Illegal opioids create challenges for public health and safety. There is imperfect understanding of when use of illegally manufactured opioids increased. This paper examined data on self-reported year of first heroin use in the United States. Secondary analysis of general population survey data. United States. 1 708 720 across 38 surveys from 1979 to 2023. The U.S. National Survey on Drug Use and Health and its predecessors ask respondents about their year of first use for various substances. In any single survey, few report initiating heroin in a specific year, but combining multiple surveys improves precision, enabling the plotting of time trends. Those who initiate can be broken down by age and by whether they report having misused pain relievers before they first used heroin. Self-reported heroin initiation appears to have been rare before the late 1960s, although data for those years are sparse. It rose sharply to a peak in 1972, fell by almost half, and remained stable from 1978 to 1994. It rose by about 75% in the late 1990s and a further 85% by the early 2010s. The proportion reporting misuse of prescription opioids before first using heroin increased from about one-third before 1990 to one-half by 2000 and 80% by 2010. The proportion who were over age 40 at the time of first heroin use increased from nearly 0 before 1990 to 10% in 2012 and about 40% in 2020-2021. In the United States, heroin initiation that is self-reported to have occurred after 2000 differs in magnitude and character from that from the late 1970s through mid-1990s. Changes began before dates commonly associated with restrictions on opioid prescribing. This appears consistent with a view that "trading down" from prescription opioid misuse to consumption of illegally manufactured opioids did not only occur after implementation of policies to reduce opioid prescribing.

The study assessed the health and economic implications as well as the cost-utility of implementing universal alcohol use disorder (AUD) screening in 15-74 years population at the primary healthcare level compared with the current practice of diagnosis and management of symptomatic AUD patients seeking formal healthcare. Model-based cost-utility analysis using a hybrid model comprising a decision tree and lifetime age- and gender-specific Markov models for alcohol attributable conditions, including road traffic accident injuries, alcohol-related liver disease and head and neck cancers. The analysis was undertaken from both an abridged societal (consideration of direct cost of care) and a societal (consideration of direct and indirect costs) perspective. India (national and sub-national level analysis). 15-74 years population segregated by gender. The intervention was 10-year annual population-based screening for alcohol use disorders using alcohol use disorder identification test by community health workers at primary care facilities. The comparator was 'usual care' scenario of diagnosis and management of symptomatic AUD patients, considering care seeking patterns in India. Differences in life years, quality-adjusted life years (QALYs), alcohol attributable deaths and morbidities, direct costs and indirect costs in the comparative scenarios, along with incremental cost-utility ratio (ICUR), benefit-cost ratio and net monetary benefit. ICUR was evaluated using the per-capita gross domestic product (GDP) threshold of ₹171 498 (US$2182), as per Indian economic evaluation guidelines. Probabilistic and deterministic sensitivity analysis was conducted to identify the parameters that are likely to have an impact on efficiency of the screening programme. The AUD universal screening programme was associated with a gain of 71.16 million QALYs at population level, with approximately one-fourth reduction in the incidence of alcohol-attributable conditions. The ICUR value indicated that the programme is likely to be cost-effective from an abridged societal perspective. The intervention is projected to generate a gain of ₹8.21 (US$1.03) trillion, equivalent to per year gain of 0.59% of GDP, based on the abridged societal perspective. The deterministic sensitivity analysis indicated that reductions in diagnostic accuracy of the screening method, prevalence of AUD and treatment coverage had an inverse impact on the ICURs and could impact efficiency of the programme. There is good health and economic evidence to support the integration of alcohol use disorder screening and management within routine primary care. It would be essential to deploy measures for effectiveness of the screening tool and continuity of care to enhance efficiency of the programme.

Mindfulness-based relapse prevention (MBRP) has been shown to be beneficial to individuals with substance use disorder (SUD) in the West. The current pilot study aimed at testing the feasibility of MBRP in a Chinese population. This pilot study adopted a design of randomized controlled trial comparing MBRP with treatment-as-usual group (TAU). Participants were recruited from residential detox centers, community addiction counseling centers and substance abuse clinics specialized addiction treatment clinics in Hong Kong. A total of 81 adults (85.2% male) with SUD (illicit drugs only) were recruited. The intervention group participants (n = 41) attended a 1-hour orientation session followed by 2-hour weekly MBRP sessions for 8weeks, delivered by a qualified MBRP teacher. The TAU group participants (n = 40) continued their service received from their referral agency. (After completion of all study assessments they were offered the same 8-week MBRP course.) MEASUREMENTS: Feasibility was measured by attendance, course satisfaction and retention rate. Participants' change in substance use and other related outcomes were captured by self-reported drug use, urine drug tests and a list of psychometric scales at baseline, immediately after MBRP and 3- and 6-month follow-up. The MBRP course satisfaction was high, and the attendance (57.4%) and retention rates (63.4%-85.4%) were comparable to previous trials. No statistically significant differences were observed between the MBRP and TAU groups for any outcomes, including craving, depression, anxiety, mindfulness and health-related quality of life; however, improvement trends were noticed in the MBRP group in self-efficacy in managing high-risk situations at post intervention, as well as in addiction severity and psychological flexibility at the 6-month follow-up. Mindfulness-based relapse prevention was shown to be feasible for substance use disorder treatment in a Chinese population. In this small study there was only limited evidence of abstinence efficacy, and no evidence of a benefit on other secondary outcomes.

