Journal of Addiction Medicine最新文献

{"title":"Split-dosing of Methadone During Pregnancy and Postpartum Period: A Systematic Review of Outcomes.","authors":"Nighat Z Khan, Dennis J Hand, Elaine Qian, Jamie L Conklin, Elisabeth Johnson, John J McCarthy, Melinda Ramage, Vania Rudolf, Charles Schauberger, Kenneth B Stoller, Mishka Terplan, Hendrée E Jones","doi":"10.1097/ADM.0000000000001470","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001470","url":null,"abstract":"<p><strong>Objectives: </strong>The primary objective of this study is to conduct a systematic review of the scientific literature on the practice of methadone split-dosing, where the total daily dose is divided into 2 or more doses taken 10-12 hours apart rather than administered as a single daily dose. The review aims to evaluate the perinatal effects of this dosing regimen on maternal, fetal, and neonatal outcomes.</p><p><strong>Methods: </strong>A systematic review was conducted by searching 6 databases, including APA PsycInfo, the Cochrane Library, CINAHL, Embase, PubMed, and Scopus, through the last search date of June 13, 2023. We included studies that reported maternal, fetal, or neonatal outcomes. Multiple researchers screened references. Data were extracted using a standardized spreadsheet, including study details and outcomes, and included studies were assessed for bias independently by 2 researchers using JBI Critical Appraisal Tools.</p><p><strong>Results: </strong>The systematic search yielded 612 unique references, of which 8 studies met the criteria. These studies focused on investigating the pharmacokinetics of methadone during pregnancy, fetal responses to maternal methadone administration, variables related to maternal substance use disorder treatment, and outcomes related to birth or neonatal health. The findings demonstrated significant alterations in methadone metabolism during pregnancy due to increased methadone metabolism as a result of enhanced hepatic enzyme activity (CYP3A4 and CYP2B6), resulting in lower plasma methadone levels and requiring dose adjustments. Neonatal outcomes were favorable, including higher birth weights, reduced preterm birth risk, improved intrauterine growth, and reduced neonatal abstinence syndrome (NAS).</p><p><strong>Conclusion: </strong>The evidence suggests that pregnancy significantly alters methadone metabolism, subsequently impacting both maternal and neonatal outcomes. These findings demonstrate that split-dosing of methadone is associated with more favorable outcomes compared with once-daily dosing.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692033","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 Detection of Xylazine in Tijuana, Mexico: Triangulating Drug Checking and Clinical Urine Testing Data.","authors":"Joseph R Friedman, Alejando González Montoya, Carmina Ruiz, Mariana A González Tejeda, Luis A Segovia, Morgan E Godvin, Edward Sisco, Elise M Pyfrom, Meghan G Appley, Chelsea L Shover, Lilia Pacheco Bufanda","doi":"10.1097/ADM.0000000000001474","DOIUrl":"10.1097/ADM.0000000000001474","url":null,"abstract":"<p><strong>Introduction: </strong>Xylazine is a veterinary anesthetic increasingly present alongside illicit fentanyl in the United States and Canada, presenting novel health risks. Although xylazine remains less common in the Western US, Mexican border cities serve as key trafficking hubs and may have a higher prevalence of novel substances, but surveillance there has been limited.</p><p><strong>Methods: </strong>We examined deidentified records from the Prevencasa free clinic in Tijuana, describing urine and paraphernalia testing from patients reporting using illicit opioids within the past 24 hours. Xylazine (Wisebatch and Safelife brands), fentanyl, opiate, methamphetamine, amphetamine, benzodiazepine, and nitazene test strips were used to test urine and paraphernalia samples. Paraphernalia samples were also analyzed with mass spectrometry.</p><p><strong>Results: </strong>Of n=23 participants providing urine and paraphernalia samples concurrently, 100%, 91.3%, and 69.6% reported using China White/fentanyl, methamphetamine, and tar heroin, respectively. The mean age was 41.7 years, 95.7% were male, 65.2% were unhoused, and 30.4% had skin wounds currently. Xylazine positivity in urine for the 2 strip types used was 82.6% and 65.2%. For paraphernalia testing, the xylazine positivity was 65.2% and 47.8%. Confirmatory testing of paraphernalia samples by mass spectrometry indicated a 52.2% xylazine positivity, as well as fentanyl (73.9%), fluorofentanyl (30.4%), tramadol (30.4%), and lidocaine (30.4%). Mass spectrometry suggested lidocaine triggered n=3 and n=0 false positives among the xylazine test strip types.