Addiction最新文献

We thank our colleagues for their responses to our article [1] in which we proposed a more nuanced approach to the emergency management of opioid overdose. We are pleased that it has generated thoughtful discussion and debate.

Wong et al. [2] raise the valid concern that evidence on responding to potent synthetic opioids is lacking, concluding that ‘the risk of inadequate reversal […] often outweighs the potential harms of over-antagonism.’ We agree that there is a pressing need for improved evidence on responses to synthetic opioid overdose to inform real-world, evidence-based practice. There is an urgent need for clinical trials, observational studies and emergency medical services data analysis involving these drugs.

Coffin [3] supports our core argument for integrating tailored dosing strategies into overdose management protocols. We agree that over-reliance on naloxone risks delaying other critical interventions, such as respiratory and cardiovascular support. Coffin also highlights the importance of timing, noting that fentanyl-related mortality may reflect not only its potency, but also the rapid onset of its effects compared with heroin.

Similarly, Morgan and Walley [4] emphasize the importance of timely intervention and how dose selection is secondary to a more fundamental issue—whether a bystander is present and able to respond, particularly given that witnesses may not be present. On this basis, not consuming drugs alone should be a core in harm reduction strategies. Our research group is one of a number around the world developing real-time overdose detection interventions to enable the earliest possible response [5].

We believe that there are three practical aspects that deserve emphasis. First, naloxone training in the community must include recognizing symptoms, basic first aid including airway and rescue breathing and alerting medical services before naloxone administration. Second, we need improved naloxone products that allow dose titration in community settings. Products designed to ensure individual incremental dosing could help bridge the gap between clinical and community environments. Recent pharmacokinetic studies have demonstrated significant inter-individual variability in naloxone absorption, supporting the need for flexible dosing approaches [6, 7]. The development of naloxone formulations that permit stepwise administration could address both efficacy and safety concerns in community settings. Third, we should develop simple, teachable principles of dose titration for lay responders. Rather than complex protocols, basic training could focus on the initial assessment and then starting conservatively if the patient is not in extremis/still breathing, monitoring respiratory response, and understanding when additional doses are warranted. Evidence from emergency medical services suggests that trained responders

Background and aims: People who use methamphetamine have a standardised mortality ratio 6.8 times greater than the general population, with several countries reporting concerning increases in methamphetamine-related mortality over the past decade. Methamphetamine use in the United Kingdom (UK) has been reported as largely confined to communities of men who have sex with men (MSM) with no previous large-scale studies describing mortality associated with methamphetamine. We aimed to determine trends and case characteristics of methamphetamine-related deaths in the UK.

Design: Retrospective cohort study.

Setting: Coronial records submitted to the National Programme on Substance Use Mortality (NPSUM) in the UK, 1997-2024.

Cases: Decedents for whom methamphetamine was determined as implicated in death following coronial investigation.

Measurements: Information was available on decedent sociodemographics, characteristics of death and drugs implicated in death.

Findings: 136 decedents had methamphetamine implicated in death. The number of deaths per year were observed to be higher over time since the first death recorded in 2006 (2005-2010, 8 deaths; 2011-2015, 24 deaths; 2016-2020, 47 deaths; 2021-2024, 57 deaths). Decedents were predominantly male (n = 124, 91%) of White ethnicity (n = 68, 50%) with a mean age of 41.5 years (standard deviation 10.4; range 18-71); 77% had a history of substance dependence, 48% of which involved injecting drug use, and 88% had a history of a mental disorder. The median blood methamphetamine concentration detected at post-mortem was 0.83 mg/l (interquartile range 0.26, 2.5). Multiple drug toxicity was implicated in the majority of cases (n = 88, 65%), the most common implicated other drugs being cocaine (n = 27, 20%), gamma-hydroxybutyrate (n = 20, 15%), opioids (n = 20, 15%), benzodiazepines (n = 18, 13%), mephedrone (n = 13, 10%) and ketamine (n = 12, 8%). Accidental poisoning was the most common direct cause of death (n = 89, 65%), with other causes including intentional poisoning, cardiovascular disease, aspiration pneumonia and ischemic bowel disease.

Conclusions: Over the past two decades there appears to have been an increase in the number of methamphetamine-related deaths in the UK. These deaths largely involve polysubstance use within an overwhelmingly male population with a high prevalence of substance dependence and mental health disorders.

Background and aims: Understanding lifetime alcohol exposure is fundamental to appreciating the risks of alcohol dependence and the multiplicity of alcohol-related harms, such as cirrhosis. However, most research relies on self-reported alcohol use measures that rarely extend beyond recent consumption. This represents a critical limitation in assessing the relationship between alcohol exposure and biological or psychological outcomes. Concerns about recall bias may be overstated and risk obstructing translational research into long-term effects of alcohol, including treatment engagement. This scoping review examined the evidence for the reliability and validity of self-reported measures of lifetime alcohol consumption.

Methods: We searched the MEDLINE, EMBASE and PsycINFO databases in June 2024 for English-language articles published since 1970. We included studies that performed at least one of the following psychometric assessments on a lifetime alcohol exposure measure: test-retest reliability, internal consistency, concurrent validity or construct validity.

Results: The search identified 1607 unique records. After title and abstract screening, 24 studies underwent full-text review, with nine meeting the inclusion criteria. Most studies were conducted in North America (78%). The most frequently used instrument was the Lifetime Drinking History (LDH) (67%). Across all studies, there were 6010 participants (3478 male, 2532 female), with sample sizes ranging from 49 to 3255. In 78% of studies, alcohol exposure data were collected via face-to-face interview. Eight studies assessed test-retest reliability, with retest intervals ranging from 14 days to 13 years; none assessed internal consistency. Three studies (33%) formally assessed validity. Where assessed, test-retest reliability and concurrent and construct validity were moderate to strong. Test-retest reliability ranged from 0.67 to 0.92, and concurrent and construct validity with external reference measures ranged from 0.40 to 0.80, indicating generally acceptable performance.

Conclusions: Existing instruments for measuring lifetime alcohol exposure appear to be valid and reliable and can overcome concerns regarding biases; however, these instruments vary in structure, lack standardisation and may fail to capture binge or episodic drinking, highlighting important gaps for refinement.