To measure trends in alcohol treatment episodes in Australia, disaggregated by age, period and birth cohort. Age, period, cohort modelling with restricted cubic splines, using Australian alcohol treatment administrative data from July 2002 to June 2022. 1 253 548 closed treatment episodes where alcohol was the primary drug of concern from people aged 10 to 100 years who received treatment for their own substance use in publicly funded specialist alcohol and other drug treatment services. Count of alcohol treatment episodes by age, period, birth cohort and sex. Alcohol treatment episode rates increased over time, peaking in 2022 (330.11 per 100 000 population). Age trends first peaked at around 21 years of age [cross-sectional prevalence = 444.30, 95% confidence interval (CI) = 440.82-447.80; longitudinal prevalence = 462.45, 95% CI = 458.06-466.89], followed by a lifetime peak between 37 and 44 years and declining with older age. Cohorts born from 1974 to 1979 had the highest alcohol treatment episode rates, and the oldest and youngest birth cohorts had the lowest alcohol treatment episode rates. Males were overall 1.8 times as likely as females to have an alcohol treatment episode, but this gap closed with more recent birth cohorts. Alcohol treatment episode rates increased in Australia between 2003 and 2022, and particularly from 2017. Young to middle-aged adults and people born in the 1970s were most at risk, alongside a persistent but narrowing gap between males and females.

Non-pharmacological therapies are critical for disease management, particularly when pharmacological approaches are limited. Investigating their role as adjuncts to pharmacotherapy to improve outcomes in opioid use disorder (OUD) is of substantial clinical importance. This study aimed to evaluate the efficacy of non-pharmacological therapies as adjuncts to opioid agonist therapy (OAT) management for OUD. We systematically searched PubMed, Cochrane Controlled Register of Trials, Embase and Web of Science from inception to 8 February 2025 for randomized controlled trials (RCTs) comparing OAT alone versus OAT combined with non-pharmacological interventions in OUD. Outcomes of interest included treatment retention [assessed via odds ratios (ORs)], negative urine test results (specimen and the longest duration of continuous drug abstinence) and opioid craving scores [both evaluated via standard mean differences (SMDs)]. Bayesian network meta-analysis (NMA) using a random-effects consistency model was conducted to compare the relative effects of all non-pharmacological interventions. Local inconsistency was evaluated through node-splitting analysis, and global inconsistency was assessed using the non-consistency model. The certainty of the evidence was assessed using the GRADE framework (Grading of Recommendations, Assessment, Development and Evaluation) for network meta-analysis. Forty-two RCTs involving 5113 participants were included. For treatment retention, contingency management (CM) combined with OAT likely results in an increase [low-certainty evidence; OR = 1.64, 95% credible interval (CrI) = 1.03-2.57], while the combination of OAT with contingency management plus cognitive behavioral therapy (CBT + CM; very low-certainty evidence; OR = 2.47, 95% CrI = 1.10-5.67) or with enhanced methadone services (EMS; very low-certainty evidence; OR = 5.48, 95% CrI = 1.47-22.61) may result in an increase, compared with OAT alone. No intervention statistically significantly improved opioid-negative urine tests over OAT alone (very low certainty). For craving, acupuncture (very low certainty; SMD = -2.13, 95% CrI = - 3.09 to -1.15) and sham acupuncture (low certainty; SMD = -1.49, 95% CrI = - 2.69 to -0.31) combined with OAT may reduce craving scores. Contingency management, as adjunctive therapies for opioid agonist therapy (OAT), may improve treatment retention in patients with opioid use disorder compared with traditional OAT. Enhanced methadone services and contingency management plus cognitive behavioral therapy may improve treatment retention too but the evidence is very uncertain. Compared with OAT, sham acupuncture as an adjunct therapy may help reduce opioid cravings; acupuncture may reduce cravings too but evidence is very uncertain.

