2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T8d6,Clinicians have little guidance on the ideal length of time patients should remain on medication treatment for opioid use disorder (MOUD) before being able to safely discontinue MOUD. This study estimated how the risk of all-cause mortality changes with the duration of MOUD, controlling for patient characteristics that change the risk profile independent of duration of therapy. Retrospective cohort study using electronic health record data from the US Veterans Healthcare Administration. Veterans initiating MOUD with buprenorphine, methadone or extended-release naltrexone from October 2010 to September 2020. Our analytic sample included 19 666 buprenorphine initiators, 8675 methadone initiators and 4007 extended-release naltrexone initiators. Duration of MOUD was measured in days. Discontinuation was defined as a gap in any MOUD coverage exceeding 28 days, regardless of MOUD type initiated. The primary outcome was all-cause mortality. We estimated multistate survival models allowing for the modeling of multiple states (i.e. on and off MOUD, death) without having to consider censoring or competing events, while adjusting for sociodemographic, clinical, prescription and facility and provider characteristics. We observed approximately 226 000 person-years of time at risk for discontinuation or pre-discontinuation death, during which we observed 26 841 discontinuations (118.9 discontinuations per 1000 person-years). We similarly observed a total of about 106 000 person-years of post-discontinuation follow-up, during which we observed 3251 deaths (3.1 deaths per 1000 person-years). We found the largest marginal gain in probability of 6-year survival from an additional year on MOUD appears to occur around 2 years, as compared to 6 months on MOUD. Statistically significant gains continued through approximately 4-5 years of MOUD retention relative to 6-month MOUD retention. After 4-5 years, the marginal gain from one additional year of MOUD was not statistically significant. Among US veterans, the benefit of retention on medication treatment for opioid use disorder (MOUD) towards overall survival continues through at least 4 years of MOUD treatment. Quality metrics based on 6-month MOUD retention may be insufficient.31:Tc2f,Abstract Background and aims Clinicians have little guidance on the ideal length of time patients should remain on medication treatment for opioid use disorder (MOUD) before being able to safely discontinue MOUD. This study estimated how the risk of all‐cause mortality changes with the duration of MOUD, controlling for patient characteristics that change the risk profile independent of duration of therapy. Design, setting and participants Retrospective cohort study using electronic health record data from the US Veterans Healthcare Administration. Veterans initiating MOUD with buprenorphine, methadone or extended‐release naltrexone from October 2010 to September 2020. Our analytic sample included 19 666 buprenorphine initiators, 8675 methadone initiators and 4007 extended‐release naltrexone initiators. Measurement Duration of MOUD was measured in days. Discontinuation was defined as a gap in any MOUD coverage exceeding 28 days, regardless of MOUD type initiated. The primary outcome was all‐cause mortality. We estimated multistate survival models allowing for the modeling of multiple states (i.e. on and off MOUD, death) without having to consider censoring or competing events, while adjusting for sociodemographic, clinical, prescription and facility and provider characteristics. Findings We observed approximately 226 000 person‐years of time at risk for discontinuation or pre‐discontinuation death, during which we observed 26 841 discontinuations (118.9 discontinuations per 1000 person‐years). We similarly observed a total of about 106 000 person‐years of post‐discontinuation follow‐up, during which we observed 3251 deaths (3.1 deaths per 1000 person‐years). We found the largest marginal gain in probability of 6‐year survival from an additional year on MOUD appears to occur around 2 years, as compared to 6 months on MOUD. Statistically significant gains continued through approximately 4–5 years of MOUD retention relative to 6‐month MOUD retention. After 4–5 years, the marginal gain from one additional year of MOUD was not statistically significant. Conclusions Among US veterans, the benefit of retention on medication treatment for opioid use disorder (MOUD) towards overall survival continues through at least 4 years of MOUD treatment. Quality metrics based on 6‐month MOUD retention may be insufficient. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Opioid Antagonist: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Opioid Antagonist (modality). Clinician-written summaries and actionable practice insights. 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ECG-to-intervention delays were notable for hyperkalemia (111 min to calcium) and MI (76 min to aspirin) despite ECG changes, while opioid overdose had near-immediate response (1 min to naloxone).","limitations":"Single-centre quality improvement design at two affiliated academic EDs limits generalizability. Retrospective chart review is subject to documentation bias. No control group or pre/post intervention comparison was performed.","practice_takeaway":"Treat secondary bradycardia as a high-acuity emergency — it carries ~5× the mortality of primary bradycardia. Prioritize rapid calcium administration in hyperkalemia and early warming in sepsis-related hypothermia, as ECG-to-intervention times for these conditions lagged well behind opioid overdose and intracranial emergencies."