SciBits

Psychedelic-Assisted Psychotherapy for the Treatment of PTSD: A Systematic Review and Meta-Analysis

1. This systematic review included 11 randomized controlled trials with 358 participants evaluating MDMA, ketamine or cannabidiol-assisted interventions for PTSD.
2. Eight trials contributed to meta-analyses, with the evidence base dominated by studies of MDMA-assisted psychotherapy.
3. MDMA-assisted psychotherapy produced a significant moderate-to-large reduction in PTSD symptom severity with negligible heterogeneity.
4. Participants receiving MDMA-assisted psychotherapy were also more likely to achieve clinical response and loss of PTSD diagnosis; pooled ketamine effects were small and non-significant.
5. The interventions were generally well tolerated, but heterogeneous safety data and sparse evidence for ketamine and cannabidiol limit comparative or implementation conclusions.

Psychedelic Use and Missed Needed Mental Health Treatment: Gender Differences in Unmet Perceived Need for Care

1. This study analyzed pooled US National Survey on Drug Use and Health data from 2008–2019 to examine psychedelic use and unmet perceived need for mental health treatment.
2. The analytic framework used a large population dataset (N=458,372) and logistic regression models of lifetime psychedelic exposure and missed needed care.
3. Psychedelic use was not independently associated with lower odds of missing needed treatment after accounting for psychological distress.
4. Prior psychedelic use was associated with a weaker relationship between increasing distress and missed care, particularly among men.
5. Among women, a comparable moderating pattern was identified only for MDMA, indicating heterogeneous associations by gender and substance rather than a uniform effect on treatment engagement.

Association of Internet use disorder and the use of traditional watches

1. This cross-sectional online survey of 6,615 participants examined associations between everyday timekeeping habits and problematic Internet use measured with the CIUS.
2. Higher CIUS scores were found among people who reported excessive or prolonged Internet use after checking the time on their smartphone.
3. Not wearing a traditional watch, using a smartphone as an alarm clock, taking it into the bedroom and going online immediately after waking were also associated with higher CIUS scores.
4. Earlier first smartphone use in the morning significantly predicted problematic use, whereas the last smartphone use before bedtime did not.
5. Non-connected watches and alarm clocks may reduce smartphone-triggered online behavior, but the cross-sectional design cannot establish that changing timekeeping devices prevents Internet use disorder.

Cannabis use disorder in patients prescribed medical cannabis—Should we consider prescription cannabis use disorder as a new diagnostic condition?

1. This secondary analysis of the Australian CAMS22 survey included 2,054 adults who had used prescribed medical cannabis during the previous 12 months.
2. Of participants, 986 (48%) reported using cannabis only as prescribed, while 1,068 (52%) also used cannabis outside prescribed conditions.
3. Applying a 9-item prescription-CUD framework to as-prescribed users and standard 11-item DSM-5 criteria to others yielded 31.2% with any CUD and 11.7% with moderate–severe CUD.
4. Among as-prescribed users, prevalence fell from 20% to 9% for any CUD and from 5% to 2% for moderate–severe CUD when tolerance and withdrawal were excluded.
5. The findings suggest that standard DSM-5 CUD criteria may overestimate disorder in patients adhering to medical-cannabis prescriptions because expected pharmacological tolerance and withdrawal do not necessarily indicate impaired control or harm.

The Multilevel Effects of Political Orientation and Political Climate on Substance Use Among Adolescents

1. This multilevel observational study surveyed 11,114 Dutch-speaking Belgian students aged 14–18 across 44 secondary schools.
2. The study examined associations between individual political orientation, school-level political climate, and alcohol, cannabis, cigarette and e-cigarette use.
3. In this sample, left-wing orientation was associated with lower substance use, whereas radical-right orientation was associated with higher use.
4. There was no main effect of a left-wing school climate, but cross-level interactions indicated that associations between individual orientation and substance use varied by school context.
5. The strongest association with higher substance use was observed for radical-right-oriented adolescents in radical-right school climates; the cross-sectional observational design does not establish that political orientation or climate causes substance use.

Clinical guidance on the use of esketamine nasal spray for patients with treatment resistant depression: A European Delphi consensus report

1. This three-round modified Delphi study obtained ≥80% consensus from 30 European psychiatrists experienced in treating treatment-resistant depression with esketamine nasal spray.
2. During the acute phase (4–12 weeks), even modest or subjective improvement in core symptoms was considered sufficient to support continuation, particularly in highly treatment-resistant or chronic illness.
3. The panel supported optimizing esketamine dose and frequency up to 84 mg weekly when needed during the acute phase, alongside individualized treatment strategies.
4. During continuation (6–9 months), monitoring should include residual and fluctuating symptoms, symptom severity, functional recovery and comorbidity; persistent symptoms may justify dose/frequency escalation.
5. Long-term maintenance beyond 12 months should be individualized according to worsening during tapering, relapse consequences, episode chronicity, residual symptoms and recurrence history, with psychotherapy and other treatments integrated throughout.

Efficacy and safety of pharmacological interventions for the treatment of cocaine use disorder: A systematic review and network meta-analysis

1. This systematic review and network meta-analysis included 218 reports from 163 double-blind randomized trials involving 14,871 adults with cocaine use disorder.
2. The review assessed 89 medications grouped into eight pharmacological categories across abstinence, cocaine use, craving, retention, adherence, safety and mortality outcomes.
3. Most individual study results had some concerns or high risk of bias, and certainty for the network-meta-analysis estimates was generally rated very low.
4. No medication or pharmacological class produced consistent beneficial effects across the major effectiveness outcomes, and there was little evidence that effects differed by intervention type or comorbidity.
5. The authors conclude that current randomized evidence provides no convincing support for any pharmacological treatment for cocaine use disorder, underscoring the need for better-designed trials and more reliable evidence.

Blinding integrity in psychedelic research: Evidence from a comparative randomized controlled trial of psilocybin, MDMA, and methylphenidate in healthy volunteers

1. This double-blind randomized trial evaluated blinding in 120 healthy volunteers assigned to psilocybin, MDMA or methylphenidate as an active placebo, with 40 participants per group.
2. Overall blinding was insufficient: participant Bang blinding indices indicated strongest functional unblinding for psilocybin (0.89), intermediate unblinding for MDMA (0.48) and lowest for methylphenidate (0.25).
3. Weighting correct guesses by participants’ certainty reduced the corresponding indices to 0.77, 0.40 and 0.20, but preserved the same gradient.
4. Methylphenidate functioned better as an active placebo for MDMA than for psilocybin, while prior experience with the substances did not significantly improve forced-choice identification accuracy.
5. The findings show that distinctive subjective drug effects can compromise masking in psychedelic trials and support routine, multidimensional assessment and transparent reporting of blinding integrity.

Cannabis use settings matter: National-level prevalence rates, correlates, and consequences of solitary cannabis use among high school students in Norway

1. Two nationally representative Norwegian surveys included 973 high-school students reporting past-year cannabis use.
2. Almost all reported social cannabis use, but 24.3% also used cannabis alone.
3. Solitary users reported substantially more negative consequences than social-only users (5.41 vs 2.89).
4. Solitary use remained associated with harms after adjustment for cannabis frequency, including mental-health (aOR 1.7), apathy (2.1), relationship (2.1), school (1.8) and law-enforcement problems (2.2).
5. Cannabis-use setting may therefore provide prevention-relevant information beyond frequency alone.

Cannabinoid neuropharmacology across the lifespan: how aging recalibrates risk and benefit

1. This Hot Topic article argues that cannabinoid effects in older adults cannot be reliably extrapolated from younger populations.
2. US past-year cannabis use among adults aged ≥65 has risen almost 20-fold over two decades, and about one-third of older users meet CUD criteria in cited data.
3. Age-related reductions in CB1-receptor availability may alter cognitive responses to THC, while reduced cardiovascular reserve may increase tachycardia, orthostatic hypotension and fall risk.
4. Increased adiposity, reduced hepatic blood flow and altered metabolism may prolong exposure to THC and 11-OH-THC; route of administration further modifies exposure.
5. The authors call for age-, dose-, route- and outcome-specific controlled studies because current late-life guidance remains largely observational.

Understanding the causal effect of migration on psychosis risk

1. This conference abstract addresses why migration is consistently associated with increased psychosis risk.
2. It contrasts selection effects—greater premigration vulnerability—with causal migration-related exposures such as social adversity, discrimination and environmental stress.
3. The presented approach uses the EU-GEI WP2 case-control study of first- and second-generation migrants and non-migrants with and without first-episode psychosis.
4. Analyses are designed to account for underlying vulnerability while comparing migrant status and ancestry.
5. The abstract describes the causal question and study framework but does not report numerical results, so no conclusion about the predominant mechanism can be drawn from it.

