Journal of Addiction Medicine最新文献

{"title":"Global, Regional, and National Burdens Attributable to Drug Use Across 204 Countries and Territories Between 1990 and 2021: The Global Burden of Disease Study 2021.","authors":"Xinsheng Wu, Thomas Fitzpatrick, Guozhen Wu, Yuanyi Chen, Leiwen Fu, Huachun Zou","doi":"10.1097/ADM.0000000000001587","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001587","url":null,"abstract":"<p><strong>Objectives: </strong>Diseases, injuries, and death attributable to drug use are a major global public health problem.</p><p><strong>Methods: </strong>This was a cross-sectional study that used data from the Global Burden of Diseases (GBD) 2021. Data on years of life lost (YLLs), years lived with disability (YLDs), disability adjusted life years (DALY), and deaths from HIV/AIDS, acute hepatitis B, acute hepatitis C, cirrhosis, liver cancer, drug use disorders, and self-harm attributable to drug use in 204 countries and territories from 1990 to 2021 were retrieved from the GBD 2021.</p><p><strong>Results: </strong>Globally, drug use accounted for 463.4 thousand deaths, 18.0 million YLLs, 9.6 million YLDs, and 27.7 million DALYs in 2021. Globally, 0.96% of all DALYs (95% uncertainty intervals 0.85% to 1.07%) were attributable to drug use in 2021, and 71.82% of age-standardized rates of DALYs attributed to drug use disorders were due to opioid use disorders. High-income North America (2117.6), Eastern Europe (911.1), and Australasia (559.4) had the highest DALYs attributable to drug use in 2021. Globally there was not a nonsignificant annual trend [estimated annual percentage change (EAPC) 0.16, 95% CI: -0.16 to 0.47] in age-standardised DALYs attributable to drug use from 1990 to 2021; however, there were regional increases during this period, with the largest increases seen in High-income North America (4.83, 4.52 to 5.14), Western sub-Saharan Africa (1.84, -0.79 to 4.55), and Eastern Europe (1.07, 0.21 to 1.93).</p><p><strong>Conclusions: </strong>Burdens attributable to drug use were high and continued to grow rapidly in some regions, particularly high-income North America.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280276","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":"A Novel Intravenous Buprenorphine Micro-Infusion Strategy: Application in Critical Care and Opioid Use Disorder.","authors":"David K Carroll, Andrew King, Brandtly Yakey, Aria Darling, Eric A Woodcock, Krista Wahby, Rachel Wein, Mark K Greenwald, Andrew R Isaacson, Bram A Dolcourt","doi":"10.1097/ADM.0000000000001588","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001588","url":null,"abstract":"<p><strong>Objectives: </strong>Buprenorphine (BUP), a partial mu-opioid receptor (MOR) agonist, is an effective analgesic and is standard-of-care for treating opioid use disorder (OUD). Transitioning from full MOR agonists to stable BUP dosing can be challenging as some patients experience BUP-precipitated opioid withdrawal (BPOW) due to its ability to displace full MOR agonists. To improve patient tolerability low-dose BUP initiation protocols deliver small, progressively escalating BUP doses, allowing gradual displacement of other opioids and replacement with BUP. We describe a case series using a novel intravenous BUP \"micro-infusion\" protocol for rapid medication transition with no patients meeting the operational criteria for BPOW.</p><p><strong>Methods: </strong>A retrospective case series of patients who received an 8-hour 1200 mcg BUP infusion (150 mcg/hr) and one (or more) sublingual BUP doses after medical or nonmedical full MOR agonist administration. Variables included demographic characteristics, presence of OUD, opioid medications, BUP continuation/prescription fill rates, and evidence of BPOW based on Clinical Opiate Withdrawal Scale (COWS) scores.</p><p><strong>Results: </strong>Of 23 patients included, 8 presented with current OUD (34.8%) and 15 were treated with full MOR agonists for analgesia (65.2%) before BUP micro-infusion. There were no instances of BPOW. Among the 8 patients with OUD, 5 (62.5%) continued sublingual BUP and filled their prescription for BUP upon discharge.</p><p><strong>Conclusions: </strong>Overall, the 8-hour intravenous 1200 mcg BUP micro-infusion protocol was well-tolerated with no clinically apparent cases of BPOW and similar rates of continued sublingual BUP treatment post-discharge among patients with OUD compared with other low-dose BUP initiation protocols.