Energy poverty and physical dependency among older adults

Many patients with chronic noncancer pain (CNCP) are prescribed opioid medication. However, concerns have been raised about the use of high opioid doses and the misuse of opioids in these patients. Research is needed to better understand the factors that influence day-to-day opioid intake patterns and opioid misuse behaviors in patients with CNCP. The first objective of this study was to examine the contribution of pain intensity, psychological factors, and physical dependence symptoms to daily opioid craving and opioid intake in patients with CNCP. The contribution of these factors to opioid misuse was also examined. In this ecological momentary assessment study, patients with CNCP prescribed short-acting opioids completed diaries, in between opioid doses, for 10 consecutive days. Diaries assessed a host of pain, psychological, and opioid-related variables. Diaries also assessed total daily morphine equivalent doses (MED) used by patients. Multilevel analyses indicated that intra-day increases in pain intensity, negative affect, catastrophizing, and withdrawal symptoms were associated with higher opioid craving (all P 's < 0.05). Day-to-day increases in pain intensity, catastrophizing, and craving were associated with greater opioid intake (ie, MED) (all P 's < 0.05). Patients' daily opioid craving contributed to daily opioid misuse even after accounting for other daily variables ( P < 0.05). Our findings provide new insights into the factors contributing to daily opioid craving, opioid intake, and opioid misuse among patients with CNCP. Interventions targeting these factors could potentially prevent opioid dose escalations and opioid-related harms among those maintained on opioid therapy.

The relationship between physical exercise and mobile phone dependence in college students: the chain mediating of self-control and social adaptability.

Objective: To investigate the characteristics of caregivers and the level of caregiver burden in Vietnam, and to identify associated factors. Subjects and Methods: A cross-sectional study was conducted on 137 caregivers. Demographic and clinical information was collected, and caregiver burden was assessed using the Zarit Burden Interview. Sleep quality was measured using the PSQI, and patient dependence was evaluated using the ADL/IADL scales. Results: The majority of caregivers were aged 40–60 years (69.3%), 55.5% were female, 94.9% were married, 76.6% had a university degree or higher, and 74.5% lived in urban areas. Most caregivers experienced low to moderate burden (88%), while only 11.2% had moderate to high burden. Comparing caregiver burden levels, PSQI scores were significantly higher in the high-burden group than in the low-burden group (6.5 vs. 3; p = 0.001), whereas age, gender, marital status, and ADL/IADL scores showed no significant differences. Conclusions: Most caregivers adapt well to their caregiving role. The low burden may be related to higher educational levels, better health literacy, and East Asian cultural values, where caring for relatives is considered a responsibility and duty. Sleep quality was strongly associated with caregiver burden, while the patient’s physical dependency was not a determining factor. Caregivers with high burden should be screened and provided with psychological support and opportunities for rest.

Objective: This study retrospectively evaluated the effects of treatment methods (bupropion and varenicline) used in the smoking cessation process on depression and anxiety among individuals who applied to the Hendek State Hospital Smoking Cessation Polyclinic. Materials and Methods: The Fagerström Nicotine Dependence Test (FNDT) and a questionnaire form developed specifically for this study by a pulmonologist working in the outpatient clinic were prepared. In addition, the scores obtained from the Hamilton Depression (HAM-D) rating and Hamilton Anxiety (HAM-A) rating scales were also analyzed. Results: In Spearman correlation analysis, a positive, high-level, statistically significant relationship was found between the HAM-D rating scale scores received by individuals in the first interview and the HAM-A rating scale scores (n=20, r=0.704, p=0.001). A positive, high-level, and statistically significant relationship was found between the scale scores they received in the second interview (n=20, r=0.784, p=0.001). The decrease in anxiety levels was not found to be statistically significant. Statistically significant reductions in depression levels were observed in participants (bupropion group: p=0.016; varenicline group: p=0.028). However, the decrease in anxiety levels was not statistically significant (bupropion group: p=0.069; varenicline group: p=0.150). Conclusions: The findings showed a statistically significant decrease in depression levels in individuals who received both bupropion and varenicline treatment. The research results emphasize that attention should be paid not only to the physical dependence level of individuals but also to their psychological state in the smoking cessation process.

