Journal of Addiction Medicine最新文献

{"title":"Approaches for Managing Benzodiazepine Dependence Arising From Use of the Adulterated Opioid Supply: A Delphi Technique.","authors":"Nicole Malette, Gurkiran Parmar, Josey Ross, Alexis Crabtree, Paxton Bach","doi":"10.1097/ADM.0000000000001566","DOIUrl":"10.1097/ADM.0000000000001566","url":null,"abstract":"<p><strong>Objectives: </strong>Benzodiazepine adulteration of the unregulated opioid supply presents significant clinical challenges, whereby patients can develop physical dependence to benzodiazepines inadvertently. Currently, clinicians lack evidence to guide care of patients potentially experiencing benzodiazepine withdrawal when ceasing use of unregulated opioids. We used a Delphi technique to build consensus around assessment and management of people at risk for benzodiazepine dependence due to the use of unregulated opioids.</p><p><strong>Methods: </strong>We administered a Delphi Technique with 12 clinicians (physicians, nurses, nurse practitioners, pharmacists) with expertise in substance use disorders, from a Canadian province with a high prevalence of benzodiazepine-adulterated unregulated opioids. The technique involved 4 rounds of consensus building and resulted in 122 consensus statements related to direct clinical care.</p><p><strong>Results: </strong>Final consensus statements include approaches to risk stratification, diagnosis, and management of benzodiazepine withdrawal secondary to use of benzodiazepine-adulterated opioids. At-risk groups include daily/high-volume opioid users, those who intentionally seek benzodiazepine-contaminated opioids, and those who abruptly cease using unregulated opioids. Common co-opioid and benzodiazepine withdrawal symptoms include anxiety, agitation, gastrointestinal upset, insomnia, and confusion, usually peaking around 72 hours from the time of last use. Experts formed consensus on tracking benzodiazepine withdrawal using vitals, CIWA-B, and treatment response to benzodiazepines administered in inpatient settings.</p><p><strong>Conclusions: </strong>As benzodiazepines become more prevalent in the unregulated drug supply, there is an urgent need for evidence-based care. Key future priorities should focus on developing evidence-based clinical guidance, creating decision-support tools, and advancing research efforts.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"444-452"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954803","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":"Medication Approaches for Patients With Opioid Use Disorders: Differences Between Primary Care Clinics and Specialty Addiction Treatment Programs.","authors":"Berkeley Franz, James H Ford, Hannah Cheng, Hélène Chokron Garneau, Kimberley Mount, Mark P McGovern","doi":"10.1097/ADM.0000000000001556","DOIUrl":"10.1097/ADM.0000000000001556","url":null,"abstract":"<p><strong>Objectives: </strong>Efforts to increase access to highly effective medications for opioid use disorder (MOUD) have largely focused on primary care. Ironically, many specialty addiction treatment programs have yet to adopt MOUD. To bring MOUD access to scale, researchers need to better understand medication practices across these 2 major portals of care for patients with opioid use disorder (OUD). In this study, our team examined baseline prescribing data from 62 primary care clinics and specialty addiction treatment programs (SATPs) participating in MOUD implementation endeavors across 2 states.</p><p><strong>Methods: </strong>Our primary outcomes included MOUD prescribing practices, measured by the integrating medications for addiction treatment (IMAT), which includes 7 dimensions of guideline-adherent delivery of MOUD, and an additional subscale on low threshold care. We also measured reach of MOUD to patients and adoption as the number of current MOUD prescribers. Secondary outcomes included community characteristics surrounding each type of organization. Descriptive statistics and bivariate tests explored differences between primary and specialty care settings.</p><p><strong>Results: </strong>SATPs had lower MOUD capacity and implementation as compared with primary care clinics. Specialty settings also had lower organizational support for low threshold prescribing. SATPs were located in counties with higher overdose rates, higher unemployment, fewer MOUD prescribers, and with more opioid prescriptions per capita.