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251124","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":"Extended-release Buprenorphine for Opioid Use Disorder in Hospital and Emergency Department Settings.","authors":"Megan Heeney, Erik Anderson, Lauren Roller Sirey, Robert Benard, Michelle Patregnani, Karen Lind, Amy Liang, Monish Ullal, Andrew A Herring","doi":"10.1097/ADM.0000000000001594","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001594","url":null,"abstract":"<p><strong>Objectives: </strong>Hospitalization and emergency department (ED) visits are an underutilized opportunity to reach high-risk patients with opioid use disorder (OUD) with buprenorphine (BUP) treatment and reduce the ongoing and widespread treatment gap. Monthly extended-release BUP (XR-BUP) potentially facilitates successful initiation and delivers sustained treatment. XR-BUP provides up to 30 days of medication for opioid use disorder (MOUD) with each administration and could improve retention in care during transition to outpatient addiction treatment. We aim to describe the patient characteristics and clinical outcomes of hospitalized and ED patients with OUD treated with monthly XR-BUP.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of a cohort of ED or hospitalized patients who received monthly XR-BUP at an urban, safety-net hospital over a 6-month period from September 2023 through March 2024.</p><p><strong>Results: </strong>There were 61 patient encounters where XR-BUP was administered. Within 30 days of discharge, 40/61 (65.6%) patients who received XR-BUP engaged in outpatient addiction treatment through an in-person or telemedicine provider visit; within 45 days, 29/61 (47.5%) patients received a subsequent XR-BUP. Thirty-eight (62.3%) initiated XR-BUP with low-dose initiation of sublingual buprenorphine with full agonist opioid continuation, 20 (32.8%) started after high-dose sublingual buprenorphine, 2 (3.3%) after low-dose initiation of IV buprenorphine, and 1 (1.6%) received \"direct to inject\" XR-BUP.</p><p><strong>Conclusions: </strong>In this observational retrospective study, rates of engagement in addiction treatment after discharge among patients with OUD receiving XR-BUP were high. Clinical teams utilized novel strategies to initiate XR-BUP during ED and hospital-based encounters.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244632","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":"Evaluating the Impact of Low Threshold Bridge Clinic Expansion on Equitable Access to Substance Use Disorder Treatment.","authors":"Eugene Lambert, Jasmine Irvin, Susan Regan, Dinah P Applewhite, Martha Kane, Elizabeth Powell, Lucille Jordan, Harrison Hubbell, Samata Sharma, Sunny Kung, Norma Lopez, Rebecca Cunningham, Elsie M Taveras, Thomas D Sequist, Sarah E Wakeman","doi":"10.1097/ADM.0000000000001596","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001596","url":null,"abstract":"<p><strong>Objectives: </strong>Racial inequities in substance use disorder treatment, and specifically buprenorphine treatment, contribute to overdose inequities. Bridge Clinics are a low-threshold, transitional treatment model that may improve treatment access. This report assesses the change in visit volume for Black and Hispanic patients and those with limited English proficiency (LEP) after the implementation of the Bridge Clinic expansion across 4 distinct sites.</p><p><strong>Methods: </strong>Between October 2021 and 2023, 3 hospital-based Bridge Clinics were expanded, and a community-based Bridge Clinic was established, all in regions with high racial and language inequities in overdose mortality. Implementation included creating Bridge Clinic performance measures, which were reviewed with clinic leadership monthly, developing a toolkit, and launching mobile services. We present Bridge Clinic visit volume aggregated by calendar year for Black-non Hispanic, Hispanic (any race), and LEP patients. We calculated the percent of total visits for each patient group and assessed the change over time.</p><p><strong>Results: </strong>Comparing 2021 to 2023, total visits increased from 5323 to 10,350, and unique patients increased from 1893 to 3316. Annual visits increased from 437 to 1151 visits for Black patients; 566 to 1609 for Hispanic patients; and 96 to 265 for LEP patients. The percent of visits grew significantly for Black (8.21% vs. 10.24%, P<0.001), Hispanic (10.63% vs. 15.55%, P<0.001) and LEP patients (1.80% vs. 2.56%, P=0.003) from 2021 to 2023.