Addiction最新文献

Background and aims: Substance-related emergency department (ED) visits represent a critical opportunity to link individuals with sustained treatment for substance use disorders (SUD), yet few transition to post-acute treatment. Among emerging initiatives to integrate specialized SUD care into ED services, the Stockholm SUD-ED is an example of a fully integrated model that remains unmapped. This study aimed to systematically map care pathways and identify predictors of post-acute SUD treatment engagement among SUD-ED patients in Stockholm.

Design: Retrospective cohort study. Electronic health records data were linked with five registries covering, among other aspects, clinical history and healthcare consumption.

Setting: The Stockholm SUD-ED, Sweden.

Participants: n = 9771 SUD-ED patients during a sixteen-month period (2018-2019).

Measurements: For care flow mapping, post-acute SUD treatment engagement was defined as ≥2 outpatient visits during a six-month follow-up. Four engagement levels (none, low, moderate, high) were derived using a quantile regression approach and regressed on 19 candidate predictors in multinomial logistic regression models.

Findings: Of all SUD-ED patients, one-third (33.2%; n = 3248) primarily engaged in post-acute outpatient SUD treatment, 16.9% (n = 1651) primarily engaged in non-SUD psychiatric services and 49.9% (n = 4872) did not engage in either. Police-initiated admissions had lower odds of moderate or high post-acute treatment engagement than ambulance-initiated admissions [high engagement: adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI) = 0.53-0.95]. Prior needle and syringe program visits increased the odds of post-acute treatment engagement (aOR = 2.09, 95% CI = 1.59-2.75). Lack of prior SUD outpatient treatment was consistently associated with lower odds of post-acute engagement across all levels (e.g. moderate engagement: aOR = 0.3, 95% CI = 0.25-0.35).

Conclusions: The Stockholm model for fully integrating specialized substance use disorder care into emergency departments appears to generate high post-acute treatment engagement and highlights the need for (1) targeted interventions for police-initiated admissions and (2) broad aftercare options to better attract treatment-naïve patients.

Background and aims: There has been limited evidence synthesis examining the treatment of buprenorphine precipitated opioid withdrawal (BPOW). We aimed to conduct the first systematic review to assess the clinical utility of any pharmacological intervention in the management of BPOW.

Methods: Systematic review searching Medline, Embase, PsychINFO and CENTRAL from the date of database inception to 26 August 2025 for studies of any design reporting any pharmacological intervention in the management of BPOW compared with any or no other interventions, using adult participants aged 18 or over receiving buprenorphine and experiencing BPOW. We planned to combine outcomes using random-effects meta-analysis; where this was not possible results were reported narratively. We considered two outcomes and extracted (1) any reported measure or description of the change in opioid withdrawal symptoms (OWS) and (2) the number of individuals retained in buprenorphine treatment. Outcome quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Results: Forty-three studies met inclusion criteria reporting on 137 participants. These comprised one pilot randomised controlled trial and 42 uncontrolled observational case series or case reports. Meta-analysis was not possible, and all evidence was of low or very low quality. The currently available randomised evidence suggests that use of intravenous magnesium sulphate, in addition to symptomatic treatment with clonidine, paracetamol and diazepam, may statistically significantly reduce OWS when compared with symptomatic treatment alone. The currently available observational evidence suggests that treatment strategies which include additional doses of transmucosal buprenorphine may demonstrate higher rates of symptom control and treatment retention than strategies which do not include additional doses of transmucosal buprenorphine.

Conclusions: There is a paucity of research into pharmacological management of buprenorphine precipitated opioid withdrawal. The limited very low to low quality evidence suggests treatment regimens that include magnesium sulphate and additional doses of transmucosal buprenorphine are potentially the most salient current options and avenues for future research in the management of buprenorphine precipitated opioid withdrawal.

Background and aims: Smokers quitting successfully with the help of e-cigarettes often continue vaping. It is not known whether this promotes or prevents relapse back to smoking. This study aimed to determine whether use of e-cigarettes after successful smoking cessation affects the probability of relapse later on.

Design: Secondary analysis of a randomised controlled trial where participants received combination nicotine replacement therapy (NRT) or e-cigarettes to compare relapse rates in the two study arms and in abstainers who did and did not use e-cigarettes.

Setting: Four stop-smoking services in the United Kingdom.

Participants: 886 smokers (median age 41, smoking on average 15 cigarettes per day, 48% female) seeking help with stopping smoking.

Measurements: Main outcome was relapse to smoking by 12 months in participants who were abstinent at 4 weeks or at 6 months. Relapse was defined as abstinence at 4 weeks but not at one year or abstinence at 6 months but not at one year. Abstinence from smoking was defined as no smoking over the past 7 days. E-cigarette use was defined as using e-cigarettes at the time of abstinence on at least one day per week.

Findings: Abstainers in the e-cigarette arm were less likely to relapse than abstainers in the NRT arm [relative risk (RR) = 0.78, 95% confidence interval (CI) = 0.64-0.96 for relapse between 4 weeks and 1 year; RR = 0.71, 95% CI = 0.55-0.93 for relapse between 6 months and 1 year). Relapse rates over both time periods were also lower in abstainers who used e-cigarettes compared with abstainers who did not use e-cigarettes (RR = 0.79, 95% CI = 0.65-0.97 and RR = 0.75, 95% CI = 0.57-0.98, respectively).

Conclusions: Use of e-cigarettes after stopping smoking is associated with a reduced risk of relapse.