Drug and alcohol review最新文献_第6页

An empirically based typology of temporary alcohol abstinence challenge participants using latent class analysis 利用潜类分析法，根据经验对临时戒酒挑战参与者进行分类。

IF 3 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2024-08-18 DOI: 10.1111/dar.13924

Nathalie Kools, Andrea D. Rozema, Jeroen K. Vermunt, Rob H. L. M. Bovens, Dike van de Mheen, Jolanda J. P. Mathijssen

Introduction

Identifying subgroups of Temporary (alcohol) Abstinence Challenge (TAC) participants may offer opportunities to enhance intervention effectiveness. However, knowledge about such subgroups is missing. This study aimed to (i) describe a TAC population; (ii) identify subgroups of participants based on determinants of changes in drinking behaviour; and (iii) characterise subgroups in terms of sociodemographic and other characteristics.

Methods

Data from 3803 Dutch TAC participants were analysed to identify subgroups using three-step Latent Class Analysis. Classes were based on determinants of changes in drinking behaviour (i.e., drinking refusal self-efficacy, craving and behavioural automaticity) and were characterised by sociodemographic characteristics, drinking behaviour, previous participation in TACs, self-reported health and life satisfaction.

Results

The majority of TAC participants were female, highly educated, employed, 53 years old on average, participated in previous TACs and reported relatively high alcohol use. Four classes of participants were identified: (i) ‘ordinary drinkers’ (49.0%); (ii) ‘drinkers in control’ (21.4%); (iii) ‘habitual drinkers with perceived control to refuse’ (18.4%); and (iv) ‘drinkers not in control’ (11.2%). Class 2 drank least often and non-excessive volumes, while other classes typically drank 4 or more days per week and 3 to 4 glasses per drinking day, with the highest alcohol use found in class 4.

Discussion and Conclusions

Different configurations of determinants in this study's four subgroups may require different intervention approaches and might inform personalised support. Future research is needed to examine the predictive value of these subgroups on post-challenge drinking behaviour to assess support needs and participation value.

导言：识别临时戒酒挑战赛（TAC）参与者中的亚群体可能为提高干预效果提供机会。然而，有关此类亚群的知识尚缺。本研究旨在：(i) 描述临时戒酒挑战人群；(ii) 根据饮酒行为变化的决定因素确定参与者亚群；(iii) 从社会人口学和其他特征方面描述亚群的特征：对 3803 名荷兰 TAC 参与者的数据进行分析，采用三步潜类分析法确定亚组。这些类别是基于改变饮酒行为的决定因素（即拒绝饮酒的自我效能感、渴望和行为自动性），并根据社会人口学特征、饮酒行为、以前参加戒酒中心的情况、自我报告的健康状况和生活满意度来确定：大多数戒酒中心参与者为女性，受过高等教育，有工作，平均年龄 53 岁，曾参加过戒酒中心活动，并报告了相对较高的饮酒量。参与者分为四类(i) "普通饮酒者"（49.0%）；(ii) "有控制能力的饮酒者"（21.4%）；(iii) "有控制能力的习惯性饮酒者"（18.4%）；(iv) "无控制能力的饮酒者"（11.2%）。第 2 类饮酒频率最低，饮酒量也不多，而其他类别一般每周饮酒 4 天或以上，每天饮酒 3 至 4 杯，其中第 4 类饮酒量最高：在本研究的四个分组中，不同的决定因素可能需要不同的干预方法，并可能为个性化支持提供依据。未来的研究需要考察这些分组对挑战后饮酒行为的预测价值，以评估支持需求和参与价值。

{"title":"An empirically based typology of temporary alcohol abstinence challenge participants using latent class analysis","authors":"Nathalie Kools, Andrea D. Rozema, Jeroen K. Vermunt, Rob H. L. M. Bovens, Dike van de Mheen, Jolanda J. P. Mathijssen","doi":"10.1111/dar.13924","DOIUrl":"10.1111/dar.13924","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Identifying subgroups of Temporary (alcohol) Abstinence Challenge (TAC) participants may offer opportunities to enhance intervention effectiveness. However, knowledge about such subgroups is missing. This study aimed to (i) describe a TAC population; (ii) identify subgroups of participants based on determinants of changes in drinking behaviour; and (iii) characterise subgroups in terms of sociodemographic and other characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from 3803 Dutch TAC participants were analysed to identify subgroups using three-step Latent Class Analysis. Classes were based on determinants of changes in drinking behaviour (i.e., drinking refusal self-efficacy, craving and behavioural automaticity) and were characterised by sociodemographic characteristics, drinking behaviour, previous participation in TACs, self-reported health and life satisfaction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The majority of TAC participants were female, highly educated, employed, 53 years old on average, participated in previous TACs and reported relatively high alcohol use. Four classes of participants were identified: (i) ‘ordinary drinkers’ (49.0%); (ii) ‘drinkers in control’ (21.4%); (iii) ‘habitual drinkers with perceived control to refuse’ (18.4%); and (iv) ‘drinkers not in control’ (11.2%). Class 2 drank least often and non-excessive volumes, while other classes typically drank 4 or more days per week and 3 to 4 glasses per drinking day, with the highest alcohol use found in class 4.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusions</h3>\u0000 \u0000 <p>Different configurations of determinants in this study's four subgroups may require different intervention approaches and might inform personalised support. Future research is needed to examine the predictive value of these subgroups on post-challenge drinking behaviour to assess support needs and participation value.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"43 7","pages":"1997-2009"},"PeriodicalIF":3.0,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.13924","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Screening and early intervention for substance use during pregnancy: A retrospective case note review of antenatal care records 孕期药物使用的筛查和早期干预：产前护理记录的回顾性病例记录。

