The research team, led by first author Kirsten Marchand and colleagues, recruited 17 participants purposefully through youth mental health and substance use services across the province. The group included six youth aged 16 to 24 with experience accessing opioid agonist treatment, four caregivers of such youth, five service providers, and two decision-makers. British Columbia was a deliberate choice of setting: overdose is one of the leading causes of accidental death among youth in the province, making the local urgency of the question acute.

Participants took part in semi-structured interviews, and the researchers applied a directed content analysis to the transcribed interviews to synthesize and describe the experts’ recommendations for improving the delivery of opioid agonist treatment to youth. This method allowed the team to organize what participants said into a coherent set of actionable guidance points drawn from across the four participant groups.

The analysis produced eight recommendations. First, services should establish and maintain trusting relationships with youth. Second, providers should regularly check in with young patients about their goals and about the benefits and challenges they experience with treatment. Third, all medication options should be presented alongside their respective benefits and challenges, rather than steering youth toward a single default. Fourth, induction plans for starting medication should be developed collaboratively with the young person rather than imposed on them.

The remaining four recommendations extend beyond the clinical encounter. Opioid agonist treatment should be delivered as part of a comprehensive approach to a young person’s health and life circumstances, not as an isolated prescription. Services should operate in low-barrier and non-judgmental settings that reduce the friction of staying in care. Tapering processes, when a young person chooses to reduce or stop medication, should likewise be developed collaboratively. Finally, caregivers should be empowered and supported, recognizing the role families play in sustaining youth engagement with treatment.

Underlying all eight recommendations, the researchers identified four foundational pillars. These emphasized positive relationships between youth and service providers, flexible treatment plans that can adapt to changing circumstances, and service delivery settings that are both low-barrier and holistic. Together, the pillars frame opioid agonist treatment for youth as a service built on relationships, flexibility, and accessibility rather than on medication alone.

The study’s design carries important limitations. It captured the perspectives of 17 purposively recruited participants in a single Canadian province, so the findings represent expert recommendations rather than tested outcomes. The authors are explicit that future research is needed to examine how youth-centred models of care actually perform once implemented, with specific attention to how these models address the diverse needs of youth across different communities, age ranges, genders, and clinical, social, and cultural contexts.

Even so, the recommendations offer a practical blueprint for services aiming to improve uptake and retention of opioid agonist treatment among young people. By centering trust, choice, collaboration, and caregiver support, the study reframes treatment for youth as a relationship-driven service rather than a purely pharmacological one. Whether these expert-grounded principles translate into measurable improvements in treatment engagement and outcomes will depend on the implementation research the authors call for next.

Subject of Research: Expert recommendations for youth-centred models of opioid agonist treatment in British Columbia

Article Title: Optimizing the quality of opioid agonist treatment for youth: experts’ recommendations for youth-centred models of care

Article References: Marchand, K., Turuba, R., Cameron, V., Eekhoudt, C. R., Fast, D., Knight, R., Marsh, D. C., Ignaszewski, M. J., Sassi, R., Mathias, S., & Barbic, S. (2026). Optimizing the quality of opioid agonist treatment for youth: experts’ recommendations for youth-centred models of care. Addiction Science & Clinical Practice. https://doi.org/10.1186/s13722-026-00729-4

Image Credits: AI Generated

DOI: 10.1186/s13722-026-00729-4

Keywords: opioid agonist treatment, opioid use disorder, youth health, qualitative research, British Columbia, overdose, models of care, addiction medicine, caregivers, service providers, Optimizing, quality

A study protocol published in Addiction Science & Clinical Practice describes an effort to close that gap in the setting where many of these patients actually receive care, the primary care clinic. The trial, called CoCare, short for Collaborative Care for Polysubstance Use in Primary Care Settings, is a cluster-randomized controlled trial registered at ClinicalTrials.gov under identifier NCT06116266 on October 31, 2023. Randomization occurs at the level of the primary care provider rather than the individual patient, so entire provider panels are assigned to the intervention or to a comparison condition of enhanced usual care.

The study will be conducted across six distinct geographic sites and will enroll adult primary care patients with moderate to severe opioid, stimulant, and/or alcohol use disorder who report concurrent use of at least two of these substance classes. The trial is designed to test the efficacy of the CoCare intervention in decreasing polysubstance use over a six-month intervention period. CoCare assembles four roles around each patient.

A practice-embedded nurse care manager manages medications for opioid and alcohol use disorder, conducts contingency management, links patients to mental health and addiction treatment, and provides general care management. The patient's own primary care provider prescribes medications and manages medical conditions. A remote health coach delivers patient-centered counseling, motivational enhancement, and cognitive behavioral therapies.

Finally, an addiction specialist advises the nurse care manager and health coach on evidence-based patient care, using population health management tools to guide those recommendations. The primary outcome is deliberately practical: the total number of self-reported days of opioid use, stimulant use, and heavy alcohol use, summed over months four through six. Heavy alcohol use is defined as four or more drinks per day for women and five or more drinks per day for men.

These outcomes are assessed monthly via text messages using items drawn from the Addiction Severity Index, a structured assessment instrument. On the analysis side, the primary outcome data will be examined with a mixed-effects negative binomial model with a log link, a statistical approach suited to count outcomes such as days of use. Secondary outcomes reach beyond substance use itself.

The investigators plan to track progress in treatment and recovery, substance use frequency and severity, mental health, quality of life, healthcare utilization, overdose risk, and pain, along with primary care provider attitudes and behaviors. The choice of primary care as the setting is grounded in who seeks treatment: according to the protocol, only a minority of individuals with active polysubstance use disorder enter specialty addiction treatment, but these patients frequently visit primary care. As a protocol publication, the article describes the trial's design rather than its results, and no efficacy findings are yet available.

The registered design does, however, lay out a detailed technical blueprint: cluster randomization by provider, six geographic sites, a six-month intervention with four defined roles, monthly text-message assessment using Addiction Severity Index items, and a prespecified statistical model for the primary outcome. The investigators state that, given the importance of addressing polysubstance use disorder in primary care settings, this trial of collaborative care offers a blueprint for a feasible and effective approach.

Subject of Research: Study protocol for a cluster-randomized controlled trial of collaborative care for polysubstance use disorder in adult primary care patients

Article Title: Collaborative care for polysubstance use in primary care settings (co-care): protocol for a cluster randomized controlled trial

Article References: Liebschutz, J. M., Subramaniam, G. A., Stone, R., Appleton, N., Beers, D., Bradley, K., Bui, E., Case, A., Gauthier, P., Gelberg, L., Hefner, K., Kline, M., Lovejoy, T. I., McCormack, J., Otterstatter, M., Park, T., Scott, D., Mazel, S., & McNeely, J. (2026). Collaborative care for polysubstance use in primary care settings (co-care): protocol for a cluster randomized controlled trial. Addiction Science & Clinical Practice. https://doi.org/10.1186/s13722-026-00727-6

Image Credits: AI Generated

DOI: 10.1186/s13722-026-00727-6

Keywords: polysubstance use, substance use disorder, collaborative care, primary care, cluster randomized trial, opioid use disorder, alcohol use disorder, stimulant use disorder, nurse care manager, contingency management, Addiction Severity Index, study protocol

Mr. R was already a long-term resident of a skilled-nursing facility when acute on chronic liver disease and a septic hip led to his hospitalization. He had been treated for pain with a low-dose fentanyl patch and oxycodone as needed, but his severe opioid use disorder was untreated. Following hepatic encephalopathy, clinicians increased his lactulose dosing and proposed buprenorphine-naloxone through a low-dose initiation protocol.

