Addiction最新文献

Background and aims: Mechanisms of varenicline preloading in promoting smoking abstinence have not been evaluated. Based on an extinction of reinforcement framework, we tested the hypothesis that pre-quit reductions in smoking rate mediate the effect of extended preloading on abstinence. We also tested alternative indicators of change in smoking reinforcement, as well as smoking aversion, nausea and abstinence self-efficacy as candidate mediators.

Design, participants and intervention: Randomized, double-blind, placebo-controlled trial (NCT03262662) comparing extended (4-week varenicline) to standard (3 weeks of placebo, 1-week varenicline) preloading, preceding 11 weeks of open-label varenicline, in 320 adults (56% female). The primary outcome was self-reported continuous smoking abstinence during the last 4 weeks of treatment, with cotinine bio-verification at end of treatment (EOT).

Setting: University at Buffalo, State University of New York, USA (part of the trial was conducted at participants' homes due to the COVID-19 pandemic).

Measurements: Candidate mediators, including smoking rate and subjective effects of smoking (reward, satisfaction, aversion), self-reported craving, withdrawal, nausea and abstinence self-efficacy, were assessed daily during the pre-quit period with ecological momentary assessment. At two laboratory visits participants completed a choice task to assess smoking reinforcement.

Findings: There was a statistically significant indirect effect of extended preloading on greater EOT abstinence rates through pre-quit declines in smoking rate [a*b = 0.284, 95% confidence interval (0.072,0.616)] and percent reduction in smoking across the pre-quit period [a*b = 0.225, (0.080,0.437)]. There were also statistically significant indirect effects through reductions in pre-quit craving [a*b = 0.150, (0.01,0.420)] and increases in pre-quit self-efficacy [a*b = 0.157, (0.038,0.375)]. Sex-specific analyses suggested these mediated effects were consistently limited to females. No other candidate mediators yielded statistically significant indirect effects.

Conclusions: Extended varenicline preloading mediated smoking abstinence through reduced pre-quit smoking and craving among female smokers seeking to quit; increased pre-quit abstinence self-efficacy was also a significant mediator.

Intravascular injection of dissolved medicinal preparations such as crushed tablets is associated with a risk of injecting particulate material into the vasculature. This particulate material will naturally pass to the lungs where it will be largely filtered out in the pulmonary vascular bed, and in turn, it can result in a range of pathological processes in the lungs including pulmonary arterial hypertension, granulomatous lung disease, and pulmonary fibrosis. On rare occasions, a rapid increase in pulmonary vascular resistance can result in sudden death of the injecting drug user.

Background and aims: Identifying those who use methamphetamine or are at high risk of using methamphetamine is essential so that early, appropriate intervention can be made. This study evaluated the use of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for identifying methamphetamine use among people on methadone maintenance treatment (MMT) in Vietnam.

Methods: From June 2021 to May 2023, all people on MMT at 15 methadone clinics in Hanoi and Ho Chi Minh City, Vietnam, were invited to participate in this study. Participants underwent a face-to-face interview to complete the 8-item ASSIST. Participants also had a urine drug test (UDT) for methamphetamine use. Discriminant properties of the ASSIST were evaluated using UDT as the reference.

Results: Among 6709 participants, 10.7% (n = 717) tested positive for methamphetamine use via UDT. The ASSIST demonstrated robust discriminant abilities to identify those who used methamphetamine [area under the curve (AUC) = 0.872; 95% confidence interval (CI) = 0.856-0.887]. At the commonly used cutoff of 4, the ASSIST had a sensitivity of 83.8% and a specificity of 82.0%. At this cutoff, 82.2% of the ASSIST results aligned with UDT outcomes (kappa coefficient = 0.41, P < 0.001) and the ASSIST identified a prevalence of 25.0%. At higher cutoffs, the sensitivity of the ASSIST decreased but both the specificity and the agreement with the UDT results increased.

Conclusions: The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) appears to be reliable and valid in identifying methamphetamine use among people on methadone treatment in Vietnam. Cutoff adjustments may help to reduce false positive rates.

Background and aims: Smoking cessation during pregnancy results in short- and long-term health benefits for the mother and infant. Despite public health policies and initiatives to reduce smoking, smoking in pregnancy remains unacceptably high in Australia, particularly among populations of high disadvantage. Internationally, the use of financial incentives has shown some promise in assisting pregnant women to quit smoking, but more research is needed in different contexts. This study aims to determine the efficacy, cost-effectiveness and acceptability of the use of financial incentives in Australia.

Design: 2-arm parallel-group randomised controlled trial.

Setting: Australian antenatal care setting.

Participants: Pregnant women who smoke.

Intervention: Women randomised to the intervention group will receive financial incentives of increasing value at three time points throughout their pregnancy (4 and 12 weeks from the first antenatal visit and 37 weeks gestation) upon confirmation of smoking abstinence.

