Amoxicillin and Clarithromycin Use and Delirious Mania in an Adolescent With Recurrent Catatonia and Psychosis.

Sleep disturbance is highly prevalent (51–75%) among people with opioid use disorder (OUD), including individuals receiving medications for OUD such as buprenorphine. These symptoms may complicate outpatient treatment through associations with symptom burden, co-occurring pain and psychiatric symptoms, and recovery-related functioning. In office-based buprenorphine treatment, clinicians often evaluate nighttime sleep complaints while also reconciling active medications and reviewing recent substance use. Because sleep complaints are managed within this broader addiction-care context, describing patient-reported nighttime symptoms alongside documented sleep-relevant or potentially sedating medications may provide clinically useful information for medication review and safety in outpatient OUD care. Nighttime sleep concerns are commonly identified through patient-reported symptoms such as difficulty falling asleep, difficulty staying asleep, and waking too early. These symptoms can be assessed using validated self-report measures such as the Insomnia Severity Index (ISI). Pharmacotherapy for sleep complaints is also encountered in routine care, but medication review is especially important among patients receiving buprenorphine because sedating medications and other central nervous system depressants can increase risks of sedation and respiratory depression when combined with opioids. In addition, cannabis use is common among people receiving medications for OUD, and sleep-related concerns are among the reasons some individuals report cannabis use. Recent substance exposures may therefore provide clinically relevant context that is not captured by the active medication list alone. Prior claims-based work examined sleep-related medication prescriptions among buprenorphine-treated adults with OUD using diagnostic codes for insomnia. However, coded diagnoses, prescription claims, active medication lists, and patient-reported nighttime symptoms do not always align in routine care, and active outpatient medication lists typically do not specify prescribing rationale. Accordingly, this study aimed to: (1) estimate the prevalence of patient-reported nighttime sleep symptoms among adults receiving buprenorphine for OUD; (2) describe sleep-relevant medication class documentation on the active outpatient medication list; and (3) describe how medication class documentation varied across nighttime symptom groups.