Substance use & addiction journal最新文献

{"title":"Beyond Disorder: Stigma and Identity Across the Substance Use Health Spectrum in a Public Health Framework.","authors":"Tanisse Epp, Mya Duffy, Kim Hellemans","doi":"10.1177/29767342261483468","DOIUrl":"https://doi.org/10.1177/29767342261483468","url":null,"abstract":"<p><strong>Background: </strong>Despite the widespread prevalence and health impacts of substance use (including alcohol), policies and services remain anchored in diagnostic criteria, overlooking people whose substance use does not fit clinical categories. This structural emphasis on meeting diagnostic thresholds often means people wait until crisis to seek help rather than engaging with support earlier. Substance use health frameworks instead encourage understanding substance use as an aspect of health that occurs along a continuum rather than a simple binary between \"healthy\" and \"disordered\" making visible a wider range of experiences and outcomes. While there is early adoption of this framework, little is known about how people understand their place on this spectrum or how it shapes their relationships with substances, identity, and stigma.</p><p><strong>Methods: </strong>Semi-structured focus groups were conducted with men and women across the substance use health spectrum (n = 18). Codebook thematic analysis was used to identify dominant narratives about substance use, identity, and stigma.</p><p><strong>Results: </strong>Participants described diverse and shifting relationships with substances, including individuals who do not currently or have never used substances (n = 7), who have a relationship with one or more substances (n = 8), and who notice a change in their health with regard to their substance use (n = 3). Analysis generated four themes: spectrum identity negotiation and fluidity; social contexts, norms, and hierarchies; negotiating stigma across public, self, and structural levels; and gendered patterns in substance use discussions.</p><p><strong>Conclusion: </strong>The substance use health spectrum offers language for describing substance use as a dynamic aspect of health and identity rather than a fixed diagnostic status. By exploring how people across the continuum understand and negotiate stigma, our findings show how the spectrum can inform public health messaging, services, and research that reflect substance use across the population and move stigma reduction beyond disorder‑focused approaches.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261483468"},"PeriodicalIF":2.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877086","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 Systematic Review of Interventions to Reduce Clinician Stigma Toward Individuals With Opioid Use Disorder.","authors":"Kara J Pavone, Cierra Penny, Karen Jennings Mathis, Anita N Jacobson, Nicole H Weiss, Peggy Compton","doi":"10.1177/29767342261476442","DOIUrl":"10.1177/29767342261476442","url":null,"abstract":"<p><strong>Background: </strong>Despite declines in opioid overdose deaths, stigma toward individuals with opioid use disorder (OUD) among clinicians remains a critical barrier to high-quality care. Stigma compromises therapeutic relationships, discourages care-seeking, and negatively affects clinical decision-making. This review aimed to: (1) identify clinician groups targeted by stigma-reduction interventions; (2) describe stigma measurement tools used; and (3) examine the types and effectiveness of interventions designed to reduce OUD-related stigma.</p><p><strong>Methods: </strong>A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and CINAHL were searched for studies published between 2020 and 2025. Studies were included if they evaluated interventions explicitly aimed at reducing stigma toward individuals with OUD among U.S. clinicians or trainees. Study quality was assessed using the Johns Hopkins Nursing Evidence-Based Practice guidelines.</p><p><strong>Results: </strong>Nineteen studies met inclusion criteria, predominantly single-group pretest-posttest designs, with sample sizes ranging from 5 to 1842 participants. Thirteen studies targeted students or trainees, while 6 focused on practicing clinicians. Interventions were categorized as didactic, contact-based, or experiential. Didactic interventions produced modest improvements in attitudes, particularly among students, but were less effective for practicing clinicians. Contact-based interventions, involving exposure to individuals with lived experience, were generally more effective among students, with mixed results among clinicians. Experiential interventions, including simulation, virtual reality, and supervised clinical experiences, consistently reduced stigma across student and clinician populations.</p><p><strong>Conclusions: </strong>Experiential and contact-based interventions appear most effective for reducing stigma toward individuals with OUD, particularly among practicing clinicians. Future research should prioritize practicing clinicians, employ theory-informed designs, standardize stigma measures, and evaluate long-term and scalable effects to optimize stigma reduction in healthcare settings.