</p><p><strong>Conclusions: </strong>Expanding low-barrier Bridge Clinics may increase substance use disorder (SUD) treatment visits for Black and Hispanic patients and those with LEP.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244642","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":"Illicit Fentanyl Exposures in Cats and Dogs Reported to a North American Veterinary Poison Control Center From 2019 to 2023.","authors":"Orrin D Ware, Ginger Watts Brown","doi":"10.1097/ADM.0000000000001593","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001593","url":null,"abstract":"<p><strong>Objectives: </strong>As a prominent concern for addiction medicine, illicit fentanyl and its analogues have been implicated in numerous poisonings among people. Many households in Canada and the United States include cats or dogs as pets who may be exposed to substances such as fentanyl.</p><p><strong>Methods: </strong>This case-series examined data from the American Society for the Prevention of Cruelty to Animals' Poison Control, a 24-hour call center for animal poison-related emergencies. Descriptive statistics were used on records in which cats or dogs had a reported exposure to illicit fentanyl between 2019 and 2023.</p><p><strong>Results: </strong>The sample included 117 animals (n=4 cats and n=113 dogs). Breeds most identified in this sample were Chihuahuas (n=21) and American Pit Bull Terriers (n=14). Among dogs, the average age was 1.9 (SD=2.8) years and the average weight was 10.5 (SD=11.1) kg. Among cats, the average age was 2.0 (SD=1.2) years and the average weight was 6.0 (SD=2.8) kg. Among dogs, the most reported illicit fentanyl exposure formulation included powder/crystals (n=34; 30.1%). Hypersalivation was reported as a clinical sign for n=2 (50.0%) cats in the sample. The top clinical signs reported among dogs in the sample include lethargy (n=39; 34.5%), vocalization (n=37; 32.7%), and ataxia (n=27; 23.9%).</p><p><strong>Conclusions: </strong>Impacts of illicit fentanyl and its analogues on society extend to 2 common household animals, cats and dogs. Any potential exposure to illicit fentanyl among cats or dogs should promptly seek emergency veterinarian services for reversal with naloxone and supportive care.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244549","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":"Trends in Newly Filled GLP-1 Receptor Agonist Prescriptions for US Patients With Versus Without Comorbid Alcohol Use Disorder, 2016-2024.","authors":"Joshua D Wallach, Stephanie S O'Malley, Kasia J Lipska, Joseph S Ross, Molly M Jeffery, Samuel T Savitz","doi":"10.1097/ADM.0000000000001575","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001575","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate trends in newly filled GLP-1 receptor agonist (GLP-1RA) prescriptions among U.S. adults with type 2 diabetes (T2DM) and/or obesity, comparing those with and without comorbid alcohol use disorder (AUD), and to assess differences in their demographic and clinical characteristics.</p><p><strong>Methods: </strong>We used national claims data from Optum Labs Data Warehouse, which includes de-identified administrative and pharmacy claims from commercially insured and Medicare Advantage (MA) enrollees throughout the U.S., to identify adults who newly filled GLP-1RA-based prescriptions between April 1, 2016, and March 31, 2024. We calculated quarterly rates of new GLP-1RA fills per 100 person-years and compared the characteristics of individuals with T2DM and/or obesity with and without comorbid AUD.</p><p><strong>Results: </strong>From 2016 to 2024, 555,224 individuals with T2DM and/or obesity newly filled prescriptions for GLP-1RAs, of whom 6606 had comorbid AUD. The rate of new GLP-1RA fills for individuals with comorbid AUD increased from 1.27 to 6.02 per 100 person-years between 2016-2024 [incident rate ratio (IRR): 4.73 (95% CI 3.38, 6.79)], compared with an increase of 2.21 to 6.55 per 100 person-years among individuals without comorbid AUD [IRR: 2.96 (95% CI 2.88, 3.05)]. Individuals with AUD were more likely to be MA enrollees under age 65, male, have had a recent emergency department visit, and have co-occurring psychiatric and medical conditions compared with those without comorbid AUD.