Addiction is a chronic, relapsing condition characterized by compulsive substance use despite harmful consequences. Ayurveda conceptualizes addiction (Vyasanā) not merely as a physical dependency but as a psychosomatic disorder rooted in Prajñāparādha (intellectual blasphemy), vitiation of Manas Doṣas (Rajas and Tamas), Vāta aggravation, Oja-kṣaya, and Dhātu depletion. Classical Ayurvedic texts describe alcohol addiction under Madatyaya and recognize harmful habits under Vyasanam and Manasa Vikāra. The Ayurvedic approach to de-addiction emphasizes holistic management through Śodhana (purification), Śamana (pacification), Rasāyana (rejuvenation), Sattvavajaya (psychotherapy), and Daiva Vyapāśraya (spiritual therapy), along with regulation of diet, lifestyle, and conduct. This review systematically presents the Ayurvedic etiopathogenesis, chikitsā siddhānta, psychological framework, dietary principles, withdrawal management, and rehabilitation strategies, with correlations to modern de-addiction concepts. Ayurveda thus offers a multidimensional, sustainable, and person-centred model for recovery and relapse prevention.¹.

Solitary drinking represents a high-risk pattern of drinking across individuals but when examined within individuals, solitary moments are associated with less risk. One possibility is that solitary drinking confers risk for specific negative consequences at the day level, but aggregate measures of negative consequences mask such relations. Thus, this study examined the extent to which solitary drinking increased the likelihood of reporting specific negative consequences, controlling for drinking quantity. College students (N = 1043; 51.8% female) completed a 30-day Timeline Followback Interview in which they reported day-level drinking context, drinking quantity, and negative consequences. A total of 7340 drinking days were reported. Two-level multilevel probit regressions with Bayesian estimation tested whether drinking context (i.e., solitary vs. social) was associated with an increased likelihood of experiencing each of eight unique negative consequences (i.e., social/interpersonal, risky behavior, blackouts, occupational, impaired control, physical dependence, self-care, and self-perception), controlling for drinking quantity. When controlling for drinking quantity, solitary (vs. social) drinking days were associated with a higher likelihood of occupational consequences [β = 0.05, 95% BCI = (0.01, 0.08)] and diminished self-perception [β = 0.06, 95% BCI = (0.03, 0.10)]. Solitary drinking days were also associated with a lower likelihood of interpersonal consequences (β = -0.06, 95% BCI = [-0.11, -0.03]) and blackout drinking (β = -0.06, 95% BCI = [-0.09, -0.03]). Person-level results suggest that those who more often drink alone experience greater blackout drinking, impaired control, dependence, occupational consequences, and diminished self-perception (all p's < 0.001). When consequences were summed, solitary drinking days (vs. social) were associated with fewer negative consequences (β = -0.023, 95% BCI = [-0.049, -0.005]), whereas at the person level, those who more frequently drink alone experienced more negative consequences (β = 0.10, 95% BCI = [0.04, 0.17]). Results suggest that social and solitary drinking contexts confer risk for specific consequences and that risk for consequences differs if consequences are aggregated. Findings may inform future interventions by emphasizing certain protective behavioral strategies in specific drinking contexts to reduce the likelihood of negative outcomes.

BackgroundThe association between cognitive impairment among older adults and risks of falls and physical dependence still remains unclear.MethodIn this longitudinal study, we aim to investigate whether cognitive impairment increases the risk of falls, recurrent falls, and subsequent physical dependency in older adults. We used data from the 8th and 9th waves (2018‐2021) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a nationally representative cohort of adults aged 65 and older in China. Of 14,779 participants aged 65 and older surveyed in 2018, 8,665 were followed up in 2021 and included in the analysis. Falls were assessed through self‐reports over the past 12 months, with severe falls defined as requiring medical treatment. Physical dependency was defined as any difficulty in functional mobility or being bedridden. Participants were categorized by their Mini‐Mental State Examination (MMSE) scores: cognitively healthy (CH, MMSE: 25–30), mild cognitive impairment (MCI, MMSE: 10–24), and severe cognitive impairment (SCI, MMSE: 0–9). Multivariate logistic regression was used to examine associations between cognition and the risk of falls and physical dependency.ResultAt baseline, 6,408 (74.0%) participants were CH, 1,845 (21.3%) had MCI, and 412 (4.7%) had SCI. Falls were reported by 1,694 (19.5%) participants, with 662 (7.6%) reporting severe falls. At follow‐up, 2,085 (24.1%) participants reported falls, and 731 (8.4%) reported severe falls. Cognitive impairment was associated with a significantly higher risk of falls, particularly for those with SCI (OR for SCI vs. CH: 1.37 [95%CI 1.05–1.79] for falls). Among baseline fallers, cognitive impairment was linked to recurrent falls (OR for SCI: 1.64 [95%CI 1.11–2.44]) and recurrent severe falls (OR for SCI: 2.94 [95%CI 1.35–6.40]). Cognitive impairment also predicted higher risk of fall‐related physical dependency (OR for SCI: 8.26 [95%CI 1.94–35.28]).ConclusionCognitive impairment significantly increases the risk of falls and subsequent physical dependency in older adults, adversely affecting late‐life quality and placing substantial burdens on family caregivers. Targeted interventions to prevent falls and mitigate dependency in this vulnerable population are urgently needed.

