Illicit Opioid Use Research Articles (Page 1)

Access to evidence-based treatment for opioid use disorder remains limited, particularly for individuals who have not responded to oral opioid agonist treatment (OAT). A community pharmacy-based model of injectable OAT (iOAT) was piloted in Vancouver, Canada from March 2017 to December 2018. This brief report describes the program structure, participant sociodemographics, reported outcomes, and strengths and areas for improvement of the program. A retrospective review of cross-sectional, interviewer-led questionnaire data from participants who accessed iOAT at the pharmacy site (n = 176) and provided informed consent was conducted. Outcomes include participant-reported changes in symptomatology, function and satisfaction, analysed through descriptive statistics. Open-ended responses were analysed using content analysis to identify strengths and areas for improvement of the program. Fifty-one participants (29%) completed the questionnaire, and most had multiple previous overdoses and trials of oral OAT. The most commonly reported outcomes were reduction in illicit opioid use (76%), opioid cravings (45%) and illicit substance use (45%). Participants identified key strengths of the program as positive experiences with staff and efficiency of the pharmacy model including flexible dosing time and the ability to pick up other medications at the same time. Suggested improvements focused on medication options (e.g., access to diacetylmorphine, alternate routes of administration), expanded hours and flexibility, additional support services, and increased capacity and space. Community pharmacy-based iOAT represents a novel strategy to expand access to evidence-based opioid use disorder treatment among individuals who inject opioids and have not responded to or do not prefer oral OAT.

BackgroundOpioid overdose is a global public health emergency, with the United States experiencing high rates of morbidity and mortality due to prescription and illicit opioid use. Traditional public health monitoring systems often fail to provide real-time insights, limiting their capacity for early detection and intervention. Social media platforms, especially Reddit, offer a promising alternative for timely toxicovigilance due to the abundance of user-generated, real-time content.ObjectiveThis study aimed to explore the use of Reddit as a real-time, high-volume source for toxicovigilance and develop an automated system that can classify and analyze opioid-related social media posts to detect behavioral patterns and monitor the evolution of public discourse on opioid use.MethodsTo investigate evolving social media discourse around opioid use, we collected a large-scale dataset from Reddit spanning 6 years, from January 1, 2018, to December 30, 2023. Using a comprehensive opioid lexicon—including formal drug names, street slang, common misspellings, and abbreviations—we filtered relevant posts for further analysis. A subset of these data was manually annotated according to well-defined annotation guidelines into 4 categories: self-misuse, external misuse, information, and unrelated, with distributions of 37.21%, 27.25%, 27.57%, and 7.97%, respectively. To automate the classification of opioid-related chatter, we developed a robust natural language processing pipeline leveraging classical machine learning algorithms, deep learning models, and transformer-based architecture, and fine-tuned a state-of-the-art large language model (LLM; OpenAI GPT-3.5 Turbo). In the final stage, the trained LLM was deployed on an unlabeled dataset comprising 74,975 additional Reddit chatter posts. This enabled a detailed temporal analysis of opioid-related discussions, aligned with 6 years of opioid-related death records from the Centers for Disease Control and Prevention (CDC). For this study, self-misuse and external misuse were merged into a misuse category for direct comparison with the CDC’s mortality data, examining whether trends in social media discourse on opioid misuse reflect patterns in real-world mortality statistics.ResultsThe fine-tuned GPT-3.5 Turbo model achieved the highest classification accuracy of 0.93, outperforming the baseline (random forest 0.85) by representing a performance improvement of 9.14% over the machine learning model. The temporal analysis of the unlabeled data revealed evolving trends in opioid-related discussions, indicating shifts in user behavior and overdose-related chatter over time. To quantify this relationship, we calculated the Pearson correlation coefficient between misuse-related posts and CDC death records (r=0.854). This correlation was statistically significant (P<.001), indicating a strong positive relationship between web-based discussions and CDC mortality data.ConclusionsThis study demonstrates the potential of integrating advanced natural language processing techniques and LLMs with social media data to support real-time public health surveillance. Reddit provides a valuable platform for identifying emerging trends in opioid use and overdose risk. The proposed system offers a proactive tool for researchers, clinicians, and policymakers to better understand and respond to the opioid crisis.

