Uptake of a treatment for opioid use disorder is highly uneven across the United States

Rutgers and Columbia researchers investigate overall increased use of a long-acting injectable buprenorphine, but large disparities persist

Rutgers University

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There was a substantial increase in recent years in the use of a form of the primary medication to treat opioid use disorder, according to a Rutgers Health study.

 

Researchers also noted sharp differences in growth trends across the United States.

 

The first long-acting injectable form of buprenorphine, the most common medication for treating opioid use disorder, was approved by the Food and Drug Administration for use in 2018. As a partial rather than full blocker of the opioid receptor, it blocks the effects of opioid drugs such as heroin or fentanyl and reduces risk of overdose. Long-acting injectables deliver buprenorphine via a shot, slowly releasing it into the bloodstream over a full month to provide a steady level of medication over time, as opposed to sublingual or oral forms.

 

The study, published in Health Affairs, examined pharmacy prescription claims from 2021 to 2024, including more than 4 billion prescriptions dispensed annually. Researchers explored state-level trends in the volume of long-acting injectable buprenorphine prescriptions as well as trends in insurance payer type, such as Medicaid, Medicare, commercial or self-pay and prescriber specialty, such as physicians or advanced practice clinicians.

 

“The data showed a rapid uptake of long-acting injectable buprenorphine, with the total number of buprenorphine prescriptions in injectable form increasing tenfold from 2021 to 2024,” said Stephen Crystal, the director of the Rutgers Center for Health Services Research and a coauthor of the study. “This matters because an injectable formulation could be lifesaving for those patients who struggle to stabilize on a daily oral medication. Sustained levels of medication, potentially reducing cravings for illicit drugs and assured protection for a full month may reduce the risk of overdose, particularly for individuals at high risk, such as those treated for prior overdose or in unstable living situations.”

 

Researchers observed marked increases in prescriptions for patients with Medicaid insurance benefits, the joint federal and state program that provides free or low-cost health coverage to low-income or disabled Americans. Pennsylvania, Louisiana, Alaska and Ohio had the highest rates of long-acting injectable prescriptions, possibly because of policies of their Medicaid plans that made this type of buprenorphine more accessible, according to researchers.

 

While overall prescription increases were observed, researchers noted significant differences in growth trends across states. In some states, less than 1% of buprenorphine prescribed was in long-acting injectable form, and in other states, close to 13% of buprenorphine was prescribed in injectable form by 2024.

 

“Given the variation across states, it’s evident that state-level policy decisions and insurance plan designs have a meaningful impact on expanding access to lifesaving opioid-use disorder treatment,” said Arthur Robin Williams, an associate professor at Columbia University and the lead author of the study.

 

Researchers also found disproportionate increases in long-acting injectable buprenorphine prescriptions among advanced practice clinicians, such as nurse practitioners and physician assistants.

 

“These findings highlight the crucial role of Medicaid, as well as advanced practice clinicians, rather than physicians in combating the opioid crisis,” said Crystal, who is also a Distinguished Research Professor at Rutgers School of Social Work.

 

Coauthors include Mark Olfson of Columbia University and Hillary Samples and Jialiang Hua of Rutgers Institute for Health.

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Journal

Health Affairs

Method of Research

Data/statistical analysis

Subject of Research

People

Article Publication Date

7-Jul-2026

 

Perceived risk of fentanyl use among US adolescents

JAMA Network Open

About The Study: 

In this survey study, an appreciable portion of adolescents—particularly the younger ones—were not aware of the dangers of fentanyl use. Clinicians, parents, schools, and public education programs all have important roles in communicating the potentially life-threatening risks of fentanyl misuse to adolescents.

Corresponding Author: To contact the corresponding author, Richard Miech, PhD, email ramiech@umich.edu.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamanetworkopen.2026.22039)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

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Journal

JAMA Network Open

 

Boom in ketamine clinics and at-home delivery sparks safety concerns

Anesthesiologists call for stronger oversight

American Society of Anesthesiologists

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Key Takeaways:

• Anesthesiologists are urging lawmakers and regulators to act on ketamine use that occurs without consistent medical oversight. Texas is among the states proposing stricter regulations.
• The boom in the U.S. ketamine market — projected to reach more than $14 billion by 2035 — results from the surge in clinics and at-home telehealth prescribing and delivery for mental health conditions.
• Ketamine can cause serious risks — including breathing problems, blood pressure and heart rate instability and potential misuse — and should only be administered with appropriate monitoring and trained medical supervision.

