Drug and alcohol dependence最新文献_第7页

Sex differences in distributed error-related neural activation in problem-drinking young adults 问题饮酒青少年分布式错误相关神经激活的性别差异

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-08-22 DOI: 10.1016/j.drugalcdep.2024.112421

Jillian E. Hardee, Alexander S. Weigard, Mary M. Heitzeg, Meghan E. Martz, Lora M. Cope

Background

Detecting and responding to errors is central to goal-directed behavior and cognitive control and is thought to be supported by a network of structures that includes the anterior cingulate cortex and anterior insula. Sex differences in the maturational timing of cognitive control systems create differential periods of vulnerability for psychiatric conditions, such as substance use disorders.

Methods

We examined sex differences in error-related activation across an array of distributed brain regions during a Go/No-Go task in young adults with problem alcohol use (N=69; 34 females; M=19.4 years). Regions of interest previously linked to error-related activation, including anterior cingulate cortex, insula, and frontoparietal structures, were selected in a term-based meta-analysis. Individual differences in their responses to false alarm (FA) inhibitory errors relative to “go” trials (FA>GO) and correct rejections (FA>CR) were indexed using multivariate summary measures derived from principal components analysis.

Results

FA>GO and FA>CR activation both revealed a first component that explained the majority of the variance across error-associated regions and displayed the strongest loadings on salience network structures. Compared to females, males exhibited significantly higher levels of the FA>GO component but not the FA>CR component.

Conclusions

Males exhibit greater salience network activation in response to inhibitory errors, which could be attributed to sex differences in error-monitoring processes or to other functions (e.g., novelty detection). The findings are relevant for the further characterization of sex differences in cognitive control and may have implications for understanding individual differences in those at risk for substance use or other cognitive control disorders.

背景检测错误并对其做出反应是目标导向行为和认知控制的核心，被认为得到了包括前扣带皮层和前脑岛在内的结构网络的支持。认知控制系统成熟时间上的性别差异造成了不同时期的精神疾病易感性，如药物使用障碍。方法我们研究了有酗酒问题的年轻成年人（N=69；34 名女性；M=19.4 岁）在进行 Go/No-Go 任务时，错误相关激活在一系列分布式大脑区域的性别差异。在基于术语的荟萃分析中选择了以前与错误相关激活有关的相关区域，包括前扣带回皮层、脑岛和额顶叶结构。结果FA>GO和FA>CR激活都显示了一个第一成分，它解释了错误相关区域的大部分变异，并显示了对显著性网络结构的最强负载。与女性相比，男性的FA>GO分量水平明显更高，但FA>CR分量水平却不高。结论男性在抑制性错误时表现出更高的显著性网络激活，这可能是由于错误监控过程中的性别差异或其他功能（如新奇事物检测）。这些发现对进一步描述认知控制中的性别差异具有重要意义，并可能对理解药物使用或其他认知控制障碍高危人群的个体差异产生影响。

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引用次数: 0

Hub disruption in HIV disease and cocaine use: A connectomics analysis of brain function 艾滋病毒疾病和可卡因使用中的枢纽干扰：大脑功能的连接组学分析

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-08-21 DOI: 10.1016/j.drugalcdep.2024.112416

Kareem Al-Khalil , Ryan P. Bell , Sheri L. Towe , Jessica R. Cohen , Syam Gadde , James Mu , Shana A. Hall , Christina S. Meade

Background

Cocaine use (CU) is prevalent in people with HIV (PWH). Both conditions are linked to changes in cognitive functioning and neural network topology. The current study utilizes graph theory to investigate functional connectomics associated with HIV and CU, focusing on disruption of densely connected nodes called hubs.

Methods

Resting state functional magnetic resonance imaging (fMRI) from 206 adults (ages 22–55 years) were analyzed. A HIV x CU factorial design was implemented with participants in four groups: HIV+CU (n= 41), HIV only (n= 88), CU only (n= 36), and controls (n= 41). Functional connectomes were constructed, and thresholded graph metrics were calculated. Network centrality metrics – betweenness centrality (BC), participation coefficient (PC), and within module degree (WD) – were quantified into hub disruption indices (HDI). For each index, a 2×2 ANCOVA was performed controlling for education.

