Journal: Journal of School Health, 2025, doi: 10.1111/josh.70095
Authors: Hannah L. Maxey, Brittany J. Daulton, Mykayla Moore, & Kelsey Binion
Abstract:
Background: Substance use among youth can have lifelong consequences and therefore requires early and targeted services for those at risk. Schools possess a unique opportunity to provide substance use services to youth for both prevention and intervention. However, limited research exists on the school-based substance use services and their effectiveness.
Methods: Using PRISMA guidelines, online databases were searched for studies done between 2004 and 2024 on school-based substance use services, their outcomes, and the characteristics of those administering them.
Findings: Results showed school-based substance use services being offered in multiple settings. Screening and intervention were the most common services provided. Although specific outcomes varied by study, including academic performance, perceptions, and actions, most were positive.
Implications for school health policy, practice, and equity: Schools should create strategic plans for feasible and sustainable substance use services. Use of the screening, brief intervention, and referral to treatment (SBIRT) framework can be used to organize these efforts. Establishing robust referral networks is of particular importance for schools.
Conclusions: This review highlights opportunities for schools to focus on screening and brief intervention for in-school services while also building a strong referral network for times when treatment is necessary.
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Journal: JAMA Network Open, 2025, doi:10.1001/jamanetworkopen. 2025.48043
Authors: Rajinder Shiwach, Bernard Le Foll, Hannu Alho, Kelly E. Dunn, Stephanie Strafford, Yue Zhao, & Robert L. Dobbins
Abstract:
Objective: To compare the efficacy and safety of 100-mg vs 300-mg once-monthly maintenance doses of extended-release buprenorphine among individuals with high-risk opioid use, including fentanyl.
Design, Setting, and Participants: This multicenter, randomized, double-blind clinical trial was conducted from October 26, 2021, to June 26, 2024, at 28 outpatient treatment centers in the US and Canada among treatment-seeking participants with moderate or severe opioid use disorder who injected opioids, used high doses of opioids, or used fentanyl.
Interventions: After completing buprenorphine induction and extended-release buprenorphine initiation (week 6), participants were randomized in a 1:1 ratio to receive 8 additional 100-mg or 300-mg extended-release buprenorphine maintenance injections.
Main Outcomes and Measures: The primary end point was the proportion of responders for weekly opioid use, defined as participants whose percentage of visits with opioid abstinence was 80% or more over weeks 20 to 38. Post hoc analyses were performed to identify any subgroups that might benefit more from the 300-mg than 100-mg extended-release buprenorphine maintenance dose. Adverse events, including injection-site reactions, were reported. Analysis was conducted on an intent-to-treat basis.
Results: Of 436 participants randomized, 435 (mean [SD] age, 41.6 [10.9] years; 248 men [57.0%]) received injections and were analyzed (218 in the 100-mg arm and 217 in the 300-mg arm). There were 44 of 218 responders (20.2%) in the 100-mg arm and 50 of 216 responders (23.2%) in the 300-mg arm (Cochran-Mantel-Haenszel difference, 2.6%; 95% CI, −4.7% to 9.9%). In post hoc analyses, the 300-mg maintenance dose performed significantly better than the 100-mg maintenance dose among participants who used fentanyl daily (difference, 11.1%; 95% CI, 0.4%-21.6%), used fentanyl 14 times or more per week (difference, 12.2%; 95% CI, 2.4%-22.1%), or both (difference, 15.4%; 95% CI, 4.6%-26.1%). With both dosing regimens, the frequency of opioid use decreased from more than 43 instances at screening to fewer than 3 instances by week 3 (through week 38). Extended-release buprenorphine–related adverse events were similar between groups, except for injection-site reactions, which were higher in the 300-mg arm (difference, 9.2%; 95% CI, 3.7%-15.2%). Both maintenance doses were well tolerated with no new safety signals.
Conclusions and Relevance: In this randomized clinical trial, both extended-release buprenorphine maintenance doses were well tolerated and effective among participants with high-risk opioid use. The 300-mg maintenance dose may perform better among individuals with heavy fentanyl use. These results are particularly relevant because individuals with opioid use disorder in North America are increasingly exposed to highly potent synthetic opioids, such as fentanyl, a driver of high levels of opioid overdose deaths.
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Journal: American Journal of Lifestyle Medicine, 2025, doi: 10.1177/155982 76251404883
Authors: Osayande Agbonlahor, Delvon T. Mattingly, Joy L. Hart, Maggie K. Richardson, Alison C. McLeish, & Kandi L. Walker
Abstract:
Background: Despite increases in cardiovascular disease (CVD) prevalence among young and middle-aged adults in the United States (U.S.), associations between lifetime use of cannabis, non-cigarette tobacco products, and illicit drugs with CVD are not fully known. This study aimed to examine these associations among young and middle-aged U.S. adults.
Methods: We analyzed a sample of 2933 adults aged 20-59 years from the National Health and Nutrition Examination Survey (2017-2018). CVD (i.e., health care provider diagnosis of coronary heart disease, stroke, or high blood pressure), and substance use (i.e., ever use of cannabis, non-cigarette tobacco, or illicit drugs) were assessed. Adjusted odds ratios were estimated using multivariable logistic regression.
