Substance use & addiction journal最新文献

{"title":"Exploring Staff Beliefs About Unplanned Discharge and Related Harms in VA Substance Use Disorder Residential Programs: A Qualitative Study.","authors":"Natalie B Riblet, Susan Stevens, Lauren Kenneally, Lisa Zubkoff, Daniel J Gottlieb, Brian Shiner, Melissa Ley-Thomson, Brett Rusch","doi":"10.1177/29767342251335731","DOIUrl":"https://doi.org/10.1177/29767342251335731","url":null,"abstract":"<p><strong>Background: </strong>Unplanned discharge is common in substance use disorder (SUD) residential programs and associated with worse outcomes such as relapse and suicide. There is high variation in unplanned discharge rates across Department of Veterans Affairs (VA) SUD residential programs. Little is known about program factors related to unplanned discharge in these settings. We aimed to discover staff beliefs about avoiding unplanned discharge and related harms in VA SUD residential programs.</p><p><strong>Methods: </strong>We identified VA sites with low (<10%) and high rates (≥30%) of unplanned discharge. Informed by the Theory of Planned Behavior, we conducted semi-structured interviews with staff members at sites to learn about staff beliefs about unplanned discharge and its related harms in SUD residential settings. Two analysts reviewed the data and employed a combination of directed-content analysis and inductive methods to identify themes stratified by high- versus low-rate sites.</p><p><strong>Results: </strong>We enrolled 10 sites (20 participants). There was high variability in how participants and sites operationalized unplanned discharge. Participants at low-rate sites generally emphasized harm-reduction approaches as useful ways to treat problematic behaviors that could result in an unplanned discharge. Participants at high-rate sites, on the other hand, favored the use of boards or councils to manage these concerns.</p><p><strong>Conclusions: </strong>SUD residential programs should standardize the way that they define and document unplanned discharge. Future research should study the role of harm-reduction strategies and councils in mitigating unplanned discharge and related harms.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342251335731"},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Alcohol Use Disorder and Problem Use in Adult Primary Care Patients: Comparison of the Tobacco, Alcohol, Prescription Medication and Other Substance (TAPS) Tool With the Alcohol Use Disorders Identification Test Consumption Items (AUDIT-C).","authors":"Angéline Adam, Eugene Laska, Robert P Schwartz, Li-Tzy Wu, Geetha A Subramaniam, Noa Appleton, Jennifer McNeely","doi":"10.1177/29767342251326678","DOIUrl":"https://doi.org/10.1177/29767342251326678","url":null,"abstract":"<p><strong>Background: </strong>The Tobacco, Alcohol, Prescription Medication, and Other Substance (TAPS) tool is a screening and brief assessment instrument to identify unhealthy tobacco, alcohol, drug use, and prescription medication use in primary care patients. This secondary analysis compares the TAPS tool to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) for alcohol screening.</p><p><strong>Methods: </strong>Adult primary care patients (1124 female, 874 male) completed the TAPS tool followed by AUDIT-C. Performance of each instrument was evaluated against a reference standard measure, the modified World Mental Health Composite International Diagnostic Interview, to identify problem use and alcohol use disorder (AUD). Area under the curve (AUC) appraised discrimination, and sensitivity and specificity were calculated for Youden optimal score thresholds.</p><p><strong>Results: </strong>For identifying problem use: On the AUDIT-C, AUC was 0.90 (95% Confidence Interval: 0.86-0.92) for females and 0.91 (0.89-0.93) for males. Sensitivity and specificity for females were 0.89 (0.83-0.93) and 0.78 (0.75-0.80), respectively, and for males were 0.84 (0.79-0.88) and 0.82 (0.79-0.85). On the TAPS tool, AUC was 0.82 (0.79-0.86) for females and 0.81 (0.78-0.84) for males. Sensitivity and specificity for females were 0.78 (0.72-0.84) and 0.78 (0.75-0.81), respectively, and for males were 0.76 (0.71-0.81) and 0.76 (0.72-0.79). For AUD: On the AUDIT-C, AUC was 0.90 (0.88-0.93) for both females and males. Sensitivity and specificity for females were 0.83 (0.74-0.90) and 0.83 (0.80-0.85), respectively, while for males, they were 0.81 (0.74-0.87) and 0.84 (0.81-0.87). On the TAPS tool, AUC was 0.84 (0.80-0.89) for females and 0.82 (0.78-0.86) for males. Sensitivity and specificity for females were 0.73 (0.63-0.81) and 0.85 (0.83-0.88), respectively, while for males, they were 0.75 (0.68-0.81) and 0.84 (0.81-0.86).</p><p><strong>Conclusion: </strong>The AUDIT-C performed somewhat better than the TAPS tool for alcohol screening. However, the TAPS tool had an acceptable level of performance for alcohol screening and may be advantageous in practice settings seeking to identify alcohol and other substance use with a single instrument.