Journal of Addiction Medicine最新文献

{"title":"Xylazine Test Strip Use Among People Who Use Drugs in New York State.","authors":"Kitty H Gelberg, Fernando Montero, Mingway Chang, Mary R Russo, Matthew R Lootens, James L David, Redonna Chandler, Emmanuel Oga, Louisa Gilbert, Nabila El-Bassel","doi":"10.1097/ADM.0000000000001550","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001550","url":null,"abstract":"<p><strong>Objectives: </strong>Xylazine test strips (XTS) allow for rapid identification of xylazine in drugs, yet little is known about those using XTS. Therefore, this study explores the characteristics of people who use drugs (PWUDs) who use XTS and examines risk reduction behaviors associated with XTS use.</p><p><strong>Methods: </strong>This observational cohort study was conducted in New York between September and December 2023 as part of a larger study. Questions about XTS use were added to the parent study's baseline survey of PWUDs and were completed by 254 PWUDs. Sociodemographic characteristics compared XTS users to nonusers. Propensity score weighting using inverse probability of treatment weights was used to examine the association of ever-using XTS with risk reduction behaviors and the drug type used.</p><p><strong>Results: </strong>Sixty-six participants (26%) had used XTS; 80% trusted the results, and 79% were confident in their ability to use XTS to detect xylazine. Those who had used XTS were more likely to have naloxone nearby (aOR=7.51, 95% CI: 2.26-24.95, P=0.001), use a test shot (aOR=2.43, 95% CI: 1.18-5.01, P=0.016), have someone check on them while using (aOR=2.52, 95% CI: 1.23-5.19, P=0.012), and watch someone use the same drugs (aOR=2.35, 95% CI: 1.19-4.65, P=0.014). XTS use was associated with using opioids (aOR=3.68, 95% CI: 1.38-9.81, P=0.009) and injecting drugs (aOR=4.32, 95% CI: 1.91-9.77, P<0.001).</p><p><strong>Conclusions: </strong>Our study demonstrates that XTS use appears to be associated with engaging in risk reduction behaviors, suggesting XTS can be a useful harm reduction tool. More research is needed to assess whether PWUDs change their drug consumption behaviors based on XTS results.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690351","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":"\"She Was Real About It and Made Me Feel Life Is Important\": Patient Perspectives on Peers' Role in Peer-Assisted Telemedicine Hepatitis C Treatment for People Who Use Drugs in Rural Communities.","authors":"Kim Hoffman, Leichtling Gillian, Sarah Shin, Andrew Seaman, Tonhi Gailey, Hunter C Spencer, P Todd Korthuis","doi":"10.1097/ADM.0000000000001544","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001544","url":null,"abstract":"<p><strong>Objectives: </strong>Telemedicine is a promising approach to reach people with limited access to treatment for hepatitis C. People who use drugs (PWUD) and are disengaged from services, however, experience barriers to telemedicine access. The Oregon HOPE TeleHCV study employed peer support specialists to provide outreach to engage PWUD, support pretreatment screening, facilitate telemedicine Hepatitis C virus visits, and assist HCV medication initiation and adherence. In our randomized controlled trial (N =203), the model demonstrated substantially higher HCV treatment initiation and cure compared with enhanced usual care. Our qualitative investigation examined the role of peers from the perspective of patients.</p><p><strong>Methods: </strong>We conducted semistructured phone interviews with 34 patients to better understand the influence of peer interactions on patient experiences and the role of peer support in shaping patient outcomes. The domains of interest were to better understand (1) the influence of peer interactions on patient experiences and (2) the role of peer support in shaping patient outcomes. Interviews were recorded, professionally transcribed and analyzed using Thematic Analysis.</p><p><strong>Results: </strong>We identified 3 major themes regarding the role of peers in the model: (1) peers' lived experience and ways of engaging with patients create an alliance with patients, (2) peers serve as a communication bridge with the health care system, and (3) peers facilitate access to resources and support.</p><p><strong>Conclusions: </strong>Peers were key to the success of the model. Expansion of the Oregon HOPE TeleHCV model of using peer support specialists to engage, retain, and support PWUD could galvanize efforts to eliminate HCV.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690350","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":"Low-dose Buprenorphine Initiation in Pregnancy: A Systematic Review.","authors":"Kyle A Grenier, Carly S Sanderson, Giuliano Paoletta, Kathleen K Adams","doi":"10.1097/ADM.0000000000001546","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001546","url":null,"abstract":"<p><strong>Objectives: </strong>Clinicians developed dosing strategies termed low-dose buprenorphine initiation (LDBI) to circumvent the prerequisite opioid withdrawal with traditional buprenorphine initiation. We aimed to determine the rates of withdrawal in patients who are pregnant transitioning from full opioid agonists to buprenorphine using LDBI.