Environmental enrichment as a tractable approach to promoting psychiatric resilience across the lifespan

1. This Hot Topics article argues that psychiatry has studied adverse environments far more extensively than protective environmental enrichment.
2. Rodent enrichment combines physical, cognitive and social stimulation with novelty and exploration and reduces stress-related, depression-like, anxiety-like and drug self-administration behaviors.
3. Enriched housing improves learning and memory by about 10% overall and by about 25% in stressed animals, while promoting cortical and hippocampal plasticity.
4. Preliminary human data link within-person increases in physical stimulation and exploration with improved affective well-being in adolescents and young adults.
5. The authors propose operationalizing human enrichment through measures such as green space, walkability, intellectual hobbies, school engagement, peer connectedness and environmental novelty.

Change in alcohol consumption among French adults participating in Dry January: A 9-month prospective cohort study

1. This prospective cohort followed 1,886 French adults participating in Dry January 2024 through 1-, 3- and 9-month assessments.
2. AUDIT-C scores fell substantially by three months (Cohen’s d=0.68) and remained below baseline at nine months (d=0.57), despite some rebound.
3. Reductions occurred across all baseline drinking-risk groups and were larger among hazardous or harmful drinkers than among low-risk drinkers.
4. Recognizing one’s own drinking as excessive was the most consistent baseline predictor of later reductions in frequency, quantity and heavy episodic drinking.
5. The observational design cannot establish causality, but participation in Dry January was associated with moderate reductions in alcohol consumption sustained for up to nine months.

Associations of cannabis, alcohol, and tobacco use combinations with sleep health

1. An online national survey examined cannabis, alcohol and cigarette use in 518 adults and related use patterns to multidimensional sleep health.
2. Participants comprised cannabis-only users (25%), alcohol+cannabis users (45%), cigarette+cannabis users (12%) and users of all three substances (19%).
3. Higher CUDIT-R scores were associated with poorer Pittsburgh Sleep Quality Index scores (β=0.09) and greater daytime sleepiness (β=0.16).
4. Compared with cannabis-only use, use of cannabis, alcohol and cigarettes together was associated with worse sleep quality, insomnia, daytime sleepiness and lower sleep satisfaction.
5. The findings suggest that polysubstance use may be more informative for sleep health than cannabis use alone, although the cross-sectional design precludes causal conclusions.

Identifying factors that contribute to burnout and resilience among hospital-based addiction medicine providers: A qualitative study

1. This qualitative study interviewed 26 multidisciplinary clinicians from addiction consultation services at 12 US hospitals about burnout and resilience.
2. Three major themes emerged: systemic barriers promoted burnout, meaningful addiction work promoted resilience, and team dynamics could either protect against or worsen burnout.
3. Administrative obstacles, inadequate community resources and structural barriers to addiction treatment were recurrent sources of frustration.
4. Providers described meaningful patient work, supportive colleagues, debriefing difficult encounters and advocacy as important sources of resilience.
5. The authors suggest structured team debriefings and advocacy training as potentially useful organizational strategies for sustaining the hospital addiction workforce.

Do values and political attitudes affect help-seeking? Exploring reported help-seeking for mental health problems in a general population sample using a milieu framework

1. A representative German cross-sectional survey of 3,042 adults examined whether value- and attitude-based social milieus were associated with previous mental-health help-seeking.
2. Membership in a cosmopolitan-intellectual milieu was associated with greater reported use of psychotherapy/psychological help (OR=2.09, 95% CI 1.11–3.93).
3. The same milieu was also associated with greater primary-care help-seeking for mental-health problems (OR=2.21, 95% CI 1.15–4.24).
4. Individualist and conservative milieu groups reported less psychotherapeutic help-seeking, while differences were not observed for general-practitioner help-seeking.
5. Milieu variables added explanatory value beyond age, gender and education, suggesting that values and attitudes may help explain disparities in mental-health service use.

Evidence for pro-cognitive benefits of cannabinoids in people with bipolar disorder

1. Two studies examined temporal perception, attention and inhibitory control in bipolar disorder (BD), comparing chronic cannabis-use groups and testing acute THC in a randomized pilot experiment.
2. In the chronic-use study, 81 adults were recruited; BD participants without cannabis use showed less precise timing than the other groups.
3. BD participants who used cannabis showed temporal-discrimination and continuous-performance results comparable to healthy participants who did not use cannabis.
4. In the acute study, THC altered timing in BD participants, producing faster timing relative to placebo-treated healthy controls.
5. The authors interpret the pattern as consistent with attempts at self-medication, but the findings do not establish cannabis as a treatment for bipolar cognitive deficits and require further cannabinoid-treatment research.

Beyond the Bud: new cannabis products and modes of consumption in Ontario, Canada’s legal hybrid market

1. This environmental scan examined product types, consumption modes and advertised THC/CBD potency across the online inventories of 10 large Ontario cannabis retailers.
2. The legal market included flower, hash, oils, vape pens, concentrates, edibles, beverages and topicals, with substantial diversity within product categories.
3. Consumption routes extended beyond smoking and vaping to dabbing, eating, drinking, sublingual and vaginal use, and topical or transdermal application.
4. Potency information was reported using non-standardized units, and the scan identified new terminology, multimodal products and features not captured by existing Canadian survey categories.
5. The authors argue that rapidly commercializing cannabis markets require adaptable surveillance systems able to track changing products, modes of use and potency reporting.

The mediating role of motives in the associations between the big five personality traits and marijuana outcomes: A cross-national study across four countries

1. The cross-sectional study included 1,031 university students with past-month cannabis use from the United States, Argentina, Spain and the Netherlands.
2. Coping, expansion and enhancement motives were associated with higher cannabis-use frequency, while coping was also associated with more negative consequences.
3. Coping motives mediated the relationship between lower emotional stability and both cannabis-use frequency and negative consequences.
4. Expansion motives mediated the association between openness and cannabis-use frequency, suggesting a distinct personality-to-use pathway.
5. Only minor cross-country differences emerged, supporting motives as relatively generalizable proximal mechanisms linking personality traits to cannabis outcomes.

Determining the impact of cannabis use on tobacco cessation: Results from a prospective non-randomized tobacco treatment trial

1. A 12-week prospective tobacco-cessation trial enrolled 181 adults aged 18–40: 110 regular cannabis–tobacco co-users and 71 tobacco-only smokers.
2. All participants received varenicline, abstinence incentives and counseling; cannabis use itself was not targeted by treatment.
3. At week 12, biochemically confirmed 7-day tobacco abstinence was 59% in tobacco-only participants versus 33% among cannabis co-users.
4. Within the cannabis co-use group, neither baseline daily cannabis use nor cannabis-use frequency during treatment significantly predicted tobacco abstinence.
5. Regular cannabis co-use was associated with poorer tobacco-cessation outcomes, supporting consideration of cannabis use within standard tobacco treatment.

Acute and post-acute neurobehavioral responses to lysergic acid diethylamide in healthy subjects: a randomized controlled study

1. Forty-five healthy adults participated in a randomized crossover trial comparing 100 µg LSD with placebo and assessing neurobehavioral effects for up to one week.
2. Offline motor learning was significantly improved one day after LSD, suggesting enhanced post-practice consolidation rather than simply acute performance effects.
3. One week after LSD, participants reported reduced perceived stress and improvements in aspects of cognitive flexibility.
4. LSD acutely altered auditory EEG responses and motor-evoked potentials, with modulation of the P2 auditory response still detectable one week later.
5. Peripheral BDNF levels were unchanged; the study supports persistent functional effects after LSD while highlighting limitations of current human neuroplasticity measures.

Electronic cigarettes for smoking cessation: An overview of systematic reviews and evidence and gap map

1. The overview included 14 systematic reviews of intervention studies, seven rated high quality and seven low quality, plus an evidence-and-gap map of 90 completed primary studies.
2. Across 21 meta-analytic comparisons, every point estimate favored nicotine e-cigarettes for smoking cessation over comparator interventions.
3. Effect estimates were typically RR/OR 1.17–1.67 versus nicotine-replacement therapy and 1.46–2.09 versus non-nicotine e-cigarettes, with more consistent findings in higher-quality reviews.
4. Pooled adverse-event estimates generally suggested little or no difference, but evidence concerning serious adverse events remained inconclusive.
5. Major evidence gaps include comparisons with cytisine, bupropion and nicotine pouches, serious-adverse-event data, and research from low- and middle-income countries.

Understanding Daily Cannabis Use among Young Adults in Post-Legalization Québec: Motivations, Consumption Practices, and Control Strategies

1. Semi-structured interviews with 46 daily cannabis users aged 18–34 in Québec explored motivations, consumption practices and self-regulation using the COM-B framework.
2. Motivations were diverse and dynamic, including management of mental or physical health, relaxation, spirituality and enhancement of everyday experiences.
3. Many participants deliberately organized cannabis use around responsibilities, for example restricting use to evenings or abstaining before work or study.
4. Self-control strategies included adjusting dose and product type, while participants simultaneously acknowledged risks such as dependence and physical-health effects.
5. Daily cannabis use emerged as a heterogeneous, actively managed behavior, suggesting harm-reduction approaches should account for users’ own regulation strategies in legalized markets.