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342251326678"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Unsolved Problem of Attrition Rates on Randomized Clinical Trials for Cocaine Use Disorders: A Scoping Review.","authors":"Amanda Bernardino Sinatora, Daniela Mendes Chiloff, Juliana P M Santos, Kevin Y Xu, Vitor S Tardelli, Thiago Marques Fidalgo","doi":"10.1177/29767342251326374","DOIUrl":"https://doi.org/10.1177/29767342251326374","url":null,"abstract":"<p><strong>Background: </strong>Cocaine use disorder (CUD) is a significant and insufficiently studied public health issue, especially considering that the global prevalence of CUD is estimated to be higher than ever. There is still no consensus on effective treatments for CUD. Important barriers for research in the field include the high attrition levels observed in randomized controlled trials (RCTs) for CUD treatment and the lack of emphasis on methods to reduce attrition in CUD RCTs.</p><p><strong>Methods: </strong>The goal of this study was to systematically review over 2 decades of CUD RCTs, with the objective of evaluating the reporting of attrition bias and methods used to mitigate attrition.</p><p><strong>Results: </strong>Our scoping review extracted information from 106 RCTs, of which only 82 explicitly evaluated attrition as an outcome. Thirty-eight studies had an attrition rate above 50%, and five 16 studies had medium attrition bias, 6% to 19%. The remaining 68 had large attrition bias.</p><p><strong>Conclusion: </strong>Across all included studies, discussion of attrition as a limitation was uncommon. Overall, these analyses suggest that most RCTs evaluating CUD treatments have not adequately accounted for attrition in their analyses or employed approaches to mitigate attrition.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342251326374"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benzodiazepines and Opioid co-use Among Rural People Who Use Drugs: Findings From the Rural Opioid Initiative.","authors":"L Sarah Mixson, Arvind Venkataraman, Lydia N Drumright, Bridget M Whitney, Wiley D Jenkins, Peter D Friedmann, William A Zule, Jennifer Havens, Stephanie A Ruderman, Thomas J Stopka, P Todd Korthuis, Mai T Pho, Ryan P Westergaard, David W Seal, Vivian F Go, William C Miller, Judith Feinberg, Gordon Smith, Judith I Tsui, Joseph A Delaney, Heidi M Crane","doi":"10.1177/29767342251331701","DOIUrl":"https://doi.org/10.1177/29767342251331701","url":null,"abstract":"<p><strong>Background: </strong>Benzodiazepines and opioids are among the most frequently misused psychoactive substances, but their patterns of co-use (polysubstance use) in rural areas are unclear. As resources to address substance use are disproportionally scarce in rural areas, a better understanding of this polysubstance use is critical to allocate and direct interventions.</p><p><strong>Methods: </strong>The Rural Opioid Initiative comprises 8 research cohorts spanning 10 states and 65 rural counties. Participants were recruited from January 2018 to March 2020 and eligibility included past 30-day opioid use by any route or past 30-day injection of any substance. Analyses were restricted to participants reporting past 30-day opioid use and either benzodiazepine or stimulant use. We described bivariate cross-sectional associations between benzodiazepine+opioid use, compared with stimulant+opioid use, and substance use behaviors, health outcomes, injection drug use, addiction treatment, and criminal legal system involvement.</p><p><strong>Results: </strong>Of the 1107 ROI participants that met inclusion criteria, 10% (n = 107) reported benzodiazepine+opioid use, and 90% (n = 1000) reported stimulant+opioid use. The benzodiazepine+opioid group, compared with the stimulant+opioid group, had a higher use of opioid pain medication (73% vs 55%), gabapentin (43% vs 23%), and clonidine (12% vs 4%) to get high and used these substances more frequently; they also reported more frequent heavy episodic drinking (6.1 days per 30 days, SD = 9.4 vs 4.1 days, SD 7.5). The benzodiazepine+opioid group reported a lower prevalence in the past 6 months of law enforcement stop-and-search incidents (29% vs 48%), arrests (11% vs 28%), probation (22% vs 34%), jail/prison (18% vs 41%), and fewer days in jail/prison (4.7, SD = 19.1 days vs 15.9, SD = 35.7 days).</p><p><strong>Conclusion: </strong>We found that benzodiazepines+opioids use was associated with more heavy episodic drinking and gabapentin use, and lower prevalence of criminal legal system involvement. These data suggest that individuals reporting benzodiazepines+opioids use have distinct behavioral patterns and outcomes that require targeted interventions for rural populations.