</p><p><strong>Conclusions: </strong>SATPs have lower MOUD implementation capacity than their primary care counterparts and are more likely to be in counties with greater OUD-related needs, economic distress, and fewer treatment resources. Selecting more precise implementation support strategies for SATPs that are late adopters of MOUD is a major need.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"400-408"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760133","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":"Exploring Diversion Concerns as a Modifiable Buprenorphine-prescribing Barrier Among Primary Care Professionals.","authors":"Elizabeth A Abrams, Cheyenne Fenstemaker, Katherine King, Johnathan Rausch, Ronak Tripathy, Jenna Shalash, Berkeley Franz","doi":"10.1097/ADM.0000000000001738","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001738","url":null,"abstract":"<p><strong>Objectives: </strong>Efforts to increase medications for opioid use disorder (MOUD) prescribing among primary care professionals (PCPs) are a priority for reducing overdose and related harms. A primary concern among PCPs, however, is that prescriptions will be diverted or sold to someone else. Understanding and contextualizing diversion concerns among PCPs can inform implementation strategies to support buprenorphine adoption and expand access to medication.</p><p><strong>Methods: </strong>We conducted semistructured interviews with Ohio PCPs as part of the design and pilot of a training intervention to increase PCP buprenorphine prescribing. Interviews were transcribed and analyzed using three-step thematic analysis in Dedoose. Detailed memos on all codes were written and inductively informed key themes pertaining to addressing PCPs' diversion concerns.</p><p><strong>Results: </strong>Twenty-six PCPs completed in-depth interviews. Diversion concerns were common and limited willingness to prescribe buprenorphine or changed the way PCPs prescribed. Three key themes emerged: (1) Diverse diversion concerns continue to influence prescribing behavior; (2) Prescribing experience and comfort with harm reduction shaped views on diversion; and (3) Specific forms of diversion information can motivate buprenorphine prescribing.</p><p><strong>Conclusions: </strong>Buprenorphine is highly effective for reducing mortality in patients with opioid use disorder, but it is vastly underutilized in the primary care setting. Diversion concerns among both nonprescribers and current prescribers are a significant barrier to expanding access in this setting. Leveraging data and personal anecdotes on the scope of, public health impact of, and reasons for diversion may help overcome this commonly cited barrier to prescribing MOUD.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368599","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":"Multiple Substance Use Disorders From Adolescence to Midlife.","authors":"Sean Esteban McCabe, Ty S Schepis, Timothy E Wilens, Emily Pasman, Vita V McCabe, Philip T Veliz","doi":"10.1097/ADM.0000000000001745","DOIUrl":"10.1097/ADM.0000000000001745","url":null,"abstract":"<p><strong>Objectives: </strong>To assess associations between symptomatic polysubstance use and symptom severity during adolescence and later substance use disorder (SUD) symptoms in midlife.</p><p><strong>Methods: </strong>Multi-cohorts of nationally representative US adolescents in 12th grade (N=12,025; baseline cohort years 1976-2002) were followed longitudinally to age 55 (follow-up years 1993-2019). Poisson regression models were fitted longitudinally, accounting for repeated measures, panel attrition, and covariates.</p><p><strong>Results: </strong>An estimated 8.9% (95% CI=8.3%-9.5%) of US adolescents had moderate-to-severe SUD symptoms involving multiple substances (ie, 4+ SUD symptoms for 2+ substances). The bivariate and multivariate relationships between SUD symptom severity and multiple SUDs at baseline and subsequent SUD symptoms in midlife (ages 35-55) indicated a positive near-linear association. Over two-thirds of adolescents with moderate-to-severe SUD symptoms involving multiple substances had multiple SUD symptoms in midlife (68.6%, 95% CI=63.0%-73.7%). Most adolescents with moderate-to-severe SUD symptoms of one substance and those with fewer SUD symptoms involving multiple substances (ie, 1-3 SUD symptoms for 2+ substances) persisted with multiple SUD symptoms in midlife (57.2%, 95% CI=53.2%-61.0% and 56.4%, 95% CI=51.4%-61.4%, respectively). Adolescents with moderate-to-severe SUD symptoms involving multiple substances had substantially greater odds of SUD symptoms in midlife relative to asymptomatic adolescents (aRR=2.80, 95% CI=2.49-3.15).