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261476442"},"PeriodicalIF":2.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868809","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":"Implementation of Alcohol-Related Care in 3 Veterans Health Administration Hepatology Clinics: A Mixed-Methods Summative Evaluation.","authors":"Emily C Williams, Madeline C Frost, Olivia V Fletcher, Carol E Achtmeyer, Jessica A Chen, Rachel L Bachrach, E Jennifer Edelman, Bryan J Weiner, George N Ioannou, Judith I Tsui","doi":"10.1177/29767342261472352","DOIUrl":"https://doi.org/10.1177/29767342261472352","url":null,"abstract":"<p><strong>Background: </strong>Hepatology specialty clinics present a unique opportunity to provide alcohol-related care (brief counseling, treatment referral, medications for alcohol use disorder [MAUD]). We used practice facilitation to implement alcohol-related care in 3 distinct Veterans Health Administration hepatology clinics in the western U.S. and conducted a mixed-methods summative evaluation assessing documented alcohol-related care (adoption) and patient experiences (acceptability/fidelity).</p><p><strong>Methods: </strong>Three sources of data were triangulated. <i>Electronic health record (EHR) data</i> extracted for patients receiving care at the 3 clinics pre-, during, and post-implementation measured patient characteristics and trends in documented alcohol-related care (adoption). <i>Structured chart reviews</i> for a random sample of 137 patients with documented unhealthy alcohol use assessed documentation of 3 additional adoption measures: (1) alcohol-related discussions, (2) discussion of/referral to treatment, and (3) discussion/receipt of MAUD. <i>Qualitative interviews</i> with 12 patients (4/clinic) with documented alcohol-related discussions during the implementation/post-period were conducted to assess patients' perspectives (acceptability/fidelity).</p><p><strong>Results: </strong>Five thousand four hundred three unique patients were seen during the study; 2566 at Site 1, 2428 at Site 2, and 409 at Site 3. EHR data showed dynamic but little overall change in alcohol use or alcohol-related care over time. In chart reviews during pre-implementation, 74% had documented alcohol discussions, 23% of those with alcohol discussions had discussion of/referral to treatment, and 15% had discussion/receipt of MAUD. During/post-implementation, 75% had alcohol discussions, 59% of those with alcohol discussions had discussion of/referral to treatment, and 25% had discussion/receipt of MAUD. Interview participants generally remembered and were satisfied with alcohol-related discussions. Patients appreciated when clinicians described how liver damage can reverse with abstinence and expressed confidence in their ability to abstain.</p><p><strong>Conclusions: </strong>Practice facilitation may have supported adoption of alcohol-related care in hepatology clinics, which patients generally appreciated. Clinicians in hepatology specialty clinics should encourage honesty, emphasize the benefits of abstinence, and provide patient-centered messaging.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261472352"},"PeriodicalIF":2.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868795","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":"Evaluation of an Online, Asynchronous Tobacco Treatment Specialist Training: A Mixed-Methods Analysis of Reach, Perceived Trainee Competency, and Training Quality.","authors":"Tresza D Hutcheson, Sharon Fitzgerald Wolff, MeLinda Lair, Kimber P Richter, Babalola Faseru","doi":"10.1177/29767342261477938","DOIUrl":"https://doi.org/10.1177/29767342261477938","url":null,"abstract":"<p><strong>Background: </strong>Although tobacco use disorder is the most prevalent substance use disorder in the United States and remains the world's leading cause of preventable mortality, health care and social service providers receive little training in how to treat it during their formal education. To enhance access to Tobacco Treatment Specialist (TTS) training, we developed an online, self-paced, asynchronous training paired with a 1-day virtual workshop for skills building and demonstration.</p><p><strong>Methods: </strong>We calculated the reach of our training based on the counties in which trainees worked. Trainees assessed their perceived competence in comprehensively addressing tobacco use across 11 nationally defined competency areas. They assessed the quality of the course and provided written qualitative feedback on course strengths, weaknesses, and areas for improvement. We calculated descriptive statistics for quantitative data and used descriptive content analysis to summarize qualitative data.