Changes over time in hallucinogen-related emergency department visits in Ontario, Canada

1. Ontario administrative data identified 8,274 hallucinogen-related ED visits among 7,735 people aged ≥10 years from 2008–2023.
2. Visit rates nearly doubled, from 3.3 to 6.5 per 100,000, corresponding to an average annual increase of 5.6% (95% CI 3.9–7.3).
3. Visits were often high-acuity: 54% arrived by ambulance and 13.2% resulted in hospitalization.
4. Another substance or comorbid mental-health diagnosis contributed in 42% of visits.
5. Relative increases were especially large among ages 25–44 and people with anxiety or schizophrenia, indicating that rising hallucinogen use may have disproportionate impacts in clinically vulnerable groups.

Exploring the effects of cannabidiol on pain sensitivity using quantitative sensory testing among individuals receiving methadone or buprenorphine for opioid use disorder: an open-label, proof-of-concept study

1. Seven people with OUD, chronic pain and methadone or buprenorphine treatment received oral CBD 400, 800 and 1,200 mg in an open-label proof-of-concept study.
2. Quantitative sensory testing showed no significant overall main effect of CBD dose or time on pain sensitivity.
3. A significant MOUD-by-dose interaction emerged for heat-pain threshold and tolerance, with higher values in buprenorphine than methadone participants at selected doses.
4. Descriptively, 400 mg CBD produced the most favorable pain-response pattern across several measures in the buprenorphine group.
5. CBD was well tolerated without serious adverse events or cognitive impairment, but the very small uncontrolled sample requires confirmation in larger placebo-controlled trials.

Efficacy signals in a 12-week trial of clavulanic acid to decrease cocaine use

1. Sixty-four participants with cocaine use disorder were randomized to clavulanic acid or placebo for 12 weeks, using 500 mg/day followed by 750 mg/day from week 5.
2. The primary overall comparison showed no statistically significant benefit of clavulanic acid versus placebo.
3. A sex-specific signal emerged: women receiving clavulanic acid had significantly more cocaine-free days from week 4 onward than women receiving placebo.
4. During the final three weeks, women on clavulanic acid gained a median 4.0 cocaine-free days/week from baseline versus 0.6 with placebo; early withdrawal symptoms also improved.
5. No comparable benefit was identified in men; treatment was reasonably well tolerated, supporting further dose-finding and sex-specific investigation.

Lower risk drinking guidelines and the ‘no safe level’ message: Finding a balance in risk communication

1. “No safe level” and “low-risk drinking” are not inherently contradictory: they address different questions about alcohol-related risk.
2. “No safe level” refers specifically to the absence of an identified biologically risk-free threshold for outcomes such as certain cancers.
3. Low-risk guidelines instead provide pragmatic consumption thresholds associated with comparatively low risk and necessarily incorporate normative judgments about acceptable risk.
4. Evidence on public interpretation is limited; categorical “no safe level” messaging may increase problem recognition but can also provoke fear, lower credibility and defensive responses.
5. The authors favor clear contextualization: communicate the absence of a cancer-risk-free threshold without presenting this narrow biological statement as an absolute behavioral prescription.

Redefining the real problem in psychedelic trials: Why fighting the Lessebo matters more than blinding integrity

1. This essay argues that imperfect blinding is not unique to psychedelic trials and is rarely assessed in other psychiatric RCTs.
2. The authors distinguish loss of perfect blinding from the more important requirement that participants retain reasonable uncertainty about allocation.
3. Correctly inferred allocation may create expectancy effects, including a “lessebo” effect in participants who believe they received placebo.
4. Disappointment is proposed as an underrecognized mechanism that may worsen outcomes in control arms and distort treatment-effect estimates.
5. Structured psychoeducation, realistic non-stereotyped expectations and a strong therapeutic alliance are proposed to mitigate disappointment and improve trial interpretability.

The impact of taxes on prices and the demand for legally sold recreational Cannabis in the U.S.—An economic evaluation

1. State-month data from January 2014 to June 2023 were used to estimate how cannabis excise taxes affect legal recreational cannabis prices and sales.
2. A $1 increase in cannabis tax was associated with a $4–$6 increase in retail cannabis prices.
3. A 10% tax increase reduced legal recreational cannabis sales by 12.6% (p<0.05).
4. A 10% increase in cannabis prices reduced legal sales by 17.8% (p<0.001), indicating substantial price responsiveness.
5. Higher cannabis taxes reduced both legal sales and tax revenue; cigarette and beer taxes were also associated with lower legal cannabis sales, suggesting economic complementarity.

Abolition of coercion in psychiatry on the horizon? A descriptive ecologic data study from six European countries

1. Longitudinal ecological data from Austria, England, Germany, Norway, Sweden and Switzerland were used to examine trends in involuntary admissions and coercive measures.
2. Available national or regional datasets covered periods of 4–10 years and allowed rates per psychiatric admission and per 100,000 inhabitants to be calculated.
3. No country showed an absolute decrease in both involuntary admissions and coercive measures.
4. Involuntary-admission rates changed from −5.4% in Sweden to +37% in Germany, while admissions exposed to coercive measures increased from +11% in Austria to +86% in Norway.
5. Coercive practices therefore persisted or increased despite policy commitments; the ecological design cannot determine whether changes reflect societal factors, admission patterns or inpatient practice.

Impulsivity, reward sensitivity, and dopamine 2/3 receptors availability in people with cocaine use disorder: A [11C]PHNO PET study

1. PET imaging with [11C]PHNO compared dopamine D2/3 receptor availability and impulsivity-related traits in 15 people with cocaine use disorder and 14 healthy controls.
2. Participants with cocaine use disorder showed significantly higher impulsivity across all measured domains (all FDR-p≤0.03).
3. In healthy controls, reward- and avoidance-related traits correlated with D2/3 receptor availability across several striatal and limbic regions.
4. These dopamine–behavior associations were absent in cocaine use disorder, with significant group interactions in the amygdala, pallidum and putamen.
5. The authors interpret this pattern as dopamine–behavior decoupling, a potential neurobiological feature of cocaine use disorder that requires confirmation in larger samples.

Parental alcohol supply in early childhood and adolescent drinking: Evidence from a prospective cohort

1. A prospective Czech cohort of 1,891 mother–child pairs examined parental alcohol supply at ages 3, 5, 7 and 11 and alcohol use at ages 18–19.
2. Fourteen percent of children had been supplied alcohol by age 3 and around 20% by age 11; by age 19, one-third reported frequent alcohol use.
3. Early parental supply predicted greater adolescent drinking for both occasional (β=0.14; p=0.041) and frequent supply (β=0.22; p=0.005).
4. Concurrent maternal, but not paternal, drinking was associated with adolescent alcohol use (β=0.24; p<0.001).
5. The findings do not support the idea that early supervised alcohol exposure is protective and instead link early parental supply with higher later alcohol use.

Psychedelic Use Covaries with Psychological Flexibility Through Mystical Experiences: Results of a Retrospective Web Survey

1. More than 200 participants completed measures of mystical experience, psychological flexibility and psychedelic use in a retrospective web survey.
2. Participants with psychedelic experience reported higher MEQ-30 mystical-experience and psychological-flexibility scores than participants reporting only non-drug mystical experiences.
3. Psychedelic use showed an indirect statistical association with psychological flexibility through the intensity of mystical experiences.
4. A reversed model did not reach statistical significance, supporting—but not proving—the proposed directional pathway.
5. The cross-sectional retrospective design precludes causal inference, but the findings support further study of mystical experience and ACT-related psychological flexibility as potential therapeutic processes.

Evaluating comparative effect of non-pharmacological interventions adjunctive to opioid agonist therapy for opioid use disorder: A systematic review with network meta-analysis

1. This systematic review and Bayesian network meta-analysis included 42 randomized trials with 5,113 participants receiving opioid agonist therapy (OAT).
2. Contingency management plus OAT improved treatment retention versus OAT alone (OR 1.64, 95% CrI 1.03–2.57), although evidence certainty was low.
3. CBT plus contingency management (OR 2.47) and enhanced methadone services (OR 5.48) also favored retention, but evidence certainty was very low.
4. No adjunct significantly improved opioid-negative urine outcomes; acupuncture and sham acupuncture reduced craving scores, with low or very-low certainty.
5. Contingency management appears the best-supported adjunct for retention, but most comparative estimates remain uncertain and stronger trials are needed.