</p><p><strong>Discussion: </strong>Xylazine is present on the US-Mexico border, requiring public health intervention. High lidocaine positivity complicates the clinical detection of xylazine via testing strips. Routine urine testing for xylazine in clinical scenarios is likely feasible, yet confirmatory urine studies are needed.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662529","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":"Acute Alcohol Consumption Reduces Uncertainty Choices.","authors":"Hao Liu, Yi Zhang, Duo Li, Chun Wang, Ti-Fei Yuan, Yanbing Jia, Fei Wang","doi":"10.1097/ADM.0000000000001456","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001456","url":null,"abstract":"<p><strong>Background and aims: </strong>Drinking alcohol results in clear effects on decision-making in humans. Alcohol intake impairs information processing and executive function. However, the potential effects of alcohol on human uncertainty decision-making remain unknown.</p><p><strong>Design: </strong>Here we examined the pattern of uncertain decision-making and working memory upon 3 alcohol intake paradigms (a dose of 1.5 g/L of body water, 1.0 g/L body water, and placebo beverage), with a 1-month wash-out between the 3 measurements. Twenty participants (15 males, 5 females) were randomly assigned to different groups and received alcohol drinking programs in different orders. The breath alcohol concentration was assessed to quantify alcohol intake effects, and the cortical silent period using the transcranial magnetic stimulation technique was assessed as an index for cortical inhibition level. The choice under risk and ambiguity task and N-Back task were assessed.</p><p><strong>Results: </strong>The results showed that after intake of the alcoholic beverage with a concentration is 1.5 g/L, participants reduced tolerance for risk and ambiguity, resulting in an altered pattern of uncertain decision-making. What is more, under the same condition, acute alcohol consumption (1.5 g/L) efficiently reduced accuracy and d-prime of 2- and 3-back tasks, indicating the impairment of executive function. Such changes correlate to prolonged cortical silent period. However, no significant differences were observed in the acute alcohol consumption at a concentration of 1.0 g/L.</p><p><strong>Conclusions: </strong>The study shows that alcohol intake reduces uncertain choices, along with enhanced cortical GABABR functions, suggesting alcohol-induced changes in decision-making. These findings provide insights into alcohol's mechanisms and potential targets for intervention, like transcranial magnetic stimulation on the frontal cortex or GABABR antagonist.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663590","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":"Increasing Initiation of Medications for Opioid Use Disorder Through Recovery Coaches: The Role of Implementation Setting.","authors":"Hannah K Knudsen, Amanda Fallin-Bennett, Laura Fanucchi, Michelle R Lofwall, Margaret McGladrey, Carrie B Oser, Gary Biggers, Anna Ross, Jimmy Chadwell, Sharon L Walsh","doi":"10.1097/ADM.0000000000001482","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001482","url":null,"abstract":"<p><strong>Objectives: </strong>Programs to increase linkage to medications for opioid use disorder (MOUD) through peer recovery coaches may hold promise in increasing MOUD initiation. However, the impact of linkage programs may vary based on contextual factors, such as the implementation setting. This study examines whether implementation setting is associated with MOUD initiation following participation in peer-based linkage programs.</p><p><strong>Methods: </strong>The University of Kentucky and Voices of Hope Lexington, a recovery community organization, trained recovery coaches to implement a MOUD linkage program. Coaches were deployed in 9 criminal-legal organizations (ie, jails, specialty court, and pretrial services) and 20 community organizations in 4 rural and 4 urban counties. Coaches worked with participants (n = 754) to set person-centered goals, provided MOUD education, addressed MOUD initiation barriers, and assisted with scheduling appointments. A typology of implementation setting categorized participants by where they enrolled in the linkage program: (1) urban community organizations (reference group), (2) urban criminal-legal organizations, (3) rural community organizations, or (4) rural criminal-legal organizations. The odds of MOUD initiation were estimated using multivariate logistic regression.