Journal of substance use and addiction treatment最新文献

{"title":"Post-overdose outreach programs in Massachusetts before and after the onset of the COVID-19 pandemic.","authors":"Alexander Y Walley, Jiayi Wang, C To, MaryKate Duska, Stephen Murray, Moriah Wiggins, Andrew Rolles, Shapei Yan, Sarah Kosakowski, Sarah M Bagley, Ziming Xuan, Justeen Hyde, Scott W Formica","doi":"10.1016/j.josat.2025.209799","DOIUrl":"https://doi.org/10.1016/j.josat.2025.209799","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the characteristics of Massachusetts post-overdose outreach programs before and after the onset of the COVID-19 pandemic and identify program adaptations and practices.</p><p><strong>Methods: </strong>We surveyed Massachusetts post-overdose programs about programming onset, funding, outreach encounters, naloxone distribution, medication for opioid use disorder (MOUD) referrals, and program practices before and after the onset of the COVID-19 pandemic. We calculated frequencies and summary statistics for program characteristics and practices. We compared programs that started before and after the onset of the COVID-19 pandemic using Pearson Chi-squared and Fisher's Exact tests.</p><p><strong>Results: </strong>As of July 2022, we identified 256 programs active in 242 (69 %) of Massachusetts' 351 municipalities. Before March 2020, 160 \"pre-pandemic onset\" programs were active. After March 2020, 96 \"post-pandemic onset\" programs started. In 2022, most were grant funded (89 % (227/256)). Initial survivor contact was attempted via phone (79 % (201/256)) and text (47 % (120/256)), most commonly by a recovery coach (77 % (196/256)). Most programs offered fentanyl test strips and naloxone. Some programs, more commonly pre-pandemic onset, offered safer smoking and injecting supplies. Among the 160 pre-pandemic onset programs, new practices included recommending virtual spotting (44 % (70/160)), facilitating MOUD telemedicine (24 % (39/160)), outreach for people using cocaine and methamphetamine (42 % (67/160)), and referring to race and ethnicity congruent services (31 % (50/160)).</p><p><strong>Conclusion: </strong>Massachusetts post-overdose outreach programs expanded following the COVID-19 pandemic onset. Services and innovations included resources to reduce harms from the unregulated drug supply (e.g., fentanyl test strips) and more inclusive outreach (e.g., include people using stimulants and race and ethnicity congruent services).</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209799"},"PeriodicalIF":1.9,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056394","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":"U.S. states opting out of expanded methadone take-home policies and associated mortality","authors":"Victor Roy ,&nbsp;Michele J. Buonora ,&nbsp;Cristina Murray-Krezan ,&nbsp;Anthony Fabio ,&nbsp;Paul J. Joudrey","doi":"10.1016/j.josat.2025.209800","DOIUrl":"10.1016/j.josat.2025.209800","url":null,"abstract":"<div><h3>Background</h3><div>Historically, federal regulations limited take-home methadone doses largely due to concerns about methadone-related overdose. In response to the COVID-19 pandemic, an emergency federal policy in March 2020 permitted states to expand take-home methadone doses. Our objective was to utilize state-level variation in take-home expansion to compare changes in methadone related overdose death rates among states that opted into and then out of expanded take-home dosing with states that opted into and continued the policy.</div></div><div><h3>Methods</h3><div>We used an extended two-way fixed effects difference-in-differences (DID) approach. The intervention group included states that initially opted into and then out of expanded take-home dosing, while the comparison group included states that opted into and continued the policy. Our primary outcome was the average treatment effect on the treated states (ATET) using quarterly rate of methadone-related overdose deaths per 100,000 persons from April 2020 to December 2022. Data sources included a state policy review, CDC WONDER, and U.S. Census Bureau.</div></div><div><h3>Results</h3><div>The intervention group included three states that opted out of expanded take-home dosing, while the comparison group comprised 16 states maintaining the policy. We found no significant association between opting out of expanded take-home dosing and methadone-related overdose death rates [ATET = 0.02, 95 % CI = (−0.03, 0.47), <em>p</em> = 0.47]. Adjustments for non-methadone-related overdose variables yielded similar results.</div></div><div><h3>Conclusion</h3><div>States who continued expanded take-home methadone dosing did not subsequently experience a detectable increase in methadone-related overdose deaths relative to states that opted out of the policy. This evidence suggests that policies expanding methadone take-homes are safe at a population level, which can inform deliberations within states that currently maintain strict restrictions.