BackgroundJustice-impacted persons aged 40 and up with substance use disorders (SUD) demonstrate increased health risks and health disparities relative to general population peers. Persons with SUD are less likely to age out of criminal behavior, appearing on criminal dockets, in jails, prisons, and under community supervision throughout the life course, with greater community-level cost burdens as they age. Justice system involvement presents health risks that compound with SUD to undermine well-being, which is amplified as people age and experience age-related health decline. Propensity for premature mortality from overdose is startlingly high for this population, highlighting demand for targeted policies to better meet the needs of this vulnerable group. To better understand justice-impacted older adults in treatment for SUD and inform policy, we examined opioid use outcomes among 357 low-income justice-impacted adults in SUD treatment in the Midwest, USA, including a natural oversampling of Black and American Indian or Alaska Native (AIAN) persons. We explored patterns among persons in their 40s, 50s, and 60s, relative to those under 40, conceptualizing life-course risk factors and using logistic regression to assess overdose, opioid use, and opioid agonist medication use.ResultsSignificant differences in opioid use by age were observed, with older persons less likely to report opioid prescription misuse or illicit opioid use. Differences were not significant once controlling for user preferences, race/ethnicity, gender, family, childhood, and life course experiences. Overdose history was also significantly less likely for the 40 and older SUD patient, though this was no longer significant when controlling for demographic covariates. Opioid agonist medication use did not significantly differ by age.ConclusionsJustice-involved patients aged 40 and up in SUD treatment were less likely to have experienced overdose or report opioid use, relative to their younger peers, but this variation dissipated when considering demographic, family and/or life course factors. Targeted treatment services for gender and racial minorities may be beneficial for patients 40 and up. We identify preference for one substance, versus two, as protective against overdose and opioid use among older persons who use drugs.

Opioid misuse and suicide among youth remain pressing public health challenges. This scoping review examined studies published between 2020 and 2024 on associations between opioid misuse and suicidal ideation, suicide attempts, or non-suicidal self-injury (NSSI) among adolescents and young adults aged 12–30, emphasizing sex and racial or ethnic differences. Guided by Arksey and O’Malley’s framework and PRISMA-ScR, we searched MEDLINE (PubMed), PsycINFO, Scopus, Embase, and CINAHL for peer-reviewed cross-sectional studies in English. Eligible studies assessed nonmedical prescription or illicit opioid use and excluded clinical or incarcerated samples and those with older participants. Seventeen studies met the inclusion criteria. Fifteen analyzed U.S. national or state data, one examined youth in the Northern Mariana Islands, and one used Canadian data. Sixteen studies identified a positive association between opioid misuse and suicide-related outcomes, while one showed a recency gradient, with current misuse carrying the highest risk. Other findings showed that frequent misuse increased risk, multiple substance use heightened danger, and females and youth from racial and ethnic minority groups were more vulnerable. Opioid misuse is strongly associated with suicide risk. Integrated, sex- and culturally responsive prevention strategies are needed, alongside further research clarifying mechanisms and protective factors.

