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Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based intervention to evaluate alcohol misuse. Researchers used a large data set to assess utilization of each step in the care cascade unconditional on the previous step. Overall, 16% of individuals reported past-year heavy alcohol use and 11% met criteria for alcohol use disorder (AUD). Among those reporting past-year health care utilization, 69% reported being screened, with those aged 50 years or older and non-White individuals being less likely to be screened. Overall, 8.4% of individuals received BI, and less than 4% of those reporting heavy alcohol use received BI. Among those meeting criteria for AUD only 7% were referred to treatment, while 8% reported treatment in the last year. Women were less likely to receive BI and referral for treatment. The authors note these data highlight the need to better implement SBIRT, addressing gaps and differences in access to the care cascade.

Researchers used national emergency medical service (EMS) data to examine temporal changes in nonfatal overdoses and naloxone administrations by EMS clinicians and laypersons relative to the national peak in overdose deaths. EMS-documented nonfatal overdose activations and naloxone administrations declined sharply after May 2023, coinciding with the national decline in opioid overdose mortality. Total naloxone administrations per overdose remained stable, while layperson-administered naloxone administrations per overdose declined. These findings extend prior research on overdose mortality and suggest that recent declines in overdose deaths may, in part, reflect fewer incident overdose events. Identifying the factors contributing to reduced overdose incidence—whether disruptions to illicit opioid supply; changes in the size or behavior of the population at risk; shifts from drug injection to smoking, treatment, and harm reduction expansion; or some combination—remains important for informing ongoing medical and public health responses.

This survey study of 2,009 participants drawn from the RAND American Life Panel assessed awareness of medications for AUD (MAUD) and OUD (MOUD), as well as perceived appropriateness of MAUD. Two-thirds of participants were unaware of MAUD; more participants were aware of MOUD (49.2%) than MAUD (33.5%). Of the participants, 66.5% stated it was appropriate to use MAUD as part of treatment while 16.4% said it was inappropriate. The most common concerns about MAUD were adverse events or safety, the view that unhealthy alcohol use should be handled without medication, and a preference for counseling or support groups.

Researchers used hospital discharge data from 1,297,847 hospitalizations for drug overdose from 2016 to 2025. Of the total, 35% had a diagnosis of acute kidney injury (AKI). AKI could result from ischemia, rhabdomyolysis (33% of patients hospitalized with cocaine), or nephrotoxicity of the substance used. Diagnosis of AKI was lower among females (29%) than males (38%, p<.001). Of those with AKI, 61% had a severe hospital course, with a higher proportion among those less than 24 years (68%) than those over 65 years (56%, p<.001). This higher incidence in younger patients is concerning because they have more years of life in which to develop chronic kidney disease and kidney failure. The authors call for monitoring for AKI after drug overdose and follow-up kidney care post discharge.

This study examined risk factors for adolescent cannabis use. Surveys were completed by 829 students in 3 schools in Lubeck, Germany. Cannabis use increased steadily with age from 1% at age 13 to 39% at age 18. Social media influenced cannabis use. Instagram use had a strong effect (OR=4.3, p=.003); TikTok use had a weaker effect (OR=2.1, p=.03). Students enrolled in the academic track (college bound) had less cannabis use compared to the comprehensive track (non-selective) (OR=0.47, p=.004). Exposure to parental smoking and digital nicotine advertising increased odds of cannabis use. The strongest effect was found for perceived health risk of cannabis compared to cigarettes, with those rating cannabis "much healthier than cigarettes" having much higher odds of cannabis use (OR=23, p=.001). The authors suggest prevention research should focus on risk perception and digital platform use.

Massachusetts mandated certain jails offer all medications for opioid use disorder (MOUD) as part of a pilot test, and in this article researchers present some of the lessons learned. Notably, patients and staff recommended universal provision of MOUD at intake for all individuals with OUD. The authors note the importance of jail leadership in mobilizing staff and altering negative perceptions of MOUD as well as importance of partnerships with external agencies and providers. Concerns about MOUD diversion have been a cited concern about MOUD implementation in jails, but the authors note this appeared to be less likely when prescribed MOUD was easily accessible. Other important factors were re-entry planning and assessment of post-release environment risk, including availability of the MOUD provided while incarcerated.

This nationwide prospective observational cohort study examined the association between sleep disturbance and long-term opioid therapy (LTOT) for individuals with chronic low back pain (CLBP). A total of 81 adults (ages 21-75) with CLBP receiving LTOT were enrolled and completed ecological momentary assessment and overnight actigraphy monitoring. The primary outcome was wake after sleep onset (WASO); morning and nocturnal opioid cravings were also measured, as well as pain severity. Greater perceived WASO was associated with higher nocturnal opioid craving; pain severity was a strong predictor of nocturnal and morning cravings and moderated the association between WASO and opioid dose.

This cross-sectional, dual-centre diffusion MRI study compared white-matter microstructure in 87 individuals with cannabis (n=48), opioid (n=16), or nicotine dependence (n=23) and 53 nonsmoking healthy controls, examining associations with impulsive decision-making and substance use severity. Cannabis and opioid dependence exhibited overlapping, widespread reductions in fractional anisotropy and increases in mean diffusivity and orientation dispersion across frontotemporoparietal and limbic pathways, whereas nicotine dependence showed more circumscribed alterations, primarily in mean diffusivity within anterior and callosal regions. In cannabis dependence, greater orientation dispersion in the middle longitudinal fasciculus was associated with steeper delay discounting, with moderated mediation analyses identifying a significant indirect association through cannabis consumption only among daily users; no significant corresponding association was observed in opioid dependence.