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Opioid use disorder is a chronic disease characterized by a maladaptive pattern of opioid use despite negative consequences. In the US, nearly 75 000 overdose deaths occurred in 2023, a 10-fold increase from 1999.1 However, only 1 in 4 US adults eligible for MOUD received it in 2022.2 The 2024 CRISM guideline outlines evidence-based OUD management that can be implemented by clinicians with or without specialized MOUD training for patients aged 18 years or older.3 It does not address withdrawal induction protocols, scheduling of opioid agonist therapies, or urine drug testing.
Importance: The US Supreme Court decision Murphy v National Collegiate Athletic Association allowed states beyond Nevada to legalize sports betting, including online wagers. How sports betting has evolved and its association with gambling harms has not been studied.
Objective: To describe how US sports betting evolved after Murphy v National Collegiate Athletic Association and offer insights into the potential health effects of sportsbooks, which are platforms for wagering on sporting events.
Exposure: Enactment of (1) Murphy v National Collegiate Athletic Association nationally and (2) the opening of retail or online sportsbooks in states.
Design, setting, and participants: In this longitudinal study, aggregate US internet search trends for gambling addiction and wagers on sports were described before and after the emergence of legalized sportsbooks.
Main outcomes and measures: Internet searches per 10 million queries that mentioned gambling and addiction, addict, anonymous, or hotline (such as gambling addiction hotline) made to Google from January 1, 2016, through June 30, 2024.
Results: The number of states with operational sportsbooks increased from 1 during 2017 to 38 during 2024. Total sports wagers increased from $4.9 billion during 2017 to $121.1 billion during 2023, with 94% of wagers during 2023 being placed online. There were 23% (95% CI, 15%-30%) more searches nationally for gambling addiction help-seeking after Murphy v National Collegiate Athletic Association. Massachusetts (47%; 95% CI, 21%-79%), New Jersey (34%; 95% CI, 21%-45%), New York (37%; 95% CI, 26%-50%), and Pennsylvania (50%; 95% CI, 35%-66%) each had more searches than expected after the opening of any sportsbooks in their state. Additional analyses suggest the opening of online, vs retail, sportsbooks corresponded with a larger increase in searches.
Conclusions and relevance: The results of this time series study suggest that access to sportsbooks, sports wagers, and potential help-seeking for gambling addiction increased substantially and highlight the need to address the health implications of sportsbooks, including recognition and treatment of gambling problems and their broader societal implications.
The American Society of Addiction Medicine (ASAM) developed this National Practice Guideline for the Treatment of Opioid Use Disorder to provide information on evidence-based treatment of opioid use disorder. This guideline is an update and replacement of the 2015 ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.
In 2021, opioid overdose deaths exceeded 80 000 in the US.1 Naloxone, a competitive opioid receptor antagonist that reverses symptoms of opioid intoxication and overdose by displacing opioids from μ-opioid receptors, is a safe and effective medication for preventing opioid overdose death. Naloxone meets US Food and Drug Administration (FDA) criteria for approval without a prescription: its benefits outweigh risks, it treats a condition that can be identified by people in the community, it has a low potential for misuse, and it can be labeled to facilitate correct administration.
The use of naltrexone plus bupropion to treat methamphetamine use disorder has not been well studied.
METHODS
We conducted this multisite, double-blind, two-stage, placebo-controlled trial with the use of a sequential parallel comparison design to evaluate the efficacy and safety of extended-release injectable naltrexone (380 mg every 3 weeks) plus oral extended-release bupropion (450 mg per day) in adults with moderate or severe methamphetamine use disorder. In the first stage of the trial, participants were randomly assigned in a 0.26:0.74 ratio to receive naltrexone–bupropion or matching injectable and oral placebo for 6 weeks. Those in the placebo group who did not have a response in stage 1 underwent rerandomization in stage 2 and were assigned in a 1:1 ratio to receive naltrexone–bupropion or placebo for an additional 6 weeks. Urine samples were obtained from participants twice weekly. The primary outcome was a response, defined as at least three methamphetamine-negative urine samples out of four samples obtained at the end of stage 1 or stage 2, and the weighted average of the responses in the two stages is reported. The treatment effect was defined as the between-group difference in the overall weighted responses.
RESULTS
A total of 403 participants were enrolled in stage 1, and 225 in stage 2. In the first stage, 18 of 109 participants (16.5%) in the naltrexone–bupropion group and 10 of 294 (3.4%) in the placebo group had a response. In the second stage, 13 of 114 (11.4%) in the naltrexone–bupropion group and 2 of 111 (1.8%) in the placebo group had a response. The weighted average response across the two stages was 13.6% with naltrexone–bupropion and 2.5% with placebo, for an overall treatment effect of 11.1 percentage points (Wald z-test statistic, 4.53; P<0.001). Adverse events with naltrexone–bupropion included gastrointestinal disorders, tremor, malaise, hyperhidrosis, and anorexia. Serious adverse events occurred in 8 of 223 participants (3.6%) who received naltrexone–bupropion during the trial.
CONCLUSIONS
Among adults with methamphetamine use disorder, the response over a period of 12 weeks among participants who received extended-release injectable naltrexone plus oral extended-release bupropion was low but was higher than that among participants who received placebo
t To evaluate the accuracy of detecting 16 year old male (N=465) and female (N=162) youths who subsequently manifest opioid use disorder (OUD) at 25 years of age. We hypothesized that the combined measures of two components of etiology, heritable risk and substance use, accurately detect youths who develop OUD.
Study design
Heritable risk was measured by the transmissible liability index (TLI). Severity of the prodrome presaging OUD was quantified by the revised Drug Use Screening Inventory (DUSI-R) containing the consumption frequency index (CFI) documenting substance use events during the past month and the overall problem density (OPD) score indicating co-occurring biopsychosocial problems. Diagnosis of OUD was formulated by a clinical committee based on results of the Structured Clinical Interview for DSM-IV in conjunction with medical and social history records.
Results
Bivariate analysis shows that the TLI, CFI, and OPD scores at 16 years of age predict OUD at 25 years. Multivariate modeling indicates that the TLI combined with the CFI predict OUD with 86% accuracy (sensitivity = 87%; specificity = 62%). The TLI and CFI at 16 years of age mediate the association between parental substance use disorder and OUD in offspring at 25 years of age, indicating that these measures respectively evaluate risk and prodrome.
Conclusion
These results demonstrate the feasibility of identifying youths requiring intervention to prevent OUD.
Kratom is a tropical tree native to Southeast Asia, with leaves that can have psychotropic effects. Kratom is not currently illegal and has been easy to order on the internet. Most people take kratom as a pill or capsule. Some people chew kratom leaves or brew the dried or powdered leaves as a tea. Sometimes the leaves are smoked or eaten in food. Two compounds in kratom leaves, mitragynine and 7-α-hydroxymitragynine, interact with opioid receptors in the brain, producing sedation, pleasure, and decreased pain. Mitragynine can also interact with other receptor systems in the brain to produce stimulant effects. Reported health effects of kratom use include nausea, sweating, seizures, and psychotic symptoms. Commercial forms of kratom are sometimes laced with other compounds that have caused deaths. Some users have reported becoming addicted to kratom. Behavioral therapies and medications have not specifically been tested for treatment of kratom addiction.
Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services
