JAMA Network Open

BackgroundThe 340B Drug Pricing Program was established to expand access to care for low-income and uninsured patients by allowing safety-net hospitals and clinics to purchase outpatient drugs at discounted prices. Over time, the program has expanded substantially, raising questions about whether participating hospitals are meeting the programs intended objectives. MethodsUsing 2023 hospital financial data from the RAND Corporation, we conducted cross-sectional descriptive comparisons of 340B a...

BackgroundLong-acting injectable buprenorphine (LAI-BUP) is safe and effective, however is dramatically underutilized in comparison to oral formulations. Little is known regarding how buprenorphine prescribers view LAI-BUP, and which medication attributes they prioritize when selecting treatment for opioid use disorder (OUD). MethodsA secondary analysis of a national, cross-sectional online survey of U.S. physicians who prescribe buprenorphine for OUD was conducted. Respondents reported OUD cas...

Emergency department (ED) triage decisions critically impact patient care and are standardized, yet ethnoracial disparities in triage assignment are well documented. We analyzed ethnoracial differences in triage assignments across four U.S. EDs (two adult, two pediatric), comprising 1.4 million encounters from 2011-2025. To better characterize these disparities, we developed an automated triage algorithm that replicates the Emergency Severity Index (ESI) criteria, the standard triage protocol us...

AimsTo characterize decreases in overdose mortality in the United States between 2023 and 2024 by substance involvement, geography, race/ethnicity, demographic, and other key dimensions. DesignPopulation-based study of national death records. SettingUnited States. Participants/casesAll individuals who died from drug overdose between January 1999 and December 2024. MeasurementsAnnual or monthly (annualized) overdose deaths per 100,000 population. Year and month of occurrence of overdose death...

Alcohol use disorder (AUD) remains a major public health problem, with few effective medications and suboptimal adherence. L-type calcium channel blockers (LTCCBs) have genetic and preclinical support as potential treatments for AUD. We evaluated whether brain penetrant (BP)-LTCCBs are associated with reduced alcohol consumption by conducting two preregistered (https://osf.io/huawv) observational cohort studies using electronic health records (EHRs) from the US Department of Veterans Affairs (VA...

BackgroundThe strength and transparency of clinical trial evidence supporting drug approvals has become increasingly scrutinized, particularly considering the increased use of regulatory flexibility and expedited pathways. While U.S. Food and Drug Administration (FDA) standards have been extensively analyzed, evidence standards at the European Medicines Agency (EMA) remain less well-characterized. Thus, this study aims to systematically assess the design, quality, and outcomes of pivotal efficac...

Background and ObjectivesPatient portals allow adolescents and caregivers of pediatric patients to better engage with health care, improving their medication adherence, health knowledge, self-efficacy, and receipt of preventive care. However, disparities in access to and comfort with using these portals persist. Hospitalization represents a promising opportunity to address these disparities among a high-risk population. Design/MethodsWe conducted a cross-sectional analysis to identify dispariti...

IMPORTANCEAdverse childhood experience (ACE) scores mask substantial heterogeneity within the 2-, 3-, and [≥]4-ACE exposure categories. The magnitude of this heterogeneity has not been sufficiently quantified. OBJECTIVETo quantify and visualise the heterogeneity of ACE scores. DESIGNCross-sectional analysis of the 2023 National Survey of Childrens Health, an address-based, nationally representative survey. SETTINGUS households. PARTICIPANTSA national sample of 385,000 addresses was drawn....

BackgroundA growing population of working-aged men are not in employment, education, or training (NEET). The COVID-19 pandemic increased rates of substance use disorders (SUDs) and affected treatment seeking in the general population, but the COVID era substance use patterns among NEET men are unknown. MethodsWe estimated the prevalence and correlates of NEET status among working-aged (18-64) men using data from the 2022 National Survey on Drug Use and Health, a nationally representative survey...

BACKGROUNDThis study evaluates the reach, scalability, and implementation of a large-scale, multi-site tele-buprenorphine program designed to treat opioid use disorder (OUD) within rural carceral settings. Given that individuals transition frequently between jails and the community, these facilities represent a critical window for OUD intervention, yet they often face significant provider shortages and logistical barriers. We conducted a retrospective chart review of 842 unique patients (1,321 t...

