The objective of this study is to explore addiction medicine physicians' and addiction psychiatrists' perspectives on prescribing methadone for opioid use disorder (OUD) to be dispensed at community pharmacies. Board-certified addiction medicine/psychiatry physicians (n = 87) in North Carolina completed an online Qualtrics survey from April to July 2025, with a purposive nested sample (n = 10) completing interviews between June and July 2025 via Zoom. We report descriptive results of the survey and emergent themes from interviews. Attitudes toward prescribing methadone for OUD to be dispensed at community pharmacies were positive. The most highly endorsed benefits reported in the survey were reduced barriers to care for complex patients (65.5%), and increased access to methadone in the community; interviews revealed an additional perceived benefit as having the potential to reduce stigma associated with treatment (63.2%). The most highly endorsed negative consequence reported in the survey was misuse/diversion; yet, interviews elucidate that prescribers are concerned about misuse/diversion for all controlled substances, not methadone alone. Alternatively, the most highly endorsed barriers were lack of a nearby pharmacy willing to dispense and lack of community pharmacist training on methadone dispensing. Interview results reveal that increased communication between the pharmacy and prescriber would be necessary to facilitate implementation. Physicians with addiction specialty training are willing to prescribe methadone to be dispensed to community pharmacies and hold positive attitudes toward pharmacy-based dispensing.
The validity and psychometric qualities of the Difficulties in Emotion Regulation Scale (DERS) in populations with a broader range of personality disorders (PDs) are still unclear. The aim of the current study was to analyze the factor structure and validity of DERS and two of its short-forms (DERS-SF and DERS-18), their relation to PD features and personality functioning, gender differences, and the overlap between concepts of alexithymia and emotion regulation. Data were extracted from a multi-site clinical sample of patients with PDs or personality related problems referred to specialist mental health services (n = 2093). Confirmatory factor analyses (CFA)-specifically first-order correlated and bifactor analysis, as well as analysis of measurement invariance-were applied. Linear associations and group differences were investigated by correlational analysis and independent samples t-tests. DERS and its shortforms were validated through associations with PD features (PD criteria), measures of personality functioning (LPFS-BF), and alexithymia (TAS-20). CFA of the short forms revealed good model fit, while the full version of DERS showed poorer fit. None of the bifactor analyses supported a strong general factor. Gender differences were prominent, and substantial associations were found between DERS and PD criteria, LPFS-BF, and TAS-20. DERS and its short forms demonstrated acceptable reliability and validity in a sample of patients with PDs and personality related problems. Without support for a general factor, interpretation of the total scores of DERS should be conducted with care, especially if the subscales Awareness and Clarity are included. Given the advantages of the short forms, the selection of one version over another seems to be of limited consequence.
This study explored the utilization of medication for addiction treatment (MAT) by participants in one state physician health program (PHP) over the course of 30 years, and reviewed patterns of use and monitoring outcomes. Data were extracted from the PHP records of 45 physicians and 37 pharmacists with substance use disorder (SUD), with or without co-occurring pain disorder, who used opioid [partial] agonist or antagonist medication, with or without other MAT. Variables of interest included demographics, type/length of monitoring, use of medications during monitoring, results of neurocognitive testing, and monitoring outcomes. Descriptive statistics were used to characterize PHP participants. χ2 tests, Fisher exact test, and t tests were used for group comparisons. Findings demonstrated positive outcomes among the PHP participants, regardless of MAT use status, with over 70% graduating monitoring or currently in good standing. A minority completed their initial monitoring but returned to the PHP due to return-to-use (n=4, 4.9%), discontinued monitoring against recommendations (n=4, 4.9%), or were turned over to the licensing board due to noncompliance with monitoring (n=4, 4.9%). There were 5 deaths (unrelated to substance use). Periods of MAT use were not associated with worse outcomes or additional impairment. All FDA-approved MAT should be considered for physicians and pharmacists monitored by a PHP, on an individual basis, when deemed clinically appropriate. Extended-release formulations may be particularly helpful for this population. Results may help clarify misunderstandings and controversies surrounding the use of MAT for PHP participants, while also advancing patient-centered, evidence-based care.
