Substance use & addiction journal最新文献

{"title":"Examining External and Internal Factors That Could Influence Adolescent Smoking Behaviors in Adolescents of Crete, Greece: The Cross-Sectional FRESHAIR4Life Study.","authors":"Theodoros Krasanakis, Izolde Bouloukaki, Antonios Christodoulakis, Antonia Aravantinou-Karlatou, Charlotte M Hoffman, Rianne M J J van der Kleij, Ioanna Tsiligianni","doi":"10.1177/29767342261446843","DOIUrl":"10.1177/29767342261446843","url":null,"abstract":"<p><strong>Introduction: </strong>Adolescent smoking continues to pose significant public health challenge, persisting due to a multifaceted interplay of internal and external factors. The present study aimed to explore internal and external factors that may influence adolescents' smoking behaviors in Crete, Greece.</p><p><strong>Methods: </strong>Conducted as part of Phase A of the European-funded FRESHAIR4Life Program; this cross-sectional study included adolescents aged 14 to 21 years, recruited between January and February of 2024. Ten educational institutions in the Municipality of Heraklion, Crete, were selected, including high schools (n = 7), technical schools (n = 2), and universities (n = 1).</p><p><strong>Results: </strong>The sample consisted of 179 participants with a mean (SD) age of 16.8 (1.9). Smoking history was reported by 34% (n = 60). Older adolescents had higher odds of ever smoking (OR = 1.57, 95% CI: 1.32-1.88; <i>P</i> < .001). The most prevalent reasons for smoking initiation were reported to be addiction after the initial use of nicotine products (60%), stress (43%), and to look cool and attractive (27%). Ignoring smoking's negative consequences was positively associated with ever smoking (OR = 3.89, 95% CI: 1.85-7.99, <i>P</i> < .001). The perception of smoking as a risk factor for the development of illness (OR = 2.6, 95% CI: 1.2-5.3, <i>P</i> = .012), and concerns about the health impact (OR = 5.7, 95% CI: 2.3-14.1, <i>P</i> < .001) were positively associated with non-smoking behaviors. External factors positively associated with ever smoking were smoking exposure at school (OR = 2.81, 95% CI: 1.36-5.81; <i>P</i> = .005), use of nicotine products by parent(s) (OR = 7.64, 95% CI: 1.95-29.96, <i>P</i> = .004), close friend(s) (OR = 12.88, 95% CI: 3.24-51.15, <i>P</i> < .001), and sibling(s) (OR = 25.13, 95% CI: 3.23-195.63, <i>P</i> = .002).</p><p><strong>Conclusion: </strong>Our findings highlight the need for multifaceted, targeted interventions. Future research should evaluate tailored interventions and investigate emerging potential influences like social media and alternative nicotine products on youth smoking.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1151-1163"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019944","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":"A Tiered Framework for Outpatient Perinatal Substance Use Disorder Services.","authors":"Melinda Ramage, Caitlin E Martin, Casey Tak, Kimberly Simcox, Elisabeth Johnson, Phillip M Hughes, Molly Ramage, Arthur Ollendorff","doi":"10.1177/29767342261448442","DOIUrl":"10.1177/29767342261448442","url":null,"abstract":"<p><p>Substance use disorder (SUD) during pregnancy and the postpartum period presents unique clinical and structural challenges that require integrated, evidence-based care. The intensity of perinatal care visits creates a critical opportunity to embed treatment for SUD within routine medical services. While many models of perinatal SUD (PSUD) care exist, they vary widely in structure and scope. A foundational and adaptable framework is needed to support implementation, promote consistency, and evaluate care quality across diverse health care settings. This manuscript presents a tiered framework for outpatient PSUD care, adapted from the SAMHSA-HRSA Integrated Behavioral Health model. The framework outlines 3 core domains: (1) Team Scope of Services, (2) Systematic Communication, and (3) Degree of Coordination stratified across 3 tiers that reflect increasing levels of integration and service maturity. By defining the components of integrated PSUD care, this model provides a shared language for clinical teams, researchers, and policymakers. The framework is illustrated through examples from established PSUD programs in Virginia and North Carolina, highlighting real-world application. Common challenges and regional considerations, including the unique needs of Appalachian populations and financial sustainability, are also discussed. This framework serves as a beginning tool for quality improvement, research, and health system planning. It prioritizes patient-centered care and scalability, supporting risk-appropriate models of PSUD treatment. By promoting consistency in service delivery, this approach aimed to improve mother-baby dyad outcomes and reduce overdose-related mortality.