Addiction最新文献

Background and aims: Smoking tobacco increases the risk of intra- and post-operative complications. Abstinence before surgery reduces these risks and costs to healthcare services. This study measured smoking abstinence among elective pre-operative patients who smoked following a modified clinical pathway.

Design: An observational, follow-up study of patients who received the changed pre-operative pathway, supplemented by a controlled interrupted time series analysis (ITSA) of hospital patients referred to the community Stop Smoking Service (SSS) between April 2020 and August 2024. Patients referred to the SSS by primary care clinicians acted as a negative control to assess whether any observed changes reflected general time trends rather than the intervention effect.

Setting: A district general hospital in Nottinghamshire, United Kingdom, during January 2024.

Participants: 476 pre-operative patients recorded as smokers in primary care electronic health records (52% female; mean age 52 years) awaiting elective procedures taking place in more than 6 weeks were included.

Intervention: Patients who had completed the routine pre-operative care pathway were invited via Short Message Service message (SMS) to opt out of SSS referral. Those who did not respond within 14 days were referred. The SSS provided usual care consisting of face-to-face or virtual counselling and an offer of nicotine replacement therapy. The intervention was low-cost and used existing pre-operative services.

Measurements: The primary outcome was patient-reported smoking abstinence 28 days after an agreed quit date. This is a routinely collected SSS outcome. Controlled ITSA compared weekly counts of first SSS appointments between secondary care and primary care referrals among patients who subsequently achieved abstinence, before and after the intervention was implemented.

Findings: 10.5% (50/476) of patients reported 28-day abstinence. 25.4% (121/476) booked an SSS appointment and 16% (77/476) opted out of SSS referral. 63.9% (304/476) were contactable by the SSS and 54.2% (258/476) confirmed smoking. 19.4% (50/258) of patients who were contactable and confirmed smoking stopped. ITSA indicated an immediate increase in weekly hospital patients referred who reported abstinence was not due to any general time trends (5.83, 95% confidence interval = 2.50-9.16, P < 0.001), consistent with a pulsed intervention of limited duration.

Conclusions: Inviting elective surgical patients to opt out of Stop Smoking Service referral via Short Message Service message appears to increase 28-day smoking abstinence.

The article provides an overview of key substance use and addictive behaviors in Vietnam, alongside the development of addiction science, drawing from a synthesis of literature and the authors' perspectives. Over the last two decades, the primary illicit drug of concern has shifted from heroin to methamphetamine and other psychoactive substances. Tobacco use has declined but remains widespread while alcohol consumption is high compared with other countries in the region with common binge drinking. Studies on behavioral addictions in Vietnam are limited. While the impacts of opioid addiction are well documented, reports on the societal impacts of methamphetamine use remain scarce. Public discourse has often framed substance use negatively, fueling stigmatization and supporting abstinence-oriented policies. Vietnam's drug policy reflects a tension between abstinence-focused and harm reduction approaches. The nationwide expansion of methadone treatment is a significant achievement. However, the country's responses to the new epidemic of methamphetamine and other psychoactive substances are still evolving. International cooperation has continued to play an important role in advancing research and surveillance as well as adapting evidence-based interventions. There are promising signs that Vietnam will strengthen public awareness and expand workforce training and policy innovation to address the issue of substance use in the population.

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.