This combination was intended to treat the opioid use disorder while avoiding further cognitive complications associated with full opioid agonists. His pain and opioid use disorder were controlled on a sublingual dose of 16 milligrams of buprenorphine with 4 milligrams of naloxone, and his encephalopathy resolved. Despite that clinical improvement, the skilled-nursing facility refused to accept him back while he was receiving buprenorphine, citing the prescribing qualifications of the physician who had been managing his opioid analgesia.

The hospital team resisted returning him to the prior regimen, which had failed to control his opioid use disorder. Unable to secure a discharge destination that would allow him to continue treatment, Mr. R remained hospitalized for an additional month. The episode extended his hospital stay and placed the hospital team in direct conflict with the receiving facility, even though the medication had been effective and the proposed transfer required him to stop it.

Buprenorphine was a rational choice for Mr. R, according to the perspective. It is a partial mu-opioid agonist associated with reduced all-cause mortality in patients with opioid use disorder and is recommended when opioid use disorder occurs alongside chronic pain. Its ceiling effect on respiratory depression gives it a lower overdose risk than full opioid agonists.

For Mr. R, it also offered a way to limit the potential for hepatic encephalopathy associated with full agonists. Long-acting injectable buprenorphine has demonstrated analgesic efficacy, but the authors note a lack of sufficient studies in patients with cirrhosis and a relative contraindication in acute hepatic dysfunction, favoring the sublingual formulation in this case. The comparison with other treatments was also important.

Methadone was not favored because of its effects on body mass index and cardiovascular risk factors, while full opioid agonists require close monitoring in decompensated cirrhosis because they can produce supratherapeutic effects and worsen hepatic encephalopathy. Naltrexone was not considered because it lacks analgesic effectiveness and can be difficult to initiate in people currently taking opioid agonists. The authors note that short-acting fentanyl and oxycodone are not approved to treat opioid use disorder, although transient short-acting opioids may sometimes be used as adjuncts for acute pain in patients already receiving buprenorphine.

At the center of the refusal was a misunderstanding that had already been overtaken by federal policy. Under the Drug Addiction Treatment Act of 2000, buprenorphine previously could be prescribed only by clinicians with a special Drug Enforcement Administration registration identified by an X license. Those requirements were eliminated in January 2023, and any clinician with an active, unrestricted DEA registration can now prescribe buprenorphine as they can other controlled substances.

In addition, inpatient clinicians and facilities, including skilled-nursing facilities, were never required to hold an X license to dispense and administer buprenorphine. Nevertheless, the source perspective reports that clinicians and healthcare organizations continued to miss this change after it took effect. The prescribing data described in the perspective show that removing the waiver did not immediately translate into substantially broader treatment.

The number of clinicians prescribing buprenorphine rose only marginally in 2023, while the number of patients receiving the medication remained relatively unchanged. Attitudes also continue to shape access. Clinicians may acknowledge that opioid use disorder is common yet still believe they encounter too few affected patients to justify additional training.

The authors describe this as “intervention stigma,” a reluctance to treat opioid use disorder that has been reported across healthcare settings and is intensified by gaps in training and health literacy. Refusal by skilled-nursing facilities is part of a broader pattern documented in the perspective, with the authors stating that it is not uncommon. Such refusals can prolong hospitalizations, delay rehabilitation and contribute to worse health outcomes.

They also trap clinicians in an untenable choice: continue an effective, morbidity- and mortality-reducing medication and postpone discharge while seeking another facility, or revert to a less suitable regimen to secure placement. Multiple court settlements have established that refusing care because a patient receives medication for opioid use disorder can violate the Americans with Disabilities Act, which protects people with physical or mental disabilities, including substance use disorder, and applies to public and private hospitals and skilled-nursing facilities. The obstacles are not purely individual attitudes.

Staff shortages, inadequate training, medication-storage difficulties and low reimbursement can make facilities reluctant to accept patients receiving medication for opioid use disorder. The authors also point to the disproportionate Medicaid coverage of people with opioid use disorder: when facilities are reimbursed below the cost of care, financial and staffing pressures may discourage them from adopting medication treatment. State rules can add further barriers through dosage or prescription-duration caps, frequent or random drug testing and prior-authorization requirements.

Although the elimination of the federal X license was an important policy change, the perspective argues that this patchwork of clinical, financial and regulatory obstacles helps sustain discriminatory practices. Mr. R eventually returned to the skilled-nursing facility on buprenorphine after sustained clinician-to-clinician discussion, hospital advocacy and the facility’s willingness to learn about current clinical guidance and disability law. The outcome was possible because the hospital team assumed that the refusal reflected inadequate knowledge rather than an intention to punish or harm him.

That approach allowed the receiving physician to engage with the updated federal requirements while preserving clinically appropriate treatment. The perspective concludes that eliminating gaps in care requires interventions across the healthcare system, including targeted training, mentorship, policy reform and adequate support for facilities that provide medication for opioid use disorder. It nevertheless identifies hospital-based advocacy as an immediate tool for improving transitions of care.

Mr. R’s month-long delay demonstrates that a regulatory change alone cannot guarantee access when clinicians, administrators and institutions continue to operate under outdated assumptions. His eventual acceptance after education and negotiation shows both the cost of those assumptions and the potential for hospital teams to intervene constructively. The case does not establish how often such refusals occur or whether one conversation resolves them, but it provides a detailed account of how the post-X-waiver era can still leave patients facing discriminatory barriers to an established treatment.

Subject of Research: How barriers to buprenorphine access persist in skilled-nursing facilities after elimination of the federal X-waiver.

Article Title: Discriminatory Practice in Opioid Use Disorder: In a Post-X-Waiver Era, Barriers to Buprenorphine Persist

Article References: Freibert, H., Lofwall, M. R., & South, A.-M. (2026). Discriminatory Practice in Opioid Use Disorder: In a Post-X-Waiver Era, Barriers to Buprenorphine Persist. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10945-y

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10945-y

Keywords: buprenorphine, opioid use disorder, skilled-nursing facilities, medication treatment, X-waiver, healthcare discrimination, Americans with Disabilities Act, clinical stigma, health policy, hospital advocacy, Discriminatory, Practice

The program was designed as a collaboration between the preoperative assessment team and clinical pharmacy for patients considered to be at high risk of new opioid dependence or increased postoperative opioid requirements. A clinical pharmacist conducted a virtual chart review that focused on chronic pain, current medications, substance use disorder and psychiatric comorbidities. Care teams then received patient-specific plans for inpatient and postoperative multimodal pain management.