Results

Participants were 68 % male and 74 % African-American with a mean age of 44.4 years. HIV and CU were associated with hub disruption in all three indices. Interactions were significant for HDI-PC and HDI-WD, such that HIV disease was associated with greater hub disruption among participants without CU, but not among participants with CU. Overall, lower global cognitive functioning was associated with greater hub disruption on all three indices.

Conclusions

Widespread hub disruption was evident in HIV disease and CU, highlighting topological reorganization in both diseases with neurocognitive effects. Hub-related measures inform functional connectivity disruptions in HIV disease and CU, particularly with respect to changes in network topology throughout the connectome.

背景可卡因的使用（CU）在艾滋病病毒感染者（PWH）中很普遍。这两种情况都与认知功能和神经网络拓扑结构的变化有关。目前的研究利用图论研究与 HIV 和 CU 相关的功能连接组学，重点关注被称为 hubs 的密集连接节点的破坏。研究采用 HIV x CU 的因子设计，将参与者分为四组：HIV+CU 组（41 人）、仅 HIV 组（88 人）、仅 CU 组（36 人）和对照组（41 人）。构建了功能连接组，并计算了阈值图指标。网络中心性指标--间度中心性（BC）、参与系数（PC）和模块内度（WD）--被量化为中心中断指数（HDI）。对每个指数都进行了 2×2 方差分析，并对教育程度进行了控制。结果参与者中 68% 为男性，74% 为非裔美国人，平均年龄为 44.4 岁。艾滋病毒和 CU 与所有三项指数的中枢紊乱有关。HDI-PC和HDI-WD的交互作用非常明显，在没有CU的参与者中，HIV疾病与更大的中枢中断有关，但在有CU的参与者中则没有。总体而言，在所有三个指数中，较低的全球认知功能与更大的集线器中断有关。结论HIV疾病和CU中明显存在广泛的集线器中断，这突显了这两种疾病的拓扑重组对神经认知的影响。与中枢相关的测量结果显示了HIV疾病和CU的功能连接中断，尤其是整个连接组中网络拓扑结构的变化。

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引用次数: 0

Views and experiences of involuntary civil commitment of people who use drugs in Massachusetts (Section 35) 马萨诸塞州对吸毒者非自愿民事收容的看法和经验（第35节）

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-08-21 DOI: 10.1016/j.drugalcdep.2024.112391

Joseph Silcox , Sabrina S. Rapisarda , Jaclyn M.W. Hughto , Stephanie Vento , Patricia Case , Wilson R. Palacios , Sofia Zaragoza , Shikhar Shrestha , Thomas J. Stopka , Traci C. Green

Background

Involuntary civil commitment (ICC) is a court-mandated process to place people who use drugs (PWUD) into substance use treatment. Research on ICC effectiveness is mixed, but suggests that coercive drug treatment like ICC is harmful and can produce a number of adverse outcomes. We qualitatively examined the experiences and outcomes of ICC among PWUD in Massachusetts.

Methods

Data for this analysis were collected between 2017 and 2023 as part of a mixed-methods study of Massachusetts residents who disclosed illicit drug use in the past 30-days. We examined the transcripts of 42 participants who completed in-depth interviews and self-reported ICC. Transcripts were coded and thematically analysed using inductive and deductive approaches to understand the diversity of ICC experiences.

Results

Participants were predominantly male (57 %), white (71 %), age 31–40 (50 %), and stably housed (67 %). All participants experienced ICC at least once; half reported multiple ICCs. Participants highlighted perceptions of ICC for substance use treatment in Massachusetts. Themes surrounding ICC experience included: positive and negative treatment experience’s, strategies for evading ICC, disrupting access to medications for opioid use disorder (MOUD), and contributing to continued substance use and risk following release.

Conclusions

PWUD experience farther-reaching health and social consequences beyond the immediate outcomes of an ICC. Findings suggest opportunities to amend ICC to facilitate more positive outcomes and experiences, such as providing sufficient access to MOUD and de-criminalizing the ICC processes. Policymakers, public health, and criminal justice professionals should consider possible unintended consequences of ICC on PWUD.