People with substance-use disorders (SUDs) have increased mortality risk, yet Chilean estimates of SUD-based mortality are scarce. This study aimed to quantify all-cause and cause-specific mortality following SUD treatment in Chile compared with the general population and assess variation across key clinical and demographic subgroups. National-level registry-based retrospective data linkage cohort study. Publicly funded SUD psychosocial treatments offered by the Chilean National Drug Agency, linked with official national mortality records from 2010 to 2020. 70064 adults aged 18-64 years (24% women, median age 35 at treatment entry) were followed after their first treatment episode until death or 31 December 2020. Primary outcome was all-cause mortality. Secondary outcomes were cause-specific mortality by the International Classification of Diseases, 10th revision, underlying and external causes. We estimated age-sex-calendar year directly standardized rates (DSR), and standardized mortality ratios (SMR) compared with the expected rate for the (sub)population. We also stratified rates and ratios by sex (men/women), attained age (18-29, 30-44, 45-59, 60+), setting (ambulatory/residential), primary substance (alcohol; illicit: predominantly cocaine paste base, marijuana and cocaine hydrochloride) and treatment compliance (not completed/completed). Additionally, we estimated rates and SMRs for underlying and external causes of mortality. Over a median 4.9-year follow-up (353 826 person-years), 2996 deaths occurred [DSR = 10.6, 95% confidence interval (CI) = 8.6-13.1]. Overall SMR was 3.65 (95% CI = 3.52-3.79). Excess risk was particularly pronounced for women (SMR = 5.57, 95% CI = 5.14-6.03), patients admitted due to alcohol use disorder (SMR = 4.59, 95% CI = 4.33-4.86), in residential care (SMR = 4.91, 95% CI = 4.45-5.42) and treatment noncompletion (SMR = 4.04, 95% CI = 3.85-4.24). Cause-specific mortality revealed elevated external-cause excess risk for SUD patients, including intentional self-harm (SMR = 6.67, 95% CI = 6.05-7.36), unintentional injuries (SMR = 5.37, 95% CI = 4.79-6.02) and assaults (SMR = 4.98, 95% CI = 4.16-5.96). Notable excess risk was also observed for non-external mortality causes: digestive system (SMR = 8.20, 95% CI = 7.62-8.83), symptoms and signs (SMR = 5.18, 95% CI = 4.29-6.26) and respiratory diseases (SMR = 5.18, 95% CI = 4.47-5.99) were greater than expected. In Chile, patients with a history of publicly funded substance-use disorder treatment appear to have an all-cause mortality up to 3.7 times higher than the general population, driven predominantly by digestive and respiratory causes, as well as self-harm, unintentional injuries and assaults.

Our primary aim was to conduct a network meta-analysis (NMA) for the effectiveness, safety and acceptability of all psychosocial interventions and all pharmacotherapies for cannabis use disorder (CUD). We conducted a NMA of studies identified from two completed systematic reviews examining the effectiveness, safety and acceptability of pharmacotherapies and psychosocial interventions for CUD in people aged ≥16 years. Outcomes were level of cannabis use, abstinence, adverse events and treatment completion. Fifty-seven studies were eligible for NMA. Depending on outcome, NMAs of psychosocial interventions included 6-16 studies (445-2287 participants), and NMAs of pharmacotherapies included 5-36 studies (260-3106 participants). Results are described relative to minimum clinically meaningful difference [mean difference (MD) ±0.05, odds ratio (OR) ≤0.8 or ≥1.25]. Evidence for pharmacological interventions reducing cannabis use was very uncertain. However, low-certainty evidence suggested that dialectical behavioural/acceptance and commitment therapies [DBT/ACT; MD -0.18, 95% credible interval (-0.26 to -0.09)] and cognitive-behavioural therapy with motivation enhancement (MET-CBT) with contingency management [CM; MD -0.15 (-0.23 to -0.07)] reduced use frequency relative to a nonspecific comparator. Interventions including CM also supported abstinence (very low certainty). Limited, low-certainty evidence indicated that cannabidiol [OR 2.91 (0.45 to 27.98)], N-acetylcysteine [OR 1.30 (0.55 to 3.74)] and varenicline [OR 4.85 (0.65 to 48.26)] promoted abstinence compared with placebo, although cannabidiol was associated with adverse events [OR 1.58 (0.26 to 8.98)]. Very low-certainty evidence suggested mixed-action antidepressants, benzodiazepines, bupropion and buspirone also had more adverse events than placebo, without any indication of effectiveness. Very low-certainty evidence indicated that DBT/ACT and CM improved treatment completion. In contrast, MET-CBT, with/without affect management, reduced completion, relative to a nonspecific comparator. Low-certainty evidence suggested N-acetylcysteine [OR 1.29 (0.76 to 2.19)] and delta-9-tetrahydrocannabinol preparations [OR 1.32 (0.89 to 1.97)] increased treatment completion, while fatty acid amide hydrolase inhibitor [OR 0.80 (0.40 to 1.58)] and selective serotonin reuptake inhibitors [OR 0.56 (0.29-1.04)] reduced it, relative to placebo. There is some evidence that dialectical behavioural/acceptance and commitment therapies, contingency management alone or with cognitive-behavioural therapy with motivation enhancement, N-acetylcysteine, cannabidiol or varenicline may facilitate abstinence, reduce use and/or support treatment completion for cannabis use disorder. Some interventions may have unfavourable effects on those outcomes, relative to placebo or nonspecific comparators. While safety data for psychosocial interventions is lacking, several pharmacotherapies may be associated with adverse events. These findings should be interpreted with caution as all evidence is low- to very-low-certainty due to imprecise or heterogeneous treatment effects and high risk of bias in some study results.