</p><p><strong>Conclusions: </strong>Most US adolescents with symptomatic polysubstance use or moderate-to-severe SUD symptoms persisted with multiple SUD symptoms in midlife. Adolescent symptomatic polysubstance use is associated with a more severe developmental course in midlife than those with the same SUD symptom burden concentrated within a single substance, therefore, early comprehensive screening and intervention strategies are needed.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13405161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421212","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 Randomized Pilot Trial of an Integrated Intervention Combining Computerized Behavioral Therapy and Recovery Coaching for People With Opioid Use Disorder: The OVERCOME Study.","authors":"Irene Pericot-Valverde, Moonseong Heo, Erik G Ortiz, Ashley C King, Angelica Perez, Laksika B Sivaraj, Snehal S Lopes, Kaileigh A Byrne, Alain H Litwin","doi":"10.1097/ADM.0000000000001578","DOIUrl":"10.1097/ADM.0000000000001578","url":null,"abstract":"<p><strong>Background: </strong>People with opioid use disorder (OUD) often exhibit high rates of nonprescribed drug use and low retention on buprenorphine. This study tested the feasibility, acceptability, and preliminary efficacy of an intervention combining peer recovery coaching and CBT4CBT-buprenorphine (CBT4CBT+RC) to reduce nonprescribed drug use and increase buprenorphine retention.</p><p><strong>Methods: </strong>A randomized trial conducted from December 15, 2020, to November 24, 2021, compared an 8-week CBT4CBT+RC intervention to treatment as usual (TAU). Outcomes included feasibility (recruitment, treatment initiation, and completion), acceptability (of CBT4CBT, recovery coaching, and integrated intervention), and preliminary efficacy (saliva toxicology and buprenorphine retention during treatment and at 1- and 3-mo follow-ups). Participants (N=38) had been receiving buprenorphine for an average of 270.1 days (SD=444.0) and reported recent nonprescribed drug use.</p><p><strong>Results: </strong>Recruitment feasibility was 33.7%. Of the 19 participants assigned to CBT4CBT+RC, 94.7% met with a coach, and 52.6% initiated CBT4CBT. The average number of modules completed was 6.0 (299.7 min). Satisfaction with the intervention, coach, and CBT4CBT-buprenorphine was high (M≥4.9). Drug use was significantly lower in the CBT4CBT+RC group compared with TAU during treatment (35% vs. 69%, P =0.03), at 1 month (34% vs. 69%, P =0.009), and at 3 months (0% vs. 88%, P <0.001). Retention and opioid-positive tests did not differ between groups.</p><p><strong>Conclusions: </strong>The CBT4CBT+RC condition resulted in lower rates of saliva toxicology positive for drug use during treatment and follow-ups, but showed comparable buprenorphine retention rates to TAU. These findings provide promising support for the potential of CBT4CBT+RC to reduce drug use among individuals with OUD.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"488-497"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015344","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":"Prenatal Fentanyl Exposure Association With Characteristic Neonatal Anomalies.","authors":"Elizabeth Mirsky, Cynthia Cockerham, John O'Brien, Wendy Whitley, Gregory Hawk, Barbara Parilla","doi":"10.1097/ADM.0000000000001679","DOIUrl":"10.1097/ADM.0000000000001679","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate if previously described anomalies associated with fentanyl could be identified in our cohort of individuals with active fentanyl use in pregnancy.</p><p><strong>Methods: </strong>Potential cases of a novel syndrome were identified from a prospectively collected database of obstetric patients with substance use disorder enrolled in a multispecialty treatment program from 2014 to 2024 in this case series study. Suspected Fetal Fentanyl Syndrome (FFS) was defined as small head circumference (<10%ile) and at least one other sign: cleft palate, clubfoot, rocker bottom feet, toe syndactyly, single palmar crease, hypoplastic corpus callosum, and hypospadias. The database was screened for findings consistent with this syndrome resembling Smith-Lemli-Opitz Syndrome.