BackgroundMedical devices offer an established therapeutic approach for managing the transition from polysubstance use to abstinence, but little is known about longer-term outcomes.AimDetermine opioid and psychostimulant use over 12 weeks post-discharge following residential use of the NET Device™ or sham among participants with opioid use disorder (OUD).DesignTwelve-week observation following randomized controlled trial of active NET Device (n = 53) versus sham (n = 55) as monotherapy during residential opioid discontinuation in 103 participants who completed >1 post-discharge interview (95% follow-up rate).Setting and participantsAdults with OUD (50.0% with psychostimulant use) recruited at admission from 4 residential addiction treatment facilities in Kentucky.MeasuresPercentage of days using illicit opioids and psychostimulants as well as medications for OUD (MOUD) from weekly timeline follow-back interviews.ResultsActive and sham device groups reported similar rates of MOUD use and illicit opioid and psychostimulant use. In a planned secondary analysis, participants who self-administered active stimulation >24 hours (n = 23) compared to active <24 hours (n = 25), sham >24 hours (n = 21), and sham <24 hours (n = 34) reported significantly (p <.05) lower percentages of days using opioids (1.4% vs 7.4%, 6.8%, and 4.4% respectively) and psychostimulants (1.3% vs 4.1%, 6.7%, and 4.3% respectively) and MOUD (1.2% vs 20.7%, 11.3%, and 16.7% respectively).ConclusionsThe randomized groups did not differ on outcomes. However, participants who self-administered active NET Device stimulation >24 hours reported significantly fewer post-discharge days of opioid or psychostimulant use than those who self-administered active <24 hours or sham, but these findings need to be replicated.Clinical Trial Registration: ClinicalTrials.gov, identifier NCT04916600.

Introduction: Substance use during pregnancy presents critical risks to both maternal and fetal health. Addressing addiction in pregnant women requires a multidisciplinary and evidence-based approach. Purpose: This review aims to explore treatment modalities for substance use disorders in pregnant women, with emphasis on clinical efficacy, regional programs, and best practices in Greece and Europe. Methods: We conducted a literature review from PubMed, EMBASE, and Google Scholar using keywords such as “pregnancy,” “addiction,” “substance use disorder,” “methadone,” and “treatment” within the time frame 2000–2025. Fifty-two studies were included based on predefined inclusion and exclusion criteria. Results: Methadone reduced illicit opioid use by up to 60% but increased neonatal abstinence syndrome by 30%. Buprenorphine showed fewer neonatal complications compared to methadone. Multidisciplinary programs improved maternal retention in care by 40%. Major barriers included social stigma, limited accessibility, and lack of integrated services. Greek-specific data highlighted gaps in coordination and underfunded regional initiatives. Conclusions: Effective management of addiction in pregnancy necessitates integrated care models, updated clinical protocols, and targeted public health policies. Investment in prevention, staff training, and postnatal follow-up is crucial.

BackgroundIn Australia, methamphetamine use is a significant public health concern, and is common among people involved with the criminal justice system. This study aimed to investigate the prevalence and correlates of adult imprisonment history among adults who primarily smoke methamphetamine.MethodsA cross-sectional study was conducted using baseline data from ‘VMAX’, a cohort of adults who regularly use methamphetamine. Data were collected between June 2016 and March 2020 from 718 participants. Sampling methods included convenience and respondent-driven sampling. Prison exposure was measured by asking if participants had ever been imprisoned due to a conviction (and was distinguished from juvenile detention). Logistic regression was used to examine how this correlated with socio-demographics, drug use, mental health, and criminogenic characteristics.ResultsNearly one-third (30%) of 718 participants reported having been imprisoned. Increased odds of reporting a history of imprisonment were found for participants reporting older age, male gender, non-metropolitan residential location, past-year homelessness, not being currently employed, schooling ≤ Year 9, ≥ weekly methamphetamine use, past-year illicit opioid use, injecting drug use history, and juvenile detention history. In contrast, participants reporting past-year other illicit stimulant (cocaine, ecstasy, illicit pharmaceutical stimulant) use were less likely to report a history of imprisonment.ConclusionsSocial characteristics, patterns of drug use, and juvenile detention history were found to be correlated with imprisonment history. These findings point to the importance of providing targeted services to address characteristics of social disadvantage and drug use behaviours among people who use drugs, including among people who primarily smoke methamphetamine.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12954-025-01307-8.

Extended-release injectable buprenorphine for the treatment of opioid use disorder among individuals at high risk of overdose: The FASTER-BUP udy.

Long-Acting injectable buprenorphine PLGA microparticle formulation.