背景非自愿民事承诺（ICC）是一种法院授权的程序，用于将吸毒者（PWUD）安置到药物使用治疗机构。有关 ICC 效果的研究结果不一，但都表明像 ICC 这样的强制戒毒治疗是有害的，会产生一系列不良后果。我们从定性角度研究了马萨诸塞州吸毒者（PWUD）接受 ICC 治疗的经历和结果。分析数据收集于 2017 年至 2023 年，是一项针对马萨诸塞州居民的混合方法研究的一部分，这些居民披露了他们在过去 30 天内使用非法药物的情况。我们研究了完成深度访谈并自我报告 ICC 的 42 名参与者的记录誊本。我们采用归纳和演绎的方法对笔录进行了编码和主题分析，以了解 ICC 体验的多样性。结果参与者主要为男性（57%）、白人（71%）、31-40 岁（50%）和有稳定住所者（67%）。所有参与者都至少经历过一次 ICC；半数参与者报告了多次 ICC。参与者强调了对马萨诸塞州药物使用治疗 ICC 的看法。围绕 ICC 经验的主题包括：积极和消极的治疗经验、逃避 ICC 的策略、中断阿片类药物使用障碍 (MOUD) 的药物治疗，以及导致获释后继续使用药物和面临风险。研究结果表明，有机会对 ICC 进行修改，以促进更积极的结果和体验，例如提供足够的机会获得 MOUD，以及将 ICC 过程非刑罪化。政策制定者、公共卫生和刑事司法专业人员应考虑综合儿童保育中心可能对残疾人产生的意外后果。

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引用次数: 0

Prevalence and trends of suspected cannabinoid hyperemesis syndrome over an 11-year period in Northern California: An electronic health record study 北加州 11 年间疑似大麻素吐泻综合征的患病率和趋势：电子健康记录研究

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-08-17 DOI: 10.1016/j.drugalcdep.2024.112418

Brianna Costales , Yun Lu , Kelly C. Young-Wolff , Dale M. Cotton , Cynthia I. Campbell , Esti Iturralde , Stacy A. Sterling

Background

As access to cannabis has increased, there has been a rise in a condition called cannabinoid hyperemesis syndrome (CHS). This study estimates annual prevalence of suspected CHS at emergency department visits (ED) over an 11-year period in Northern California.

Methods

This retrospective observational cohort study used electronic health records from Kaiser Permanente Northern California. Two CHS case definitions were used to construct two cohorts of adults (18+) with ≥1 CHS visits from 2009 to 2019. The primary definition used a narrow definition based on past studies (CHS group 1) and an exploratory definition allowed for a broader range of codes (CHS group 2); both definitions required a primary diagnosis of vomiting. Annual prevalence of CHS and annual rates of counts of CHS visits estimated using a log-link Poisson model are reported per group.

Findings

There were 57,227 patients with ≥1 CHS visits included in CHS group 1 and 65,645 patients included in CHS group 2. Over eleven years, CHS increased across groups with the fastest rise in CHS group 1 (prevalence ratio = 2.75, 95 % confidence interval [CI] 2.65–2.85, p<.0001 from 2009 to 2019 vs. prevalence ratio = 2.34, 95 % CI 2.27–2.43). CHS group 1 also exhibited the largest increase in ED visits (rate ratio = 2.35, 95 % CI 2.27–2.43, p<.0001).

Conclusion

In a large California population, suspected CHS increased over time across definitions. Annual prevalence increased by 134–175 %, depending on CHS definition. CHS group 2’s definition may have been too broad and changes in ICD-10-CM coding may have impacted estimates.

背景随着大麻获取途径的增加，一种名为大麻素分泌过多综合征（CHS）的病症也在增加。本研究估算了北加州 11 年间急诊科就诊（ED）中疑似大麻中毒综合征的年发病率。方法这项回顾性观察队列研究使用了北加州凯撒医疗机构的电子健康记录。研究采用了两种CHS病例定义，对2009年至2019年期间≥1次CHS就诊的成年人（18岁以上）构建了两个队列。主要定义使用了基于过去研究的狭义定义（CHS 组 1），探索性定义允许使用更广泛的代码（CHS 组 2）；两种定义都要求主要诊断为呕吐。每组报告了 CHS 的年流行率和使用对数链接泊松模型估算的 CHS 就诊次数年率。研究结果CHS 组 1 共有 57,227 名就诊次数≥1 次的患者，CHS 组 2 共有 65,645 名患者。11年间，各组的CHS人数均有所增加，其中CHS第1组上升最快（2009年至2019年的患病率比值=2.75，95%置信区间[CI]为2.65-2.85，p<.0001；2009年至2019年的患病率比值=2.34，95%置信区间[CI]为2.27-2.43）。CHS 组 1 的急诊就诊率增幅也最大（比率 = 2.35，95 % CI 2.27-2.43，p< .0001）。根据不同的 CHS 定义，年患病率增加了 134-175 %。CHS 第 2 组的定义可能过于宽泛，ICD-10-CM 编码的变化可能会影响估计值。

