Substance use & addiction journal最新文献

{"title":"Centering Patient Health Over Legal Status: A Student-Driven Cannabis Risk Stratification Framework for Undergraduate Medical Education.","authors":"Jessie J Liu, Sydney Moore, Xiadi Zhai, Rory Vu Mather, William Oles, Ivo Cerda, Patrick McGuire, Hilary S Connery","doi":"10.1177/29767342261489469","DOIUrl":"https://doi.org/10.1177/29767342261489469","url":null,"abstract":"<p><strong>Background: </strong>Cannabis use is increasing worldwide, both for evidence-supported indications and conditions with limited evidence such as anxiety, depression, and chronic pain. Although incongruence between state and federal cannabis laws has delayed expanding cannabis education within medical schools, patients will continue to use cannabis and physicians must be prepared to counsel them. Therefore, evidence-informed cannabis education is needed to prepare medical students to discuss cannabis use using a patient-centered and harm reduction-oriented framework rather than relying on legal status alone.</p><p><strong>Methods: </strong>We convened a student-faculty working group in addiction psychiatry, addiction medicine, and pain medicine to develop a practical teaching framework grounded in peer-reviewed literature on cannabis-related risks, patterns of use, and patient counseling. We reviewed existing cannabis curricula and identified points within medical school courses where this content could be incorporated without major restructuring.</p><p><strong>Results: </strong>We developed a Cannabis Use Risk Stratification Framework intended to help medical students organize cannabis-related health benefits and risks into teachable categories based on use-related (frequency, potency, and route) and patient-related (age, comorbidities, and functional impact) factors. The framework is taught in two 1-hour sessions: a preclinical lecture introducing the framework, and a preclerkship session using cases and simulations to apply it. By centering discussion on patient health and harm reduction rather than legality alone, the framework remains applicable across jurisdictions and provides students with a role in clinical encounters: obtaining a cannabis history, identifying benefits and potential risk factors, and delivering brief, educational counseling to promote shared decision-making.</p><p><strong>Discussion: </strong>This framework addresses a foundational gap in undergraduate medical education by providing an educational approach to discussing cannabis-related benefit and risk that is adaptable across institutions, resource settings, and jurisdictions. The risk categories are pragmatic and teachable, offering learners a conceptual framework for recognizing when cannabis use warrants monitoring, brief counseling, or escalation to formal intervention.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261489469"},"PeriodicalIF":2.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229571","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":"Impact of Opt-Out Versus Opt-In Recruitment on Engagement of FDNY WTC-Exposed Responders in a Tobacco Cessation Intervention.","authors":"Tyrone Moline, Alexandra K Mueller, David J Prezant, Matthew P Bars, Rachel Zeig-Owens, Mayris P Webber, Theresa Schwartz, Madeline F Cannon, Brandon Vaeth, Julia H Arnsten, Shadi Nahvi, David G Goldfarb","doi":"10.1177/29767342261489476","DOIUrl":"https://doi.org/10.1177/29767342261489476","url":null,"abstract":"<p><strong>Background: </strong>World Trade Center (WTC)-exposed Fire Department of the City of New York (FDNY) rescue/recovery workers have an elevated risk of smoking-related morbidity. Despite access to free tobacco cessation treatment, some individuals in this population continue to smoke. In other settings, opt-out treatment approaches increase treatment initiation, but effectiveness in occupational health programs is unclear. Accordingly, we (1) assessed whether an opt-out strategy increases engagement with a Tobacco Cessation Program and (2) identified factors associated with engagement.</p><p><strong>Methods: </strong>This was a randomized trial among FDNY firefighters and Emergency Medical Service (EMS) who self-reported smoking and were eligible for the WTC Health Program Lung Cancer Screening Program. 1:1 randomization occurred prior to contact for opt-out recruitment with Enhanced Care treatment (Opt-Out/Enhanced) or opt-in recruitment with Standard Care treatment (Opt-In/Standard). Opt-Out/Enhanced included proactive outreach and tailored biofeedback during counseling; Opt-In/Standard included participant-initiated engagement and standard counseling. Both groups were offered identical no-cost pharmacotherapy (varenicline). Engagement was defined as: consented enrollment (expressed interest and provided informed consent) and treatment initiation (attendance at ≥1 counseling session). Engagement differences were evaluated using logistic regression; sociodemographic and health-related factors were characterized descriptively without formal testing due to small numbers.