We aimed to identify methamphetamine use patterns and impact by gender/sexual orientation among people with HIV (PWH) in care. We queried 3-month drug use/impact. Women were grouped by gender (cis/trans); cisgender men by sexual orientation. Differences in drug use/impact were assessed using chi-squared and t-tests. We used linear and logistic regression models for each drug use measure, adjusting for age and race/ethnicity. Among 13938 PWH (MA 48), 30% reported ever using methamphetamine; 10% reported current use; 79% were cisgender men (74% men who have sex with men (MSM), 20% men who have sex with women (MSW), 6% men who have sex with men/women (MSMW). Among women (21%), 8% were transgender (TW). TW and MSM reported higher current methamphetamine use (each 14%) than other groups [MSMW (13%), MSW (6%), CW (3%)(p < 0.001)]. Severity of use was highest among TW, compared to MSM (17.8 vs. 14.1, p = 0.04). All groups using methamphetamine were more likely than MSM to currently use cocaine/crack (p = 0.002-0.04); all but TW were more likely than MSM to report illicit opioid use (p < 0.001-0.03). MSM had highest injection use (34% vs. 17-25%, p = 0.05). Related health/legal/financial/social problems were most frequent among TW and MSMW (71%, 55%)]. Persons currently using methamphetamine had lower antiretroviral adherence than those not using (81-85% vs. 91-94%), and higher detectable viral load (28-41% vs. 13-20%). In the adjusted analysis, TW were more likely than MSM to report daily/almost daily use (p = 0.04). Methamphetamine use and impact differ by gender and by cisgender men's sexual orientation, warranting inquiry into moderating factors.

Between 2013 and 2017, Canadian federal policymakers grappled with mandating abuse-deterrent formulations (ADFs) for oxycodone products as a response to the overdose crisis. Marketed as a safeguard against misuse and diversion, ADFs promised a technological fix to opioid-related harms, yet their population-level effectiveness remained contested. This study systematically analyzes federal parliamentary debates and committee hearings, identifying key arguments in framings to support or oppose ADF mandates. Proponents framed the crisis through the lens of individual misuse, positioning ADFs as pharmaceutical safeguards that protected "legitimate" patients while curbing illicit opioid use. Opponents challenged ADFs' effectiveness, highlighted Purdue Pharma's role in the crisis, and warned of unintended consequences, including shifts to more dangerous illicit markets. These discursive struggles reinforced a bifurcation between "legitimate" and "illegitimate" opioid use, shaping perceptions of responsibility, medical necessity, and the scope of appropriate intervention. Divergent framings reflected deeper ideological fissures over the etiology of the overdose crisis and who should be considered a justifiable opioid patient. By demonstrating how ADF debates entrenched a dichotomy between acceptable and unacceptable opioid use, this study advances theories of problem framing to demonstrate how policy debates actively shape regulatory paradigms and the boundaries of acceptable government intervention.

The opioid overdose crisis has become a global public health emergency, claiming more than 100,000 lives each year. In North America, shifting opioid prescribing practices in response to the crisis have profoundly affected people living with chronic pain, who now face reduced access to prescription opioids. Against this backdrop, pain stakeholders have become increasingly active in policymaking arenas to shape how opioids and pain are understood. This study examines the Canadian Pain Task Force (CPTF) - a federal advisory body charged with creating a national pain strategy - by analyzing its reports, public and patient consultations, and internal documents. Through qualitative framing analysis, we find that stakeholders overwhelmingly depicted the overdose crisis as the result of illicit and irresponsible opioid use, while positioning stigma as both a driver and consequence of the crisis that compounded the challenges faced by people with chronic pain. From these problem definitions flowed policy proposals centered on expanding opioid access, reducing stigma, and advancing patient-centered care. These findings demonstrate how pain stakeholders shape, and are simultaneously shaped by, opioid policy debates - with consequences for both overdose prevention and chronic pain management.

Injectable buprenorphine during transition out of prison: A pilot partially randomized preference trial protocol.