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"974-981"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978444","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":"How Is Food Addiction Addressed at U.S. Substance Use Disorder Treatment Facilities? Perspectives of Service Providers.","authors":"Danyi Li, Eric Shanazari, Artur Galimov, Deborah L Sinclair, Lizbeth Becerra, Leah Meza, Ashley N Gearhardt, Steve Sussman","doi":"10.1177/29767342261443841","DOIUrl":"10.1177/29767342261443841","url":null,"abstract":"<p><strong>Background: </strong>Substance use disorders (SUDs) are a leading public health concern in the United States. Food addiction (FA), as a common comorbidity or substitute addiction of SUDs, is not currently a fifth edition of the <i>Diagnostic and Statistical Manual of Mental Disorders</i> (DSM-5) diagnosis, with overlaps with SUDs and eating disorders (EDs). How FA is addressed in SUD treatment is understudied.</p><p><strong>Methods: </strong>Cross-sectional survey interviews with service providers (N = 85) from 68 SUD treatment facilities across 20 U.S. states asked an open-ended question on how FA was addressed. Descriptive statistics of FA prevalence were reported; Chi-square tests were used to assess bivariate associations between facility funding sources, FA treatment, and referral availability. Thematic analysis was conducted to identify emerging over-arching themes regarding FA-related practice.</p><p><strong>Results: </strong>Eight themes were identified: formal treatment offered at the facility; no treatment; referral for treatment; education; screening; monitoring; comorbidities or triggers of FA; and potential misunderstandings of FA. Among the 80% of facilities observing FA issues, 29% provided explicit/formal treatment, and 53% made referrals to ED treatment facilities. Facilities that accept insurance (<i>P</i> = .046) and self-pay (<i>P</i> = .008) were more likely to make referrals. Methamphetamine use, substitute addiction, trauma, homelessness experience, and malnutrition were potential FA triggers. Potential misconceptions about FA and EDs may undermine appropriate treatment.</p><p><strong>Conclusions: </strong>Formalizing FA assessment and diagnosis, and improving reimbursement mechanisms, may reduce potential health inequities between market-driven and publicly funded SUD treatment centers in FA treatment and referral resources. More training on FA, integrating evidence-based FA screening, monitoring, and treatment measures, is warranted to improve holistic SUD treatment quality and outcomes.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1183-1190"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147950712","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":"Upstream Overdose Prevention: Why the US Should Pilot a Safer, Regulated Drug Supply.","authors":"Tessa L Rife-Pennington, Katherine Hill, Claire M Zagorski, Jenna L Butner, Kimberly L Sue, Corey S Davis, Michael A Incze","doi":"10.1177/29767342261462675","DOIUrl":"10.1177/29767342261462675","url":null,"abstract":"<p><p>The United States overdose crisis is driven in large part by an increasingly unpredictable and contaminated drug supply, including fentanyl and its analogs and emerging adulterants such as xylazine and nitazenes. Drug checking interventions such as fentanyl test strips and Fourier Transform Infrared Spectroscopy are essential for harm reduction, yet they also highlight a central policy failure: they place the burden of safety on people who use drugs (PWUD) and frontline programs after drugs have already entered an unregulated market. We argue for a more pragmatic upstream public health response, authorizing pilots of a safer, regulated drug supply (\"safer supply\"), broadly defined as legal and regulated access to psychoactive substances or close pharmaceutical alternatives intended to reduce reliance on the unregulated drug market. International experience, particularly models in Switzerland, Canada, and the United Kingdom, demonstrates feasibility and suggests potential benefits, including improved health and social stability, reduced reliance on unregulated supply, and reduced acute care utilization in some settings. For the United States context, we propose a portfolio approach: near-term, healthcare-based pilots leveraging existing controlled-substance infrastructure (eg, opioid treatment programs, clinics, pharmacies, and tech-enabled dispensing) while preserving space for community-governed models with legal protections and longer-horizon, state-regulated pathways. We address predictable concerns (secondary sharing, youth initiation, community impact, mixed population-level findings) and outline guardrails and evaluation strategies that are PWUD-led, nonpunitive, and methodologically rigorous. We conclude with concrete policy actions to authorize pilots, establish legal protections, fund independent evaluation, and scale models that demonstrably reduce harm while integrating with harm reduction and treatment services.