</p><p><strong>Results: </strong>From 2014 to 2024, 639 patients were enrolled in the cohort. Of the 103 patients found to have neonates with a small head circumference, 51 individuals self-reported fentanyl use within the last year. Six of these individuals had confirmatory toxicology testing for fentanyl upon program enrollment. Of these individuals' neonates, 4 displayed characteristic anomalies consistent with FFS. All cases shared lagging head growth, while additional anomalies identified included cleft palate (n=3), short nasal tip (n=1), thin upper lip (n=1), micrognathia (n=1), and hypospadias (n=1). Genetic screening/diagnostic testing varied but an assessment of cholesterol metabolism was not performed.</p><p><strong>Conclusions: </strong>In this cohort, 7.8% of individuals with self-reported fentanyl use had neonates with signs of the previously described FFS. FFS is a proposed syndrome and results should be interpreted with caution. Similar data is needed to confirm and delineate this association and determine long-term developmental effects.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"e12-e14"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147485864","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":"Xylazine Test Strip Use Among People Who Use Drugs in New York State.","authors":"Kitty H Gelberg, Fernando Montero, Mingway Chang, Mary R Russo, Matthew R Lootens, James L David, Redonna Chandler, Emmanuel Oga, Louisa Gilbert, Nabila El-Bassel","doi":"10.1097/ADM.0000000000001550","DOIUrl":"10.1097/ADM.0000000000001550","url":null,"abstract":"<p><strong>Objectives: </strong>Xylazine test strips (XTS) allow for rapid identification of xylazine in drugs, yet little is known about those using XTS. Therefore, this study explores the characteristics of people who use drugs (PWUDs) who use XTS and examines risk reduction behaviors associated with XTS use.</p><p><strong>Methods: </strong>This observational cohort study was conducted in New York between September and December 2023 as part of a larger study. Questions about XTS use were added to the parent study's baseline survey of PWUDs and were completed by 254 PWUDs. Sociodemographic characteristics compared XTS users to nonusers. Propensity score weighting using inverse probability of treatment weights was used to examine the association of ever-using XTS with risk reduction behaviors and the drug type used.</p><p><strong>Results: </strong>Sixty-six participants (26%) had used XTS; 80% trusted the results, and 79% were confident in their ability to use XTS to detect xylazine. Those who had used XTS were more likely to have naloxone nearby (aOR=7.51, 95% CI: 2.26-24.95, P =0.001), use a test shot (aOR=2.43, 95% CI: 1.18-5.01, P =0.016), have someone check on them while using (aOR=2.52, 95% CI: 1.23-5.19, P =0.012), and watch someone use the same drugs (aOR=2.35, 95% CI: 1.19-4.65, P =0.014). XTS use was associated with using opioids (aOR=3.68, 95% CI: 1.38-9.81, P =0.009) and injecting drugs (aOR=4.32, 95% CI: 1.91-9.77, P <0.001).</p><p><strong>Conclusions: </strong>Our study demonstrates that XTS use appears to be associated with engaging in risk reduction behaviors, suggesting XTS can be a useful harm reduction tool. More research is needed to assess whether PWUDs change their drug consumption behaviors based on XTS results.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"392-399"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Ongoing Clinical Trials for Cocaine Use Disorder Registered on Global Clinical Trial Databases.","authors":"Fernanda Gushken, Thiago Marques Fidalgo, Vítor S Tardelli","doi":"10.1097/ADM.0000000000001580","DOIUrl":"10.1097/ADM.0000000000001580","url":null,"abstract":"<p><strong>Objectives: </strong>Cocaine use disorder (CUD) affects 1.4 million people in the United States, yet no FDA-approved treatments exist. In 2023, the Food and Drug Administration (FDA) released a draft guideline on treatments for stimulant use disorders, providing direction for trial design, outcomes, and population selection. In this study, we aimed to review ongoing clinical trials for CUD and assess their alignment with the FDA's recommendations.</p><p><strong>Methods: </strong>We conducted a systematic search of the 6 major clinical trial databases (United States, Australia, Canada, Iran, Netherlands, and Switzerland) to identify ongoing interventional studies for CUD. We included trials evaluating pharmacological, behavioral, device-based, and mixed treatments. We extracted data on intervention type, target population, study design, duration, and primary outcomes. Trials were assessed for alignment with 5 key FDA recommendations, including trial duration, use of both self-reported and biological outcome measures, randomization, placebo control, and double blinding.