CHICAGO — The American Society of Anesthesiologists is calling on policymakers to address the fast-growing problem of home delivery of ketamine and the lack of physician oversight in ketamine clinics.

As the U.S. ketamine market surpasses $5 billion, the rapid boom in clinics and at-home telehealth prescribing is alarming anesthesiologists who warn that access to the powerful anesthetic is expanding faster than patient safety standards. The market is projected to nearly triple in the next decade, prompting calls for stronger safeguards and broader regulatory action.

Used in hospitals for anesthesia and sedation, ketamine is increasingly prescribed off-label for mental health conditions. Existing literature suggests that the drug can benefit patients, including Veterans, with conditions such as depression and post-traumatic stress disorder. However, in some cases, ketamine is prescribed remotely and delivered to patients’ homes —without an in-person evaluation or direct medical supervision.

The risks are not theoretical. Last year, a 41-year-old New York woman seeking relief from depression died after being prescribed at-home ketamine through a telehealth company — even though she had reported taking Xanax, a combination the FDA warns can lead to fatal breathing problems.

ASA is urging policymakers and medical experts to scrutinize this trend and work to advance proposals to strengthen patient protections.

The Texas Medical Board recently proposed rules to regulate the administration of ketamine in medical facilities and clinics and require greater oversight during treatment. ASA submitted a comment letter emphasizing that ketamine administration should occur under the direct supervision of a qualified physician who is immediately available for in-person evaluation and intervention. Rather than endorsing Texas’ proposed rules, ASA urged stronger safeguards. Bills to strengthen patient protections have been introduced in Georgia, Missouri and Utah.

“We have grave concerns about the home delivery and use of ketamine,” said ASA President Patrick Giam, M.D., FASA. “You can move very quickly from feeling relaxed to becoming deeply sedated, and without proper monitoring and supervision, this can become dangerous. I’m concerned that without stronger regulation, we risk repeating another opioid-like public health crisis, particularly because many people underestimate the potential dangers of ketamine.”

Anesthesiologists note three key safety concerns that require close medical supervision:

• Breathing complications: Ketamine can slow or stop breathing, especially at higher doses or when combined with other medications.
• Heart and blood pressure instability: The drug can cause sudden and dangerous increases in blood pressure and heart rate.
• Risk of misuse and diversion: Without proper safeguards, ketamine may be misused, shared, illegally resold or combined with other substances, increasing the risk of harm.

In hospitals and accredited medical facilities, ketamine is administered with continuous monitoring and immediate access to emergency care. These safeguards — including trained personnel to manage airway or cardiovascular emergencies — may not be available in all outpatient settings and are typically not available at home.

“You can go from a short online screening to receiving a powerful anesthetic at home,” said Dr. Giam. “If something goes wrong, there may be no one there trained to respond. In the hospital, we have strict protocols to account for every milligram of ketamine administered, yet ketamine used at home is subject to far less scrutiny.”

In guidance updated this month, ASA emphasizes that ketamine used for non-anesthetic purposes should meet the same safety standards as other anesthetic drugs, including appropriate patient selection, monitoring and physician oversight.

Patients considering ketamine therapy for mental health conditions should talk with their physician and ask how the drug will be administered, who will monitor them and what safety protocols are in place in case of an emergency.

 

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 60,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during, and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/madeforthismoment. Follow ASA on Facebook, X, Instagram, Bluesky, and LinkedIn.

 

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Time for better opioid detoxification strategies, researchers say

Addiction services must urgently consider the way in which they offer support for opioid substitute withdrawal

Imperial College London

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Addiction services must urgently consider the way in which they offer support for those wanting to come off opioid substitutes through their detoxification, according to researchers at Imperial College London.  

Following a review of relevant studies, they say different strategies are needed to better support individuals who are diagnosed with opioid dependence but who aspire to live an opioid-free life, if results are to improve.  

Among their recommendations are: specialist training for addiction services staff to manage opioid withdrawal during detoxification; better provision of medication to alleviate withdrawal symptoms; and more control by individuals over their own tapering (gradual withdrawal) process.

Other strategies they suggest include supporting people going through detoxification from experienced peer support workers, and enabling psychological support during the process. They also recommend increasing the availability of in-patient or residential settings for those without an appropriate home environment.

Amy Bagshaw at Imperial College London, the first author of the paper, said: “In our experience as an addiction research team, many people with opioid dependence do want to come off opioids and their substitutes completely, at some stage. But few people are managing to do this successfully every year. Having reviewed the evidence and the factors involved in successful withdrawal, we believe these steps could really help to improve the present situation.”