Toward a public health and prevention-oriented approach to stimulant-induced psychosis

1. This commentary frames stimulant-induced psychosis (StIP) as both a psychiatric and public-health problem requiring more than acute crisis management.
2. Across jurisdictions, the authors identify similar problems: fragmented care, limited evidence-based guidance, high morbidity and rapidly changing stimulant markets.
3. They propose primary prevention addressing social and structural vulnerability, secondary prevention targeting early psychotic symptoms, and tertiary prevention reducing relapse, rehospitalization, overdose and suicide.
4. StIP commonly co-occurs with other substance use, psychiatric disorders, infectious disease and social instability, supporting integrated longitudinal care.
5. The authors argue for coordinated surveillance, rapid knowledge exchange and prevention-oriented psychiatric, addiction and public-health systems; the article is a conceptual commentary rather than an intervention study.

Stimulant-induced psychosis requires the same clinical priority as other psychotic disorders

1. This commentary argues that stimulant-induced psychosis (StIP) should receive clinical priority comparable with other severe psychotic disorders rather than being treated as a transient substance-use complication.
2. Diagnostic frameworks differ: ICD places substance-induced psychosis with substance-use disorders, whereas DSM places it among psychotic disorders, potentially contributing to fragmented care.
3. The author cites evidence that 14% of people with incident StIP received an ICD-10 F20–F29 diagnosis within one year and that about one in five were rehospitalized within two years.
4. Major evidence gaps concern relapse prevention, antipsychotic selection and duration, long-acting injectables, ADHD treatment and the long-term course of psychosis associated with synthetic cathinones.
5. The commentary calls for dedicated guidelines, longitudinal research and integrated prevention of psychosis relapse, suicide and overdose; its numerical examples are drawn from cited studies rather than new data.

Keeping stimulant-induced psychosis in sight

1. This commentary uses the Australian experience to argue that stimulant-induced psychosis (StIP) is a core presentation for general psychiatry and emergency medicine, not a niche addiction problem.
2. Australian estimates attributed 28,400–80,900 additional psychiatric admissions and 29,700–151,800 emergency presentations annually to methamphetamine use in 2018.
3. Because frequent methamphetamine use and dependence predict psychosis, the author frames effective stimulant-use-disorder treatment as a form of psychosis prevention.
4. Cited data link methamphetamine use with dose-dependent violence risk, further amplified by psychotic symptoms, creating substantial consequences for patients, families and healthcare workers.
5. The article calls for explicit inclusion of StIP in mainstream psychosis pathways, workforce training and integrated addiction treatment; it is a commentary synthesizing existing evidence rather than a new empirical study.

The new EU Drugs Strategy: failure to consult, lack of balance, and reliance on outdated concepts

1. This viewpoint critiques the EU Drugs Strategy published in December 2025 and its accompanying Action Plan against drug trafficking; it does not present new empirical outcome data.
2. The authors argue that Member States, scientific experts and civil society were insufficiently consulted during development of the strategy.
3. They describe an imbalance in which supply reduction and law-enforcement measures are framed as concrete commitments, while prevention, treatment, harm reduction and social integration rely more on recommendations or other frameworks.
4. The authors particularly criticize the reframing and positioning of harm reduction and argue that several concepts used in the strategy do not reflect contemporary public-health and human-rights approaches.
5. Their central recommendation is a more balanced, evidence-informed drug policy with stronger stakeholder participation and greater parity between health/social responses and supply reduction; these are the authors’ policy judgments rather than neutral findings.

Metacognition and mentalising as core mechanisms of psychotherapy

1. This guest editorial proposes metacognition and mentalising as transdiagnostic mechanisms through which different psychotherapies may produce change.
2. Metacognition is defined broadly as the capacity to recognize, differentiate and flexibly use representations of one’s own and other people’s mental states to regulate distress and relationships.
3. Impairments are documented across complex disorders including schizophrenia, personality disorders and eating disorders and are associated with symptoms, social withdrawal, rigidity and poor adaptation.
4. Therapy should move beyond abstract insight by helping patients apply mental-state understanding in emotionally significant real-world situations, interpersonal ruptures and personally meaningful goals.
5. A metacognitive framework may help explain why different therapies can reach similar outcomes, why some patients fail to change despite adequate techniques, and when interventions should target reflective capacity most directly.

Supply and demand of medical cannabis in Germany after legalisation: exploring 12 months of data from an online dispensary

1. This case study tracked cannabis-flower products, prices, stock quantities and THC/CBD concentrations at one German online dispensary for 12 months after medical cannabis access was liberalized in April 2024.
2. The number of available flower products increased from 266 in December 2024 to 401 in November 2025, with 996 different products observed across the study period.
3. Median THC concentration remained broadly stable, but the price per 10 mg THC fell by €0.003 per week; products containing 20–29.9% THC accounted for more than two-thirds of total demand.
4. Demand increased by 13% for every one-percentage-point increase in THC (IRR 1.13) and fell markedly with each €1 increase in price (IRR 0.59); price reductions were associated with higher demand.
5. The authors describe an increasingly commercialized market favoring cheaper, high-THC products and question whether the current German medical-cannabis regulatory framework aligns with public-health principles.

Contemporary Approaches to Opioid Dependence Treatment Delivery: A Rapid Review of Novel Models Relevant to Implementation in Victoria, Australia

1. This rapid review examined academic and grey literature published from January 2019 through August 2025 on innovative models for delivering opioid dependence treatment (ODT), using Victoria, Australia as the implementation context.
2. Fifty-six publications were identified and grouped into organizational models, workforce innovations and technology-enabled approaches.
3. Promising organizational approaches included mobile outreach, emergency-department initiation and low-threshold rapid-access clinics; workforce models included nurse-practitioner prescribing and pharmacist-prescriber collaboration.
4. Telehealth and hybrid models may expand access by using existing community infrastructure, but most studies focused on short-term outcomes such as retention up to 12 months and provided limited longitudinal evidence.
5. The review supports staged implementation with workforce investment and sustainable funding while identifying major evidence gaps in patient-reported outcomes, cost-effectiveness and long-term effectiveness.

Effects of intensive home treatment: a quasi experimental study

1. This quasi-experimental study compared psychiatric crisis care delivered through Intensive Home Treatment (IHT) with crisis management within Flexible Assertive Community Treatment (FACT) teams over six months.
2. A total of 463 patients in psychiatric crisis were referred to IHT, while 59 comparable patients could not enter IHT because of treatment availability and remained in FACT.
3. Voluntary hospital admission occurred in 27.2% of the IHT group versus 33.9% of the FACT group, a 6.7-percentage-point difference whose confidence interval included no effect.
4. Involuntary admission occurred in 7.1% versus 8.5%, while median hospital length of stay was substantially lower after IHT referral: 31.0 versus 61.5 days.
5. The authors conclude that IHT may reduce hospital-bed use and possibly involuntary admissions in patients already receiving outpatient care, while the non-randomized allocation and small comparison group limit causal interpretation.

Changes in the illegal fentanyl market do not mainly explain the recent decreases in drug poisoning deaths in Canada

1. Canadian opioid poisoning deaths increased from 2,382 in 2016 to 7,997 in 2023, but then declined by 9% in 2024 and by 29% in the first half of 2025 compared with the same period in 2024.
2. The authors re-analyzed data used to support the hypothesis that a major fentanyl supply shock was the principal cause of the recent mortality decline and added province-level analyses for British Columbia, Alberta and Ontario.
3. Although fentanyl-market indicators and overdose mortality moved in parallel, synthetic-opioid deaths declined more rapidly than fentanyl powder and pill purity after May 2023, suggesting that additional mechanisms were operating.
4. Considerable heterogeneity across Canadian provinces in drug markets, health systems and policies further weakens a single national supply-shock explanation.
5. The authors conclude that changes in the illicit fentanyl market probably contributed to falling deaths but are unlikely to explain them mainly or completely; attributing the change specifically to Chinese precursor controls remains plausible but unproven.

Explaining an abrupt, substantial reduction in US opioid overdose deaths

1. US opioid overdose deaths declined by about 30% beginning in mid-2023 after approximately three decades of steep increases, creating an important challenge for causal interpretation.
2. The authors regard a fentanyl supply shock as a reasonably cogent explanation because the mortality decline coincided with reduced fentanyl purity and reports from people who use opioids that high-purity fentanyl had become harder to obtain.
3. They compare the episode with Australia’s 2001 heroin shortage, when reduced availability, lower purity and higher prices coincided with an approximately 60% decline in opioid overdose deaths over the following year.
4. The proposed explanation that Chinese restrictions on precursor exports caused the North American fentanyl shock is considered plausible but substantially less certain because the supporting evidence is indirect.
5. Alternative explanations—including a shrinking population at highest overdose risk and the cumulative effects of prevention, treatment and harm reduction—must therefore remain part of the causal account.

