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Background The opioid epidemic has prompted nationwide efforts to expand access to medications for opioid use disorder (MOUD). Primary care settings have been identified as a critical access point for patients who may benefit from MOUD treatments. Despite implementation efforts, there is limited understanding of how MOUD practice capability in primary care settings evolves over time or what factors influence clinic-level implementation trajectories. Methods We conducted a longitudinal study of 95 primary care clinics in California from 2019 to 2024. MOUD practice capability was measured using the Integrating Medications for Addiction Treatment in Primary Care (IMAT-PC) index across three timepoints. Using latent class growth analysis, we analyzed implementation growth trajectories and examined their associations with clinic characteristics and MOUD implementation outcomes (e.g., patient reach and provider adoption). Results Three distinct implementation trajectory classes emerged: elevated improving (41.0%), moderate improving (47.4%), and low improving (11.6%). All clinics demonstrated improvements in MOUD practice capability over time. Elevated improving clinics primarily consisted of smaller clinics (< 15,000 patients) and achieved significantly higher number of patients receiving MOUD compared to moderate ( p  = 0.03) and low improving clinics ( p  = 0.04). Clinics serving medically underserved populations disproportionately represented the low improving class ( p  < 0.01). Increase in the number of providers prescribing MOUD did not differ significantly across trajectory classes. Conclusions Although all clinics increased MOUD capability, we found significant associations between implementation trajectory classes and changes in patients receiving MOUD over time in primary care-based MOUD programs. Implementation supports may be more effective and efficient if selected and delivered based upon clinic contextual factors, particularly in resource-constrained and underserved settings.

Researchers with lived experience (RWLE) of serious mental illness or substance use disorders (SMI/SUD) bring critical dual expertise to psychiatric neuroscience as both scientists and individuals directly affected by the conditions they study. Yet their participation and leadership remain profoundly limited by entrenched stigma, disclosure risks that can obstruct promising career trajectories, lack of mentorship from senior RWLE, and the absence of structural protections against discrimination and exclusion. These systemic barriers silence voices that can help transform the field’s understanding of mental illness and its biological underpinnings. Drawing on the authors’ lived and/or professional experiences, this Perspective challenges the assumption that lived experience introduces bias, reframing it as a source of empirical strength, innovation, and epistemic diversity. Here, the authors propose structural reforms to reshape admissions, mentorship, and leadership pathways. Centering RWLE is both a scientific necessity and an ethical imperative for advancing a more equitable and representative psychiatric neuroscience. Lay Summary Researchers who live with serious mental illness or substance use disorders bring unique insight to psychiatric neuroscience, yet they remain underrepresented in the field. This paper calls for recognizing and removing the barriers that limit their participation and leadership. Including these researchers strengthens the science, improves the relevance of the research to real-world needs, and helps to ensure that research about mental illness includes those who live it.

This cross-sectional survey of US Departments of Correction websites found significant heterogeneity in the availability and content of prison-based research policy, procedure, and contact information.

At the intersection of drug policy, the opioid crisis, and fragmented care systems, persons with opioid use disorder (OUD) in the United States are significantly vulnerable to contact with the criminal legal system (CLS). In CLS settings, provision of evidence-based treatment for OUD is variable and often secondary to punitive approaches. Linkage facilitation at every touch point along the CLS Sequential Intercept Model has potential to redirect persons with OUD into recovery-oriented systems of care, increase evidence-based OUD treatment connections, and therefore reduce CLS re-exposure risk. Research in this area is still nascent. Thus, this narrative review explores the state of the science on linkage facilitation across the varied CLS contexts, including general barriers, facilitators, and opportunities for using linkage facilitation for OUD treatment and related services. Following the CLS Sequential Intercept Model, the specific CLS contexts examined include community services, police encounters, the courts (pre- and post-disposition), incarceration (pre-trial detention, jail, and prison), reentry (from jails, prisons, and unified systems), and community supervision (probation and parole). Examples of innovative linkage facilitation interventions are drawn from the Justice Community Opioid Innovation Network (JCOIN). Areas for future research and policy change are highlighted to advance the science of linkage facilitation for OUD services in the CLS.