Researchers reviewed all Veterans who received a perioperative PharmD e-consult from the program’s inception in October 2023 through September 2024. This was a quality improvement initiative that met the SQUIRE criteria for reporting. Process measures included fidelity to the multimodal recommendations, while outcome measures covered pain prescriptions before and after surgery and surgical outcomes through 90 days.

The e-consult cohort was predominantly male: 46 of 51 patients, or 90.2%, were male. Median age was 65 years, with an interquartile range of 48 to 71 years, and the median Risk Analysis Index frailty score was 25, with an interquartile range of 17 to 37. Psychiatric conditions were documented in 48 patients, or 94.1%, and substance use disorder was present in 26 patients, or 51.0%.

Most of the cohort used opioids chronically before the e-consult: 39 patients, or 76.5%, met the report’s definition of chronic preoperative use, defined as use for 60 consecutive days or at least three prescriptions within the 90 days before surgery. The most frequent reasons for referral were chronic preoperative opioid use, reported for 39.2% of the 51 patients, and a history of substance use disorder, reported for 34%. Among patients with chronic opioid use, 64.1% had been prescribed opioids for chronic pain and 35.9% had been prescribed medication for opioid use disorder.

Of the 39 patients who underwent surgery, 22, or 56.4%, required an inpatient stay. Inpatient pain-management recommendations were partly followed 95.5% of the time and completely followed 4.5% of the time. Discharge pain-management recommendations were partly followed for 32 patients, or 82.1%, and fully followed for seven, or 17.9%. Eighteen patients, representing 46.2% of the surgical cohort, were discharged with the pharmacist-recommended opioid plan.

The report stated that 32 of 39 surgical patients had reverted to their preoperative opioid requirement by 90 days. That group included eight of the nine patients who had not taken opioids preoperatively. Three patients required a higher chronic opioid dose, and one patient who had received medication for opioid use disorder remotely in the past year resumed it after surgery. The report also identified two patients lost to follow-up and one mortality, so complete 90-day information was not available for every member of the surgical cohort.

Fidelity to the multimodal recommendations varied. The authors noted that postoperative conditions, including limited enteral intake, may have contributed to this variability, but the report did not establish that those constraints definitively prevented full implementation. The surgical cohort also included a moderate number of patients receiving medication for opioid use disorder, a group the authors said had favorable postoperative outcomes.

Because the initiative was conducted at one institution, included a small surgical cohort and lacked a comparison group, the findings describe care and outcomes in this setting rather than demonstrating an intervention effect. The authors said a larger study across multiple institutions would be required to better assess the program’s value.

Subject of Research: Evaluation of a clinical-pharmacy perioperative pain-management program and postoperative opioid outcomes in Veterans at elevated risk

Article Title: A Multidisciplinary Approach to Reduce Prolonged Postoperative Opioid Use in High-risk Patients

Article References: Furman, L., Donnelly, S., Bardawil, C., Muluk, V., & Dhupar, R. (2026). A Multidisciplinary Approach to Reduce Prolonged Postoperative Opioid Use in High-risk Patients. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10810-y

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10810-y

Keywords: quality improvement, postoperative opioid use, perioperative pain management, Veterans, clinical pharmacy, opioid use disorder, chronic opioid therapy, retrospective chart review, multimodal analgesia, Multidisciplinary, Approach, Reduce

Researchers recruited the participants from the HEAL Together trial and conducted semi-structured interviews at a methadone clinic in a low-income urban neighborhood in Baltimore, Maryland. The interviews examined how participants perceived their neighborhoods and how stressors associated with finances, housing stability, transportation, and the built environment influenced methadone treatment engagement and recovery experiences. The researchers analyzed interview transcripts using both inductive and deductive thematic analysis. They developed a codebook from the coded material and then derived main themes and subthemes from it.

Economic stressors were among the most prominent issues identified in the interviews. Financial difficulties emerged as a major trigger that could disrupt engagement with treatment, while residential instability and transportation challenges were also described as barriers to consistent attendance. Participants discussed neighborhood features more broadly, including the surrounding built environment, as factors that could affect their treatment experiences. Because the study was qualitative, these findings represent the experiences and interpretations reported by 18 participants rather than estimates of how frequently each barrier occurs.

Pervasive exposure to drugs was another prominent neighborhood stressor in participants’ accounts. Interviewees described drug exposure as a feature of the local environment that could disrupt their engagement with methadone treatment. At the same time, many participants said they had developed personal strategies to avoid high-risk situations. Their accounts show deliberate efforts to sustain engagement despite environmental pressures. Strong motivation to remain in treatment was also widely reported, suggesting that neighborhood stressors did not eliminate participants’ desire to continue receiving care.

The study offers a focused perspective on treatment engagement among adults with opioid use disorder in one Baltimore setting. Its small, exploratory qualitative design can illuminate recurring experiences, priorities, and coping strategies identified by participants, but it cannot establish the prevalence of these barriers among all people receiving methadone treatment. The findings are also limited to the clinic, trial sample, and urban context examined. The results do not test particular interventions or demonstrate clinical benefit. Instead, they indicate that financial instability and drug exposure can pose substantial challenges to treatment engagement while also showing that coping strategies and motivation may help participants sustain care. Addressing economic and community barriers and reinforcing patient-driven coping and support mechanisms could inform future efforts to improve engagement and reduce opioid-related disparities in urban communities.

Subject of Research: How adults with opioid use disorder in Baltimore described neighborhood stressors affecting methadone treatment engagement

Article Title: The role of neighborhood stressors in methadone treatment engagement: an explorative qualitative study

Article References: Anane, J. S., Nahabedian, S., Butler, J., Kalan, E., Alcalá, H. E., Belcher, A., Bradley, V. D., Milam, A. J., & Magidson, J. F. (2026). The role of neighborhood stressors in methadone treatment engagement: an explorative qualitative study. Addiction Science & Clinical Practice. https://doi.org/10.1186/s13722-026-00732-9

Image Credits: AI Generated

DOI: 10.1186/s13722-026-00732-9

Keywords: methadone treatment, opioid use disorder, treatment engagement, neighborhood stressors, financial hardship, housing instability, drug exposure, qualitative interviews, Baltimore, patient resilience, role, neighborhood

The investigators analyzed 2,533 eligible participants from three National Health and Nutrition Examination Survey cycles: 2013–2014, 2015–2016 and 2017–2018. The survey analysis included 1,252 participants classified as having substance use disorder and 1,281 healthy controls. Substance use disorder was diagnosed according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, using self-reported information on lifetime use of cannabis with or without other illicit drugs, and cocaine, heroin and/or methamphetamine.

Sleep disturbance was identified with a single yes-or-no question asking whether a doctor or other health professional had ever told participants that they had trouble sleeping. Because the data were cross-sectional, the findings show associations but cannot establish whether substance use, inflammation, impaired sleep or another factor preceded the others. SIRI was calculated by multiplying the monocyte count by the neutrophil count and dividing the result by the lymphocyte count.

