Psychopharmacology bulletin最新文献

{"title":"Multisystem Sequelae of Chronic Diphenhydramine Misuse in an Adolescent: A Case Highlighting the Importance of Comprehensive History-Taking.","authors":"Justin M Howe, Jay Vora, Abhishek Reddy","doi":"10.64719/pb.15435","DOIUrl":"10.64719/pb.15435","url":null,"abstract":"<p><strong>Background: </strong>Diphenhydramine, an over-the-counter antihistamine, is increasingly misused by adolescents for its sedative and hallucinogenic effects. Despite its accessibility and perceived safety, chronic misuse poses serious risks, including neurologic, psychiatric, and gastrointestinal complications, especially in vulnerable youth with preexisting trauma or psychiatric illness.</p><p><strong>Case: </strong>We present a case of a teenage female with a history of traumatic brain injury, major depressive disorder, and restrictive eating disorder who was admitted following a diphenhydramine overdose. Her suicide attempt was preceded by a two-year history of undisclosed daily diphenhydramine misuse, initially for mood regulation and later escalating to dependency. Multisystem symptoms including seizures, disordered eating, and behavioral changes were retrospectively linked to her chronic use. Her TBI and initial seizure also coincided with a period of increased diphenhydramine ingestion, raising concern for misattributed or missed diagnoses.</p><p><strong>Discussion: </strong>This case highlights the diagnostic challenges posed by diphenhydramine misuse in adolescents. Chronic use can mimic or exacerbate psychiatric and neurologic conditions, delay appropriate intervention, and contribute to unnecessary polypharmacy or healthcare utilization. Her improvement with structured psychiatric care and medication discontinuation supports the role of early identification and trauma-informed management in preventing further harm.</p><p><strong>Conclusion: </strong>Diphenhydramine misuse should be considered in adolescents with overlapping psychiatric, neurologic, and gastrointestinal complaints. Routine psychosocial screening and awareness of non-traditional substances of abuse are essential for timely diagnosis and intervention.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 1","pages":"131-136"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967938","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":"A Pilot Study Exploring the Impact of Pro Re Nata Medication Utilization on Aggression in Forensic Psychiatric Patients.","authors":"Gabrielle Morgan, O Greg Deardorff, Raja Hussain, Alexandria Choate, Manfredo Flores Cruz, Roger W Sommi, Niels C Beck","doi":"10.64719/pb.15427","DOIUrl":"10.64719/pb.15427","url":null,"abstract":"<p><strong>Objective: </strong>To analyze patterns of pro re nata (PRN) medication utilization during the seven-day periods preceding and following aggressive incidents in a forensic setting, including both psychotropic and somatic agents, to identify trends in use surrounding aggression.</p><p><strong>Methods: </strong>This was a retrospective chart review at a long-term state forensic psychiatric facility. Patients housed on units associated with the New Outlook Program (NOP) within a six-month period who received PRN medications were included.</p><p><strong>Results: </strong>Out of 106 patients evaluated, 42 were included. The mean age for study participants was 37 years old, with 83% being male. Out of 322 aggressive incidents, the overall PRN utilization rate was higher than the baseline in 38.8% of events (N = 125). For the overall seven-day period preceding and following an aggressive incident, there was no significant difference between psychotropic and somatic PRNs (β = -0.16, p = 0.74), and neither type showed a meaningful deviation from baseline (Intercept = -0.25, p = 0.46). Additionally, there was no significant difference in PRN utilization when separately assessing the seven-day period preceding or following an aggressive incident.</p><p><strong>Conclusion: </strong>No consistent group-level trends in PRN utilization were identified in relation to aggression. However, some patient-level variation was observed post-incident, suggesting individualized patterns compared to group-level trends. These findings support the clinical value of monitoring individuals' PRN utilization patterns to inform treatment planning.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 1","pages":"92-97"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967652","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":"Differences in the Prevalence of Use and Dosage of Psychotropic Drugs by Smoking Status in Inpatient and Outpatient: An Observational, Analytical, Cross-Sectional Study.","authors":"Pedro Damian Gargoloff, Martín A Urtasun, Raul Riveros, Iván Omar Moreno Frade, Martín Cañás","doi":"10.64719/pb.15417","DOIUrl":"10.64719/pb.15417","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the association between tobacco use and the prevalence of psychotropic medication use and prescribed dosage among inpatients and outpatients with severe mental disorders treated at a neuropsychiatric hospital.</p><p><strong>Methods: </strong>Observational, cross-sectional, analytical study conducted on May 3, 2023. Smoking status and prescribed psychotropic medications were recorded for all hospitalized patients and community-based outpatients. Dosages were reported in mg/day, defined daily doses (DDD), and for antipsychotics as chlorpromazine equivalents (CPZeq). Bivariate and multivariate analyses were performed.