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342251331701"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study Protocol for Implementation of Pharmacist-Led Interventions to Increase Access to Medications for Opioid Use Disorder for Incarcerated Individuals (PLI-MOUD Study).","authors":"Meghan Breckling, Holly Handley, Jennifer Shuler, Michael Mancino, Azizi Ray","doi":"10.1177/29767342251333241","DOIUrl":"https://doi.org/10.1177/29767342251333241","url":null,"abstract":"<p><p>Illicit opioid use and opioid use disorder (OUD) are public health crises that often lead individuals to encounter the criminal justice system. Illegally manufactured fentanyl contaminates much of the illicit drug supply, including opioids and stimulants, leading to unintentional drug overdoses. Access to evidence-based treatment with medications for opioid use disorder (MOUD) and an opioid overdose reversal agent (OORA) is paramount to preventing overdose deaths. However, few jails or prisons in the state of Arkansas currently provide access to or education about these evidence-based medications. One strategy to increase evidence-based medication utilization within a carceral setting is to engage pharmacists, who are under-utilized healthcare professionals and who have considerable expertise in MOUD and OORA. There is currently limited evidence to support pharmacists' roles within a jail setting. With federal and state opioid response funding, we are conducting the Pharmacist-Led Interventions to Increase Access to Medications for Opioid Use Disorder (PLI-MOUD) study. This randomized controlled study evaluated the preliminary efficacy of pharmacist-led interventions to expand knowledge and access to MOUD among individuals identified with a history of symptoms suggestive of OUD. In addition, it aims to assess knowledge and confidence in OORA among individuals with a history of symptoms suggestive of stimulant use disorder alone or in combination with OUD, who are currently incarcerated and enrolled in an established Re-Entry program within a single county regional detention facility. The three aims of the study include (1) assessment of the prevalence of OUD symptoms and racial/ethnic differences within this unique study setting, (2) comparison of the effectiveness of a naloxone administration training intervention delivered by a pharmacist versus an Alcohol and Drug Counselor (ADC), and (3) compare the effectiveness of two pharmacist-delivered MOUD education interventions, Brief Intervention and Referral to Treatment versus standard medication counseling.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342251333241"},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding How Persons With Maternal Opioid Use Disorder Experience Public Food Assistance Programs WIC and SNAP.","authors":"Meghan Gannon, Kimberly McLaughlin, Vanessa Short, Trami Nguyen, Dennis J Hand, Diane J Abatemarco","doi":"10.1177/29767342251336041","DOIUrl":"https://doi.org/10.1177/29767342251336041","url":null,"abstract":"<p><strong>Background: </strong>The current opioid epidemic persists in tandem with the food insecurity crisis, especially among pregnant persons and parents with opioid use disorder (OUD). Limited research exists examining the experience of pregnant persons and parents with OUD and their engagement in federal food assistance programs. This understanding is imperative to address service gaps, destigmatize practices, and ensure food assistance programs are culturally relevant and acceptable. Therefore, the aim of this study were (1) to understand food access and nutrition needs among pregnant persons and parents in OUD treatment and (2) to describe challenges and limitations associated with current food assistance benefits among pregnant persons and parents in OUD treatment.</p><p><strong>Methods: </strong>This qualitative study conducted at an OUD treatment program utilized focus group discussions to elicit feedback from participants. A total of 24 participants (≥18 years of age, parent, recipient of food assistance program and OUD treatment) participated.</p><p><strong>Results: </strong>The average age of participants was 40 years (SD = 7.4), all received outpatient OUD services, and all participants received Medicaid benefits. All but one (95.8%) reported receiving medication for OUD (ie, methadone). A total of 7 major themes were identified from the data including the following: (1) risky behaviors to access food, (2) Breastfeeding Concerns and Women, Infants, and Children (WIC), (3) Challenges with end of Emergency Allotments payments, (4) WIC/Supplemental Nutrition Assistance Program Enrollment and Support, (5) The impact of food insecurity on maternal and family health, (6) Complexity of food shopping with limited resources, and (7) Impact of food insecurity on recovery domains.