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"179 ","pages":"Article 209800"},"PeriodicalIF":1.9,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024860","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 effects of psychostimulant prescription on opioid use disorder among people with co-occurring ADHD","authors":"Mohammad Yaseliani ,&nbsp;Youngsuhk Jo ,&nbsp;Lake Lindo ,&nbsp;Jabed Al Faysal ,&nbsp;Md Mahmudul Hasan","doi":"10.1016/j.josat.2025.209794","DOIUrl":"10.1016/j.josat.2025.209794","url":null,"abstract":"<div><h3>Importance</h3><div>Attention-deficit/hyperactivity disorder (ADHD) is a condition often comorbid with substance use disorders. With the increase in opioid and stimulant overdoses, there remains concern regarding the appropriateness of psychostimulants for patients on maintenance therapy for opioid use disorder (OUD) with co-occurring ADHD.</div></div><div><h3>Objectives</h3><div>To assess the impact of psychostimulant use on outcomes of OUD maintenance therapy with buprenorphine based on rates of (1) treatment discontinuation and (2) opioid-related hospitalization.</div></div><div><h3>Design, setting, and participants</h3><div>This present investigation used a retrospective cohort study design consisting of a secondary analysis of data collected from IBM MarketScan Commercial claims from 2011 to 2021. Individuals were aged 12 to 64 with concurrent ADHD and OUD diagnosis receiving buprenorphine treatment.</div></div><div><h3>Exposures</h3><div>Presence of psychostimulant prescriptions.</div></div><div><h3>Main outcomes and measures</h3><div>Primary outcomes were buprenorphine discontinuation and opioid-related hospitalization.</div></div><div><h3>Results</h3><div>Study sample included 10,712 individuals with comorbid ADHD and OUD (mean age of 31.7 years, SD 10.9) who initiated buprenorphine maintenance therapy. 5190 individuals received psychostimulant prescriptions while 5522 individuals did not. Individuals who received psychostimulants demonstrated lower odds of buprenorphine discontinuation (OR = 0.669, 95 % CI = 0.610, 0.734) and hospitalization (OR = 0.493, 95 % CI = 0.418, 0.581). A one-unit increase in the psychostimulant fill count (IRR = 0.580, 95 % CI = 0.493, 0.683) was associated with a lower incidence rate of hospitalization.</div></div><div><h3>Conclusions</h3><div>In patients with a dual diagnosis of ADHD and OUD on buprenorphine therapy, treatment of ADHD with prescription psychostimulants is associated with improved adherence to buprenorphine and lower odds of opioid-related hospitalization.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"179 ","pages":"Article 209794"},"PeriodicalIF":1.9,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981287","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":"“What's the point of telling them?”: Unspoken struggles of pregnant women with substance use history in Australian prisons","authors":"So Bi Kim ,&nbsp;Maja Lindegaard Moensted ,&nbsp;Bethany White ,&nbsp;Jillian Roberts ,&nbsp;Katerina Lagios ,&nbsp;Carolyn A. Day","doi":"10.1016/j.josat.2025.209791","DOIUrl":"10.1016/j.josat.2025.209791","url":null,"abstract":"<div><h3>Introduction</h3><div>Pregnant women with substance use histories face many challenges during incarceration, leading to potentially harmful outcomes for both maternal and infant health. However, research on how to address these challenges is limited. Early disclosure of substance use is crucial for engaging in and receiving timely, appropriate intervention and follow-up care post-release. Current evidence suggests women under-report their substance use when pregnant due to stigma and fear of losing child custody. Whilst these factors are likely exacerbated in the prison environment, specific underlying factors that influence women's decisions to withhold disclosure of their substance use in the context of prison reception are unknown.</div></div><div><h3>Methods</h3><div>We conducted qualitative interviews to explore the viewpoint of currently or recently pregnant women (<em>n</em> = 31) with a history of substance use currently incarcerated in two adult women's prisons in New South Wales, Australia, between April and October 2022. Thematic analysis was used with line-by-line coding. Goffman's theory of total institution, mortification, and stigma was used to examine the experiences and underlying factors influencing pregnant women to disclose their substance use during the prison reception process.</div></div><div><h3>Findings</h3><div>Several unique barriers to disclosing in prison settings were identified. Barriers included tension surrounds the reception process itself (e.g. long waits, hunger, fatigue, and lack of privacy), frustration due to repeated requests for recounting substance use history, fear of negative consequences following disclosure (e.g., possible extension of incarceration or impacting on child custody post-release), and perceived a lack of benefit of disclosing, including insufficient treatment options, particularly for methamphetamine use disorder, or being housed longer in a restricted high-security cell.