She added: “Staff at addiction services may not be aware of how to adequately support individuals through the detoxification process, or how to approach the initial conversations.”

Globally, 16 million people have been diagnosed with opioid dependence and there are over 120,000 opioid overdose deaths a year. Patients can be treated with opioid substitution therapy, involving treatments like buprenorphine and methadone, sometimes coupled with psychosocial support. This has resulted in improved wellbeing and long-term stability for many patients. While for many this is sufficient, and complete detoxification is often not recommended for people with addiction problems, many people decide they want to come off the substitute therapies completely. But withdrawal is notoriously challenging.

The researchers note that the number of individuals leaving their treatment ‘free of opioid dependence’ in England has been falling over the last decade, from around 37% to around 23%.*

The researchers, in the Addiction team at Imperial College London, reviewed existing research studies of individuals with a diagnosis of opioid dependence undergoing detoxification from substitution therapies, as well as of staff responsible for providing the treatment.

Their systematic narrative review study, published today in Addiction journal, examined 41 research studies originating from the USA (22), UK (7), Sweden (6), as well as single papers from each of Canada, Ireland, Norway, Switzerland, Australia and China.

The medications explored across the studies included methadone (28), buprenorphine (5), both forms (6), and unspecified treatments (2).

The study found that key barriers to success included psychological challenges, such as fear of withdrawal, relapse and instability; low confidence or motivation; and physical challenges including severe withdrawal symptoms during the dose taper. Social environmental and service-related factors strongly influenced outcomes, with unstable housing, negative social networks, and inadequate professional support all hindering detoxification. The researchers also highlight a lack of recommended medicines to alleviate the emergence of opioid withdrawal symptoms. These varied symptoms are currently treated with a mixture of benzodiazepines, antidepressants, antihistamine, and anti-inflammatories. The only drug licensed to support multiple symptoms of opioid withdrawal, Lofexidine, is no longer available in the UK, although it is available in the United States.

Dr Louise Paterson at Imperial College London’s Department of Brain Sciences said: “Detoxification from opioid substitutes is a difficult process to complete, but here we have found a clear roadmap to better treatment provision to support people who want to undertake it. In fact, many of these strategies are routine in alcohol detoxification pathways but less often present for opioid detoxification. Our recommendations should be urgently considered by addiction services to improve results for those who aspire to live an opioid-free life.”

The work was funded by the UK’s Economic and Social Research Council and Medical Research Council.

Barriers and Facilitators to Detoxification from Opioid Substitution Treatment: A Mixed-Methods Systematic Review, by Amy Bagshaw, Louise Paterson et al, is published in Addiction. DOI 10.1111/add.70482

 

* Office for Health Improvement and Disparities. Adult substance misuse treatment statistics 2023 to 2024: report [Internet]. GOV.UK; 2024 [cited 2025]. Available from: https://www.gov.uk/government/statistics/substance-misuse-treatment-for-adults-statistics-2023-to-2024/adult-substance-misuse-treatment-statistics-2023-to-2024-report.

 

-ENDS-

This press release uses a labelling system developed by the Academy of Medical Sciences to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf

 

About Imperial College London
 

We are Imperial – a world-leading university for science, technology, engineering, medicine and business (STEMB), where scientific imagination leads to world-changing impact.   

As a global top ten university in London, we use science to try to understand more of the universe and improve the lives of more people in it. Across our nine campuses and throughout our Imperial Global network, our 22,000 students, 8,000 staff, and partners work together on scientific discovery, innovation and entrepreneurship. Their work navigates some of the world’s toughest challenges in global health, climate change, AI, business leadership and more.  

Founded in 1907, Imperial’s future builds on a distinguished past, having pioneered penicillin, holography and fibre optics. Today, Imperial combines exceptional teaching, world-class facilities and a habit of interdisciplinary practice to unlock scientific imagination.  

https://www.imperial.ac.uk/

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Journal

Addiction

DOI

10.1111/add.70482 

Method of Research

Systematic review

Subject of Research

People

Article Title

Barriers and Facilitators to Detoxification from Opioid Substitution Treatment: A Mixed-Methods Systematic Review

Article Publication Date

18-Jun-2026

 

New study projects thousands of preventable deaths if US federal support for syringe service programs is reduced

Modeling study estimates up to 39,600 additional deaths over five years among people who inject drugs

University of Colorado Anschutz

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Key findings:

• Researchers modeled a variety of scenarios that include 11%-80% cuts to syringe service program funding.