Care Trajectories for a Cohort of First-Time Nursing Home Admissions: A 5-Year Longitudinal Study in Minnesota.

We present the concept of a new bolometer based on soft x-ray-UV to IR conversion with a high-Z foil and individual Lines of Sight (LOS). A solid block collimator is used with drilled channels defining the LOS. Each LOS is equipped with a separate metallic circular carbonized foil of 2μm thickness, and the edge of the foil is cooled to maintain a constant temperature. Laboratory experiments with carbonized gold foils have shown that it is possible to obtain a calibration curve for the IR response as a function of incoming UV power in stationary mode. The IR signal is found to be proportional to the incoming UV signal. Levels as low as 50 μW of UV incoming power have been detected in unfavorable conditions (in air, at room temperature) with both an IR camera and industrial low-cost thermopiles. In addition, there is no crosstalk between two adjacent detectors. An analytical model confirms that the IR power is proportional to the X-UV input power and gives the physical dependences of the proportionality factor in the stationary mode. The time-dependent solution allows us to get the radiative power as a function of the time varying voltage measured at the output of the thermopiles. Using a platinum foil and the parameters of an industrial low-cost thermopile, we find that levels as low as five μW should be measured. A prototype is under construction to be tested in the WEST tokamak. It consists of two lines of sight observing the low divertor and the center of the plasma. The interest of this system is that it can be rendered compatible with ITER or DEMO. Another point is that, due to its simplicity, the cost of the diagnostic can be reduced to a fraction of the price of standard metallic resistive bolometers used in tokamaks to measure the radiated power [Mast etal., Rev. Sci. Instrum. 62, 744 (1991)].

Introduction: Smoking addiction is a multidimensional process resulting from the combination of many factors that mutually influence and reinforce each other. Physical addiction to cigarettes progresses through stages of craving, longing, and need, with increased addiction levels making cigarette cravings more difficult to resist. This progression in physical dependence is accompanied by a corresponding increase in heightened psychological dependence, which constitutes an additional dimension of tobacco addiction. The stressful environment of medical education necessitates examining the nicotine dependence of students. In our study, we aimed to assess nicotine dependence in medical students by examining both the physical and psychological dimensions of smoking behavior within this population. Methods: This is a cross-sectional study conducted with 169 medical students enrolled at a medical school in Turkey. Data were collected using a questionnaire including sociodemographic information, the Fagerström Test for Nicotine Dependence (FTND), and the Test to Assess the Psychological Dependence on Smoking (TAPDS). Categorical variables are reported as n (%), and continuous variables as mean ± SD or median (IQR). The Kolmogorov-Smirnov test was employed to assess the normality of the distribution. For group comparisons based on normal distribution, independent samples t-test, one-way ANOVA, Mann-Whitney U test, and Kruskal-Wallis test were used. Multiple linear regression analysis was performed to identify independent predictors of the TAPDS score. Results: The median score on the FTND was 3.0 (IQR 1.0-6.0). The mean TAPDS score was 49.40 ± 9.98.The age at smoking initiation was significantly higher in females compared to males (p=0.039), while the number of cigarettes smoked per day was significantly lower (p=0.015).A moderate positive correlation was found between FTND and TAPDS scores (r=0.459, p

