Following the national implementation of the Affordable Care Act (ACA) in 2014, barriers still exist that limit the adoption of substance use treatment (SUT) services in mainstream health care (MHC) settings in the United States. This study provides an overview of current evidence on barriers and facilitators to integrating various SUT services into MHC. A systematic search was conducted with the following databases: “PubMed including MEDLINE”, “CINAHL”, “Web of Science”, “ABI/Inform”, and “PsycINFO.” We identified barriers and/or facilitators affecting patients, providers, and programs/systems. Of the 540 identified citations, 36 were included. Main barriers were identified for patients (socio-demographics, finances, confidentiality, legal impact, and disinterest), providers (limited training, lack of time, patient satisfaction concerns, legal implications, lack of access to resources or evidence-based information, and lack of legal/regulatory clarity), and programs/systems (lack of leadership support, lack of staff, limited financial resources, lack of referral networks, lack of space, and lack of state-level support). Also, we recognized key facilitators pertaining to patients (trust for providers, education, and shared decision making), providers (expert supervision, use of support team, training with programs like Extension for Community Health Outcomes (ECHO), and receptivity), and programs/systems (leadership support, collaboration with external agencies, and policies e.g., those expanding the addiction workforce, improving insurance access and treatment access). This study identified several factors influencing the integration of SUT services in MHC. Strategies for improving SUT integration in MHC should address barriers and leverage facilitators related to patients, providers, and programs/systems.

Pancreatic ductal adenocarcinoma (PDAC) remains among the most lethal malignancies, with a five-year survival rate below 12%, largely attributable to its asymptomatic onset, late-stage diagnosis, and limited curative treatment options. Although PDAC accounts for approximately 3% of all cancers, it is projected to become the second leading cause of cancer-related mortality in the United States by 2030. A major contributor to its dismal prognosis is the lack of validated early detection strategies for asymptomatic individuals. In this review, we present a comprehensive synthesis of current advances in the early detection of PDAC, with a focus on the identification of high-risk populations, novel biomarker platforms, advanced imaging modalities, and artificial intelligence (AI)-driven tools. We highlight high-risk groups—such as those with new-onset diabetes after age 50, pancreatic steatosis, chronic pancreatitis, cystic precursor lesions, and hereditary cancer syndromes—as priority populations for targeted surveillance. Novel biomarker panels, including circulating tumor DNA (ctDNA), miRNAs, and exosomes, have demonstrated improved diagnostic accuracy in early-stage disease. Recent developments in imaging, such as multiparametric MRI, contrast-enhanced endoscopic ultrasound, and molecular imaging, offer improved sensitivity in detecting small or precursor lesions. AI-enhanced radiomics and machine learning models applied to prediagnostic CT scans and electronic health records are emerging as valuable tools for risk prediction prior to clinical presentation. We further refine the Define–Enrich–Find (DEF) framework to propose a clinically actionable strategy that integrates these innovations. Collectively, these advances pave the way for personalized, multimodal surveillance strategies with the potential to improve outcomes in this historically challenging malignancy.

Background: The impact of multiple substance use on the risk of pancreatitis remains underexplored. Objective: To systematically review peer-reviewed observational studies assessing the association of multiple substance use with the risk of acute pancreatitis (AP) or chronic pancreatitis (CP) in adults. Design: We conducted a systematic review informed by the Preferred Reporting Items for Systematic Review and Meta-Analyses guideline. Data sources and methods: EMBASE, MEDLINE, and PsycINFO were searched up to March 2024. Reference lists of included studies were reviewed. From 5205 records identified, 181 relevant records were evaluated in full text. Studies evaluating the association of ⩾2 substances, including tobacco, alcohol, cannabis, and illicit substances, with AP or CP were included. Data were extracted by one reviewer, with quality control by a second reviewer. Quality assessments were independently conducted by two reviewers, with differences resolved by a third. Results: Of 11 included studies, 6 investigated AP as the outcome and 5 examined CP. Among AP studies, 5 comparing smoking and alcohol to alcohol-only use showed high heterogeneity ( I ² = 90.9%), with relative risks (RRs) from 1.40 to 11.40. One study examining cannabis and alcohol versus alcohol found a lower risk of AP in cannabis users. Among CP studies, four comparing smoking and alcohol to alcohol-only use were heterogeneous ( I ² = 81%) with odds ratios 1.21–31.50. Where examined, smoking increases the risk of AP and CP in a dose-dependent fashion. Heavy alcohol users demonstrated a significant increase in CP risk across all smoking categories in one study. Conclusion: Combined alcohol and tobacco use increases pancreatitis risk compared to single substance use, despite heterogeneity in RRs and exposure definitions. Evidence suggests a dose-dependent impact of smoking on pancreatitis risk when added to alcohol. Studies on the impact of a combination of other substance use on pancreatitis risk are needed. Trial registration (PROSPERO): CRD42024503677.