The formula combines circulating measures associated with innate immune activity and adaptive immune function, allowing the researchers to assess systemic inflammatory balance using routine hematology measurements. Among participants with substance use disorder, those reporting sleep disturbance had a median SIRI of 1.217, compared with 1.043 among those without sleep disturbance. The difference was statistically significant, with a reported p-value below 0.001.

The clinical cohort also showed a difference in the same direction: mean SIRI was 0.93 in the opioid use disorder group and 0.74 in healthy controls. Adjusted survey analysis showed a graded relationship between SIRI and the odds of reporting sleep disturbance. The model accounted for age, sex, education, race, marital status, annual family income and body mass index.

The odds ratio was 1.29, with a 95% confidence interval of 1.19–1.39, for SIRI from 1.125 to 1.622 and 2.00, with a 95% confidence interval of 1.85–2.17, for SIRI above 1.622. These are cross-sectional odds ratios rather than estimates of future risk, and the categories were defined within the analyzed sample. The researchers also performed a mediation analysis across the full survey sample, treating substance use disorder status as the exposure, SIRI as the mediator and sleep disturbance as the outcome.

The estimated total effect was 0.168, with a 95% confidence interval of 0.120–0.216; the average direct effect was 0.128, with a 95% confidence interval of 0.080–0.173; and the average indirect effect through SIRI was 0.040, with a 95% confidence interval of 0.026–0.056. The estimated proportion of the association statistically mediated through SIRI was 23.9%, with a 95% confidence interval of 15.3%–35.1%. The remainder was described as direct or potentially mediated through unmeasured pathways.

The analysis supports a partial statistical relationship, but its cross-sectional design does not demonstrate causal mediation. The clinical dataset provided a focused test of the same pattern in opioid use disorder. Between January and December 2024, researchers recruited 44 people with opioid use disorder from Changsha, Hunan Province, and 44 healthy controls matched on age, education, sex, body mass index, smoking and drinking.

The opioid group had used opioids for a median of 18 years, and all reported hot smoking as their primary route of administration. Urine screening was positive for heroin, and participants met Diagnostic and Statistical Manual of Mental Disorders criteria for opioid use disorder. The groups did not differ significantly in most demographic characteristics, although marital status differed significantly.

Sleep quality in the clinical cohort was measured with the Chinese version of the Pittsburgh Sleep Quality Index, an 18-item questionnaire organized into seven domains and scored from 0 to 21, with higher scores indicating poorer sleep quality. The median score was 11 in the opioid use disorder group and 4.5 in healthy controls, a significant difference with a reported p-value below 0.001. Within the opioid group, SIRI was positively correlated with PSQI, with a partial correlation coefficient of 0.327 and a p-value of 0.037 after adjustment for age, sex, body mass index, education, Fagerstrom Test for Nicotine Dependence score, Alcohol Use Disorders Identification Test score and marital status.

The correlation was modest, and the sample was small and geographically narrow. Machine-learning analysis offered a second way of examining whether SIRI contributed information about sleep status within the survey population. Eleven algorithms were evaluated, including LASSO, CatBoost, gradient boosting, support vector machines, decision trees, LightGBM, neural networks, naive Bayes, XGBoost, random forest and logistic regression.

The data were divided into stratified training and test sets at a 70%–30% ratio, with ten-fold cross-validation used for training and hyperparameters selected according to mean cross-validated area under the receiver operating characteristic curve. Missing continuous variables were imputed with medians, categorical variables with modes, and variables with at least 10% missingness were excluded before modeling. CatBoost had the highest test-set area under the ROC curve at 0.880, followed by random forest at 0.846.

The other algorithms had test-set areas ranging from 0.500 to 0.688. In the training set, CatBoost and random forest achieved areas of 0.999 and 0.996, respectively, indicating a degree of overfitting. Test-set calibration and decision-curve analyses identified CatBoost as demonstrating optimal performance and the greatest net benefit.

The investigators used SHAP analysis to interpret model predictions. SIRI ranked first in both models. In CatBoost, the next leading features were race, body mass index, age and sex; in random forest, they were neutrophil count, body mass index, monocyte count and white blood cell count.

These results identify SIRI as an influential feature in the fitted models, not as a validated diagnostic test. Biologically, the findings were consistent with previous observations discussed by the investigators that substance use and withdrawal can be accompanied by systemic immune responses, while inflammatory signaling can influence the central nervous system through humoral mediators, neural pathways and transport across the blood-brain barrier. Neutrophils and monocytes participate in innate immune regulation and can generate pro-inflammatory factors including tumor necrosis factor-alpha and interleukin-6.

The paper also discusses possible immune effects of opioids, including signaling through toll-like receptor 4 on myeloid cells. The present study did not directly measure these proposed pathways, test anti-inflammatory treatments or demonstrate that inflammation caused sleep disruption. Its evidence is observational and cross-sectional.

Important limitations constrain the conclusions. Sleep was self-reported in both datasets, creating the possibility of recall and classification bias. The NHANES measure was a single question, whereas the clinical cohort used the multidimensional PSQI, so sleep estimates from the two populations were not directly equivalent.

Detailed route-of-use information was unavailable in the survey data, limiting comparisons between intravenous and other administration methods. The clinical cohort contained only 44 participants with opioid use disorder, excluded people with major psychiatric comorbidities, antidepressant use or anti-inflammatory treatment, and represented one Han Chinese community in Changsha. External validation, longitudinal follow-up and experimental work are therefore needed before the observed associations can establish temporal order, causation or clinical utility.

The evidence supports SIRI as a promising marker for further study alongside established sleep assessments, rather than as a standalone diagnostic or treatment-selection tool.

Subject of Research: Association of the systemic inflammatory response index with sleep disturbance in substance use disorders

Article Title: Systemic inflammatory response index: a potential mediator between substance use disorder and sleep disturbance

Article References: Yang, L., Tang, Y., Wang, X., Chen, X., Zou, Q., Zeng, Y., Chen, Q., & Liu, J. (2026). Systemic inflammatory response index: a potential mediator between substance use disorder and sleep disturbance. Frontiers in Pharmacology, 17, Article 1964417. https://doi.org/10.3389/fphar.2026.1964417

Image Credits: AI Generated

DOI: 10.3389/fphar.2026.1964417

Keywords: systemic inflammatory response index, substance use disorder, sleep disturbance, opioid use disorder, peripheral inflammation, NHANES, machine learning, cross-sectional study, Pittsburgh Sleep Quality Index, blood biomarkers, Systemic, inflammatory

The research team recruited 104 male patients who met DSM-5 criteria for opioid use disorder and were in sustained remission on medication. Each participant completed a battery of validated instruments: the Addiction Profile Index (API) to measure addiction severity, the Rosenberg Self-Esteem Scale (RSES) to assess global self-worth, the Substance Use Stigma Mechanism Scale (SU-SMS) to capture both anticipated and internalized stigma, the Arizona Sexual Experiences Scale (ASEX) as a screening tool, and the Golombok–Rust Sexual Satisfaction Inventory (GRISS) for a detailed multidimensional profile of sexual function and satisfaction. Sexual dysfunction was defined using established ASEX cut-off scores, giving the study a clear, clinically anchored endpoint rather than relying solely on continuous scores.

