001461","DOIUrl":"10.1097/ADM.0000000000001461","url":null,"abstract":"<p><strong>Objectives: </strong>Individuals with stimulant use disorders (StSUDs) present an elevated risk of cardiovascular complications compared with the general population. However, it remains unclear whether, within the subpopulation of individuals with substance use disorders (SUDs), those specifically affected by StSUDs face even higher cardiovascular complications.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the EVERSANA databank, spanning from January 2015 to December 2023. The EVERSANA data set comprises deidentified electronic health record data aggregated and standardized across the United States. Participants included patients diagnosed with SUDs, encompassing alcohol, cannabis, opioids, stimulants, tobacco, hallucinogens, sedative-hypnotics, or inhalants. We employed the International Classification of Disease 10th (ICD-10) version codes to define the presence of StSUD and SUD. Major adverse cardiac events (MACE) were assessed, and Cox proportional hazard ratios were adjusted using high-dimensional propensity score (hdPS) matching to account for potential confounders.</p><p><strong>Results: </strong>Among 137,106 patients with SUD, 7706 (5.6%) had StSUD. The cohort was 50.2% female, 53.0% non-White, with a mean age of 49.1 years (SD±15). After adjustment, stimulant users exhibited significantly higher MACE rates (HR=1.37, 95% CI: 1.22-1.53, P <0.001), including an elevated risk of death (HR=1.23, 95% CI: 1.02-1.47, P =0.026).</p><p><strong>Conclusion: </strong>Individuals with StSUD face increased MACE compared with those with nonstimulant SUDs.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatricians' Attitudes Toward and Use of Terminology About Mothers With Opioid Use Disorder.","authors":"Jessica A Ratner, Barbara H Chaiyachati, Neera Shah Demharter, Meghan Gannon, Jobayer Hossain, Olivia Larkin, Jennifer M McAllister, Fateh Peera, Davida M Schiff, Erica M S Sibinga, Jessica F Rohde, Neera K Goyal","doi":"10.1097/ADM.0000000000001467","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001467","url":null,"abstract":"<p><strong>Objectives: </strong>Stigmatizing experiences for mothers with opioid use disorder (OUD) may impede health care engagement. We sought to characterize attitudes and terminology use among pediatric primary care clinicians as a potential target for improvement.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey of 1004 clinicians at 28 clinics affiliated with 7 US residency programs (April to June 2022). Survey questions focused on trust, blame, and support for mothers with OUD were adapted from prior studies of self-reported attitudes, and terminology was categorized as preferred versus nonpreferred based on national recommendations. Frequencies were tabulated, and a 2-stage process of factor analysis and k-means clustering was used to group respondents by attitudinal responses. Multivariable logistic regression evaluated the association between participant characteristics and attitudinal groups.</p><p><strong>Results: </strong>Of 272 respondents (response rate 27.1%), most were female, non-Hispanic White residents; the distribution of clinical roles was similar among nonrespondents. Use of nonpreferred terminology was infrequent, although over 69% reported usual or occasional use of \"substance abuse.\" Analyses supported clustering respondents across 3 main constructs of trust, blame, and support. About 27% were categorized as having a low level of blame, and about 38% had a high level of trust. Adjusting for covariates, high trust was associated with confidence in training to provide care for opioid-exposed children (adjusted odds ratio [AOR] 1.84, P=0.04), and low blame was associated with education on OUD stigma (AOR 3.43, P=0.001).</p><p><strong>Conclusions: </strong>Pediatrician attitudes reflecting mistrust and blame toward mothers with OUD are not uncommon but may be addressed through training and education.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menstrual Pain and Substance Use in Women Receiving Inpatient Treatment for Substance Use Disorders.","authors":"Dawn E Sugarman, Mia A Haidamus, R Kathryn McHugh, Margaret L Griffin, Roger D Weiss, Laura A Payne","doi":"10.1097/ADM.0000000000001468","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001468","url":null,"abstract":"<p><strong>Objectives: </strong>Pain is a risk factor for substance use and can negatively affect outcomes of substance use disorder (SUD) treatment. Menstrual pain is common among menstruating women yet has received little attention in the substance use literature. This study aimed to characterize menstrual pain and explore the association between menstrual pain and substance use in women receiving SUD treatment.</p><p><strong>Methods: </strong>Participants in SUD inpatient treatment were recruited for a cross-sectional self-report survey study. The current analyses focused on participants who reported a menstrual cycle in the past 6 months (N=56) and completed a questionnaire to assess menstrual cycle characteristics, menstrual pain severity, and menstrual pain interference. Substance use (eg, alcohol, cocaine) and misuse of medications to relieve menstrual pain (ie, used without a prescription or in any way other than prescribed) was also assessed.</p><p><strong>Results: </strong>Half of the participants (n=28) reported using substances for menstrual pain; the most commonly used substances were cannabis, alcohol, and nicotine/tobacco. Menstrual pain severity was associated with substance use to manage menstrual pain (B=0.34, SEB=0.11, P<0.01); higher pain interference was associated with higher odds of using substances to manage menstrual pain (B=0.55, SEB=0.16, P<0.001).