Addiction最新文献

Background and aims: Opioid addiction poses a significant challenge to both the health of mothers and the outcomes for their newborns. Treatments based on buprenorphine offer a proven strategy for addressing opioid dependence among pregnant women. Various studies have examined the effectiveness of buprenorphine treatments versus methadone, revealing several potential advantages of buprenorphine for the outcomes of newborns. This systematic review sought to clarify the benefits and risks associated with buprenorphine therapy.

Methods: The PubMed, Web of Science and Scopus databases were searched with keywords for qualifying papers published before February 2025. Mean differences (MD) and 95% confidence intervals (CIs) were calculated for continuous data, while pooled proportions were estimated for categorical variables. Interstudy heterogeneity and publication bias were assessed using I² and Egger's tests with Meta-Essential software analyses.

Results: The initial database search identified 2019 studies. Following a screening process based on inclusion criteria, 38 studies were selected for data extraction. The number of participants involved in all included studies was 5524. The results indicated that infants exposed to methadone had a higher incidence of neonatal abstinence syndrome (NAS) and required more pharmacologic treatment compared with those exposed to buprenorphine-naloxone (0.44, 95% CI = 0.25-0.75, P < 0.01). Additionally, infants exposed to buprenorphine had slightly higher birth weights than those exposed to methadone (0.17 kg, 95% CI = -0.14 to 1.49, P = 0.049), which might be linked to a greater need for NAS treatment.

Conclusion: Compared with methadone in treating opioid use disorder during pregnancy, buprenorphine-based therapies, buprenorphine-naloxone in particular, have demonstrated greater efficacy in enhancing neonatal outcomes.

Aims: This study sought to validate a community-acceptable Substance Use & Sex Index (SUSI) for use in substance use intervention research. SUSI aims to measure behaviours associated with the transmission of blood-borne viruses (BBV) and sexually transmitted infections (STI) among people who use substances and incorporate contemporary sexual and drug practices.

Design: Validation of a self-administered online behavioural questionnaire.

Setting and participants: An Australian anonymous online questionnaire advertised through health services and social media resulted in 289 respondents with a mean age 35 years (standard deviation [SD] 10.9 years).

Measurements: A 26-item scale assessing BBV- and STI-associated behaviours based on previous piloting and expert review was assessed for scale structure using exploratory and confirmatory factor analytic approaches. Item Response Theory (IRT) analyses were applied in decisions to retain and categorise items. Item weightings were defined following expert consensus informed by local BBV, STI and HIV epidemiological profiles. Test-retest reliability was examined on a subsample (n = 98) over three to five days. Criterion validity of the new SUSI-2 scale was examined in comparison to the HIV Risk-taking Behaviour subscale of the Opiate Treatment Index (OTI-HRBS).

Findings: Factor analysis identified a two-factor model ("sex"; "drugs with sex"), with moderate magnitude correlation (r = 0.38; 95% confidence interval [CI] 0.19-0.54) between factors and acceptable model fit (p = 0.061). IRT discrimination was statistically significant for all items (p < 0.05). Kappa values for test-retest reliability (n = 98 subsample) ranged from 0.66 to 1.00 with high agreement (all above 87%). Free text responses indicated the questionnaire items were acceptable to respondents, with minimal suggestion for improvements. There was a statistically significant positive correlation between the SUSI-2 and OTI-HRBS sex subscales (weighted r = 0.63, p < 0.001) and between the SUSI-2 sex with drugs and OTI-HRBS drug subscale (weighted r = 0.21, p < 0.01). Four additional items were retained to reflect local other BBV and STI transmission risk.

Conclusions: The Substance Use & Sex Index 2 (SUSI-2) appears to be a valid and acceptable two-factor brief scale for the measurement of behaviours associated with blood-borne viruses and sexually transmitted infections for use in substance use interventional research.

Background and aims: Opioid use disorder (OUD), cannabis use disorder (CUD) and cocaine use disorder have been associated with a range of adverse health outcomes, including certain ocular manifestations; however, their impact on diabetic retinopathy (DR) remains insufficiently explored. This study aimed to measure the association between OUD, CUD and cocaine use disorder and the risk of DR among patients with type 2 diabetes mellitus (T2DM).

