Journal: Journal of Family Psychology, 2026, doi: 10.1037/fam0001473
Authors: Jenny Meyer, José Szapocznik, Uzochukwu Imo, James Dziura, Lynn Fiellin, & Kammarauche Aneni
Abstract:
Adolescents with better family functioning and higher opioid risk perception are at lower risk for opioid misuse. However, studies examining the association between family functioning and opioid risk perception are lacking. We conducted an exploratory cross-sectional analysis of baseline data from a randomized controlled trial with adolescents aged 16-19 (n = 262) in high schools in Connecticut from 2022 to 2024. Bivariate and multivariable logistic regression models tested the association between family functioning and opioid misuse risk perception. Using principal component analysis, a family functioning score was derived from eight variables: cohesion, conflict, open and problematic communication, connectedness, parental monitoring, parenting practices, and family support. Higher scores indicated better family functioning. Perception of risk of harm from opioid misuse was assessed using eight items. Seventeen percent (44/262) of adolescents reported great risk from opioid misuse. The median family functioning score among adolescents perceiving great risk was 1.07 (interquartile range = 2.75), while the median score among those not perceiving great risk was 0.11 (interquartile range = 2.62; χ² = 7.27, p < .01). After adjusting for covariates, adolescents had 35% higher odds of reporting great risk of harm from opioids for every 0.5-unit increase in the family functioning score (adjusted odds ratio = 1.35, 95% CI [1.09, 1.67]). Adolescents in the top tertile of family functioning had more than 300% higher odds of reporting great risk compared to those in the lowest tertile (adjusted odds ratio = 4.26, 95% CI [1.53, 11.92]). Findings suggest that family functioning is associated with perceiving great risk of harm from opioids. Future studies are needed to uncover potential mediating/moderating factors that explain this association.
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Journal: Frontiers in Psychiatry, 2026, doi: 10.3389/fpsyt.2026.1741907
Author: Nicholas M. Graziane
Abstract:
Background: Harm reduction strategies for opioid use disorder (OUD) emphasize pragmatic, evidence-based approaches that reduce overdose risk, relapse, and other adverse outcomes without requiring abstinence. Medication for opioid use disorder (MOUD) and structured psychotherapy represent core harm-reduction modalities, yet their real-world comparative effectiveness, alone and in combination, remains underexplored at scale.
Methods: A retrospective cohort study was conducted using the TriNetX Research Network, comprising de-identified electronic health records from 112 U.S. health systems. 18,047 adults aged 18-45 were identified with a diagnosis of opioid dependence (ICD-10 F11.20) between 2016 and 2025. Subjects were assigned to eight mutually exclusive treatment cohorts: no treatment (Cohort 1); buprenorphine alone (Cohort 2); methadone alone (Cohort 3); psychotherapy alone (30 minutes (Cohort 4), 45 minutes (Cohort 5), or 60 minutes (Cohort 6)); buprenorphine + psychotherapy (Cohort 7); and methadone + psychotherapy (Cohort 8), with combination treatments defined within a ±30-day window. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) for remission (F11.21, F11.11) within 12 months.
Results: Buprenorphine (aHR = 2.33; 95% CI: 1.85-2.94), methadone (aHR = 2.50; 95% CI: 2.05-3.04), and psychotherapy (30 min: aHR = 2.18; 45 min: aHR = 2.38) were each independently associated with significantly higher remission compared to no treatment. The combination of buprenorphine + psychotherapy yielded the strongest effect (aHR = 5.26; 95% CI: 2.68-10.32). Anxiety diagnoses and gabapentinoid prescriptions were positively associated with remission; benzodiazepine co-prescription was negatively associated.
Conclusions: In this first national-scale, multi-health-care-organization analysis, both pharmacologic and psychosocial harm-reduction interventions were independently associated with improved OUD remission, with additive benefit when integrated. These findings underscore the value of embedding comprehensive, multimodal harm-reduction services within routine care and support policies promoting equitable access to both MOUD and behavioral health supports across diverse health systems.
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Journal: Injury Epidemiology, 2026, doi: 10.1186/s40621-026-00687-0
Authors: John Beckerle, Vlada Stark, & Bertille Assoumou
Abstract:
Background: Traumatic injury remains a leading cause of morbidity and mortality in the United States, with substance use and social determinants of health playing important roles in injury risk and clinical outcomes. People experiencing homelessness are disproportionately exposed to trauma and are screened for alcohol and drugs at higher rates than housed patients, raising questions about whether differences in substance positivity reflect true variation in exposure or disparities in screening practices. This study examines patterns of alcohol and drug screening and positivity among housed and unhoused trauma patients.