}},{"doi":"10.1001/jama.2026.12038","pmid":"42406571","title":"Alcohol-Related Liver Disease","journal_title":"JAMA","journal_issn":"0098-7484","published_at":"2026-07-06T00:00:00.000Z","url":"https://doi.org/10.1001/jama.2026.12038","source_score":70,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-11T13:32:53.597Z","updated_at":"2026-07-11T13:32:53.597Z","tags":[{"paper_doi":"10.1001/jama.2026.12038","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"category","value":"Medicine, General & Internal","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"condition","value":"Alcohol-Associated Hepatitis","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"condition","value":"Alcohol-Related Liver Disease","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"condition","value":"Hepatocellular Carcinoma","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"condition","value":"Liver Cirrhosis","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"condition","value":"Portal Hypertension","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"generic","value":"baclofen","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"generic","value":"naltrexone","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"modality","value":"Cognitive Behavioral Therapy","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"modality","value":"GABA-B Agonist","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"modality","value":"Liver Transplantation","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"modality","value":"Motivational Enhancement Therapy","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"modality","value":"Noninvasive Fibrosis Testing","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"modality","value":"Opioid Antagonist","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"warning","value":"Specific thresholds for alcohol consumption risk (20 g/day women, 30 g/day men) are presented as guidelines; individual risk may vary based on genetic and metabolic factors noted in the paper.","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"warning","value":"The impact_flag 'practice_changing' reflects the review's consolidation of transplant and noninvasive testing recommendations, but the underlying evidence base varies in quality across individual recommendations.","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"warning","value":"This is a narrative review, not a systematic review or RCT — the abstinence-mortality association cited is from an observational cohort embedded in the review, not a primary trial result.","value_numeric":null}],"summaries":{"what_studied":"This JAMA review covers the epidemiology, diagnosis, risk factors, and management of alcohol-related liver disease (ALD), including alcohol-associated hepatitis and cirrhosis, with emphasis on noninvasive fibrosis testing and alcohol cessation strategies.","key_result":"Sustained alcohol abstinence in patients with alcohol-related cirrhosis was associated with significantly reduced liver-related mortality (aHR 0.43, 95% CI 0.26–0.70) and all-cause mortality (aHR 0.45, 95% CI 0.30–0.67) over a median 36-month follow-up. ALD-related mortality in the US nearly doubled from 6.7 to 12.5 deaths per 100,000 people between 1999 and 2022.","limitations":"This is a narrative review, not a systematic review or meta-analysis, so findings reflect curated evidence rather than pooled analysis. Mortality statistics are population-level and may not capture subgroup heterogeneity. Alcohol consumption data rely partly on self-report, which is known to be underreported.","practice_takeaway":"Screen patients with chronic daily heavy alcohol use (>20 g/day in women, >30 g/day in men) for ALD using noninvasive tools like Fibrosis-4 score and transient elastography. Prioritize alcohol cessation — with motivational therapy, CBT, or pharmacotherapy (baclofen, naltrexone) — and refer patients with severe alcohol-associated hepatitis or decompensated cirrhosis for liver transplant evaluation."}},{"doi":"10.1002/ejp.70321","pmid":"42385209","title":"Efficacy of Low‐Dose Naltrexone in Women With Fibromyalgia Syndrome: A 12‐Month Randomised, Double‐Blind, Placebo‐Controlled Single‐Centre Clinical Trial (\n INNOVA\n Study)","journal_title":"European Journal of Pain","journal_issn":"1090-3801","published_at":"2026-07-01T00:00:00.000Z","url":"https://doi.org/10.1002/ejp.70321","source_score":16,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-06T13:36:08.798Z","updated_at":"2026-07-06T13:36:08.798Z","tags":[{"paper_doi":"10.1002/ejp.70321","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1002/ejp.70321","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1002/ejp.70321","tag_type":"condition","value":"Chronic Pain","value_numeric":null},{"paper_doi":"10.1002/ejp.70321","tag_type":"condition","value":"Fibromyalgia