</p><p><strong>Methods: </strong>We conducted a systematic review of the literature using Embase (including MEDLINE) and Scopus through February 5, 2025, augmented with searches in Google, Google Scholar, and www.clinialtrials.gov. Studies of any design were included if they evaluated LDBI in a patient who was pregnant; reports of traditional initiation were excluded. Studies were required to report the presence or absence of any withdrawal during initiation as an outcome. Investigators screened citations and articles for inclusion. Patient data were extracted using a standardized spreadsheet, and risk of bias was assessed using a tool by Murad et al. Data were synthesized with basic counts of variables and outcomes.</p><p><strong>Results: </strong>We included 7 studies, all observational, reporting 25 unique patients. Precipitated withdrawal was uncommon, occurring in 8% (n=2) of patients. Withdrawal of minimal, mild, or moderate severity was reported in 32% (n=8) of patients; however, this outcome was not consistently reported. Most studies did not describe selection methods or use validated tools to ascertain withdrawal.</p><p><strong>Conclusions: </strong>Reports of LDBI in pregnant patients are emerging. While some level of withdrawal appears to be frequent, few studies reported precipitated withdrawal, and findings align with LDBI outcomes seen in nonpregnant patients. It is unknown how selection and/or reporting bias impact findings, and prospective, randomized, controlled trials are needed.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649484","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":"Patients' Perspectives on Alternative Antibiotic Treatment Strategies for Infective Endocarditis Among Persons Who Inject Drugs.","authors":"D Kane Cooper, Eunice A Okumu, Bailey McInnes, Maisun M Ansary, Maria Esposito, Carson Merenbloom, Bayla Ostrach, Vivian H Chu, Li-Tzy Wu, Carol Golin, David L Rosen, Asher J Schranz","doi":"10.1097/ADM.0000000000001545","DOIUrl":"10.1097/ADM.0000000000001545","url":null,"abstract":"<p><strong>Objectives: </strong>Injection drug use is a leading and growing risk factor for infective endocarditis (IE), as evidenced by a marked national increase in hospitalizations for drug use-associated infective endocarditis (DUA-IE). The typical treatment approach for persons with DUA-IE is a 6-week inpatient course of intravenous antimicrobials. This approach is resource-intensive, requiring substantial hospital resources and lengthy stays. Alternative methods of antibiotic delivery for DUA-IE treatment have been proposed and piloted, but their acceptance among people who inject drugs is unknown.</p><p><strong>Methods: </strong>Persons hospitalized with DUA-IE (N = 16) completed semi-structured interviews to identify facilitators and barriers to 3 proposed IE treatment options: (A) hospitalization for the entirety of antibiotic treatment, the current standard of care; (B) home-based outpatient parenteral antimicrobial therapy via indwelling catheter; or (C) weekly outpatient visits for long-acting antibiotic infusion. Interviews were transcribed and thematically coded to identify participant perspectives and preferences among these strategies.</p><p><strong>Results: </strong>Option A was ranked the most preferred treatment regimen (8 participants, 50%), followed by options C (5 participants, 31%) and B (3 participants, 19%). Participants felt option A provided the most effective treatment for their endocarditis, despite dissatisfaction with the hospitalization length. Options B and C appealed to participants given the convenience of outpatient care; however, inadequate transportation and housing instability were prominently cited as barriers.</p><p><strong>Conclusions: </strong>These diverse patient perspectives should inform trials to evaluate the effectiveness of alternative antibiotic delivery strategies, as well as interventions to improve patient-centered decision-making for DUA-IE treatment.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649485","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":"Sex Differences in Illicitly Manufactured Fentanyl Use: Prevalence and Sociodemographic, Health, and Environmental Correlates.","authors":"Elina A Stefanovics, Jack Tsai, Marc N Potenza","doi":"10.1097/ADM.0000000000001543","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001543","url":null,"abstract":"<p><strong>Objectives: </strong>Illegally manufactured fentanyl use (IMFU) constitutes a public health concern. Understanding sex differences in IMFU can help plan population-based interventions.</p><p><strong>Methods: </strong>We utilized the 2022 National Survey on Drug Use and Health, a nationally representative sample of the noninstitutionalized US population, to examine sex differences in IMFU and how IMFU relates to sociodemographic and health characteristics. Bivariate and multivariate analyses were used to estimate adjusted odds ratios and 95% CIs.</p><p><strong>Results: </strong>The weighted lifetime prevalence of IMFU was 0.78% among men and 0.44% among women. Men were at greater risk for IMFU than women across models. Among both sexes, IMFU was positively associated with middle age (26-46 years old) and negatively with Hispanic ethnicity, being married/separated or divorced, higher than high-school educational attainment, and higher incomes (>$75,000+). Among men only, living below the federal poverty level was associated with IMFU. Among women alone, IMFU was additionally associated with being White. In the multivariable model, for both sexes, IMFU was associated with being young-to-middle aged, White, male, and unmarried and having high school or lower education and low income, mental and physical health concerns, and greater availability of heroin.