</p><p><strong>Results: </strong>Tobacco use data were collected from 325 out of 425 total patients (71.7% male, mean age [SD]: 51.4 [14.4] years, 56% inpatients, 70.2% with schizophrenia and related psychosis). The prevalence of smoking was 72.3%, with differences by gender (78.1% in males vs. 57.8% in females, p < 0.001), and decreased with age (18-39 years: 86.1%; 40-59 years: 71.7%; ⩾ 60 years: 63.2%; p = 0.01). Mean dosages of antipsychotics, clozapine, and olanzapine measured in CPZeq were higher in smokers than in non-smokers by 35.4%, 37.1%, and 33.3%, respectively. After adjusting for confounding factors, smoking was associated with a 21.8% higher dosage of antipsychotics (95% CI: 0.4%-43.2%; p = 0.046), equivalent to an additional 132.2 mg/day (24.2-240.1; p = 0.017) of clozapine and 5.4 mg/day (1.2-9.6; p = 0.012) of olanzapine. The average dosage of sedatives/hypnotics was 45.5% higher among smokers (13.6%-89.5%; p = 0.008).</p><p><strong>Conclusion: </strong>A high prevalence of smoking was found among patients with severe mental disorders, associated with higher average dosages of sedatives/hypnotics and antipsychotics, particularly clozapine and olanzapine.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 1","pages":"48-63"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967853","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":"Personalizing Treatment for Acute Alcoholic Hallucinosis: Clinical Utility of Integrated Pharmacogenetic Testing, Metabolic Phenotyping, and microRNA Biomarkers.","authors":"Valentin Skryabin, Anton Masyakin, Sergei Pozdniakov, Igor Shatokhin, Svetlana Sokolova, Valentina Ivanchenko, Polina Makartseva","doi":"10.64719/pb.15425","DOIUrl":"10.64719/pb.15425","url":null,"abstract":"<p><strong>Background: </strong>Acute alcoholic hallucinosis (ICD-10 F10.52) necessitates urgent antipsychotic treatment but carries high risks of adverse drug reactions (ADRs). While pharmacogenetic clinical decision support systems (CDSS) show promise, their utility is limited by static genotyping and incomplete biomarker integration.</p><p><strong>Purpose: </strong>This study aimed to develop and validate a multi-omics framework integrating pharmacogenetic testing, CYP phenotyping, and microRNA biomarkers to personalize antipsychotic therapy and improve outcomes in acute alcoholic hallucinosis.</p><p><strong>Material and methods: </strong>In this three-arm study, 300 Russian inpatients with acute alcoholic hallucinosis underwent: 1) Randomized pharmacogenetic-guided vs. standard therapy (n = 100); 2) CYP2D6/CYP3A4 phenotyping via urinary pinoline/cortisol ratios (n = 100); and 3) microRNA quantification (<i>miR-27b</i>, <i>miR-370-3p</i>; n = 100). Efficacy (PANSS) and safety (UKU) were assessed over 6 days.</p><p><strong>Results: </strong>Pharmacogenetic guidance significantly reduced ADRs (UKU day 6: 5.0 [3.0 - 8.0] vs. 12.0 [10.0 - 16.0], p < 0.01) with comparable efficacy (PANSS≈1.0). Phenotyping identified 28% CYP2D6 poor metabolizers (vs. 15% by genotyping), exhibiting 40% higher haloperidol levels (r = 0.72, p < 0.001). Baseline <i>miR-27b</i> inversely correlated with day-3 PANSS (r = - 0.54, p < 0.001), while <i>miR-370-3p</i> predicted poorer day-6 response (ΔPANSS r = 0.48, p < 0.001) and higher UKU scores (r = 0.52, p < 0.001). Integrating microRNAs with phenotyping improved ADR prediction accuracy by 22% versus single modalities.</p><p><strong>Conclusion: </strong>A multi-omics approach synergistically optimizes antipsychotic therapy by addressing genotyping limitations through dynamic phenotyping and microRNA-based prognostication, significantly enhancing safety in this high-risk population.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 1","pages":"82-91"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967963","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":"Risk of Obesity in Patients Treated with Clozapine or Olanzapine: A Simple, Clinically Useful Prediction Tool.","authors":"Roberto Lozano, Carina Bona","doi":"10.64719/pb.15423","DOIUrl":"10.64719/pb.15423","url":null,"abstract":"<p><strong>Background: </strong>Clozapine and olanzapine are associated with clinically relevant weight gain and metabolic risk.</p><p><strong>Objective: </strong>To compare the risk of obesity (BMI ⩾ 30) between clozapine and olanzapine and to develop a parsimonious prediction model with performance and clinical-utility evaluation.</p><p><strong>Methods: </strong>We fit a multivariable logistic regression on complete cases using index drug, daily dose, prolactin (PRL), cortisol, free thyroxine (FT4), and HDL. Discrimination (AUC), probability accuracy (Brier score), calibration (intercept/slope and deciles), and decision-curve analysis (DCA) were reported.</p><p><strong>Results: </strong>In the classification cohort, obesity counts were equal for clozapine (9/19) and olanzapine (9/19). The model achieved strong internal discrimination (AUC 0.869) with good calibration (slope 1.00; intercept -0.00) and Brier 0.123. DCA indicated net benefit at practical thresholds (∼5-15%), supporting low-harm preventive actions.</p><p><strong>Conclusions: </strong>Drug-related risk can be individualized with a lean model using routine variables. External validation and unit harmonization-especially for HDL-are recommended before broad deployment.