</p><p><strong>Results: </strong>Overall, 312 individuals were randomized (Opt-Out/Enhanced, n = 156 and Opt-In/Standard, n = 156). Engagement was low (7.4%). Consented enrollment (n = 23; OR = 3.05; 95% CI = 1.11-9.72) and treatment initiation (n = 18; OR = 2.08; 95% CI = 0.72-6.73) were higher in Opt-Out/Enhanced versus Opt-In/Standard. Treatment initiators had a median age of 60.5 (vs 65.0 years among non-initiators); 38.9% were EMS (vs 18.0%), 22.2% were female (vs 6.9%), 77.8% had a prior cessation attempt (vs 23.5%), and 55.6% had abnormal lung function (vs 32.9%). Participants were too few to analyze cessation outcomes in depth.</p><p><strong>Conclusions: </strong>Despite low engagement overall, opt-out treatment had higher engagement with tobacco cessation treatment. This supports other work that has found opt-out treatment to be encouraged for hard-to-reach populations.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261489476"},"PeriodicalIF":2.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229633","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":"Takotsubo Cardiomyopathy Associated With Severe Medetomidine Withdrawal: A Case Report.","authors":"Divya Krishna, Barrington Bennett, Andrew Lin, Anthony Spadaro","doi":"10.1177/29767342261493888","DOIUrl":"https://doi.org/10.1177/29767342261493888","url":null,"abstract":"<p><strong>Background: </strong>Takotsubo cardiomyopathy (TCM) is a transient syndrome of cardiac dysfunction with no occlusive coronary arterial disease, which may mimic an ischemic cardiac event. The pathogenesis of TCM is thought to be primarily driven by the effects of a temporary catecholamine surge on cardiac and vascular tissue. Medetomidine (an a2 agonist commonly found in the Philadelphia fentanyl supply) withdrawal is characterized by agitation and sympathetic hyperactivity that can precipitate a catecholamine surge. Though withdrawal from other Central Nervous System (CNS)-depressing substances such as opioids and clonidine have been found to be associated with TCM, there is little documentation of this phenomenon occurring from medetomidine withdrawal.</p><p><strong>Case: </strong>A 51-year-old woman with no reported medical history other than opioid use disorder presented to the emergency department due to concern for withdrawal from fentanyl and medetomidine. Her opioid withdrawal was well controlled with methadone and oxycodone. Shortly after coming off her dexmedetomidine infusion (started for medetomidine withdrawal), she developed acute ST-segment changes on electrocardiogram, elevated troponin levels on bloodwork, and regional wall-motion abnormalities on transthoracic echocardiogram. Her coronary angiography showed no occlusion and repeat cardiac laboratory workup days later had normalized with improvement in ejection fraction on cardiac echocardiography and magnetic resonance imaging. This signifies a temporary stress cardiomyopathy, likely from a2 agonist withdrawal.</p><p><strong>Discussion: </strong>This case describes TCM in a patient experiencing medetomidine withdrawal. This patient's cardiac dysfunction was transient, temporally correlating with the cessation of her dexmedetomidine infusion. This suggests an a2 agonist mediated withdrawal leading to sympathetic hyperactivity which can precipitate TCM.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261493888"},"PeriodicalIF":2.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229630","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":"Characterizing Buprenorphine Dosing Frequency During Outpatient Medication Treatment For Opioid Use Disorder.","authors":"Phoebe Dacha, Michelle Eglovitch, Monica Melmer, Caitlin E Martin, Madison M Marcus","doi":"10.1177/29767342261492538","DOIUrl":"https://doi.org/10.1177/29767342261492538","url":null,"abstract":"<p><strong>Background: </strong>Sublingual buprenorphine for opioid use disorder (OUD) is indicated as a once-daily medication during stabilization and long-term treatment, yet patients may engage in \"split dosing,\" dividing the daily dose into multiple administrations.</p><p><strong>Methods: </strong>This secondary analysis examined buprenorphine dosing patterns among 165 stable non-pregnant outpatients with OUD and assessed concordance between patient-reported dosing and provider documentation.</p><p><strong>Results: </strong>Patients had been taking buprenorphine for a median of 16 months (range 1-78). Most patients reported 2- (n = 63, 38.2%) or 3-times- (n = 74, 44.8%) daily dosing. A Cohen's kappa analysis revealed substantial agreement (κ = 0.604, <i>P</i> < .001) between patient self-report and clinical documentation. Patient-reported buprenorphine total daily doses were higher and chronic pain comorbidities more common among patients splitting their dose than once-daily dosing patients.</p><p><strong>Conclusions: </strong>These results characterize sublingual buprenorphine dosing frequencies among outpatients with OUD and highlight real-world divergence from Food and Drug Administration labeling among patients stabilized on buprenorphine, indicating the need for evidence-based, patient-centered dosing strategies in OUD treatment.