• All-cause mortality increased up to 5.0% across modeled scenarios; overdose mortality increased up to 6.9%.

• The worst-case scenario projected:
• 39,600 additional deaths
• 15,600 additional overdose deaths

• Increased mortality was observed in most analyses

 

AURORA, Colo. (June 18, 2026) – A new study published today in JAMA Network Open projects that reductions in federal funding for syringe service programs (SSPs) could lead to substantial increases in mortality among people who inject drugs in the United States.

Researchers from the University of Colorado Anschutz examined the potential long-term effects of federal funding cuts to SSPs using a microsimulation model representing people who inject drugs nationwide in a variety of funding reduction scenarios over a five-year period. SSPs provide evidence-based harm reduction services, including sterile syringe access, naloxone distribution and wound care as well as provide access to medications for opioid use disorder and connections to health and social services.

“Our findings suggest that disruptions to SSP funding like the ones currently proposed are likely to have serious and measurable consequences for public health,” says Kirk Fetters, MD, infectious disease clinical fellow at CU Anschutz and study co-first author. “Even relatively modest reductions in services will be associated with increased mortality, while sustained, large-scale funding losses could be catastrophic.”

Researchers modeled scenarios in which total SSP funding was cut by 11% and 80%, lower and upper estimates of how much funding comes to SSPs from federal sources across the US. Across all scenarios, all-cause mortality increased 0.1-5%, and overdose mortality increased 0.2-6.9% over five years. In the worst-case scenario, at 80% sustained reduction in federal funding, the model projected 39,600 additional deaths overall among people who inject drugs nationwide, 15,600 of which would be due to overdose.

“These estimates underscore the critical role that SSPs play in preventing overdose deaths and supporting the health of vulnerable populations,” says Josh Barocas, MD, associate professor at CU Anschutz and study senior author. “Policies that reduce access to these services will have far-reaching consequences that extend well beyond the immediate funding cuts themselves and impede our ability to end the overdose crisis. This is a time we should be doubling down on evidence-based strategies to curtail overdoses, not cutting funding.”

The researchers used data from the Centers for Disease Control and Prevention’s National HIV Behavioral Surveillance system and other published sources to create a representative cohort of people who inject drugs across the United States. The study found that increased mortality was observed across most analyses, reinforcing the conclusions that cuts to or restrictions on SSP funding will worsen health outcomes.

“SSPs are a cornerstone of evidence-based harm reduction,” says Pranav Padmanabhan, MPH, epidemiology PhD student at CU Anschutz and study co-first author. “This study provides important data for policymakers evaluating the public health implications of funding decisions affecting overdose prevention and related services.”

 

About the University of Colorado Anschutz
The University of Colorado Anschutz is a world-class academic medical campus leading transformative advances in science, medicine, education and patient care. The campus includes the University of Colorado’s health professional schools, more than 60 centers and institutes, and two nationally ranked independent hospitals - UCHealth University of Colorado Hospital and Children's Hospital Colorado - which see nearly three million adult and pediatric patient visits each year. Innovative, interconnected and highly collaborative, CU Anschutz delivers life-changing treatments, exceptional patient care and top-tier professional training. The campus conducts world-renowned research supported by $890 million in funding, including $762 million in sponsored awards and $128 million in philanthropic gifts for research.

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Journal

JAMA Network Open

DOI

10.1001/jamanetworkopen.2026.19402 

Article Publication Date

18-Jun-2026

 

Legalizing cannabis increases use and addiction – unless it is tightly controlled

Major global analysis finds that removing criminal penalties for cannabis possession is not associated with increased levels of use, but when cannabis can be sold for profit, use, addiction and psychiatric hospital admissions rise.

University of Bath

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Removing criminal penalties for possessing cannabis for personal use, or introducing tightly controlled legalisation of cannabis, does not appear to increase levels of cannabis use.

However, the commercial sale of cannabis is linked to increased health risks, with large-scale for-profit markets – such as those seen in the US and Canada – resulting in more potent products and higher rates of addiction.

These findings are reported in a study published on Wednesday, June 17, in The Lancet Psychiatry led by experts in addiction and mental health at the University of Bath in the UK, together with an international team from the Americas, Europe, Africa, Australia, New Zealand and Asia.

Co-authors Professor Tom Freeman, and Dr Rachel Lees Thorne, both from the Department of Psychology at Bath, say their findings highlight the distinct effects of different policy approaches globally.