Racial and ethnic disparities in opioid overdose deaths in the US have widened in recent years, potentially driven by inequitable access to naloxone. This study evaluated engagement across the naloxone care cascade, a framework encompassing awareness, access, training, possession, and use of naloxone. Using a nationally representative US sample, we analyzed data from 57,719 adults who completed the 2024 Survey of Non-Medical Use of Prescription Drugs to characterize differences by race and ethnicity in the degree of contact with any component of the naloxone care cascade. Black, Hispanic, and Asian adults had significantly lower engagement across all steps of the cascade compared with White adults. These trends were similar among a subgroup of adults with recent illicit or nonmedical opioid use. Culturally tailored, equity-focused strategies are needed to address the systemic drivers of racial and ethnic disparities in naloxone engagement.

Longitudinal patterns of opioid and stimulant use by route of administration among people who inject drugs in the South Atlantic Fentanyl Test Strip Study: A latent transition analysis.

Using quality improvement (QI) methods, we sought to improve the inpatient screening of opioid withdrawal symptoms using the Clinical Opioid Withdrawal Scale (COWS), an industry validated instrument that is not widely used in the inpatient setting. By educating nurses and providers on the clinical manifestations of opioid withdrawal and implementing an evidence-based Opioid Withdrawal Screening Pathway, we sought to improve outcomes for those at risk for opioid withdrawal during hospitalization. The pre-post test design using Plan-Do-Study-Act cycles involved two implementation phases. Phase I consisted of a 2-week formal education program for nurses and providers, including topics such as opioid use disorder, opioid withdrawal symptoms, COWS, opioid withdrawal treatment options, and criteria for consultation with the Inpatient Pain Management Team. Phase II involved a 12-week implementation of the Opioid Withdrawal Screening Pathway using COWS assessments and QI chart audits of pathway compliance data. Screening of illicit drug use rates were low, yet significantly increased during the QI pilot. Education completion rates were high. Discharge against medical advice rates and average length of stay were significantly reduced. Transfers to a higher level of care did not involve illicit opioid use and were not significant for two units. The incidence of workplace violence events was equal between baseline and implementation data. Through the implementation of an education program and screening pathway, the health care organization improved its screening rates of illicit opioid use and number of COWS assessments.

Objectives: Individuals under community supervision (e.g., probation and parole) have high rates of illicit substance use (ISU) and substance use disorders (SUDs), increasing their risk for numerous health issues, including HIV transmission. While SUD treatment can reduce substance use and HIV transmission risk, gaps remain in our understanding of its receipt among community-supervised individuals at risk for HIV. Methods: Using baseline data from the Southern Pre-Exposure Prophylaxis Study (SPECS), we examined the prevalence and demographic characteristics associated with SUD treatment receipt among community-supervised individuals at risk for HIV. Two participant subsets from SPECS were analyzed: those with a history of ISU (n = 346) and, among these participants, those specifically reporting a history of illicit opioid use (IOU; n = 211). Results: A high prevalence of SUD treatment receipt was found among participants reporting ISU (58.7%) and IOU (73.9%). Among participants with a history of ISU, Black non-Hispanic individuals had a significantly lower prevalence of treatment receipt than White non-Hispanic individuals (aPR = 0.68, 95% CI: 0.51, 0.90, p = 0.007). Among participants reporting IOU, White non-Hispanic individuals were 2.7 (95% CI: 1.2, 6.3) times more likely to receive medication for an SUD than individuals of any other race or ethnicity. Conclusions: Study findings highlight missed opportunities to engage people on community supervision who are at risk for HIV in evidence-based SUD care. Targeted efforts are needed to promote the adoption of medications for opioid use disorders (MOUDs) among individuals under community supervision, particularly for racially minoritized populations.