</div></div><div><h3>Conclusions</h3><div>Findings highlighted the underlying dynamics and contextual factors that influence the decision of pregnant women to disclose their substance use at prison reception. Understanding these factors and addressing gaps in clinical practice is crucial to enhancing open disclosure of substance use, leading to timely and appropriate intervention, thereby reducing potential harm for both mother and foetus.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"178 ","pages":"Article 209791"},"PeriodicalIF":1.9,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913074","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":"Factors associated with mortality following hospitalization among veterans with opioid use disorder.","authors":"Michael A Incze, Sophia Huebler, Jacob D Baylis, Andrea Stofko, A Taylor Kelley, Ingrid A Binswanger, Gavin Bart, Andrew J Saxon, Ajay Manhapra, Adam J Gordon","doi":"10.1016/j.josat.2025.209797","DOIUrl":"10.1016/j.josat.2025.209797","url":null,"abstract":"<p><strong>Introduction: </strong>Hospitalizations are common among people with opioid use disorder (OUD). While hospitalizations represent opportunities to engage patients and offer treatment, they are also destabilizing events associated with an increased risk of death in the post-hospitalization period.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study within the Veterans Health Administration including all Veterans with OUD who experienced at least one medical hospitalization between January 2011 and December 2021. We examined which patient-level clinical and demographic factors were associated with all-cause and opioid-related mortality within 0-30 and 0-365 days following an index medical hospitalization.</p><p><strong>Results: </strong>The cohort included 90,920 Veterans with OUD who experienced one or more medical hospitalizations during the study period. Median age was 58 years, and 93 % were male. Older age (adjusted Odds Ratio [aOR] range 30d: 1.50-2.66; 1y: 1.58-3.28), higher medical complexity (aOR range 30d: 2.11-6.23; 1y: 1.96-7.34), multiple substance use disorders (SUD; aOR 30d: 1.81 (95 % CI 1.44, 2.27) 1y: 1.48 [95 % CI 1.36, 1.62]), and length of hospitalization (aOR 30d: 6.78 [95 % CI 4.85, 9.47] 1y: 3.45 [95 % CI 2.96, 4.01]) were associated with increased all-cause mortality following hospitalization. Homelessness (aOR 30d: 0.75 [95 % CI 0.63, 0.90]; 1y: 0.85 [95 % CI 0.80, 0.91]), depression (aOR 1y: 0.89 [95 % CI 0.84, 0.95]), bipolar disorder (aOR 1y: 0.88 [95 % CI 0.82, 0.94]), buprenorphine receipt (aOR 1y: 0.79 [95 % CI 0.69, 0.91]), and service connection (aOR 30d: 0.76 [95 % CI 0.60, 0.97] 1y: 0.64 [95 % CI 0.59, 0.70]) were associated with reduced all-cause mortality. Younger age (aOR range 30d: 3.21-5.24; 1y: 2.71-2.38), homelessness (aOR 1y: 1.40 [95 % CI 1.20, 1.63]), and multiple SUD (aOR 1y: 1.78 [95 % CI 1.33, 2.38]) were among factors associated with increased opioid-related mortality after hospitalization. Black race (aOR 1y: 0.61 [95 % CI 0.50, 0.74]) and higher service connection (aOR 30d: 0.41 [95 % CI 0.21, 0.81]; 1y: 0.53 [95 % CI 0.43-0.66]) were associated with reduced opioid-related mortality after hospitalization.</p><p><strong>Conclusions: </strong>Several patient-level factors were associated with increased all-cause mortality (e.g., length of hospital stay), reduced all-cause mortality (e.g., homelessness), increased opioid-related mortality (e.g., multiple SUD), and reduced opioid-related mortality (e.g., service connection) after hospitalization. This information provides a roadmap for future development and study of tailored supports and risk stratification tools to enhance post-hospitalization transitional care for patients with OUD.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209797"},"PeriodicalIF":1.9,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981270","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":"Changing patterns and predictors of opioid use disorder and treatment of adults released from state detention in Pennsylvania","authors":"Liba Blumberger ,&nbsp;Guodong Liu ,&nbsp;William Calo ,&nbsp;Daniel Mallinson ,&nbsp;Douglas Leslie","doi":"10.1016/j.josat.2025.209796","DOIUrl":"10.1016/j.josat.2025.209796","url":null,"abstract":"<div><h3>Introduction</h3><div>There is increased effort among states to enhance access to pharmacological treatment, a best practice for those diagnosed with opioid use disorder (OUD), within carceral settings to lower risk of overdose fatalities after release. This study examines trends in OUD and medications for opioid use disorder (MOUD) received by individuals released from state correctional institutions (SCIs) in Pennsylvania.</div></div><div><h3>Methods</h3><div>Using prison data, this retrospective cohort study analyzes annual rates of substance use disorder by sub-type, focusing specifically on OUD and subsequent treatments, among adults (≥18 years) released between 2014 and 2022 (<em>n</em> = 134,781). Changes in rates were evaluated using Cochran-Armitage tests, while logistic regression models identified predictive factors for OUD and treatment received before release.