Objective: This study aimed to investigate the relationship between nutritional status, assessed by the Controlling Nutritional Status (CONUT) score, and functional recovery in patients with stroke undergoing inpatient rehabilitation. Methods: A total of 113 patients diagnosed with stroke were included in this observational study. Nutritional status was evaluated using the CONUT score, and functional independence and baseline disability were assessed with the Modified Barthel Index (mBI) and the Modified Rankin Scale (mRS) at admission. Functional independence was reassessed with the mBI at discharge. Patients were divided into four groups based on their CONUT score: normal, mild, moderate, and severe malnutrition risk. Results: According to CONUT classification, 37.2% of patients were normal, 46.0% were at mild, 13.3% at moderate, and 3.5% at severe risk of malnutrition. A weak positive correlation was found between CONUT score and age (r = 0.186, p = 0.049). CONUT score was negatively correlated with vitamin D (r = -0.212, p = 0.024), albumin (r = -0.636, p < 0.001), total protein (r = -0.387, p < 0.001), LDL (r = -0.445, p < 0.001), and total cholesterol (r = -0.444, p < 0.001). Within-group comparisons showed significant improvement in mBI scores from admission to discharge in the normal (p < 0.001), mild (p < 0.001), and moderate (p = 0.024) groups, but not in the severe malnutrition group (p = 0.317). Conclusions: Although no statistically significant association was found between the CONUT score and mBI outcomes, patients with better nutritional status showed a clinical trend toward greater functional improvement during rehabilitation, whereas those with severe malnutrition demonstrated limited gains. These findings should be interpreted cautiously due to the very small number of patients in the severe malnutrition group. Early screening and appropriate nutritional management using objective tools such as the CONUT score may still support rehabilitation planning in stroke patients.

Chronic heroin addiction induces severe physiological dependence and systematically impairs the neural mechanisms underlying basic cognitive functions. However, the specific effects of opioids on divergent thinking-a higher-order cognitive function-and its neural basis remain underexplored. This study recruited individuals with chronic heroin use disorder (HUD, n = 38) and healthy controls (HC, n = 35) to record neural activity during divergent thinking tasks (Alternative Uses Test, AUT) using electroencephalography (EEG). Source-space analysis quantified power spectral density (PSD) in brain regions, complemented by functional connectivity analysis using weighted phase lag index (wPLI) from selected seed regions. Machine learning assessed the utility of connectivity metrics as cognitive impairment markers. Source-space analysis revealed that compared to the HC group, the HUD group exhibited increased alpha-band power in the left precuneus (L.PCUN) and left superior parietal lobule (L.SPL) and beta-band power in the right superior parietal lobule (R.SPL). Functional connectivity analysis revealed weakened cross-network coupling between the default mode network (DMN) and frontoparietal control network (FPN), with reduced alpha connectivity between the right superior frontal gyrus (R.SFG) and L.PCUN correlating with impaired divergent thinking. Machine learning confirmed this metrics as effective neurobiological markers (AUC = 0.772, accuracy = 0.767) of cognitive impairment in heroin addiction. The findings indicate that abnormal local oscillatory activity and disrupted network integration impair the dynamic "generation-evaluation" loop of divergent thinking, constituting a compensatory pathological mechanism. This study provides neural evidence linking opioid addiction to creativity deficits and supports precision interventions targeting cognitive dysfunction in addiction.

Benzodiazepines are an important class of psychiatric medicines used widely for the treatment of anxiety and sleep disorders, but clinical use is limited by their significant liability for addiction and physical dependence. We identified a compound with a promising pharmacological profile for treating benzodiazepine addiction: The imidazotriazine TPA023B, which has no intrinsic efficacy (i.e., is a silent allosteric modulator) at α1-subunit containing GABAA receptors (α1GABAA receptors), but has partial positive modulatory activity at α2GABAA, α3GABAA and α5GABAA receptors. TPA023B previously showed only limited addiction liability compared to available addictive benzodiazepines. In the present study, TPA023B dose-dependently blocked self-administration of the conventional benzodiazepine, midazolam, in rhesus monkeys but had no effects on food self-administration in these same subjects. Importantly, TPA023B had anxiolytic-like effects in monkeys at the same doses that blocked benzodiazepine self-administration, which were estimated to result in 70–80% receptor occupancy (levels shown to be achievable in human patients). In acute dependence models, TPA023B did not precipitate withdrawal-like effects after diazepam administration in rats or midazolam administration in rhesus monkeys. Most strikingly, TPA023B reversed the withdrawal-like effects precipitated by the benzodiazepine silent allosteric modulator flumazenil in monkeys. Because TPA023B has been administered successfully to human subjects in clinical trials, our preclinical data support the development of TPA023B as the first maintenance pharmacotherapy for patients misusing benzodiazepines, having a use disorder involving a benzodiazepine, and/or having physical dependence.