BackgroundRecreational cannabis legalization has expanded rapidly across US states. The regulatory approaches states adopt vary widely, with varying implications for public health. This study aimed to characterize heterogeneity in recreational cannabis laws (RCLs) across US states and to identify state-level characteristics associated with these regulatory models. MethodsWe conducted Latent Class Analysis (LCA) of state-year RCL provisions from 2013 to 2024 (n=612) to identify distinct RCL appr...

BackgroundCo-occurring substance use and mental health disorders (COD) represent a growing public health concern, yet healthcare utilization studies with a large sample size remain limited. This study examined healthcare utilization patterns and sociodemographic correlates among COD adults using data from the All of Us Research Program (2018-2023). MethodsElectronic health record data were analyzed for adults aged [≥]18 years with confirmed diagnoses of substance use and mental health disord...

Background and AimsCocaine use disorder (CUD) is an increasingly widespread concern worldwide. Various pharmacological treatments have been investigated for CUD, but their efficacy remains unclear, and none have been licensed for treatment. Therefore, we assessed the comparative effectiveness, safety, and acceptability of pharmacological interventions for the treatment of CUD and prevention of relapse. DesignSystematic review and network meta-analyses of double-blind randomized controlled trial...

PurposeTo describe the rationale, methods, and baseline sample descriptives of the Adolescent and Young Adult Tracking Engagement and Management Skills (AYA TEAMS) cohort. The AYA TEAMS study is a longitudinal observational cohort study that aims to identify determinants and patterns of self-management and engagement in cancer-related long-term follow-up (LTFU) care and validate a novel transition readiness assessment among adolescent and young adult (AYA) survivors of childhood cancer. Partici...

BackgroundAs cigarette smoking continues declining among youth and young adults, smoking rates among older Americans remain unchanged. Historically, cigarette and, more recently, e-cigarette tax policies influenced smoking behavior in younger smokers. Understanding how older smokers respond to tax changes can inform public health strategies. MethodsWe assembled a quarterly panel of state cigarette and e-cigarette tax rates using the CDC STATE System Tobacco (2000-2024) and E-Cigarette Legislati...

This study aimed to identify drugs disproportionately reported with malignant neoplasm progression, an uncommon but clinically important endpoint, using large spontaneous reporting systems. Public reports were analyzed from the FDA Adverse Event Reporting System (FAERS; 2004Q1-2024Q4) and the Japanese Adverse Drug Event Report database (JADER; 2004-2024). Cases were defined using MedDRA Preferred Terms for malignant neoplasm/tumour progression, and reports in which progression was recorded as an...

BackgroundGabapentin and pregabalin have potential utility for treating alcohol use disorder (AUD), but their comparative effectiveness in reducing alcohol consumption in real-world settings is unknown. We compared changes in alcohol consumption associated with gabapentin or pregabalin treatment with those of matched unexposed comparators. MethodsWe identified patients who were prescribed gabapentin or pregabalin for [≥]60 days for any indication between 1 January 2009 and 30 June 2022 using...

Background and AimsAlcohol use disorder (AUD) remains a major public health concern, with persistent disparities in access to evidence-based treatment. This study aimed to examine associations between perceived discrimination in healthcare settings (PDHS), patient-clinician communication (PCC), and receipt of treatment for AUD, and compared these with sociodemographic and insurance-related factors. DesignCross-sectional analysis using structural equation modeling (SEM), logistic and multinomial...

ImportancePrenatal cannabis exposure is increasing in prevalence, yet its associations with early brain development--particularly how the timing and frequency of exposure across gestation relate to neonatal brain structure--remain insufficiently understood. Clarifying these associations is essential for informing early risk identification and guiding perinatal care. ObjectiveTo examine associations between patterns of maternal prenatal cannabis exposure, including exposure presence, gestational...

Background In the United States, streamlining the kidney transplantation (KT) evaluation process may reduce disparities and barriers to KT access. Prior work showed that the Kidney Transplant Fast Track (KTFT) program shortened this process and reduced racial disparities in waitlisting and overall KT. However, within a setting where evaluation-related structural barriers have been addressed, a comprehensive longitudinal evaluation incorporating sociocultural factors (e.g., medical mistrust, hea...