</p><p><strong>Results: </strong>In total, 38 trials were identified, primarily from the United States (32). Most trials were randomized: 36 (94.7%), while 21 (55.3%) trials had combined endpoints or a 3-month minimum duration. Only 7 trials (18.4%) met all 5 key FDA recommendations. New treatment approaches were identified, including psilocybin and the dAd5GNE vaccine, as well as digital platforms for behavioral therapies.</p><p><strong>Conclusions: </strong>A variety of promising treatments for CUD are under investigation. However, many trials fall short of current FDA design recommendations. Improved adherence to regulatory guidance and stronger collaboration between researchers and regulators will be essential to advance effective, scalable treatments for CUD.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"511-515"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Student's Call for Medical School Wellness Curriculums to Include Harm Reduction.","authors":"Cameron K Ormiston","doi":"10.1097/ADM.0000000000001547","DOIUrl":"10.1097/ADM.0000000000001547","url":null,"abstract":"<p><p>Substance use among medical students is high, has had fatal consequences, and continues postgraduation, with substance use rates among physicians being higher than the general population. Unfortunately, many institutions lack specific policies on substance use, have policies centered on punitive and disclosure-prohibitive approaches, or students are unaware of such policies. Notably, though physical and mental wellness are typical components of medical school curricula and policy, student substance use is often glaringly absent. As a result, schools can be unprepared to address substance use and students can be left feeling unsupported as they grapple with their evolving role in medicine-some of whom may use drugs during this time. Reasons for the shortcomings in addressing student substance use are multifactorial, with stigma, dwindling preclinical time, and overconfidence possibly playing a role. To address this problem, schools must integrate into their undergraduate medical wellness curricula a harm reduction framework that (1) includes student perspectives and input, (2) changes school culture, and (3) improves access to harm reduction education and resources as well as substance use and mental health treatment. Preparing students for their own interactions with alcohol or drugs must be a priority, especially as they enter a profession with a multitude of overlapping risk factors for unhealthy alcohol and drug use, and this must be done in a destigmatizing, supportive, and compassionate way.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"389-391"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of 7-Hydroxymitragynine Use Requiring Inpatient Medically Managed Withdrawal.","authors":"Rachel S Wightman, David Hu","doi":"10.1097/ADM.0000000000001558","DOIUrl":"10.1097/ADM.0000000000001558","url":null,"abstract":"<p><strong>Objectives: </strong>There is an increased interest in kratom and kratom-related products such as 7-hydroxymitragynine (7-OH). Here we present the case of a patient seeking inpatient substance use treatment for daily 7-OH use and the clinical course of care including clinical opiate withdrawal scale (COWS) and medication treatment response.</p><p><strong>Methods: </strong>This is a single case report from an inpatient medically managed withdrawal level of substance use treatment care.</p><p><strong>Results: </strong>A 38-year-old man with a history of opioid use disorder reported escalation of use including kratom to 7-OH complicated by the development of use disorder, tolerance, and withdrawal. The patient experienced a withdrawal syndrome consistent with opioid withdrawal upon stopping use, with COWS peaking at 14. The patient was treated with a short course of buprenorphine sublingual (daily dosing 2-8 mg) based on signs and symptoms. He did not want to remain on buprenorphine after the medically managed withdrawal period and was successfully tapered off buprenorphine during his treatment stay and transitioned to residential level of care.</p><p><strong>Conclusions: </strong>Given the widespread availability of kratom and kratom-related products it is important for health care providers to screen for use and development of use disorder and be prepared to provide counseling, support, and treatment for patients.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"416-418"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784349","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}