Background: Substance Use Disorder (SUD) is frequently associated with psychiatric comorbidity, including psychotic symptoms, impulsivity and neurodevelopmental traits. The influence of age and duration of substance use on these clinical characteristics and on treatment retention remains insufficiently understood. Objectives: To examine the influence between age, duration of substance use, clinical presentation, patterns of violence, and treatment retention in individuals with SUD. Methods: A prospective 6-month cohort study was conducted at the Alcoholism Treatment Unit of the CAUSA Hospital Complex in Salamanca, Spain. A total of 264 patients with SUD were classified into two groups: prolonged substance use (≥55 years of age or ≥25 years of substance use; n = 127) and shorter substance use trajectories (<55 years and <25 years of substance use; n = 137). Participants completed structured clinical interviews and validated measures of quality of life, impulsivity, autistic traits, addiction severity, psychotic symptoms and violence. Non-parametric analyses were applied (α = 0.05; 95% CI). Results: Younger participants showed a significantly higher prevalence of auditory and visual hallucinations and persecutory delusions at baseline. During follow-up, both groups exhibited a reduction in physical aggression while driving and an increase in insults and verbal threats. No significant differences were observed in recent uncontrolled violence. Positive screening results for ADHD, autistic traits and impulsivity were not associated with treatment retention. Lower baseline physical functioning was associated with reduced completion of the 6-month follow-up assessment. Conclusions: Age and duration of substance use were associated with differences in the clinical presentation of SUD. Younger individuals exhibited a greater burden of psychotic symptoms and violence-related behaviours, whereas poorer physical functioning was associated with lower follow-up retention among individuals with prolonged substance use histories. These findings support the importance of age-sensitive assessment and management strategies in patients with SUD.
The folding pattern of the anterior cingulate cortex is variable among individuals. The paracingulate sulcus (PCS), in particular, can be difficult to identify because of this variability. In this paper, we assessed the benefits of a new protocol to identify the PCS and measure its length using 3D reconstructions of the brain obtained through the BrainVISA software. Both the previous state-of-the-art protocol and the new protocol were applied to identify the PCS in subjects from a UK cohort (n = 50), with the length of the PCS computed automatically by BrainVISA after PCS identification. We assessed inter-rater reliability for PCS length under both protocols and the correlation of PCS length values output by the two protocols. Inspection of the results indicated an advantage of the new protocol as there are 8 out of 100 hemispheres in which the old protocol detects a PCS due to the mislabelling of the intra-limbic sulcus as the cingulate sulcus and the new protocol does not. This advantage is conferred by the incorporation of identification of the intra-limbic sulcus (when present) in the new protocol. For instances where the protocols agreed on the presence of a PCS, the new protocol for PCS length obtained intra-class correlations of 0.85 and 0.86 on respectively untrained and trained experimenters, compared to 0.81 when trained experimenters used the previous protocol. The PCS length correlation between both protocols was 0.73 for the entire sample and 0.85 after excluding instances where the protocols disagreed on the presence of a PCS. These findings suggest that taking into account the intra-limbic sulcus and taking advantage of 3D sulcal visualisation may help improve reliable PCS identification, and that the new protocol is a reliable tool that is likely to prove useful in research into cingulate and paracingulate cortical folding.
Our study aimed to identify social determinants of health (SDoH), demographic, and clinical features associated with opioid use disorder (OUD) and then to develop a risk calculator, termed Social and Clinical Opioid Use Disorder Predisposition Evaluation (SCOPE), that clinicians may use at the bedside to risk-stratify for OUD. Participant data from the All of Us Research Program were used. Multivariable logistic regression was used to identify various SDoH, demographic, and clinical predictors for OUD. The dependent variable of OUD was defined as occurring ≥90 days after participants completed a survey that queried questions related to SDoH. Calculated odds ratios from the model were used to construct a score-based calculator, SCOPE, and model performance was measured by area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity. There were 624,431 included participants, of whom 2475 (0.39%) had OUD that was diagnosed >90 days after survey completion. SCOPE's performance was assessed using 10-fold cross-validation, resulting in an average AUROC [SD] of 0.85 [0.011], specificity of 78% [0.16%], and sensitivity of 78% [2.42%]. Defining a cutoff score of 8 as high-risk yielded a sensitivity of 0.79 [95% CI: 0.76-0.83], specificity of 0.76 [95% CI: 0.75-0.76], positive likelihood ratio of 3.35, and negative likelihood ratio of 0.26. We identified individual- and SDoH-related risk factors for OUD and developed SCOPE, which may be used as a clinical decision-making aid for personalized risk identification of OUD.