IF 3 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2024-08-13 DOI: 10.1111/dar.13927

Matthew W. R. Stevens, Megan Cooper, Lynette Cusack, Robert L. Ali, Chris Holmwood, Annette L. Briley

Introduction

Screening for substance use during pregnancy is critical for enhancing maternal health and perinatal outcomes. However, disparities persist in screening and intervention rates within maternity services. This retrospective case note review explored contemporaneous practices around screening and interventions for substance use among pregnant women during routine antenatal care.

Methods

A random sample of 100 sets of maternity records were reviewed. Eligible cases included any woman attending initial pregnancy assessments at one of two South Australian metropolitan Hospital-based antenatal clinics, from July 2019–September 2020. Screening rates for past and current alcohol, tobacco and other substance use were identified and compared with data from a subset of a nationally representative survey. Intervention details and referral pathways were also assessed.

Results

The final sample of eligible cases (n = 93) demonstrated prioritisation of screening for current use, over past use, across all substances (p < 0.001). Screening was most likely for tobacco and least likely for e-cigarettes (p < 0.001). Significant underreporting of past use compared with the benchmark was identified for all substances (except tobacco, p = 0.224). Interventions typically involved written resources, which were usually declined by clients.

Discussion and Conclusions

Despite longstanding recommendations, screening and intervention practices for substance use appear inconsistent. With the recent emergence of vaping, no evidence of updated approaches to identifying e-cigarette consumption in pregnant women was found. Several opportunities for enhancing routine screening and intervention practices within antenatal clinics were identified, and will inform the development of policy directives, targeted training modules, and other resources for health professionals working in these services.

导言：筛查孕期药物使用情况对于改善孕产妇健康和围产期结果至关重要。然而，产科服务中的筛查和干预率仍存在差异。这项回顾性病例研究探讨了在常规产前检查中对孕妇进行药物使用筛查和干预的做法：方法：随机抽样审查了 100 份产科记录。符合条件的病例包括 2019 年 7 月至 2020 年 9 月期间，在南澳大利亚州两家都市医院产前诊所中的一家接受初次妊娠评估的任何女性。我们确定了过去和现在的酒精、烟草和其他物质使用筛查率，并将其与一项全国代表性调查的子集数据进行了比较。此外，还对干预细节和转诊途径进行了评估：结果：符合条件的最终样本（n = 93）显示，在所有物质的使用中，优先筛查当前使用情况，而不是过去使用情况（p 讨论和结论：尽管建议由来已久，但针对药物使用的筛查和干预措施似乎并不一致。最近出现了吸食电子烟的现象，但没有证据表明有更新的方法来识别孕妇吸食电子烟的情况。研究发现了一些在产前检查诊所加强常规筛查和干预措施的机会，并将为制定政策指令、开发有针对性的培训模块以及为在这些服务机构工作的医疗专业人员提供其他资源提供参考。

{"title":"Screening and early intervention for substance use during pregnancy: A retrospective case note review of antenatal care records","authors":"Matthew W. R. Stevens, Megan Cooper, Lynette Cusack, Robert L. Ali, Chris Holmwood, Annette L. Briley","doi":"10.1111/dar.13927","DOIUrl":"10.1111/dar.13927","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Screening for substance use during pregnancy is critical for enhancing maternal health and perinatal outcomes. However, disparities persist in screening and intervention rates within maternity services. This retrospective case note review explored contemporaneous practices around screening and interventions for substance use among pregnant women during routine antenatal care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A random sample of 100 sets of maternity records were reviewed. Eligible cases included any woman attending initial pregnancy assessments at one of two South Australian metropolitan Hospital-based antenatal clinics, from July 2019–September 2020. Screening rates for past and current alcohol, tobacco and other substance use were identified and compared with data from a subset of a nationally representative survey. Intervention details and referral pathways were also assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The final sample of eligible cases (<i>n</i> = 93) demonstrated prioritisation of screening for current use, over past use, across all substances (<i>p</i> < 0.001). Screening was most likely for tobacco and least likely for e-cigarettes (<i>p</i> < 0.001). Significant underreporting of past use compared with the benchmark was identified for all substances (except tobacco, <i>p</i> = 0.224). Interventions typically involved written resources, which were usually declined by clients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusions</h3>\u0000 \u0000 <p>Despite longstanding recommendations, screening and intervention practices for substance use appear inconsistent. With the recent emergence of vaping, no evidence of updated approaches to identifying e-cigarette consumption in pregnant women was found. Several opportunities for enhancing routine screening and intervention practices within antenatal clinics were identified, and will inform the development of policy directives, targeted training modules, and other resources for health professionals working in these services.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"43 7","pages":"1817-1828"},"PeriodicalIF":3.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.13927","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Identifying and responding to fetal alcohol spectrum disorder in child and family health: Lessons from an exploratory mixed methods study 在儿童和家庭健康中识别和应对胎儿酒精谱系障碍：一项探索性混合方法研究的启示。

IF 3 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2024-08-13 DOI: 10.1111/dar.13917

Susan Evans, Barbara R. Lucas, Lauren Ann Monds, Mark Montebello

Introduction

Developmental outcomes for children and young people with fetal alcohol spectrum disorder (FASD) are optimised if their needs are identified early. Yet, health workers miss vital opportunities to identify and respond to FASD due to a lack of support, knowledge and skills.

