Addiction最新文献

Background and aims: Clinicians have little guidance on the ideal length of time patients should remain on medication treatment for opioid use disorder (MOUD) before being able to safely discontinue MOUD. This study estimated how the risk of all-cause mortality changes with the duration of MOUD, controlling for patient characteristics that change the risk profile independent of duration of therapy.

Design, setting and participants: Retrospective cohort study using electronic health record data from the US Veterans Healthcare Administration. Veterans initiating MOUD with buprenorphine, methadone or extended-release naltrexone from October 2010 to September 2020. Our analytic sample included 19 666 buprenorphine initiators, 8675 methadone initiators and 4007 extended-release naltrexone initiators.

Measurement: Duration of MOUD was measured in days. Discontinuation was defined as a gap in any MOUD coverage exceeding 28 days, regardless of MOUD type initiated. The primary outcome was all-cause mortality. We estimated multistate survival models allowing for the modeling of multiple states (i.e. on and off MOUD, death) without having to consider censoring or competing events, while adjusting for sociodemographic, clinical, prescription and facility and provider characteristics.

Findings: We observed approximately 226 000 person-years of time at risk for discontinuation or pre-discontinuation death, during which we observed 26 841 discontinuations (118.9 discontinuations per 1000 person-years). We similarly observed a total of about 106 000 person-years of post-discontinuation follow-up, during which we observed 3251 deaths (3.1 deaths per 1000 person-years). We found the largest marginal gain in probability of 6-year survival from an additional year on MOUD appears to occur around 2 years, as compared to 6 months on MOUD. Statistically significant gains continued through approximately 4-5 years of MOUD retention relative to 6-month MOUD retention. After 4-5 years, the marginal gain from one additional year of MOUD was not statistically significant.

Conclusions: Among US veterans, the benefit of retention on medication treatment for opioid use disorder (MOUD) towards overall survival continues through at least 4 years of MOUD treatment. Quality metrics based on 6-month MOUD retention may be insufficient.

Background and aims: Extensive critique of the evidence-based policy paradigm has led to new ways of considering the role of evidence; for example Katherine Smith suggests that "ideas" rather than evidence mediate "the relationship between research and policy". In this paper, we used Smith's typology on "ideas" to explore how this can be applied to a case of Australian policy making: a police diversion scheme for simple possession of drugs. We aimed to analyse the idea's journey into policy in one Australian jurisdiction (New South Wales) and assess its fit with the four different types of ideas outlined by Smith.

Method: Qualitative case study analysis using data from New South Wales, Australia, over the period 2018 to 2024. Multiple data sources were used: interviews with stakeholders (n = 26), documents [reports, non-governmental organization (NGO) advocacy documents], media and official reports of a Drug Summit. Each data source was searched for narration/text concerned with police diversion in addition to decriminalisation, extracted and analysed against Smith's typology.

Results: Features of 'institutionalised ideas' suggest that police diversion is not an institutionalised idea. It appears in this case to be a 'chameleonic idea' inasmuch as its characteristics change and are malleably deployed by different stakeholders with different interests. 'Flexian policy actors' (including police, government officials, advocates and researchers) are able to interpret, transform and shape the meaning of police diversion to suit their interests and commitments. Despite evidence synthesis and expert review recommending police diversion as a second-best option to decriminalisation, it was taken up into policy. We suggest this is because of its chameleonic nature, serving simultaneously at the hands of different policy actors as a roadblock to decriminalisation and as a Trojan horse for decriminalisation reform whilst also obscuring tensions between police diversion and decriminalisation.

Conclusions: Applying Katherine Smith's typology of ideas to an Australian police diversion scheme for simple possession of drugs shows that the scheme is not an institutionalised idea but rather a chameleonic idea. Smith's typology of ideas adds another layer to policy process frameworks, enhancing analysis seeking to understand the uptake of ideas into policy.