A sensitive and environmentally friendly spectrofluorimetric method was developed for the determination of guanfacine in pharmaceutical formulations. The method is based on derivatization of guanfacine with 4-chloro-7-nitrobenzofurazan in alkaline medium to yield a highly fluorescent product measured at 535 nm after excitation at 466 nm. Experimental conditions affecting the reaction were systematically optimized to achieve maximum fluorescence intensity. The method exhibited excellent linearity over the concentration range of 50-500 ng/mL with a correlation coefficient of 0.9994. The limits of detection and quantitation were found to be 13.80 and 41.82 ng/mL, respectively, indicating high sensitivity. The method was validated in accordance with ICH guidelines and demonstrated satisfactory accuracy, precision, robustness, and selectivity. It was successfully applied to the analysis of guanfacine in commercial tablet formulations without interference from excipients. Greenness assessment using Analytical Eco-scale and AGREE tools confirmed the environmentally benign nature of the method, achieving a high Eco-scale score of 89 and an AGREE score of 0.68. Compared with a reported method, the proposed approach offers improved sensitivity and superior environmental benignity, making it suitable for routine quality control analysis.
The coronavirus disease 2019 (COVID-19) pandemic has strongly challenged health systems, but Italian community mental health services, rooted in the Basaglia reform and the World Health Organization (WHO) QualityRights framework, may have preserved a high perception of care quality and respect for human rights. This study compared users' perceptions of quality of care, human rights, and resource adequacy in public mental healthcare facilities during and after the pandemic in Sardinia, Italy. A cross-sectional survey was conducted in 2025 among users attending three community mental health services (Nuoro and Sanluri Local Health Networks) and one university hospital facility (Cagliari). Data were compared with a previous survey carried out in the same network during the COVID-19 pandemic (2021). Users completed a brief sociodemographic form and the "Well-Being at Work and Respect for Human Rights Questionnaire" (WWRR, user version), inspired by the United Nations (UN) Convention on the Rights of Persons with Disabilities and WHO QualityRights. Group differences were analyzed using chi-square tests and one-way analysis of variance (ANOVA). The final 2025 sample included 118 users, compared with 200 users in 2021. Mean satisfaction scores for overall care and organizational aspects (WWRR items 1-3) remained very high in both surveys (>5/6) without significant differences. Perceived respect for users' rights (item 4) and staff rights (item 5) significantly increased post-pandemic (5.26 ± 1.10 vs. 5.51 ± 0.98, p = 0.042; and 4.89 ± 1.22 vs. 5.35 ± 1.04, p = 0.001, respectively). Perception of resource adequacy (item 6, reverse-coded) also improved (2.68 ± 1.10 vs. 2.06 ± 0.98, p < 0.001), although it remained the most critical domain. Item 7 indicated an evolving demand for a more diversified workforce, with psychologists being the most frequently requested professionals, and an emerging perceived need to increase multiple professionals across multiple categories and administrative/management staff. Users of Sardinian community mental health services reported persistently high satisfaction and an increased perception of respect for human rights after the COVID-19 pandemic, despite ongoing concerns about limited resources. These findings highlight the resilience of community-based mental healthcare and underscore the need for structural investment and the strengthening of the multidisciplinary workforce strengthening to sustainably align service provision with international human rights standards.
Early recognition of alcohol use disorder (AUD) in women can reduce the risk of developing alcohol-related liver disease (ALD). For many women, reproductive health visits, including cervical cancer screening may be their only health care contact. We aimed to evaluate the prevalence of AUD and ALD in women undergoing cervical cancer screening and whether these visits represent missed opportunities for AUD identification. This is a retrospective analysis of adult women aged 21-65 who underwent cervical cancer screening in the nationwide MarketScan Database 7/1/2013-12/31/2021. ICD coding was used to identify inpatient/outpatient AUD/ALD diagnoses. Median time to AUD/ALD diagnosis was calculated, and the cumulative incidence of inpatient AUD/ALD following an initial outpatient encounter was estimated using the Kaplan-Meier method. A total of 11,429,720 women underwent cervical cancer screening (mean age 41.7 y). AUD was identified in approximately 1 in 50 women, one-quarter of whom required hospitalization. Notably, 30.7% of women hospitalized for AUD previously saw a provider for cervical cancer screening where AUD was not diagnosed. ALD was present in 0.1% (1 in 1,000) of women screened for cervical cancer, with about half requiring hospitalization. Among those hospitalized for ALD, 24.5% previously saw a provider for cervical cancer screening where AUD had not been identified. A notable proportion of women hospitalized for AUD/ALD had a prior cervical cancer screening visit where AUD was not identified, representing a missed opportunity for intervention. Standardized screening and referral for treatment at these visits may reduce downstream consequences of harmful alcohol use.