</p><p><strong>Conclusions: </strong>Certain socioeconomic segments of the US population are at elevated risk for IMFU, particularly when heroin is available. Targeted interventions addressing these groups and their communities are needed, and improved support is needed to promote better mental and physical health.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636995","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 Student's Call for Medical School Wellness Curriculums to Include Harm Reduction.","authors":"Cameron K Ormiston","doi":"10.1097/ADM.0000000000001547","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001547","url":null,"abstract":"<p><p>Substance use among medical students is high, has had fatal consequences, and continues postgraduation, with substance use rates among physicians being higher than the general population. Unfortunately, many institutions lack specific policies on substance use, have policies centered on punitive and disclosure-prohibitive approaches, or students are unaware of such policies. Notably, though physical and mental wellness are typical components of medical school curricula and policy, student substance use is often glaringly absent. As a result, schools can be unprepared to address substance use and students can be left feeling unsupported as they grapple with their evolving role in medicine-some of whom may use drugs during this time. Reasons for the shortcomings in addressing student substance use are multifactorial, with stigma, dwindling preclinical time, and overconfidence possibly playing a role. To address this problem, schools must integrate into their undergraduate medical wellness curricula a harm reduction framework that (1) includes student perspectives and input, (2) changes school culture, and (3) improves access to harm reduction education and resources as well as substance use and mental health treatment. Preparing students for their own interactions with alcohol or drugs must be a priority, especially as they enter a profession with a multitude of overlapping risk factors for unhealthy alcohol and drug use, and this must be done in a destigmatizing, supportive, and compassionate way.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626375","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":"Cannabis and Cannabinoids for Treating Pain: What Are the Data?","authors":"Jag H Khalsa, Marc N Potenza, Gregory Bunt, Robert DuPont","doi":"10.1097/ADM.0000000000001537","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001537","url":null,"abstract":"<p><p>Cannabis is the most used federally illicit drug in the United States. Although cannabis use is associated with serious health consequences including cognitive dysfunction, memory problems, psychosis, and hyperemesis, and there is scant clinical evidence to support its use as a medicine, it is nevertheless being widely promoted to treat a wide range of health conditions including chronic pain. Currently, the body of clinical research taken together does not support the use of cannabis in any dosage form for treating any pain, particularly given the potential adverse effects. Certain cannabinoids have the potential to treat many clinical conditions, including perhaps specific pain conditions, but current research is insufficient to support their use for treating pain. More clinical research in compliance with regulatory guidelines is needed to consider approval of cannabis and related products as therapeutics for treating pain. If asked about the use of cannabis and related products for treating pain, providers should exercise caution and engage in evidence-informed discussions with patients to engage in shared decision-making. The lack of evidence supporting efficacy, with the potential of considerable adverse effects associated with the use of high-potency products of cannabis often being consumed currently, should be considered.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626376","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":"Neonate With Intrauterine Xylazine Exposure: A Case Report.","authors":"Cera E Cissna, Hayley M Grzych, Megan K Kalinowski, Justin B Josephsen","doi":"10.1097/ADM.0000000000001539","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001539","url":null,"abstract":"<p><strong>Background: </strong>Fentanyl is a rising cause of morbidity and mortality in the United States, affecting neonates exposed in utero. Xylazine, an alpha-2 receptor agonist, is a non-narcotic sedative that is becoming an increasingly common adulterant. There are case reports describing the clinical manifestations of xylazine exposure and toxicity in adult populations; however, cases involving neonatal populations are not described in the literature. Limitations of toxicology analyses for neonates cause delays in the identification and treatment of affected patients.</p><p><strong>Case summary: </strong>We present the case of a term neonate who presented to the neonatal intensive care unit with a strong foul-smelling odor, diffuse rash, hypertonicity, irritability, and inconsolability. This case describes additional symptoms that presented over the subsequent 120 hours of life, including sustained bradycardia, significant peripheral vasoconstriction, and focalization of odor to breath, urine, feces, and umbilical stump. Mass spectroscopy toxicology of the neonate's serum confirmed the presence of methamphetamine, fentanyl, multiple fentanyl metabolites, and xylazine. Management strategies are discussed, including the role of alpha-2 receptor agonists in treating withdrawal.