Methods

Through surveys and interviews, our study investigated what child and family health workers in an Australian metropolitan local health district understand, already do and want to learn about FASD.

Results

The study provided evidence of low FASD knowledge and confidence and a lack of referral options with some workers ‘patching together’ care planning in a ‘referral black hole’. Qualitative data provided insight into how skilled clinicians engage families in FASD assessment and negotiate gaps in clinical knowledge.

Discussion and Conclusions

Health workers in this study requested high-quality training and the development of FASD practice guidelines to improve role clarity and clinical impact when working with FASD populations.

导言：如果能及早发现患有胎儿酒精中毒谱系障碍（FASD）的儿童和青少年的需求，就能优化他们的发育成果。然而，由于缺乏支持、知识和技能，医务工作者错失了识别和应对 FASD 的重要机会：我们的研究通过调查和访谈，调查了澳大利亚一个大都市地方卫生区的儿童和家庭卫生工作者对 FASD 的理解、已在做的工作以及想要了解的情况：研究结果：研究结果表明，FASD 知识和信心不足，缺乏转介选择，一些工作人员在 "转介黑洞 "中 "拼凑 "护理计划。定性数据让我们深入了解了熟练的临床医生如何让家庭参与 FASD 评估，以及如何弥补临床知识的不足：本研究中的医务工作者要求提供高质量的培训并制定 FASD 实践指南，以提高他们在与 FASD 患者合作时的角色清晰度和临床效果。

{"title":"Identifying and responding to fetal alcohol spectrum disorder in child and family health: Lessons from an exploratory mixed methods study","authors":"Susan Evans, Barbara R. Lucas, Lauren Ann Monds, Mark Montebello","doi":"10.1111/dar.13917","DOIUrl":"10.1111/dar.13917","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Developmental outcomes for children and young people with fetal alcohol spectrum disorder (FASD) are optimised if their needs are identified early. Yet, health workers miss vital opportunities to identify and respond to FASD due to a lack of support, knowledge and skills.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Through surveys and interviews, our study investigated what child and family health workers in an Australian metropolitan local health district understand, already do and want to learn about FASD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study provided evidence of low FASD knowledge and confidence and a lack of referral options with some workers ‘patching together’ care planning in a ‘referral black hole’. Qualitative data provided insight into how skilled clinicians engage families in FASD assessment and negotiate gaps in clinical knowledge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusions</h3>\u0000 \u0000 <p>Health workers in this study requested high-quality training and the development of FASD practice guidelines to improve role clarity and clinical impact when working with FASD populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"43 6","pages":"1505-1514"},"PeriodicalIF":3.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Trends in substance use disorder mortality in the United States and worldwide, 1990–2021 1990-2021 年美国和全球药物使用障碍死亡率趋势。

IF 3 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2024-08-12 DOI: 10.1111/dar.13919

Abdul Mannan Khan Minhas, Salim S. Virani, Dmitry Abramov

引用次数: 0

Emergence of deaths due to nitazene toxicity in Australia 澳大利亚出现硝基苯中毒死亡事件。

IF 3 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2024-08-11 DOI: 10.1111/dar.13920

Shane Darke, Johan Duflou, Michael Farrell, Julia Lappin, Amy Peacock

引用次数: 0

Substance use among trans and gender diverse young people in Australia: Patterns, correlates and motivations 澳大利亚变性和性别多元化青少年的药物使用情况：模式、相关因素和动机。

IF 3 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2024-08-11 DOI: 10.1111/dar.13915

Sasha Bailey, Ashleigh Lin, Angus Cook, Sam Winter, Vanessa Watson, Dani Wright-Toussaint, Emma L. Barrett, Nicola Newton, Yael Perry, Lucinda Grummitt, Penelope Strauss

Introduction

There is a dire paucity of research into the burden, correlates and motives of substance use among trans young people in Australia.

Method

Using data from a national survey of Australian trans young people (N = 859, M_age = 19.4), we estimated prevalence of past 6-month substance use (tobacco, alcohol, cannabis, other drugs) and lifetime substance use disorder diagnoses. Covariate-adjusted multivariate logistic regression models tested associations between substance use types with 18 interpersonal factors. Open-ended responses regarding substance use motives (n = 489) were qualitatively analysed using thematic analysis with an interpretative phenomenological approach.

Results

Prevalence of lifetime substance use disorder diagnosis was 13.5% (95% confidence interval [CI] 11.1, 16.1). Alcohol use was most reported (72.4%; 95% CI 68.9, 75.6) followed by tobacco (31.1%; 95% CI 27.7, 34.6) and cannabis (30.6%; 95% CI 27.2, 34.2). Trans women reported highest rates of alcohol and cannabis use; use of other drugs was highest among trans men. Highest risk of substance use was observed among trans youth who experienced discrimination, intimate partner abuse, peer rejection and lack of family support (adjusted odds ratios ranging 1.5 to 3.0). Four multi-levelled themes of substance use motives were identified: circumstantial use, somatic use, feeling better about oneself and one's life, and harm reduction.