</p><p><strong>Conclusions: </strong>From 2016 to 2024, the rate of newly filled GLP-1RA prescriptions increased among individuals with T2DM and/or obesity and comorbid AUD. Individuals with comorbid AUD were more likely to be male and to have clinical characteristics linked to greater AUD severity. Additional clinical studies on the efficacy and safety of GLP-1RAs for AUD are needed to guide their appropriate use.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206468","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":"Naltrexone in the Treatment of Ketamine Use Disorders: A Case Report and Literature Review.","authors":"Rishi Verma, Tom Colley, Claire Waldock, Louisa Bird, Irene Guerrini","doi":"10.1097/ADM.0000000000001589","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001589","url":null,"abstract":"<p><strong>Background: </strong>Nonprescribed use of ketamine has increased worldwide due to its hallucinogenic and psychedelic effects. Ketamine use disorders (KUDs) are marked by intense cravings and tolerance, which often trigger relapses and worsen recovery outcomes, defined as sustained ketamine abstinence with reduced cravings, resolved withdrawal symptoms, and improved psychosocial functioning. Currently, there are no approved pharmacological treatments for KUDs. This report examines the off-label use of naltrexone in a patient with KUDs.</p><p><strong>Case presentation: </strong>The case was a 25-year-old woman diagnosed with KUDs enrolled in an outpatient, specialist addiction service. The patient presented with ketamine daily use and intense cravings when trying to stop. The patient was prescribed oral naltrexone at the initial dose of 25 mg/day, which was increased to 50 mg/day after 7 days. After the initiation of treatment, the patient experienced a marked reduction in ketamine cravings. She was able to maintain abstinence and to progress in her recovery. The positive response to naltrexone suggests its potential as an effective intervention for managing KUDs.</p><p><strong>Conclusions: </strong>Our findings are consistent with 2 prior reports that have highlighted the use of naltrexone in KUDs. The 2 previous case reports indicated that naltrexone at the dosage of 50 mg/day successfully helped the patients to achieve abstinence. Studies have shown that naltrexone reduces the antidepressant effects of ketamine in treatment-resistant depression, indicating an overlap between the opioid system and ketamine's NMDA receptor activity. Larger, double-blind studies are needed to evaluate naltrexone's efficacy, safety, and optimal dosing for KUDs.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206431","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":"Experiences With Substance Use Disorder Treatment and the Role of Social Norms in the Asian American Pacific Islander Community: A Qualitative Study.","authors":"Warren Yamashita, Jessica As Wang, Gael Perez, Connie Chen, Connie Tian, Dean Nakashini, Christopher Villongco, Timothy Fong, Huiqiong Deng, Anna Lembke, Yelba Castellon-Lopez","doi":"10.1097/ADM.0000000000001586","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001586","url":null,"abstract":"<p><strong>Objectives: </strong>The Asian American Pacific Islander (AAPI) community accesses substance use disorder (SUD) services less frequently and at more advanced stages compared with the general population. Understanding experiences of AAPI patients with SUDs is important to identify opportunities to engage patients into treatment earlier and address community needs. This study explored the experiences of diverse AAPI patients with SUD and treatment services in a large urban setting, specifically examining influences of social norms within the AAPI community.</p><p><strong>Methods: </strong>We conducted semi-structured qualitative interviews with AAPI participants who received SUD treatment in Los Angeles. Participants discussed their experiences with SUD and treatment services. We used the Rigorous and Accelerated Data Reduction (RADaR) data analysis approach to identify key themes related to SUD treatment experiences, specifically highlighting facilitators or barriers to accessing care.</p><p><strong>Results: </strong>Among 20 interviews analyzed, the following themes were identified: the model minority myth, family dynamics, and AAPI community connection. Sub-themes are presented as facilitators or barriers to SUD treatment services.