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"995-1005"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440657","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":"Advancing Opioid Use Disorder Treatment: A Narrative Review of Evidence-Based Solutions to Systems-Level Barriers in the US.","authors":"Amelia Bailey, Augustine W Kang, Rosemarie A Martin","doi":"10.1177/29767342261452648","DOIUrl":"10.1177/29767342261452648","url":null,"abstract":"<p><strong>Background: </strong>Evidence-based practices to treat opioid use disorder (OUD) include behavioral interventions and medications to treat OUD (MOUD). Each type of treatment has unique systems-level challenges that limit care access and care engagement. It is important to identify and address these challenges and provide evidence-based strategies to reduce barriers.</p><p><strong>Methods: </strong>In this narrative review, systems-level barriers that impede OUD treatment service delivery are reviewed by treatment type (MOUD, cognitive behavioral therapy, and contingency management), and how recent regulatory changes have the ability to reduce or alter these barriers are discussed. To do so, we review empirical literature and regulatory documents to cover the breadth of this topic.</p><p><strong>Results: </strong>Several OUD treatments that have established effectiveness are not able to reach full potential (ie, dissemination, uptake) because of systems-level barriers, notably related to rigid regulations, broad perceptions of treatment, and training and financing constraints. Recent changes aim to lessen restrictions surrounding MOUD delivery (eg, greater allowance for take-home doses of methadone) and allow for delivery of MOUD in innovative settings (eg, mobile health units). There are also reduced restrictions at the treatment provider level, including removal of the X-waiver. Despite lowering some barriers, OUD treatment delivery is still barred by strong forces related dominantly to stigma and financing.</p><p><strong>Conclusions: </strong>Future research directions to further understand and enhance effective OUD treatment delivery are identified, including the need to address individual, organizational, and external factors that surround the implementation of regulatory changes.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1244-1256"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207474","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 Health Impacts of Climate Change on People Who Use Alcohol and Other Drugs: Position Statement of AMERSA, Inc. (Association for Multidisciplinary Education and Research in Substance use and Addiction).","authors":"Jenna L Butner, Shannon Smith-Bernardin, Joyce Roberson-Steele, Brandee Madden, Valerie A Gruber, Judith I Tsui, Emma T Biegacki","doi":"10.1177/29767342261461050","DOIUrl":"10.1177/29767342261461050","url":null,"abstract":"<p><p>Climate change broadly threatens the health of individuals and communities. As adverse health impacts of climate change become more prevalent, researchers are beginning to investigate how climate-related events (CRE), such as extreme temperatures, intensified hurricanes, etc., impact the health of people who use alcohol and other drugs (PWUD). A growing body of evidence suggests that CREs exacerbate harms related to substance use and disrupt treatment and harm reduction services, exposing PWUD and those with substance use disorders (SUDs) to increased morbidity and mortality. The adverse health impacts of CREs and substance use interact in a synergistic manner, influenced by individual, community, and structural factors. Understanding this evolving intersection is crucial for developing policies and interventions to reduce the increased risk to PWUD. CREs exact a costly toll on health and healthcare infrastructure and are increasing in frequency and severity. Concurrently, substance use and addiction result in thousands of deaths each year and cost the United States hundreds of billions of dollars annually. Without efforts to improve our understanding of the social, medical, and economic implications of CREs on PWUD, and develop more prepared, resilient systems of care, we can expect this compounding burden to intensify over time with deadly consequences. Effective action will require sustained, multi-level commitments from researchers, policymakers, as well as frontline clinical and non-clinical service providers. AMERSA recommends 3 areas of action: advancing research at the intersection of CREs and substance use, enhancing policies and practice guidelines to ensure uninterrupted treatment and harm reduction services during and following CREs, and facilitating education and training for awareness and preparedness. AMERSA endeavors to provide leadership and guidance in fostering more resilient and adaptive systems of care for PWUD and those with SUD as characterized by driving awareness, understanding, preparedness, and the production of a climate change-prepared addiction workforce.