Syndrome","value_numeric":null},{"paper_doi":"10.1002/ejp.70321","tag_type":"generic","value":"naltrexone","value_numeric":null},{"paper_doi":"10.1002/ejp.70321","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1002/ejp.70321","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1002/ejp.70321","tag_type":"modality","value":"Opioid Antagonist","value_numeric":null},{"paper_doi":"10.1002/ejp.70321","tag_type":"sample_size","value":"n=96","value_numeric":96},{"paper_doi":"10.1002/ejp.70321","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1002/ejp.70321","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1002/ejp.70321","tag_type":"warning","value":"Perceived treatment allocation was assessed only at 12 months; early blinding integrity cannot be evaluated.","value_numeric":null},{"paper_doi":"10.1002/ejp.70321","tag_type":"warning","value":"Race/ethnicity data were not collected, limiting demographic characterization of the sample.","value_numeric":null},{"paper_doi":"10.1002/ejp.70321","tag_type":"warning","value":"Study was single-centre and enrolled only women aged 18–70, limiting generalizability to men and broader age ranges.","value_numeric":null},{"paper_doi":"10.1002/ejp.70321","tag_type":"warning","value":"The ITT population was 96, not 98 as randomized (2 excluded post-randomization for not meeting inclusion criteria); the safety population was 98.","value_numeric":null}],"summaries":{"what_studied":"The INNOVA RCT compared LDN 4.5 mg/day to placebo as add-on therapy in 96 women with fibromyalgia (FMS) over 12 months, with the primary outcome being change in NRS pain intensity at 3 months (ITT population); secondary outcomes included functional impairment (FIQR), mood, cognition, disability, and global impression of change at 3, 6, and 12 months.","key_result":"LDN did not outperform placebo at any time point: the adjusted between-group difference in NRS pain at 3 months was 0.49 points in favor of placebo (p=0.236, d=0.19), and differences remained non-significant at 6 and 12 months; responder rates were low and similar across all thresholds (e.g., ≥30% pain reduction: LDN 10.6% vs. placebo 18.4%), with no serious treatment-related adverse events in either arm.","limitations":"- Sample was smaller than planned (n=96 vs. 100) due to logistical constraints, slightly reducing statistical power, though CIs were centered near zero suggesting no meaningful effect.\n- Single fixed dose (4.5 mg) precluded dose-response evaluation, and no objective pain measures were included.\n- All-female, single-centre Spanish sample limits generalizability to men and other settings.","practice_takeaway":"LDN 4.5 mg/day does not reduce pain or improve function meaningfully compared to placebo in women with FMS over 12 months—current evidence does not support its routine use for this indication. Clinicians should focus on multimodal, evidence-based strategies rather than off-label LDN for FMS."}},{"doi":"10.1097/pec.0000000000003640","pmid":"42299025","title":"Improving Naloxone and Buprenorphine Provision in the Pediatric Emergency Department Through Education and Chief Complaint-Triggered Screening","journal_title":"Pediatric Emergency Care","journal_issn":"0749-5161","published_at":"2026-06-16T00:00:00.000Z","url":"https://doi.org/10.1097/pec.0000000000003640","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-20T13:24:59.796Z","updated_at":"2026-06-20T13:24:59.796Z","tags":[{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"age_group","value":"adolescent","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"condition","value":"Opioid Overdose","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"condition","value":"Opioid Use Disorder","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"generic","value":"buprenorphine","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"generic","value":"naloxone","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"modality","value":"Opioid Antagonist","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"modality","value":"Partial Opioid Agonist","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"sample_size","value":"n=309","value_numeric":309},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"warning","value":"Sample size of 309 reflects medication recipients only, not total encounters analyzed over 45 months; the denominator for all PED visits is not reported in the abstract.","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"warning","value":"Study design is labeled QI (quality improvement), which lacks a concurrent control group; pre-post comparisons may be subject to secular trend bias.","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"warning","value":"The full text was not accessible — only the abstract was available for extraction. Statistical significance, confidence intervals, and detailed demographic breakdowns could not be verified.","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"warning","value":"The 'practice_changing' impact flag is applied cautiously given the single-site, non-randomized design, but the intervention represents a scalable, EHR-integrated model with clear outcome improvements.","value_numeric":null}],"summaries":{"practice_takeaway":"Embedding chief complaint–triggered electronic alerts with provider education in a PED can meaningfully raise naloxone and buprenorphine provision for at-risk adolescents without driving more return visits. EDs caring for adolescents should consider implementing similar