</div></div><div><h3>Results</h3><div>From 2014 to 2022, the prevalence of OUD in Pennsylvania SCIs increased from 16.6 % to 25.2 % (<em>p</em> &lt; .0001) and pharmacological engagement rose from 0.0% to 22.6% (p &lt; .0001), especially for buprenorphine (0.0% to 15.7%; p &lt; .0001). This occurred alongside reduced rates of behavioral health services, which dropped from 69.6 % to 41.9 % (p &lt; .0001), and a decline in OUD prevalence in later years. Predictive factors for OUD and MOUD included being female, white, released in later years, and being younger, specifically in late 20s or early 30s.</div></div><div><h3>Conclusion</h3><div>The use of pharmacological treatment, particularly buprenorphine, has increased, while behavioral health services have declined for those released from PA SCIs with an OUD, with varying levels of OUD presence and demographic variations in its provision. This highlights the progress of MOUD expansions and reveals too that further improvements are necessary to meet treatment need to assist in recovery and reintegration into society.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"179 ","pages":"Article 209796"},"PeriodicalIF":1.9,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981336","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":"Multi-method evaluation of a physician-led pilot addiction consult service","authors":"Laura Rodger ,&nbsp;Kathleen Ann Sheehan ,&nbsp;Andrew Pinto","doi":"10.1016/j.josat.2025.209795","DOIUrl":"10.1016/j.josat.2025.209795","url":null,"abstract":"<div><h3>Introduction</h3><div>Addiction consultation services are hospital-based specialist programs designed to support the care of patients with substance use disorders (SUDs). This study aimed to: (1) describe service volumes and patient demographics for a pilot addiction consultation program, (2) compare clinical outcomes between patients seen prior to and after program implementation, and (3) explore provider perceptions, referral patterns, and clinical practice.</div></div><div><h3>Methods</h3><div>Using the RE-AIM framework, we conducted a formative multi-method evaluation at a tertiary care hospital. Quantitative data about the uptake of the pilot program and clinical descriptions of three patient groups (consult patients, pre-program baseline patients, post-program non-consult patients) was collected through chart review. A provider survey with closed and open-ended questions was used to explore provider practice patterns, perceived needs, roles, and challenges.</div></div><div><h3>Results</h3><div>Most consult requests were from General Internal Medicine (136/181, 75.1 %). Consult orders were usually placed during service hours (169/181 93.4 %), with a median time between admission and consult request of 1 day (IQR 0–2). Consultation was linked to higher odds of receiving a pharmacotherapy prescription compared to baseline (OR 5.82 [95 % CI 3.05–11.99], <em>p</em> &lt; 0.001) and patients not receiving consultation (OR 6.78 [95 % CI 2.76–20.75], p &lt; 0.001). Survey findings highlighted non-addiction specialist providers' lack of confidence with substance use pharmacotherapy and consultation for counselling, resource navigation, and harm reduction.</div></div><div><h3>Conclusions</h3><div>The consult program demonstrated consistent uptake and was associated with increased access to pharmacotherapy for hospitalized patients, supporting improved inpatient addiction care. Non-addiction providers identified value in the consult program beyond pharmacotherapy and identified challenges with this patient population.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"178 ","pages":"Article 209795"},"PeriodicalIF":1.9,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144906898","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":"Quality of life assessment instruments used in clinical trials for alcohol use disorder: A systematic review","authors":"Jeppe Sig Juelsgaard Tryggedsson ,&nbsp;Kjeld Andersen ,&nbsp;Anette Søgaard Nielsen ,&nbsp;Camilla Dahl Haislund Olsen ,&nbsp;Angelina Isabella Mellentin","doi":"10.1016/j.josat.2025.209793","DOIUrl":"10.1016/j.josat.2025.209793","url":null,"abstract":"<div><h3>Background</h3><div>Quality of life (QoL) measures are increasingly used as outcome indicators in both pharmacological and non-pharmacological intervention trials for alcohol use disorder (AUD). However, there is no current and comprehensive review to inform standardization and utilization of psychometrically sound measures adapted to an AUD population. Therefore, this systematic review aims to identify QoL assessment instruments used in clinical trials targeting AUD and provide an overview of the psychometric properties of the most frequently used instruments.