</p><p><strong>Results: </strong>Between 2021 and 2024, 371 individuals participated, representing 54% of the counties and 91% of the state's population. Post-training, the proportion of trainees reporting that they met each tobacco treatment competency ranged from 77% to 91%. All trainees met predefined performance criteria on standardized knowledge assessments, despite that most (82%) reported little experience in treating tobacco. Trainees agreed the program met quality standards for online trainings. Trainee work settings were diverse, and most trainees (79.8%) received a scholarship. Qualitative analysis identified skills-building activities, program flexibility, and the self-paced format as key strengths of the program.</p><p><strong>Conclusion: </strong>The online TTS program increased state capacity to address tobacco use across multiple settings and geographic regions, demonstrating a scalable, accredited approach to expanding the tobacco treatment workforce. This approach is relevant to other state and regional efforts and has the potential to increase access to evidence-based tobacco treatment interventions. Providing state agency-funded scholarships alongside asynchronous training increased training capacity and expanded geographic reach.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261477938"},"PeriodicalIF":2.4,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841952","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":"Benzodiazepine Withdrawal Masked by Clonidine: An Emergency Presentation With a Diagnostic Challenge.","authors":"Isuri Wimalasiri, Simon Boyd, Soumitra Das, Naveen Thomas","doi":"10.1177/29767342261479888","DOIUrl":"https://doi.org/10.1177/29767342261479888","url":null,"abstract":"<p><strong>Background: </strong>Benzodiazepines are central nervous system depressants that act on GABA-A receptors and enhance the activity of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). Prolonged use of benzodiazepines carries a high risk of physiological dependence and abrupt discontinuation following high-dose or long-term benzodiazepine use may precipitate withdrawal. Benzodiazepine withdrawal symptoms include autonomic hyperarousal (e.g., tachycardia, hypertension, sweating and tremors), anxiety, insomnia, confusion and rarely psychotic features including delusions and hallucinations. Clonidine is an α₂-adrenergic agonist that has sympatholytic activity and thereby attenuates the features of autonomic hyperarousal. In a person who is on regular clonidine, benzodiazepine withdrawal symptoms may be masked by clonidine, resulting in a diagnostic dilemma.</p><p><strong>Case: </strong>A 35-year-old man with no significant past psychiatric history presented to the Emergency Department with confusion, persecutory delusions, auditory and visual hallucinations, and bradycardia (40-45 bpm) for 3 days. He underwent a below-knee amputation a few months ago following complications of a crush injury. He had been on multiple medications for post-amputation pain and had abruptly ceased long-term diazepam a week before his current presentation. Organic screening for delirium, metabolic and infective causes were unremarkable. The presentation was suggestive of benzodiazepine withdrawal psychosis; however, persistent bradycardia was inconsistent with the typical autonomic hyperarousal seen in benzodiazepine withdrawal.A thorough medication review revealed concomitant administration of clonidine, and a diagnosis of benzodiazepine withdrawal masked by clonidine's sympatholytic effect was made. With recommencement and titration of benzodiazepines, psychosis and confusion resolved within 24 hours.</p><p><strong>Discussion: </strong>This case highlights the need for awareness of drug interactions that may mask typical withdrawal symptoms of benzodiazepines. Furthermore, it emphasises the need for thorough collateral history particularly when the patient is incapacitated and highlights the importance of addressing complex pain needs to prevent self-medication.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261479888"},"PeriodicalIF":2.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815379","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":"Health Harms Associated With Forced Displacements Among People Who Use Drugs in San Francisco, California.","authors":"Esther O Chung, Cariné E Megerian, Leslie W Suen, Lynn D Wenger, Bradley Ray, Barrot H Lambdin, Alex H Kral","doi":"10.1177/29767342261476437","DOIUrl":"10.1177/29767342261476437","url":null,"abstract":"<p><strong>Background: </strong>Forced displacements may increase overdose risk among people who use drugs (PWUD) through disruptions to naloxone, safer drug use supplies, and substance use disorder (SUD) treatment access. We investigated whether forced displacements were associated with nonfatal overdose, naloxone access, and SUD treatment access among PWUD in San Francisco, California.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey of 790 PWUD from September 2024 to September 2025. Participants reported number of forced displacements by police, security guards, or other officials in the past 3 months. Outcomes included past 3-month overdoses, naloxone access, and SUD treatment. We conducted separate multivariable modified Poisson models with robust standard errors for each outcome, adjusting for age, gender, race, housing status, past 3-month opioid use, and interviewer.