Journal: Journal of Adolescent Health, 2026, doi: 10.1016/j.jadohealth .2026.01.003
Authors: Nicholas Szoko, Patrece Joseph, Casey D. Hanner, Alex Ramsey, Kristen Mueller, Elizabeth Miller, Stephen Strotmeyer, & Alison J. Culyba
Abstract:
Purpose: Substance use (SU) and violence drive a significant proportion of adolescent mortality. Identifying shared protective factors is crucial. We aimed to characterize adolescent SU and violence typologies and examine associations with protective factors.
Methods: Using cross-sectional surveys from 17 high schools, we assessed individual (psychological empowerment and future orientation), interpersonal (social support and school connectedness), and environmental (Child Opportunity Index) protective factors. We used latent class analysis to identify risk profiles across multiple forms of SU and violence. Multinomial regression assessed relationships between protective factors and latent class membership.
Results: Among 3,641 respondents, fighting was the most frequent violence type (20.2%). Marijuana use (20.0%) and vaping (17.6%) were common. Latent class analysis revealed five groupings: (1) low violence and low SU (72.7%); (2) low violence and high SU (10.3%); (3) sexual violence and moderate SU (5.7%); (4) high multiple violence and high SU (2.4%); and (5) fighting and marijuana/vaping (8.8%). Opioid use was highest (55.1%) in the high SU and high multiple violence class. Sexually diverse youth comprised most of the sexual violence and moderate SU (52.9%) and high multiple violence and high SU (50.6%) classes. Compared to the low violence and low SU class, high social support was associated with lower odds of membership in other categories. High future orientation was associated with lower odds of membership in the sexual violence and moderate SU class relative to low violence groups.
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Journal: Therapeutic Advances in Infectious Disease, 2026, doi.org/10.1177/2049936 1261420916
Authors: Nadia Mattanah, Aditi Ringwala, & Shivakumar Narayanan
Abstract:
Background: Contingency management (CM) has been used to reinforce abstinence in the treatment of substance use disorders (SUD). Novel applications of CM in people who use drugs (PWUD) have been used to facilitate other desirable behaviors.
Objective: Describe and assess preliminary outcomes of a program intended to reduce risk for HIV and related infections in a population of PWUD through increased healthcare engagement.
Design: Patients receiving care for SUD at a collocated clinic receive shaping CM-based incentives for risk assessment, testing, and clinic attendance.
Methods: Baseline cohort characteristics are assessed, and engagement in clinical care during the early period of the program is described.
Results: Participants are majority African American, female, and meet criteria for experiencing financial resource strain. During the first year of the program, no significant changes in clinic appointment attendance were observed.
Conclusion: Patient-centered CM-based incentivization implemented in a low-barrier, harm-reduction setting may facilitate incremental health behavior changes to reduce infection-related comorbid risk. There is a need to expand approaches to those with high risk and barriers.
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Journal: The Lancet Psychiatry, 2026, doi: 10.1016/S2215-0366(26)00015-5
Authors: Jack Wilson, Olivia Dobson, Andrew Langcake, Palkesh Mishra, Zachary Bryant, Janni Leung, … Emily Stockings
Abstract:
Background: Mental disorders and substance use disorders (SUDs) are among the leading reasons for which the medical use of cannabinoids has been approved, but their efficacy and safety in treating these conditions is yet to be established. We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) testing the efficacy and safety of cannabinoids as the primary treatment for mental disorders or SUDs.
Methods: We searched Ovid MEDLINE, PsychINFO, Cochrane Central Register of Controlled Clinical Trials, Cochrane Database of Systematic Reviews, and Embase for peer-reviewed articles published between Jan 1, 1980, and May 13, 2025, evaluating the efficacy of cannabinoids in reducing or treating mental disorders and SUDs as the primary indication. Primary outcomes were remission of disorder or reduction in disorder symptoms. Safety was assessed via synthesis of all-cause and serious adverse events, which was used to calculate the number needed to treat to harm (NNTH). Two independent reviewers screened all studies and performed data extraction. Evidence was synthesised as odds ratios (ORs) for dichotomous measures and standardised mean differences (SMDs) for continuous measures, via random-effects meta-analysis in Review Manager, version 5.4. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias 2.0 tool. We evaluated the quality of the primary outcomes using the GRADE framework. The study was registered with PROSPERO (CRD42023392718).