Japan's addiction landscape appears paradoxical. The lifetime use of illicit drugs is among the lowest in Organisation for Economic Cooperation and Development countries, but harm from alcohol, tobacco, and gambling ranks among the world's highest. Historically, methamphetamine accounted for the majority of drug-related offenses, but the number of people who were apprehended for cannabis offenses in 2023 exceeded the number who were apprehended for stimulants for the first time since 1958. Nevertheless, the lifetime prevalence of illicit drug use among adults remains under ~3%. In contrast, heavy drinking among working-age men, decades of tobacco consumption, and rapid digitalization that has more recently led to a surge in online gambling and gaming disorder have imposed a substantial disease burden. The present review discusses Japan's epidemiology, social impact, policy changes, prevention, and treatment infrastructure of drug-related problems and the latest trends in addiction science and proposes ways to link policy and research. Japan's experience, balancing strict enforcement with health-centered care, may offer lessons for regions that have similar social contexts.

Background and aims: Persons who inject drugs (PWID) experience a high burden of early-onset frailty, primarily due to multifactorial causes such as infections (human immunodeficiency virus [HIV], hepatitis C virus [HCV]), substance use, and polypharmacy. Methadone, although an effective treatment for opioid use disorder, has demonstrated toxicity across several body systems that may impact or accelerate the aging process. Therefore, the purpose of this analysis was to determine the association of methadone use with frailty and physical function among PWID.

Design: This study performed a retrospective analysis from the AIDS Linked to IntraVenous Experience (ALIVE) longitudinal cohort between 2005 and 2020, using multivariable mixed effect logistic regression, adjusting for demographics, body mass index, substance use, HIV, and comorbidities.

Setting: Baltimore, Maryland, United States.

Participants: Adult participants (≥18 years) were recruited into the ALIVE cohort if they reported a history of or current injection drug use. Our study included 2153 participants with 13 909 person-years of follow-up.

Measurements: Methadone usage, whether prescribed or non-medical, was self-reported by participants during study follow-up. The primary outcome measurement was frailty as defined by the Fried frailty phenotype. Physical function was measured using grip strength and 4-m gait speed.

Findings: At baseline, 883 were currently using methadone. Median age was 48 (interquartile range: 42, 53) years; 81% were Black, 34% female, 80% had incomes <$5000, and 31% were living with HIV. Methadone use was associated with 25% higher odds of frailty (95% confidence interval [CI]: 1.09, 1.43). This difference suggested that the odds of frailty among individuals using methadone at age 50 were comparable to those not using methadone at age 54. Methadone use was associated with lower average grip strength [-0.71 kg (95% CI: -0.94, -0.48)], but not slower gait speed.

Conclusions: Among persons who inject drugs, those using methadone appear to be more likely to experience frailty at an earlier age compared with those not using methadone. Early screening for frailty and other geriatric conditions may be warranted among individuals with active methadone use in this population.

Background and aims: Alcohol use disorder (AUD) may induce angiotensin-converting enzyme 2 (ACE2) overexpression, potentially increasing vulnerability to severe acute respiratory syndrome coronavirus-2 infection. However, the relationship between AUD and the risk of coronavirus disease 2019 (COVID-19) infection remains unclear. This study aimed to measure the association between AUD and the incidence of COVID-19 infection.

Design: We identified 247 000 individuals with AUD between 2001 and 2019 from the Taiwan National Health Insurance Research Database. Another 2 470 000 age- and sex-matched controls without AUD were randomly selected for comparison. All study participants were followed up until the occurrence of new-onset COVID-19 infection, death, or December 31, 2021.

Setting: Taiwan National Health Insurance Research Database.

Participants: A total of 247 000 individuals with AUD and 2 470 000 controls without AUD.

Measurements: A new diagnosis of COVID-19 was determined by a positive real-time reverse transcriptase-polymerase chain reaction test. We employed a Cox regression model, considering death as a competing risk, to assess the impact of AUD on the risk of COVID-19 infection.