Measurements: The primary comparison outcome is a composite binary measure of abstinence at three time points during pregnancy (4, 12 and 37 weeks). Smoking abstinence will be determined by a carbon monoxide breath analysis reading of ≤3 ppm. The primary statistical analysis is estimation of the absolute difference in the prevalence of abstinence at all three time points based on the intention-to-treat groups. A cost-effectiveness analysis will be undertaken to quantify the social returns of the intervention. A qualitative process evaluation will also be conducted to determine fidelity, contextual factors and the acceptability of the intervention to pregnant women and healthcare workers.

Comments: This study will be the first Australian trial of financial incentives in reducing smoking in pregnancy. The findings will provide evidence on the acceptability, effectiveness and cost-effectiveness of financial incentives to reduce smoking in pregnancy in Australia.

Background and aims: The clandestine production and distribution of anabolic-androgenic steroids (AAS) poses health risks due to the uncertainty of their contents. This study aimed to test the chemical content of AAS samples and provide aggregate results back to the community, exploring how these results influenced usage decisions and risk management.

Design: A mixed-methods approach was used, combining chemical analysis of AAS samples with qualitative interviews. Participants submitted samples for testing, and the results were later shared with them. Semi-structured interviews explored participants' perceptions of AAS risks and the impact of testing results on their behaviour.

Setting: The study was conducted at CheQpoint drug checking service in Brisbane, Australia.

Participants: Thirty-two samples were submitted for testing between 19 April and 7 June 2024, with 23 samples analysed. A total of 25 active AAS users participated in interviews.

Measurements: Chemical analyses identified substances present and assessed active ingredient concentrations. Qualitative interviews gathered participants' perceptions, and these data were analysed through iterative categorisation, guided by the Health Belief Model.

Findings: Chemical analysis identified that 13% of samples contained substances different from what was expected. Concentrations of active ingredients were close to expected levels [e.g. testosterone propionate at 96.2 mg/mL (range = 91.39-101.01 mg/mL)]. Interviews identified four key theme categories. Participants sought testing primarily for substance verification, expressing concerns about contamination and dosage. Barriers to testing included limited access and fear of disclosure. While testing was seen as a valuable harm reduction tool, gaps in health guidance and follow-up support were identified as areas for improvement.

Conclusions: Thirteen percent of 23 anabolic-androgenic steroid (AAS) samples analysed contained substances different from what was expected. Interviews with active AAS users highlighted the need for reliable information, accessible testing services and tailored health approaches for AAS use.

Background and aims: Alcohol and gambling industries use a range of strategies to oppose and undermine public health policies targeting their industries. Industry associations often play a visible role in advancing alcohol and gambling industry interests, yet there are few studies analysing who their members or partners are and the relationships between them. Our study developed an approach to map the landscape of Australian alcohol and gambling associations, their members and partners and the connections between commercial actors.

Methods: We conducted our study in four phases: first, we systematically searched for alcohol and gambling industry associations; second, we identified and classified association members and/or partners; third, we mapped three types of relationships between associations and members/partners (umbrella associations, co-location and joint membership/partnerships); lastly, we analysed the disclosures of the members and partners of the Australian Hotels Associations and Clubs Associations.

Results: We identified 126 industry associations and 1486 unique companies/organisations from multiple industry sectors that were members/partners. Only 75 (59.5%) associations provided a list of members/partners. Most companies/organisations were partners of only one association (n = 1218), while five companies were partners of more than 20 associations. Concerning relationships, we identified five national clusters, 27 instances of co-location and an extensive network linking associations through shared partnerships. Finally, we assessed 658 relationships between Hotels and Clubs Associations and their partners, of which only 91 (13.8%) were transparently disclosed.

Conclusions: In Australia, many alcohol and gambling industry associations do not disclose their members or corporate partners and provide limited funding information. Members and corporate partners of Australian alcohol and gambling industry associations rarely disclose their support and are diverse in focus, size, members, partners, purpose and activities.

Background and aims: Substance use (SU) is prevalent among individuals in the criminal justice system (CJS). However, there is often poor access to treatment. We aimed to assess the effectiveness of two medications, extended-release naltrexone (XR-NTX) and extended-release buprenorphine (XR-BUP) for the prison population.

Methods: We searched Scopus, OVID/Embase, PubMed/Medline, ProQuest, EBSCO, Cochrane Library and Australian Criminology Database for original articles published from 1 January 2002 to 31 December 2022.