</p><p><strong>Results: </strong>Of 754 participants, 23.1% (n = 174) reported initiating MOUD. Relative to urban community organizations, individuals enrolled in rural community organizations were more likely to initiate MOUD (odds ratio = 1.85, P = 0.04), whereas individuals enrolled in rural criminal-legal organizations were less likely to initiate MOUD (odds ratio = 0.34, P = 0.005).</p><p><strong>Conclusions: </strong>Implementation setting may impact the likelihood of MOUD initiation through peer-based linkage programs. Future research should examine how implementation strategies might overcome setting-specific barriers to MOUD initiation, particularly in rural criminal-legal settings.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656954","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 Retrospective Cohort Study of Oral Antimicrobial Therapy Offers in Hospitalized People Who Inject Drugs Who Elect for Self-directed Discharge.","authors":"Christen J Arena, Bryce Vanhorn, Rachel M Kenney, Dana M Parke, Geehan Suleyman, Susan L Davis, Michael P Veve","doi":"10.1097/ADM.0000000000001472","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001472","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate infection management in people who inject drugs (PWID) who elect for self-directed discharge (SDD) and to identify characteristics associated with an oral antimicrobial therapy offer (OATO).</p><p><strong>Methods: </strong>This was a retrospective cohort of hospitalized adult PWID with an injection drug use (IDU)-related infection who elected for SDD between January 1, 2014, to January 31, 2024, at a five-hospital health system in southeast Michigan. Patients were excluded if they were hospitalized for <24 hours or if antimicrobial treatment was completed before SDD. The primary outcome was the proportion of patients with an OATO at or before SDD. Secondary outcomes at 30 days included retreatment, infection-related readmission, and all-cause mortality.</p><p><strong>Results: </strong>One hundred fifty patients were included; 55 (37%) received an OATO, 95 (63%) did not receive an offer. Patient outcomes were not different between the OATO and no offer groups: infection retreatment 19 (34%) versus 32 (34%); infection-related readmission 14 (25%) versus 31 (33%); and all-cause mortality 1 (2%) versus 3 (3%). In multivariable logistic regression, variables independently associated with OATO included prescribing/continuing medications for opioid use disorder (MOUD) (adjusted odds ratio [aOR], 2.8; 95% CI: 1.36-5.92), infection source control (aOR, 2.3; 95% CI: 1.10-4.84), and early-career clinician care (aOR, 2.8; 95% CI: 1.01-7.89).</p><p><strong>Conclusions: </strong>Most hospitalized PWID with IDU-related infections with SDD did not receive an OATO. Early career clinicians more commonly offered oral antimicrobials in PWID with less complicated infection types. Standardizing OATO in PWID at risk for SDD should be considered as a future direction to improve health outcomes.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648753","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":"Oral Health Risks of Transmucosal Buprenorphine: Commentary on Tuan et al. and Zheng et al.","authors":"Anne C Black, William C Becker","doi":"10.1097/ADM.0000000000001452","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001452","url":null,"abstract":"<p><p>Opioid use disorder affects millions of people nationally and in 2022 opioid overdose deaths exceeded 80,000. Buprenorphine, a partial mu-opioid receptor agonist, is a gold standard treatment for opioid use disorder, improving withdrawal symptoms and decreasing opioid-related mortality. However, a 2022 Food and Drug Administration warning about oral health problems related to transmucosal formulations has precipitated new research into this medication's potential risks. Two timely studies included in this issue of Journal of Addiction Medicine provide important new insight into potential causal effects and mechanisms of transmucosal buprenorphine's impact on oral disease. Using propensity score-weighted survival analysis, Tuan and colleagues demonstrated significantly greater risk for oral health problems in patients with opioid use disorder exposed to transmucosal buprenorphine compared to those not exposed. Taking a vastly different approach, Zheng and colleagues explored mechanisms of oral health risk by exposing rats to transmucosal or intravenous buprenorphine. Results described prolonged oral fluid