</p><p><strong>Clinical significance: </strong>This case report presents clinical manifestations of xylazine toxicity and withdrawal in neonatal populations and highlights the need for additional attention on the effects of adulterants to improve management strategies. There is a need for improved toxicology testing to identify affected populations in a timely manner.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591285","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":"Baseline Moderators of Response to Naltrexone and Bupropion in the Treatment of Methamphetamine Use Disorder: An ADAPT-2 Study.","authors":"Thomas Carmody, Taryn L Mayes, Manish K Jha, Steven Shoptaw, Madhukar H Trivedi","doi":"10.1097/ADM.0000000000001533","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001533","url":null,"abstract":"<p><strong>Objectives: </strong>Extended-release naltrexone and once-daily bupropion (NTX-BUP) reduced methamphetamine (MA) use in the Accelerated Development of Additive Pharmacotherapy Treatment for Methamphetamine Use Disorder (ADAPT-1, ADAPT-2) trials. Using a proof-of-concept machine learning technique, we created a classification rule using baseline characteristics to identify individuals who would benefit more from NTX-BUP than from placebo (NTX-BUP-preferred).</p><p><strong>Methods: </strong>ADAPT-2 (double-blind randomized-controlled sequential parallel comparison design trial, n=147) and ADAPT-1 (open-label pilot study, n=37) were used as the training and validation data sets, respectively. Baseline characteristics were combined to create the classification rule, which was trained to predict the number of negative urine drug screens (UDS) during weeks 5 and 6 of the ADAPT-2 trial and optimized using the ADAPT-1 data set. ADAPT-2 placebo nonresponders rerandomized to NTX-BUP (n=80) were used as the test data set. The performance of the classification rule was assessed by the number of negative UDS during weeks 11 and 12 and the number of responders.</p><p><strong>Results: </strong>NTX-BUP-preferred participants (who would obtain greater benefit from NTX-BUP than from placebo), when compared with all NTX-BUP participants in the test data set, had higher response rates (0.26 vs. 0.16) and number of negative UDS (1.09 vs. 0.76). Placebo-preferred participants (would obtain greater benefit from placebo than from NTX-BUP) had lower response rates to NTX-BUP (0.07 vs. 0.16) and number of negative UDS (0.46 vs. 0.76) compared with all NTX-BUP participants.</p><p><strong>Conclusions: </strong>This is a proof-of-concept analysis that needs to establish generalizability. This classification rule could help improve treatment selection, clinicians' treatment decisions, and patient outcomes.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583977","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":"Craving, Impulsivity, and Subsequent Methamphetamine Use With Naltrexone-Bupropion Versus Placebo: Findings From a Randomized Clinical Trial.","authors":"Manish K Jha, Udi E Ghitza, Thomas Carmody, Snoben Kuruvila, Steven Shoptaw, Abu Minhajuddin, Sidarth Wakhlu, Joy M Schmitz, Phillip O Coffin, Gavin Bart, Edward V Nunes, Paul Kenny, Madhukar H Trivedi","doi":"10.1097/ADM.0000000000001538","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001538","url":null,"abstract":"<p><strong>Objectives: </strong>The accelerated development of additive pharmacotherapy treatment (ADAPT-2) for methamphetamine use disorder (MUD) trial demonstrated the efficacy of extended-release injectable naltrexone (NTX) and oral bupropion (BUP). In this secondary analysis, we determined whether craving and impulsivity levels could predict subsequent use of methamphetamine.</p><p><strong>Methods: </strong>Participants (N = 357) of the ADAPT-2 trial with at least one transition point [transition from positive-to-negative urine drug screen (UDS) or vice versa] during stage 1 (baseline through week-6) were included in this secondary analysis. Craving was assessed using the Visual Analog Scale (VAS). Impulsivity was assessed using the 2-item impulsivity factor of the Concise Health Risk Tracking (CHRT) Scale.</p><p><strong>Results: </strong>A significant treatment by craving by time interaction was noted (P = 0.018), where higher craving levels were consistently associated with a lower likelihood positive-to-negative UDS transition at the next visit in both NTX-BUP and placebo groups. However, no such effect was present by week 6 of treatment in the placebo group. CHRT Impulsivity also had a significant effect on the probability of a positive-to-negative UDS transition (P = 0.019) in addition to the 3-way interaction of VAS, week, and treatment group. Individuals with lower craving levels but higher impulsivity exhibited a lower probability of transitioning to negative UDS at the next visit. Higher craving, but not impulsivity, was associated with a higher likelihood of negative-to-positive UDS transition at the next visit in both treatment groups.</p><p><strong>Conclusions: </strong>Further investigations are necessary to optimize NTX-BUP treatment, focusing on the impact of craving and impulsivity on outcomes.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583906","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}