The headline number is striking: 36.5 percent of the men—38 out of 104—met criteria for sexual dysfunction. That is a substantial burden in a group that was, by definition, clinically stable and in remission, suggesting that sexual health problems persist well beyond acute withdrawal and may be an underrecognized feature of long-term recovery from opioid dependence. Opioids are well known to suppress the hypothalamic–pituitary–gonadal axis, lowering testosterone and dampening libido, but this study shifts attention toward psychological and social mechanisms that operate alongside these biological effects.

When the researchers compared patients with and without sexual dysfunction, most expected differences failed to materialize. Sociodemographic variables showed no significant associations except for income level, where patients with dysfunction differed from those without (p = .025). Perhaps more surprising, scores on the Addiction Profile Index and the Rosenberg Self-Esteem Scale did not differ significantly between the two groups when compared directly. This pattern hinted that sexual dysfunction in this population is not simply a marker of more severe, more visible illness, but something that cuts across the clinical picture in subtler ways.

Correlation analyses told a richer story. Higher API scores—indicating greater addiction severity—were positively associated with the GRISS total score and with subscales measuring difficulties with touching, avoidance, and satisfaction. In other words, men whose addiction was more severe reported more avoidance of intimacy, less satisfaction, and greater overall sexual difficulty. Anticipated stigma, the fear of being judged or discriminated against because of one’s substance use history, and internalized stigma, the shame a person absorbs and turns inward, were both positively correlated with several GRISS subscales and with ASEX scores. The direction of these associations is intuitive but clinically important: the more a man expects rejection or carries internalized shame about his addiction, the more his sexual functioning suffers.

To test whether these correlations reflected independent effects, the team ran multiple linear regression models. The model predicting the GRISS total score was statistically significant as a whole, although no individual predictor reached significance on its own—a signal that stigma, addiction severity, and related variables likely contribute jointly rather than in isolation. The picture sharpened for the satisfaction subscale: that model was significant, and the API total score emerged as an independent predictor of sexual satisfaction. Addiction severity, in other words, left its clearest fingerprint on how satisfied men felt with their sexual lives, even after accounting for stigma and self-esteem.

The most theoretically ambitious part of the study was its mediation analysis. The authors hypothesized that internalized stigma might erode self-esteem, and that damaged self-esteem might in turn drive sexual dysfunction—a plausible psychological cascade that has support in other stigmatized health conditions. The data did not support it. Self-esteem did not mediate the relationship between internalized stigma and sexual dysfunction in this sample. However, within that same model, addiction severity remained significantly associated with the GRISS total score, reinforcing the idea that the burden of addiction itself, rather than its psychological downstream effects on self-worth, is the more robust correlate of sexual problems in men recovering from OUD.

Why might self-esteem fail as the explanatory bridge? One possibility is measurement and range: the Rosenberg scale captures global self-worth, whereas the mechanisms linking stigma to sexual function may be more specific—performance anxiety, fear of intimacy, relational insecurity, or hypogonadism-related physiological changes that stigma merely amplifies. Another possibility is that in a remitted, medicated sample, self-esteem has partially rebounded while stigma and the neuroendocrine legacy of opioid exposure persist. Cross-sectional designs also cannot establish directionality: sexual dysfunction may itself fuel shame and perceived stigma, reversing the presumed causal arrow. The authors are appropriately cautious, noting that the independent predictive effects they observed were modest.

The clinical implications are nonetheless concrete. Men receiving medication for opioid use disorder are rarely asked about sexual health in routine psychiatric care, yet more than a third of this sample reported clinically significant dysfunction. Because sexual difficulties can undermine intimate relationships, self-image, and treatment retention, the authors argue that routine assessment of sexual functioning, addiction severity, and stigma should be integrated into OUD care. Validated tools such as the ASEX and GRISS make such screening feasible in busy clinics, and identifying stigma as a modifiable psychosocial factor opens the door to targeted interventions, from stigma-reduction psychotherapy to couple-based approaches that address avoidance and dissatisfaction directly.

The study also carries a broader message for how addiction is understood. Stigma is often framed as a barrier to seeking treatment; this work suggests it may also permeate life during treatment, shaping intimacy and satisfaction long after opioid use stops. Anticipated and internalized stigma correlated with sexual difficulties even in men stabilized on buprenorphine–naloxone, implying that recovery programs that address only abstinence and craving may be leaving a significant dimension of quality of life unaddressed. As the authors conclude, greater addiction severity and stigma are linked to more severe sexual dysfunction in men with opioid use disorder, and attending to sexual health, severity, and stigma together may be clinically relevant to durable recovery. For a population already carrying heavy social burdens, that reframing could matter as much as any single statistic.

Subject of Research: The relationship between stigma, self-esteem, addiction severity, and sexual dysfunction in men with opioid use disorder in remission on buprenorphine–naloxone treatment.

Article Title: Examining the relationship between stigma, self-esteem, and sexual dysfunction in patients with opioid use disorder

Article References: Niazi, S., Yazici, A. B., Bardakçı, M. R., Akbulut, K., & Yazici, E. (2026). Examining the relationship between stigma, self-esteem, and sexual dysfunction in patients with opioid use disorder. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08616-7

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08616-7

Keywords: opioid use disorder, sexual dysfunction, stigma, self-esteem, addiction severity, buprenorphine-naloxone, remission, ASEX, GRISS, medication-assisted treatment, psychiatry, men's health

Against this backdrop, a research team at Maryland Treatment Centers in Baltimore, working with colleagues at Johns Hopkins University School of Medicine, has adapted a behavioral intervention called Youth Opioid Recovery Support, or YORS, for adolescents aged 13 to 17. The intervention had already shown large effects on medication adherence in young adults aged 18 to 28 across multiple pilot trials since 2018, but it had never been tested in younger adolescents, nor in patients taking sublingual buprenorphine, the dissolvable tablet under the tongue that is by far the most common medication choice among youth. The new pilot, published in Frontiers in Adolescent Medicine, also took a broader view of success than previous work. Rather than measuring only medication adherence and opioid use, the researchers explored recovery capital, a framework describing the accumulated resources across financial, human, social, and community dimensions that support a person’s recovery. For adolescents, these resources include stable housing, school engagement, sober friendships, supportive family, and access to peer recovery groups.