Cannabis use prevalence before and early after partial legalisation in Germany

1. Germany’s Cannabis Act took effect on 1 April 2024, permitting adults to possess and cultivate limited amounts of recreational cannabis while commercial retail sales remained prohibited.
2. The study analyzed 23 repeated population surveys conducted from April/May 2022 through March/April 2026, comprising 35,957 respondents aged 14–64 years and therefore covering approximately two years before and after the reform.
3. Overall, 2,302 participants (6.4%) reported past-12-month cannabis use, and neither this prevalence nor the proportion of daily or almost-daily users changed significantly after the reform.
4. No statistically significant post-reform slope changes were detected in the total sample or the examined age and gender subgroups, and sensitivity analyses using alternative intervention dates supported the main findings.
5. The authors conclude that partial legalization was not associated with an early increase in cannabis-use prevalence or heavy use, while emphasizing that longer follow-up and multiple data sources are needed to detect possible later effects.

Behavioral economic cannabis demand following recreational cannabis legalization: Six-year findings from an observational cohort study of community adults in Canada

1. This longitudinal Canadian cohort followed 1,103 community adults across 14 assessment waves from September 2018 to April 2025, with median retention of 86.86%, to examine behavioral-economic cannabis demand after legalization.
2. Contrary to the authors’ hypothesis, all indices of cannabis demand—the relative reinforcing value or incentive salience of cannabis—declined significantly over the six-year period, while actual cannabis-use frequency remained comparatively stable.
3. Participants already using cannabis before legalization showed declining demand, and the decline was steeper among those with more frequent pre-legalization use; participants not using cannabis before legalization showed stable or increasing demand.
4. Men showed steeper declines than women on selected demand indices, including intensity, Omax and breakpoint, indicating meaningful heterogeneity in post-legalization motivational trajectories.
5. The findings suggest that greater legal availability does not necessarily increase cannabis’s reinforcing value and may coexist with declining within-person demand, although the observational design does not establish that legalization itself caused these changes.

When Tobacco and Cannabis Use Motives Interact: Implications for Dependence and Quitting

1. A cross-sectional survey examined 357 French young adults aged 18–30 years who co-used tobacco and cannabis, assessing 21 tobacco- and cannabis-related motives and their relationships with dependence and readiness to quit.
2. Most motives within each substance and all motives shared across tobacco and cannabis were correlated, demonstrating substantial motivational overlap between the two behaviors.
3. Cluster analysis identified three profiles: high tobacco/moderate cannabis motive endorsement with high nicotine dependence (n=188), low overall motive endorsement except pleasure with low dependence (n=39), and high endorsement of motives for both substances with high dependence (n=130).
4. Endorsing a greater number of tobacco-use motives was associated with lower readiness to quit tobacco but, notably, with greater readiness to quit cannabis.
5. The results suggest that interventions for tobacco-cannabis co-use should assess the configuration of motives across both substances rather than treating each substance independently, although the cross-sectional design precludes causal conclusions.

Glucagon-like peptide 1 receptor agonists in substance use disorders: A systematic review of ClinicalTrials.Gov

1. This systematic survey searched ClinicalTrials.gov through 2 July 2025 for trials testing GLP-1 receptor agonists in people with substance use disorders and requiring substance-use outcomes such as toxicology, Timeline Follow-Back or craving.
2. Of 192 registry records screened, 33 met inclusion criteria: 15 addressed alcohol use disorder, nine nicotine/tobacco, four cocaine, four opioids, one methamphetamine and none cannabis use disorder.
3. Semaglutide was the most frequently studied agent (15 trials), followed by exenatide (8), tirzepatide (6), liraglutide (2), dulaglutide (1) and pemvidutide (1).
4. Trial designs and outcome measures were highly heterogeneous, frequently combining self-reported and objective substance-use measures, which will complicate comparison and synthesis of eventual efficacy findings.
5. GLP-1 receptor agonists are a promising pharmacotherapy research direction, but the current trial landscape is concentrated on alcohol and nicotine and leaves major evidence gaps for methamphetamine and cannabis use disorders and for newer-generation agents.

The Role of Residential Treatment in Addiction Care

1. The commentary challenges the common assumption that addiction treatment primarily means residential “rehab”; in most systems, outpatient treatment is the main modality and residential care is reserved for selected cases within stepped-care models.
2. Residential treatment may be life-saving for some patients but can also disrupt family relationships, employment and continuity with long-term caregivers, making patient selection clinically important.
3. Discussing a Norwegian observational study, the author notes that greater alcohol-use-disorder severity was associated with referral to residential treatment, whereas psychiatric and somatic comorbidity did not significantly distinguish residential from outpatient referrals.
4. Evidence defining who benefits from residential treatment remains weak, and the author calls for large randomized trials where feasible as well as high-quality cohort studies using long-term outcomes and population registers.
5. Involuntary residential addiction treatment is highlighted as an especially controversial and poorly studied practice; given its ethical implications, high cost and use among vulnerable patients, stronger evidence is considered a research priority.

Balancing safety and access in Oregon’s psilocybin services

1. Oregon permits adults aged 21+ to receive psilocybin at licensed service centers under facilitator supervision without a medical referral or clinical indication.
2. Data from the first full year indicate that reported adverse reactions were relatively uncommon, although the reporting system uses a high threshold for reportable events.
3. Access remains socially selective, with many clients being high-income and coming from outside Oregon.
4. Clients use the program both for general health and wellness and for clinical-type concerns such as depression and anxiety.
5. The authors argue that Oregon illustrates the tension between broad access and safety, particularly because broad eligibility and non-clinical supervision may be insufficient for clients with significant psychiatric symptoms.

Changes in heroin-related ambulance attendances following the introduction of a medically supervised injecting room in Victoria, Australia

1. An interrupted time-series analysis examined heroin-related ambulance attendances from 2015–2023 around Melbourne’s Medically Supervised Injecting Room.
2. At opening in June 2018, the predicted rate was 123 heroin-related ambulance attendances per 100,000 population per month, approximately 48 attendances monthly.
3. After opening, the previous upward trend reversed, declining by about 2.3 attendances per 100,000 population per month relative to the pre-intervention trend.
4. By December 2023, the predicted rate had fallen to 36 per 100,000, approximately 14 attendances per month—a 70.7% reduction from implementation.
5. No comparable decline occurred in central Melbourne or the rest of Victoria, supporting an association between the injecting room and reduced acute heroin-related ambulance utilization.

Supervised consumption service use and high-frequency public injecting among people who inject drugs in Toronto: A cross-sectional analysis (2018–2020)

1. Cross-sectional data from 700 people who inject drugs in Toronto were used to examine the association between supervised consumption service use and frequent public injecting.
2. Fifteen percent reported high-frequency public injecting, while 87% had used a supervised consumption service in the previous six months.
3. Recent supervised consumption service use was associated with a 51% lower prevalence of high-frequency public injecting (aPR 0.49; 95% CI 0.32–0.77).
4. Among participants experiencing predominantly unstable housing, service use was similarly associated with lower public injecting (aPR 0.47; 95% CI 0.29–0.75).
5. The findings support supervised consumption services as a means of shifting injecting away from public spaces, while highlighting the importance of integrating harm reduction with housing interventions.

Buprenorphine initiation by a street medicine program is associated with reduced opioid-related emergency department utilization among people experiencing homelessness

1. A retrospective study examined 115 people experiencing homelessness who initiated buprenorphine through a street-medicine program in 2023.
2. OUD-related emergency-department visits fell significantly from 79 in the year before initiation to 44 in the year after initiation.
3. Overdose-related ED visits decreased from 26 to 13, although this reduction was not statistically significant.
4. Total ED visits declined from 221 to 191, also without statistical significance.
5. Forty-four percent renewed buprenorphine prescriptions—13% through street medicine and 31% through another provider—supporting street medicine as a low-barrier entry point to ongoing OUD care.

Cultural heritage tourism as an adjunct in schizophrenia

1. Tourism-based activities are proposed as psychosocial adjuncts to usual pharmacological and psychological treatment for schizophrenia.
2. Two small randomized trials (N=100 and N=80) reported improvements in social functioning, negative symptoms and subjective well-being following structured tourism programs.
3. Cultural heritage settings may offer specific benefits through identity, belonging, social connectedness and participation in ordinary civic roles outside clinical environments.
4. Potential barriers include cognitive impairment, negative symptoms, social anxiety, mobility and transport difficulties, suggesting a need for adapted itineraries, smaller groups and peer or staff support.
5. Evidence remains preliminary; future trials should distinguish heritage-focused, nature-focused and mixed interventions and examine outcomes such as social participation, self-stigma, belonging and identity.

A perfect calming: Exploring the etiology of declining US overdose deaths

1. US overdose deaths declined by 37% between August 2023 and October 2025 after decades of growth, creating a major epidemiological discontinuity requiring explanation.
2. The authors consider a fentanyl supply shock plausible: fentanyl-related mortality tracked falling purity, with reported correlations of 0.37 for powder and 0.62 for pills.
3. Historical examples such as Australia’s heroin shortage—associated with a 71% fall in fatal overdoses from 1999 to 2001—show that major supply changes can rapidly affect mortality.
4. The authors nevertheless regard supply disruption as only a partial explanation and discuss concurrent changes in drug use, market adaptation, harm reduction and population vulnerability.
5. The decline is framed as a potentially multifactorial “perfect calming,” cautioning against attributing a complex population-level change to a single intervention or mechanism.

