Journal of Addiction Medicine最新文献

{"title":"Naltrexone in the Treatment of Ketamine Use Disorders: A Case Report and Literature Review.","authors":"Rishi Verma, Tom Colley, Claire Waldock, Louisa Bird, Irene Guerrini","doi":"10.1097/ADM.0000000000001589","DOIUrl":"10.1097/ADM.0000000000001589","url":null,"abstract":"<p><strong>Background: </strong>Nonprescribed use of ketamine has increased worldwide due to its hallucinogenic and psychedelic effects. Ketamine use disorders (KUDs) are marked by intense cravings and tolerance, which often trigger relapses and worsen recovery outcomes, defined as sustained ketamine abstinence with reduced cravings, resolved withdrawal symptoms, and improved psychosocial functioning. Currently, there are no approved pharmacological treatments for KUDs. This report examines the off-label use of naltrexone in a patient with KUDs.</p><p><strong>Case presentation: </strong>The case was a 25-year-old woman diagnosed with KUDs enrolled in an outpatient, specialist addiction service. The patient presented with ketamine daily use and intense cravings when trying to stop. The patient was prescribed oral naltrexone at the initial dose of 25 mg/day, which was increased to 50 mg/day after 7 days. After the initiation of treatment, the patient experienced a marked reduction in ketamine cravings. She was able to maintain abstinence and to progress in her recovery. The positive response to naltrexone suggests its potential as an effective intervention for managing KUDs.</p><p><strong>Conclusions: </strong>Our findings are consistent with 2 prior reports that have highlighted the use of naltrexone in KUDs. The 2 previous case reports indicated that naltrexone at the dosage of 50 mg/day successfully helped the patients to achieve abstinence. Studies have shown that naltrexone reduces the antidepressant effects of ketamine in treatment-resistant depression, indicating an overlap between the opioid system and ketamine's NMDA receptor activity. Larger, double-blind studies are needed to evaluate naltrexone's efficacy, safety, and optimal dosing for KUDs.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"634-636"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care Service Presence, Social Vulnerability, and Opioid Overdose Rate Acceleration: A United States, County-level Analysis, 2020-2022.","authors":"Robert Baillieu, Joyce Maring, Yngvild Olsen","doi":"10.1097/ADM.0000000000001602","DOIUrl":"10.1097/ADM.0000000000001602","url":null,"abstract":"<p><strong>Background: </strong>The United States continues to experience an opioid overdose epidemic with mortality patterns that reflect existing social and environmental inequities. Although research has examined various factors associated with opioid-related mortality, the relationships between social-environmental vulnerability (SEV), health care presence, and geography remain poorly characterized.</p><p><strong>Purpose: </strong>To explore whether SEV accelerates opioid overdose rates and to assess how the presence of health care services-specifically opioid treatment programs (OTPs) and primary care providers (PCPs)-modifies these patterns across rural and urban contexts.</p><p><strong>Methods: </strong>A retrospective ecological analysis using hierarchical linear modeling was conducted from January 2020 to December 2022, analyzing 172,359 observations across 57,453 census tracts within 1219 US counties. The primary exposure was census-tract-level SEV, operationalized using the CDC Environmental Justice Index. Health care indicators included county-level presence of OTPs and PCPs.</p><p><strong>Results: </strong>Areas in the highest quartile of SEV demonstrated elevated acceleration coefficients (β=3.224; SE=0.803; P <.001), with pronounced patterns observed in rural areas, though ecological design limitations preclude individual-level causal inference. Interaction analyses suggested that high-SEV counties containing both OTP and primary care resources demonstrate lower acceleration coefficients (β= -11.478, SE=5.429, P =0.035). Areas without health care presence showed higher baseline rates in overdose acceleration, particularly in urban high-vulnerability settings.</p><p><strong>Conclusions: </strong>High SEV was associated with accelerated opioid overdose rates during 2020-2022, particularly in rural areas. The presence of OTPs and primary care services within counties was associated with attenuated acceleration in high-vulnerability areas. This may indicate that policies prioritizing comprehensive health care services in high-SEV communities could address opioid overdose disparities.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"602-609"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329233","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 Economic Impact of Medetomidine on Critical Care Utilization: A Longitudinal Analysis of Intensive Care Unit Charges for Opioid Withdrawal Across the Adulterated Era.","authors":"Robert Hilton, Shourjo Chakravorty, Mina Ghbrial, Julian Rose, Alan Cherney, Frederick Randolph, Rebecca Jaffe, Lara C Weinstein, Philip Durney, Kory S London","doi":"10.1097/ADM.0000000000001714","DOIUrl":"10.1097/ADM.0000000000001714","url":null,"abstract":"<p><strong>Objectives: </strong>To quantify the impact of the adulterated fentanyl supply, through the eras of xylazine and medetomidine predominance, on critical care charges associated with treatment of opioid withdrawal.</p><p><strong>Methods: </strong>A longitudinal retrospective analysis was conducted at 2 intensive care units (ICUs) in Philadelphia, PA, USA, from April 1, 2017, to September 30, 2025. Primary outcomes included median per quarter and per patient charges and median quarterly ICU admissions with a primary or secondary ICD-10 diagnosis of opioid withdrawal (F11.23) from Q2 2017 to Q3 2025. These dates were correlated with quarterly drug supply adulterant prevalence reports by the Philadelphia Department of Public Health (PDPH). Secondary outcomes included ICU length of stay.