Inclusion criteria: 18+, substance use disorder; XR treatment; recent incarceration. We extracted study, participants, treatment characteristics and outcome variables. We conducted risk of bias assessments using the RoB-2, ROBINS-I, JBI tools and Evers et al. RESULTS: We identified 25 papers (16 studies) examining 3403 participants. Sixteen papers (9 studies) focused on XR-NTX, eight (7 studies) on XR-BUP and one on both. Eighteen papers (11 studies) were from the US, with the remainder from Norway, Australia, UK, Canada and Germany. There were eight RCTs (10 papers), four secondary observational analyses, four cohort studies, four economic analyses, two case series and one qualitative paper. Most studies had small-moderate samples, with varying retention and follow-up periods. Among RCTs, two XR-NTX studies for opioid use found no difference in retention vs treatment as usual and placebo, while one reported improved retention for XR-NTX implant vs methadone. One RCT showed mixed retention results for XR-NTX vs placebo in alcohol use. One XR-BUP study showed improved or equivalent treatment retention (depending on measures) vs sublingual buprenorphine. There was no difference in overdoses. SU for XR-NTX was challenging to assess due to differing definitions, measures and comparators. XR-BUP yielded mixed SU results, with one indicating a greater effect and another no difference from comparators.

Conclusions: There is no clear evidence for the effectiveness of extended release naltrexone and buprenorphine among individuals in the criminal justice system compared with shorter acting formulations. But there is growing evidence for the effectiveness of extended release buprenorphine in reducing opioid use and improving treatment retention in that population, with potential cost offsets from initial medication expenses.

Aims: To assess the evidence for a relationship between the use of e-cigarettes and subsequent smoking in young people (≤29 years), and whether this differs by demographic characteristics.

Methods: Systematic review with association direction plots (searches to April 2023). Screening, data extraction and critical appraisal followed Cochrane methods. Our primary outcome was the association between e-cigarette use, availability or both, and change in population rate of smoking in young people. The secondary outcomes were initiation, progression and cessation of smoking at individual level. We assessed certainty using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).

Results: We included 126 studies. For our primary outcome, there was very low certainty evidence (limited by risk of bias and inconsistency) suggesting that e-cigarette use and availability were inversely associated with smoking in young people (i.e. as e-cigarettes became more available and/or used more widely, youth smoking rates went down or, conversely, as e-cigarettes were restricted, youth smoking rates went up). All secondary outcomes were judged to be very low certainty due to very serious risk of bias. Data consistently showed direct associations between vaping at baseline and smoking initiation (28 studies) and smoking progression (5 studies). The four studies contributing data on smoking cessation had mixed results, precluding drawing any conclusion on the direction of association. There was limited information to determine whether relationships varied by sociodemographic characteristics.

Conclusion: At an individual level, people who vape appear to be more likely to go on to smoke than people who do not vape; however, it is unclear if these behaviours are causally linked. Very low certainty evidence suggests that youth vaping and smoking could be inversely related.

Background and aims: This is the first systematic review of the extant literature on all major psychedelic-assisted treatment for alcohol use disorder (AUD), tobacco use disorder (TUD) and other substance use disorders (SUD). We aimed to summarise the evidence for efficacy of psychedelic-assisted treatment for AUD, TUD, and SUD; to evaluate its quality; and to offer recommendations for research.

Methods: This was a prospectively registered narrative systematic review of open-label, randomised controlled trials (RCT), and observational studies of d-lysergic acid diethylamide (LSD), mescaline, psilocybin, ayahuasca, ketamine, ibogaine and 3,4-methylenedioxymethamphetamine (MDMA). Eligible studies had SUD outcome measures including craving, substance use, relapse, and remission. Study quality was evaluated using the Cochrane Collaboration Risk of Bias (RoB), and Cochrane Collaboration RoB in Non-randomised Studies of Interventions tool. Certainty of evidence for RCTs was judged using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool.

Findings: 37 studies (2035 participants) were reviewed: LSD (14; n = 1047); mescaline (1; n = 7); psilocybin (4; n = 135); ayahuasca (3; n = 101); ketamine (10; n = 579); ibogaine (5; n = 166); and MDMA (1; n = 14). There were no serious adverse events reported in any study. A two-centre, placebo-controlled, phase 2 superiority RCT of psilocybin for AUD, and a two-centre, double-blind, four-arm, placebo-controlled phase 2 RCT of ketamine for AUD yielded the best evidence of efficacy. Progression support to a phase 3 trials was secured from an open-label phase 2 study of psilocybin for TUD and nine phase 2 RCTs of ketamine for AUD, cannabis use disorder, cocaine use disorder, and opioid use disorder (all nine with high-RoB and low-GRADE evidence certainty).

Conclusions: Psilocybin-assisted treatment for alcohol use disorder appears to have the best evidence of efficacy among all major psychedelic-assisted treatments for alcohol, tobacco, and other substance use disorders. Future research of psychedelic-assisted treatment should report all safety events; screen for person-level characteristics indicating that psychedelic-assisted substance use disorders treatment is contraindicated; strive to mitigate blinding of participants to interventions; use factorial designs for drug and psychotherapy randomised controlled trials; and build consensus for a field-specific Core Outcome Set.