buprenorphine exposure, a condition proposed to increase risk for tooth decay, was associated with greater accumulated buprenorphine in the salivary gland associated with sublingual buprenorphine administration. These novel studies advance our understanding of the plausibility of a causal relationship between transmucosal buprenorphine and oral health problems and suggest the importance of prescriber-patient discussions about risk mitigating oral hygiene practices and close monitoring of oral disease development. Additional research is needed into the relative oral health risks of full-opioid agonist versus transmucosal buprenorphine exposure and current barriers to long-acting injectable buprenorphine.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604894","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":"Risk of Cannabis Use Disorder in Chronic Pain: Longitudinal Links to Pain Outcomes.","authors":"Chung Jung Mun, Patricia Timmons, Iosef I Perez, Madeline H Meier, Stephen T Wegener, Claudia M Campbell, Rachel V Aaron","doi":"10.1097/ADM.0000000000001446","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001446","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to compare individuals with chronic pain who were cannabis nonusers and those at low, moderate, and high cannabis use disorder (CUD) risk levels on baseline psychosocial and pain-related characteristics, as well as the longitudinal trajectories of pain severity and interference.</p><p><strong>Methods: </strong>A cohort of 1453 individuals with chronic pain, recruited online, participated in this 2-year longitudinal study, which included baseline, 3-, 12-, and 24-month follow-up surveys. The Cannabis Abuse Screening Test was used to assess CUD risk, and the Brief Pain Inventory was used to assess pain outcomes.</p><p><strong>Results: </strong>Among participants (65.5% female; 86.1% White), 36.3% reported using cannabis, and 39.8% of cannabis users showed high CUD risk. Compared with nonusers, individuals at higher CUD risk tended to be younger, male, of lower socioeconomic status, and at higher risk of alcohol use disorder. They also reported greater pain severity and interference, more pronounced central sensitization symptoms, and elevated mental health symptoms. However, pain severity and interference trajectory slopes over 2 years were not different among the nonusers versus individuals at varying CUD risk levels.</p><p><strong>Conclusions: </strong>A significant portion of individuals with chronic pain who use cannabis may be at risk for CUD. Although higher CUD risk was not associated with worsening pain outcomes over 2 years compared to nonusers, its connection to worse mental health and pain symptoms at baseline highlights the need for targeted CUD risk assessments, patient education on CUD risk, and integrated care with mental health support in chronic pain management.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604897","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":"Relationship Between Methadone Induction Dosing and Retention in Treatment in Opioid Treatment Programs.","authors":"Robert C Sherrick","doi":"10.1097/ADM.0000000000001473","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001473","url":null,"abstract":"<p><strong>Objectives: </strong>Methadone medication for opioid use disorder is effective in reducing opioid use and associated risks, but early dropout from treatment remains a challenge. Current guidelines recommend conservative methadone dose titration, yet slower dose escalation may lead to continued withdrawal symptoms, opioid use, or premature treatment discontinuation. This study investigates the relationship between the first week of methadone dosing and 30-day treatment retention.</p><p><strong>Methods: </strong>This retrospective cohort study included 14,489 patients newly admitted to a network of 64 OTPs between 2020 and 2023. Patients who received an initial methadone dose >30 mg or missed any dosing during the first week were excluded. The primary outcome was 30-day retention. Logistic regression was used to examine the association between methadone dose at day 7-day and 30-day retention.</p><p><strong>Results: </strong>Higher methadone doses on day 7 were significantly associated with improved 30-day retention (P < 0.0001). Patients receiving 70 mg or more on day 7 had a retention rate of 91.24%, compared with 79.51% for those receiving <30 mg. A clear dose-response relationship was observed, with retention rates increasing as the day 7 dose increased.