Open research questions in Opioid Use Disorder Treatment

What the literature leaves open

• One challenge is the lack of availability of mental health expertise at specialty addiction treatment programs, which can limit the effectiveness of integrated care approaches. Another challenge is the difficulty in engaging patients in mental health treatment, particularly in rural areas where access to care may be limited. The study also highlights the challenge of addressing the complex needs of patients with comorbid mental health and substance use disorders.

  Treatment for Comorbid Mental Health Disorders Among Patients Treated for Opioid Disorder: The Role of a Hub and Spoke Intervention · 2026 · DOI

• There is a lack of research on the effectiveness of the Hub and Spoke model in improving treatment outcomes for patients with comorbid mental health disorders. Prior studies have shown that patients with opioid use disorder often have poor adherence to psychotropic medication, but few studies have examined the effectiveness of integrated care approaches. The study aims to address this gap by examining the relationship between Hub and Spoke participation and psychotropic medication use and adherence.

  Treatment for Comorbid Mental Health Disorders Among Patients Treated for Opioid Disorder: The Role of a Hub and Spoke Intervention · 2026 · DOI

• One challenge is the limited external validation and fairness assessment of AI models for SUD. Another challenge is the need for sustained digital engagement and reliable connectivity for management applications. The review also highlights the challenge of addressing existing care disparities and ensuring equity in AI implementation for SUD screening and management.

  Artificial intelligence for alcohol, opioid, and cannabis use disorders screening and management: a narrative review of barriers and facilitators to clinical implementation · 2026 · DOI

• Limited external validation of AI models, - Limited fairness assessment and deployment readiness, - Lack of systematic fairness evaluation comparable to opioid research, - No confidence intervals or inferential statistics for estimates, - Real-world, nonrandomized character of the underlying data

  Artificial intelligence for alcohol, opioid, and cannabis use disorders screening and management: a narrative review of barriers and facilitators to clinical implementation · 2026 · DOI

• There remains a paucity of comprehensive reports on the spatiotemporal distribution, driving factors, and future trends of drug use disorders at global, regional, and national levels. The importance of drug use disorders as a public health issue among young people is not reflected in, and remains unaddressed by, the allocated resources for an extended period. The disparity in treatment availability across different geographical areas has continued to expand, exacerbating the challenges faced by affected populations in certain regions.

  Global burden on drug use disorders from 1990 to 2021 and projections to 2046 · 2025 · DOI

• Background: Social support is an established determinant of health behaviors, yet its role in COVID 19 booster uptake and general healthcare utilization remains unclear.

  Role of emotional social support in COVID-19 booster uptake among drug use disorder communities · 2026 · DOI

• Black men face elevated risk from opioid and stimulant co-use, including overdose from unintentional opioid exposure, yet heterogeneity in trauma exposure among men who co-use substances is understudied.

  Trauma Profiles and Cocaine Use Among Formerly Incarcerated Black Men Who Co-Use Opioids and Stimulants · 2026 · DOI

• OBJECTIVE: Reduction of craving is a key mechanism of buprenorphine treatment for opioid use disorder but has not been examined as an indicator of early response versus nonresponse.

  Investigating craving as an indicator of early response to buprenorphine treatment among adults with opioid use disorder. · 2026 · DOI

• Background: Prescription opioid misuse (POM) remains a significant public health concern among college students, yet few studies have examined POM prevalence, misuse behaviors among those with prescriptions, and how students access opioids in college settings.

  Exploring prescription opioid misuse among college students: a secondary analysis of ACHA National College Health Assessment data (2019–2022) · 2025 · DOI

• Changes in drug use in the general population during the COVID-19 pandemic and their long-term consequences are not well understood.

  Changes in recreational drug use, reasons for those changes and their consequence during and after the COVID-19 pandemic in the UK · 2025 · DOI

• Results highlight bisexual men as an understudied group in chronic pain research.

  Embodied inequities: an intersectional examination of the roles of gender, sexual orientation, and social support in chronic pain inequities in the United States · 2025 · DOI

• BACKGROUND: Prescribing high-potency opioids for chronic non-cancer pain has increased in Germany, despite limited evidence of long-term efficacy.

  Exploring opioid management challenges in chronic non-cancer pain: findings from a mixed-methods study among general practitioners in Germany · 2025 · DOI

• The guideline "Long-term use of opioids for chronic non-cancer pain" (LONTS) provides recommendations for responsible opioid management, but its uptake in primary care remains unclear.

  Exploring opioid management challenges in chronic non-cancer pain: findings from a mixed-methods study among general practitioners in Germany · 2025 · DOI

• However, the relationship between novel biomarkers such as the Pan-Immune-Inflammation Value (PIV) and uric acid-to-albumin ratio (UAR) and cardiac structural abnormalities in this population remains poorly understood.

  Valvular dysfunction and cardiovascular risk in individuals with opioid use disorder who are maintained on buprenorphine/naloxone: a focus on pan-immune-inflammation value and uric acid-to-albumin ratio · 2025 · DOI

• The long-term effects of the COVID-19 pandemic and lockdown measures on these prescriptions remain uncertain.