Misinformation about cannabis and opioid use disorder (OUD) may increase morbidity and mortality if it leads individuals with OUD to forego evidence-based treatment. It has not been systematically evaluated whether officially designating OUD as a qualifying condition for medical cannabis is associated with cannabis dispensaries suggesting cannabis as a treatment for OUD. To examine whether state-level policies designating OUD a qualifying condition for medical cannabis are associated with more dispensaries claiming cannabis can treat OUD. This cross-sectional, mixed-methods study of 208 medical dispensary brands was conducted in 2019 using the brands' online content. The study included dispensaries operating in New Jersey, New York, and Pennsylvania, where OUD is a qualifying condition for medical cannabis, and in Connecticut, Delaware, Maryland, Ohio, and West Virginia, where this policy does not exist. Presence of OUD on the list of qualifying conditions for a state's medical cannabis program. Binary indicators of whether online content from the brand said cannabis can treat OUD, can replace US Food and Drug Administration-approved medications for OUD, can be an adjunctive therapy to Food and Drug Administration-approved medications for OUD, or can be used as a substitute for opioids to treat other conditions (eg, chronic pain). After excluding duplicates, listings for nonexistent dispensaries, and those without online content, 167 brands across 7 states were included in the analysis (44 [26.3%] in states where OUD was a qualifying condition and 123 [73.7%] in adjacent states). A dispensary listed in a directory for West Virginia was not operational; therefore, comparison states were Connecticut, Delaware, Maryland, and Ohio. In policy-exposed states, 39% (95% CI, 23%-55%) more dispensaries claimed cannabis could treat OUD compared with unexposed states (P < .001). For replacing medications for OUD and being an adjunctive therapy, the differences were 14% (95% CI, 2%-26%; P = .002) and 28% (95% CI, 14%-42%; P < .001), respectively. The suggestion that cannabis could substitute for opioids (eg, to treat chronic pain) was made by 25% (95% CI, 9%-41%) more brands in policy-exposed states than adjacent states (P = .002). In this study, state-level policies designating OUD as a qualifying condition for medical cannabis were associated with more dispensaries claiming cannabis can treat OUD. In the current policy environment, in which medical claims by cannabis dispensaries are largely unregulated, these advertisements could harm patients. Future research linking these policies to patient outcomes is warranted.

People in prison are particularly vulnerable to infectious disease due to close living conditions and the lack of protective equipment. As a result, public health professionals and prison administrators seek information to guide best practices and policy recommendations during the COVID-19 pandemic. Using latent profile analysis, we sought to characterize Texas prisons on levels of COVID-19 cases and deaths among incarcerated residents, and COVID-19 cases among prison staff. This observational study was a secondary data analysis of publicly available data from the Texas Department of Criminal Justice (TBDJ) collected from March 1, 2020, until July 24, 2020. This project was completed in collaboration with the COVID Prison Project. We identified relevant profiles from the data: a low-outbreak profile, a high-outbreak profile, and a high-death profile. Additionally, current prison population and level of employee staffing predicted membership in the high-outbreak and high-death profiles when compared with the low-outbreak profile. Housing persons at 85% of prison capacity was associated with lower risk of COVID-19 infection and death. Implementing this 85% standard as an absolute minimum should be prioritized at prisons across the USA.

To combat high-risk alcohol consumption, we introduced a 30-day alcohol abstinence challenge targeted at heavy drinkers with and without chronic pain. Our study aimed to assess the challenge's feasibility and safety and to explore its perceived benefits. Our exploratory aim was to identify participants' coping strategies during the challenge. Our single-arm study recruited heavy drinkers from a pain clinic and a university setting (n = 34, 64.7% chronic pain). Participants underwent a modified community-based 30-day challenge, which included motivational interviewing, an individualized start date, and weekly phone check-ins. We found the 30-day challenge was feasible and safe; 72.3% of eligible heavy drinkers participated in the challenge with no serious adverse events. Most challengers (94.1%) reported some benefit from the challenge, which included improvements in alcohol withdrawal symptoms, sleep, and alcohol abstinence self-efficacy, but not in pain. We identified 25 perceived benefits and 21 coping strategies. Our study confirms that a 30-day alcohol abstinence challenge is a feasible and safe intervention for heavy drinkers with and without chronic pain, yielding notable health benefits. The challenge also facilitated the development of effective coping strategies. Future studies should explore the long-term benefits of such interventions in broader outpatient settings. •A 30-day alcohol abstinence challenge was feasible for heavy drinking individuals with and without chronic pain.•No significant change in pain intensity was observed after the challenge.•About two thirds of challengers reported successful alcohol abstinence for 30 days.•Most challengers (94.1%) reported some health benefit from the challenge by drinking zero or less for 30 days.•The most frequently endorsed benefits were improved sleep, less fatigue, and increased alcohol abstinence self-efficacy.