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261492538"},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198723","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":"State Variation in the Availability of Women-Specific Alcohol Use Disorder Treatment.","authors":"Sage R Feltus, Rachel Sayko Adams, Katherine M Keyes, Jake R Morgan, Miriam T H Harris, Maureen T Stewart","doi":"10.1177/29767342261479908","DOIUrl":"https://doi.org/10.1177/29767342261479908","url":null,"abstract":"<p><strong>Background: </strong>In the United States (U.S.), the prevalence of alcohol use disorder (AUD) is increasing among women; however, few women seek treatment. System-level information on the need for AUD treatment among women and the availability of services relevant to women is essential to ensure that women have access to care. This study describes state variation in the number of addiction treatment facilities serving clients with AUD per 10 000 women with AUD, state variation in treatment facilities offering women-specific programming, and services that address commonly cited barriers to treatment, and estimates the availability of women-specific programming and services in states with disproportionately higher AUD prevalence among women.</p><p><strong>Methods: </strong>Using the 2024 National Substance Use and Mental Health Services Survey data, this study identified the number of addiction treatment facilities that offered women-specific programming and services addressing frequently cited treatment barriers for women and estimated the 2024 proportion of facilities with these services per 10 000 women aged 18+ with AUD by state.</p><p><strong>Results: </strong>State-level prevalence estimates of AUD among women ranged from 6.2% to 12.7%. Of the 13 818 treatment facilities in the U.S. offering alcohol treatment, 58.5% offered women-specific programming, 59.0% offered trauma therapy, 55.4% offered intimate partner violence services, 55.2% offered transportation assistance, and 4.6% offered childcare. States with a higher proportion of women with AUD had fewer alcohol treatment facilities offering women-specific programming per woman with AUD.</p><p><strong>Conclusions: </strong>There is state-level variation in the availability of facilities offering women-specific programming and services. Of concern, many states with greater than average AUD prevalence had disproportionately lower availability of services.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261479908"},"PeriodicalIF":2.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186859","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":"Association of Cannabis Use With Cigarette Use in People Certified for Medical Cannabis for Chronic Pain: A Secondary Analysis of a Prospective Cohort Study.","authors":"Deepika E Slawek, Chenshu Zhang, Gayatri Nangia, Shadi Nahvi, Haruka Minami, Frances R Levin, Nancy Sohler, Giovanna Calderon DiFrancesca, Chinazo O Cunningham, Julia H Arnsten, Joanna L Starrels","doi":"10.1177/29767342261489466","DOIUrl":"https://doi.org/10.1177/29767342261489466","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain is associated with cigarette use and cannabis use and people with chronic pain report using each to manage pain. Little is known about how medical cannabis legalization impacts cigarette use among people with chronic pain. We aimed to examine the relationship between cannabis use and cigarette use in New York State.</p><p><strong>Methods: </strong>Secondary analysis of a prospective, longitudinal cohort study of adults with chronic pain, using opioids and newly certified to use medical cannabis. Quarterly questionnaires over 9 months collected self-reported cannabis use, cigarette use, pain, anxiety and depression. The primary outcome was past 30-day cigarette use [yes/no] and cigarettes per day [CPD]. Four two-step mixed-effect models assessed the longitudinal impact of cannabis on cigarette use. Independent variables for each were cannabis use days in the past 30 days of: (1) any cannabis; (2) cannabis by source (unregulated, medical, mixed); (3) cannabis by route (inhaled, non-inhaled); (4) added interaction between cannabis use and pain severity.</p><p><strong>Results: </strong>Of 223 participants, 75 (33.6%) used cigarettes and 164 (73.5%) used cannabis at baseline. In Model 1, any cannabis use was not significantly associated with cigarette use or CPD. In Model 2, days of unregulated cannabis use (β = .058, <i>P</i> = .002) and mixed cannabis use were associated with CPD (β = .041, <i>P</i> = .018). In Model 3, non-inhaled cannabis use was negatively associated with CPD (β = -.015, <i>P</i> = .015). In Model 4, the interaction term between any cannabis use and pain intensity was significant (β = -.006; <i>P</i> = .047). The association between cannabis use and CPD was positive at pain severity scores less than 6.73, but above it, cannabis use was negatively associated with CPD.</p><p><strong>Conclusion: </strong>Unregulated and non-inhaled cannabis use were implicated in the association between cannabis use and cigarette use, and pain severity moderated the effect of cannabis use on CPD. Further studies are needed to fully understand this relationship.