Journal of Addiction Medicine最新文献

{"title":"Xylazine Exposure and Association With Early Physiological and Withdrawal Symptoms in People With Opioid Use Disorder.","authors":"Justin C Strickland, Cecilia L Bergeria, Andrew S Huhn, Greer McKendrick, Dhathri Srungaram, Emma Pattillo, Kelly E Dunn","doi":"10.1097/ADM.0000000000001659","DOIUrl":"10.1097/ADM.0000000000001659","url":null,"abstract":"<p><strong>Objectives: </strong>The prevalence of xylazine, an agonist at the alpha-2 adrenergic receptor often used in veterinary medicine, has increased in the illicit opioid drug supply. Case series and survey data suggest that xylazine may increase the nature and severity of opioid withdrawal. We sought to evaluate the association between quantified levels of xylazine exposure and withdrawal symptoms in people undergoing opioid withdrawal.</p><p><strong>Methods: </strong>People (n=36; 11 female) with opioid use disorder and physical dependence were enrolled in two harmonized clinical trials. Urine specimens were collected at admission to a residential unit and were analyzed for xylazine, fentanyl, and its inactive metabolite norfentanyl. Opioid withdrawal and physiological effects were collected during stabilization on oral hydromorphone without illicit opioid access.</p><p><strong>Results: </strong>Urinary xylazine was detected in 69% of samples with concentrations ranging from 5.7 to 15481.1 ng/mL. Among participants with detectable urinary xylazine, higher xylazine concentrations were significantly associated with higher systolic blood pressure ( b =7.68 [2.03, 13.33], P =0.011) and COWS total scores ( b =1.53 [0.17, 2.88], P =0.029). No significant differences in blood pressure or COWS were observed between participants with and without xylazine detected.</p><p><strong>Conclusions: </strong>Potential rebound hypertensive effects following xylazine exposure were observed, consistent with alpha-2 adrenergic mechanisms, which may be accompanied by an exacerbated withdrawal syndrome. Continued preclinical and clinical evaluation of strategies are needed to understand how co-exposure to drug adulterants like xylazine influences withdrawal expression and the utility of existing pharmacological approaches for withdrawal management in clinical settings.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"e77-e80"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13084727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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":"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":"584-592"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","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":"Naloxone Prescribing and Naloxone Administration in Response to Overdose Events Among Women With Opioid Use Disorder During Pregnancy and Postpartum Period - MAT-LINK, Seven Clinical Sites, 2014-2021.","authors":"Kaitlin Schrote, Amy Board, Shawn A Thomas, Pierre-Olivier Cote, Kathryn Miele, Mishka Terplan, Neil S Seligman, Pilar M Sanjuan, Marcela Smid, Mei Elansary, Kara Rood, Autumn Davidson, Anthony Kendle, Shin Y Kim","doi":"10.1097/ADM.0000000000001655","DOIUrl":"10.1097/ADM.0000000000001655","url":null,"abstract":"<p><strong>Objectives: </strong>Opioid use disorder (OUD) and overdose among pregnant and postpartum women pose severe risks to maternal and infant health. Naloxone, a life-saving opioid antagonist, effectively reverses opioid overdoses but remains underutilized in this population. We examined naloxone prescription or receipt and administration during overdose events among perinatal women with OUD from the MATernaL and Infant Clinical NetworK (MAT-LINK).</p><p><strong>Methods: </strong>We analyzed data collected through 7 MAT-LINK clinical sites from pregnant women with OUD and known pregnancy outcomes between January 1, 2014 and August 31, 2021. Outcomes included naloxone prescriptions and naloxone administration during overdose events during pregnancy or within 12 months postpartum (perinatal period). Weighted prevalence estimates and confidence intervals were calculated by demographic characteristics, substances involved in overdoses, and receipt of medications for opioid use disorder (MOUD).</p><p><strong>Results: </strong>Only 3.1% of women received a naloxone prescription during the perinatal period; the percentage of women receiving naloxone from the clinic without a prescription was unknown and not systematically captured in the data. Women experiencing overdose events most commonly were non-Hispanic, white, had public health insurance, and lived in urban areas, reflecting the demographic composition of the MAT-LINK cohort, with high co-occurrence of tobacco/nicotine (80.5%) and stimulant use disorders (59.2%). Among women who experienced an opioid-involved overdose event, 23.4% were not administered naloxone. No significant demographic differences were observed by naloxone administration.</p><p><strong>Conclusions: </strong>These findings highlight the need for further investigation into barriers and facilitators to naloxone clinical documentation, access, and use during the perinatal period.