</p><p><strong>Conclusions: </strong>Despite 2 long-standing federal programs aimed at increasing nutrition and food security for families with children, families affected by maternal OUD continue to face significant barriers to nutritional equity. This study provided context to the additive challenges that families affected by OUD experience in the face of food insecurity, and how they have important implications for the family's health.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342251336041"},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences of Trainees From Underrepresented Groups Within Addiction Medicine Training Programs: A Qualitative Study.","authors":"Amanda M Fitzpatrick, Sophia M Ly, Jules Canfield, Kaku So-Armah, Jennifer A Palmer, Emily E Hurstak","doi":"10.1177/29767342251319610","DOIUrl":"https://doi.org/10.1177/29767342251319610","url":null,"abstract":"<p><strong>Purpose: </strong>Training environments that embrace diversity, equity, inclusion, and accessibility (DEIA) in their mission, recruitment, and curriculum may foster development and retention of a diverse workforce and promote novel approaches to address inequities in addiction care. We sought to elicit perspectives regarding how addiction medicine training programs influenced the training experience and career trajectories for participants from underrepresented groups (URGs).</p><p><strong>Methods: </strong>We conducted semi-structured interviews with 20 URG physician participants of addiction medicine programs at a single institution from 2016 to 2022 regarding their identities and experiences in the training program(s). We completed a rapid thematic analysis of qualitative interviews.</p><p><strong>Results: </strong>The sample of participants was 55% women, 25% black or African American, 25% Asian, 25% white, 17% Hispanic or Latina/o/x, and 4% American Indian or Alaska Native. We identified over-arching themes: (1) areas for program improvement including increasing diversity in program leadership, educators, participants, and educational content; (2) URG identity positively influences physician choice to pursue addiction medicine careers working with communities that are underserved and/or experience health disparities; (3) addiction medicine programs impact participants' short- and long-term goals as addiction health professionals including achieving research goals, attaining leadership roles, and finding opportunities for networking and mentorship.</p><p><strong>Conclusions: </strong>We identified themes emphasizing addiction medicine program successes in creating welcoming educational environments, while also prioritizing areas for improvement around topic inclusion, faculty development and representation, and mentorship. Our results offer critical insights into the priorities and views of the next generation of the physician addiction medicine/research workforce and how to effectively improve DEIA efforts within training programs.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342251319610"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"If We Didn't Have Our Babies, We Wouldn't Be Here Right Now\": A Qualitative Exploration of New Motherhood While Navigating Substance Use Disorder Recovery.","authors":"Leah Holcomb, Bonnie Treado, Rachel Mayo, Kathleen Cartmell, Lori Dickes, Jennifer Barkin, Kacey Eichelberger, Lior Rennert","doi":"10.1177/29767342251331398","DOIUrl":"https://doi.org/10.1177/29767342251331398","url":null,"abstract":"<p><strong>Background: </strong>Postpartum women with substance use disorder (SUD) are at heightened risk of adverse health outcomes problems. The current understanding of early motherhood while managing SUD is poorly understood, as the transitional period following delivery has been a neglected area within research. This qualitative study examined how postpartum women balance new motherhood while navigating early recovery from SUDs.</p><p><strong>Methods: </strong>The primary aim was to elicit individual experiences in the context of maternal functioning (social support, psychological well-being, infant care, self-care, mother-child interaction, management, and adjustment). In 2023, we purposefully recruited a sample of postpartum women receiving residential services for SUD (N = 22) and conducted semi-structured individual interviews. Interviews were audio-recorded and transcribed verbatim, and codes were analyzed using deductive and subsequent inductive analysis to identify themes unique to each functioning domain among postpartum women with SUDs.</p><p><strong>Results: </strong>Participants were predominately white (81%), single (86%), and between 20 and 40 years of age and were the primary caregivers for their children, and half were less than 3 months postpartum. Balancing infant care and self-care was cited as a significant challenge. Several participants expressed a need for more early parenting support and assistance in navigating social services and life after leaving residential treatment. Pregnancy catalyzed entering and remaining in treatment while remaining engaged in recovery and sustaining sobriety was a form of self-care. The social network gained as part of the treatment was frequently described as crucial for new moms to care for their children while navigating early recovery.