Background: An effective treatment for Opioid Use Disorder is Medication-Assisted Treatment (MAT). However, in the United States (US), this is still being underutilized by youth. Research indicates the need to develop strategies to reduce treatment barriers among these youth. Thus, we explored the rates of treatment completion and dropout among youth receiving MAT in US substance use treatment facilities and examined factors associated with treatment completion and dropout. Methods: This study used the 2019 Treatment Episode Data Set—Discharges. Our analysis was restricted to youth (12–24 years) who primarily used heroin at admission. Log-binomial regression was used to examine various determinants of treatment completion and dropout, guided by Andersen’s Behavioral Model. Results: The final sample size was 4917. Among youth reporting heroin use with receipt of MAT, those showing a higher likelihood of treatment completion than dropout were males [ARR: 1.23; 95% CI: 1.088–1.381; p = 0.0008], had 1–7 times [ARR: 1.33; 95% CI: 1.115–1.584; p = 0.0015] and 8–30 times self-help group participation [ARR: 1.50; 95% CI: 1.246–1.803; p < 0.0001], had co-occurring mental and substance use disorders [ARR: 1.28; 95% CI: 1.133–1.448, p < 0.0001], were admitted to detoxification [ARR: 2.80; 95% CI: 2.408–3.255; p < 0.0001] and residential/rehabilitation settings [ARR: 2.05; 95% CI: 1.749–2.400; p < 0.0001], and were located in the Midwest/West [ARR: 1.18; 95% CI: 1.030–1.358; p = 0.0173]. Conversely, other races (excluding Whites and Blacks/African Americans) [ARR: 0.75; 95% CI: 0.609–0.916; p = 0.0051], those who used MAT [ARR: 0.81; 95% CI: 0.694–0.946; p = 0.0077], and youth in the South [ARR: 0.45; 95% CI: 0.369–0.549; p < 0.0001] were less likely to report treatment completion than dropout. Conclusions: The majority of youth receiving MAT dropped out of treatment. We identified various factors that should be prioritized to address youth underutilization of MAT in the US.

Objectives: Smoking increases the risk of the first episode of acute pancreatitis (AP), its recurrence, and progression to chronic pancreatitis. Co-use of cigarettes with marijuana may exacerbate health risks, complicating pancreatitis management. Our study aims to investigate the lifetime smoking history and co-use of cigarettes and marijuana in AP patients. Materials and Methods: We analyzed smoking history and marijuana use data from a multicenter case-crossover study of alcohol-associated AP patients (n = 145) recruited from June 2020 to June 2024. Lifetime cigarette use was categorized as: history of smoking <1 pack per day (PPD), ≥1 PPD, and nonsmokers. Age-based smoking prevalence was estimated across 2 birth cohorts (1956–1979 and 1980–1998). Risk factors for co-use were also assessed. Results: Of the 143 participants enrolled and who completed smoking history interview, 76% were current smokers and 24% were former smokers. Median cumulative pack-years of smoking until enrollment was 20.4 years in ≥1 PPD smokers versus 4.2 years in <1 PPD smokers ( P < 0.001). Peak smoking prevalence was higher in females born in 1980–1998 than females born in 1956–1979 (100% vs 67%), while males showed an opposite trend (61% for 1956–1979 vs 52% for 1980–1998). Of all participants, 20% reported co-use of cigarettes and marijuana, 22% cigarette-only use, and 14% marijuana-only use. Trauma and stressor-related disorders were associated with a lower likelihood of co-use than cigarette-only use (AOR: 0.19, 95% CI: 0.05–0.63, P = 0.010). Conclusions: Smoking is highly prevalent in patients with alcohol-associated AP, many of whom also use marijuana. Tailored smoking cessation interventions are needed for AP patients.

Background: Chronic pancreatitis (CP) is a progressive fibroinflammatory disease associated with substantial long-term morbidity. Synthesized evidence on mortality remains limited. Objectives: To systematically review all-cause and cause-specific mortality in adults with CP compared with individuals without CP. Design: This systematic review of observational studies adhered to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Data sources and methods: We searched PubMed, Web of Science, Embase, Scopus, and Cochrane Central Register of Controlled Trials from database inception to May 29, 2025. Reference list screening, citation tracking, and targeted author- and consortium-based searches were also conducted. Eligible studies included adults with CP that reported mortality outcomes with a non-CP comparator. Data extraction was conducted by one reviewer while another confirmed accuracy. Quality assessment was done by two independent reviewers and conflicts resolved by a third reviewer. Narrative synthesis was done due to high heterogeneity across studies. Results: Of 11,957 records screened through title and abstract, 347 underwent full-text review, and 12 met inclusion criteria. Four additional studies were found through reference list, citation tracking, and targeted searches, yielding a total of 16 included studies with cohort design. Across seven comparative studies, CP was consistently associated with higher all-cause mortality, with standardized mortality ratios ranging from 1.20 to 5.50 and hazard ratios ranging from 1.25 to 5.00. Malignancy was the most frequently reported cause of death. Other causes included cardiovascular, suicide, infectious, liver-related, gastrointestinal, endocrine, renal, respiratory, and accidental. Conclusion: CP is associated with excess all-cause mortality and a broad cause-specific mortality burden extending beyond pancreas-related complications alone. These findings support recognizing CP as a systemic, high-risk chronic disease and highlight the need for more consistent mortality reporting and better-designed studies to clarify which patients are at highest risk. Registration (PROSPERO): CRD420251041174.