Background: An increase in opioid use has led to an opioid crisis during the last decade, leading to declarations of a public health emergency. In response to this call, the Houston Emergency Opioid Engagement System (HEROES) was established and created an emergency access pathway into long-term recovery for individuals with an opioid use disorder. A major contributor to the success of the program is retention of the enrolled individuals in the program. Methods: We have identified an increase in dropout from the program after 90 and 120 days. Based on more than 700 program participants, we developed a machine learning approach to predict the individualized risk for dropping out of the program. Results: Our model achieved sensitivity of 0.81 and specificity of 0.65 for dropout at 90 days and improved the performance to sensitivity of 0.86 and specificity of 0.66 for 120 days. Additionally, we identified individual risk factors for dropout, including previous overdose and relapse and improvement in reported quality of life. Conclusions: Our informatics approach provides insight into an area where programs may allocate additional resources in order to retain high-risk individuals and increase the chances of success in recovery.

Opioid use in women has increased by 300% since 1999, and opioid use disorder among pregnant women has quadrupled. The stigma of substance use disorder is a significant barrier to treatment, especially among women. The purpose of this study was to explore the experiences and perceptions of stigma among mothers and the underlying themes. (1) Background: To understand the stigmatization of women with substance use disorders, we interviewed mothers in recovery from opioid use disorder. (2) Methods: Qualitative methods and descriptive analysis was used to extrapolate themes related to the experienced stigma. (3) Results: A total of 20 mothers in recovery from opioid use disorder were interviewed and three main themes emerged from the data: internal stigma, external stigma, and healing from stigma. (4) Conclusion: The examination of stigma is important in reducing its effect on all individuals with substance use disorders, and it is important to understand gender inequities.

Background: Financial sustainability remains a central challenge for U.S. hospitals as rising operating costs, shifting federal reimbursement, and policy uncertainty intensify economic pressures. This study estimates the prevalence and recent changes in financial distress among U.S. short-term acute care hospitals. Methods: We conducted a national longitudinal analysis of all U.S. short-term acute care hospitals from 2021 to 2023 using financial and operational data from Medicare cost reports linked with community-level data from the American Community Survey. Financial distress was measured using the Altman Z-score, with severe distress defined as Z ≤ 1.8. Logistic regression models were used to identify organizational, operational, and market characteristics associated with distress. Results: The proportion of hospitals classified as severely financially distressed increased from 18.6% in 2021 to 22.0% in 2023. Operating margins and returns on assets declined significantly over the study period, while mean Z-scores showed a modest but non-significant downward trend. In adjusted models, urban hospitals had higher odds of distress (OR 1.27, 95% CI 1.15–1.40, p < 0.001), as did hospitals with longer average lengths of stay (OR 1.07 per day, 95% CI 1.04–1.09, p < 0.001) and higher debt-to-equity ratios (OR 1.05 per unit, 95% CI 1.05–1.06, p < 0.001). Higher occupancy rates were protective (OR 0.31, 95% CI 0.25–0.40, p < 0.001). Larger market population was also associated with increased distress risk (OR 1.61, 95% CI 1.21–2.14, p = 0.001), while other market characteristics were not significant. Conclusions: Financial distress remains widespread and appears to be increasing among U.S. acute care hospitals. Operational efficiency, capital structure, and local market scale are key drivers of financial vulnerability, highlighting the need for targeted strategies to strengthen hospital resilience and preserve access to essential acute care services.

Criminal justice system (CJS) involvement is common among individuals with opioid use disorder (OUD), yet limited research examines retention in medications for OUD (MOUD) within community settings. This study assessed whether CJS involvement predicted retention on buprenorphine/naloxone and explored related demographic and clinical factors. A retrospective cohort included adults (n = 367) enrolled in a low-barrier outpatient MOUD program in Texas (January 2022–April 2024). CJS involvement was identified from program records. Retention was measured as the number of continuous days with buprenorphine/naloxone prescriptions. Analyses used univariate tests, logistic regression, and nonparametric kernel regression. Nearly one-quarter (24.8%) were CJS-involved. Retention at 180 days was similar between CJS and non-CJS groups (38%). CJS participants initiated substance use earlier and reported higher heroin and injection drug use. Behavioral health sessions were associated with both CJS involvement (OR = 1.10, p ≤ 0.001) and longer retention (β = 10.81 days/session, p = 0.001). With comprehensive, low-barrier services, individuals involved with CJS achieved MOUD retention comparable to their peers. Early behavioral health engagement was a strong predictor of retention, suggesting a key intervention point to enhance outcomes and advance equity for justice-involved populations.

Background/Objectives: School-age athletes occupy a paradoxical position in the adolescent opioid crisis, combining health-oriented activity with elevated risk of sports-related injury and prescription opioid exposure. In response to the opioid epidemic, states enacted opioid prescribing limit laws (OPLLs) beginning in 2016–2017, yet whether these supply-side policies reached high-risk youth subgroups remains unclear. This study evaluated national temporal trends in prescription opioid misuse among U.S. high school students during the period of OPLL implementation and examined differences across athletic participation, concussion history, sex, grade, race/ethnicity, and substance-use profiles. Methods: Using four biennial waves of the Youth Risk Behavior Surveillance System with a consistent prescription pain-medicine measure (2017, 2019, 2021, and 2023; total N = 44,501), we conducted survey-weighted multivariable logistic regression models producing adjusted odds ratios (aORs) for lifetime prescription opioid misuse, controlling for survey year, sports participation, sex, grade, race/ethnicity, alcohol use, and other illicit drug use. Interaction and stratified models examined differences associated with sports participation, concussion history, demographic characteristics, and substance use. Results: Weighted prescription opioid misuse declined from 13.9% in 2017 to 12.0% in 2023, with a significant unadjusted linear decline per two-year survey wave (OR = 0.936; 95% CI: 0.879–0.997; p = 0.040). This overall trend was attenuated after adjustment (aOR = 0.967; 95% CI: 0.914–1.024; p = 0.248). Temporal patterns differed significantly across race/ethnicity, sex, grade, and selected substance-use groups. White and male students demonstrated significant adjusted linear declines, whereas Hispanic/Latino and female students remained flat. Black/African American students showed significant year-to-year variation, with elevated adjusted odds in 2019 and 2021 relative to 2017. Concussion history was independently associated with misuse among athletes (aOR = 1.645; 95% CI: 1.417–1.909; p < 0.001), with significant associations observed among White, Asian, Black/African American, and Hispanic/Latino athletes. The pooled concussion-by-race/ethnicity interaction, however, was not significant (p = 0.295). Conclusions: Although prescription opioid misuse declined descriptively between 2017 and 2023, adjusted analyses did not identify a significant overall national temporal change. Since subgroup patterns diverged, prevention planning and surveillance should be disaggregated by race/ethnicity and sex rather than guided by national totals, and groups whose misuse did not decline may require strategies extending beyond clinical prescribing controls.