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 1","pages":"71-81"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967897","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":"Lorazepam-Assisted Interview in Clinical Psychiatry: A Narrative Review of Current Evidence and Research Gaps.","authors":"Omar Afroz, Raja Babu Ramawat, Romil Saini, Siddharth Sarkar","doi":"10.64719/pb.15429","DOIUrl":"10.64719/pb.15429","url":null,"abstract":"<p><strong>Introduction: </strong>Drug-assisted interviews have been used in psychiatry for about a century. The use of barbiturates for this purpose has declined, and the use of lorazepam has gained popularity over time for conducting drug-assisted interviews, given a better safety profile. However, the evidence for the use of lorazepam for drug-assisted interviews is fragmented and anecdotal, and mostly in the form of case reports. The current review aims to synthesize available evidence on the use of lorazepam-assisted interviews in psychiatry.</p><p><strong>Methods: </strong>For this narrative review, a literature search was conducted using PubMed, Scopus, and Google Scholar. Peer-reviewed articles on the use of lorazepam for drug-assisted interviews for psychiatric patients were identified, and data were manually extracted and synthesized.</p><p><strong>Results: </strong>Eleven case reports and one case series on lorazepam-assisted interviews were identified. Dissociative disorder was the common diagnosis where it was used, with most studies reporting significant improvement after the interviews. Adverse events, though rare, included excessive sedation, disinhibition, agitation, and emotional lability. Interview protocols varied among the studies, with doses ranging from 2 to 18 mg, administered through intravenous routes either as boluses or infusion (rates ranging from 0.05 mg/min to 0.1 mg/min). Most studies involved single sessions, with a maximum of 12 sessions in one case report.</p><p><strong>Conclusion: </strong>Lorazepam-assisted interview may hold potential clinical utility in appropriate cases. Future studies are needed to establish efficacy and safety and to evaluate interview protocols.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 1","pages":"98-111"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967887","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":"The Intersections of Fetal Alcohol Syndrome with Autism Spectrum Disorder and Mood Dysregulation: A Rare Case of Behavioral Complexity.","authors":"Parsa Khaksar, Anuradha Reddy","doi":"10.64719/pb.15437","DOIUrl":"10.64719/pb.15437","url":null,"abstract":"<p><p>This case report presents a complex psychiatric profile of a 19-year-old female with diagnoses of Fetal Alcohol Syndrome (FAS), Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), mild intellectual disability, and mood dysregulation, complicated by trauma history, psychotic features, and repeated hospitalizations. Her neurodevelopmental and psychiatric disorders have contributed to persistent high-risk behaviors, legal involvement, and challenges with independent living, ultimately necessitating group home placement. This case highlights the unique relationship between FAS and coexisting neurodevelopmental conditions, emphasizing the poor long-term outcomes frequently associated with FAS and ultimately the importance of comprehensive, multidisciplinary care in managing such patients. We review the current literature on co-occurrence of ASD and FAS, prognosis, and clinical management challenges posed by these overlapping conditions.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 1","pages":"137-141"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968041","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":"Emerging Innovations in Third- and Fourth-Generation Antipsychotics: Mechanistic Advances and Clinical Implications.","authors":"Adel Awadh Baeissa","doi":"10.64719/pb.15431","DOIUrl":"10.64719/pb.15431","url":null,"abstract":"<p><p>Over the last twenty years, the development of antipsychotic medications has progressed from simple dopamine receptor antagonism to more complex, multi-receptor strategies. This evolution reflects an effort to improve therapeutic effectiveness, reduce side effects, and address a broader spectrum of psychiatric symptoms. Traditional first-generation antipsychotics primarily block dopamine D₂ receptors, which often results in motor-related side effects and limited benefits for cognitive and negative symptoms. Second-generation agents introduced the combination of dopamine and serotonin receptor modulation, improving outcomes in emotional and social functioning with fewer extrapyramidal side effects. This class represented a significant improvement in tolerability and addressed a wider range of symptoms. Third-generation antipsychotics further refined this approach by acting as partial agonists at dopamine D₂/D₃ receptors while continuing to influence serotonergic pathways. These medications offer more balanced dopaminergic activity, improved cognitive and mood effects, and reduced metabolic and motor risks. The latest developments, referred to as fourth-generation antipsychotics, signal a major shift in psychopharmacology. These agents, which include novel compounds with minimal direct dopamine activity, act on receptors such as 5-HT₂A, TAAR1, muscarinic, glutamate, and sigma. This receptor diversity allows for greater effectiveness in managing negative symptoms and cognitive impairments, while substantially lowering the risks of endocrine disturbances and movement disorders. These emerging agents hold promise for better overall patient outcomes. This review highlights the clinical relevance of third- and fourth-generation antipsychotics and supports the growing trend toward targeted, receptor-specific treatments in managing psychotic disorders.