</p><p><strong>Conclusions: </strong>These results indicate that menstrual pain is highly prevalent in this population and may be a risk factor for substance use among women in SUD treatment. Conducting menstrual history assessments with patients seeking SUD treatment might be clinically helpful. It may also be helpful for clinicians to closely monitor the impact of menstrual pain on substance use and treatment outcomes.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and Ethnic Inequities in the Receipt of Medications to Treat Opioid Use Disorder Among Pregnant People: A Meta-analysis.","authors":"Grace Gerdts, Katherine Sale, Phyllis Raynor, Davida M Schiff, Mishka Terplan, Elsie Bush, Nichole Nidey","doi":"10.1097/ADM.0000000000001465","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001465","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this meta-analysis is to examine inequities in the receipt of medications for opioid use disorder (MOUD) by race and ethnicity among pregnant people.</p><p><strong>Methods: </strong>PubMed and Embase were searched for studies examining the relationship between race and ethnicity and the receipt of MOUD during pregnancy. Studies were included if they were observational in nature and reported sufficient data to ascertain effect measures. Random-effects meta-analyses were conducted to estimate the pooled odds ratios (OR) with 95% CIs.</p><p><strong>Results: </strong>Fourteen studies were included with data on 157,208 individuals. Receipt of MOUD among Black (pooled OR: 0.35, 95% CI: 0.23, 0.55) and Hispanic (pooled OR: 0.60, 95% CI: 0.40, 0.89) pregnant people was significantly lower compared to their White counterparts. Among all other racial and ethnic categories, receipt of MOUD was nonsignificantly lower compared to White pregnant people (pooled OR: 0.79, 95% CI: 0.56, 1.12). Ten studies utilized self-reported race and ethnicity, and 3 studies reported data on well-defined racial and ethnic categories outside of White, Black, and Hispanic.</p><p><strong>Conclusions: </strong>There is strong evidence of racial and ethnic inequities in the receipt of MOUD during pregnancy. We hypothesize these inequities to be caused by structural and interpersonal racism impacting the quality of care for pregnant people with opioid use disorder. Increased use of self-identified race and ethnicity alongside improved reporting of racial and ethnic categories beyond Black, White, and Hispanic is needed in future research to better understand and measure constructs related to racism.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Dyadic Association Between Patient Overdose Risk and Family Attitudes Toward Medications for Opioid Use Disorder.","authors":"Kevan Shah, Katherine Nameth, Jasmin Choi, Lane Burgette, Karen Chan Osilla","doi":"10.1097/ADM.0000000000001464","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001464","url":null,"abstract":"<p><strong>Objectives: </strong>Strong social support is beneficial in the care of patients with opioid use disorder. While medications for opioid use disorder (MOUD) are the gold standard treatment for OUD, the beliefs of support persons (SP; family, friend, partner of the individual) about MOUD can influence whether a person initiates and adheres to MOUD.</p><p><strong>Methods: </strong>We examined dyadic baseline data (n=219) of patients receiving buprenorphine treatment and their identified SP across five community health clinics in California. We evaluated SP attitudes about and familiarity with MOUD using 5 items and patient risk via sum scores on an opioid overdose risk assessment scale. We conducted multiple linear regression models using opioid overdose risk score as the outcome and SP attitudes as predictors, controlling for SP age, sex, and race as covariates.</p><p><strong>Results: </strong>The majority of SPs (80%) reported being at least somewhat familiar with MOUD, which was associated with patients who had lower opioid overdose risk scores. SPs who reported agreement with the belief statement that people should be able to stop their opioid use on their own without medication were associated with patients with higher opioid overdose risk scores (P=0.048). When adjusting for covariates, only increased familiarity with MOUD and lower patient overdose risk remained significant (P=0.028).</p><p><strong>Conclusions: </strong>Efforts that aim to promote familiarity with and decrease stigmatizing attitudes toward MOUD may be beneficial in both building support in the patient-SP relationship and potentially reducing overdose risk among patients with OUD.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post Void Residuals: Medications for Opioid Use Disorder, Patient Outcomes, and How Not to Get Fooled by Urine Toxicology Results.","authors":"Jarratt D Pytell, David A Fiellin","doi":"10.1097/ADM.0000000000001466","DOIUrl":"10.1097/ADM.0000000000001466","url":null,"abstract":"<p><p>As opioid-related mortality has increased in the United States, greater emphasis has been placed on ensuring access to medications for opioid use disorder(MOUD) and improving outcomes. While abstinence using urine toxicology testing was a mainstay of assessing MOUD treatment outcomes, there have been major shifts in clinical, research, and public health communities away from placing untoward emphasis on these metrics. Herein we challenge the purported objective truth of urine testing and highlight how we can be easily fooled into thinking a patient is or is not abstinent. We highlight the potential value of patient-reported outcomes (PROMs) that are easily obtained and may more accurately reflect the benefits of MOUD, such as decreases in overdose, retention in treatment, and improved health outcomes.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}