Guidelines recommend symptom-triggered therapy for the management of alcohol withdrawal, and the most commonly used assessment scale is the Clinical Institute Withdrawal Assessment, Revised (CIWA-Ar). CIWA-Ar has been criticized, however, for relying on patient self-report, and numerous alternative scales have been developed that incorporate vital signs to be more objective. Few studies compare alcohol withdrawal outcomes based on the type of assessment scale. We conducted a retrospective cohort study of patients hospitalized with alcohol withdrawal on medical wards in 19 Veteran Health Administration (VHA) hospitals between October 1, 2018, and September 30, 2019. Hospital outcomes, including treatment duration and the occurrence of complicated withdrawal were analyzed based on the use of CIWA-Ar compared with withdrawal scales that incorporated vital signs. In total, 461 (78%) patients were managed using CIWA-Ar, and 127 (22%) patients were managed using symptom scales that included vital signs. The mean duration of treatment was 3.4 days (SD, 2.0) for patients managed with CIWA compared with 3.9 days (SD, 2.0) for patients managed with scales incorporating vital signs (P=0.007). In multivariable analysis, duration of treatment remained longer using scales with vital signs (RR 1.30, 95% CI, 1.15-1.48). There was no difference in rates of complicated withdrawal (OR 1.00, 95% CI, 0.41-2.46). Our results indicate that the use of alcohol withdrawal scales that incorporate vital signs are associated with increased treatment duration and no difference in rates of complicated withdrawal. Randomized clinical trials are needed to ascertain which assessment scale is best.
This article provides an overview of alcohol exposure and attributable mortality and burden of disease in the World Health Organization Western Pacific Region, and trends in alcohol exposure over the past two decades. We employed a comparative risk assessment and trend analyses to evaluate alcohol exposure patterns and attributable burden. In 2019, almost half a million deaths and more than 22 million disability-adjusted life years lost were attributable to the consumption of alcohol in the Western Pacific Region, representing 3.5% (95% uncertainty interval 2.5, 4.8) of all deaths and 4.4% (95% uncertainty interval 3.6, 5.4) of all disability-adjusted life years lost. This was caused by an average consumption of 6.06 litres of pure alcohol per year (APC; 95% confidence interval 4.46-7.84), higher than the global average of 5.45 litres. Trends in APC have varied across subregions: China saw increasing consumption up to 2016, with a marked decrease since then, likely due to an anti-corruption campaign prohibiting consumption in public spaces and during official functions. In other Asian countries, consumption steadily increased until the COVID-19 pandemic, then decreased during it, and has now partially returned to pre-pandemic levels. APC in Oceania including Australasia was relatively stable between 2000 and 2020 and has decreased since. Overall, alcohol use remains high and normalised in the region, necessitating robust alcohol control policies. Strengthening these efforts is particularly critical in some Asian countries that experienced the largest increases in levels of alcohol consumption between 2000 and 2024.
The renewal of psychedelic medicine has garnered significant scientific interest, with large efforts dedicated to the understanding of the complex subjective experiences induced by these substances. The Altered States of Consciousness (ASC) questionnaire represents the most comprehensive instrument for measuring such experiences yet lacks a validated French translation despite its centrality to research. A psychometric validation of the French 5D-ASC and 11 OAV subscales was conducted using data from 777 participants recruited through online platforms. Participants completed the 94-item questionnaire based on a past naturalistic psychedelic experience induced by a classical or non-classical psychedelic substance. Confirmatory factor analysis (CFA) of established factorial structures, multiple-indicator multiple-cause (MIMIC) modeling assessing measurement invariance across substance categories, and comprehensive reliability analyses were used. The 11-subscale solution demonstrated better fit compared to higher-order structures (CFI = 0.882, RMSEA = 0.051, SRMR = 0.061), though comparative fit indices remained marginally below conventional thresholds. Internal consistency was excellent for global scores (α = 0.95) and satisfactory across individual subscales (α = 0.63-0.84). Construct validity was supported by theoretically consistent inter-scale correlations and convergent validity with single-item validators. MIMIC modeling revealed modest differential item functioning but confirmed measurement invariance, with latent factor differences aligning with known pharmacological profiles. This study provides preliminary evidence for the psychometric validity of the French 5D-ASC. These findings enable future research examining the relationship between subjective experience and therapeutic outcomes in francophone contexts, contributing to the international standardization of psychedelic research instruments.
