Journal of Addiction Medicine最新文献

{"title":"Association of Coverage-Promoting Policies With Initiation and Discontinuation of Buprenorphine Treatment During Medicaid Unwinding.","authors":"Rachel K Landis, Kandice A Kapinos, Phoebe Rose Levine, Bradley D Stein","doi":"10.1097/ADM.0000000000001695","DOIUrl":"10.1097/ADM.0000000000001695","url":null,"abstract":"<p><strong>Objectives: </strong>We examined associations between coverage-promoting policies and changes in initiation and discontinuation of buprenorphine treatment during Medicaid unwinding.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of national retail pharmacy data (2021-2023) to examine the association between 4 separate coverage-promoting policies and the number of initiations and discontinuations of buprenorphine treatment episodes in the 6 months after unwinding began. Statistical significance was assessed using 2-sample t tests.</p><p><strong>Results: </strong>Following up with enrollees nonresponsive to renewal requests and improving ex parte renewal rates were associated with smaller decreases in initiations (-1.4 percentage point difference [pp] [95% CI: -1.5 to -1.4] and -1.5 pp [95% CI: -1.5 to -1.5], respectively) and smaller increases in discontinuations (0.6 pp [95% CI: 0.5-0.7] and 0.6 pp [95% CI: 0.6-0.7], respectively). Following up on returned mail and mostly automated renewal processing had mixed effects. Following up on returned mail was associated with a larger decrease in initiations (1.1 pp [95% CI: 1.0-1.2]) but a smaller increase in discontinuations (1.1 pp [95% CI: 1.0-1.2]); automated renewal processing was associated with a smaller decrease in initiations (-1.6 pp [95% CI: -1.6 to -1.6]) but a larger increase in discontinuations (-2.5 pp [95% CI: -2.6 to -2.5]).</p><p><strong>Conclusions: </strong>Some coverage-promoting policies were associated with smaller disruptions in buprenorphine treatment during Medicaid unwinding; potential protective effects varied by policy type.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690213","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 Pharmacist-Based Models of Care on Treatment Retention Among Individuals With Opioid Use Disorder: A Systematic Review and Meta-Analysis.","authors":"Ruth N Jeminiwa, Jam M M Yu, Maria Foy, Steve Kwon, Lauren Isaacs, Drew Lockstein, Dennis Goodstein","doi":"10.1097/ADM.0000000000001694","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001694","url":null,"abstract":"<p><strong>Objectives: </strong>This review aimed to evaluate the effectiveness of pharmacist-based interventions on treatment retention and nonprescribed opioid use among individuals with opioid use disorder (OUD). A secondary objective was to characterize the types of pharmacist-based interventions for treating OUD.</p><p><strong>Methods: </strong>PubMed, PsycINFO, and CINAHL were searched for records published from the inception of each database until 2025 by 2 independent reviewers. We also searched clinicaltrial.gov and Google Scholar. Eligible studies reported retention in treatment following pharmacist-based interventions for patients with OUD. We performed meta-analyses using the generic inverse variance method and random effects models to estimate the pooled retention rates and the proportion of negative urine opioid toxicology tests following pharmacist-based interventions.</p><p><strong>Results: </strong>Of 3318 records screened and 47 full‑text reviewed, 13 were included. The overall pooled retention rate following pharmacist-based intervention was 77% (pooled proportion=0.77, 95% CI: 0.67-0.87). A pooled retention rate of 76% at 6 months (pooled proportion=0.76, 95% CI: 0.63-0.90) and 59% at 1 year (pooled proportion=0.59, 95% CI: 0.50-0.68) were observed. The pooled proportion of negative urine opioid toxicology test was 84% (pooled proportion=0.84, 95% CI: 0.73-0.96). Pharmacists performed comprehensive functions, including collaborating on OUD diagnostic confirmation, prescribing, and initiating medications for OUD.</p><p><strong>Conclusions: </strong>Pharmacist-based interventions were associated with a pooled retention rate of 77% and reduced nonprescribed opioid use. Our findings underscore the value of pharmacists' multifaceted roles and support their integration into comprehensive care models addressing OUD.