Evolving policies around the world

Cannabis policies are rapidly evolving worldwide. Today, they range from strict prohibition to fully commercialised legalisation. The new paper examines global changes in cannabis policy between 2000 and 2025, and how these are linked to changes in cannabis use, cannabis addiction and other psychiatric disorders.

In the UK, cannabis is a Class B controlled drug, with a maximum penalty for possession of up to five years in prison, an unlimited fine, or both. A 2025 report by the London Drugs Commission, commissioned by London Mayor Sadiq Khan, titled The Cannabis Conundrum: a way forward for London, proposed decriminalising possession of cannabis for recreational use.

Such a change could shift the focus from managing cannabis through criminal law enforcement to healthcare, and address the disproportionate level of cannabis policing found in black communities. The findings of this new global analysis indicated that when other countries had decriminalised cannabis, there was little evidence for changes in cannabis use.

Other countries have gone a step further by legalising cannabis. The first country in the world to do this was Uruguay, which today has a tightly controlled approach where adults can access a restricted range of cannabis products from pharmacies (with limits on their potency) as well as cannabis social clubs, or by growing cannabis themselves.

In Uruguay, along with other contexts in which cannabis legalisation is tightly controlled, there is little evidence of changes in cannabis use.

By contrast, in many US states and in Canada, cannabis is legally sold through well-established, for-profit markets, making cannabis widely available. In these commercialised legal markets, use of the drug has increased. Cannabis potency has also increased since the legalisation of commercial sales, along with rates of addiction among adults, characterised by people struggling to stop using the drug despite negative effects on daily life.

Professor Freeman said: “In a rapidly changing global cannabis policy landscape it is increasingly important to ask how policy will change, rather than if it will change at all. The type of policy change is critical.

“We found little evidence for changes in use after decriminalisation or tightly controlled legalisation. By contrast, in Canada and the US, policy changes have been more substantial through commercialised legalisation, which have increased sales and consumption.

“There are now more daily consumers of cannabis than daily consumers of alcohol in the US. What followed commercialised legalisation was a rise in cannabis addiction as well as increases in hospital admissions for psychosis, including cases where psychotic disorders occurred alongside cannabis addiction.

“The emergence of a for-profit cannabis industry can result in commercial interests being prioritised over public health – just as we have seen with the alcohol and tobacco industries. Increased availability of cannabis products, greater product strength and active marketing of these products can increase the risk of harm.

“Alternative policies – such as decriminalisation or strictly regulated legalisation – can remove the harms of criminalising people who use cannabis, while limiting changes in use.”

Medical cannabis

The researchers found that poorly regulated access to medical cannabis, particularly in the absence of clear evidence on its safety and effectiveness, may also increase the risk of harm to people’s health.

The Advisory Council on the Misuse of Drugs is currently reviewing evidence on the impact of the UK’s 2018 legalisation of medical cannabis, including whether it has achieved its desired aims and whether there have been unintended consequences.

Professor Freeman said: “As global cannabis policies continue to evolve, we need to do more to track their impact – particularly in countries outside of the US and Canada, where fewer studies are conducted.”

The new review is part of a collection of papers on cannabis published in The Lancet Psychiatry and led by the University of Bath in collaboration with international partners.

Cannabis products and mental illness

The second review finds evidence that daily cannabis use can act with other risk factors to increase the risk of psychosis, but its role in depression, anxiety and risk of suicidal thoughts or suicide was less clear. 

The third paper synthesises evidence from clinical trials into the use of medical cannabinoids (the active ingredients in cannabis) for the treatment of psychiatric disorders.

Though there is a growing trend to prescribe these substances to treat mental health and substance use disorders, the researchers found little strong evidence of their effectiveness on the basis of the available evidence from clinical trials.

Across 54 trials, limited benefits were found: cannabinoids modestly reduced cannabis withdrawal and use, improved sleep in insomnia, and helped with tics and some autism traits. But they also increased cocaine craving in people with cocaine use disorder and showed no meaningful effect for anxiety, PTSD, psychosis or opioid dependence. There were no trials for the treatment of depression.

ENDS.

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Journal

The Lancet Psychiatry

DOI

10.1016/S2215-0366(26)00087-8 

Method of Research

Systematic review

Subject of Research

People

Article Title

International cannabis policies and their association with cannabis use, cannabis use disorder, and other psychiatric” disorders” published in The Lancet Psychiatry

Article Publication Date

17-Jun-2026