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261489466"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186724","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":"\"You Do What You Have To Do\": Risk Environments in Xylazine Wound Care.","authors":"Olivia Studnicki, Margaret Shang, Ilana Hull, Kevan Schultz, David Halpern, Alice Bell, Jane M Liebschutz, Raagini Jawa","doi":"10.1177/29767342261489216","DOIUrl":"https://doi.org/10.1177/29767342261489216","url":null,"abstract":"<p><strong>Background: </strong>Xylazine, a veterinary sedative, has become a prevalent adulterant in the unregulated opioid supply and can lead to chronic ulcerative wounds among people who use drugs (PWUD). Without regular care, these wounds can progress and result in infectious and limb-threatening complications. Despite this, PWUD face many barriers to wound self-management and medical treatment. Using the Rhodes' Risk Environment framework, we investigated factors that influence wound care practices and healing among PWUD with xylazine-associated wounds in Pittsburgh, Pennsylvania.</p><p><strong>Methods: </strong>From March to April 2024, we conducted semi-structured interviews with 20 PWUD with at least one xylazine-associated wound and past-90-day xylazine exposure confirmed by laboratory urine testing or self-reported xylazine test strip results. Using content analysis guided by the Rhodes' Risk Environment framework, we categorized individual-level, micro-level, and macro-level factors influencing wound care and outcomes and defined care practices shaped by these factors.</p><p><strong>Results: </strong>At the individual level, xylazine-associated wound care and healing were shaped by participant knowledge, prior experience, and resourcefulness. Pain, withdrawal, ongoing substance use, and emotional responses like fear and guilt also strongly influenced wound care practices and care-seeking behaviors. At micro and macro levels, multiple factors across the physical, economic, social, and health care environments further impacted wound outcomes, including environmental hazards, resource scarcity (eg, wound supply availability and affordability), health care and public stigma, social support networks, punitive policies, and quality of medical care and access.</p><p><strong>Conclusion: </strong>Overall, xylazine-associated wound care practices and healing are modified by various individual and structural factors within the risk environment that may lead to disruption in consistent wound care. To improve clinical outcomes, health care systems should prioritize low-barrier strategies that minimize gaps in care, support timely reentry to facilitate wound self-management, and foster continued engagement by addressing the underlying factors that drive treatment hesitation and interruptions.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261489216"},"PeriodicalIF":2.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139788","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":"Shifting Perspectives: Harm Reduction Staff Perceptions of Drug Checking Implementation.","authors":"Kaitlyn Jaffe, Whitney Ludwig, Steve Alsum, Nick DeHaan, Clayton J Shuman, Robert Ploutz-Snyder, Mary Dwan, Chin Hwa Dahlem","doi":"10.1177/29767342261444522","DOIUrl":"10.1177/29767342261444522","url":null,"abstract":"<p><strong>Background: </strong>As the overdose crisis continues to devastate communities, expanding access to harm reduction services, such as drug checking, is essential. Drug checking services (DCS) enable people who use drugs (PWUD) to identify the likely active ingredients within their substances, supporting safer use and reducing overdose risk. However, implementing DCS in community settings may encounter barriers such as stigma, legal ambiguity, and organizational constraints. This study examines harm reduction staff perspectives on the implementation and delivery of a community-based DCS program in Michigan.</p><p><strong>Methods: </strong>This study explored the perceptions of staff from a harm reduction organization before and after implementing Michigan's first community-based DCS using Fourier-Transform Infrared spectroscopy. Six focus groups, each composed of 2 to 5 staff members, were conducted before and after implementing DCS. Rapid qualitative methods, informed by the Consolidated Framework for Implementation Research, were used for analysis.</p><p><strong>Results: </strong>Prior to implementation, staff anticipated that DCS would empower PWUD and provide crucial drug supply information to communities. Staff also believed that strong relationships with PWUD and effective service integration would facilitate uptake. Post-implementation, staff noted there was considerable engagement with DCS among PWUD, enhanced by dissemination via peer networks and strategic communication approaches. However, staff encountered several barriers to smooth implementation, including ongoing concerns about legal risks and criminalization, as well as organizational capacity constraints.</p><p><strong>Conclusion: </strong>Findings from this study highlight the need for legal protections, adequate staffing, and community support to sustain and expand drug checking programs.