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in PubMed, EMBASE, and PsycINFO up to July 20th, 2023. Studies were included if they were original controlled trials assessing QoL in adults with AUD. Data extraction included study characteristics and details of QoL assessment instruments. Psychometric properties of frequently used instruments were analyzed.</div></div><div><h3>Results</h3><div>Out of 3751 studies, 61 met inclusion criteria. Across these, 19 different QoL instruments were identified, with the SF-36 being the most frequently used. Our findings indicate that while several generic and health-related QoL instruments were employed, more than half of the instruments were applied in only one study, and generally few studies report on the psychometric properties specific to AUD populations.</div></div><div><h3>Conclusions</h3><div>The findings underscore a lack of standardized practice and utilization of the most empirically sound QoL assessment instruments in clinical trials targeting AUD. This review provides an updated and more comprehensive synthesis than previous reviews, highlights the need for validated, AUD-specific QoL measures, and suggests directions for future research, including the development of core outcome sets.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"178 ","pages":"Article 209793"},"PeriodicalIF":1.9,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144902132","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 past-year mental and physical health conditions with intentional or unintentional drug overdoses","authors":"Veer Vekaria ,&nbsp;Wenna Xi ,&nbsp;Braja G. Patra ,&nbsp;Sean M. Murphy ,&nbsp;Jonathan Avery ,&nbsp;Mark Olfson ,&nbsp;Jyotishman Pathak","doi":"10.1016/j.josat.2025.209792","DOIUrl":"10.1016/j.josat.2025.209792","url":null,"abstract":"<div><h3>Introduction</h3><div>Recent studies have explored the role of suicidal behavior in drug overdoses; however, differentiating intentional versus unintentional overdoses using large-scale, real-world electronic health records (EHRs) remains under-investigated. This study compared individuals with intentional or unintentional drug overdoses based on (1) demographic characteristics, (2) past-year diagnoses of mental and physical health conditions, and (3) the number and types of substances involved.</div></div><div><h3>Methods</h3><div>This retrospective cohort analysis used EHRs derived from five health systems across New York City. The study identified patients with an incident overdose encounter between 2011 and 2019 based on ICD-9 and ICD-10 codes, then stratified them as ‘intentional’ or ‘unintentional’ according to the intent specified by the ICD code. ICD codes also extracted past-year substance use disorders (SUDs), suicidal thoughts and behaviors (STBs), psychiatric disorders, and chronic conditions. Multivariable logistic regression models adjusted for age, sex, and race/ethnicity evaluated clinical predictors of an intentional overdose, and odds ratios (ORs) and 95 % confidence intervals (CIs) estimated effect sizes.</div></div><div><h3>Results</h3><div>The study identified 9622 patients, including 1737 (18.1 %) with an intentional overdose and 7885 (81.9 %) with an unintentional overdose. Intentional overdose patients (38.8 ± 19.8 years) were younger than unintentional overdose patients (53.3 ± 20.1 years). Women comprised the majority of intentional (67.6 %) and unintentional (52.4 %) overdose patients. An intentional overdose was more likely than an unintentional overdose in patients with past-year alcohol use disorder (OR: 1.94 [95 % CI: 1.54–2.44]), STBs (3.63 [2.90–4.54]), and psychiatric disorders (2.92 [2.51–3.39]), and less likely in those with past-year chronic conditions (0.50 [0.43–0.58]) (<em>p</em> &lt; 0.001). Finally, intentional compared with unintentional overdoses were commonly observed during emergency department encounters (2.10 [1.87–2.35]) and involved multiple substances (19.8 %) such as non-opioid pain relievers (8.63 [7.30–10.21]), sedative-hypnotics (2.49 [2.04–3.04]), and benzodiazepines (3.42 [2.77–4.21]), whereas most unintentional overdoses involved a single substance (92.9 %) (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Younger patients, often with mental health and SUD problems, have a relatively higher risk of intentional overdose, while older patients with chronic health conditions are more prone to unintentional overdose. Understanding the distinct mechanisms driving overdose intent is vital for tailoring interventions, given the greater risk of suicide death following a nonfatal intentional overdose.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"178 ","pages":"Article 209792"},"PeriodicalIF":1.9,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981182","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":"C2: editorial board","authors":"","doi":"10.1016/S2949-8759(25)00162-6","DOIUrl":"10.1016/S2949-8759(25)00162-6","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"177 ","pages":"Article 209783"},"PeriodicalIF":1.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885648","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}