Supply matters: What the sudden drop in overdose deaths reveals about the drug crisis

1. US overdose deaths began falling sharply in 2023, with preliminary data showing just over 70,000 deaths in the latest 12-month period—almost 30% below the 2023 peak.
2. The commentary argues that disruptions in precursor-chemical flows and fentanyl supply are an important explanation for the sudden decline.
3. Changes in fentanyl availability were reflected in indicators including price, purity, seizures and online discussion of drug “droughts” and “shortages.”
4. Supply disruption is not presented as a substitute for harm reduction or treatment; the author argues that supply-side gains should be consolidated alongside demand-side interventions.
5. Because illicit supply chains can rapidly adapt, the article emphasizes continuous drug-market surveillance, precursor monitoring and sustained investment in prevention, treatment and harm reduction.

Long-term perspective on the recent abrupt decline in drug overdose mortality

1. The authors place the abrupt 2023–2024 decline in synthetic-opioid mortality within the much longer US overdose trajectory, which has followed an approximately exponential rise since 1979.
2. They accept a fentanyl supply shock as a plausible contributor but argue that short-term mortality changes can reflect several overlapping mechanisms.
3. Their previous modeling estimated 67,571 excess overdose deaths from March 2020 through May 2023, 24.4% above the long-term baseline.
4. During the pandemic period, fentanyl seizures were associated with mortality, but income showed an even stronger association: a 10% increase in relative income was associated with approximately 11% higher overdose mortality.
5. The current downturn may therefore reflect both fentanyl-market disruption and the unwinding of pandemic-related social, service and economic forces rather than a single causal process.

Explaining the abrupt and substantial decline in North American fentanyl overdoses

1. The authors respond to critiques of their hypothesis that a major negative fentanyl supply shock contributed substantially to the recent decline in North American opioid overdoses.
2. Multiple indicators—including fentanyl seizures, purity measures and online reports from people who use fentanyl—shifted abruptly around the same time that fentanyl-related morbidity and mortality declined.
3. Parallel declines in the US and Canada led the authors to hypothesize an upstream disruption, potentially involving Chinese precursor chemicals, despite largely independent downstream fentanyl markets.
4. They explicitly do not claim that the supply shock explains 100% of the decline and acknowledge contributions from changes in the population at risk and demand-side interventions.
5. Supply and demand mechanisms may reinforce each other: reduced availability, reliability and purity-adjusted affordability can increase incentives to reduce use, substitute drugs or enter opioid-agonist treatment.

Network analysis of the genetic relationships between twenty psychiatric and substance use disorders

1. Family genetic risk scores for 20 psychiatric and substance use disorders were analysed in 1,510,974 individuals from the Swedish population.
2. Genetic risks formed five interconnected clusters: internalizing, externalizing, neurodevelopmental, eating and psychotic disorders.
3. ADHD, bipolar disorder, OCD and autism spectrum disorder occupied transitional positions between diagnostic clusters.
4. Major depression and drug use disorder were the most central nodes; bipolar disorder linked most strongly to major depression and schizoaffective disorder, not directly to schizophrenia.
5. Genetic risk for suicide attempt was most strongly linked to drug use disorder, while suicide death was most strongly linked to alcohol use disorder, illustrating extensive cross-diagnostic genetic overlap.

Psilocybin as an emerging anxiolytic: mechanisms, evidence, and open questions

1. Psilocin acts primarily through 5-HT2A and 5-HT1A receptors and may promote BDNF–TrkB signalling, synaptic plasticity and remodeling of prefrontal-limbic circuits.
2. Psilocybin reduces default-mode-network hyperactivity and may modify prefrontal-amygdala fear circuitry implicated in anxiety.
3. In patients with life-threatening cancer, two randomized trials reported large and sustained anxiety reductions, with about 80% maintaining clinically significant improvement at six months.
4. A meta-analysis of six double-blind RCTs (N=528) found acute anxiety reactions were generally transient and resolved within 48 hours.
5. Direct evidence for primary anxiety disorders remains limited; larger disorder-specific trials, biomarkers and clearer separation of therapeutic from hallucinogenic mechanisms are needed.

Use of a discrete choice experiment to support the service design of the safer drug consumption facility in Scotland

1. A discrete choice experiment assessed preferred safer drug consumption facility features among 77 people who use drugs in Dundee, Edinburgh and Glasgow.
2. Participants strongly preferred facilities involving peer workers (coefficient 0.953; p<0.001).
3. Inhalation spaces (0.668; p<0.05) and drug checking (0.677; p<0.001) were independently preferred service components.
4. Twenty-four-hour opening was preferred to daytime-only access, while increasing travel time significantly reduced willingness to use the facility.
5. Service-user preferences support low-threshold facilities combining peer involvement, inhalation capacity, drug checking and high temporal and geographic accessibility.

Impact of bariatric surgery on alcohol-use disorder and alcohol-related liver disease: A retrospective study

1. This retrospective cohort included 30 patients seeking treatment for alcohol problems after sleeve gastrectomy (n=20) or Roux-en-Y gastric bypass (n=10).
2. Mean AUDIT score increased from 10.2 before surgery to 18.1 after surgery (p<0.001).
3. The number meeting AUDIT criteria for alcohol dependence increased from 9 before surgery to 29 after surgery.
4. Despite a mean BMI reduction of 14.5 kg/m² and fewer metabolic comorbidities, non-invasive liver-fibrosis markers FIB-4 and APRI significantly worsened.
5. The findings support systematic pre-operative alcohol assessment and continued post-operative monitoring for alcohol-use disorder and alcohol-related liver injury.

Cannabis consumer responses to the concept of standard THC units

1. Qualitative interviews explored reactions to standard THC units among 50 adult cannabis consumers in US states with both legalized and criminalized cannabis markets.
2. Most participants responded positively to the concept, although some questioned how a standard unit would work across diverse products and routes of administration.
3. Standard THC units were viewed as particularly useful for novice and infrequent consumers.
4. Experienced consumers also saw potential value for tolerance management, avoiding dependence, reducing overconsumption and managing driving-related risk.
5. Successful implementation will require clear consumer education and translation of the unit into established real-world consumption practices.

Stop calling it self-medication: Tobacco smoking is not medicine

1. The editorial argues that describing tobacco smoking as “self-medication” falsely confers therapeutic legitimacy on an addictive and harmful behaviour.
2. Smoking is highly prevalent among people with severe mental illness, yet evidence indicates that smoking contributes to psychiatric morbidity rather than treating it.
3. Short-term perceived benefits are better explained by relief of nicotine withdrawal and temporary coping effects than by genuine therapeutic action.
4. Smoking cessation can improve mental health after withdrawal resolves, and effective cessation treatment is available even for people with severe mental illness.
5. The authors recommend replacing the self-medication framing with “maladaptive coping” to acknowledge subjective relief without implying medical benefit.

Policy pathways and historical insights: Canada's evolving approach to psychedelic access for end-of-life distress

1. The commentary traces Canada’s gradual shift from psychedelic prohibition toward cautious medical and compassionate access for end-of-life psychological distress.
2. Clinical studies in serious or life-threatening illness suggest potential reductions in anxiety, depression and existential distress, while larger and more diverse controlled trials remain necessary.
3. Canada’s policy pathway has been shaped by federal compassionate-access mechanisms, patient advocacy, palliative-care traditions and debates surrounding medical assistance in dying.
4. Federal flexibility coexists with substantial heterogeneity across provinces and substances, making access politically and administratively contingent.
5. Canada illustrates how psychedelic medicalization can emerge incrementally through interaction between clinical evidence, end-of-life ethics, advocacy and multilevel governance.

How many traffic fatalities can be attributed to cannabis each year in the US?

1. This commentary re-examines a previous estimate attributing about 5,000 US traffic deaths per year to recent cannabis use.
2. Correcting two identified calculation errors reduces the estimate from about 5,000 to approximately 3,550 deaths annually.
3. The estimate falls below 2,000 when alternative assumptions and more appropriate parameter values are used.
4. Alcohol co-use is a major source of confounding because THC-positive traffic fatalities frequently involve alcohol and should not automatically be attributed to cannabis.
5. The analysis demonstrates that cannabis-attributable traffic mortality is highly sensitive to assumptions about relative risk, THC prevalence and confounding; the author argues that values close to zero remain statistically plausible.

The Ontological Tourism Problem in Psychedelic Science

1. Psychedelic experiences can generate compelling insights about consciousness, selfhood and reality, but subjective experience alone does not establish metaphysical truth.
2. The author calls the leap from phenomenology to claims about reality “ontological tourism” and warns that it can undermine scientific and clinical rigor.
3. The opposite extreme—dismissing psychedelic experiences as mere pharmacological artifacts—is considered equally inadequate.
4. First-person reports should be treated as meaningful evidence, but integrated with mechanistic, neuroscientific and philosophical analysis.
5. The proposed middle position takes psychedelic phenomenology seriously while limiting conclusions to what the evidence can actually support.