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"953-958"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388419","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":"Strengthening the Peer Recovery Workforce: Recommendations in Response to the Office of National Drug Control Policy's Priorities.","authors":"Justin S Bell, Anna Unnerstall, Jon Soske, Dennis P Watson, William L White","doi":"10.1177/29767342261461474","DOIUrl":"10.1177/29767342261461474","url":null,"abstract":"<p><p>The expansion of peer recovery support services has not only rapidly integrated peers across service systems but also threatens to drift peer roles toward clinical duties and erode values that gave rise to the peer support movement. The earliest peer professional roles emerged from social advocacy efforts that rejected clinical, hierarchical, and coercive models of care, instead advancing nonclinical, mutual, and person-centered recovery support. As the U.S. Office of National Drug Control Policy calls to strengthen the peer workforce, it offers an opportunity to revisit the social movements that built peer support, clarify why these founding values were considered essential, and use these principles to guide contemporary policy and funding decisions. In this commentary, we provide historical context for the intention of professional peer support roles and articulate how federal and state policy can resist the force of role drift by grounding future workforce development in the movement's original values.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"982-989"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148428024","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":"Perspectives of Racial and Ethnic Emergency Department Patient-Clinician Concordance in Opioid Use Disorder Encounters.","authors":"Edouard Coupet, Marek C Chawarski, Kavari Hercules, Joseph L Williams, Alexandra Murphy Ward, Patricia H Owens, David A Fiellin, Kathryn F Hawk, Shara H Martel, Gail D'Onofrio","doi":"10.1177/29767342261489718","DOIUrl":"https://doi.org/10.1177/29767342261489718","url":null,"abstract":"<p><strong>Background: </strong>Significant racial and ethnic disparities in the treatment of opioid use disorder (OUD) in the emergency department (ED) remain. Little is known about how ED patients with OUD perceive racial and ethnic concordance and whether these perceptions differ by race and ethnicity. This study seeks to elicit and compare perspectives on ED patient-clinician racial and ethnic concordance among Black, Hispanic, and White individuals with OUD.</p><p><strong>Methods: </strong>Two trained qualitative investigators conducted semi-structured individual interviews with 57 participants (20 non-Hispanic Black, 20 non-Hispanic White, and 17 Hispanic) previously enrolled in Project ED-Innovation. We used the National Institute on Minority Health and Health Disparities research framework to explore perspectives on ED patient-clinician racial and ethnic concordance. Participants were recruited using purposeful sampling from 8 ED sites: Cooper (NJ), Grady Memorial (GA), Henry Ford (MI), Maine (ME), University of New Mexico (NM), University of Utah, and the Alameda Health System (CA). Transcripts were analyzed by race and ethnicity.</p><p><strong>Results: </strong>The mean age (SD) of participants was 41.7 years (12.8) and 35.1% (20/57) were female. Twenty participants (35.1%) identified as Black, 17 (29.8%) as Hispanic, and 20 (35.1%) as White. A consistent theme among all groups was the importance of compassion and professionalism over racial and ethnic ED patient-clinician concordance, particularly when discussing addiction. A unique theme among Black and Hispanic participants was a feeling of comfort and connection derived from perceived shared cultural experiences and experiences of discrimination with an ED clinician of the same racial and ethnic background.</p><p><strong>Conclusions: </strong>Participants from all 3 groups valued the therapeutic patient-clinician relationship more than racial and ethnic concordance. Black and Hispanic participants felt comfort from shared cultural experiences with ED clinicians with racial and ethnic concordance. These findings underscore the importance of patient-centered communication in enhancing ED access to OUD treatment for all populations.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261489718"},"PeriodicalIF":2.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083484","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":"\"I Just Knew That I Needed Help\": Primarily Latine Adolescents and Young Adults Speak About Medication Treatment for Opioid Use Disorder in the Fentanyl Era.","authors":"Catherine A Raney, Julia H Raney, Paige Tripp, Bonnie Halpern-Felsher, Lee A Trope, Jayme L Congdon","doi":"10.1177/29767342261489719","DOIUrl":"10.1177/29767342261489719","url":null,"abstract":"<p><strong>Background: </strong>Medications for opioid use disorder (MOUD) are evidence-based, lifesaving treatments for adolescents and young adults (AYAs) with opioid use disorder (OUD). However, AYAs access MOUD at alarmingly low rates. Therefore, this study investigated facilitators, barriers, and health services preferences for accessing MOUD among AYAs desiring treatment for OUD within a safety-net health system.