Although alcohol use disorder (AUD) regularly co-occurs with other conditions, there has not been investigation of specific multimorbidity classes among military members with at-risk alcohol use. We used latent class analysis (LCA) to cluster 138,929 soldiers with post-deployment at-risk drinking based on their co-occurring psychological and physical health conditions and indicators of alcohol severity. We examined the association of these multimorbidity classes with healthcare utilization and military readiness outcomes. Latent class analysis was conducted on 31 dichotomous indicators capturing alcohol use severity, mental health screens, psychological and physical health diagnoses, and tobacco use. Longitudinal survival analysis was used to examine the relative hazards of class membership regarding healthcare utilization (e.g., emergency department visit, inpatient stay) and readiness outcomes (e.g., early separation for misconduct). Latent class analysis identified five classes: Class 1 –Relatively Healthy (51.6 %); Class 2 – Pain/Tobacco (17.3 %); Class 3 – Heavy Drinking/Pain/Tobacco (13.1 %); Class 4 – Mental Health/Pain/Tobacco (12.7 %); and Class 5 – Heavy Drinking/Mental Health/Pain/Tobacco (5.4 %). Musculoskeletal pain and tobacco use were prevalent in all classes, though highest in Classes 2, 4, and 5. Classes 4 and 5 had the highest hazards of all outcomes. Class 5 generally exhibited slightly higher hazards of all outcomes than Class 4, demonstrating the exacerbation of risk among those with heavy drinking/AUD in combination with mental health conditions and other multimorbidity. This study provides new information about the most common multimorbidity presentations of at-risk drinkers in the military so that targeted, individualized care may be employed. Future research is needed to determine whether tailored prevention and treatment approaches for soldiers in different multimorbidity classes is associated with improved outcomes. •We investigated multimorbidity classes among soldiers with at-risk alcohol use.•Latent class analysis identified five clinical classes ranging in severity.•Classes varied widely in hazards for healthcare utilization and readiness outcomes.•Classes inclusive of mental health and heavy drinking exhibited the highest risks.•Research is needed to evaluate tailored prevention and treatment by class.

Much of what is currently known regarding treatment for opioid use disorder has been derived from heroin users, with very few investigations into the unique processes that may be involved with individuals who primarily misuse prescription opioids. Relapse is common in treatment for opioid use disorder, making the parallel processes related to relapse during treatment critical for examination. Pain and depression often co-occur in substance use disorder treatment, including opioid substitution treatments. Advanced statistical analyses that can simultaneously model these two conditions may lead to targeted clinical interventions. The objective of this dissertation was to utilize a discrete survival analysis with a growth mixture model to test time to prescription opioid relapse, predicted by parallel growth trajectories of depression and pain, in a clinical sample of patients in buprenorphine/naloxone treatment for primary prescription opioid use disorder. The latent class analysis characterized heterogeneity among patients (n=359) in the Prescription Opioid Addiction Study, a Clinical Trials Network project collected from 2006-2009. The results from this secondary analysis suggested that a 4-class solution was the most parsimonious based on global fit indices and clinical relevance. In order of class size, the 4 classes identified were: 1) typical treatment, 2) high depression and moderate pain, 3) high pain, and 4) low treatment motivation. Odds ratios for time-to-first use indicated no statistically significant difference in relapse between the high pain and the high depression classes, but all other classes differed significantly. These results emphasize the need to monitor the influence of pain and depression during stabilization on buprenorphine and naloxone. Future work may identify appropriate interventions that can be introduced to extend time-to-first prescription opioid use among patients in this clinical population.