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147673578","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 Direct Initiation of Injectable Buprenorphine in a Harm Reduction Agency and Primary Care Clinic: A Retrospective Case Series.","authors":"Clarissa O'Conor, Elliott Brady, Benjamin Hayes, Michele Buonora, Joseph Deluca, Brent Gibson, Susan Spratt, June Mota, Greg Allen, Andrea Jakubowski, Matthew Holm","doi":"10.1097/ADM.0000000000001696","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001696","url":null,"abstract":"<p><strong>Objectives: </strong>Initiating weekly long-acting injectable buprenorphine (LAIB) without prior sublingual buprenorphine (\"direct-to-inject\" or DTI) may reduce buprenorphine initiation barriers. In this case series, we describe outpatient DTI outcomes.</p><p><strong>Methods: </strong>We conducted a manual chart review of 24 patients undergoing DTI between October 2024 and February 2025 at 3 New York City sites: 2 harm reduction agency-based clinics and a federally qualified health center. Pre- and post-DTI withdrawal data were collected from chart documentation and provider report. Buprenorphine retention was ascertained using electronic medical record medication administration and prescription data and defined as being within the LAIB therapeutic window or having an active sublingual buprenorphine prescription at 30 and 90 days with no gaps greater than 9 or 14 days, respectively. We also measured median buprenorphine treatment days over 90 days post-DTI.</p><p><strong>Results: </strong>Of the 23 patients with available data, 19 (83%) had no withdrawal symptoms pre-DTI. Of the 20 patients with documented post-DTI withdrawal symptoms, 3 (15%) had no withdrawal, 12 (60%) had mild, 4 (20%) had moderate, and one (5%) patient had severe withdrawal. Thirty days post-DTI, 14 (58%) patients were retained on any buprenorphine formulation, and 11 (46%) patients were retained at 90 days. The median post-DTI buprenorphine treatment days were 77 (range: 9-90).</p><p><strong>Conclusions: </strong>The majority of patients had no pre-DTI withdrawal symptoms, no or mild withdrawal symptoms post-DTI, and were retained on buprenorphine at 30 days post-DTI, with nearly half retained at 90 days. DTI is a promising buprenorphine initiation strategy, but further research is warranted.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147673621","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 Buprenorphine and Methadone Initiation for Opioid Use Disorder Among Patients Using Fentanyl: A Mixed-methods Analysis From an Inpatient Addiction Consult Service.","authors":"Dustin P Kee, Kenneth A Feder, Lyndon Wood, William M Garneau, Megan E Buresh","doi":"10.1097/ADM.0000000000001693","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001693","url":null,"abstract":"<p><strong>Objectives: </strong>To analyze trends in initiation of medications for opioid use disorder (MOUD) among hospitalized patients with opioid use disorder (OUD) and explore patient-reported factors underlying medication selection amid widespread fentanyl prevalence.</p><p><strong>Methods: </strong>This retrospective mixed-methods study included adult patients with OUD hospitalized at an urban academic hospital between January 2018 and December 2022. Eligible patients were not on MOUD before admission and were seen by the addiction consult service. We evaluated trends in MOUD (buprenorphine, methadone and no MOUD) selection and performed multivariable logistic regression to examine the association between admission year and methadone initiation. In addition, we performed an in-depth review of 100 medical records (10 per MOUD type per year) to examine patient perspectives on prior MOUD experiences and potential challenges influencing selection.</p><p><strong>Results: </strong>Among 1034 patients, methadone selection increased from 14.6% in 2018 to 41.4% in 2022, while buprenorphine was not significantly different (34.6%-37.9%). Selection of no MOUD decreased from 50.8% to 20.7%. Later admission year was associated with a higher likelihood of methadone selection compared with no MOUD, highest in 2021 (aRRR: 9.29, 95% CI: 4.98-17.33) compared with 2018. In qualitative review, most patients (70%) were afraid of fentanyl contamination; 90% had prior MOUD experience, primarily positive; 38% (23/61) expressed fear of precipitated withdrawal, and 63% (33/52) were concerned about slow methadone titration.</p><p><strong>Conclusions: </strong>Methadone selection increased during the study period. Early initiation challenges were the primary patient-reported barriers. These findings underscore evolving challenges related to fentanyl and need to optimize MOUD stabilization strategies.