</p><p><strong>Methods: </strong>We conducted 11 semi-structured interviews with AYAs aged 16 to 21 who initiated MOUD in a county safety-net health system. Patients started MOUD (primarily buprenorphine) in inpatient, outpatient, and/or emergency department settings. We employed combined inductive and deductive coding and thematic analysis.</p><p><strong>Results: </strong>Ten of 11 (91%) AYAs identified as Latine, and 9 (82%) were publicly insured. We identified 4 themes: (1) AYAs weighed the consequences of ongoing non-prescribed opioid use when deciding to engage in treatment; (2) perceived therapeutic and adverse effects of MOUD influenced AYAs' desire to start and continue MOUD; (3) Relationships with peers, caregivers, parole officers, and healthcare providers enabled AYAs to start and continue OUD treatment; (4) Inpatient MOUD initiation experiences were largely positive, though a few had negative experiences.</p><p><strong>Conclusion: </strong>This predominantly publicly insured, Latine sample of AYAs with OUD identified relationships, perceived risks of opioids, and perceived effectiveness of MOUD as key facilitators to engage in MOUD. Also, AYAs largely appreciated starting MOUD inpatient, though many identified barriers to continuing MOUD long-term. These perspectives provide essential input into future research, clinical, and public health interventions.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261489719"},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining Site-Level and Structural Factors Influencing the Recruitment and Engagement of Participants of Color in Perinatal Substance Use Research: Insights From the Medication Treatment for Opioid Use Disorder in Expectant Mothers (MOMs) Trial.","authors":"Erin Major, Alexindra Wheeler, Julyvette Vazquez, Latisha Goullaud, Frankie Kropp, Shelly F Greenfield, Marcela C Smid, Timothy Wilens, T John Winhusen, Davida M Schiff","doi":"10.1177/29767342261478707","DOIUrl":"https://doi.org/10.1177/29767342261478707","url":null,"abstract":"<p><strong>Background: </strong>Racial and ethnic inequities persist in perinatal opioid use disorder (OUD) care, with pregnant and postpartum people of color facing structural barriers to using medications to treat OUD (MOUD). Because access to clinical research is often mediated through treatment settings, these structural barriers may also shape who is reached, recruited, and retained in perinatal OUD trials. The Medication Treatment for OUD in Expectant Mothers trial (NCT03918850) provided an opportunity to assess how site-level and policy contexts influenced equitable recruitment, including gaps between projected and actual enrollment.</p><p><strong>Methods: </strong>We employed a convergent parallel mixed-methods design integrating thematic analysis of semi-structured qualitative interviews with non-White and/or Hispanic trial participants and research staff, site survey data, state policy classifications, and administrative enrollment data from the 13 trial sites. We examined how clinical structures, staffing composition, and policy environments shaped equitable recruitment. For each site, we calculated a recruitment ratio (actual/expected non-White and/or Hispanic enrollment).</p><p><strong>Results: </strong>Among the 13 trial sites, 3 exceeded projected recruitment of non-White and/or Hispanic participants, 7 fell below projections, and 2 enrolled no non-White and/or Hispanic participants. Recruitment ratios (actual/expected) ranged from 0.0 to 6.3. Sites that exceeded projections commonly reported the inclusion of peer clinical staff and integration of prenatal and OUD care and were more often located in states without mandated reporting of MOUD during pregnancy. Qualitative analyses of participant (n = 17) and research staff interviews (n = 32) identified themes of trust, representation, and lived experience, emphasizing their importance for equitable recruitment and engagement.</p><p><strong>Conclusion: </strong>Equity in perinatal substance use disorder (SUD) research depends not only on inclusive trial design but also on the relational and policy conditions that build trust and enable participation. Beyond demographic targets, findings point to institutional practices, community partnerships, and supportive policy environments as actionable levers to promote equitable recruitment and engagement in perinatal SUD research.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261478707"},"PeriodicalIF":2.4,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070849","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}