</p><p><strong>Conclusions: </strong>This study highlights the importance of exploring the postpartum experience and needs among postpartum people in SUD recovery. Maintaining recovery through sustainable sobriety was considered a form of self-care, indicating that the postpartum period is a critical point in both a mother's life and a unique intervention point for postpartum women with SUD.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342251331398"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of Drugs Involved in Fatal Overdose and Demographic Correlates: A Latent Class Analysis of Polysubstance-Involved Deaths in the Urban Midwest.","authors":"Julia Richardson, Devin E Banks, Kanila L Brown, Melissa Nance, Ryan W Carpenter, Rachel P Winograd","doi":"10.1177/29767342251330411","DOIUrl":"https://doi.org/10.1177/29767342251330411","url":null,"abstract":"<p><strong>Background: </strong>Fentanyl contributes to the majority of overdose deaths in the United States but the risk of fatal overdose increases when other substances are involved. Although polysubstance overdose involving fentanyl and stimulants has been characterized as increasing nationally and in urban coastal cities, little is known about patterns of drugs involved in fatal overdose in the urban Midwest.</p><p><strong>Methods: </strong>The current study examined drug-involved death data from St. Louis City and County. Cases included were drug overdose deaths occurring from 2016 to 2021 (N = 4088; 73% male; 50% white, 49% black). Latent class analysis was used to examine prototypical patterns and demographic associations.</p><p><strong>Results: </strong>Results indicated fentanyl was involved in the majority (75.0%) of overdose deaths. A five-class solution best fit the data, characterized by deaths involving: predominant fentanyl (48.5%), fentanyl and heroin (20.0%), fentanyl and psychostimulants (12.8%), prescription opioid/undifferentiated (10.6%), and predominant cocaine (8.0%). Relative to predominant fentanyl, decedents in the fentanyl and heroin class and predominant cocaine class were more likely to be black (<i>P</i>s < .05) whereas those in the fentanyl and methamphetamine class and prescription opioid/undifferentiated class were more likely to be white (<i>P</i>s < .05). Females comprised a larger proportion of decedents in the fentanyl and heroin, predominant cocaine, and prescription opioid/undifferentiated classes (<i>P</i>s < .05). Deaths in the predominant fentanyl class were more likely to occur in urban versus suburban environments (<i>P</i>s < .05).</p><p><strong>Conclusions: </strong>Findings diverge from previous research and national patterns highlighting the importance of local data for informing health care and policy in mid-sized and Midwest cities. Overdose prevention that addresses both intentional ingestion and unintentional ingestion of fentanyl with other substances, particularly stimulants, are warranted as its ubiquity in the drug supply persists.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342251330411"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing a Mobile Clinic for Opioid Use Disorder Treatment in an Urban and Rural Context.","authors":"Orrin D Ware, Divya Venkat, Mary Sligh, Aaron Arnold, Robyn Jordan","doi":"10.1177/29767342251333972","DOIUrl":"https://doi.org/10.1177/29767342251333972","url":null,"abstract":"<p><p>Different barriers inhibit access to medications for opioid use disorder (MOUD), such as transportation limitations or reduced geographic proximity to providers. Mobile clinics for opioid use disorder (OUD) treatment provide opportunities to expand access to MOUD. There is limited literature describing the lessons learned and barriers faced when implementing a mobile clinic for OUD treatment in an urban and rural context. This paper focuses on 2 mobile clinics: Prevention Point Medical Mobile Unit, which was implemented in an urban location in Pittsburgh, Pennsylvania, and Addiction Treatment: Linking Access & Services, which was implemented in a rural location in Robeson County, North Carolina. The focal points of this paper include (1) community engagement, (2) community environment, (3) cost, (4) low-barrier MOUD, (5) mobile unit, (6) partnerships with local pharmacies, and (7) weather. With direct insight from providers who led programs in 2 different geographic contexts, this paper offers valuable guidance and lessons learned for those considering initiating mobile clinics to increase access to OUD treatment.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342251333972"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}