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"629-633"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13507980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Oral-Nasal Damage in a Person Using Fentanyl and Xylazine.","authors":"Julie Kmiec, Garret Choby","doi":"10.1097/ADM.0000000000001732","DOIUrl":"10.1097/ADM.0000000000001732","url":null,"abstract":"<p><strong>Background: </strong>Xylazine, an alpha-2-adrenergic agonist, was added to illicitly manufactured fentanyl within the past decade. Intranasal drug use is common and associated with damage to nasal structures and the palate. There have been no case reports detailing intranasal damage secondary to fentanyl and xylazine use.</p><p><strong>Case summary: </strong>We present a case of a 39-year-old woman with a long history of intranasal opioid use and, more recently, xylazine use who presented for treatment due to nasal septum perforation and oral-nasal fistulas. She started treatment for opioid use disorder and was referred to otolaryngology for further examination and treatment of palate damage thought to be secondary to intranasal fentanyl and xylazine use. She exhibited severe damage to her palate, nasal structures, and skull base.</p><p><strong>Clinical significance: </strong>This case illustrates damage to the nose, palate, and skull base, likely secondary to co-use of fentanyl and xylazine intranasally. It is important for clinicians to recognize that nasal damage may result from fentanyl and xylazine use and refer to appropriate substance use disorder and otolaryngology treatment to prevent further destruction.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"e88-e91"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148205026","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":"Identifying Factors Associated With Intentional and Unintentional Fentanyl Use Among People Who Use Drugs in New York City.","authors":"Mehrdad Khezri, Karen Choe, Brittany Griffin, Amanda M Bunting","doi":"10.1097/ADM.0000000000001649","DOIUrl":"10.1097/ADM.0000000000001649","url":null,"abstract":"<p><strong>Objective: </strong>Fentanyl is a major driver of the overdose crisis in the United States, yet little is known about the intentionality of fentanyl use and its correlates among people who use drugs (PWUD). We examined the intentionality of fentanyl use and associated factors among PWUD.</p><p><strong>Methods: </strong>We recruited 246 PWUD in New York City in 2023. Participants completed structured interviews and provided urine samples for toxicology screening. Fentanyl use was classified as no use (negative in both self-report and urine toxicology), unintentional use (self-report negative but toxicology positive), and intentional use (positive in self-report with or without positive toxicology). We used multinomial logistic regression to identify factors associated with fentanyl use intentionality.</p><p><strong>Results: </strong>Fentanyl was detected in 40.7%, while 26.0% self-reported intentional fentanyl use. Intentional fentanyl use was significantly associated with chronic pain (RRR: 2.21; 95% CI: 1.02-4.80) and higher Risk Assessment Battery (RAB) scores (RRR: 1.09; 95% CI: 1.01-1.18), and inversely associated with high cannabis use severity (RRR: 0.16; 95% CI: 0.05-0.61). Unintentional fentanyl use was positively associated with older age (RRR: 1.08; 95% CI: 1.02-1.13) and negatively with moderate alcohol use severity (RRR: 0.25; 95% CI: 0.09-0.69).</p><p><strong>Conclusions: </strong>Unintentional fentanyl use was more common among older PWUD, highlighting the need for targeted outreach and fentanyl education. Intentional fentanyl use, while reflecting awareness of the drug supply, was associated with chronic pain and elevated HIV risk behaviors, indicating a subgroup with greater health and prevention needs. Tailored interventions integrating harm reduction, pain management, and HIV prevention are needed.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"e49-e56"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12910611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Maternal and Neonatal Withdrawal After Exposure to Fentanyl Adulterated With Medetomidine.","authors":"Ilana Hull, Megan Gates, Kelly Dimattio, Lois Bangiolo, Kenichi Tamama, Christine E Bishop","doi":"10.1097/ADM.0000000000001605","DOIUrl":"10.1097/ADM.0000000000001605","url":null,"abstract":"<p><p>The emergence of medetomidine, a potent veterinary alpha-2 adrenergic receptor agonist, as a common fentanyl adulterant in many areas of the United States poses new threats to pregnant women who use illicit opioids and their neonates. We present a case of severe withdrawal seen in a postpartum woman and her neonate after exposure to fentanyl adulterated with medetomidine up to the time of delivery. The case demonstrates the need for obstetric and pediatric providers to be aware of this emerging trend to allow for early recognition and prompt treatment of the potentially life-threatening symptoms of medetomidine withdrawal, which differs from traditional withdrawal patterns, and highlights the importance of communication and coordination between obstetric and pediatric teams caring for this population.