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1098-1107"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147984929","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":"Addiction Medicine Fellowship Curricula: How Programs are Meeting ACGME Requirements and Providing Educational Innovation.","authors":"Randi Sokol, Bari-Sue Brodsky, Gregory Jaffe","doi":"10.1177/29767342261444855","DOIUrl":"10.1177/29767342261444855","url":null,"abstract":"<p><strong>Background: </strong>As of 2026, physicians must complete an Accreditation Council for Graduate Medical Education (ACGME)-accredited addiction medicine fellowship to seek addiction medicine board certification. While the ACGME has developed general goals and objectives, they also allow for curricular flexibility. Little is known, however, about how individual programs meet these requirements.</p><p><strong>Objective: </strong>To describe how addiction medicine fellowship training programs meet ACGME requirements, including commonalities and innovative curricular and education strategies.</p><p><strong>Methods: </strong>In 2025, 5 experts in addiction education developed a survey tool to capture comparisons of addiction medicine fellowship curricula. The principal investigator (R.S.) sent this survey via e-mail to 104 addiction fellowship program directors; responses were kept anonymous and not linked to individual programs. Data were analyzed using quantitative descriptive statistics and inductive and deductive thematic analysis.</p><p><strong>Results: </strong>Forty-seven of 104 program directors (45%) completed the survey. Program directors described both shared elements and unique features of their curricula, reflecting differences in program settings, available community resources, specialty focus, faculty diversity and expertise, and patient population.</p><p><strong>Conclusion: </strong>There is a wide array of curricula that meet addiction medicine fellowship ACGME requirements. Future research and efforts should describe individual programs' curricula in more depth to support new and existing programs in growing and improving their programs to suit the growing demand for diverse practices in addiction medicine and to recruit fellows with aligned interests.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1130-1137"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019816","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":"Determinants of Implementation and Sustainability of Transitional Opioid Programs Within Rural and Urban Safety Net Hospitals.","authors":"Cheyenne Fenstemaker, Alden Yuanhong Lai, Ji Eun Chang, José A Pagán, Zoe Lindenfeld, Cory E Cronin, Berkeley Franz","doi":"10.1177/29767342261451111","DOIUrl":"10.1177/29767342261451111","url":null,"abstract":"<p><strong>Background: </strong>Hospitalization presents a critical juncture to engage patients with opioid use disorder, but safety net hospitals are less likely to offer transitional opioid programs (TOPs), which initiate treatment and connect patients to care after discharge. This study explored determinants of TOP adoption in 4 diverse safety net health systems.</p><p><strong>Methods: </strong>We interviewed key participants affiliated with safety net health systems and partner community-based organizations about TOPs within their organization. We used inductive coding informed by grounded theory to identify emerging themes related to TOP implementation and thematic analysis to compare determinants across health systems. A deductive approach was then used to map data that aligned with an existing TOP typology to document the presence of specific programs and promote comparison in implementation progress across sites. Throughout the iterative process, we developed analytic themes related to the extent to which TOPs were integrated into each health system. Finally, determinants were mapped to Consolidated Framework for Implementation Science Research domains.</p><p><strong>Results: </strong>Determinants spanned inner and outer setting domains and shaped the presence of TOPs and their integration into routine health system operations. The number and types of care transition models varied across organizations. We grouped health systems into 2 patterns, foundational and embedded, reflecting differences in how their TOPs were organized and supported. Reimbursement rates, inefficient organizational functioning, and stigma hindered TOPs at all phases of implementation, while organizational champions were key facilitators. Foundational programs experienced severe staffing shortages and low organizational support. Embedded programs were distinguished by grant-writing staff and more supportive outer contexts.</p><p><strong>Conclusions: </strong>This study highlights the challenges and opportunities faced by safety net health systems in implementing TOPs. The findings emphasize the need for tailored implementation strategies that address the unique barriers and leverage facilitators within resource-constrained settings, particularly at different phases of implementation.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1138-1150"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145924","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}