Methods: We conducted a retrospective cross-sectional analysis of adult trauma patients included in the 2021 National Trauma Data Bank. Alcohol and drug screening within the first 24 h of hospital encounter were examined, along with screening results and the presence of multiple concurrent drug positives. Homelessness was the primary exposure of interest. Multivariable logistic regression models were used to assess the association between housing status and screening practices as well as positive alcohol, drug, and polydrug results, adjusting for age, sex, race, ethnicity, injury severity, Glasgow Coma Scale score, physical and behavioral comorbidities.
Results: Among 1,000,269 adult trauma patients, 9,466 (0.9%) were unhoused. Unhoused patients were significantly more likely to be screened for alcohol and drugs than housed patients. After adjustment, homelessness remained the strongest predictor of screening for both alcohol and drugs. Among those screened, homelessness was associated with markedly higher odds of positive drug and polydrug results. The association with positive blood alcohol concentration was modest despite substantially higher screening rates. Injury severity and lower Glasgow Coma Scale scores were also associated with increased screening and positivity.
Conclusions: Unhoused trauma patients experience substantially higher rates of alcohol and drug screening and higher odds of drug and polysubstance positivity compared with housed patients. These findings suggest that housing status strongly shapes diagnostic practices in trauma care and may influence the interpretation of substance use epidemiology. Standardized, non-stigmatizing screening approaches that are paired with appropriate clinical and social interventions are needed to ensure equitable trauma care.
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Journal: Addiction Behaviors Reports, 2026, doi: 10.1016/j.abrep.2026.100706
Authors: Abubakar Ibrahim Elbur, Bow Suprasert, Ali Mirzazadeh, Erin C. Wilson, & Willi McFarland
Abstract:
Background: Injection drug use (IDU) is a major public health concern linked to HIV and hepatitis C infections, overdose deaths, and other adverse health and social welfare outcomes. We examined the role of self-reported painkiller dependence in shaping the timing and progression of IDU initiation.
Methods: Data are from the National HIV Behavioral Surveillance (NHBS) survey conducted in San Francisco in 2022. Cumulative IDU initiation patterns were analyzed, stratified by prior painkiller dependence and other background characteristics using survival analysis. The chi-square was used to examine differences in age at first injection and related characteristics.
Results: Of 519 people who inject drugs (PWID) surveyed, 23.3% reported initiating IDU before the age of 18 years and 35.3% reported being hooked on painkillers before initiating IDU. Early IDU initiation was also associated with bisexual sexual orientation, lower educational attainment, younger age, and starting injection before 1990. Participants hooked on painkillers showed earlier and faster progression to injection drug use, with 50% initiating by age 40 compared to after age 50 among those not previously hooked (P < 0.001). By race/ethnicity, divergence in age at initiating IDU was evident after the late 20s and early 30s, with Black PWID having a later and slower onset of IDU compared to other groups (P < 0.001).
Conclusions: We found a strong continuing association between prior self-reported painkiller dependence and earlier progression to IDU. These findings underscore the critical need for comprehensive public health interventions that address the root causes of opioid misuse and effectively target the transitions contributing to IDU.
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Journal: Translational Psychiatry, 2026, doi: 10.1038/s41398-026-04096-1
Authors: Barbara Schilling, Baptiste Pasquier, Martine Elbejjani, Jared Reis, Jamal S. Rana, Kali Tal, Lenore J. Launer, … Julian Jakob
Abstract:
Cannabis was previously associated with worse memory function in men but not in women. As the hippocampus is crucial in the formation and retrieval of memory, we studied if cumulative exposure to cannabis is associated with differences in the hippocampal tissue volume, fractional anisotropy (FA) and cerebral brain perfusion (CBF) by MRI, overall and by sex, stratified by ever tobacco smoking, in multivariable adjusted linear regression models in both sexes. We included participants of the CARDIA cohort, followed since 1985, with cannabis assessed during each follow up. Categories of self-reported cumulative exposure were never, <0.5, 0.5-<2, and >2 cannabis-years, where 1 cannabis-year=365 days of use. We included 648 participants: 52% were women; mean age was 55 years, 86% reported ever using cannabis and 48% ever smoking tobacco. There was no difference in mean hippocampal volume according to greater cumulative use of cannabis. The coefficient of hippocampal volume in participants never smoking tobacco reporting >2 cannabis-years was -37.99mm3 (95% CI -201.08-125.09) compared to never users. There was no significant difference when stratifying by sex or ever tobacco exposure, or for FA or CBF. Cumulative cannabis exposure over 30 years was not associated with hippocampal volume, integrity or blood flow in middle age. The differences in memory function in cannabis users are likely not attributable to the hippocampus only. Future studies should assess further neuronal mechanisms and social determinants associated with cognition in cannabis users.
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