Design: Propensity-score-matched retrospective cohort study.

Setting: This study used the TriNetX US Collaborative Network to access electronic health records (EHRs), including data on demographics, diagnoses, medication use and laboratory results.

Participants/cases: A total of 131 088 adult patients with T2DM and comorbid OUD, CUD or cocaine use disorder, and 131 088 adult patients with T2DM without these conditions, were identified following propensity score matching.

Measurements: The primary outcome was the risk of DR evaluated over a 5-year follow-up period. The risks of various DR subtypes and diabetic macular edema (DME) were also assessed. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated.

Findings: Over a 5-year follow-up period, patients with T2DM comorbid with OUD, CUD or cocaine use disorder had a statistically significantly higher risk of developing DR [HR (95% CI) = 2.90 (2.55-3.30), P < 0.00] compared with those without any drug use disorder. Drug use disorders were also associated with elevated risks of vision-threatening diabetic retinopathy (VTDR) [HR (95% CI) = 2.78 (2.24-3.46), P < 0.00], non-proliferative diabetic retinopathy (NPDR) [HR (95% CI) = 3.10 (2.61-3.68), P < 0.00], proliferative diabetic retinopathy (PDR) [HR (95% CI) = 3.17 (2.26-4.45), P < 0.00] and DME [HR (95% CI) = 2.64 (2.04-3.42), P < 0.00] among patients with T2DM.

Conclusions: Opioid use disorder, cannabis use disorder and cocaine use disorder appear to be associated with an elevated risk of diabetic retinopathy among patients with type 2 diabetes mellitus.

Background and aims: Addressing the opioid crisis requires opioid use disorder (OUD) prevalence estimates at the community level for targeted interventions. This study presents a new method that utilizes Medicaid claims data and publicly available data to estimate OUD prevalence at the United States (US) county level and compares it with other existing estimates.

Design, setting and participants: This study utilized data on OUD diagnoses among Medicaid beneficiaries in combination with national survey data, Census data and published literature to estimate the prevalence of OUD (including undiagnosed OUD) in each of the US state of Ohio's 88 counties for the years 2019 to 2021 among the population aged 12 years and older. Prevalence estimates were adjusted for misclassification in claims data and for variation in healthcare utilization among individuals with OUD.

Measurements: Counts and proportions of the population aged 12 and older with OUD at the US state and county level.

Findings: OUD prevalence for Ohioans aged 12 years and older was relatively stable at 3.6% [95% uncertainty interval (UI) = 3.5%-3.8%] in 2019 and 3.7% (95% UI = 3.5%-3.9%) in 2021. County-level prevalence estimates ranged from 0.7% to 14.2% in 2021. Southern counties generally had higher OUD prevalence than northern counties. The prevalence estimates were strongly correlated (Pearson's r = 0.88) with prevalence estimates for 19 Ohio counties from a previous study. Compared with the previous estimates, estimates from the current study tended to be lower for most communities but remained within the 95% credible intervals of previous estimates.

Conclusions: This approach for estimating opioid use disorder prevalence within United States communities by using Medicaid claims data and publicly available data is a robust alternative to methods relying on individual-level data or multiple linked datasets.

Background and aims: To evaluate changes in community consumption and wholesales of alcohol before and after alcohol restrictions were implemented in 2023, aimed at reducing alcohol-related crime and violence.

Design: Longitudinal observational study.

Setting: Alice Springs, a regional town in the Northern Territory, Australia, from December 2019 to February 2024.

Participants: The population of Alice Springs serviced by the wastewater treatment plant catchment, and wholesales data for Alice Springs.

Measurements: Community consumption of alcohol was measured by analysing a biomarker of alcohol consumption in wastewater before and after the alcohol restrictions were implemented. Quarterly alcohol wholesales for the region were also modelled.