Findings: Among 2 717 000 participants, 2374 developed incident COVID-19 during an average follow-up of 1.98 years, including 415 (0.17%) individuals with AUD and 1959 (0.08%) controls. After adjusting for age, sex, urbanization, COVID-19 vaccination status, anxiety disorder, and the Charlson Comorbidity Index, AUD was statistically significantly associated with a higher risk of incident COVID-19 infection (adjusted hazard ratio [AHR]:1.19; 95% confidence interval [CI]:1.06-1.34). Subgroup analyses, stratified by age, sex, and COVID-19 vaccination status, revealed that AUD was linked to the risk of incident COVID-19 infection across all subgroups, except for individuals aged 18-49 years, men, and those who were unvaccinated.

Conclusions: Alcohol use disorder appears to be an independent risk factor for incident COVID-19 infection. These findings highlight the importance of prioritizing individuals with AUD as a key target population for COVID-19 prevention efforts.

Background and aims: Alcohol use behaviors (AUBs) manifest in a variety of normative and problematic ways across the life course, all of which are heritable. Twin studies show that genetic influences on AUBs change across development, but this is usually not considered in research identifying and investigating the genes linked to AUBs. Understanding the dynamics of how genes shape AUBs could point to critical periods in which interventions may be most effective and provide insight into the mechanisms behind AUB-related genes. In this project, we estimated how genetic influences on AUBs unfold across development using longitudinal modelling of polygenic scores (PGSs).

Design: Using results from genome-wide association studies (GWASs), we created PGSs to index individual-level genetic risk for multiple AUB-related dimensions: Consumption, Problems, a temporally variable pattern of drinking associated with a preference for beer (BeerPref) and externalizing behavior (EXT). We created latent growth curve models and tested PGSs as predictors of latent growth factors (intercept, slope, quadratic) underlying trajectories of AUBs.

Setting: PGSs were derived in six longitudinal epidemiological cohorts from the United States, United Kingdom and Finland.

Participants: Participant data were obtained from the longitudinal studies AddHealth, ALSPAC, COGA, FinnTwin12, the older Finnish Twin Cohort and Spit for Science (total n = 19 194). These cohorts included individuals aged 14 to 67, with repeated measures collected over a span of 4 to 36 years.

Measurements: Primary measures included monthly frequency of typical alcohol consumption (CON) and heavy episodic drinking (HED).

Findings: When drinking behaviors were averaged across time, higher Consumption, Problems and EXT PGSs were robustly associated with higher levels of CON and HED (βs ranged from 0.105 to 0.333, P < 3.09E-04) and higher BeerPref PGSs with higher HED (β = 0.064, P = 3.65E-05). However, these PGSs were largely not associated with drinking trajectories in the latent growth curve models. In the meta-analysis, only PGSs for chronic alcohol Problems consistently predicted a steeper slope (increasing trajectory) of CON across time (B = 0.470, P = 4.20E-06). Other PGSs were associated with latent growth factors in some individual cohorts, but there was a large degree of heterogeneity.

Conclusions: Genetic associations appear to differ not only between alcohol use behaviors, but also across developmental time points and across cohorts, highlighting the need for genetic studies to take such heterogeneity into account. Individual-level genetic profiles may be useful to point to personalized intervention timelines, particularly for individuals with high genetic risk scores for alcohol problems.

Background and aims: There is an urgent unmet need for novel treatments for methamphetamine (MA) use disorder. We explored the qualitative experiences of people participating in a study of psilocybin-assisted psychotherapy (PAT) to treat MA use disorder.

Design and setting: Qualitative study of participants enrolled in a single arm, open-label pilot study of PAT for MA use disorder delivered in an outpatient stimulant treatment program setting in Sydney, Australia.

Participants: Twelve participants were interviewed before starting PAT and then again one month following PAT.

Measurements: Pre-PAT interviews explored participants' experiences of MA use and expectations of receiving PAT. Post-PAT interviews explored participants' experiences of PAT, with a focus on phenomena related to the acute subjective effects of psilocybin, the perceived effects of PAT on MA use, self-perception, beliefs, values, behaviours, interpersonal relationships and spirituality, and acceptability of the intervention. Interviews were audio recorded, transcribed verbatim and analysed using an inductive qualitative approach.