Discussion and Conclusions

While substance use among trans young is largely circumstantial, hedonistic and altruistic, facilitating self-exploration, friendship and community connectedness, substance use among trans young people is highly prevalent and may be used to cope with sleep difficulties, depression/anxiety and cisnormativity, including delays and waitlists for accessing gender-affirming care.

导言：有关澳大利亚变性青少年使用药物的负担、相关因素和动机的研究极为匮乏：我们利用对澳大利亚变性青年（N = 859，Mage = 19.4）的全国调查数据，估算了过去 6 个月使用药物（烟草、酒精、大麻、其他药物）和终生药物使用障碍诊断的流行率。协变量调整多变量逻辑回归模型检验了物质使用类型与 18 个人际因素之间的关联。对有关药物使用动机的开放式回答（n = 489）采用主题分析和解释现象学方法进行了定性分析：结果：终生药物使用障碍诊断率为 13.5%（95% 置信区间 [CI] 11.1，16.1）。报告最多的是酗酒（72.4%；95% CI 68.9，75.6），其次是吸烟（31.1%；95% CI 27.7，34.6）和吸食大麻（30.6%；95% CI 27.2，34.2）。据报告，变性女性使用酒精和大麻的比例最高；变性男性使用其他药物的比例最高。据观察，遭受歧视、亲密伴侣虐待、同伴排斥和缺乏家庭支持的变性青少年使用药物的风险最高（调整后的几率比为 1.5 至 3.0）。研究确定了四个多层次的药物使用动机主题：环境使用、躯体使用、自我感觉和生活更好以及减少伤害：虽然变性青年使用药物主要是间接的、享乐主义的和利他主义的，是为了促进自我探索、友谊和社区联系，但变性青年使用药物的情况非常普遍，可能是为了应对睡眠困难、抑郁/焦虑和顺式规范化，包括获得性别确认护理的延迟和等待。

{"title":"Substance use among trans and gender diverse young people in Australia: Patterns, correlates and motivations","authors":"Sasha Bailey, Ashleigh Lin, Angus Cook, Sam Winter, Vanessa Watson, Dani Wright-Toussaint, Emma L. Barrett, Nicola Newton, Yael Perry, Lucinda Grummitt, Penelope Strauss","doi":"10.1111/dar.13915","DOIUrl":"10.1111/dar.13915","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>There is a dire paucity of research into the burden, correlates and motives of substance use among trans young people in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Using data from a national survey of Australian trans young people (<i>N</i> = 859, <i>M</i><sub>age</sub> = 19.4), we estimated prevalence of past 6-month substance use (tobacco, alcohol, cannabis, other drugs) and lifetime substance use disorder diagnoses. Covariate-adjusted multivariate logistic regression models tested associations between substance use types with 18 interpersonal factors. Open-ended responses regarding substance use motives (<i>n</i> = 489) were qualitatively analysed using thematic analysis with an interpretative phenomenological approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Prevalence of lifetime substance use disorder diagnosis was 13.5% (95% confidence interval [CI] 11.1, 16.1). Alcohol use was most reported (72.4%; 95% CI 68.9, 75.6) followed by tobacco (31.1%; 95% CI 27.7, 34.6) and cannabis (30.6%; 95% CI 27.2, 34.2). Trans women reported highest rates of alcohol and cannabis use; use of other drugs was highest among trans men. Highest risk of substance use was observed among trans youth who experienced discrimination, intimate partner abuse, peer rejection and lack of family support (adjusted odds ratios ranging 1.5 to 3.0). Four multi-levelled themes of substance use motives were identified: circumstantial use, somatic use, feeling better about oneself and one's life, and harm reduction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusions</h3>\u0000 \u0000 <p>While substance use among trans young is largely circumstantial, hedonistic and altruistic, facilitating self-exploration, friendship and community connectedness, substance use among trans young people is highly prevalent and may be used to cope with sleep difficulties, depression/anxiety and cisnormativity, including delays and waitlists for accessing gender-affirming care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"43 7","pages":"1940-1953"},"PeriodicalIF":3.0,"publicationDate":"2024-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.13915","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Trends in toxicological findings in unintentional opioid or stimulant toxicity deaths in Québec, Canada, 2012–2021: Has Québec entered a new era of drug-related deaths? 2012-2021 年加拿大魁北克省阿片类药物或兴奋剂中毒意外死亡的毒理学发现趋势：魁北克省是否已进入毒品相关死亡的新时代？

IF 3 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2024-08-06 DOI: 10.1111/dar.13918

Uyen Do, Paul-André Perron, Julie Bruneau, Sarah Larney

Introduction

We aimed to describe rates and toxicological findings of unintentional opioid and stimulant toxicity deaths, 2012–2021.

Methods

The dataset included accidental deaths determined by the Coroner to be due to opioids or stimulants. We calculated annual crude mortality rates and described combinations of drugs identified in toxicological examinations of these deaths. We described temporal trends in the detection of specific opioids, stimulants, benzodiazepines (including novel benzodiazepines), gabapentinoids and z-drugs in deaths due to opioids and stimulants.

