Sarah Rosenwohl-Mack

Background: Methadone is effective for treating opioid use disorder (OUD) but must be accessed through federally regulated opioid treatment programs (OTPs). Geographic scarcity, waitlists, and limited intake schedules can delay OTP enrollment, causing patients to miss treatment opportunities. Regulations permit non-OTP practitioners to provide up to three days of methadone to bridge patients to OTP enrollment. This study evaluates the rates of linkage to and early retention in an OTP after initiation of three-day methadone at a Bridge Clinic. Methods: We conducted a retrospective case series of all patients who initiated methadone under the three-day rule at the San Francisco General Hospital Bridge Clinic between June 2024 and July 2025. The hospital also houses an OTP in the same building, which referred patients to Bridge who were unable to complete an intake at the OTP. Outcomes included linkage to OTP care within seven days and retention at 30 days. Safety monitoring included review of all urine drug screens that were either positive for methadone or negative for non-prescribed opioids, emergency department visits, hospitalizations within seven days, and Medical Examiner overdose reports. Multivariable logistic regression examined the association between referral from an OTP to Bridge Clinic and 30-day retention. Results: Among 166 unique patients who received at least one dose of three-day methadone, 63% percent (104/166) linked to an OTP within seven days. Among patients who linked within seven days, 62% (64/104) were retained at 30 days. Referral from the OTP to Bridge clinic was associated with 3.1-fold increased odds of 30-day retention. No methadone-related emergency department visits, hospitalizations, or deaths within 30 days of receipt of methadone were observed. Medical record review of unexpected urine drug screen results revealed that one patient was already enrolled in methadone treatment prior to receiving a dose. Conclusions: Initiating methadone in a low-threshold Bridge Clinic is feasible for engaging patients in OTP care. Referral from OTP to Bridge Clinic was associated with improved treatment retention. Trial registration: Not applicable.

Artificial intelligence (AI) is embedded in addiction scholarship, not only as a methodological tool in research but also as a tool for manuscript preparation. In addiction research and clinical care, AI is already used to analyze data and support clinical decision-making. In parallel, AI tools are increasingly used to summarize literature, revise prose, generate outlines, draft text, and assist with interpretation and presentation of findings. These developments create an urgent need for addiction journals to clarify how AI use should be governed and disclosed. In this editorial, we argue for a principled, proportionate framework for AI disclosure grounded in materiality. We distinguish AI used in the conduct of research from AI used in manuscript preparation and propose a practical taxonomy of assistive, intermediate, and generative AI mapped onto 6 escalating levels of involvement. We identify intermediate AI as a key governance challenge because it may appear to provide editorial assistance while materially shaping scholarly content. We argue that disclosure should be required when AI materially contributes to the conduct of research or to the intellectual content, interpretation, argument, or presentation of a manuscript, while routine low-risk assistive uses should not require disclosure. Transparent governance, organized around materiality rather than specific technologies, is the appropriate response to AI in addiction publishing.

Background Methadone is effective for treating opioid use disorder (OUD) but must be dispensed through federally regulated opioid treatment programs (OTPs). Geographic scarcity, waitlists, and limited intake schedules can delay OTP enrollment, causing patients to miss treatment opportunities. Regulations permit non-OTP practitioners to provide up to three days of methadone to bridge patients to OTP enrollment. This study evaluates the rates of linkage to and early retention in an OTP after initiation of three-day methadone at a Bridge Clinic. Methods We conducted a retrospective case series of all patients who initiated methadone under the three-day rule at the San Francisco General Hospital Bridge Clinic between June 2024 and July 2025. The hospital also houses an OTP in the same building, which referred patients who were unable to complete intake. Outcomes included linkage to OTP care within seven days and retention at 30 days. Safety monitoring included review of all urine drug screens with either positive for methadone or negative for non-prescribed opioids, emergency department visits, hospitalizations within seven days, and Medical Examiner overdose reports. Multivariable logistic regression examined the association between OTP referral and 30-day retention. Results Among 166 unique patients who received at least one dose of three-day methadone, 63% percent (104/166) linked to an OTP within seven days. Among patients who linked within seven days, 62% (64/104) were retained at 30 days. Referral from OTP to Bridge clinic was associated with 3.1-fold increased odds of 30-day retention. No methadone-related emergency department visits, hospitalizations, or deaths within 30 days of receipt of methadone were observed. Medical record review of unexpected urine drug screen results revealed that one patient was already enrolled in methadone treatment prior to receiving a dose. Conclusions Initiating methadone in a low-threshold Bridge Clinic is feasible for engaging patients in OTP care. Referral from OTP to Bridge Clinic was associated with improved treatment retention. Trial registration: not applicable

Background: Buprenorphine is an effective treatment for opioid use disorder, but it can be challenging to avoid withdrawal in the process of buprenorphine initiation. After the recent FDA approval of 7-day long-acting injectable buprenorphine, some clinicians have used this formulation to start patients on buprenorphine without a prior sublingual “test dose.” Very little is known about the feasibility of this practice in an outpatient setting. Cases: In this case series, we conducted a retrospective chart review of electronic health record data for all patients who were ordered 7-day long-acting injectable buprenorphine for a “direct-to-inject” initiation within a single public health system from January 1, 2024 to November 15, 2024. We excluded patients who received a cumulative dose of 4 mg or more of sublingual buprenorphine in the 24 hours before injection. We reported on chart-documented patient experiences after injection, whether patients returned to care, and retention on buprenorphine at 7- and 30-days post-injection. We identified 21 unique patients who received direct-to-inject buprenorphine in 22 attempts. In 17 (77%) attempts, the patient received no buprenorphine in the preceding 24 hours. In 5 (23%) attempts, patients received some buprenorphine in the preceding 24 hours (<4 mg) and/or had evidence of buprenorphine in a same-day urine drug screen. Patient experiences post-injection fit into 1 of 3 themes: “It felt fine” (n = 6), “I felt unwell but okay” (n = 13), and “It felt very rough” (n = 3). Most attempts resulted in buprenorphine treatment retention at 7 days (n = 17, 77%) and 30 days (n = 16, 73%) after injection. Discussion: Direct-to-inject buprenorphine was generally well tolerated, with excellent retention on buprenorphine at 7- and 30 days post-injection. Further research is needed to evaluate the correlation between preinjection patient characteristics (time since last use, level of withdrawal) and post-injection patient experience of withdrawal.

Objectives: Many older homeless adults maintain contact with family. We conducted a qualitative study examining the role of family caregiving for older homeless adults. Method: We conducted semi-structured qualitative interviews with a sample of 46 homeless participants who reported spending at least one night with a housed family member in the prior 6 months. Results: A total of 13 of 46 older adult participants provided caregiving. Themes included (a) the death of the care recipient led to the participant’s homelessness; (b) feeling a duty to act as caregivers; (c) providing care in exchange for housing; (d) caregivers’ ability to stay was tenuous; (e) providing care conflicted with the caregiver’s needs; and (f) resentment when family was ungrateful. Discussion: In a sample of older homeless adults in contact with family, many provided caregiving for housed family. For some, caregiving precipitated homelessness; for others, caregiving provided temporary respite from homelessness, and for others, caregiving continued during homelessness.