BPA-driven OUD screening pathways.","what_studied":"This quality improvement (QI) initiative evaluated whether electronic Best Practice Alerts (BPAs) triggered by specific chief complaints — combined with provider education, formulary changes, and clinical pathways — could increase naloxone dispensing and buprenorphine prescribing for adolescents with opioid use disorder (OUD) in a pediatric emergency department (PED) over a 45-month period.","key_result":"Among patients with BPA-qualifying chief complaints, naloxone dispensing rose from 3.89% to 11.39% and buprenorphine prescribing rose from 1.04% to 2.46% post-implementation; overall naloxone prescribing across all PED visits increased from 0.40% to 0.79%. In total, 63 adolescents initiated buprenorphine and 246 received naloxone. Black/African American adolescents and those with government insurance received more medications post-implementation. BPA-triggered encounters had longer ED stays but no increase in return visits.","limitations":"Single-site QI study limits generalizability. The full-text was not accessible for review — findings are drawn from the abstract alone, so confounders and statistical significance details are unavailable. Absolute prescribing rates remain low even post-intervention, suggesting substantial room for improvement."}},{"doi":"10.1080/10903127.2026.2673361","pmid":"42149954","title":"Prehospital Outcomes Associated with an Initial Strategy of Intranasal versus Intramuscular Naloxone Administration by EMS Clinicians: A Nationwide Cohort Study","journal_title":"Prehospital Emergency Care","journal_issn":"1090-3127","published_at":"2026-06-03T00:00:00.000Z","url":"https://doi.org/10.1080/10903127.2026.2673361","source_score":10,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-13T15:34:50.188Z","updated_at":"2026-06-13T15:34:50.188Z","tags":[{"paper_doi":"10.1080/10903127.2026.2673361","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2673361","tag_type":"brand","value":"Narcan","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2673361","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2673361","tag_type":"condition","value":"Opioid Overdose","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2673361","tag_type":"generic","value":"naloxone","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2673361","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2673361","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2673361","tag_type":"modality","value":"Opioid Antagonist","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2673361","tag_type":"sample_size","value":"n=16550","value_numeric":16550},{"paper_doi":"10.1080/10903127.2026.2673361","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2673361","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2673361","tag_type":"warning","value":"Brand tag 'Narcan' is inferred from context; the paper does not specify proprietary formulations used.","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2673361","tag_type":"warning","value":"Naloxone formulation details (e.g., 4 mg vs. 8 mg IN sprays) and exact dose amounts per administration were not reported, limiting dose-response interpretation.","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2673361","tag_type":"warning","value":"Precipitated withdrawal was not directly measured; agitation and nausea/vomiting treatment served as proxies, which may underestimate true withdrawal rates.","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2673361","tag_type":"warning","value":"The 'practice_changing' impact flag is applied cautiously — this is observational data and the result directionally favors IM, but residual confounding (e.g., EMS agency protocols, patient acuity differences) cannot be excluded.","value_numeric":null}],"summaries":{"what_studied":"This nationwide cohort study compared initial intranasal (IN) vs. intramuscular (IM) naloxone administration by EMS in 16,550 adult opioid overdose patients across 1,481 agencies (2023–2024 ESO Data Collaborative), examining physiologic and operational outcomes.","key_result":"Initial IM naloxone was associated with lower odds of needing additional naloxone dosing (aOR 0.39 [0.35–0.44]), lower odds of EMS transport (aOR 0.82 [0.71–0.95]), and higher odds of GCS recovery >12 (aOR 1.15 [1.01–1.30]). IM route showed no increased odds of agitation (aOR 1.06 [0.81–1.39]) or nausea/vomiting (aOR 0.97 [0.80–1.17]) compared to IN.","limitations":"Observational design precludes causal inference. Naloxone dose per administration was not analyzed, and exact formulations (e.g., 4 mg vs. 8 mg IN) are unknown. Precipitated withdrawal was inferred indirectly from treatment for agitation/nausea rather than a validated clinical definition.","practice_takeaway":"EMS clinicians may consider IM over IN as the initial naloxone route for opioid overdose—it required less redosing and achieved better neurologic recovery without increasing signs of precipitated withdrawal. This supports agency-level protocol review favoring IM naloxone administration."