</p><p><strong>Results: </strong>In the past 3 months, 70% of participants were forcibly displaced at least once and 36% were displaced 20 or more times. Of those forcibly displaced at least once, 65% had their belongings taken by those displacing them. Eleven percent experienced an overdose; 62% were provided with naloxone; 33% received any SUD treatment, and 18% were currently receiving any treatment. Those forcibly displaced 20+ times had 1.99 times the prevalence of overdose of non-displaced participants (95% confidence interval [CI]: 1.01-3.93). Participants who had their belongings taken had 1.59 times the prevalence of nonfatal overdose of those who did not (95% CI: 1.00-2.53). There was no association between forced displacements and receiving any SUD treatment, but participants who were forcibly displaced 20+ times had a lower prevalence of currently receiving any treatment (adjusted prevalence ratio = 0.44, 95% CI: 0.27-0.72).</p><p><strong>Conclusions: </strong>Our findings demonstrate forced displacements have significant health harms and negatively affect treatment services. Forced displacement policies should be replaced with public health approaches that prioritize stability, housing, and supportive services.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261476437"},"PeriodicalIF":2.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13618012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815315","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":"Distinguishing Medical From Nonmedical Cannabis Use Among US Young Adult Cancer Survivors.","authors":"Carla J Berg, Laura C Schubel, Darcey M McCready, Hermela Amdeta, Diane Ndisebuye, Cassidy R LoParco, Hannah Arem","doi":"10.1177/29767342261477601","DOIUrl":"https://doi.org/10.1177/29767342261477601","url":null,"abstract":"<p><strong>Background: </strong>Many young adults (YAs) who use cannabis use it both medically and nonmedically, which poses particular risks (eg, problematic use). Given the relevance of cannabis use among those with cancer, this qualitative study assessed YA cancer survivors' experiences with and distinctions between medical and nonmedical use.</p><p><strong>Methods: </strong>From April to June 2025, we conducted qualitative interviews with 23 YA survivors (ages 18-39) reporting past-month cannabis use (<i>M</i>_age = 33.65 [SD = 5.99], 73.9% female, 73.9% White, <i>M</i> = 1.22 [SD = 1.09] years post-treatment). Data regarding experiences with and distinctions between medical versus nonmedical use were analyzed using deductive-inductive thematic analysis.</p><p><strong>Results: </strong>The majority first used nonmedically (60.9%) and currently used both medically and nonmedically (56.4%). Some participants believed that the distinction was clear (ie, medical use addresses specific symptoms). Some likened nonmedical use to how people generally use alcohol (eg, to relax or socialize). Some distinguished medical versus nonmedical use based on the context (eg, daytime for nonmedical and bedtime for medical) or product used (eg, sativa for nonmedical and indica for medical). Some believed that people had overly restricted definitions of medical use (eg, for those in chemotherapy or hospice), which disregards other medical uses (eg, for pain, anxiety, and insomnia). The majority said the medical versus nonmedical distinction was unclear, particularly regarding use for anxiety. Some underscored that using cannabis to treat symptoms (eg, pain, nausea, and anxiety) provided both symptom relief that enabled enjoyable activities and the recreational \"high.\"</p><p><strong>Conclusion: </strong>The findings underscore the need to enhance medical oversight of cannabis use among YA cancer survivors to minimize risks and facilitate potential therapeutic benefits.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261477601"},"PeriodicalIF":2.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820873","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 Clinic-Level Intervention May Promote Methadone Patients' Consistent Daily Adherence to Their Dosing Schedules.","authors":"Alissa Davis, Richard A Crosby, Gregory A Carter, Sana Yousaf, Benjamin R Brady, Linnea B Linde-Krieger, Zhanette Coffee, Arlene N Mahoney, David Frank, Patrick S Rivers, Beth E Meyerson","doi":"10.1177/29767342261476896","DOIUrl":"https://doi.org/10.1177/29767342261476896","url":null,"abstract":"<p><strong>Background: </strong>Substandard practices in opioid treatment programs (OTPs) contribute to missed doses and treatment discontinuation. Training OTP staff to deliver trauma-informed methadone treatment can facilitate the adoption of patient-centered practices and improve patient methadone access and use. A clinic-level, multimodal intervention to promote patient-centered methadone care was pilot-tested in 2 Arizona OTP clinics.