</p><p><strong>Conclusions: </strong>We found that social norms within the AAPI community can be both facilitators and barriers to treatment. We explored the role of the model minority myth and saving face as barriers to care, and family dynamics rooted in cultural beliefs and AAPI community values as facilitators during recovery. These findings reveal opportunities for cultural nuances to be incorporated into SUD care, inform more inclusive clinical practices, and potentially improve AAPI patient outcomes. Such insights may help reduce stigma and enhance SUD treatment engagement in the AAPI community.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137642","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":"Estimated Hospital Cost Reduction Following Implementation of Hospital-dispensed Discharge Methadone.","authors":"Susan L Calcaterra, Yevgeniya Jenny Scherbak, Julie Nickell, Eric Grimm, Daniel Schonlau, Grant Optican","doi":"10.1097/ADM.0000000000001591","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001591","url":null,"abstract":"<p><strong>Objectives: </strong>US regulatory changes now allow practitioners to dispense up to a 3-day supply of methadone from the inpatient pharmacy at hospital dishcarge at one time. We characterized outcomes related to hospital-dispensed discharge methadone, including saved hospital days and reductions in hospital costs.</p><p><strong>Methods: </strong>We included all hospitalizations involving hospital-dispensed discharge methadone for opioid use disorder. We identified the mean number of discharge methadone doses ordered per hospitalization to determine a reduction in length of hospital stay, where 1 discharge methadone dose equals 1 hospital day saved. We used 2 approaches: a health care cost accounting approach that uses patient-level health care cost data and an adjusted inpatient day metric that uses data from the hospital's aggregated operating costs to estimate hospital cost reductions related to discharge methadone.</p><p><strong>Results: </strong>Between April 2023 and July 2025, 175 hospitalizations involving 374 orders for discharge methadone reduced length of stay by 357 days after accounting for split doses, that is, twice daily doses for pain, pregnancy, or rapid methadone metabolism. The mean number of discharge methadone doses per hospitalization was 2.1. Using a health care cost accounting approach, the median cost reduction was $850/d with a total cost reduction of $304,450 over the study period. Using an adjusted inpatient day estimate, the total cost reduction was $3953/d with a total cost reduction of $1,411,221 over the study period.</p><p><strong>Conclusions: </strong>Hospital-dispensed discharge methadone reduced costs by facilitating hospital discharges. Cost savings related to reduced emergency department overcrowding or avoidance of nosocomial infections were not captured and should be considered when implementing discharge methadone processes.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130827","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 Shifting Landscape of a Fentanyl Adulterant: Moving From Xylazine to Medetomidine.","authors":"Samantha Huo, Jeanmarie Perrone","doi":"10.1097/ADM.0000000000001592","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001592","url":null,"abstract":"<p><p>Medetomidine has been increasingly found in the illegal opioid supply across the country over the last few years. In 2024, it replaced xylazine as the most common adulterant of the illegal opioid supply in the Philadelphia area. Medetomidine is estimated to be over 100 times as potent and selective for the alpha-2 receptor than xylazine. This leads to increased sedative effects compared with other alpha-2 agonists and in some patients, a severe autonomic withdrawal syndrome when medetomidine is abruptly stopped. Severe hypertension, tachycardia, vomiting, and tremors have been seen, often requiring hospital admission and critical care. As a result, the capacity of local health systems and ability to accurately triage patients to the proper level of care have been stretched. Drug checking and testing of biospecimens for medetomidine remains limited. Clinician and public health awareness of this new entity will be foundational to robust responses to this next adulterant threat.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130782","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}