}},{"doi":"10.1037/pha0000796","pmid":"40839512","title":"The effects of vaped cannabis on the severity of naloxone-precipitated opioid withdrawal.","journal_title":"Experimental and Clinical Psychopharmacology","journal_issn":"1936-2293","published_at":"2026-06-01T00:00:00.000Z","url":"https://doi.org/10.1037/pha0000796","source_score":19,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-24T13:21:37.278Z","updated_at":"2026-06-24T13:21:37.278Z","tags":[{"paper_doi":"10.1037/pha0000796","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1037/pha0000796","tag_type":"category","value":"Psychiatry","value_numeric":null},{"paper_doi":"10.1037/pha0000796","tag_type":"category","value":"Psychology, Clinical","value_numeric":null},{"paper_doi":"10.1037/pha0000796","tag_type":"condition","value":"Opioid Use Disorder","value_numeric":null},{"paper_doi":"10.1037/pha0000796","tag_type":"condition","value":"Opioid Withdrawal","value_numeric":null},{"paper_doi":"10.1037/pha0000796","tag_type":"generic","value":"cannabis","value_numeric":null},{"paper_doi":"10.1037/pha0000796","tag_type":"generic","value":"morphine","value_numeric":null},{"paper_doi":"10.1037/pha0000796","tag_type":"generic","value":"naloxone","value_numeric":null},{"paper_doi":"10.1037/pha0000796","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1037/pha0000796","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1037/pha0000796","tag_type":"modality","value":"Cannabinoid","value_numeric":null},{"paper_doi":"10.1037/pha0000796","tag_type":"modality","value":"Opioid Antagonist","value_numeric":null},{"paper_doi":"10.1037/pha0000796","tag_type":"sample_size","value":"n=1","value_numeric":1},{"paper_doi":"10.1037/pha0000796","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1037/pha0000796","tag_type":"study_design","value":"Proof-of-Concept Study","value_numeric":null},{"paper_doi":"10.1037/pha0000796","tag_type":"warning","value":"Cannabis was administered by vaping, which may limit comparability to other cannabinoid formulations or delivery routes used in clinical practice.","value_numeric":null},{"paper_doi":"10.1037/pha0000796","tag_type":"warning","value":"Extreme caution warranted: all findings are from a single participant (n=1) who completed testing before a major protocol redesign — no statistical analysis is possible and results are anecdotal at best.","value_numeric":null},{"paper_doi":"10.1037/pha0000796","tag_type":"warning","value":"Study design is ambiguous; labeled here as 'Proof-of-Concept Study' rather than a standard RCT or crossover trial due to the single-subject nature and protocol interruption.","value_numeric":null}],"summaries":{"what_studied":"This proof-of-concept inpatient study tested whether vaporized cannabis pretreatment (12.5 mg or 25.0 mg) could reduce the severity of naloxone-precipitated opioid withdrawal in a single participant with opioid use disorder stabilized on oral morphine (120 mg/day), using the Clinical Opiate Withdrawal Scale (COWS) as the primary outcome.","key_result":"Naloxone alone (4.0 mg intranasal) produced a COWS score of 22 at T+30 min; cannabis pretreatment at 12.5 mg and 25.0 mg reduced COWS scores to 17 and 14, respectively. The naloxone + cannabis combination did not raise heart rate or blood pressure beyond what naloxone alone produced.","limitations":"Only a single participant (n=1) completed testing before a major methodological redesign, making all findings purely hypothesis-generating with no statistical power. Results cannot be generalized beyond this one case.","practice_takeaway":"These very preliminary findings suggest cannabinoids may blunt naloxone-precipitated withdrawal, but clinicians should not change practice based on a single-participant proof-of-concept study — larger controlled trials are needed before any clinical application."}},{"doi":"10.1016/j.annemergmed.2026.03.021","pmid":"42138679","title":"An Emergency Department Nudge-Based Strategy to Screen and Treat Patients With Alcohol Misuse","journal_title":"Annals of Emergency Medicine","journal_issn":"0196-0644","published_at":"2026-05-15T00:00:00.000Z","url":"https://doi.org/10.1016/j.annemergmed.2026.03.021","source_score":26,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-10T14:24:11.609Z","updated_at":"2026-06-10T14:24:11.609Z","tags":[{"paper_doi":"10.1016/j.annemergmed.2026.03.021","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.021","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.021","tag_type":"condition","value":"Alcohol Misuse","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.021","tag_type":"condition","value":"Alcohol Use Disorder","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.021","tag_type":"generic","value":"naltrexone","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.021","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.021","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.021","tag_type":"modality","value":"Clinical Decision Support","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.021","tag_type":"modality","value":"Opioid Antagonist","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.021","tag_type":"sample_size","value":"n=8909","value_numeric":8909},{"paper_doi":"10.1016/j.annemergmed.2026.03.021","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.021","tag_type":"study_design","value":"Quasi-Experimental Study (Difference-in-Differences)","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.021","tag_type":"warning","value":"Absolute prescribing rates remained very low (peak 3.2%), so the clinical impact at a population level may be modest despite statistically significant odds ratios.