  A longitudinal cohort study on dispensed analgesic and psychotropic medications in older adults before, during, and after the COVID-19 pandemic: the HUNT study · 2025 · DOI

• Limited information is available regarding the incidence of new persistent use after surgery in other countries.

  New Persistent Opioid Use After Surgery · 2025 · DOI

• As antiracist perspectives inform research practices and cultural humility principles guide care, we will be better equipped to close current gaps in knowledge and address widening healthcare disparities.

  Disentangling the effects of racism-related stress on opioid use disorder and chronic pain outcomes · 2024 · DOI

• Background: Little is known regarding the extent to which substance use disorder (SUD) treatment facilities adopt comprehensive services to meet patients’ medical and social needs.

  Trends in the availability of comprehensive services within outpatient substance use treatment facilities from 2018 to 2022 · 2024 · DOI

• The extent to which individuals with chronic pain are aware of these deleterious outcomes is considerably understudied.

  Awareness of the potential consequences of alcohol consumption in the context of chronic pain and prescription opioid use · 2024 · DOI

• While the disease-versus-choice model debate permeates discussions about addiction, little is known about how judges—key actors in the legal system—conceptualize addiction and make decisions accordingly.

  French Judges’ Beliefs About Addiction: Divided on Causes, Aligned on Individual Responsibility · 2024 · DOI

• PURPOSE: Few studies have addressed beliefs about treatment for opioid use disorder (OUD) among family members of people with OUD, particularly in rural communities.

  “I don't think that a medication is going to help someone long‐term stay off opioids”: Treatment and recovery beliefs of rural Vermont family members of people with opioid use disorder · 2024 · DOI

• Importance: Although substantial evidence supports buprenorphine for treatment of opioid use disorder (OUD) in controlled trials, prospective study of patient outcomes in clinical implementation of emergency department (ED) buprenorphine treatment is lacking.

  Emergency Department Access to Buprenorphine for Opioid Use Disorder · 2024 · DOI

• Future research should investigate techniques to optimize both the uptake and effectiveness of buprenorphine initiation in low-threshold settings such as the ED.

  Emergency Department Access to Buprenorphine for Opioid Use Disorder · 2024 · DOI

• Emergency department-based peer support is a promising approach for promoting treatment linkage, but evidence of its effectiveness is lacking.

  Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose · 2024 · DOI

• The PCPs described gaps in knowledge on how to taper, a lack of clinical access to monitor patients during tapering, and concerns about patient resistance.

  Older Adult and Primary Care Practitioner Perspectives on Using, Prescribing, and Deprescribing Opioids for Chronic Pain · 2024 · DOI

Most-cited papers in Opioid Use Disorder Treatment

• CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 · JAMA · 2016 · 3,318 citations
• Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015 · MMWR Morbidity and Mortality Weekly Report · 2016 · 1,757 citations
• Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014 · MMWR Morbidity and Mortality Weekly Report · 2015 · 1,356 citations
• Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths · JAMA · 2011 · 1,279 citations
• The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction · Annual Review of Public Health · 2015 · 1,170 citations
• Drug and Opioid-Involved Overdose Deaths — United States, 2013–2017 · MMWR Morbidity and Mortality Weekly Report · 2018 · 1,104 citations
• Drug and Opioid-Involved Overdose Deaths — United States, 2017–2018 · MMWR Morbidity and Mortality Weekly Report · 2020 · 984 citations
• Vital Signs: Changes in Opioid Prescribing in the United States, 2006–2015 · MMWR Morbidity and Mortality Weekly Report · 2017 · 957 citations
• Mortality and Morbidity in the 21st Century · Brookings Papers on Economic Activity · 2017 · 948 citations
• Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths — United States, 2013–2019 · MMWR Morbidity and Mortality Weekly Report · 2021 · 944 citations

Most recent work

• Global burden of amphetamine, cannabis, cocaine and opioid use in 204 countries, 1990–2023: a Global Burden of Disease Study · Nature Medicine · 2026
• Medications for Opioid Use Disorder, Opioid Withdrawal, and Opioid Overdose · JAMA · 2026
• Emergency Department–Initiated Buprenorphine for Opioid Use Disorder · JAMA · 2026
• Community Pharmacist Perspectives on Observing and Dispensing Methadone for Opioid Use Disorder: Cross-sectional Survey Study · Journal of Addiction Medicine · 2026
• Adolescent-Led Opioid Education and Naloxone Distribution in a High School · PEDIATRICS · 2026
• First-Year Impact of Drug Decriminalization on Mental- and Substance Use Disorder-Related Healthcare Encounters in British Columbia: An Interrupted Time Series Analysis · The Canadian Journal of Psychiatry · 2026
• As US Overdose Deaths Drop, Researchers Search for Explanations · JAMA · 2026
• US Trends in Long-Term Opioid Therapy · JAMA · 2026
• The Veterans Affairs’ Whole Health Approach for Chronic Pain Management · JAMA · 2026
• “I can't take in every stray puppy”: How U.S. pain specialists purify pain management through opioid-related gatekeeping · Social Science & Medicine · 2026

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