Psilocybin-Assisted Therapy for Alcohol Use Disorder: A Systematic Review of Clinical Evidence

1. The systematic review identified only three clinical studies of psilocybin-assisted therapy for alcohol use disorder.
2. Across studies, psilocybin-assisted therapy was associated with reductions in heavy drinking days.
3. Results for abstinence and relapse prevention were inconsistent, with some comparisons showing no significant advantage over control conditions.
4. Safety appeared acceptable in controlled research settings with carefully selected participants.
5. The evidence remains too limited for routine clinical use; larger randomized trials, standardized protocols and longer follow-up are required.

US drug overdose deaths involving stimulants without opioids continued to rise in 2024

1. US overdose mortality fell 27.9% from its 2022 peak to 2024, largely reflecting fewer fentanyl-involved deaths.
2. In contrast, overdose deaths involving stimulants without opioids continued to increase from 2023 to 2024.
3. Cocaine-without-opioid mortality rose 1.7%, while methamphetamine-without-opioid mortality rose 2.4%.
4. Trends differed substantially by age, race/ethnicity and region, with particularly concerning methamphetamine increases in some American Indian/Alaska Native populations.
5. Falling overall overdose mortality may therefore conceal a distinct stimulant toxicity problem requiring stimulant-specific prevention strategies.

Real-World Therapeutic Use of Ketamine in Clinical and Non-Clinical Settings: A Cross-Sectional Survey

1. The survey compared 238 people using ketamine clinically with 222 using it therapeutically without medical supervision.
2. Non-clinical users had substantially greater lifetime experience with ketamine, psychedelics and other recreational substances.
3. Both groups reported similarly high perceived effectiveness: 83.3/100 in clinical users versus 81.2/100 in non-clinical users.
4. Depression and anxiety symptom levels at survey time were similar between the two groups.
5. Non-clinical users had higher odds of reporting persistent hallucinations after ketamine use (OR 2.58), highlighting potential risks of unsupervised use.

Estimated prevalence of gaming disorder based on ICD-11 and DSM-5 frameworks in a large and representative sample of young Swiss men

1. The study assessed gaming disorder in 2,620 young Swiss men using both DSM-5 and ICD-11 criteria.
2. Estimated prevalence was 3.83% with DSM-5 criteria but only 2.48% with ICD-11 criteria (p < .001).
3. The findings confirm that ICD-11 produces a more conservative estimate of gaming disorder than DSM-5.
4. Among past-year gamers, depression was associated with gaming disorder under both diagnostic frameworks.
5. Anxiety was associated with gaming disorder only under DSM-5, showing that classification choice also influences observed psychiatric correlates.

Varenicline for the management of cannabis use disorder: A systematic review

1. The systematic review identified five studies with 299 participants evaluating varenicline for cannabis use disorder, including four randomized trials.
2. Overall efficacy findings were mixed, and study quality ranged from poor to good.
3. The single high-quality study found significant reductions in cannabis use and withdrawal symptoms with varenicline.
4. Tolerability findings were inconsistent; the best-quality trial found similar overall adverse-event rates but more nausea with varenicline.
5. Current evidence is insufficient to establish varenicline as an effective or well-tolerated treatment for cannabis use disorder.

Who leaves satisfied? Exploring individual factors associated with substance use disorder service satisfaction

1. This mixed-methods study examined treatment satisfaction among 420 parents receiving substance use disorder services across 23 organizations.
2. Substance-use severity itself was not significantly associated with satisfaction.
3. Greater psychopathology was associated with lower treatment satisfaction, even after adjustment for age and household income.
4. Dissatisfied parents described rigid compliance rules, stigmatizing interactions and insufficient family-oriented support.
5. Childcare, flexible scheduling, housing assistance and attention to psychiatric comorbidity may therefore be important components of more responsive SUD services for parents.

Psychedelics and suicidality: A double-edged sword - risks, mechanisms, and moving forward

• Classic psychedelics are being investigated for psychiatric disorders associated with suicidality, but rare reports of increased suicidal ideation, suicidal behaviour and deaths require careful consideration of safety.
• In non-medical use, several deaths have followed psychedelic consumption, although accidents, unsafe settings and uncertain suicidal intent make causal attribution difficult; clinical trials have reported rare increases in suicidality without demonstrating a significant excess over placebo or causality.
• The authors propose a “double-edged sword” model in which reduced fear of death, altered representations of the world and reduced experiential avoidance can contribute both to therapeutic change and, in vulnerable individuals, to destabilization.
• The same psychological flexibility and profound changes in perspective that may help patients escape rigid depressive patterns could therefore increase risk when experiences occur without sufficient support or are negatively integrated.
• Suicide-risk screening, preparation, careful in-session guidance and post-session integration are presented as essential elements for shifting these mechanisms toward therapeutic benefit rather than harm.

The association between chronotype and incident dementia: exploring age, educational-attainment and sex differences

• The longitudinal study linked chronotype data with health records in 16,757 adults aged 60 years or older and followed incident dementia for a mean of 6.6 years.
• Chronotype was measured using the Munich ChronoType Questionnaire and categorized from extremely early to extremely late; 56% had an intermediate chronotype and approximately 7% developed dementia.
• Compared with an intermediate chronotype, a slightly early chronotype was associated with a 26% higher dementia risk (HR 1.26; 95% CI 1.08–1.46).
• An extremely late chronotype was associated with a 42% higher risk (HR 1.42; 95% CI 1.00–2.02), although the confidence interval indicates substantially greater uncertainty for this relatively uncommon group.
• Age, sex and educational attainment did not significantly modify the associations, suggesting that both slightly early and extremely late chronotypes may represent markers of elevated dementia risk in older adults.

Recreational cannabis access via pharmacies: A 1-year Swiss study on cannabis use and mental health

• The study followed 374 regular cannabis users for one year under a Swiss regulated-access model in which recreational cannabis was dispensed through pharmacies, with products limited to 20% THC and a maximum of 10 g THC per month.
• Mean depressive symptoms, anxiety symptoms and CUDIT-R scores decreased significantly over the year, but the absolute changes were small; for example, mean PHQ-9 scores decreased from 5.37 to 4.53.
• The proportion meeting clinical thresholds did not change significantly: the proportion above the CUDIT-R threshold fell from 32.7% to 28.6%, but this difference was not statistically significant.
• Cannabis-use frequency increased modestly while the quantity consumed remained unchanged; participants with high baseline CUDIT-R scores showed a larger reduction in problematic use.
• Because there was no control group, the changes cannot be attributed causally to regulated access, but importantly the pharmacy-based model was not associated with deterioration in mental health or problematic cannabis use over one year.

Early dating behaviors and problematic substance use in adolescence

• This longitudinal study examined whether dating-related behaviours before age 13 predicted later problematic substance use in a cohort of 132 adolescents initially aged 11–12 years.
• Cluster analysis identified two broad profiles: adolescents with no or limited early dating involvement and adolescents showing higher involvement in romantic interests and dating-related activities.
• Participants were subsequently assessed every six months for up to 84 months, allowing problematic substance use emerging after age 13 to be examined prospectively.
• Adolescents with higher early dating involvement had more than five times the odds of later problematic substance use compared with those with no or limited involvement (adjusted OR 5.14; 95% CI 2.00–14.92).
• The authors do not frame early dating itself as pathological; rather, unusually early romantic involvement may be a developmental marker of broader differences in social or emotional adjustment that also increase vulnerability to substance-related problems.

Higher prevalence of non-fatal overdose with opioid and stimulant use compared to use of opioids alone

• Data from four diverse North American cohorts were combined to examine how patterns of polysubstance use relate to non-fatal overdose among 7,573 people who use drugs.
• Drug use was classified into opioids alone, opioids plus stimulants, opioids plus non-stimulant drugs, and non-opioid drug use, with analyses adjusted for demographic factors and study time.
• At the most recent study visit, 13.7% of participants reported a non-fatal overdose during the preceding six months.
• In pooled analyses, people using both opioids and stimulants had more than twice the prevalence of non-fatal overdose compared with people reporting opioid use alone (PR 2.26; 95% CI 1.56–3.27).
• The consistency of this association across heterogeneous cohorts suggests that overdose-prevention strategies should explicitly address combined stimulant-opioid use rather than conceptualizing opioid overdose risk in isolation.