Findings: 54 trials were identified for inclusion (2477 participants; 1713 [69%] males, 764 [31%] females; median age 33·3 years [IQR 28·1–38·05; ethnicity data not available). 24 (44%) of these trials had a high risk of bias, and the certainty of evidence for most outcomes was low. Our meta-analysis revealed that a combination of cannabidiol and delta-9-tetrahydrocannabinol reduced cannabis withdrawal symptoms (SMD –0·29, 95% CI –0·57 to –0·02) and weekly grams of cannabis use (–1·00, –1·69 to –0·30) among those with cannabis use disorder, and a reduction in tic severity among those with tic or Tourette’s Syndrome (–0·68, –1·03 to –0·34) compared with placebo. Any cannabinoid type led to an increase in sleep time as recorded by an electronic device (0·54, 0·14 to 0·95) and sleep diary (0·55, 0·01 to 1·09) among those with insomnia. There was a reduction in autistic traits (–0·36, –0·66 to –0·07) among those with autism spectrum disorder. Cannabinoids led to an increase in cocaine craving among those with cocaine use disorder (0·69, 0·22 to 1·15) compared with placebo. There were no significant effects on outcomes associated with anxiety, anorexia nervosa, psychotic disorders, post-traumatic stress disorder, and opioid use disorder. There were insufficient data to meta-analyse studies of ADHD, bipolar disorder, obsessive-compulsive disorder, and tobacco use disorder. There was an absence of RCT evidence for the treatment of depression. Meta-analysis revealed higher odds of all-cause adverse events (OR 1·75, 95% CI 1·25 to 2·46) among those using cannabis versus control group (NNTH=7) but no higher odds of serious adverse events or study withdrawal.
Interpretation: There was some evidence that cannabinoids can reduce symptoms of cannabis use disorder, insomnia, tic or Tourette’s syndrome, and autism spectrum disorder, but the quality of this evidence was generally low. Cannabinoids were associated with a greater risk of any adverse events but not of serious adverse events. Overall, there is a crucial need for more high-quality research. Given the scarcity of evidence, the routine use of cannabinoids for the treatment of mental disorders and SUDs is currently rarely justified.
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Journal: Lancet Regional Health. Americas, 2026, doi: 10.1016/j.lana.2026.101435
Authors: Nisha Nataraj, Yijie Chen, Andrea Stewart, S. Michaela Rikard, Kun Zhang, Ketra Rice, … Jan L. Losby
Abstract:
Background: Despite recent declines in fatal overdoses in the United States, the overdose crisis remains a persistent public health challenge. We modeled hypothetical scenarios of short-term increases or decreases in opioid-involved overdose rates among individuals with opioid use disorder (OUD) and estimated overdose-related outcomes, costs, and prevention efforts to counteract potential increases in fatal overdoses.
Methods: We updated a previously validated simulation model of the US population with OUD using 2021–2024 data. Fatal and nonfatal overdoses, individuals with OUD and in remission, and estimated economic costs were projected between 2025 and 2028 under baseline conditions and hypothetical scenarios assuming annual 5% increases or decreases in fatal overdose rates. We quantified prevention efforts to counteract increases in overdose across four prevention strategies aimed at improving access to medications for OUD (MOUD) and reducing fatal overdose.
Findings: The baseline scenario estimated 97,000 fatal and 3.4 million nonfatal opioid-involved overdoses among individuals with OUD, and an economic burden of $3.94 trillion between 2025 and 2028. Assuming decreased fatal overdose rates, we estimated 14.1% fewer fatal overdoses, and $202 billion in reduced economic burden. Conversely, assuming fatal overdose rates increased, we estimated an additional 16.5% fatal overdoses and $236 billion in economic burden. Model simulations estimated increasing annual MOUD initiation to 62.6% and naloxone administration to 14.2% could independently prevent additional lives lost.
Interpretation: The economic burden of overdose and OUD highlights the importance of continued investments in overdose prevention. Increased prevention efforts, such as naloxone use and increased MOUD initiation, could help counteract potential increases in fatal overdose rates.
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Journal: Drug and Alcohol Dependence, 2026, doi.org/10.1016/j.drugalcdep 2026 .113121
Authors: Jessica M. Mongilio, Luisa Kcomt, & Rebecca J. Evans-Polce
Abstract:
Purpose: The present study examines an underutilized measure of electronic nicotine delivery system (ENDS) use quantity—the number of puffs taken per day (PPD)—and its associations with sociodemographic characteristics, device characteristics, and other tobacco/nicotine use behaviors.
Methods: The U.S. nationally representative Population Assessment of Tobacco and Health Study Wave 7 (2022–23) data were used. The sample was restricted to adolescents and young adults (AYAs; aged 12–30) who reported past-month ENDS use (N = 2606). Using linear regression models, differences by device characteristics (product type and flavor), nicotine use behaviors (other tobacco/nicotine use, nicotine dependence), and sociodemographics (age, sex, race, ethnicity) were examined as predictors of the average number of PPD. Predictors were examined for the full sample and stratified by age (12–20 and 21–20).
Results: AYAs reported picking up their ENDS device 26.1 times per day and took 3.9 puffs each time they picked up the ENDS device. The mean number of PPD was 66.9. Greater nicotine dependence (b=32.66; 95% CI=[20.48,35.84]) and use of a tank system (vs disposable devices; b=20.53, 95% CI=[7.39,33.67]) were associated with greater PPD. Average PPD did not vary by legal sales age or sex.
Conclusions: On average, AYAs picked up their ENDS device more than once per hour each day and took multiple puffs each time. No differences were observed by sociodemographic characteristics. Other nicotine use behaviors are associated with more PPD among AYAs.
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