The rise of the "fourth wave" of the US overdose crisis has been characterized by the increasing polysubstance use of illicit opioids combined with other drug classes. Polysubstance combinations are increasingly better understood through community-based drug checking. Here we share findings from a drug checking program in Los Angeles, California, highlighting quetiapine-a commonly used atypical antipsychotic-as a novel additive in heroin samples. This study leveraged data from a community-based drug checking program in Los Angeles, CA. Substance determination was performed through direct analysis in real-time mass spectrometry (DART-MS). Fisher exact tests were used to assess differences in heroin samples containing versus not containing quetiapine. Of n=52 samples containing heroin, n=13 (25.0%) contained quetiapine. Among quetiapine-positive heroin samples, n=4 (30.8%) contained fentanyl, compared with n=27 (69.2%) quetiapine-negative heroin samples (P=0.022). No significant differences were observed between quetiapine-positive and negative samples with respect to xylazine, cocaine, or methamphetamine prevalence. All quetiapine-positive samples were identified by clients as expected to contain black tar heroin, and no clients reported expecting their samples to contain quetiapine. Anecdotally, some participants identified increased euphoria and "pins and needles" sensations from quetiapine-positive samples. This small observational study provides the first drug-checking-based evidence in the academic literature-to our knowledge-of quetiapine as an additive to the illicit heroin supply. The presence of quetiapine was associated with less fentanyl adulteration and may reflect an alternative augmentation strategy. Further confirmatory studies are needed to assess the degree to which this phenomenon exists in other locations and the potential health implications.

Prior research indicated intergenerational transmission of substance use behaviors via genetic mechanisms. However, there remain gaps in our understanding of these processes. There is a dearth of research examining parental drug use as a predictor of offspring illicit opioid use among justice-involved youth and age-graded effects. The Pathways to Desistance data were analyzed. Mixed effects modeling examined the direct effect of parent drug use history on offspring illicit opioid use risk and tested for moderation by age. Having a parent with a history of drug use predicted increased offspring's illicit opioid use risk, net of all control covariates. There was no significant interaction with age. The impact of parent drug use history appears to exert a consistent effect on opioid use risk across the life-course. Justice-involved youth whose parents have a history of drug use should be prioritized for intervention to prevent opioid use.

BackgroundMedical cannabis (MC) is approved for the treatment of opioid use disorder (OUD) in Pennsylvania, but little is known about how MC impacts illicit opioid use or the clinical and psychosocial factors including pain severity levels that can precede illicit opioid use. This observational study examined the extent to which changes in rates of illicit opioid use and in pain and psychosocial functioning were observed following the first three months of MC treatment.MethodsA referred sample of 47 adults taking buprenorphine/naloxone for OUD with a minimum pain severity rating of 5/10 enrolled from March 2022–April 2023. Participants were recruited from an outpatient MC physician recommender’s office and were offered a discounted MC 1:1 tetrahydrocannabinol:cannabidiol 5 mg:5 mg daily oral capsule. The primary study outcomes were pain severity, self-efficacy and interference, and the rates of illicit substance use as assessed via urine drug screening (UDS).ResultsParticipants (64% male, 49% Black, average age = 44 years) reported significant decreases in pain severity from baseline (M = 5.18, SD = 2.09) to Month 3 (M = 4.39, SD = 2.28), P < 0.01, Cohen’s d = 0.54, and pain interference from baseline (M = 5.21, SD = 2.79) to Month 3 (M = 4.32, SD = 2.86), P < 0.01, Cohen’s d = 0.47, and increases in pain-related self-efficacy from baseline (M = 6.55, SD = 3.57) to Month 3 (M = 8.05, SD = 3.30), P < 0.01, Cohen’s d = 0.44. Rates of opioid use (X2[1] = 4.00, P = 0.13) did not differ significantly from baseline (16%) to Month 3 (5%). Cravings for opioids were mildly higher at baseline (M = 2.15, SD = 2.88) than at 3-months (M = 1.78, SD = 2.95) but this difference was not statistically significant, P = 0.49, d = 0.1. Sleep quality scores improved significantly from baseline (M = 12.38, SD = 4.40) to Month 3 (M = 10.95, SD = 4.95), P < 0.05, d = 0.33. Quality of life significantly improved in seven of eight domains (P < 0.05).ConclusionMC treatment initiation was associated with reductions in pain severity and interference and improvements in quality of life and sleep quality, but not in illicit opioid use or cravings in adults with chronic pain receiving buprenorphine/naloxone for OUD.