Background: The prevalence of opioid use disorder (OUD) among women giving birth in US hospitals continues to rise. Increasing fatalities due to perinatal drug overdose have in part been attributed to decreased access to social support and treatment services. In recent years, mobile health (mHealth) technologies have been used to provide care to patients outside of traditional clinical settings. Given that perinatal OUD treatment works best when there is frequent contact between patient and clinician, harnessing mHealth could be valuable for improving patient engagement in perinatal OUD care. Objective: To address the increasing epidemic of perinatal OUD, which is compounded by loneliness and social isolation, this study aimed to adapt an existing mHealth chatbot intervention for postpartum individuals by developing educational and supportive content relevant to people in the postpartum period experiencing OUD and recovery. Methods: We used a participatory design to conduct a needs assessment via in-depth qualitative interviews with patients (n=12) and providers (n=11). Interview data were analyzed using NVivo software (Lumivero) according to a priori codebooks and using inductive coding, which identified major themes to address in a future adaptation of an interactive chatbot. An advisory board was convened to review the data and contribute to content generation that would be most useful for perinatal mothers who are in treatment for OUD. Results: Patients and providers agreed that an interactive chatbot would be useful for patients seeking information on childbirth recovery, substance use recovery, pain management, and infant care, including feeding. Patients specifically wanted a chatbot that felt personal and addressed their individual and specific needs. Providers indicated that the chatbot should address topics that came up frequently in after-hours phone calls to reduce provider burden. Conclusions: Conducting an in-depth participatory-driven needs assessment will support the refinement of an existing chatbot to better meet the needs of a high-risk, difficult-to-reach population. As we move forward to test the chatbot for acceptability and feasibility, data from the needs assessment will support ongoing iterative enhancement of the content, delivery, and safety of the chatbot.
<img src="https://jmir-production.s3.us-east-2.amazonaws.com/thumbs/4711641658d6f7798d35a50de0518027" />
Altered attention network dynamics in resting-state fMRI of individuals with high smartphone addiction scores
IntroductionAltered attention network activity has been consistently reported in recent neuroimaging literature of smartphone addiction and problematic smartphone use. However, many functional imaging studies have relied on traditional static functional connectivity analyses, which cannot capture time-varying or recurrent dynamics of attention networks.MethodsGiven the importance of temporal and spatial dynamics for attentional processing, we applied two complementary dynamic functional connectivity approaches: functional connectivity-based attractor networks (fcANN), which characterize transitions between discrete attractor states related to internal-external context and action-perception dynamics, and cPCA-based quasi-periodic pattern (QPP) analysis, which captures phase relationships between cortical networks including the default mode network, dorsal attention network, and frontoparietal control network.ResultsIn a resting-state fMRI dataset comparing participants with High and Low SAS-M scores (SAS-M: Smartphone addiction scale-Malay version questionnaire), we observed context-dependent differences in DMN-attention-network relationships across attractor states. The most consistent effects emerged during transitions between internal and external attractor states, where subjects with high smartphone addiction (SPA) scores showed greater DMN dominance relative to attention-related networks. For DMN-FPN, these differences correlated with subject SAS-M scores.DiscussionOverall, these findings provide preliminary evidence that smartphone addiction may be associated with altered large-scale attentional dynamics at rest, warranting further investigation in larger and more diverse samples.
STAT+: FDA adcomm members’ ties to industry under scrutiny
Good morning. Yesterday, we got the devastating news that STAT’s infectious disease correspondent, Helen Branswell, passed away. She was a reporter I always looked up to and was also an incredibly generous colleague. Please take the time to read this tribute to her.
The need-to-know this morning
- Liquidia and United Therapeutics reached a settlement agreement that resolves their ongoing patent litigation over Liquidia’s treatment for pulmonary arterial hypertension.
New trial to test effect of GLP-1s on social outcomes
Researchers in Pittsburgh are launching a novel type of GLP-1 trial — testing not only if the drug will help people with addiction, but also if it will help reduce recidivism while improving other employment, health, and housing outcomes.
The Center for Addiction Science, Policy and Research (CASPR), a non-profit organizing the effort, and the Allegheny County Department of Human Services are planning to launch the trial in early 2027. They will enroll up to 1,200 adults with alcohol use disorder, opioid use disorder, or both, who are also at high risk of criminal-justice involvement. Half will be randomly assigned to take Novo Nordisk’s Wegovy, according to a press release issued yesterday.
Nicotine and tobacco smoke reshape neuronal signaling networks from a single-nucleus transcriptomic perspective
Nicotine and cigarette smoke exposure significantly impact brain function, yet their distinct cellular and molecular mechanisms remain unclear. To address this, we conducted comprehensive single-nucleus RNA sequencing (snRNA-seq) analysis on whole-brain samples and specifically on the ventral tegmental area (VTA) of adult C57BL/6 mice following nicotine or smoke exposure. Our study identified 18 major transcriptionally distinct cell populations across the whole brain and 27 distinct clusters within the VTA, covering major neuronal and glial cell types. Differential gene expression and KEGG pathway enrichment analyses revealed distinct transcriptional responses: nicotine exposure was associated with enrichment of synaptic and addiction-related transcriptional pathways in neuronal populations, including dopaminergic and glutamatergic pathways, whereas smoke exposure was associated with broader enrichment of metabolic-, immune-, and endocrine-related pathways. CellChat predicted condition-associated communication differences, including higher inferred NRXN communication from excitatory neurons to oligodendrocytes and other excitatory neurons under nicotine exposure. Smoke exposure also increased oligodendrocyte PISD expression, a transcriptomic change potentially associated with mitochondrial phospholipid metabolism. Collectively, these data define cell-type-specific transcriptional and predicted communication signatures of nicotine and smoke exposure that require functional validation.