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.021","tag_type":"warning","value":"Age group tagged as 'adult' by inference from ED context; the paper does not explicitly report age breakdown.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.021","tag_type":"warning","value":"The study design is quasi-experimental with only 2 control hospitals, which limits causal inference; labeled here as a quasi-experimental difference-in-differences study rather than a randomized controlled trial.","value_numeric":null}],"summaries":{"what_studied":"A multicomponent ED intervention — including a discharge order set with clinical decision support (Phase 1) and universal triage-based alcohol screening with EHR banners (Phase 2) — was evaluated across 4 intervention hospitals vs. 2 control hospitals over 43 months to see if it increased naltrexone prescribing at discharge for patients with alcohol-related diagnoses.","key_result":"Naltrexone prescribing at discharge rose from 0.2% (baseline) to 2.7% (Phase 1) and 3.2% (Phase 2) at intervention hospitals, vs. a flat 0.0%–0.3% at controls; the difference-in-difference showed a 2.9% (95% CI 2.4%–3.5%) greater absolute increase at intervention sites, with odds ratios of 12.3 (Phase 1) and 14.6 (Phase 2) vs. baseline.","limitations":"- Absolute rates of naltrexone prescribing remained low (≤3.2%), suggesting most eligible patients still did not receive treatment.\n- Study is limited to a single academic health system, which may reduce generalizability.\n- The observational design with only 2 control hospitals limits the strength of causal inference despite the difference-in-difference approach.","practice_takeaway":"Adding a discharge order set with clinical decision support and universal triage-based alcohol screening to your ED workflow can meaningfully increase naltrexone prescribing for patients with alcohol misuse. Even with these gains, rates stay low — so ongoing efforts to close the treatment gap remain essential."}},{"doi":"10.1080/10903127.2026.2668009","pmid":"42114053","title":"The Role of Emergency Medical Services in Addressing Opioid Use Disorder – A Position Statement and Resource Document of NAEMSP","journal_title":"Prehospital Emergency Care","journal_issn":"1090-3127","published_at":"2026-05-11T00:00:00.000Z","url":"https://doi.org/10.1080/10903127.2026.2668009","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-18T13:25:33.074Z","updated_at":"2026-05-18T13:25:33.074Z","tags":[{"paper_doi":"10.1080/10903127.2026.2668009","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2668009","tag_type":"brand","value":"Narcan","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2668009","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2668009","tag_type":"condition","value":"Opioid Overdose","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2668009","tag_type":"condition","value":"Opioid Use Disorder","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2668009","tag_type":"generic","value":"buprenorphine","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2668009","tag_type":"generic","value":"naloxone","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2668009","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2668009","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2668009","tag_type":"modality","value":"Opioid Antagonist","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2668009","tag_type":"modality","value":"Partial Opioid Agonist","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2668009","tag_type":"study_design","value":"Position Statement / Consensus Guideline","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2668009","tag_type":"warning","value":"Brand tag 'Narcan' added as the most recognized naloxone brand, though the paper does not explicitly name it — other naloxone formulations exist.","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2668009","tag_type":"warning","value":"The age group tag defaults to 'adult' as the paper does not specify pediatric populations, though OUD can affect adolescents as well.","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2668009","tag_type":"warning","value":"This is an expert consensus position statement, not an original clinical trial — level of evidence reflects opinion/guideline rather than experimental data.","value_numeric":null}],"summaries":{"what_studied":"This NAEMSP position statement evaluates the role of EMS in addressing opioid use disorder (OUD), covering harm reduction, prehospital medications for OUD (MOUD), alternate dispositions, naloxone distribution, and clinician education.","key_result":"NAEMSP recommends EMS agencies establish low-barrier protocols for prehospital buprenorphine administration, integrate community harm-reduction resources, support alternate patient destinations, expand naloxone distribution, and deliver comprehensive anti-stigma education for EMS clinicians.","limitations":"This is a position statement rather than an original study — recommendations are based on existing evidence synthesis without new primary data or formal meta-analysis. Implementation feasibility may vary widely by local EMS system scope-of-practice laws and resources.","practice_takeaway":"EMS medical directors should work now to authorize buprenorphine in prehospital protocols and connect overdose patients to treatment rather than defaulting to ED transport. Harm-reduction strategies like naloxone distribution and stigma-focused training should be standard across EMS systems."