Faculty Bibliography

BACKGROUND AND AIMS/OBJECTIVE:There are currently no brief quantitative assessments that capture the drug patterns of people who engage in use of more than one drug on the same day or simultaneously. The current study examined the retest reliability, acceptability and feasibility of a new quantitative assessment to measure polysubstance use. DESIGN/METHODS:A tool for assessing simultaneous and same-day polysubstance behaviors, the polysubstance assessment tool (PAT) was developed in interviewer-administered and electronic self-administered formats. Participants were allocated 1:1 to receive either version of the PAT and returned one to three days later to repeat the assessment. SETTING/METHODS:New York City, New York, USA. PARTICIPANTS/METHODS:Adults (18 + years, n = 115) who reported use of more than one drug per day in the last 30 days. MEASUREMENTS/METHODS:Test-retest reliability estimates for dichotomous items were assessed using Cohen's kappa, Gwet's Agreement Coefficient 1 (AC1) and percent agreement. Continuous items were assessed with two-way mixed effects intraclass correlations. Bivariate analyses examined acceptability using nine Likert-type survey questions. Feasibility was examined via time to completion. FINDINGS/RESULTS:Overall reliability was moderate to excellent [Gwet's AC1 range 0.70-0.96; intraclass correlation (ICC) range 0.62-0.88]. Reliability was higher for simultaneous polysubstance use (Gwet's AC1 = 0.90) as compared with same-day (Gwet's AC1 = 0.70). Acceptability was high, with no statistically significant difference between the self- and interviewer-administered versions of the tool. Median time to completion was 7 minutes, and was statistically significantly lower for the self-administered tool (median = 5 minutes) compared with the interviewer-administered version (median = 8 minutes) (P < 0.001). CONCLUSIONS:A new polysubstance assessment tool appears to have good reliability and can be considered by researchers seeking a quantitative measure of polysubstance use behaviors given its simplicity, high acceptability and quick completion time.

BACKGROUND:Access to oncologists is crucial to quality cancer care. We aimed to assess the geospatial distribution of oncologists in the United States and its association with cancer mortality. METHODS:We used county-level oncologist data from the 2025 Doctors and Clinicians national downloadable file and county-level cancer outcome data from the 2018-2022 State Cancer Profiles. We assessed urban-rural differences in the distribution of oncologists in the United States and used Local Moran's I to identify clusters of high and low oncologist density and cancer mortality rates. We classified counties using the 2023 Rural-Urban Continuum Codes (RUCC) with RUCC 1-3 as urban and RUCC 4-9 as rural. RESULTS:13,332 oncologists were identified nationwide. The median oncologist density per 100,000 population was 6.0 in urban counties and 0.0 in rural counties (p-value <0.001). The median age-adjusted cancer mortality rate per 100,000 population was 156.1 in urban counties and 166.8 in rural counties (p-value <0.001). Clusters of low oncologist density were observed in the South. CONCLUSION/CONCLUSIONS:There are significant geospatial differences in oncologist accessibility and cancer outcomes. Targeted interventions are necessary to ensure that rural areas maintain access to oncology care.

INTRODUCTION/BACKGROUND:With increasing legalization of medical cannabis and prevalence of polysubstance use in the United States comes the need for standard psychometrically validated measures to study these substances' health effects in the population. The PhenX (consensus measures for Phenotypes and eXposures) Toolkit (www.phenxtoolkit.org) is a freely accessible catalog of recommended measurement protocols to promote data compatibility across studies, but this extensive catalog did not include measures in these important areas. METHODS:In 2024, a PhenX Working Group of experts followed a well-established consensus process to identify and recommend measurement protocols suitable for inclusion in studies on medical cannabis and polysubstance use. The broader scientific community was invited to review and provide feedback that was considered in the process of finalizing recommendations. RESULTS:In 2025, the PhenX Toolkit released 15 new medical cannabis and polysubstance use protocols, which assess medical and other cannabis use-including consumption levels, product types, sources, motives, expectancies, medical card status, provider-patient communication, and biochemical validation-as well as polysubstance use patterns and related overdose risk. These protocols complement existing substance-related content in PhenX Toolkit and facilitate future development of knowledge on health effects of cannabis and polysubstance use and clinical guidance on safety or dosing for medical cannabis. CONCLUSION/CONCLUSIONS:Researchers are encouraged to adopt these measurement protocols, so results across studies can be better compared and combined to efficiently and reliably evaluate the health effects of medical cannabis and polysubstance use. Measures in these domains will continue to be updated as new knowledge is gained.

BACKGROUND:Lifesaving medications for opioid use disorder (MOUD) exist; however, most people with opioid use disorder (OUD) do not receive treatment. Hospitalization is one important opportunity to engage people with OUD and offer treatment, including MOUD. Between 2018 and 2020, 6 public hospitals in New York City launched the "Consult for Addiction Treatment and Care in Hospitals" (CATCH) program to provide interprofessional addiction consult services to hospitalized patients. METHODS:This qualitative study aims to add perspectives from 30 racially and ethnically diverse people with opioid-related diagnoses who were hospitalized at a CATCH hospital between October 2019 and April 2021. We used purposive sampling to recruit demographically diverse individuals who accepted or declined aspects of CATCH services. Interviews were audio-recorded, transcribed, and coded for emergent themes using grounded theory techniques. The framework of structural vulnerability was utilized to highlight how social context impacts patients' experiences of healthcare, and in turn affects their addiction trajectories. RESULTS:Participants overwhelmingly accepted MOUD to manage withdrawal symptoms during hospitalization, and many planned to continue MOUD after discharge. Participants appreciated the interprofessional support of CATCH teams which included medical providers, social workers, addiction counselors, and peers. While participants felt that CATCH made holistic addiction treatment including MOUD more accessible, structural issues created barriers to continuing treatment long term. Some participants still felt stigmatized or "punished" for their drug use by non-CATCH providers. CONCLUSION/CONCLUSIONS:CATCH met an urgent need for nonjudgmental care and medical management of opioid withdrawal. Additional interventions that address broader needs, including housing and social supports, as well as trust-building healthcare encounters for patients who have been historically marginalized, are needed to meet the public health goal of preventing overdose and reducing drug-related morbidity for this population.