</p><p><strong>Methods: </strong>A single-arm, repeated measures pilot trial consisting of 1.5 months preintervention onboarding and 4 months intervention and data collection was conducted from September 2024 to March 2025. Consistent daily methadone adherence was the primary outcome. Data were collected from patients (n = 91) in surveys at baseline and monthly thereafter. Bayesian multilevel generalized linear mixed models estimated the changes in consistent daily dosing from baseline (preintervention) to study conclusion (postintervention).</p><p><strong>Results: </strong>Patients had a greater likelihood of consistent daily methadone adherence in the past 30 days at study endpoint compared to baseline (adjusted odds ratio 3.63 [95% credible interval 1.27-10.60]).</p><p><strong>Conclusions: </strong>Findings from this exploratory study indicate the potential of this clinic-level intervention to support more consistent methadone use. Interpretive caution is advised as this is a single-arm design with study attrition, and limited follow-up period. Future studies will assess the effectiveness of this intervention in a large-scale, multisite randomized controlled trial.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261476896"},"PeriodicalIF":2.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815332","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 Know Far More Dead People Than I Do Live Ones\": Social Isolation Among Older Adults Who Use Stimulants.","authors":"Grace Gundy, Vanessa M McMahan, Nigel Anderson, Xochitl L Marti, Phillip O Coffin","doi":"10.1177/29767342261478829","DOIUrl":"https://doi.org/10.1177/29767342261478829","url":null,"abstract":"<p><strong>Background: </strong>Social isolation is associated with poor physical health and premature mortality. Midlife and older adults who use stimulants (cocaine or methamphetamine) may be especially vulnerable to social isolation.</p><p><strong>Methods: </strong>We conducted in-depth semi-structured interviews with 35 participants who used cocaine or methamphetamine for at least 5 years and 10 of the past 30 days in San Francisco, CA. Interviews included validated scales and open-ended questions on sociodemographic characteristics, substance use history, social support, and social capital. We present proportions of categorical measures and medians of continuous variables. Social support and capital scores were compared using Wilcoxon rank sum tests. Qualitative data were transcribed verbatim and coded until consensus. Inductive thematic analysis identified emergent themes of social isolation.</p><p><strong>Results: </strong>Median age was 55 years (interquartile range: 47-62), 58% were black or African American, and 34% were unhoused/marginally housed. All participants smoked cocaine or methamphetamine. Social support and capital were limited. Participants described profound loss of loved ones that deepened their isolation, while stigma around substance use further eroded remaining relationships. With limited support, many participants used stimulants to cope with grief and loneliness. A strong preference for solitary substance use emerged, as both a means of control and a response to mistrust, but this practice reinforced cycles of isolation and substance use.</p><p><strong>Conclusions: </strong>Older people who use stimulants represent a population with distinct needs, and interventions that increase their social engagement may help address social isolation, substance use, and related health outcomes.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261478829"},"PeriodicalIF":2.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809691","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":"Policy Pathways for Addressing Opioid-Stimulant Polysubstance Use.","authors":"Kechna Cadet, Ashly E Jordan, Noa Krawczyk, Amanda Hall, Pat Lincourt, Pamela Mund, Amanda M Bunting","doi":"10.1177/29767342261469746","DOIUrl":"10.1177/29767342261469746","url":null,"abstract":"<p><p>The United States continues to grapple with the shifting substance use landscape among the emerging concurrent use of opioids and stimulants. Polysubstance use (PSU) of opioids and stimulants, whether intentionally or unintentionally, has increased substance use related morbidity and mortality. Changes at the policy level are needed to effectively curb overdose and other adverse outcomes. This article outlines 3 policy changes that are particularly relevant to opioid-stimulant PSU: (1) reforms in opioid agonist treatment policy, (2) reforms in payment for evidence-based treatment, and (3) reforms of drug paraphernalia laws. The current overdose crisis requires a multidimensional paradigm shift toward patient-centered and harm reduction focused policies that will expand access to comprehensive evidence-based treatments and services for individuals engaged in opioid and stimulant PSU.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261469746"},"PeriodicalIF":2.4,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804308","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}