Results

Mortality rates increased over time, reaching their peak in 2020 and remaining high in 2021. In deaths due to opioids, there was a decline in the proportion of deaths involving pharmaceutical opioids after 2019, and a corresponding increase in the proportion of deaths with fentanyl detected. Benzodiazepines were often present in deaths due to opioids, with novel benzodiazepines increasing rapidly from 2019 onwards. Cocaine was the most frequently detected drug in deaths due to stimulants, but amphetamine/methamphetamine was detected in around half of all stimulant deaths from 2016 onwards.

Discussion and Conclusions

Despite availability of a multitude of overdose prevention interventions, mortality rates due to drug toxicity have increased in Québec. Toxicological findings of these deaths suggest concerning shifts in the illicit drug market, with Québec potentially having entered a new era of elevated overdose mortality. Intervention scale-up is essential, but unlikely to be sufficient, to reduce drug-related mortality. Policy reform to address the root causes of drug toxicity deaths, including an unpredictable drug supply, strained health systems and socio-economic precarity, is essential.

介绍：我们旨在描述2012-2021年阿片类药物和兴奋剂中毒意外死亡的比率和毒理学发现：数据集包括经法医鉴定为阿片类药物或兴奋剂导致的意外死亡。我们计算了年度粗死亡率，并描述了在这些死亡病例的毒理学检查中发现的药物组合。我们描述了在阿片类药物和兴奋剂导致的死亡病例中检测出特定阿片类药物、兴奋剂、苯二氮卓类（包括新型苯二氮卓）、加巴喷丁类和z类药物的时间趋势：死亡率随时间推移而上升，2020 年达到峰值，2021 年居高不下。在阿片类药物导致的死亡中，2019 年后涉及药用阿片类药物的死亡比例有所下降，而检测到芬太尼的死亡比例则相应增加。苯二氮卓类药物经常出现在类阿片导致的死亡中，新型苯二氮卓类药物从2019年起迅速增加。可卡因是兴奋剂致死案例中最常检测到的药物，但从2016年起，在大约一半的兴奋剂致死案例中检测到苯丙胺/甲基苯丙胺：尽管有多种预防用药过量的干预措施，但魁北克省因药物毒性导致的死亡率仍在上升。这些死亡病例的毒理学研究结果表明，非法毒品市场发生了令人担忧的变化，魁北克省可能已进入吸毒过量死亡率上升的新时代。加大干预力度对于降低毒品相关死亡率至关重要，但这可能还不够。必须进行政策改革，以解决毒品中毒死亡的根本原因，包括不可预测的毒品供应、紧张的卫生系统和社会经济的不稳定性。

{"title":"Trends in toxicological findings in unintentional opioid or stimulant toxicity deaths in Québec, Canada, 2012–2021: Has Québec entered a new era of drug-related deaths?","authors":"Uyen Do, Paul-André Perron, Julie Bruneau, Sarah Larney","doi":"10.1111/dar.13918","DOIUrl":"10.1111/dar.13918","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>We aimed to describe rates and toxicological findings of unintentional opioid and stimulant toxicity deaths, 2012–2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The dataset included accidental deaths determined by the Coroner to be due to opioids or stimulants. We calculated annual crude mortality rates and described combinations of drugs identified in toxicological examinations of these deaths. We described temporal trends in the detection of specific opioids, stimulants, benzodiazepines (including novel benzodiazepines), gabapentinoids and z-drugs in deaths due to opioids and stimulants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mortality rates increased over time, reaching their peak in 2020 and remaining high in 2021. In deaths due to opioids, there was a decline in the proportion of deaths involving pharmaceutical opioids after 2019, and a corresponding increase in the proportion of deaths with fentanyl detected. Benzodiazepines were often present in deaths due to opioids, with novel benzodiazepines increasing rapidly from 2019 onwards. Cocaine was the most frequently detected drug in deaths due to stimulants, but amphetamine/methamphetamine was detected in around half of all stimulant deaths from 2016 onwards.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusions</h3>\u0000 \u0000 <p>Despite availability of a multitude of overdose prevention interventions, mortality rates due to drug toxicity have increased in Québec. Toxicological findings of these deaths suggest concerning shifts in the illicit drug market, with Québec potentially having entered a new era of elevated overdose mortality. Intervention scale-up is essential, but unlikely to be sufficient, to reduce drug-related mortality. Policy reform to address the root causes of drug toxicity deaths, including an unpredictable drug supply, strained health systems and socio-economic precarity, is essential.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"43 6","pages":"1613-1624"},"PeriodicalIF":3.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.13918","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Overdose prevention centres as spaces of safety, trust and inclusion: A causal pathway based on a realist review 作为安全、信任和包容空间的药物过量预防中心：基于现实主义审查的因果途径。

IF 3 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2024-08-05 DOI: 10.1111/dar.13908

Alex Stevens, Jolie R. Keemink, Sam Shirley-Beavan, Zarnie Khadjesari, Adelina Artenie, Peter Vickerman, Mat Southwell, Gillian W. Shorter

Issues

Overdose prevention centres (OPC) are non-residential spaces where people can use illicit drugs (that they have obtained elsewhere) in the presence of staff who can intervene to prevent and manage any overdoses that occur. Many reviews of OPCs exist but they do not explain how OPCs work.

Approach

We carried out a realist review, using the RAMESES reporting standards. We systematically searched for and then thematically analysed 391 documents that provide information on the contexts, mechanisms and outcomes of OPCs.