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 1","pages":"112-125"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967826","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":"Cannabidiol Induced Manic Episode: A Case Report.","authors":"Anas Ibn Auf, Razan A Almakki, Nora M Alhummayani","doi":"10.64719/pb.4542","DOIUrl":"10.64719/pb.4542","url":null,"abstract":"<p><strong>Background: </strong>Cannabidiol (CBD), a non-intoxicating compound derived from Cannabis sativa, has gained widespread popularity for its proposed therapeutic effects in conditions such as anxiety, insomnia, and chronic pain. Unlike tetrahydrocannabinol (THC), CBD is often perceived as safe, with minimal psychoactive properties. However, its psychiatric safety profile, particularly in relation to mood disorders, remains poorly understood.</p><p><strong>Case presentation: </strong>We report the case of a 31-year-old male with no prior psychiatric history who developed a manic episode characterized by irritability, decreased need for sleep, hyperactivity, and aggression. These symptoms emerged after three months of escalating daily CBD use via vaping, reaching high doses shortly before admission. Toxicology screening was negative for other substances, and the patient showed clinical improvement with mood stabilizers and antipsychotics following the discontinuation of CBD.</p><p><strong>Discussion: </strong>This case raises concerns about the potential of high-dose CBD to induce manic symptoms in certain individuals. While CBD has been proposed to have anxiolytic and antipsychotic effects, its influence on mood regulation may be complex and dose-dependent. The variability in commercial CBD product composition, including possible contamination or mislabeling, further complicates risk assessment. Current evidence from clinical trials on CBD's effects in mood disorders is limited and inconclusive.</p><p><strong>Conclusion: </strong>Clinicians should remain alert to the psychiatric effects of CBD, particularly in patients presenting with new-onset mood symptoms. This report underscores the need for controlled studies to assess the safety of CBD in psychiatric populations and calls for stricter regulation of cannabinoid products.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"55 4","pages":"116-122"},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593362","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":"Prevalence of THC-Positive Urine Drug Screens in Patients Receiving Chronic Opioid Therapy: A Retrospective Review.","authors":"Jamal Hasoon, Omar Viswanath, Ivan Urits, Alaa Abd-Elsayed, Alan D Kaye","doi":"10.64719/pb.4549","DOIUrl":"10.64719/pb.4549","url":null,"abstract":"<p><strong>Purpose of study: </strong>This retrospective review aimed to evaluate the prevalence of tetrahydrocannabinol (THC)-positive urine drug screens (UDS) in patients undergoing chronic opioid therapy (COT) for chronic pain at a single academic institution. With a growing national trend toward cannabis legalization and increased public access to marijuana for medical and recreational purposes, understanding the intersection between THC use and opioid prescribing practices is essential. The presence of THC on UDS has clinical, legal, and ethical implications, especially in regions where cannabis remains illegal. This study sought to quantify the prevalence of THC positivity in patients receiving COT for chronic pain.</p><p><strong>Findings: </strong>A total of 244 UDS results were reviewed from January 1, 2024, to December 31, 2024. Among these, 24 patients (9.8%) tested positive for THC. Documentation and clinical responses to positive results varied, with some providers documenting patient counseling, while others did not acknowledge the result in the medical record. In a small subset of cases, positive THC findings contributed to changes in opioid therapy, including tapering or discontinuation.</p><p><strong>Conclusion: </strong>THC-positive UDS results are relatively common among patients receiving chronic opioid therapy, highlighting the increasing prevalence of cannabis use in this population. These findings align with prior literature and reinforce the need for individualized, non-punitive approaches to care. Routine screening, consistent documentation, and open communication about cannabis use are essential components of effective opioid risk stratification, safe prescribing practices, and informed treatment planning. These considerations are critical in regions where recreational marijuana remains illegal, which may further influence provider decision-making regarding ongoing opioid therapy.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"55 4","pages":"36-42"},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593302","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}