Cannabis Retail Accessibility and Adolescent Use Across a Maturing Market: Evidence from Canada

• Repeated cross-sectional COMPASS data from 419,887 Canadian secondary-school students between 2018 and 2023 were linked to geospatial measures of cannabis retailer accessibility around schools.
• Despite rapid expansion of the legal retail market, past-year cannabis use declined markedly from 22.2% in 2018 to 10.0% in 2023 in the study population.
• Distance to the nearest retailer, retailer density and distance-weighted retailer density generally showed small, inconsistent or non-significant associations with adolescent cannabis use across 264 model specifications.
• Greater geographic accessibility was associated with higher use frequency among cannabis-using students early after legalization in 2018, but this relationship disappeared as the retail market matured and outlets became widespread.
• Perceived ease of obtaining cannabis remained strongly associated with use but correlated only modestly with objective retail accessibility, suggesting that policies based solely on retailer proximity may have limited effects in mature legal markets.

Effectiveness of peer recovery support services for substance use disorders: A systematic review of healthcare utilization, behavioral health, and engagement outcomes

• This systematic review included 53 studies published between 2003 and 2026 evaluating peer recovery support services delivered by people with lived experience of substance use disorders.
• The clearest positive evidence concerned selected treatment-linkage and engagement outcomes, supporting the potential role of peers in helping people enter and remain connected with care.
• Effects on substance use, emergency-department utilization, hospitalization, overdose and mortality were inconsistent, so current evidence does not support broad claims that peer services improve all clinical outcomes.
• Programs reporting favorable outcomes more often included sustained navigation, practical assistance and repeated peer contact, although these components were not independently tested and therefore cannot yet be identified as causal mechanisms.
• Considerable intervention heterogeneity, high risk of bias in many non-randomized studies and limited long-term and economic evidence mean that more rigorous comparative and cost-effectiveness studies are needed.

Sex differences in cannabis use disorder study outcomes: An aggregated secondary analysis of medication trials

• Investigators pooled data from five randomized controlled medication trials for cannabis use disorder involving 570 participants, including 179 women, to examine whether treatment response differed by sex and pharmacological mechanism.
• Candidate medications were grouped according to glutamatergic, serotonergic or nicotinic mechanisms, and outcomes included substantial reductions in cannabis consumption and both self-reported and urine-confirmed abstinence.
• Men were significantly more likely than women to achieve self-reported abstinence, particularly when receiving active medication rather than placebo; urine-confirmed abstinence showed a similar pattern.
• Sex differences were driven mainly by trials of nicotinic and serotonergic medications, and men receiving active medication also showed larger reductions in cannabis consumption.
• The findings are secondary and do not establish an effective medication for CUD, but they suggest that biological sex may moderate response to candidate pharmacotherapies and reinforce the need to investigate mechanisms and treatments that are effective specifically for women.

Treatment and management approaches for ketamine misuse: A systematic review of medical interventions

73 studies found highly heterogeneous and mostly low-level evidence; supportive and symptomatic medical care remains central; psychotherapy includes motivational interviewing, CBT and occupational therapy; off-label options include benzodiazepines, SSRIs, naltrexone, lamotrigine and gabapentinoids; multidisciplinary care is essential for psychiatric and somatic complications such as K-bladder and K-cramps.

Pilot testing a multi-level stigma intervention to improve substance use care with providers in mental health settings: A cluster-randomized trial

Combined professional training with modification of an organizational controlled-substances policy; the intervention was feasible in two outpatient mental-health sites; neither arm significantly improved SUD pharmacotherapy, retention or stigmatizing attitudes; diagnosis of SUD increased only in the training-only control arm; qualitative findings suggest perceived limits of professional scope are an important organizational barrier.

Global perspectives on treatment and harm reduction services for opioid use disorder: Results from an international survey

Surveyed 42 addiction-medicine organizations representing 39 countries; illicit prescription opioids were reported in over 87% of countries and heroin in 80%; community-based outpatient treatment was the most widely available setting at 92%; availability of OUD treatment and harm-reduction services varied markedly across countries; findings highlight persistent global gaps and the need to expand evidence-based treatment and harm reduction.

Cannabis and cannabinoids for the treatment of mental and substance use disorders and symptoms: A systematic review and meta-analysis of experimental and observational studies

Included 82 experimental and 118 observational studies; RCTs showed a signal for reduced anxiety symptoms but with high heterogeneity and indirectness; no clear benefit was evident for depression and evidence for most other psychiatric disorders was weak; evidence for treating substance use disorders was very limited and one RCT found worsened CUD severity; certainty was predominantly very low and does not support cannabinoids as first-line treatment.

Frequent readmissions after hospitalization for alcohol withdrawal: a systematic review and meta-analysis

Twenty-five studies assessed rehospitalization after inpatient alcohol detoxification; pooled readmission was 17% within one month; readmission increased to 44% at one year; rates varied substantially across settings and populations; housing stability, employment and treatment engagement emerged as possible protective factors but evidence was limited.

Non-alcoholic beer consumption among alcohol consumers in the US

Nationally representative survey included 1,031 US adults drinking alcohol at least weekly; 25% had consumed non-alcoholic beer in the past year and 37% were interested in future use; 59% of consumers perceived that they drank less alcohol when using non-alcoholic beer; leading motivations were reducing alcohol intake, perceived health benefits and novelty; non-alcoholic beer may support alcohol reduction, although causal effects were not tested.

Why taking the trip out of psychedelic medicine is a mistake

Critiques attempts to develop non-hallucinogenic psychoplastogens as substitutes for classic psychedelics; argues that subjective experience may be central rather than incidental to therapeutic action; emphasizes set, setting and broader social context as components of psychedelic effects; warns that pharmaceuticalization may privilege scalability and standardization over relational and ecological dimensions; proposes understanding psychedelics as context-dependent amplifiers of experience rather than isolated pharmacological agents.

Claims to crisis: Rethinking opioid overdose in Canada

Examines how Canadian opioid overdose has been framed as a crisis and increasingly as a toxic-drug crisis; notes that overdose mortality growth predates the commonly cited fentanyl-era crisis boundary; argues that crisis framing shapes which causes, evidence and solutions become visible; questions whether a toxic-supply narrative alone adequately captures longer-term structural drivers; calls for approaches beyond damage-centred crisis narratives when conceptualizing overdose and policy responses.

“Success has many fathers” – The fentanyl overdose decline was the result of many uncoordinated policy efforts

Discusses the US decline in fentanyl overdose deaths as likely reflecting multiple simultaneous influences; precursor controls in China were followed by reduced fentanyl purity but causal attribution remains uncertain; correlations between forensic fentanyl measures and overdose mortality vary by measure and region; treatment, harm reduction, behavioral adaptation and supply changes may all have contributed; cautions against attributing the decline to a single policy intervention.

Towards Full Recovery with Lurasidone: Effective Doses in the Treatment of Agitation, Affective, Positive, and Cognitive Symptoms in Schizophrenia and of Dual Psychosis

Lurasidone improved positive, negative, cognitive and affective symptoms; higher doses showed greater efficacy; beneficial in agitation; useful in dual psychosis and post-psychotic depression; favorable tolerability profile.

Third-Generation Antipsychotics and Lurasidone in the Treatment of Substance-Induced Psychoses: A Narrative Review

Reviews lurasidone and other TGAs in substance-induced psychosis; covers cannabis, cocaine and stimulant psychoses; highlights efficacy and tolerability; supports use in dual diagnosis; identifies research gaps.

Lurasidone Compared to Other Atypical Antipsychotic Monotherapies for Adolescent Schizophrenia

Effective versus placebo; significantly less weight gain than several atypicals; lower discontinuation rates than some comparators; similar EPS risk; favorable adolescent profile.

Efficacy and Safety of Lurasidone Versus Placebo as Adjunctive to Mood Stabilizers in Bipolar I Depression

Improved MADRS and CGI-BP-S scores; increased response and remission; effective adjunctive treatment; minimal metabolic effects; good tolerability.

Efficacy of Lurasidone in First-Episode Psychosis: Patient Phenotypes, Dosage, and Recommendations from an Expert Panel

Effective in first-episode psychosis; useful in substance-associated psychosis; benefits affective symptoms; low weight-gain risk; favorable long-term tolerability.

Lurasidone for Treating Schizophrenia and Bipolar Depression: A Review of Its Efficacy

Effective in schizophrenia and bipolar depression; low metabolic risk; common AEs akathisia/somnolence; minimal ECG effects; well tolerated.

Lurasidone for the Treatment of Schizophrenia: Design, Development, and Place in Therapy

Strong D2/5HT activity; effective for positive and negative symptoms; low metabolic burden; relapse prevention; first-line option.

Lurasidone for the treatment of schizophrenia in adult and paediatric populations

Recommended in adults and adolescents; acute and maintenance efficacy; favorable weight profile; cognitive benefits; real-world support.

Efficacy and acceptability of lurasidone for bipolar depression

Optimal dose 40–60 mg/day; improves depression and anxiety; higher doses increase side effects; no increased mania switch; well tolerated.

Lurasidone: A Clinical Overview

Good metabolic and cardiovascular safety; low QTc risk; effective in acute schizophrenia; possible cognitive benefits.