Key Findings

Our retroductive analysis identified a causal pathway that highlights the feeling of safety – and the immediate outcome of not dying – as conditions of possibility for the people who use OPCs to build trust and experience social inclusion. The combination of safety, trust and social inclusion that is triggered by OPCs can – depending on the contexts in which they operate – generate other positive outcomes, which may include less risky drug use practices, reductions in blood borne viruses and injection-related infections and wounds, and access to housing. These outcomes are contingent on relevant contexts, including political and legal environments, which differ for women and people from racialised minorities.

Conclusions

OPCs can enable people who live with structural violence and vulnerability to develop feelings of safety and trust that help them stay alive and to build longer term trajectories of social inclusion, with potential to improve other aspects of their health and living conditions.

问题：用药过量预防中心（OPC）是一种非住宿场所，人们可以在这里使用非法药物（他们从其他地方获得的药物），有工作人员在场，他们可以进行干预，预防和处理任何用药过量的情况。有许多关于 OPC 的评论，但它们并没有解释 OPC 是如何运作的：我们采用 RAMESES 报告标准进行了现实主义审查。我们系统地搜索了391份文件，然后对其进行了专题分析，这些文件提供了有关OPCs的背景、机制和结果的信息：我们的追溯分析确定了一条因果途径，强调了安全感--以及不会死亡的直接结果--是使用OPCs的人建立信任和体验社会包容的可能性条件。根据使用环境的不同，OPCs 所带来的安全感、信任和社会包容可以产生其他积极的结果，其中可能包括降低使用毒品的风险、减少血液传播病毒以及与注射相关的感染和伤口，以及获得住房。这些成果取决于相关的环境，包括政治和法律环境，妇女和少数种族人群的政治和法律环境有所不同：结论：OPCs 可以使那些生活在结构性暴力和脆弱性中的人产生安全感和信任感，帮助他们维持生命，并建立长期的社会融入轨迹，从而有可能改善他们的健康和生活条件的其他方面。

{"title":"Overdose prevention centres as spaces of safety, trust and inclusion: A causal pathway based on a realist review","authors":"Alex Stevens, Jolie R. Keemink, Sam Shirley-Beavan, Zarnie Khadjesari, Adelina Artenie, Peter Vickerman, Mat Southwell, Gillian W. Shorter","doi":"10.1111/dar.13908","DOIUrl":"10.1111/dar.13908","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Issues</h3>\u0000 \u0000 <p>Overdose prevention centres (OPC) are non-residential spaces where people can use illicit drugs (that they have obtained elsewhere) in the presence of staff who can intervene to prevent and manage any overdoses that occur. Many reviews of OPCs exist but they do not explain how OPCs work.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>We carried out a realist review, using the RAMESES reporting standards. We systematically searched for and then thematically analysed 391 documents that provide information on the contexts, mechanisms and outcomes of OPCs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key Findings</h3>\u0000 \u0000 <p>Our retroductive analysis identified a causal pathway that highlights the feeling of safety – and the immediate outcome of not dying – as conditions of possibility for the people who use OPCs to build trust and experience social inclusion. The combination of safety, trust and social inclusion that is triggered by OPCs can – depending on the contexts in which they operate – generate other positive outcomes, which may include less risky drug use practices, reductions in blood borne viruses and injection-related infections and wounds, and access to housing. These outcomes are contingent on relevant contexts, including political and legal environments, which differ for women and people from racialised minorities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>OPCs can enable people who live with structural violence and vulnerability to develop feelings of safety and trust that help them stay alive and to build longer term trajectories of social inclusion, with potential to improve other aspects of their health and living conditions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"43 6","pages":"1573-1591"},"PeriodicalIF":3.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.13908","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The associations of supervised consumption services with the rates of opioid-related mortality and morbidity outcomes at the public health unit level in Ontario (Canada): A controlled interrupted time-series analysis 加拿大安大略省公共卫生单位一级的监督消费服务与阿片类药物相关死亡率和发病率之间的关系：受控间断时间序列分析

IF 3 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2024-08-05 DOI: 10.1111/dar.13921

Tessa Robinson, Forough Farrokhyar, Benedikt Fischer

Introduction

This study aimed to assess the impact of the implementation of legally sanctioned supervised consumption sites (SCS) in the Canadian province of Ontario on opioid-related deaths, emergency department (ED) visits and hospitalisations at the public health unit (PHU) level.

Methods

Monthly rates per 100,000 population of opioid-related deaths, ED visits and hospitalisations for PHUs in Ontario between December 2013 and March 2022 were collected. Aggregated and individual analyses of PHUs with one or more SCS were conducted, with PHUs that instituted an SCS being matched to control units that did not. Autoregressive integrated moving average models were used to estimate the impact of SCS implementation on opioid-related deaths, ED visits and hospitalisations.

Results

Twenty-one legally sanctioned SCS were implemented across nine PHUs in Ontario during the study period. Interrupted time series analyses showed no statistically significant changes in opioid-related death rates in aggregated analyses of intervention PHUs (increase of 0.02 deaths/100,000 population/month; p = 0.27). Control PHUs saw a significant increase of 0.38 deaths/100,000 population/month; p < 0.001. No statistically significant changes were observed in the rates of opioid-related ED visits in intervention PHUs (decrease of 0.61 visits/100,000 population/month; p = 0.39) or controls (increase of 0.403 visits; p = 0.76). No statistically significant changes to the rates of opioid-related hospitalisations were observed in intervention PHUs (0 hospitalisations/100,000 population/month; p = 0.98) or controls (decrease of 0.05 hospitalisations; p = 0.95).

