Medications for opioid use disorder (MOUD) reduce overdose mortality, yet most individuals with opioid use disorder receive no pharmacotherapy. Facility-level health information technology may reflect broader organizational capacity, but it has rarely been examined as a marker associated with readiness to offer evidence-based opioid care. This cross-sectional secondary analysis of the 2024 National Substance Use and Mental Health Services Survey (N-SUMHSS) Public Use File included a base sample of 20,813 substance use disorder treatment facilities and used complete-case adjusted logistic regression to examine whether exclusive electronic health record (EHR) use, defined as reliance on an EHR with no paper charts, was associated with the availability of buprenorphine, naltrexone, take-home naloxone with overdose education, and co-occurring opioid use disorder services. Models adjusted for ownership, program focus, opioid treatment program (OTP) registration, and financial access characteristics; federally regulated OTP methadone availability served as a regulatory contrast. Among facilities with valid EHR responses (n = 16,107), 68.3% reported exclusive EHR use. Exclusive EHR use was associated with higher adjusted odds of buprenorphine (aOR = 3.05), naltrexone (aOR = 2.90), take-home naloxone with overdose education (aOR = 3.18), and co-occurring services (aOR = 2.33), and more weakly with federally regulated OTP methadone availability (aOR = 1.23). Exclusive EHR use is an organizational marker associated with service availability, but the cross-sectional design and potential residual confounding preclude causal conclusions about whether EHR investment would expand opioid treatment access.

Climate-related disasters can disrupt health-care delivery and treatment continuity. Evidence on their effects on opioid dispensing in middle-income countries remains scarce. We assessed whether the May 2024 floods were associated with changes in outpatient opioid dispensing in Rio Grande do Sul, Brazil.

This study aimed to compare the analgesic efficacy of methadone and fentanyl infusions at a 50:1 dose rate in dogs after spinal surgery.

Interpretation of post-mortem drug concentrations remains a major challenge in forensic toxicology because factors, including post-mortem redistribution, drug tolerance, polypharmacy and inter-individual variability, limit the utility of fixed therapeutic, toxic or purportedly fatal concentration thresholds. Using data from the National Programme on Substance Use Mortality (NPSUM), we examined post-mortem blood drug concentrations within a population-based epidemiological framework. Quantitative concentration data were available for 93 psychoactive substances reported to NPSUM up to 1 November 2022. Concentrations were stratified by age, sex, ethnicity, prescription status, drug involvement in death and co-detection with other substances. Four exemplar drugs representing distinct pharmacological classes and toxicological profiles were selected for detailed evaluation: methadone, diazepam, 3,4-methylenedioxymethamphetamine (MDMA) and quetiapine. Quantifiable concentrations were available in 4514 methadone, 3482 diazepam, 540 MDMA and 677 quetiapine cases. Across all four drugs, concentration distributions demonstrated substantial variability and extensive overlap between deaths in which the drug was implicated and those in which it was not. Although some substances showed higher median concentrations in implicated cases, no concentration threshold reliably differentiated drug-related from non-drug-related deaths. Demographic stratification altered concentration distributions but did not materially improve discrimination. These findings suggest that extensive overlap in post-mortem drug concentrations is a fundamental characteristic of forensic toxicology data. Population-based concentration distributions provide important contextual information but should be interpreted within a holistic framework that incorporates pathological findings, clinical history, co-administered substances and the circumstances of death.