Reduced order modeling is of paramount importance for efficiently inferring high-dimensional spatio-temporal fields in parametric contexts. However, conventional dimensionality reduction techniques are typically limited to known and constant parameters, inefficient for nonlinear and chaotic dynamics, and uninformed to the actual system behavior. In this work, we propose a SHallow REcurrent Decoder-based Reduced Order Modeling technique (SHRED-ROM) capable of reconstructing high-dimensional state dynamics in multiple scenarios from the temporal history of limited sensor measurements. To enhance computational efficiency and memory usage, we reduce data dimensionality through data- or physics-driven basis expansions, allowing for compressive training of lightweight networks with minimal hyperparameter tuning. Through applications on chaotic and nonlinear fluid dynamics, we show that SHRED-ROM is a robust decoding-only strategy, capable of dealing with both fixed or mobile sensors, physical and geometrical (possibly time-dependent) parametric dependencies and different data sources, such as high-fidelity simulations, coupled fields and videos, while being agnostic to sensor placement and parameter values.

A subset of individuals without a history of prolonged or problematic opioid use demonstrate attenuated subjective responses to orally administered opioids despite physiological and analgesic responses. This phenotype may confer elevated risk for greater analgesic requests and physiologic dependence, but it is unclear if this is driven by differences in route of administration. This study evaluated responses to cumulative dosing of parenteral hydromorphone, versus placebo, in persons without a history of significant opioid use to further identify and characterize this subgroup. Individuals without opioid use disorder (N = 82) were exposed to a cumulative hydromorphone dosing procedure, during which they completed measures of subjective effects and were assessed for physiological opioid responses. Linear mixed effects regressions were used to examine changes in subjective and physiological measures as a function of responder phenotype, drug condition, and time. Approximately 31.7% of the sample were classified as Opioid Non-Responders. These individuals had attenuated changes in subjective responses to hydromorphone relative to other participants, despite equivalent physiological responses. Race and sex did not predict Opioid Responder status. These findings confirm the presence of a “Opioid Non-Responder” phenotype for the first time in the context of a cumulative, parenteral dosing paradigm. Further research is warranted to elucidate the clinical implications and potential risk or protective factors underlying this phenotype.

Background: In India, the older adult population grew from 43 million in 1981 to 92 million in 2011 and is expected to reach 316 million in four decades. Life expectancy also rose from 62.5 years in 2000 to 66.8 years in 2011. With joint families declining, many elders face illness, abuse, and isolation. Coping strategies influence their well-being, with adaptive coping improving health while maladaptive coping worsens distress. Promoting mental health and support is essential for dignified aging. Methodology: This chapter outlines the research methodology, including approach, design, setting, variables, population, sampling, tool development, pilot study, data collection, and analysis plan. A non-randomized, two-group survey was conducted among 60 elderly people in selected rural area using a convenient sampling technique, Data was collected through a validated and reliable structured interview schedule. Necessary permissions were obtained, and data will be analyzed using descriptive and inferential statistics, presented through tables and diagrams Results: The chi square value of age is 20.4*, education 36.29*, religion 19.88*, marital status 16.91*, gender 13.62*, type of family 18052*and degree of physical dependence 21.89*. According to that all the demographic variables are significant. As per knowledge score in the pre-test, 55% of elderly people had Poor knowledge, 30% had Average knowledge, and only 15% had Good knowledge. In the post-test, 5% of elderly people had poor knowledge, 33.34% had Average knowledge, and only 61.67% had Good knowledge. The t-test value for the psychological problem in experimental group mean score 20.7 and SD 1.14 and control group mean is 15.8 and SD 1.78and in the coping strategies in experimental group mean score 43.06 and SD 2.66 and control group mean is 32.1 and SD 3.09 (df = 59, table value p = 2.00). Conclusion: The study assessed knowledge of psychological problems and coping strategies among the elderly people and found limited awareness in the pre-test. An informational booklet educational intervention through an informational booklet significantly improved post-test knowledge. The findings confirmed that the booklet was both feasible and effective in enhancing awareness. Hence, such interventions can promote better mental health knowledge among elderly people in Bhuj-Kutch, Gujarat. Keywords: Quasi-experimental study, Effectiveness, Informational booklet knowledge, Psychological problems, coping strategies, Elderly people.