Discussion and Conclusions

This study did not find significant mortality or morbidity effects associated with SCS availability at the population level in Ontario. In the context of a highly toxic drug supply, additional interventions will be required to reduce opioid-related harms.

简介：本研究旨在评估加拿大安大略省实施法律认可的监督消费场所（SCS）对公共卫生单位（PHU）层面阿片类药物相关死亡人数、急诊室就诊人数和住院人数的影响：收集了 2013 年 12 月至 2022 年 3 月期间安大略省公共卫生单位每 10 万人口中阿片类药物相关死亡、急诊室就诊和住院的月率。对实施了一项或多项SCS的公共卫生单位进行了汇总分析和个别分析，并将实施了SCS的公共卫生单位与未实施SCS的对照单位进行了比对。采用自回归综合移动平均模型来估算《管制方案》的实施对阿片类药物相关死亡、急诊室就诊和住院的影响：在研究期间，安大略省的九个公共卫生单位实施了 21 项法律认可的 SCS。间断时间序列分析表明，在对干预的公共卫生单位进行汇总分析时，与阿片类药物相关的死亡率在统计上没有显著变化（每 100,000 人/月的死亡人数增加了 0.02 人；P = 0.27）。对照 PHU 的死亡率则大幅上升了 0.38 例/100,000 人/月；p 讨论和结论：本研究未发现安大略省人口水平上的 SCS 供应会对死亡率或发病率产生重大影响。在高毒药物供应的背景下，需要采取更多干预措施来减少与阿片类药物相关的危害。

{"title":"The associations of supervised consumption services with the rates of opioid-related mortality and morbidity outcomes at the public health unit level in Ontario (Canada): A controlled interrupted time-series analysis","authors":"Tessa Robinson, Forough Farrokhyar, Benedikt Fischer","doi":"10.1111/dar.13921","DOIUrl":"10.1111/dar.13921","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This study aimed to assess the impact of the implementation of legally sanctioned supervised consumption sites (SCS) in the Canadian province of Ontario on opioid-related deaths, emergency department (ED) visits and hospitalisations at the public health unit (PHU) level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Monthly rates per 100,000 population of opioid-related deaths, ED visits and hospitalisations for PHUs in Ontario between December 2013 and March 2022 were collected. Aggregated and individual analyses of PHUs with one or more SCS were conducted, with PHUs that instituted an SCS being matched to control units that did not. Autoregressive integrated moving average models were used to estimate the impact of SCS implementation on opioid-related deaths, ED visits and hospitalisations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-one legally sanctioned SCS were implemented across nine PHUs in Ontario during the study period. Interrupted time series analyses showed no statistically significant changes in opioid-related death rates in aggregated analyses of intervention PHUs (increase of 0.02 deaths/100,000 population/month; <i>p</i> = 0.27). Control PHUs saw a significant increase of 0.38 deaths/100,000 population/month; <i>p</i> < 0.001. No statistically significant changes were observed in the rates of opioid-related ED visits in intervention PHUs (decrease of 0.61 visits/100,000 population/month; <i>p</i> = 0.39) or controls (increase of 0.403 visits; <i>p</i> = 0.76). No statistically significant changes to the rates of opioid-related hospitalisations were observed in intervention PHUs (0 hospitalisations/100,000 population/month; <i>p</i> = 0.98) or controls (decrease of 0.05 hospitalisations; <i>p</i> = 0.95).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusions</h3>\u0000 \u0000 <p>This study did not find significant mortality or morbidity effects associated with SCS availability at the population level in Ontario. In the context of a highly toxic drug supply, additional interventions will be required to reduce opioid-related harms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"43 7","pages":"1880-1891"},"PeriodicalIF":3.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.13921","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Alcohol does not impact chronic hepatitis C treatment outcomes but increases risk for progressive liver disease: Findings from a prospective multicentre Australian study (OPERA-C) 酒精不会影响慢性丙型肝炎的治疗效果，但会增加进展性肝病的风险：澳大利亚前瞻性多中心研究（OPERA-C）的结果。

IF 3 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2024-08-02 DOI: 10.1111/dar.13914

Paul J. Clark, Patricia C. Valery, Simone I. Strasser, Martin Weltman, Alex Thompson, Miriam T. Levy, Barbara Leggett, Amany Zekry, Julian Rong, Marie Sinclair, Jacob George, William Sievert, Gerry MacQuillan, Edmund Tse, Amanda Nicoll, Amanda Wade, Wendy Cheng, Stuart K. Roberts

Introduction

Alcohol use is common in patients with chronic hepatitis C virus (HCV) infection. We examined the impact of alcohol use on direct-acting antiviral (DAA) therapy outcome and the clinical course of liver disease and 2-year survival for patients receiving HCV DAA therapy.

Methods

Adults (n = 2624) recruited from 26 Australian hospital liver clinics during 2016–2021 were followed up for 2 years. Risky alcohol use was defined by a combination of self-report (≥40 g/day of ethanol), physician-reported history of problematic alcohol use, and anti-craving medication prescription via population-based database linkage. We examined factors associated with advanced liver fibrosis and survival using multivariable logistic and Cox regression.

