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JAMA Network Open

This cohort study assessed 10,110 US veterans with homeless experience and opioid use disorder (OUD) residing in permanent supportive housing (PSH), with respect to factors associated with receipt of medications for opioid use disorder (MOUD). Only 17% received MOUD within 12 months. Greater behavioral health engagement was associated with MOUD receipt, while older age, race minority status, and prior inpatient hospitalization were associated with lower odds. These results suggest MOUD access in supportive housing should be expanding, which could require embedding addiction care into PSH teams, leveraging behavioral health touchpoints, and addressing persistent disparities.

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Harm Reduction Journal

Researchers conducted qualitative research to better understand transitions from initial drug use, non-prescribed opioid use, and injection drug use in rural areas. First exposure to drugs often occurred in childhood in the household environment, with the most common initial drug used being marijuana (60%). A combination of drug availability, normalization of use, and use as a means of coping were common themes for initial use. Initial opioid use was most commonly pill form (74%) and was commonly prescribed (44%). Transition to illicit opioid use was often related to regulations and decreased access to prescribed opioids. The most common substances first injected were methamphetamines (26%), opioid pills (22%), and heroin (22%). The study highlights the need for early intervention strategies and increased access to mental health care, particularly in rural areas.

Annals of Internal Medicine

This retrospective cohort study of veterans hospitalized with a primary diagnosis of alcohol use disorder (AUD) in 2022 or 2023 sought to describe patterns and factors associated with hospital initiation of medications for alcohol use disorder (MAUDs). Within the Veterans Health Administration (VHA), 30% of hospitalizations for AUD resulted in MAUD initiation as an inpatient or within seven days of discharge, with substantial variation across hospitals and patient demographic and clinical factors. These data indicate a need to identify and disseminate successful hospital-based strategies to increase prescribing of MAUD.

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General Hospital Psychiatry

Ketamine hepatotoxicity, and cases of liver failure requiring transplantation, have been reported with the high cumulative doses seen in chronic therapy or recreational use. The degree of risk associated with the lower doses used in treatment of psychiatric disorders is unclear. This systematic review identified 13 studies, including five RCTs, of ketamine use for psychiatric disorders and liver outcomes. The RCTs totaled 879 cases, 75 of which had elevated liver enzymes, mostly mild. In all the detailed case reports, enzymes normalized after discontinuing ketamine. Impairment of liver function was much less common. The authors conclude that the low doses of ketamine used for psychiatric disorders can produce liver enzyme elevation, but significant liver injury is rare; however, they advise liver monitoring during ketamine therapy.

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JAMA Network Open

This within-participant, double-blind, double-dummy crossover study sought to evaluate the individual and interactive effects of cannabis edibles and alcohol on simulated driving and impairment measures. A total of 25 healthy adults with a history of recent binge drinking and prior cannabis and alcohol co-use were given either placebo, alcohol alone, cannabis alone, or cannabis and alcohol combined. Driving impairment from alcohol alone at 0.08% breath alcohol concentration (BrAC) was similar to that of 0.05% BrAC and 10 mg THC, highlighting increased impairment at lower BrAC for individuals who also used cannabis. Cannabis alone at a dose of 25 mg THC resulted in similar driving impairment to 0.08% BrAC; however, impairment was not reliably picked up on standardized field sobriety tests for those who used cannabis alone.

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Drug and Alcohol Dependence

This study examined how police stop-and-search was associated with nonfatal overdose among people who use drugs in Kentucky. A total of 774 people who use drugs were enrolled in the Social Networks of Appalachian People and the Kentucky Outreach Service Kiosk studies from May 2023 to April 2024. The study population was 99% non-Hispanic white, 52% female, and 45% with both opioid and methamphetamine use. Of the study participants, 37% reported being stopped and searched, and 17% reported a nonfatal overdose during the study period. Individuals who were stopped and searched by police at least four times in the last six months had an increased likelihood of nonfatal overdose (AOR 3.19, 95% CI: 1.60–6.32).

The New England Journal of Medicine

This perspective piece notes that GLP-1 drugs have become lifestyle drugs used to achieve slimness by people without FDA-approved indications. In 2018, 4.5% of GLP-1 prescriptions were for people without type II diabetes or excessive weight, increasing to 17% in 2023. In addition, some online vendors supply GLP-1 with little meaningful medical oversight. The author raises concern that GLP-1 drugs could exacerbate restrictive eating disorders such as anorexia nervosa. Anorexia nervosa has a lifetime prevalence of 6.3% in women (0.3% in men) and carries a mortality risk five times that of the general population. With an estimated 33 million people in the US taking GLP-1 drugs there is the potential for a dramatic increase in anorexia nervosa. The author advises eating disorder screening before prescribing GLP-1s and monitoring for disordered eating during treatment.