Results: Adults who used cannabis had higher odds of coronary heart disease (OR = 5.45, 95% CI: 1.86-15.95), and adults who used cigars had higher odds of stroke (OR = 2.31, 95% CI: 1.06-5.01). Further, increased odds of high blood pressure were associated with e-cigarette (OR = 1.41, 95% CI: 1.12-1.79) and smokeless tobacco (OR = 1.46, 95% CI: 1.01-2.12) use.
Conclusions: Lifetime cannabis and non-cigarette use was associated with CVD among young and middle-aged U.S. adults, with the spectrum of disease varying based on substance type. CVD prevention should involve non-cigarette tobacco and cannabis use screening and counseling.
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Journal: JAMA Network Open, 2025, doi:10.1001/jamanetworkopen .2025.47799
Authors: Jodi M. Gilman, Corinne Cather, Harrison T. Reeder, Bryn Evohr, Gladys N. Pachas, Kevin M Gray, … A. Eden Evins
Abstract:
Importance: Cannabis use is prevalent among adolescents and young adults who vape nicotine. It is not known if cannabis use affects nicotine vaping cessation success.
Objective: To assess whether baseline frequency of cannabis use or cannabis use disorder (CUD) symptom severity was associated with nicotine vaping cessation in a randomized clinical trial.
Design, Setting, and Participants: This secondary analysis of a randomized clinical trial with youth who vaped nicotine recruited at a single site in Massachusetts from June 2022 to May 2024. The trial included 3 groups receiving 12 weeks of varenicline treatment and placebo (both double-masked, paired with counseling), as well as single-masked referral to texting-app–based nicotine vaping cessation support (enhanced usual care [EUC]). Eligible participants were aged 16 to 25 years who reported vaping nicotine regularly and did not smoke tobacco.
Exposure: Baseline cannabis use was assessed via self-reported number of days of cannabis use per week and with Cannabis Use Disorder Identification Test (CUDIT) scores.
Main Outcomes and Measures: Biochemically verified 7-day point prevalence nicotine vaping abstinence at week 12. Logistic regression models estimated associations between baseline cannabis use and vaping abstinence. Interaction terms were evaluated to examine whether cannabis use moderated the effect of varenicline on nicotine abstinence.
Results: Among the 261 participants randomized to nicotine vaping cessation treatment (mean [SD] age, 21.5 [2.0] years; 139 female [53%]), 28% (73 participants) reported no past-month cannabis use, 38% (100 participants) reported using cannabis more than 0 and less than 4 d/wk, and 30% (78 participants) reported using cannabis 4 to 7 d/wk. Cannabis use frequency was not significantly associated with nicotine vaping cessation (eg, 4 to 7 d/wk use vs no use: adjusted odds ratio [aOR], 1.14; 95% CI, 0.51-2.57; overall P = .20). Nor did cannabis frequency modify the effect of varenicline (eg, abstinence varenicline vs placebo or EUC among those with 4 to 7 d/wk use: aOR, 8.47; 95% CI, 2.78-28.25; vs among those with no use: aOR, 5.60; 95% CI, 1.97-17.06; overall interaction P = .32). Findings were similar for CUD symptom severity.
Conclusions and Relevance: Among adolescents and young adults attempting to reduce or stop nicotine vaping, baseline cannabis use was not associated with nicotine vaping abstinence. Varenicline proved helpful for nicotine vaping cessation regardless of cannabis use, indicating that co-use of cannabis may not represent a barrier to successful nicotine vaping cessation treatment.
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Journal: Developmental Cognitive Neuroscience, 2025, doi: 10.1016/j.dcn. 2025.101653
Authors: Marybel R. Gonzalez, Ty Brumback, Madison K. Wickershiem, Edith V. Sullivan, Adolf Pfefferbaum, Duncan B. Clark, … Wesley K. Thompson
Abstract:
Adolescence through young adulthood is a sensitive neurodevelopmental window characterized by ongoing maturation of gray and white matter and heightened vulnerability to alcohol’s neurotoxic effects. Although prior studies link binge drinking with disrupted brain development, the potential for recovery with reduced alcohol use remains underexplored. Using data from 690 participants (ages 12-29) in the National Consortium on Alcohol and NeuroDevelopment in Adolescence to Adulthood (NCANDA-A), we examined the longitudinal impact of binge drinking episodes, and reductions in binge drinking episodes, on regional gray and white matter volumes. Linear mixed-effects models assessed (1) past-year binge drinking frequency, (2) reductions below personal mean binge drinking across time, and (3) transitions in frequency of binge drinking across 10 annual neuroimaging assessments. Results showed that higher binge drinking frequency was associated with decreases in gray matter across frontal, parietal, temporal, and occipital cortices, as well as white matter reductions in frontolimbic and frontostriatal pathways. Reductions below personal mean drinking frequency were also associated with attenuated shrinkage in gray matter volumes. Participants who transitioned from frequent to infrequent binge drinking had significantly larger corpus callosum volumes compared to those with sustained frequent binge episodes. This longitudinal analysis demonstrates consistent negative effects of binge drinking on gray and white matter regions. Importantly, reductions in binge drinking provide evidence for neuroanatomical recovery, particularly in the corpus callosum, and suggest that the degree of recovery may vary by brain region and extent of alcohol use reduction during this key developmental period.
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