Findings: After the restrictions, alcohol consumption in Alice Springs immediately decreased, with an average 26% decrease over 12 months [95% confidence interval (CI) = -31 to -22%]. No statistically significant difference in trend slope was observed. The largest decreases in alcohol consumption were for Mondays and Tuesdays, when takeaway alcohol sales were not allowed. Total alcohol wholesales decreased by 17% (95% CI = -31 to -22%), with greatest meaningful declines of 44% for the sales of spirits (95% CI = -50 to -36%).

Conclusions: After the implementation of the 2023 restrictions on alcohol sales in the Northern Territory, Australia, wastewater-based estimates of alcohol consumption in Alice Springs were statistically significantly reduced by 26% and this was sustained for one year until the end of the data series in 2024. Total alcohol wholesales were also reduced, with differences observed by beverage type.

Background: Canada's 2018 legalization of non-medical cannabis was positioned as a public health initiative, intended to shift cannabis use from criminalization to regulation. Since then, cannabis access and consumption have grown significantly but the systems used to monitor cannabis-related harms have not kept pace. Most national surveys remain focused on patterns of use rather than indicators of harm. Cannabis use disorder (CUD), a clinical condition with well-established diagnostic criteria, remains rarely measured, often misclassified, and largely absent from policy discussions.

Argument: Canada's current surveillance tools are not equipped to detect or track CUD. Major national surveys rely on outdated DSM-IV frameworks, use skip logic that excludes individuals with lower levels of use, and fail to assess key symptoms such as loss of control, functional impairment, or withdrawal. The primary mental health surveillance tool does not align with DSM-5 standards. Administrative health records often obscure CUD due to underdiagnosis, inconsistent coding practices, and the absence of validated case-finding tools. High-risk populations are often excluded from survey samples. As a result, CUD is underdetected, undertreated, and underfunded across Canada's healthcare and policy systems.

Conclusion: Canada urgently needs a modernized surveillance infrastructure that reflects current diagnostic standards, improves the sensitivity of survey tools, incorporates equity metrics, and enables the reliable detection of cannabis use disorder in clinical data.

Background and aims: Although buprenorphine-based opioid agonist maintenance treatment (OAMT) is effective, logistical, economic and stigma-related barriers limit access. Telemedicine-Assisted Buprenorphine Induction (TABI) may address these barriers. This study evaluated the non-inferiority of TABI compared with the Standard of Care (SoC) for buprenorphine induction.

Design: Open-label, two-arm, randomized controlled non-inferiority trial. The induction period lasted 7 days, after which all participants continued buprenorphine-based OAMT as routine care. Follow-up assessments were done at one week and one month.

Settings: Addiction treatment center, Chandigarh, India.

Participants: Adults with opioid use disorder (OUD) meeting ICD-11 (International Classification of Diseases, 11th Revision) criteria, recruited between December 2023 and August 2024. A total of 138 participants were randomized (SoC = 70; TABI = 68). The mean age of participants was 28.2 years. Most participants were male (98.55%).

Intervention: SoC involved supervised in-person buprenorphine induction for three days. TABI consisted of in-person induction on Day 1, followed by telemedicine-based follow-ups for Days 2-6. In-person review on Day 7 in both arms.

Measurements: Primary outcome: treatment retention at one week, using a 15% non-inferiority margin.

Secondary outcomes: abstinence from illicit opioids, withdrawal symptoms, cravings, quality of life, satisfaction, therapeutic alliance and medication adherence.

Findings: The one-week retention rate was 75.71% in the SoC group and 82.35% in the TABI group, with an absolute difference of 6.64% [95% confidence interval (CI) = -6.88% to 20.16%]. The lower limit of the 95% confidence interval for the difference (-6.88%) is above the pre-specified non-inferiority margin, confirming the non-inferiority of TABI compared with SoC. Both groups showed statistically significant improvements in withdrawal symptoms, cravings and quality of life over time, with no statistically significant group differences. Patient satisfaction, therapeutic relationships, adherence and side effects were comparable between groups.

Conclusion: This randomized controlled trial found that telemedicine-assisted buprenorphine induction was non-inferior to standard care for one-week retention in treatment among adults with opioid use disorder. As such, it offers a patient-centred alternative to standard care and has the potential to reduce treatment barriers and improve access in resource-limited settings.