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"e85-e87"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145389847","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":"Addictive Behaviors, Mental Health, and Quality of Life in Adolescents: Toward Integrative Assessment for Early Identification of Vulnerability.","authors":"Julien Cabé, Ingrid de Chazeron, Cécile Miele, Bruno Pereira, Maryline Chalmeton, Romain Mortier, Pierre Michel Llorca, Nicolas Cabé, Georges Brousse","doi":"10.1097/ADM.0000000000001642","DOIUrl":"10.1097/ADM.0000000000001642","url":null,"abstract":"<p><strong>Objectives: </strong>Addictive behaviors are frequently associated with anxiety and depressive disorders. Adolescence represents a critical period of heightened vulnerability to both types of disorders. In recent years, a significant global decline in adolescent mental health-especially among girls-has raised concerns about the short-term evolution of addictive behaviors. Despite available data, this relationship remains poorly understood, warranting further research to improve prevention and care strategies.</p><p><strong>Methods: </strong>This study analyzed data from a French cross-sectional observational study (DOPADO), which aimed to assess addictive behaviors among adolescents aged 13 to 18 years attending middle and high schools. Data were collected between 2018 and 2020 using electronic surveys, enabling the evaluation of past-12-month psychoactive substance use, associated risky behaviors, sociodemographic characteristics, anxiety and depressive symptoms, psychological distress, and quality of life.</p><p><strong>Results: </strong>Among 4844 adolescents, half exhibited anxiety and/or depressive symptoms. These were associated with higher levels of substance use, increased risky behaviors, and impaired quality of life. A Principal Component Analysis revealed 3 distinct profiles: one with preserved well-being, and 2 with significant impairment. These were characterized by higher anxiety-depressive symptoms (especially in the second cluster) and more pronounced addictive behaviors and risky use (notably in the third cluster).</p><p><strong>Conclusions: </strong>Our study highlights robust associations between anxiety/depressive symptoms, addictive behaviors, and quality of life. Several distinct adolescent profiles emerged with respect to mental health and addictive behaviors, each characterized by specific patterns of quality of life and functioning, underscoring the importance of integrated assessment, prevention, and treatment strategies in adolescents.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"575-583"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Long-acting Naltrexone Implant (iSTEP-N) for Opioid Use Disorder: First-in-Human Phase I Trial.","authors":"Steven M Cohen, Jeffrey Benner, Pravin Soni, William R Ravis, Todd Bertoch, Janet Ransom, Jonathan Berman","doi":"10.1097/ADM.0000000000001654","DOIUrl":"10.1097/ADM.0000000000001654","url":null,"abstract":"<p><strong>Objectives: </strong>iSTEP-N is a novel, bioresorbable, subcutaneous implant designed to release naltrexone for 6-12 months after a single procedure and improve adherence. This first-in-human study evaluated the safety and pharmacokinetics of iSTEP-N.</p><p><strong>Methods: </strong>This was a single-center, randomized, double-blind, placebo-controlled, single-ascending-dose trial. Sixteen healthy adults (10 females and 6 males) were assigned to receive either 1 implant (4.8 g naltrexone), 2 implants (9.6 g naltrexone), or placebo implants. Participants were followed for 12 weeks, after which implants were removed per regulatory requirement. Plasma naltrexone concentrations and safety outcomes were assessed throughout.</p><p><strong>Results: </strong>All participants completed the study. The 9.6 g cohort maintained mean plasma naltrexone concentrations above the 2.0 ng/mL opioid blockade threshold from Tmax at 10 hours through the end of the study at 12 weeks; no mean value fell below 2.8 ng/mL during this time. The 4.8 g cohort maintained therapeutic levels of naltrexone through week 6 but dropped below threshold thereafter. In both cohorts, ∼22% of implant drug content was released over 12 weeks, based on plasma exposure and estimated clearance, indicating potential for extended coverage. In the 9.6 g group, seroma formation was observed in 3 of 6 participants (50%) and resolved without intervention. No serious adverse events occurred.</p><p><strong>Conclusions: </strong>At the 9.6 g dose, iSTEP-N provided sustained therapeutic naltrexone exposure for 12 weeks with a favorable safety profile, while releasing less than one-fourth of its drug content. Further studies will evaluate longer-term exposure, safety, and clinical feasibility in individuals with opioid use disorder.