The study enrolled 11 adolescents seeking treatment for opioid use disorder from inpatient or outpatient addiction programs in central Maryland between April 2024 and January 2025. Each participant nominated a family member or support person to serve as a treatment significant other, and 10 such adults, all parents, joined the trial. The design was a 16-week uncontrolled feasibility pilot, meaning there was no comparison group and the goal was to establish whether the adapted intervention could be delivered successfully and whether adolescents and families found it acceptable. The sample was diverse and clinically severe: participants were primarily African American and Hispanic, mostly male, with a mean age of 15.8 years, smoking fentanyl as their primary route of opioid use, and relying on public insurance. Their first opioid use occurred at a mean age of 14.3 years, and more than a quarter reported a lifetime overdose.

YORS is built on four core components, each designed to strip away the barriers that typically cause adolescents to fall out of medication treatment. The first is low-barrier access to medication: there was no requirement to attend counseling sessions in order to receive prescriptions, medications were prescribed in flexible supplies of one to four weeks, and free rideshare transportation was offered for injection visits or pharmacy pickups. Research staff monitored refills, coordinated medication visits, and offered same-day appointments outside regular business hours. The second component is motivational incentives, in which participants earned cash gift cards verified for taking their medication, with schedules totaling up to 200 dollars for injectable adherence or 208 dollars for daily sublingual buprenorphine over the 16 weeks. Incentives were dispensed only when adherence was confirmed through medical records, direct observation, or a trained support person.

The third component is assertive outreach and therapy. Every adolescent was assigned a YORS therapist for individual sessions, family sessions, and frequent contact by text and phone. Staff contacted patients weekly and support persons at least biweekly, with sessions flexible enough to accommodate school schedules, and maintaining engagement treated as the top priority even when patients declined formal sessions. The fourth component is family involvement: each adolescent and their designated support person created a written treatment agreement with the therapist to set goals and expectations, revisited in monthly family sessions, supplemented by education and coaching on opioid use disorder, coping skills, peer support, and weekly family support groups. The intervention was layered on top of usual care, which consisted of completing an acute inpatient stay where applicable and referral to continuing outpatient services.

The primary outcome was self-reported days of medication adherence, assessed biweekly with the timeline follow-back interview method. Participants averaged 78.7 days of adherence, or 70.3 percent of the 112-day intervention period, with missing days conservatively imputed as non-adherent. When calculated only across days with available self-report data, adherence reached 92.4 percent. Six of the 11 participants reported adherence above 90 percent, well over the 80 percent threshold conventionally considered good medication adherence, while the remaining participants ranged from 25 to 53 percent, producing a strikingly bimodal distribution. On the secondary outcome of opioid use, participants reported use on only 4.8 percent of days with available data, and nine of the 11 participants, or 81.8 percent, reported complete opioid abstinence across the intervention. Urine drug screen data collected as a validity check flagged only one discordance, in which a participant self-reported two abstinent weeks contradicted by a positive screen in the first month.

Feasibility signals were strong. The trial exceeded its enrollment target of eight adolescents with 11 enrollments, and reached 90.9 percent of its goal for enrolling a support person for each participant. All intervention components were implemented with variable uptake: 72.7 percent of adolescents completed at least one individual therapy session, averaging 3.3 sessions, while 72.7 percent of patient-family dyads completed at least one family session, averaging 1.2. Staff averaged 47.9 days of outreach per dyad across the intervention, and the average incentive dispensed was 93.64 dollars, roughly 46 percent of the total possible, on par with dispensation rates commonly reported in the contingency management literature. Session attendance was low, which the authors attribute to the model’s flexible principle of accommodating whatever level of care patients will accept while persistently reengaging them, and to the high volume of shorter impromptu contacts through calls, texts, and check-ins that supplemented scheduled care.

Acceptability ratings were uniformly high among the seven adolescents and five support persons who completed satisfaction surveys. Every participant with prior treatment experience rated YORS as better than previous treatment, and all adolescents described the outreach level as the right amount. Adolescents rated the helpfulness of components on a 10-point scale: having a support person involved scored a perfect 10, low-barrier access to medication 9.7, cash incentives 9.4, relapse prevention medication 8.4, individual therapy 8.3, frequent calls and texts 8.3, and family sessions 7.3. Support persons rated components similarly, with low-barrier access and support person involvement both at 10, and frequent calls and texts at 9.6. Adolescents reported mean satisfaction of 8.9 out of 10 with their family member’s involvement in recovery, while support persons reported 9.0 satisfaction with their loved one’s recovery.

The exploratory recovery capital indicators showed promising pre-to-post signals, though the authors caution these were not validated measures and missing data reached 36 percent for adolescents and 50 percent for support persons. Among the seven participants with complete data, two reported homelessness in the past year at baseline, but only one reported homelessness during the intervention. Five of seven were in school or employed at baseline; all seven were in school or employed at week 14. None attended self-help groups at intake, but four, or 57.1 percent, attended at least one group by follow-up, with two attending regularly. Five of seven reported at least one lifetime arrest at baseline, yet only one arrest occurred during the intervention and no participant was charged with a new offense. Both adolescents and support persons rated family involvement in recovery above 9 on a 10-point scale. Three psychiatric hospitalizations occurred during the trial, classified as unrelated to the intervention by the principal investigator and an independent data safety monitoring board.

The authors emphasize that this small, uncontrolled pilot cannot establish efficacy, and its limitations are substantial: no randomization, no validated adolescent recovery capital measure, reliance on self-report with 20 percent missing opioid use data suggesting the use rate may be underestimated, exclusion of non-English speakers despite a largely Hispanic sample, and a fixed rather than escalating incentive schedule for daily medication. The trial was also not pre-registered. Still, the bimodal adherence pattern offers a concrete research question for future work, since understanding what distinguishes adolescents who thrive under the model from those who struggle could guide targeted improvements. The team calls for adequately powered randomized trials, cultural adaptations for Spanish-speaking families, longer intervention durations, and the development of validated recovery capital measures for adolescents, a gap experts in the field have highlighted. If confirmed, the findings would suggest that a family-centered, low-barrier, persistently assertive treatment model can help a critically underserved population not only stay on medication but begin building the resources that make recovery durable.

Subject of Research: Behavioral treatment and recovery capital in adolescents with opioid use disorder

Article Title: Targeting recovery capital for adolescents through treatment for opioid use disorder: a pilot expansion of the Youth Opioid Recovery Support intervention

Article References: Taylor, L., Wenzel, K., Mallik-Kane, K., Pfeltz, C., Massie, E., Davis, K., Lavorato, L., & Fishman, M. (2026). Targeting recovery capital for adolescents through treatment for opioid use disorder: a pilot expansion of the Youth Opioid Recovery Support intervention. Frontiers in Adolescent Medicine, 4, Article 1720332. https://doi.org/10.3389/fradm.2026.1720332

Image Credits: AI Generated

DOI: 10.3389/fradm.2026.1720332

Keywords: adolescents, opioid use disorder, Youth Opioid Recovery Support, medication adherence, buprenorphine, recovery capital, family involvement, motivational incentives, assertive outreach, pilot trial, Frontiers in Adolescent Medicine, addiction treatment

The trial’s central hypothesis is deceptively simple but clinically consequential: the depressive and other affective symptoms that emerge during medication-assisted treatment or periods of reduced opioid use may act as motivational triggers for relapse. If ketamine can rapidly lift those symptoms, it might close a therapeutic window that current medications leave open. Ketamine has already demonstrated striking promise as a rapid-acting intervention in mood disorders, but its efficacy, safety and neuro-bio-physiological effects in people with opioid use disorder remain insufficiently characterised. This study is designed to fill that evidence gap with clinical, mechanistic and safety data.