This article examines mental health service use among 395 incarcerated individuals with opioid use disorder in 14 prison-based substance use programs, as part of the Geographic Variation in Addiction Treatment Experiences Study. It explores how mental health symptoms and loneliness relate to service utilization using two multivariate logistic regression models for before incarceration and during incarceration. Utilization rose from 19% before incarceration to 38% during incarceration. While 78% of individuals met criteria for depression and 58% met criteria for anxiety, neither predicted service use. In contrast, loneliness was significantly associated with greater utilization during incarceration (adjusted odds ratio: 1.14, p = .026). These findings highlight loneliness as a key driver of mental health service use in incarcerated populations, consistent with general population trends. Further research should explore the role of social networks in shaping service utilization in correctional settings.

OBJECTIVES/OBJECTIVE:To describe the screening processes for opioid use disorder by jails in localities with high concentrations of opioid involved overdose deaths. METHODS:A secondary data analysis of structured interviews on opioid use disorder practices from 185 jails in the United States was conducted. Descriptive statistics detailed jail screening characteristics, and bivariate statistics examined the association between screening characteristics and annual jail population. RESULTS:The majority of jails in high-overdose-burden localities had screening protocols in place for opioid use disorder (95.1%). The protocols varied, with most jails reporting the use of substance use (85.4%) or opioid use (77.0%) specific screeners. Yet few jails used validated screening tools (23.3%) and instead relied on agency or state-specific tools (89.0%). Significant differences by annual jail population were found related to who conducted screenings, such that the use of medical staff for screening (P<0.01) and clinical assessments (P<0.05) was more likely among larger jails. CONCLUSIONS:Screening and assessment of opioid use disorder is essential for individuals in jails, given the disproportionate burden of the disorder. Jails tended to rely on agency-created tools over the use of validated screeners, and more efforts may be needed to close the research-practice divide.

As the opioid crisis continues, now driven by use of fentanyl, naloxone is an increasingly important intervention to reverse overdoses. More research is needed on the willingness of populations at risk for unintentional fentanyl exposure (through adulterated drugs) to accept naloxone to reverse potential overdoses. Adults (n = 991) entering randomly selected nightclubs in New York City (NYC) were surveyed at the point-of-recruitment in 2024 and were asked about their willingness to accept a free naloxone kit. We examined the prevalence of reported willingness to accept naloxone and reasons for refusal, and we examined prevalence and correlates of participants accepting naloxone. During the survey, 65.2% of participants reported being familiar with naloxone, 62.1% agreed to accept naloxone, and 49.6% were recorded as accepting a kit. Those residing in NYC, compared to visitors, had a higher prevalence of recorded acceptance (aPR = 1.41, 95% CI: 1.11-1.79), as did those reporting familiarity with naloxone (aPR = 1.27, 95% CI: 1.02-1.58), and those with an average higher readiness to intervene in an opioid overdose (aPR = 1.18, 95% CI: 1.04-1.33). The majority who refused (56.1%) reported not being interested; 10.1% reported that they were not worried about overdoses, and 8.2% reported that they already had naloxone. Although 83.4% agreed that naloxone is used to reverse opioid overdoses, 35.4% reportedly thought that naloxone is used to reverse the effects of cocaine or any drug. While at least half of attendees were willing to accept a naloxone kit, lack of interest and lack of knowledge about naloxone were potential barriers to carrying naloxone.

BACKGROUND AND OBJECTIVE/OBJECTIVE:Youth overdose deaths have remained elevated in recent years as the illicit drug supply has become increasingly contaminated with fentanyl and other synthetics. There is a need to better understand fatal drug combinations and how trends have changed over time and across sociodemographic groups in this age group. METHODS:We used the National Vital Statistics System's multiple cause of death datasets to examine trends in overdose deaths involving combinations of synthetic opioids with benzodiazepine, cocaine, heroin, prescription opioids, and other stimulants among US youth aged 15 to 24 years from 2018 to 2022 across age, sex, race and ethnicity, and region. RESULTS:Overdose death counts rose from 4652 to 6723 (10.85 to 15.16 per 100 000) between 2018 and 2022, with a slight decrease between 2021 and 2022. The largest increases were deaths involving synthetic opioids only (1.8 to 4.8 deaths per 100 000). Since 2020, fatal synthetic opioid-only overdose rates were higher than polydrug overdose rates involving synthetic opioids, regardless of race, ethnicity, or sex. In 2022, rates of synthetic-only overdose deaths were 2.49-times higher among male youths compared with female youths and 2.15-times higher among those aged 20 to 24 years compared with those aged 15 to 19 years. CONCLUSIONS:Polydrug combinations involving synthetic opioids continue to contribute to fatal youth overdoses, yet deaths attributed to synthetic opioids alone are increasingly predominant. These findings highlight the changing risks of the drug supply and the need for better access to harm-reduction services to prevent deaths among youth.