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"548-555"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of Xylazine Qualitative Immunoassays Designed for Drug Checking in Urine Samples.","authors":"Emma Pattillo, Yi Xie, Aicha Monteiro, Dhathri Srungaram, Melanie Baime, Nicole Brown, Jennifer D Ellis, Cecilia L Bergeria, Andrew S Huhn, Kelly E Dunn","doi":"10.1097/ADM.0000000000001633","DOIUrl":"10.1097/ADM.0000000000001633","url":null,"abstract":"<p><strong>Objectives: </strong>Xylazine is a public health threat for individuals who use drugs. Data informing xylazine concentrations are hampered by a lack of point-of-care urinalysis testing. This study evaluated the performance of qualitative immunoassay strips designed for drug checking in identifying xylazine in urine samples.</p><p><strong>Methods: </strong>The ability of 2 noncleared xylazine qualitative immunoassay test strips (W.H.P.M. Inc, 500 ng/mL and Rapid Response [BTNX Inc., 1000 ng/mL]), developed for use in drug-checking paradigms, to detect xylazine in urine samples of persons presenting for opioid use disorder treatment was evaluated. Samples were tested using each test strip twice, and consensus results were compared with results from quantitative LC-MS/MS analyses (5 ng/mL).</p><p><strong>Results: </strong>Quantitative testing revealed 67% (71/106) samples tested positive for xylazine >5 ng/mL. Concentrations ranged between 5.3 and 30,900.50 ng/mL, 12 of which exceeded >500 ng/mL and 6 of which exceeded >1000 ng/mL. W.H.P.M. Inc. showed excellent sensitivity and specificity (92% and 94%, respectively) at the 500 ng/mL threshold but did not detect 63% of true positive samples (ie, those that tested positive in the quantitative testing >5 ng/mL). Rapid Response also had excellent sensitivity and specificity (100%, 100%, respectively) at the 1000 ng/mL threshold, but did not detect 74% of true positive samples.</p><p><strong>Conclusions: </strong>Two immunoassay strips designed for drug checking showed strong sensitivity and specificity at their detection thresholds; however, most samples testing positive for xylazine were below those thresholds, resulting in most participants with true xylazine exposure not being accurately identified. Prospectively designed urine point-of-care strips are necessary to help inform the relationship between xylazine exposure and its related consequences.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"e73-e76"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767932","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":"Appropriate Clinical Response Following Opioid Overdose: A Retrospective Analysis Within the Veterans Health Administration System.","authors":"Maryam Kazemitabar, Joel I Reisman, Minhee Sung, Robert D Kerns, Emily B Druhl, Hong Yu, Wenjun Li, William C Becker, Kirsha S Gordon","doi":"10.1097/ADM.0000000000001644","DOIUrl":"10.1097/ADM.0000000000001644","url":null,"abstract":"<p><strong>Background: </strong>Opioid overdose (OD) remains a pressing public health crisis in the United States, with substantial gaps in postoverdose care, particularly among veterans. Understanding the demographic and clinical factors associated with appropriate postoverdose care is essential to addressing these gaps.</p><p><strong>Methods: </strong>A retrospective cohort study of 1032 veterans who experienced a nonfatal opioid overdose and received care through the veterans Health Administration system was conducted. Data were extracted from electronic health records, including demographic, pharmacy, and clinical variables. The primary outcome was receipt of appropriate clinical response within 90 days postoverdose, defined as initiation of medication for opioid use disorder (MOUD), counseling for opioid use disorder (OUD), or a ≥25% reduction in morphine equivalent daily dose. A binary logistic regression model was used to examine factors associated with receiving appropriate overdose care.</p><p><strong>Results: </strong>Of the total sample, 57.46% received an appropriate clinical response postoverdose, the majority of which reflected opioid dose reductions rather than initiation of MOUD or counseling for OUD. There were statistically significant differences between those who received appropriate clinical response versus not by rurality, marital status, substance use disorder and treatment, care access, bipolar disorder, and schizophrenia. In adjusted models, those with a documented substance use disorder had significantly higher adjusted odds of receiving appropriate clinical response (aOR=1.91; 95% CI: 1.38-2.63; P <0.0001). Black veterans had significantly lower odds of receiving appropriate clinical response compared with White veterans (aOR=0.71; 95% CI: 0.51-0.98; P =0.04). Other variables were not statistically significantly associated with appropriate clinical response in the adjusted model.</p><p><strong>Conclusions: </strong>The primary response to OD was dose reduction and MOUD was profoundly underutilized. Future research should incorporate social determinants of health to better understand contextual influences on overdose risk and care access.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"525-531"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952059","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}