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引用次数: 0

An observational cohort study of alcohol use and cognitive difficulties among post-9/11 veterans with and without TBI and PTSD 对患有和未患有创伤后应激障碍（TBI）和创伤后应激障碍（PTSD）的 "9.11 "事件后退伍军人饮酒和认知障碍的观察性队列研究。

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-08-17 DOI: 10.1016/j.drugalcdep.2024.112419

April C. May , Rebecca C. Hendrickson , Kathleen F. Pagulayan , Abigail G. Schindler

Background

Traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and alcohol use are highly prevalent among military Veterans and independently associated with cognitive difficulties; less is known about the combined effects. This study aimed to investigate the association between alcohol use patterns and cognitive diagnoses in Veterans with TBI and/or PTSD.

Methods

Using electronic health record data,193,663 Veterans were classified into three alcohol use trajectory groups (consistently low, initially high transitioning to low, initially moderate transitioning to high) based on self-reported Alcohol Use Disorders Identification Test-C (AUDIT-C) scores. Cox proportional hazards models were used to examine the association between alcohol use patterns, TBI, PTSD, and the risk of cognitive diagnosis, while adjusting for demographic factors and comorbidities.

Results

Veterans with initially high transitioning to low (HR = 1.21, 95 % CI: 1.11–1.31) and initially moderate transitioning to high (HR = 1.42, 95 % CI: 1.33–1.51) alcohol use patterns had a significantly greater risk of cognitive diagnosis compared to those with consistently low alcohol use when accounting for TBI, PTSD, and comorbidities. TBI (HR = 5.40, 95 % CI: 5.06–5.76) and PTSD (HR = 2.42, 95 % CI: 2.25–2.61) were also independently associated with an elevated risk of cognitive diagnosis.

Conclusions

Findings suggest that Higher levels of alcohol consumption, even if decreasing over time, may confer an increased risk of cognitive diagnosis for Veterans with TBI and/or PTSD. Long-term alcohol use patterns should be considered in clinical assessments and interventions to identify individuals at greater risk for experiencing cognitive difficulties.

背景：创伤性脑损伤（TBI）、创伤后应激障碍（PTSD）和酗酒在退伍军人中非常普遍，并且与认知障碍有独立的关联；但对它们的综合影响却知之甚少。本研究旨在调查患有创伤性脑损伤和/或创伤后应激障碍的退伍军人的饮酒模式与认知诊断之间的关联：利用电子健康记录数据，根据自我报告的酒精使用障碍识别测试-C（AUDIT-C）得分，将 193,663 名退伍军人分为三个酒精使用轨迹组（持续低度、最初高度向低度过渡、最初中度向高度过渡）。在对人口统计学因素和合并症进行调整后，采用 Cox 比例危险模型对酒精使用模式、创伤后应激障碍、创伤后应激障碍和认知诊断风险之间的关系进行了研究：结果：在考虑创伤后应激障碍、创伤后应激障碍和合并症的情况下，与持续低度饮酒的退伍军人相比，最初高度饮酒过渡到低度饮酒（HR = 1.21，95 % CI：1.11-1.31）和最初中度饮酒过渡到高度饮酒（HR = 1.42，95 % CI：1.33-1.51）的退伍军人的认知诊断风险明显更高。创伤性脑损伤（HR = 5.40，95 % CI：5.06-5.76）和创伤后应激障碍（HR = 2.42，95 % CI：2.25-2.61）也与认知诊断风险升高独立相关：研究结果表明，较高的酒精消耗量，即使随着时间的推移而减少，也可能会增加患有创伤性脑损伤和/或创伤后应激障碍的退伍军人被诊断为认知障碍的风险。在进行临床评估和干预时，应考虑长期饮酒模式，以识别认知障碍风险更大的个体。

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引用次数: 0

Drug use practices and wound care experiences in the age of xylazine adulteration 在掺入甲苯噻嗪的时代，用药习惯和伤口护理经验。