Findings: While participants generally hoped to have positive outcomes from study participation, their expectations were generally tempered and realistic. Their trial experiences of PAT were often characterised by new understandings of themselves, their narrative histories and interpersonal relationships, all of which were frequently prompted by leaning into vividly presented challenging experiences within the psychedelic experience. This volitional attitude of 'leaning into the obstacle' emerged as a key theme, meriting exploration for its potential to expose the subjective dimension of the psychedelic mechanism of effect. Resolution of this obstacle was associated with a reduction in the salience of methamphetamine. Therapeutic alliance was seen as critical to positive outcomes and was achieved through high levels of concentrated therapeutic attention and intersubjective intimacy between participant and therapist.

Conclusions: Interviewed participants in a study of psilocybin-assisted psychotherapy (PAT) for methamphetamine use disorder perceived PAT as an acceptable intervention. Transformation in understandings of self and interpersonal relationships and subsequent reduced salience of methamphetamine use often occurred through confronting psychic obstacles in the context of high levels of therapeutic support from study therapists.

Aims: As clinical trial evidence on the effectiveness of smoking cessation pharmacotherapies during pregnancy is inconclusive, we conducted a large cohort study examining their effectiveness and comparative effectiveness during pregnancy.

Design: Population-based cohort study. We used propensity score matching and conditional Poisson regression to compare pharmacotherapy-exposed with unexposed pregnancies, and to compare varenicline-exposed with nicotine replacement therapy (NRT) -exposed pregnancies.

Setting: Birth records (2005-2020) from New South Wales (NSW) Australia, New Zealand (NZ) and Norway/Sweden linked to pharmacotherapy dispensing records.

Participants/cases: Women with a birth record indicating smoking in early pregnancy [during first 20 weeks' gestation (NSW), at lead maternity registration (NZ) or during the first trimester (Norway/Sweden)]. Participants were dispensed prescription NRT, varenicline or bupropion in the first 18 weeks of gestation (NSW, Norway/Sweden) or between the first antenatal visit and childbirth (NZ).

Measurements: We defined smoking cessation as not smoking after gestational week 20 (NSW), at gestational week 32-36 (Norway/Sweden) and at two weeks postpartum (NZ), identified via self-report and documented in the birth record.

Findings: Our NRT analyses included 623, 7074 and 70 exposed and 6026, 68 161 and 700 propensity-score-matched unexposed pregnancies from NSW, NZ and Norway/Sweden, respectively. The associations between NRT and smoking cessation were mixed but tended toward reduced cessation compared with no pharmacotherapy. In NSW, NRT was associated with a reduction in cessation [relative risk (RR) = 0.68, 95% confidence interval (CI) = 0.48-0.97], while in NZ, the effect was smaller (RR = 0.93, 95% CI = 0.89-0.98) but inconclusive in Norway/Sweden (RR = 0.91, 95% CI = 0.61-1.35). Smoking cessation was also equally or less common among varenicline-exposed pregnancies (NSW: 308 exposed vs 3077 matched unexposed, RR = 0.89, 95% CI = 0.72-1.09, Norway/Sweden: 196 exposed vs 1960 matched unexposed, RR = 0.49, 95% CI = 0.34-0.70). Our comparison of varenicline-exposed with NRT-exposed pregnancies indicated increased smoking cessation among varenicline-exposed pregnancies (NSW: 108 vs 154 exposed, RR = 1.91, 95% CI = 1.10-3.22). There were too few bupropion-exposed pregnancies to support interpretation.

Conclusions: Varenicline appears to be more effective at smoking cessation than nicotine replacement therapy during pregnancy. The uncertainty about the real-world effectiveness of nicotine replacement therapy and bupropion remains as this study's analyses were impacted by non-adherence and biased by unmeasured confounding.