BackgroundMuch of the existing discourse surrounding the Enhanced Games has focused on its potential to undermine traditional sporting values by permitting and promoting the use of performance-enhancing drugs (PEDs), thereby challenging established anti-doping frameworks. However, as the Enhanced Games continues to expand its brand, a broader agenda has emerged, specifically, the incorporation of telehealth services into its platform.AimThis study aims to critically examine the Enhanced Games’ role in facilitating access to testosterone replacement therapy (TRT) through its emerging telehealth services.MethodA qualitative content analysis was conducted of the Enhanced Games’ official website, with a specific focus on its telehealth offerings. Drawing on Cooper and Waldby’s (2014) concept of the bioeconomy, in which human bodies become sites for pharmaceutical accumulation and capital generation, we examine how the Enhanced Game’s seek to exploit this notion.ResultsFindings indicate that the Enhanced Games leverages sport as a vehicle to market TRT. This underscores its ambitions to extend beyond the sporting arena, positioning the organisation as a commercial actor within the broader biomedical, wellness, and longevity sector. Their telehealth advertisments explicitly promote testosterone products, signalling a shift and bluring boundaries between sport (performance enhancement) and society (longevity, wellness, optimisation).DiscussionIn light of the over-prescription of testosterone through telehealth services, the Enhanced Games may serve as a powerful force towards expanding that market. These developments raise important concerns, particularly regarding the risk of physiological dependency resulting from prolonged use of exogenous testosterone. The commodification of TRT under the guise of sport and health optimisation calls for critical reflection on the ethical, medical, and regulatory implications of such practices.

Frailty prevention is essential in older adults, as oral frailty and hypofunction are linked to increased risks of physical frailty, dependency and mortality. Declines in integrated oral functions, particularly mastication and swallowing, can reduce dietary diversity, impair nutrition and accelerate frailty progression. Although oral hypofunction tests are used for screening and management, the underlying mechanisms and priorities for targeted interventions remain unclear. To investigate the associations between declines in masticatory and swallowing functions and specific oral functional impairments among dental outpatients. In this cross-sectional study, we included 204 outpatients aged ≥ 50 years (mean age: 77.1 ± 8.5 years) who underwent oral hypofunction tests for the first time. Data were collected on systemic health and seven oral function domains: oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function and swallowing function. Pearson's correlation and multiple linear regression analyses were conducted, adjusting for age, sex and comorbidities. Masticatory function decline was significantly associated with reduced occlusal force and posterior tongue-lip motor function. Swallowing function decline was significantly associated with reduced tongue pressure and anterior tongue-lip motor function. Masticatory and swallowing functions are closely linked to occlusal force, tongue strength and tongue motor function. These findings highlight the need for targeted oral function training, especially of the tongue and occlusal system, to maintain dietary intake and support frailty prevention in older adults.

Opioids are commonly prescribed for infants after congenital heart disease (CHD) surgery, and prolonged exposure can lead to physiologic dependence requiring methadone treatment. The Risk Adjustment for Congenital Heart Surgery-2 (RACHS-2) categorizes operative mortality risk and may also help identify infants at greatest risk for methadone treatment. A retrospective cohort study of infants < 1year undergoing CHD surgery between 2016-2022 at 48 U.S. children's hospitals using the Pediatric Health Information System was performed. Infants were categorized by RACHS-2 score (1 = lowest, 5 = highest risk). Multivariable hierarchical logistic regression evaluated associations between postoperative opioid days and methadone treatment, including an interaction between RACHS-2 and opioid exposure. Secondary analyses compared postoperative length of stay (LOS), ventilator days, and total parenteral nutrition (TPN) days by methadone status. Among 34,127 infants, higher RACHS-2 scores were associated with longer postoperative opioid exposure (p < 0.001). For infants who received < 17days of opioids, increasing RACHS-2 scores predicted greater probability of methadone treatment. After 17days, RACHS-2 score 1 infants had the highest probability of methadone treatment, though they represented a minority. Methadone was independently associated with longer LOS, ventilator days, and TPN days. Higher RACHS-2 scores were associated with increased likelihood of postoperative methadone treatment in the early postoperative period. Methadone treatment was associated with adverse short-term health outcomes. For infants with prolonged opioid exposure, those with lower RACHS-2 scores were more likely receive methadone treatment- highlighting subpopulations that may benefit from targeted opioid stewardship initiatives.