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633606","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":"Opioid Overdose Risk Perceptions and Barriers and Facilitators to Naloxone Distribution for Hospitalized Patients Who Use Stimulants: A Qualitative Study of Patients and Clinicians.","authors":"Erin Bredenberg, Catherine Callister, Gina Kruse, Bethany M Kwan, Sarah Mann, Elizabeth McWilliams, Susan L Calcaterra","doi":"10.1097/ADM.0000000000001689","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001689","url":null,"abstract":"<p><strong>Objectives: </strong>Most stimulant-related deaths in the United States involve opioids due to intentional or unintentional fentanyl toxicity. It is critical to ensure patients who use nonprescribed stimulants have access to naloxone, and hospitalization is an opportunity to provide this lifesaving medication. We aimed to understand perceptions on opioid overdose risk as well as barriers to and facilitators of take-home naloxone distribution through the perspectives of hospitalized patients who use stimulants and the clinicians who care for them.</p><p><strong>Methods: </strong>We conducted key-informant interviews with hospitalized patients who use cocaine or methamphetamine and hospital-based, nonaddiction medicine specialized nurses, physicians, and advanced practice providers. We analyzed results using a rapid matrix-based qualitative technique.</p><p><strong>Results: </strong>Thirteen patients and 13 clinicians participated. Themes included: (1) people who use stimulants have personal, traumatic experiences with opioid overdose, even if they do not intentionally use opioids (patients); (2) despite awareness of stimulant adulteration with fentanyl, patients and hospital-based clinicians differ in their perceptions of opioid overdose risk (patients and clinicians); and (3) factors impacting in-hospital naloxone distribution include competing work-related priorities, logistical considerations necessary to ensure patients receive naloxone in-hand before discharge, and the cost of naloxone (clinicians).</p><p><strong>Conclusions: </strong>Strategies to increase take-home naloxone receipt among hospitalized patients must consider the specific needs of patients who use stimulants, who may view themselves as low-risk for opioid overdose but be open to carrying naloxone for the benefit of others. Clinicians suggested strategies to address logistical considerations of naloxone delivery unique to the hospital environment.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627568","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 as Pre-exposure Prophylaxis for Unintentional Opioid Overdose in Stimulant Use Disorder: A Case Report.","authors":"Gregory A Jaffe, Dennis Goodstein","doi":"10.1097/ADM.0000000000001690","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001690","url":null,"abstract":"<p><strong>Background: </strong>Stimulant-involved overdose deaths have increased sharply in the United States, largely driven by adulteration of the stimulant drug supply with fentanyl and other high-potency synthetic opioids. Individuals with stimulant use disorder (StUD) who do not intentionally use opioids remain at elevated risk for unintentional opioid overdose. Pharmacologic strategies for overdose prevention in this population remain limited.</p><p><strong>Case presentation: </strong>We describe a 32-year-old woman with severe stimulant use disorder who smoked crack cocaine and denied intentional opioid use but experienced 2 nonfatal opioid overdoses attributed to fentanyl-adulterated cocaine. After emergency department treatment with naloxone, we initiated daily oral naltrexone off-label as a harm-reduction strategy to reduce the risk of future opioid overdose. The patient tolerated naltrexone well after brief nausea and reported consistent adherence without reduction in stimulant effects or cravings. She continued daily cocaine use but experienced no further opioid overdoses during 5 months of follow-up.</p><p><strong>Discussion: </strong>This case highlights the potential role of naltrexone as pre-exposure prophylaxis (PrEP) for unintentional opioid overdoses. Framing naltrexone use around unintentional opioid overdose prevention may enhance acceptability and adherence in patients not seeking a decrease or cessation of stimulant use. This strategy does not prevent non-opioid-involved stimulant deaths and should complement, not replace, naloxone distribution and other first-line overdose prevention measures.</p><p><strong>Conclusions: </strong>Oral naltrexone may represent a novel harm-reduction intervention to mitigate opioid-related morbidity and mortality in the setting of an increasingly adulterated stimulant supply. Further research is needed to evaluate efficacy and implementation.