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-08-15 DOI: 10.1016/j.drugalcdep.2024.112390

Raagini Jawa , Samia Ismail , Margaret Shang , Stephen Murray , Cristina Murray-Krezan , Yihao Zheng , Sarah Mackin , Kenny Washington , Pedro Alvarez , Jaime Dillon , Gary McMurtrie , Michael Stein , Alexander Walley , Jane M. Liebschutz

Introduction

Exposure to xylazine has been associated with wounds distinct from typical injection-related skin and soft tissue infections. We sought to understand drug use and wound care practices, and treatment experiences of people who use drugs (PWUD) in a high-prevalence area of xylazine adulteration.

Methods

In August 2023, we surveyed adult PWUD reporting at least one past-year drug use-related wound across three Massachusetts syringe service programs. Using a representative illustration, participants indicated if they had experienced a xylazine wound in the past 90 days. We compared demographic, drug use factors, wound care, and medical treatment experiences among those with and without xylazine wounds. We also conducted additional content analysis of open-ended responses.

Results

Of the 171 respondents, 87 % (n=148) had a xylazine wound in the past 90 days. There were no statistically significant demographic differences between those with and without xylazine wounds. Among those primarily injecting (n=155), subcutaneous injection was nearly ten times more likely among people with xylazine wounds. For those with xylazine wounds (n=148), many engaged in heterogeneous wound self-treatment practices, and when seeking medical care, 74 % experienced healthcare stigma and 58 % had inadequate pain and withdrawal management.

Conclusion

People with self-identified xylazine wounds were more likely to engage in subcutaneous injection and faced several barriers seeking medical wound treatment. Programs serving people exposed to xylazine should work to support safer injection practices, including alternatives to injecting and improving access to high-quality, effective wound care. Further study is warranted to understand the causes, promoters, and prevention of xylazine-related wounds.

介绍：与注射相关的典型皮肤和软组织感染不同，接触异丙嗪会造成伤口。我们试图了解毒品使用和伤口护理方法，以及在甲苯噻嗪掺假高发区的吸毒者（PWUD）的治疗经验：2023 年 8 月，我们在马萨诸塞州的三个注射器服务项目中调查了报告在过去一年中至少出现过一次与吸毒有关的伤口的成年吸毒者。参与者使用具有代表性的插图，说明他们在过去 90 天内是否经历过异丙嗪伤口。我们比较了有和没有异丙嗪伤口者的人口统计学、吸毒因素、伤口护理和医疗经历。我们还对开放式回答进行了内容分析：在 171 位受访者中，87%（n=148）在过去 90 天内曾有过异丙嗪伤口。有和没有异嗪伤口的受访者在人口统计学上没有明显差异。在以注射为主的受访者（人数=155）中，有异丙嗪伤口的人进行皮下注射的可能性要高出近十倍。对于那些有异丙嗪伤口的人（人数=148）来说，许多人的伤口自我治疗方法各不相同，在就医时，74%的人遭遇了医疗羞辱，58%的人疼痛和戒断管理不足：结论：自我认定有甲苯噻嗪伤口的人更有可能进行皮下注射，并且在寻求伤口治疗时面临多种障碍。为接触过二甲苯嗪的人提供服务的项目应努力支持更安全的注射方法，包括注射的替代方法和改善获得高质量、有效伤口护理的途径。我们有必要开展进一步的研究，以了解木嗪相关伤口的成因、促进因素和预防措施。

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引用次数: 0

Polygenic risk scores for nicotine use and family history of smoking are associated with smoking behaviour 尼古丁使用的多基因风险评分和吸烟家族史与吸烟行为有关

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-08-15 DOI: 10.1016/j.drugalcdep.2024.112415

Jerome C. Foo , Maja P. Völker , Fabian Streit , Josef Frank , Norman Zacharias , Lea Zillich , Lea Sirignano , Peter Nürnberg , Thomas F. Wienker , Michael Wagner , Markus M. Nöthen , Michael Nothnagel , Henrik Walter , Bernd Lenz , Rainer Spanagel , Falk Kiefer , Georg Winterer , Marcella Rietschel , Stephanie H. Witt

Introduction

Formal genetics studies show that smoking is influenced by genetic factors; exploring this on the molecular level can offer deeper insight into the etiology of smoking behaviours.

