Research News Roundup: April 10, 2025

Journal: Annual Review of Public Health, 2025, doi: 10.1146/annurev-publhealth-071723-112620

Authors: Brendan Saloner, Daliah Heller, Corey S. Davis, & Susan G. Sherman

Abstract:

Harm reduction programs provide tools that enable people who use drugs to do so more safely in a nonstigmatizing environment without the goal of them necessarily seeking treatment or abstinence. Most harm reduction programs in the United States distribute sterile syringes and naloxone and safely dispose of used syringes and other drug use supplies. Many also provide drug checking services, and other safer use supplies. These programs exist on a limited scale and often face restrictions on their funding and scope of operations. While research demonstrates the effectiveness of existing programs in preventing infectious disease transmission and fatal overdose, there is less evidence about conditions that support the effective expansion and sustainment of existing models. Other harm reduction interventions such as overdose prevention centers and safer supply programs have promising international evidence but are prohibited or severely restricted under US law. In this review, we summarize the evidence for harm reduction interventions, describe the policy environment in which they exist, and provide recommendations to better align drug policy with existing and emerging evidence in the US context.
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Journal: SSM – Population Health, 2025, doi.org/10.1016/j.ssmph.2025. 101799

Authors: Angela Bruns, Amanda J. Aubel, Xiaoya Zhang, Shani A.L. Buggs, & Nicole Kravitz-Wirtz

Abstract:

In areas with high levels of violence, not just the individuals involved but entire communities experience harm. Acts of violence in the community that a young person did not witness or experience directly can still have consequences for their health behaviors. Using survey data from the Future of Families and Child Wellbeing Study merged with the Gun Violence Archive (N=3,042), we investigate associations between community exposure to firearm homicide and adolescent substance use. Results indicate that exposure to a local firearm homicide in the past 180 days is associated with 1.56 higher odds of adolescent marijuana use, and exposure to multiple incidents nearly doubles the odds of use. There is no significant association between exposure and either alcohol or cigarette use. Moderation analyses show a positive association between firearm homicide exposure and marijuana use among Black and low-income adolescents and adolescents living in disadvantaged neighborhoods. These results suggest that those who face the greatest risk of community exposure to firearm homicide also face the greatest consequences.

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Journal: Physiology & Behavior, 2025, doi: 10.1016/j.physbeh.2025

Authors: Sumin Lee, & Scott Edwards

Abstract:

Chronic pain affects over 20% of the global population and contributes to the vast burden of psychiatric illness. While effective treatments for chronic pain remain limited, both alcohol and cannabis have been used for centuries to manage pain and closely associated negative affective symptoms. However, persistent misuse of alcohol and/or cannabis in such a negative reinforcement fashion is hypothesized to increase the risk of severity of substance use disorders (SUDs). The current review describes neurobiological evidence for the analgesic efficacy of alcohol and primary cannabis constituents and how use or co-use of these substances may influence SUD risk.

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Journal: JAMA Health Forum, 2025, doi: 10.1001/jamahealthforum.2025 .0393

Authors: Sumedha Gupta, Aditya James, Jennifer Miles, Hillary Samples, Stephen Crystal, & Kosali Simon

Abstract:

Importance: Medicaid, the largest payer for medications for opioid use disorder (MOUD), disenrolled more than 19.1 million individuals by March 2024 after the continuous coverage requirement ended in April 2023-a process termed Medicaid unwinding-but the impact on buprenorphine receipt remains unknown.

Objective: To assess the association between Medicaid unwinding and dispensing of prescription buprenorphine, overall and by payment sources nationally and by state.

Design, setting, and participants: Cross-sectional study of buprenorphine dispensing (age ≥18 years) from April 2020 to March 2024 using the IQVIA Longitudinal Prescription (LRx) database containing more than 90% of US retail pharmacy claims. Interrupted time-series estimated levels and trends of buprenorphine prescription dispensation before and after Medicaid unwinding.

Main outcomes and measures: The number of patients with filled buprenorphine prescriptions each month was analyzed by payer type (Medicaid, Medicare, commercial, or self-pay) and by state. Stratified analyses assessed state factors, including automated (ex parte) Medicaid renewal rates (higher or lower than the median), income verification sources used for automated renewals (≤3, 4-5, or 6-7), and Affordable Care Act Medicaid expansion status.

Results: Of the 2 405 970 adults who filled buprenorphine prescriptions between April 2020 and March 2024, 1 154 866 (48%) had at least 1 fill covered by Medicaid, 288 716 (12%) by Medicare, 1 106 746 (46%) by commercial insurance, and 264 657 (11%) by self-pay. Medicaid unwinding was associated with reversal of previously increasing trends in buprenorphine prescriptions, with 2.9% fewer patients (-23 855 [95% CI, -32 661 to -15 054]) receiving buprenorphine each month by 8 months after unwinding vs the month before unwinding began. This decline was driven by a 12.7% drop in patients with Medicaid-paid fills (-46 545 [95% CI, -51 362 to -41 730]), partially offset by increases in patients with commercial (6.12%, 19 809 [95% CI, 12 109 to 27 509]) and self-paid (7.24%, 2525 [95% CI, 1246 to 3805]) fills. Sixteen states saw overall declines in buprenorphine use after unwinding, with reductions among patients with Medicaid-covered prescriptions in 36 states, partially offset by increases in patients with commercial insurance covered fills (32 states) and self-paid fills (23 states). Buprenorphine prescriptions remained stable in states with above-median automated Medicaid renewal rates and more income verification sources, whereas states with below-median automated renewal rates, fewer verification sources, and nonexpansion state status experienced smaller offsets for Medicaid-related losses, highlighting importance of state-specific policies.

Conclusions and relevance: This cross-sectional study of Medicaid unwinding and filled buprenorphine prescriptions found that although shifts to commercial and self-pay sources mitigated some losses, rising self-pay reliance poses affordability barriers that threaten treatment continuity. Addressing access disparities is critical amid persistently high US overdose rates.

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