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592098","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":"Kava-potentiated Withdrawal in Persons Using Multiple Substances: A Case Series of Kava and Kratom Co-ingestion.","authors":"Miki Kiyokawa, Chirstyn Okuno, Daniel Nguyen","doi":"10.1097/ADM.0000000000001678","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001678","url":null,"abstract":"<p><strong>Objectives: </strong>Kava (Piper methysticum) is indigenous to Pacific Island nations and has a long history of use in traditional medicine and ceremonies. Kava has effects similar to benzodiazepines, but its detailed mechanisms are uncertain. Although legal across the United States, kava is not without side effects. Currently, there are many kava and kratom blends accessible at stores and online. Recent case reports have emerged describing patient experiences with kava withdrawal when co-ingesting kava and kratom together; however, research remains scarce. This case series aims to add to the limited literature on kava withdrawal in co-ingestion of kava-kratom.</p><p><strong>Methods: </strong>Publications before July 2025 were searched using the Ovid Medline, PubMed, and Google Scholar databases using the terms \"kava\", \"kratom\", \"withdrawal\", and \"case report\". The 2 case reports were found describing kava withdrawal symptoms and treatment when co-ingesting with kratom. This case series presents 2 additional cases from our institutions.</p><p><strong>Results: </strong>All 4 patients were male with underlying histories of psychiatric illness and alcohol use disorder. All consumed more than the recommended amounts of the kava and kratom. Kava withdrawal symptoms were similar to sedative withdrawal. The onset of these symptoms varied considerably in relation to the last dose. Paradoxically, symptoms of kava withdrawal were observed in some cases despite sedatives still being present in the patients' systems; however, the involvement of polysubstance complexes the exact etiology of symptoms. All patients improved with phenobarbital and/or benzodiazepines.</p><p><strong>Conclusions: </strong>Exact kava mechanism is complex and not fully understood. Further research is warranted.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512218","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":"Do US Adults View Drug and Alcohol Addiction as a Health Condition?","authors":"Valerie A Earnshaw, Telli Davoodi, Annie B Fox, Jessica Hulsey","doi":"10.1097/ADM.0000000000001686","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001686","url":null,"abstract":"<p><strong>Objectives: </strong>The current study aimed to estimate the percentage of US adults who disagree or do not know that addiction is a health condition and explore associations between disagreement that addiction is a health condition with indicators of beliefs about addiction treatment and intentions to support loved ones with addiction.</p><p><strong>Methods: </strong>A nationally representative sample of US adults was recruited from Gallup's probability-based panel. A total of n=5250 (out of n=12,500 invited) responded to a web-based survey including questions about beliefs about drug or alcohol addiction and treatment. Survey sample weights were applied to correct for unequal selection probability and nonresponse rates, and data were analyzed using descriptive statistics and regression.</p><p><strong>Results: </strong>Close to one-quarter of US adults (23.0%) are estimated to either disagree or not know that addiction is a health condition. Respondents who disagreed or did not know that addiction is a health condition were less likely to believe that addiction is treatable by health care professionals (disagreed: OR=0.33, 95% CI=0.28-0.39; did not know: OR=0.28, 95% CI=0.21-0.36), early intervention for addiction is helpful (disagreed: OR=0.57, 95% CI=0.48-0.66; did not know: OR=0.40, 95% CI=0.31-0.53), or medications are effective treatments for addiction (disagreed: OR=0.47, 95% CI=0.40-0.55; did not know: OR=0.28, 95% CI=0.21-0.37). They were also less likely to indicate that they would help a loved one with addiction (disagreed: OR=0.50, 95% CI=0.40-0.63; did not know: OR=0.65, 95% CI=0.44-0.97).</p><p><strong>Conclusions: </strong>US adults likely have heterogenous views on addiction, and more research is needed to further understand how US adults conceptualize addiction.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512185","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":"Stimulant-induced Psychosis: A Comparative Systematic Review and Meta-analysis of Psychotic Outcomes from Therapeutic and Nontherapeutic Use of Stimulants.","authors":"Deepika Jangra, Ritika Tejwani, Yashita Ahluwalia, Siddharth Sarkar, Yatan Pal Singh Balhara","doi":"10.1097/ADM.0000000000001656","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001656","url":null,"abstract":"<p><strong>Objectives: </strong>Stimulant medications are increasingly prescribed for conditions including stimulant use disorders, yet both therapeutic and nontherapeutic use have been linked to stimulant-induced psychosis. Despite extensive literature, no prior systematic review has compared psychotic outcomes across these 2 contexts of use.