Brain disorders-encompassing neurological, mental, and substance use disorders-account for 10 of the top 25 causes of disability worldwide according to the Global Burden of Disease (GBD) 2021 study. Despite such an impact, they have not been centrally analyzed in prior GBD studies. This paper synthesizes the latest disability-focused GBD study to quantify the prevalence and disability burden of 35 conditions from 2010 to 2021, a period marking the first decline in global health outcomes in three decades. It further incorporates disability metrics from 2021 to 2023 to contextualize post-pandemic trends. The paper covers the prevalence and disability burden of neurological, mental, and substance use disorders along with COVID-19 using disability-adjusted life-years (DALYs) and years lived with disability (YLDs) metrics. From 2010-2021, Parkinson's, Alzheimer's, and migraine (in neurological disorders), major depressive, anxiety, and eating disorders (in mental disorders), and opioid and drug use disorders (in substance use disorders) showed the greatest increases in age-adjusted prevalence rates across both sexes. In 2021, neurological disorders were the largest contributor to DALYs among brain-disorder categories, while depressive and anxiety disorders ranked as the 2nd and 6th leading causes of global YLDs. Alzheimer's disease/dementias, Parkinson's disease, autism spectrum disorder (ASD), depressive and anxiety disorders, and opioid and drug use disorders showed the largest increases in burden within their respective categories between 2010 and 2021. In both 2021 and 2023, females had higher prevalence rates of overall neurological disorders, headache/migraine, multiple sclerosis, depressive/anxiety disorders, and anorexia nervosa, while males had higher rates of stroke, Parkinson's disease, ASD/ADHD, and substance use disorders. In DALY/YLD metrics, females showed higher rates for anorexia nervosa and multiple sclerosis, and males for ASD, certain neurological disorders, COVID-19, and substance use disorders. In the 2021-2023 extension analysis, disability data showed increases in prevalence and disability of several brain disorders, mostly anxiety disorders, while the COVID-19 disability burden declined markedly by 2023. Further sex-specific disability burden metrics, key insights from each disorder, and limitations/confounds are discussed.
There has been an increased interest in the development and use of digital health technologies (DHTs) to help treat patients with opioid use disorder (OUD), but information on the needs and preferences of the patients seeking treatment for it is lacking. This study's objective was to collect data on preferences for DHTs that are intended to support patients with OUD. A discrete choice experiment was conducted with 500 respondents who self-reported a diagnosis of OUD. The experiment included 6 attributes identified based on earlier phases of the study. These attributes included the benefit of the DHT, data sharing with one's care team, data sharing with third parties, personalized goal tracking, community support, and health care support. Tools that allow patients to connect with their care team, connect with peers, or set and track their own goals were highly valued by respondents. In general, respondents who participated in the study preferred DHTs that improve the chance of abstaining from nonprescribed opioid use over those that improve the chance of staying in treatment or reducing the chance of opioid overdose. However, we also observed heterogeneity in preferences for benefits and data-sharing features within OUD treatment, suggesting that different patients may exhibit different preferences for OUD treatment in clinical settings. DHTs can be designed to target different outcomes and can include various features that support patients being treated for OUD. Although some outcomes and features emerged as being preferred by respondents, there was significant heterogeneity in the results. It will be important for developers to think about the various needs and preferences of target users (eg, patients) for their specific DHT rather than viewing the patient population with OUD as homogenous.