}},{"doi":"10.1007/s43678-026-01143-0","pmid":"41946813","title":"Just the facts: balancing opioid reversal and withdrawal in emergency care","journal_title":"Canadian Journal of Emergency Medicine","journal_issn":"1481-8035","published_at":"2026-04-07T00:00:00.000Z","url":"https://doi.org/10.1007/s43678-026-01143-0","source_score":10,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-07T22:49:37.451Z","updated_at":"2026-05-07T22:49:37.451Z","tags":[{"paper_doi":"10.1007/s43678-026-01143-0","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01143-0","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01143-0","tag_type":"condition","value":"Opioid Overdose","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01143-0","tag_type":"condition","value":"Opioid Use Disorder","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01143-0","tag_type":"condition","value":"Opioid Withdrawal","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01143-0","tag_type":"generic","value":"naloxone","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01143-0","tag_type":"modality","value":"Opioid Antagonist","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01143-0","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01143-0","tag_type":"warning","value":"Only the paper title, DOI, journal, and publication date were provided — no abstract, methods, results, or full text were available. All tags and summary fields are inferred from the title alone. Key result, sample size, and practice takeaway cannot be verified and have been set to null. Study design is assumed to be a narrative review based on the title framing ('Just the facts'), but this is uncertain.","value_numeric":null}],"summaries":{"what_studied":"This paper examines the clinical challenge of balancing effective opioid reversal with avoidance of precipitated withdrawal in emergency care settings, likely reviewing naloxone dosing strategies and their implications for patients with opioid use disorder.","limitations":"Only an abstract/metadata was provided — no full text, methods, or results are available to extract specific findings or limitations."}},{"doi":"10.1176/appi.ajp.20250903","pmid":"41922981","title":"Regional Blood Flow Signatures of Opioidergic Modulation of Ketamine in Major Depressive Disorder: A Randomized Crossover Study","journal_title":"American Journal of Psychiatry","journal_issn":"0002-953X","published_at":"2026-04-02T00:00:00.000Z","url":"https://kclpure.kcl.ac.uk/portal/en/publications/8933b5ae-fe7d-4c32-b723-87d2b598881e","source_score":14,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-03T13:44:40.015Z","updated_at":"2026-06-03T13:44:40.015Z","tags":[{"paper_doi":"10.1176/appi.ajp.20250903","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20250903","tag_type":"category","value":"Psychiatry","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20250903","tag_type":"condition","value":"Major Depressive Disorder","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20250903","tag_type":"generic","value":"ketamine","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20250903","tag_type":"generic","value":"naltrexone","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20250903","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20250903","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20250903","tag_type":"modality","value":"NMDA Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20250903","tag_type":"modality","value":"Opioid Antagonist","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20250903","tag_type":"sample_size","value":"n=26","value_numeric":26},{"paper_doi":"10.1176/appi.ajp.20250903","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20250903","tag_type":"study_design","value":"Randomized Crossover Trial","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20250903","tag_type":"warning","value":"Antidepressant outcomes were assessed only at day 1 post-infusion; longer-term clinical implications cannot be drawn from this data.","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20250903","tag_type":"warning","value":"Receptor density profile correlations are exploratory and based on spatial alignment with external atlas data, not direct receptor measurements in participants.","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20250903","tag_type":"warning","value":"Sample size is small (n=26); effect size estimates and receptor-mapping correlations should be interpreted cautiously and require replication.","value_numeric":null}],"summaries":{"what_studied":"This randomized, double-blind crossover study (n=26 adults with MDD, ages 18–50) tested whether oral naltrexone 50 mg vs. placebo, given before IV ketamine (0.5 mg/kg over 40 min), alters acute regional cerebral blood flow (rCBF) measured by arterial spin labeling MRI, and whether rCBF changes relate to dissociative/psychotomimetic symptoms and antidepressant response at day 1.","key_result":"Ketamine significantly increased CBF in subgenual, pregenual, and dorsal anterior cingulate cortices regardless of naltrexone pretreatment. Under placebo, pregenual rCBF during infusion correlated with acute psychotomimetic effects (PSI delusional r=0.56; perceptual distortion r=0.64), and baseline subgenual rCBF correlated with day-1 antidepressant response (MADRS r=0.60; QIDS-SR r=0.67); naltrexone disrupted both associations. CBF changes mapped onto MOR and mGluR5 receptor profiles.","limitations":"- Small sample (n=26) limits statistical power and generalizability.