Results

Among 1634 patients (62.3%) with risky alcohol use, 24.6% reported consuming ≥40 g/day of alcohol, 98.3% physician-reported problematic alcohol use; only 4.1% were dispensed naltrexone/acamprosate. One hundred and forty-three patients with cirrhosis reported ≥40 g/day of alcohol, 6 (4.3%) were prescribed naltrexone/acamprosate. Risky alcohol use was associated with advanced fibrosis (adjusted-odds ratio 1.69, 95% confidence interval 1.32–2.17) and patients were over-represented for cirrhosis (45.1% vs. 25.6% in no-risky alcohol use [p < 0.001]) and hepatocellular carcinoma (5.7% vs. 2.5% [p < 0.001]). Sustained viral response (p = 0.319) and 2-year survival (adjusted-hazard ratio 1.98, 95% confidence interval 0.84–4.63) after DAA therapy were not associated with risky alcohol use.

Discussion and Conclusions

Risky alcohol use in HCV patients was prevalent, but did not reduce HCV cure. Treatment for alcohol dependence was low. Risky alcohol use may be under-recognised in liver clinics. Better integration of addiction medicine into liver services and increased resourcing and addiction medicine training opportunities for hepatologists may help address this.

导言：酗酒在慢性丙型肝炎病毒（HCV）感染患者中很常见。我们研究了饮酒对直接作用抗病毒疗法（DAA）疗效的影响，以及接受HCV DAA疗法患者的肝病临床过程和2年生存率：2016-2021年间从澳大利亚26家医院肝病门诊招募的成年人（n = 2624）接受了为期2年的随访。风险性饮酒由自我报告（乙醇摄入量≥40克/天）、医生报告的问题性饮酒史以及通过基于人群的数据库链接开具的抗嗜酒药物处方共同定义。我们使用多变量逻辑回归和 Cox 回归研究了与晚期肝纤维化和存活率相关的因素：在1634名有饮酒风险的患者（62.3%）中，24.6%的患者报告每天饮酒量≥40克，98.3%的患者由医生报告有饮酒问题；只有4.1%的患者获得了纳曲酮/阿坎酸的处方。143名肝硬化患者报告每天饮酒量≥40克，其中6人（4.3%）获得了纳曲酮/阿坎酸处方。危险饮酒与晚期纤维化有关（调整后的比率为 1.69，95% 置信区间为 1.32-2.17），而且肝硬化患者的比例过高（45.1% 对比起无危险饮酒的 25.6% [p 讨论和结论：危险饮酒在 HCV 患者中很普遍，但不会降低 HCV 的治愈率。酒精依赖治疗率较低。肝病诊所可能对酗酒风险认识不足。将成瘾医学更好地融入肝病服务、增加资源配置以及为肝病医生提供成瘾医学培训机会可能有助于解决这一问题。

{"title":"Alcohol does not impact chronic hepatitis C treatment outcomes but increases risk for progressive liver disease: Findings from a prospective multicentre Australian study (OPERA-C)","authors":"Paul J. Clark, Patricia C. Valery, Simone I. Strasser, Martin Weltman, Alex Thompson, Miriam T. Levy, Barbara Leggett, Amany Zekry, Julian Rong, Marie Sinclair, Jacob George, William Sievert, Gerry MacQuillan, Edmund Tse, Amanda Nicoll, Amanda Wade, Wendy Cheng, Stuart K. Roberts","doi":"10.1111/dar.13914","DOIUrl":"10.1111/dar.13914","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Alcohol use is common in patients with chronic hepatitis C virus (HCV) infection. We examined the impact of alcohol use on direct-acting antiviral (DAA) therapy outcome and the clinical course of liver disease and 2-year survival for patients receiving HCV DAA therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adults (<i>n</i> = 2624) recruited from 26 Australian hospital liver clinics during 2016–2021 were followed up for 2 years. Risky alcohol use was defined by a combination of self-report (≥40 g/day of ethanol), physician-reported history of problematic alcohol use, and anti-craving medication prescription via population-based database linkage. We examined factors associated with advanced liver fibrosis and survival using multivariable logistic and Cox regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1634 patients (62.3%) with risky alcohol use, 24.6% reported consuming ≥40 g/day of alcohol, 98.3% physician-reported problematic alcohol use; only 4.1% were dispensed naltrexone/acamprosate. One hundred and forty-three patients with cirrhosis reported ≥40 g/day of alcohol, 6 (4.3%) were prescribed naltrexone/acamprosate. Risky alcohol use was associated with advanced fibrosis (adjusted-odds ratio 1.69, 95% confidence interval 1.32–2.17) and patients were over-represented for cirrhosis (45.1% vs. 25.6% in no-risky alcohol use [<i>p</i> < 0.001]) and hepatocellular carcinoma (5.7% vs. 2.5% [<i>p</i> < 0.001]). Sustained viral response (<i>p</i> = 0.319) and 2-year survival (adjusted-hazard ratio 1.98, 95% confidence interval 0.84–4.63) after DAA therapy were not associated with risky alcohol use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusions</h3>\u0000 \u0000 <p>Risky alcohol use in HCV patients was prevalent, but did not reduce HCV cure. Treatment for alcohol dependence was low. Risky alcohol use may be under-recognised in liver clinics. Better integration of addiction medicine into liver services and increased resourcing and addiction medicine training opportunities for hepatologists may help address this.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"43 6","pages":"1559-1572"},"PeriodicalIF":3.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.13914","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0