Most people with alcohol use disorder (AUD) do not receive treatment. Few digital evidence-based treatments have been tested among community-based samples of people with AUD. The present trial of Computer-Based Training for Cognitive Behavioral Therapy (CBT4CBT) (1) assessed CBT4CBT usability and acceptability and (2) explored alcohol-related outcomes by study condition in a non-treatment sample of people with AUD. For the current two-arm clinical trial, a non-treatment sample of people with lifetime AUD and current heavy drinking was recruited using ResearchMatch.org and randomized (3:1) to the CBT4CBT program or an assessment-only control, stratified by sex (N = 160 total; CBT: n = 109; Co: n = 51). Study assessments included post-intervention acceptability ratings and self-reported alcohol-related measures administered at baseline, post-intervention, and 1-month follow-up. Participants were 68.1% female and 31.9% male, in their early forties (M = 42.6, SD = 15.7, range 19-76 years). Most participants identified as white (65.0%) or Black (27.5%) and non-Latinx (89.4%). Acceptability ratings and usability measures for CBT4CBT were favorable and comparable to studies among clinical treatment samples. Participants in the CBT4CBT group demonstrated faster reductions in the percentage of drinking days and were significantly less likely to report any heavy drinking days than those in the control condition at 1-month follow-up. The CBT4CBT group reported higher recovery scores than the control group. The present study provides benchmark data on the use of CBT4CBT in a sample of people with AUD not receiving treatment. Findings have important clinical and research implications for expanding the reach of evidence-based addiction treatment beyond traditional treatment settings.
Dopaminergic medication used in disorders like Parkinson's disease (PD) and restless legs syndrome can cause impulsive-compulsive behaviour (ICB), often with strong negative effects on patients' quality of life. This narrative review presents translational evidence on iatrogenic ICB, taking findings from epidemiological, clinical, neuroimaging and preclinical studies into consideration. Epidemiological and clinical studies find dopamine agonists with high D2/3-selectivity to be most strongly linked to ICB. Their effect on ICB has often been shown to be dose-dependent, but the impact of combining different dopaminergic drugs or applying extended-release formulations is less clear. Intervention studies support tapering or replacing dopamine agonists for ICB reduction, whereas no efficacious pharmacotherapy has been identified for ICB treatment specifically. Adequate animal models for mimicking different types of ICB are available, and point, in line with human neuroimaging studies, towards an involvement of striatum and prefrontal cortex in iatrogenic ICB. Overall, complementary research designs have led to profound evidence regarding the occurrence of ICB in PD and establishing methods transferable to other, less-studied patient populations. A combined approach integrating insights from human studies and animal models could contribute to developing dopaminergic drugs with lower ICB risk but also specific pharmacotherapies for impulsivity or compulsivity in the future. Diseases like Parkinson's disease and restless legs syndrome are treated with drugs that affect dopamine activity in the brain. As a side effect, these drugs can lead to a lower impulse control, manifested, for example, as gambling disorder or hypersexuality. This article summarises research on these side effects, collected through a variety of scientific methods. The drug type with the highest risk for behavioural side effects has been identified, but many details remain unclear, especially in patients with other disorders than Parkinson's disease. Results from both human brain imaging and animal models start to reveal brain pathways involved.
Youth experiencing homelessness (YEH) report higher substance use than stably housed youth, yet their perspectives and system supports are poorly understood. This youth participatory action research examines YEH perspectives on substance use and harm reduction, and identifies youth-driven opportunities to improve responses by health care providers and YEH-serving agencies (YSA). In partnership with a local YSA, we conducted 2 focus groups with YEH (n=21) to describe their (1) perspectives on substance use and harm reduction, (2) experiences navigating substance use disorder resources, and (3) recommendations for shelters and health care organizations to enhance support for YEH who use substances. Utilizing thematic analysis and an iterative youth participatory action research process generated recommendations for YEH-serving agencies and health care professionals. Five key themes were identified: (1) Youth understanding of substance use terminology highlighted varied interpretations of "substance use" and "harm reduction" and the need for shared definitions. (2) Characteristics of ideal services for YEH envisioned compassionate, nonjudgmental care and accessible resources. (3) Mitigating bias among youth-serving professionals and (4) supporting and defining recovery for YEH who use substances emphasized waiving sobriety requirements in YEH-serving agencies. (5) Advice for youth-serving professionals regarding recovery emphasized individualized, youth-centered approaches with integrated harm reduction and mental health support. Our study underscores the importance of uplifting the voices of youth with lived experiences when addressing their health needs and identifies youth-driven opportunities for systems improvements. Future directions include providing opportunities for youth to co-create systems of care that serve them.