</p><p><strong>Methods: </strong>Following PRISMA guidelines, we systematically searched PubMed, Embase, and Scopus through April 2025 and registered the protocol in PROSPERO (CRD420251049204). Eligible studies examined stimulant-induced psychosis among therapeutic (prescribed) and nontherapeutic (illicit, recreational, or misused) users. Data were extracted on demographics, stimulant type, dosage, route, comorbidities, clinical characteristics, and outcomes. Meta-analyses were conducted for incidence and prevalence where data permitted. Risk of bias was assessed using RoB 2.0, ROBINS-I, and JBI tools.</p><p><strong>Results: </strong>Seventy-seven studies (n = 687,912) were included: 9 therapeutic and 68 nontherapeutic. Therapeutic stimulants were primarily oral methylphenidate or amphetamine at guideline doses, while nontherapeutic use commonly involved high-dose methamphetamine or mixed stimulants through intravenous or smoked routes. The pooled incidence of stimulant-induced psychosis in therapeutic use was 0.6% (95% CI: 0.3-0.9). Prevalence estimates differed markedly: 0.2% (95% CI: 0.0-0.3) in therapeutic users versus 32.8% (95% CI: 25.5-40.2) in nontherapeutic users. Nontherapeutic psychosis was characterized by higher dosages, acute onset, persecutory delusions, hallucinations, and greater recurrence risk, whereas therapeutic cases often resolved with dose reduction or discontinuation. Evidence on treatment effectiveness, neurobiology, and genetic factors was limited and heterogeneous.</p><p><strong>Conclusions: </strong>Stimulant-induced psychosis occurs in both therapeutic and nontherapeutic contexts but at vastly different prevalence rates. While prescribed stimulants pose a low but clinically relevant risk, particularly in individuals with psychiatric vulnerability, nontherapeutic use carries a substantial burden of psychosis with significant public health implications. These findings underscore the need for careful monitoring in clinical practice, risk profiling, and targeted harm-reduction strategies in nonmedical use settings.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512232","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 Clinicians' Perspectives on Initiation of Medications for Opioid Use Disorder During Psychiatric Admissions.","authors":"Emma Nedell, Caridad Ponce Martinez","doi":"10.1097/ADM.0000000000001687","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001687","url":null,"abstract":"<p><strong>Objective: </strong>Despite high rates of opioid use disorder (OUD) among patients admitted for acute inpatient psychiatric treatment, medications for opioid use disorder (MOUD) are not routinely prescribed in this setting. Dually diagnosed individuals are more likely to present to the mental health system for treatment than to substance use disorder programs; therefore, initiating MOUD in psychiatric units would increase treatment access. Following the implementation of a protocol to offer MOUD to patients admitted to psychiatric units, clinical staff perspectives were evaluated.</p><p><strong>Methods: </strong>Semistructured interviews were conducted with 15 staff members following protocol implementation in 2 psychiatric units. Interviews were inductively coded and thematically analyzed.</p><p><strong>Results: </strong>Five themes emerged: (1) co-occurring OUD and psychiatric disorders are common in psychiatric units; (2) opioid withdrawal treatment during psychiatric admission is widely acceptable to staff, but support for maintenance treatment varies; (3) misconceptions regarding MOUD persist among staff; (4) patients with co-occurring disorders have complex psychosocial needs requiring multimodal treatment; (5) stigma can be a barrier to OUD treatment.</p><p><strong>Conclusions: </strong>Staff recognized the high prevalence of OUD in psychiatric units and the need for treatment. Despite some reluctance about MOUD initiation in this setting, MOUD remains the gold standard and should be available to patients with OUD wherever they seek medical care, consistent with a \"No Wrong Door\" approach. Improved education and multidisciplinary collaboration may increase staff acceptance of MOUD. Finally, MOUD initiation for dually diagnosed patients will be most successful when integrated within a multidisciplinary treatment model and coordinated community-based care.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512195","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}