The design is a classic test of adjunctive therapy. Participants with opioid use disorder who are already receiving medications for opioid use disorder will be randomised to receive either six intravenous infusions of ketamine at 0.5 milligrams per kilogram of body weight or a placebo over a two-week period. Clinical outcomes will be assessed at baseline, throughout the infusion phase, in an acute primary analysis window extending through two weeks after the final infusion, and at follow-up time points stretching to nine months after the last infusion. That long tail of follow-up is unusual for ketamine studies and reflects the trial’s explicit focus on relapse prevention rather than short-term symptom relief alone.

A notable feature of the protocol is its disciplined endpoint hierarchy. In a substantial protocol modification submitted in July 2026, the investigators replaced a previously registered broad, composite primary objective with a single primary clinical endpoint: change in total score on the Montgomery-Åsberg Depression Rating Scale over the acute primary analysis window. Everything else, including longer-term depression follow-up, craving, withdrawal symptoms, treatment retention, lapse and relapse-related outcomes, safety, electroencephalography, heart rate variability and peripheral biomarkers, is retained as secondary or exploratory. The revision was adopted to avoid a composite primary endpoint mixing heterogeneous domains and to align the protocol with SPIRIT and ICH E9 principles for coherent analysis.

The measurement battery is unusually comprehensive for a psychiatry trial of this size. Depression will be tracked with the Montgomery-Åsberg scale and the Patient Health Questionnaire-9, anxiety with the Generalised Anxiety Disorder-7 and the state version of the State-Trait Anxiety Inventory, and overall psychological distress with the Depression Anxiety Stress Scales-21. Craving will be measured with the Brief Substance Craving Scale, while withdrawal is monitored through both the Subjective and Objective Opiate Withdrawal Scales. Emotion regulation, alexithymia, anhedonia and positive and negative affect are captured with dedicated instruments, including the Difficulties in Emotion Regulation Scale-18, the Toronto Alexithymia Scale-20, the Snaith-Hamilton Pleasure Scale, the Temporal Experience of Pleasure Scale and the Positive and Negative Affect Schedule. A primary care screen for post-traumatic stress disorder rounds out the affective picture.

Beyond the clinical scales, the study is built to probe mechanism. Electroencephalography will track changes in brain oscillatory activity, heart rate variability will index autonomic nervous system function, and blood-based biomarkers, including brain-derived neurotrophic factor and stress-axis hormones such as adrenocorticotropic hormone and corticotropin-releasing factor, will be sampled to map the hypothalamic-pituitary-adrenal axis response. Dissociative effects during infusions will be quantified with the six-item Clinician-Administered Dissociative States Scale, and recovery from each session will be verified with the Modified Aldrete Score. By weaving together clinical, neurophysiological, autonomic and molecular measures, the investigators aim to identify candidate mechanisms of action and potential predictors of ketamine response, information that could eventually allow clinicians to select which patients are most likely to benefit.

Safety receives equally careful attention. Adverse events will be graded with the Common Terminology Criteria for Adverse Events, tracked through an adverse event checklist, and monitored with electrocardiograms. The protocol specifies halting rules, blinding-integrity assessment and procedures for handling concomitant medications, all clarified in the revised version 2.0 dated 13 July 2026. The trial was approved by the Cyprus National Bioethics Committee on 28 April 2022, received regulatory authorisation in EudraCT on 17 November 2022 before the first participant was enrolled, and was subsequently assigned EU CT Number 2025-520843-34-00 following the transition to the Clinical Trials Information System. It is being conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines, with written informed consent from all participants.

The trial’s status is a study in methodological transparency. Recruitment began on 2 April 2024, after prospective registration. At the time of manuscript submission, fourteen participants had been enrolled and randomised, and all fourteen had received at least one ketamine or placebo infusion. Thirteen had completed the full six-infusion treatment phase and entered the post-treatment follow-up phase. No serious adverse events had occurred to date. Crucially, the investigators report only aggregate blinded status data; no treatment-arm-specific outcome data have been examined or disclosed while the study remains blinded, and investigators, treating clinicians, outcome assessors, laboratory personnel and data analysts all remain unaware of allocation.

The study is anchored at the University of Cyprus, with the Department of Psychology and the Center for Applied Neuroscience at its core, and involves the GEFYRA Substitute Substance Unit in Nicosia, the State Health Services Organization of Cyprus, the Athalassa Psychiatric Hospital Pharmacy, European University Cyprus, Umeå University in Sweden and a clinical laboratory in Larnaca. Funding comes from the Research and Innovation Foundation of Cyprus under grant numbers EXCELLENCE/0421/0543 and EXCELLENCE/0524/0357, with the funder having no role in study design, data collection, analysis, interpretation or publication decisions. The sponsor is the University of Cyprus, which carries responsibility for trial oversight, safety reporting and insurance arrangements in line with Regulation (EU) No 536/2014.

What makes this protocol newsworthy is its positioning within the broader ketamine story. Ketamine’s rapid antidepressant action, mediated through glutamatergic pathways and studied intensively in treatment-resistant depression, has never been rigorously tested as an adjunct in opioid use disorder at this level of mechanistic depth. If the PROUD study demonstrates meaningful reductions in depressive symptoms and downstream effects on craving and relapse, it would inform the design, sample-size assumptions and endpoint selection of larger multicentre trials targeting affective symptoms and relapse vulnerability in opioid use disorder, with relevance to concomitant multidisciplinary rehabilitation approaches. If it does not, the rich biomarker dataset should still clarify why, sharpening the field’s understanding of who responds and why. Either way, the trial’s transparent registration, disciplined endpoint hierarchy and nine-month follow-up set a methodological benchmark for adjunctive interventions in addiction medicine, a field where relapse, not abstinence at discharge, is the outcome that ultimately determines whether treatment saves lives.

Subject of Research: A randomised, double-blind, placebo-controlled phase II trial protocol testing adjunctive intravenous ketamine for affective symptoms, craving and relapse prevention in opioid use disorder

Article Title: Adjunctive ketamine for affective symptoms, craving, and relapse prevention in opioid use disorder: protocol for a randomised, double-blind, placebo-controlled clinical trial

Article References: Koumas, M., Apostolakis, M., Bella, E., Michael, A., Onisiforou, A., Georgiou, P., Papacharalambous, C., Kyprianides, P., Stylianou, M., Paraskevopoulos, E., Panayiotou, G., Fotopoulos, D., Chatzittofis, A., & Zanos, P. (2026). Adjunctive ketamine for affective symptoms, craving, and relapse prevention in opioid use disorder: protocol for a randomised, double-blind, placebo-controlled clinical trial. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08628-3

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08628-3

Keywords: ketamine, opioid use disorder, clinical trial, depression, relapse prevention, MOUD, psychiatry, biomarkers, EEG, craving, Adjunctive, affective

The study, led by Jessica A. Chen and Emily C. Williams of the University of Washington and VA Puget Sound Health Care System, examined monthly treatment patterns among more than 110,000 veterans diagnosed with opioid use disorder between March 2018 and February 2022. Published in Addiction Science & Clinical Practice, the research drew on 48 monthly cohorts extracted from national electronic health records, covering outpatients aged 18 and older with a past-year opioid use disorder diagnosis. The team tracked receipt of any medication for opioid use disorder, including methadone, buprenorphine, and naltrexone, and then examined methadone and buprenorphine separately to see how each medication’s use changed over time and across racial and ethnic groups.