Comparative efficacy of naltrexone-accelerated versus sublingual buprenorphine in opioid withdrawal management and initiating injectable naltrexone treatment: study protocol for a randomized controlled trial
BackgroundExtended-release injectable naltrexone (XR-NTX), a long-acting opioid antagonist, is an effective relapse prevention strategy in the treatment of opioid use disorder (OUD). However, standard XR-NTX initiation requires completion of opioid withdrawal management and a 1–2 week opioid-free period. This interval is associated with heightened vulnerability to lapse and relapse, and many patients fail to initiate XR-NTX treatment successfully. Therefore, alternative strategies that enable rapid XR-NTX initiation are needed. This study aimed to compare the effectiveness and safety of naltrexone-accelerated (NA) versus sublingual buprenorphine (SB) withdrawal management in facilitating XR-NTX initiation among patients with OUD.MethodsThis single-center, open-label, randomized controlled trial uses a parallel-group design. Eligible patients aged 18–60 years with moderate to severe OUD who are actively using opioids and are not receiving regular maintenance treatment with methadone or buprenorphine are randomly assigned to one of two groups: (1) NA withdrawal management, comprising one day of adjunctive non-opioid medications, one day of buprenorphine administration, one day of washout, and four days of gradual oral naltrexone titration (1, 3, 12, and 25 mg/day); or (2) SB withdrawal management, comprising one day of adjunctive non-opioid medications, six days of buprenorphine tapering (up to 8 mg on Day 2, 6 mg on Day 3, 4 mg on Days 4–5, 2 mg on Day 6, and 1 mg on Day 7), and a seven-day washout period. Adjunctive non-opioid medications in both groups comprised clonidine, clonazepam, gabapentin, and trazodone. The primary outcomes are the proportions of participants who (1) achieve a negative urine drug test for the assessed opioids and (2) receive XR-NTX at the end of the withdrawal management period. Secondary outcomes include severity of withdrawal symptoms, opioid craving intensity, and adverse effects. All analyses are conducted according to the intention-to-treat principle.DiscussionThe findings of this trial may provide clinically relevant evidence to support rapid initiation of XR-NTX treatment in patients with OUD and inform clinical practice.Clinical trial registrationhttps://en.irct.ir/trial/81525, Iranian Registry of Clinical Trials IRCT20250123064499N1.
A comparison of recovery benefits associated with participation in SMART Recovery, AA, both SMART and AA, or neither, following a new alcohol use disorder recovery attempt
BackgroundSelf-Management and Recovery Training (SMART Recovery or “SMART”) is an internationally known “second-wave” addiction recovery mutual-help organization that has grown over several decades. Despite this, little is known empirically about who uses SMART and how they fare on important alcohol-specific outcomes over time relative to individuals using more established options such as Alcoholics Anonymous (AA), or indeed those who utilize both SMART and AA, or neither. Greater knowledge could deepen understanding of the clinical and public utility of SMART in its own right and inform clinical referral options.MethodsA naturalistic, longitudinal cohort study (N = 361) of individuals recruited between February 2019 and February 2022 who were initiating a new alcohol use disorder (AUD) recovery attempt and self-selected into one of four groups at study entry: (1) SMART Recovery; (2) AA; (3) SMART + AA; and (4) neither SMART nor AA. Assessments were conducted at intake, 3 months, and 6 months and measured a variety of alcohol/drug-related and functioning outcomes.ResultsCompared to the AA and Both groups, SMART Recovery pathway participants exhibited a pattern of less severe clinical pathology and legal system involvement histories, along with higher psychosocial stability and recovery capital. In terms of meeting attendance frequency, the SMART group did not attend as many meetings as the AA or Both groups, but nevertheless was able to achieve levels of improvement in alcohol indicators (i.e., fewer drinking days, fewer heavy drinking days, and fewer alcohol-related consequences) and rates of early AUD remission similar to those of the AA and Both groups.ConclusionsSMART Recovery may provide a valuable alternative source of recovery-specific support that may be a good fit, particularly for certain individuals with AUD. As such, it serves as a valuable addition to the menu of available community-based recovery-support service options.
Sleep and Drug Use: Neuroimaging Evidence for a Multidimensional Brain Framework
Sleep plays a critical role in the initiation and maintenance of drug use, as well as recovery among individuals with substance use disorders. Sleep is a multidimensional construct, and a growing body of research has demonstrated the relative independence of various components. Specific sleep characteristics including insomnia (self-reported sleep disturbances), short sleep duration, late sleep timing and sleep irregularity have each been associated with increased risks of drug use. However, it remains unclear whether these sleep components contribute to substance use through shared neurobiological pathways.
Correction: Smartphone addiction and self-esteem among university students: a moderated mediation and latent profile analysis
Access to addiction meds for young people has improved — but retention hasn’t
In 2016, the American Academy of Pediatrics issued a policy statement urging doctors to offer medications for opioid use disorder to adolescent and young adult patients who needed them.
New national data show that more young people with an opioid use disorder diagnosis did start receiving addiction medications like buprenorphine and methadone, but the increase was small. And the number of young people who stayed on medication for six months — already quite low — may have actually decreased.
Brave Heart Intervention and Mental Health Outcomes Among Young People in Sierra Leone
Conditions: Substance-related Disorders; Mental Health Literacy; Adolescent Health; Substance Use Disorder (SUD)
Interventions: Behavioral: Brave Heart Intervention
Sponsors: Slum and Rural Health Initiative; Grand Challenges Canada
Completed
Interventions: Behavioral: Brave Heart Intervention
Sponsors: Slum and Rural Health Initiative; Grand Challenges Canada
Completed