</p><p><strong>Results: </strong>Median quarterly ICU charges for F11.23 increased from $5,585,340 (2,547,466-6,966,295), during the period when the drug supply only included fentanyl (BX), to $9,627,485 (7,983,250-11,385,733) during the period of xylazine dominance (XE), to $15,283,391 (12,049,850-15,434,522) (H=15.25, P <0.001) in the period following the emergence of medetomidine (ME). This rise in charges was driven primarily by an increase in patient admissions (median 18 per quarter BX, 34 XE, 64 ME) rather than by the charge per patient, which did not increase (BX $193,492, XE $176,225, ME $121,402).</p><p><strong>Conclusions: </strong>The adulteration of synthetic opioids with medetomidine was associated with a dramatic increase in ICU admissions and charges related to opioid withdrawal diagnoses. These changes represent a substantial public health challenge that may require systematic changes to health system resource allocation and withdrawal protocols.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"e81-e84"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868414","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":"Development and Validation of an Image-Based Deep Learning Tool for Identification of Xylazine-Associated Wounds.","authors":"Pranav Sompalle, Abeed Sarker, Jennifer Love, Jeffrey Moon, Anthony Spadaro, Rachel Wightman, Jessie Torgersen, Jeanmarie Perrone","doi":"10.1097/ADM.0000000000001718","DOIUrl":"10.1097/ADM.0000000000001718","url":null,"abstract":"<p><strong>Objectives: </strong>Accurate identification of xylazine-associated wounds (XAWs) is critical to providing timely and optimal management; however, discerning the etiology of wounds by appearance alone poses a clinical challenge. This study sought to develop an accessible and accurate approach for XAW diagnosis using a deep learning tool applied to wound photographs.</p><p><strong>Methods: </strong>Publicly accessible wound photographs were curated from academic publications, Reddit, and news media to develop, train, and test the deep learning tool. XAWs were defined by provided clinical confirmation or self-reported descriptions associated with each image. The data set included images of 114 xylazine-associated and 1710 nonxylazine wounds from 17 distinct pathologies. Four deep learning models (DenseNet121, EfficientNetB0, ResNet34, and SENet154) were trained on 1185 images (65%) and 163 for validation (9%) to predict xylazine exposure and tested using 476 unseen wound images (26%).</p><p><strong>Results: </strong>All 4 deep learning models achieved consistent diagnostic performance on 476 unseen wound images (accuracy: 97.5%-98.5%; AUROC: 96.8%-99.7%; weighted F1 score: 97.2%-98.5%). High specificity, reaching 100.0%, was observed across the 4 models. Sensitivity ranged from 60.0% to 80.0% across the 4 models, with SENet154 demonstrating robust performance across all metrics. Qualitative assessment demonstrated accurate identification of XAWs with high-confidence exclusion of xylazine exposure in wounds attributed to trauma, surgery, pressure, or venous ulcers.</p><p><strong>Conclusions: </strong>This novel deep learning tool can enable accurate identification of XAW. With further validation, this tool may offer an accessible and automated approach to guide wound care, augment bedside clinical medicine assessments, and equip public health efforts to monitor xylazine's geographic distribution.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"e40-e48"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148042507","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":"Identifying Subtypes of Cannabis Use Disorder: A Latent Class Analysis Among Daily Cannabis Consumers and Associated Sociodemographic and Cannabis Characteristics.","authors":"Cara A Struble, Daniel Alschuler, Melanie Wall, Deborah S Hasin, Jacob T Borodovsky, Efrat Aharonovich, Ofir Livne, Mohammad I Habib, Alan J Budney","doi":"10.1097/ADM.0000000000001595","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001595","url":null,"abstract":"<p><strong>Background: </strong>Cannabis use disorder (CUD) is relatively common among daily cannabis consumers; however, no studies have explored subtypes of CUD based on updated DSM-5 CUD criteria among daily consumers. Our study fills this gap and explores differences between subtypes in sociodemographic and cannabis correlates.</p><p><strong>Methods: </strong>US adults aged 18 years or older were recruited from social media (February to April 2022) to complete an online survey including sociodemographic characteristics (e.g., age, sex, reason for cannabis use), cannabis use behaviors, and DSM-5 CUD criteria. Latent class analyses (LCA) identified classes of individuals based on endorsement of CUD criteria. Differences in sociodemographic and cannabis characteristics were explored with bivariate testing.</p><p><strong>Results: </strong>Data from N=4140 daily consumers were analyzed. A 5-class model was selected and labeled as (1) Minimal Problems (30%; no CUD [0-1 criteria]), (2) Common Problems (45%; mild CUD [2-3 criteria]), (3) Social, Physical, and Emotional Problems (6.6%; mild-moderate CUD [2-5 criteria] including use despite physical/emotional and social problems), (4) Physical Dependence Problems (16%; moderate-severe CUD [4+ criteria] including tolerance/withdrawal), and (5) Severe Problems (3.1%; severe CUD [6+ criteria]). Sociodemographic differences between classes included age and reasons for use (P≤0.001). Cannabis correlates (i.e., frequency, quantity) mainly differentiated the Minimal Problems class from others.