To determine whether alcohol consumption in England had returned to pre-pandemic levels by December 2024, after the initial rise in 2020 across the total population and subgroups. Monthly representative surveys were conducted through face-to-face interviews until February 2020, and then by telephone. England, March 2014 to December 2024. 208 010 adults aged 18+ living in private households. Mean weekly alcohol consumption (in UK units), prevalence of risky drinking (Alcohol Use Disorders Identification Test for Consumption [AUDIT-C] score≥5), and possible dependence (AUDIT-C ≥ 11). Further measures included age, gender, and social grade. All outcomes increased in April 2020: prevalence of risky drinking by 30.3% (95% confidence interval [CI]: 26.8, 33.8, from 26.2% in February 2020 to 34.0% in April 2020), prevalence of possible dependence by 90.2% (95% CI: 62.2, 122.9, from 0.9% to 1.7%) and mean weekly alcohol consumption by 34.5% (95% CI: 31.0, 38.0, from 5.0units to 6.6units). When adjusting for the survey mode change from face-to-face to telephone interviews, the step changes between February and April 2020 remained but were substantially attenuated. The post-pandemic trend declined more quickly than the pre-pandemic trend for the prevalence of risky drinking (difference: -1.5%/year, 95% CI: -2.4, -0.6) and mean weekly alcohol consumption (difference: -2.4%/year, 95% CI: -3.3, -1.6), indicating a slow but incomplete return to pre-pandemic levels. The trend in prevalence of possible dependence was similarly stable before and after the pandemic (difference: -1.3%/year, 95% CI: -6.2, 3.8). Alcohol consumption declined more slowly among people from less advantaged than from more advantaged social grades. The prevalence of risky drinking and mean weekly alcohol consumption in England appear to be trending towards pre-pandemic levels but the prevalence of dependent drinking in England appears to have increased since the start of the pandemic and remains elevated compared with pre-pandemic levels. Alcohol-related inequalities may be worsening due to slower declines in consumption following the pandemic among less advantaged drinkers.

This study examined whether socio-economic status (SES) and geographic remoteness are associated with cannabis consumption across Australia by comparing wastewater-based surveillance (WBS) data and self-reported cannabis use in national household surveys. We compared cannabis consumption estimates from 6years of wastewater data from the National Wastewater Drug Monitoring Program (NWDMP) with cannabis use data from the National Drug Strategy Household Survey (NDSHS). We categorised the Index of Relative Socio-economic Advantage and Disadvantage (IRSAD) into quartiles for each wastewater catchment area. Three remoteness categories (Major Cities, Inner Regional, Outer Regional/Remote) from the Australian Bureau of Statistics were used to categorise wastewater and survey data by degree of urbanisation. Trends were analysed using linear regression, analysis of variance and logistic regression. Wastewater: Estimated cannabis consumption in wastewater increased between 2018 and 2025 annually across SES quartiles from 2.9% [95% confidence interval (CI) = 2.0-3.9%] for the most disadvantaged to 5.2% (95% CI = 3.2-7.3%) for the second most disadvantaged quartile. The annual rates increased for all three categories of remoteness and ranged from 3.6% (95% CI = 2.2-5.2%) to 4.8% (95% CI = 4.2-5.5%) for Inner Regional and Major Cities, respectively. Consumption was statistically significantly higher in the most disadvantaged SES quartile (3000 mg/1000 people/day, 95% CI = 2900-3100) than in the least disadvantaged (1200 mg/1000 people/day, 95% CI = 1100-1200, P < 0.001). It was also highest in the most remote category (2400 mg/1000 people/day, 95% CI = 2300-2500), compared with the most urban category (980 mg/1000 people/day, 95% CI = 960-1000,P < 0.001). In the NDSHS the prevalence of regular cannabis use was higher in the most disadvantaged SES quintile (6.1%, 95% CI = 5.2-7.3% in 2022/2023) than in the least disadvantaged (4.2%, 95% CI = 3.5-5.1% in 2022/2023). It was also higher in the most remote category (5.9%, 95% CI = 4.8-7.4%) than in the most urban category (4.3%, 95% CI = 3.9-4.8%), in all survey years (i.e. 2016 and 2019). Wastewater-based surveillance and survey data describe similar trends in population cannabis use by socio-economic status and urban remoteness in Australia from 2018 to 2025.