\n- Only a single ketamine dose (0.5 mg/kg) and a single naltrexone dose (50 mg) were tested; dose-response relationships are unknown.\n- Antidepressant follow-up was limited to day 1, so durability of opioid-modulated effects cannot be assessed.","practice_takeaway":"Naltrexone does not blunt ketamine's core CBF signature in the anterior cingulate cortex, but it does disrupt the link between that blood flow response and both acute dissociative effects and early antidepressant benefit. Clinicians using or studying naltrexone alongside ketamine should be aware that opioid blockade may alter—not simply reduce—the neurobiological pathways mediating ketamine's antidepressant action."}},{"doi":"10.1111/add.70211","pmid":"41501983","title":"Evaluating the optimal duration of medication treatment for opioid use disorder","journal_title":"Addiction","journal_issn":"0965-2140","published_at":"2026-01-08T00:00:00.000Z","url":"https://doi.org/10.1111/add.70211","source_score":31,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-01-14","doi":"10.1111/add.70211","days":"7","issn":"0965-2140","rank":"6","field":"Clinical Medicine","score":"31","category":"Psychiatry","categories":["Psychiatry"],"_categories":["Psychiatry"]},"pubmed":{"doi":"10.1111/add.70211","title":"Evaluating the optimal duration of medication treatment for opioid use disorder.","journal":"Addiction (Abingdon, England)","methods":"","results":"","abstract":"$30","keywords":["duration of therapy","medication treatment for opioid use disorder","mortality","multistate survival analysis","opioid use disorder","veterans"],"pubmed_id":"41501983","conclusions":"","publication_date":"2026-01-08T00:00:00"},"crossref":{"DOI":"10.1111/add.70211","URL":"https://doi.org/10.1111/add.70211","ISSN":["0965-2140","1360-0443"],"link":[{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/add.70211","content-type":"application/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https://onlinelibrary.wiley.com/doi/full-xml/10.1111/add.70211","content-type":"application/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/add.70211","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Evaluating the optimal duration of medication treatment for opioid use disorder"],"author":[{"given":"Corey J.","family":"Hayes","sequence":"first","affiliation":[{"name":"Division of Pharmaceutical Evaluation and Policy, College of Pharmacy University of Arkansas for Medical Sciences Little Rock AR USA"},{"name":"Department of Biomedical Informatics, College of Medicine University of Arkansas for Medical Sciences Little Rock AR USA"},{"name":"Institute for Digital Health and Innovation, College of Medicine University of Arkansas for Medical Sciences Little Rock AR USA"},{"name":"Center for Mental Healthcare and Outcomes Research Central Arkansas Veterans Healthcare System North Little Rock AR USA"}]},{"given":"Rebecca A.","family":"Raciborski","sequence":"additional","affiliation":[{"name":"Center for Mental Healthcare and Outcomes Research Central Arkansas Veterans Healthcare System North Little Rock AR USA"},{"name":"Behavioral Health Quality Enhancement Research Initiative Central Arkansas Veterans Healthcare System North Little Rock AR USA"},{"name":"Evidence, Policy, and Implementation Center Central Arkansas Veterans Healthcare System North Little Rock AR USA"}]},{"given":"Mahip","family":"Acharya","sequence":"additional","affiliation":[{"name":"Institute for Digital Health and Innovation, College of Medicine University of Arkansas for Medical Sciences Little Rock AR USA"},{"name":"Department of Obstetrics and Gynecology, College of Medicine University of Arkansas for Medical Sciences Little Rock AR USA"}]},{"given":"Nahiyan Bin","family":"Noor","sequence":"additional","affiliation":[{"name":"Institute for Digital Health and Innovation, College of Medicine University of Arkansas for Medical Sciences Little Rock AR USA"}]},{"given":"Edward V.","family":"Nunes","sequence":"additional","affiliation":[{"name":"Division on Substance Use Disorders, Department of Psychiatry Columbia University Irving Medical Center New York NY USA"}]},{"given":"T. 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Discontinuation was a >28-day gap; multistate survival models adjusted for sociodemographic, clinical, prescription, and facility/provider factors.","key_result":"During ~226,000 person-years before discontinuation, 26,841 discontinuations occurred (118.9 per 1000 person-years); during ~106,000 post-discontinuation person-years, 3,251 deaths occurred (3.1 per 1000 person-years). The largest marginal gain in 6-year survival from one additional year on MOUD occurred around 2 years versus 6 months, with statistically significant gains through ~4–5 years; beyond 4–5 years, the marginal gain was not statistically significant.","practice_takeaway":"Retaining patients on MOUD for several years confers continued survival benefit, persisting through at least 4 years. 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