</p><p><strong>Conclusions: </strong>More rapid methadone induction, particularly higher doses by day 7, is associated with improved 30-day retention. Current conservative induction guidelines may need to be revised to allow for more rapid dose escalation while balancing improved treatment outcomes with safety. Further research is necessary to assess the impact of methadone induction dosing on mortality and adverse events.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585715","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":"Risk of Oral Health Problems in Adults with Opioid Use Disorder Treated with Transmucosal Buprenorphine.","authors":"Wen-Jan Tuan, Karl T Clebak, Elhaam Jawadi, Jessica Snyder, Aleksandra E Zgierska","doi":"10.1097/ADM.0000000000001453","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001453","url":null,"abstract":"<p><strong>Objectives: </strong>In early 2022, based on limited case-report evidence, the US Food and Drug Administration warned about possible oral health problems associated with transmucosal (sublingual, buccal) buprenorphine formulations commonly used to treat opioid use disorder (OUD). The purpose of this study was to assess the risk of adverse oral health outcomes among adults prescribed transmucosal buprenorphine for OUD.</p><p><strong>Methods: </strong>This retrospective cohort study utilizing TriNetX claims data consisted of adults diagnosed with OUD in 2002-2019, and who either filled ≥3 transmucosal buprenorphine prescriptions within any 6-month period (buprenorphine cohort) or did not fill any buprenorphine prescriptions (control cohort). Weighted propensity score matching and Cox proportional hazards regression were applied to evaluate the probability of new oral health problem diagnoses during the follow-up period, which lasted up to 5 years after the index date (ie, first buprenorphine prescription or first diagnosis of OUD date, respectively), with outcomes at 1 and 5 years serving as the main risk measures.</p><p><strong>Results: </strong>The study included 721,878 adults with OUD, with 156,594 (21.7%) in the buprenorphine cohort. Persons prescribed buprenorphine displayed a 1.24-1.30 higher adjusted risk of acquiring new oral health problem diagnoses both at 1- and 5-year follow-up (P < 0.001).</p><p><strong>Conclusions: </strong>Our claims data-based results suggest associations between transmucosal buprenorphine use and developing oral health problems among adults with OUD, underscoring the importance of targeted prospective research as well as counseling patients about this potential risk and ways to mitigate it, without unnecessarily deterring patients from this evidence-based treatment.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585716","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":"Challenges of Drug Testing in Addiction Treatment: A Case Report of Protracted Fentanyl Clearance in a Patient Involved With Child Protective Services and Probation.","authors":"Muhammet Celik, Eliza Zimmerer, Brittany Maxwell, Christopher Aloezos","doi":"10.1097/ADM.0000000000001477","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001477","url":null,"abstract":"<p><p>Fentanyl, a potent synthetic opioid, has been linked to an increasing number of overdose deaths in the United States. It began replacing heroin in the illicit drug supply in 2013, and now contributes to both drug-related criminal offenses and the need for treatment. Its unique pharmacokinetics complicate the role of drug testing, which is a ubiquitous practice in both criminal justice and treatment settings. Still, there exists no clear consensus on the role of drug testing in clinical practice for patients involved in the criminal justice system. In this case report, we describe an adult female patient in outpatient addiction treatment for opioid use disorder who self-reported fentanyl abstinence while receiving medication for addiction treatment. The patient's drug test results remained positive for fentanyl and its metabolite, norfentanyl, for 95 days and 245 days. This case illustrates the challenges of relying on drug testing in the treatment of substance use disorders due to the lack of definitive interpretation guidelines for drug levels. In addition, it highlights the importance of advocacy and collaboration between treatment providers and third-party legal entities. It may provide guidance on the role of urine drug testing in substance use treatment, particularly for emerging substances with largely unknown metabolic properties.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573037","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}