The purity, accessibility, and affordability of illicit methamphetamine have increased in recent decades, which has been linked to rising rates of methamphetamine-involved overdoses, psychosis, cardiovascular events, and other health consequences. Nevertheless, information about the quantity of methamphetamine used by regular consumers has been limited, despite the potential clinical utility of exposure quantification. From August 2024 to April 2026, self-reported daily methamphetamine consumption was assessed among n = 94 individuals in Los Angeles County. Methamphetamine samples (n = 256) were analyzed for purity using liquid chromatography-mass spectrometry. Bioavailability by route of administration and stimulant equivalency were obtained from the literature. A simulation model leveraging bootstrapping with 1,000,000 draws was used to estimate oral amphetamine milligram equivalents (AME). The average reported methamphetamine consumption was 1.09 g daily (95% prediction interval: 0.07-4.00). Average purity was 84.52% (95% PI: 14.90%-100.00%). Given estimated average bioavailability of 66.41% (95% PI: 39.35%-85.24%), the average consumer used an estimated 1432.54 AME daily (95% PI: 35.74-6973.05). We estimate that consumers of methamphetamine in Los Angeles use an average daily stimulant dose (nearly 1500 oral AME) about 25-fold higher than the maximum typical recommended clinical dose of mixed amphetamine salts (60 mg). This may help contextualize why prescription stimulant treatment trials using substantially lower doses have shown limited efficacy. Given this high dose, these findings shed light on the rising incidence of methamphetamine-related sequelae, such as psychosis, cardiovascular complications, and sudden death. Although exposure quantification is commonplace for alcohol and tobacco use disorders, uncertainties in illicit drug markets have complicated this practice for most illicit drugs. This study supports leveraging emerging information from drug checking programs so that clinicians can approximate exposure quantification.
This study assessed the societal economic burden in terms of cost of illness and health-related quality of life (HRQoL) of posttraumatic long bone non-unions in the Netherlands. An incidence-based bottom-up approach was used, focusing on adult patients with posttraumatic long bone non-unions. The analysis included healthcare costs, patient and family costs, and productivity losses, measured using the iMCQ and iPCQ questionnaires. Cost evaluations followed Dutch costing guidelines, and productivity losses were calculated using the friction cost method. HRQoL was assessed with the EQ-5D-5L. A deterministic one-way sensitivity analysis varied baseline characteristics by ± 10%. Scenario analyses were conducted from healthcare and patient perspectives, as well as for patient subgroups. Average costs per patient during the three months before the initial visit at a non-union clinic were €8,928 (healthcare, N = 78), €1,360 (patient and family, N = 58), and €4,313 (productivity losses, N = 59), the average of the observed data calculates to 10,831 (N = 44). The mean EQ-5D-5L utility score was 0.390 (± 0.29 SD). Subgroup analysis showed no significant cost increase for patients with infections or open fractures. However, a higher Non-Union Severity Score and a lower HRQoL were significantly associated with higher total costs. Posttraumatic long bone non-unions pose a substantial economic burden on Dutch society and have a tremendous impact on HRQoL. Severe non-unions and a lower quality of life were associated with increased costs, whereas initial fracture characteristics were not. These findings highlight the importance of effective preventive and therapeutic strategies to reduce the burden of posttraumatic long bone non-unions.
In the United States, significant federal cannabis policy changes occurred in 2009, 2013, and in 2018. This study reviews trends in reported cannabis exposures to children in light of those policy changes. Retrospective descriptive observational time-trend analysis. Secondary analysis of annual data from US poison centers. Participants were cases reported to US poison centers and entered in the National Poison Data System from 2000 to 2024. Rates of pediatric cannabis exposures reported to America's Poison Centers are given, along with trends in those exposures. Reported pediatric exposures of the under-6-year age group to cannabis were stable from 2000 to 2009. Starting in 2010, exposures began to increase, with the rise continuing to 2024, the most recent year of data availability. Between 2009 and 2024, such exposures increased by 6386% from 132 to a total of 8430 exposures. Cannabis exposures in the 6-12 age group also increased during the same period (increase from 21 to 2894; 13,781%). There was an increase of more than 6000% in reported pediatric exposures to cannabis in the United States between 2009 and 2024 in both the under-6 and the 6-12 years age groups. This rise is temporally associated with changes in federal cannabis policy that began in 2009. Because of the negative effects on children's health, public health policy adjustments are warranted.