</p><p><strong>Conclusions: </strong>Among daily cannabis consumers, strategies to limit use throughout the day, driving under the influence and coping with cravings are warranted. Interventions for moderate CUD should be tailored for psychological/interpersonal versus physiological problems, while those with severe CUD would benefit from interventions to target global problems.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":"20 5","pages":"593-601"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110019","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":"Response to: \"Clinician Perspectives on Barriers and Facilitators to Providing Medications for Opioid Use Disorder for Adolescents\".","authors":"Jennifer A Ross, Shannon Mountain-Ray, John Straus, Sharon Levy","doi":"10.1097/ADM.0000000000001646","DOIUrl":"10.1097/ADM.0000000000001646","url":null,"abstract":"","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"637"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010525","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":"Ibogaine for Opioid Use Disorder: An Unrecognized Risk.","authors":"Dale Terasaki, Nathan Sackett, Andrew Monte","doi":"10.1097/ADM.0000000000001645","DOIUrl":"10.1097/ADM.0000000000001645","url":null,"abstract":"<p><p>The psychedelic substance, ibogaine, has garnered growing interest among policymakers, researchers, and the public in its potential use for opioid use disorder (OUD). Many states are allocating significant funds to investigate it further. However, some proponents of ibogaine are framing it in opposition to (versus complementary to) standard, mortality-reducing medications for OUD (MOUD). Although the path to OUD remission and recovery varies greatly among individuals, the stakes are high: \"detoxification\" from methadone or buprenorphine in favor of an as-yet unproven therapy like ibogaine could result in an increased risk of opioid overdose for some. The addiction medicine community should be aware of this potential risk and defend evidence-based care, even as treatments like ibogaine are developed for OUD.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"519-521"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971033","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":"Medetomidine-Involved Overdoses Among Emergency Department Patients: Results From a US Multicenter Sentinel Surveillance Program.","authors":"Andrew Stolbach, Rachel Culbreth, Alyssa Falise, Kim Aldy, Jeanmarie Perrone, David Liss, Alex Krotulski, Barry Logan, Sara Walton, Sharan Campleman, Jennie Buchanan, Stacey House, Bliss Rogers, Paul Wax, Evan Schwarz, Anthony F Pizon, Jeffrey Brent","doi":"10.1097/ADM.0000000000001665","DOIUrl":"10.1097/ADM.0000000000001665","url":null,"abstract":"<p><strong>Objectives: </strong>Medetomidine is an alpha-2 adrenoreceptor agonist approved only for veterinary sedation and was reported in the US illicit drug supply starting in 2022. Our aim was to determine the prevalence of medetomidine exposure and associated clinical characteristics among emergency department patients presenting with opioid and/or stimulant overdoses.</p><p><strong>Methods: </strong>The Toxicology Investigators Consortium (ToxIC) Drug Overdose Toxico-Surveillance (DOTS) Reporting Program included 17 US medical centers. Emergency department (ED) patients with acute opioid and/or stimulant overdose were enrolled between April 2023 and September 2024. Blood was obtained for toxicological analysis, and chart reviews and structured patient interviews were conducted.</p><p><strong>Results: </strong>Among 964 cases, medetomidine was detected in 2.8% (n = 27). After adjusting for confounders, medetomidine exposure was associated with an increased odds (odds ratio: 4.03; 95% CI: 1.35, 10.58) of bradycardia (<50 beats per minute) within 24 hours of presentation. Patients with medetomidine exposure had significantly higher rates of BVM (20.5%) than those without medetomidine exposure (3.7%; P =0.03) but did not require more intubation, BiPAP/CPAP, or naloxone than medetomidine-unexposed patients. No differences between medetomidine-exposed and unexposed groups were found for length of stay, critical care unit disposition, hypotension (<50 mmHg), or sedation. No patients completing an interview (n = 24) reported medetomidine use.</p><p><strong>Conclusions: </strong>Medetomidine exposure among ED patients with overdose was associated with increased bradycardia but not greater sedation, respiratory support, or need for higher level of care. Sentinel toxico-surveillance can identify emerging drug trends not captured through routine clinical data.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"e31-e39"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157085","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":"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":"e64-e72"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","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":"Raising the Bar for Withdrawal Management: A Patient Centered Path Forward.","authors":"Itai Danovitch, Maureen P Boyle","doi":"10.1097/ADM.0000000000001767","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001767","url":null,"abstract":"<p><p>Managing substance withdrawal is often a necessary part of addiction care. However, without treatment of the underlying addiction, patients are at high risk for morbidity and mortality. The Fourth Edition of the ASAM Criteria sets the expectations that withdrawal management programs will have the capacity to provide integrated psychosocial services for the underlying addiction. While implementation of these updated standards will be challenging, particularly in rural and under-resourced areas, it is critical for improving care quality and patient outcomes.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828935","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}