The analytical design was deliberately granular. Rather than comparing a single pre-pandemic year with a single pandemic year, the researchers constructed 48 consecutive monthly cohorts, allowing them to trace trends with unusual precision across the entire 2018 to 2022 window. The primary outcome was receipt of any medication for opioid use disorder in a given month. Secondary analyses split the picture by medication type, because methadone and buprenorphine are delivered through very different channels: methadone is dispensed only through federally regulated opioid treatment programs with strict supervision requirements, while buprenorphine can be prescribed by office-based clinicians and carried in a patient’s pocket.

At the start of the study window, the system looked remarkably equitable on the surface. In March 2018, non-Hispanic Black and non-Hispanic White veterans with opioid use disorder received any medication for opioid use disorder at nearly identical rates, 27.3 percent and 27.8 percent respectively. Hispanic Black patients started at 28.0 percent, essentially matching Hispanic White patients at 28.4 percent and Hispanic patients who were neither Black nor White at 27.0 percent. Four years later, that parity had eroded. By February 2022, 35.0 percent of non-Hispanic White patients were receiving medication, compared with only 29.3 percent of non-Hispanic Black patients. Among Hispanic patients, the same pattern emerged: Hispanic Black patients stood at 26.2 percent, while Hispanic White and Hispanic neither Black nor White patients had climbed to 33.2 percent and 33.7 percent respectively.

The medication-specific numbers reveal where the divergence originated. Buprenorphine receipt increased after the pandemic began, but the increase was strikingly unequal. Non-Hispanic White patients rose from 27.9 percent to 29.8 percent receiving buprenorphine, while non-Hispanic Black patients moved only from 13.9 percent to 15.5 percent and Hispanic Black patients from 11.6 percent to 15.1 percent. In other words, White veterans were roughly twice as likely as Black veterans to receive buprenorphine at both the start and the end of the study period, and the pandemic-era expansion of prescribing did little to narrow that chasm.

Methadone told the opposite story. Receipt of methadone declined after the pandemic began for every group, yet Black patients remained far more dependent on it than White patients. Non-Hispanic Black patients fell from 17.4 percent to 14.4 percent receiving methadone, and Hispanic Black patients from 17.1 percent to 11.9 percent, while non-Hispanic White patients declined only from 6.6 percent to 5.5 percent. The result is a persistent structural pattern: Black veterans with opioid use disorder were more than twice as likely as White veterans to be on methadone, the medication tied to daily clinic visits and rigid dispensing schedules, and far less likely to be on buprenorphine, the medication most compatible with ordinary life, employment, and privacy.

Why does this split matter clinically? Buprenorphine and methadone are both full-strength opioid agonist treatments that reduce overdose mortality and improve retention in care, but they impose different burdens. Methadone traditionally requires daily attendance at a specialized clinic, which can be difficult for people with inflexible jobs, unreliable transportation, or childcare responsibilities. Buprenorphine, by contrast, can be prescribed in routine medical settings and taken at home. When pandemic policies loosened methadone dispensing rules and eased buprenorphine initiation, the expectation was that both medications would reach more people, particularly those historically excluded. The VHA data show that overall access did expand, but the expansion accrued disproportionately to White patients, leaving the underlying hierarchy of treatment untouched.

The study’s authors are careful to frame the findings as descriptive rather than causal. The analysis documents trends in receipt by race and ethnicity across the pre-pandemic and pandemic periods; it does not identify the specific mechanisms that produced the widening gaps. Still, the implications are pointed. Pandemic-related policy changes were intended to expand access to medications for opioid use disorder, the researchers conclude, but their benefits may not have been equitably distributed across racial and ethnic groups. Improving equity, they argue, may require targeted approaches to reduce barriers to both buprenorphine and methadone, rather than assuming that broad flexibilities will lift all boats.

The research also carries methodological significance for how health systems monitor equity. By disaggregating Hispanic patients into Hispanic Black, Hispanic White, and Hispanic neither Black nor White subgroups, the study avoided treating Hispanic veterans as a monolithic category and surfaced disparities that aggregate statistics would conceal. Hispanic Black patients, for example, ended the study period with the lowest medication receipt of any subgroup examined, a finding invisible in analyses that collapse all Hispanic patients together. The work was supported by the National Institute on Drug Abuse and was informed by consultation from groups of veterans with lived and living experience of opioid use, including the Veterans’ Opioid Use disorder Inequities CommitteE and the Research with Expert Advisors on Drug Use panel.

For a health system caring for a population at elevated risk of fatal overdose, the message is sobering. The VHA is the largest integrated healthcare system in the United States, and its electronic health records offer one of the few national windows into how treatment patterns actually shifted when prescribing rules changed. The data show that between 2018 and 2022, the share of White veterans receiving buprenorphine grew while the share of Black veterans receiving methadone shrank, and the two trends combined to leave Black patients with less access to the most flexible, most widely available treatment option. As policymakers consider making pandemic-era flexibilities permanent, the study suggests that flexibility alone is not enough; without deliberate attention to who actually receives each medication, the same structural inequities will persist, and the promise of expanded opioid treatment will remain unevenly fulfilled.

Subject of Research: Racial and ethnic inequities in receipt of methadone and buprenorphine for opioid use disorder in the Veterans Health Administration before and after COVID-19

Article Title: Trends in receipt of methadone vs. buprenorphine by race/ethnicity before and after COVID-19 (2018–2022): a Veterans Health Administration study

Article References: Chen, J. A., Dunn, J. A., Maskey, P., Austin, E. J., Durland, M. L., Ravi, V., Warth, A., Brooks, J., Marshall, S., van Draanen, J., Jones-Smith, J., & Williams, E. C. (2026). Trends in receipt of methadone vs. buprenorphine by race/ethnicity before and after COVID-19 (2018–2022): a Veterans Health Administration study. Addiction Science & Clinical Practice. https://doi.org/10.1186/s13722-026-00730-x

Image Credits: AI Generated

DOI: 10.1186/s13722-026-00730-x

Keywords: opioid use disorder, medications for opioid use disorder, methadone, buprenorphine, health disparities, Veterans Health Administration, COVID-19, race and ethnicity, veterans, addiction treatment, health policy, Trends