Methods

Summary statistics from the latest wave of the GWAS and Sequencing Consortium of Alcohol and Nicotine (GSCAN) were used to calculate polygenic risk scores (PRS) in a sample of ~2200 individuals who smoke/individuals who never smoked. The associations of smoking status with PRS for Smoking Initiation (i.e., Lifetime Smoking; SI-PRS), and Fagerström Test for Nicotine Dependence (FTND) score with PRS for Cigarettes per Day (CpD-PRS) were examined, as were distinct/additive effects of parental smoking on smoking status.

Results

SI-PRS explained 10.56% of variance (Nagelkerke-R²) in smoking status (p=6.45x10⁻³⁰). In individuals who smoke, CpD-PRS was associated with FTND score (R²=5.03%, p=1.88x10^–12). Parental smoking alone explained R²=3.06% (p=2.43×10⁻¹²) of smoking status, and 0.96% when added to the most informative SI-PRS model (total R²=11.52%).

Conclusion

These results show the potential utility of molecular genetic data for research investigating smoking prevention. The fact that PRS explains more variance than family history highlights progress from formal to molecular genetics; the partial overlap and increased predictive value when using both suggests the importance of combining these approaches.

方法利用酒精和尼古丁全球基因组研究和测序联合会（GSCAN）最新一期的汇总统计数据，计算了约2200名吸烟者/从不吸烟者样本的多基因风险得分（PRS）。结果SI-PRS解释了吸烟状况10.56%的方差（Nagelkerke-R2）（p=6.45x10-30）。在吸烟者中，CpD-PRS 与 FTND 评分相关（R2=5.03%，p=1.88x10-12）。父母吸烟本身对吸烟状况的解释率为 R2=3.06%（p=2.43×10-12），如果加入信息量最大的 SI-PRS 模型，则解释率为 0.96%（总 R²=11.52%）。PRS比家族史能解释更多的变异，这一事实凸显了从形式遗传学到分子遗传学的进步；两者的部分重叠和预测价值的提高表明了将这些方法结合起来的重要性。

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引用次数: 0

Decrease in injection and rise in smoking and snorting of heroin and synthetic opioids, 2000–2021 2000-2021 年海洛因和合成类阿片注射量减少，吸食和鼻吸量增加

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-08-15 DOI: 10.1016/j.drugalcdep.2024.111419

George Karandinos , Jay Unick , Jeff Ondocsin , Nicole Holm , Sarah Mars , Fernando Montero , Daniel Rosenblum , Daniel Ciccarone

Background

Injecting, smoking, and snorting heroin/synthetic opioids is each associated with unique health risks. It is unclear how route of administration (ROA) preferences have shifted during the opioid epidemic.

Methods

Using 2000–2021 admissions data from SAMHSA TEDS-A, we analyzed trends in heroin/synthetic opioid ROA preferences and factors associated with these preferences.

Results

7,881,318 heroin/synthetic opioid admissions reported injection, smoking, or snorting preference. Nationally, injection peaked in 2014 (69.9 %) and nadired in 2021(52.2 %), snorting nadired in 2014 (24.9 %) and peaked in 2021 (36.4 %), and smoking rose steadily from 2.5 % in 2005 to a peak of 11.4 % in 2021. From 2000–2021, the number of states with ≥10 % smoking rates grew from 2 to 27 (highest: 57.0 % in Arizona in 2021). In 2021, increased adjusted prevalence ratios (APR) of non-injection versus injection use were associated with older age at first opioid use (APR 1.52 [95 % CI: 1.51, 1.54] for those 30+ relative to ≤20), and all race/ethnicities relative to non-Latino White individuals (highest: Black individuals, APR 1.77 [1.75, 1.78]). Geography strongly predicted smoking versus snorting (Mountain APR 6.91 [6.64, 7.19], Pacific APR 6.61 [6.35, 6.88], reference: New England).

Conclusions

ROA preferences of heroin/synthetic opioids have changed substantially since 2000, with: 1) recent decreases in injection nationally; 2) increased smoking, particularly in the western US; and, 3) recent increased snorting in the eastern US. Smoking is now prevalent and growing. Public health implications include an increasing number of smoking-related fatal overdoses and the probable reduction of injection-specific morbidity and increase in smoking-specific morbidity.

背景注射、吸食和鼻吸海洛因/合成阿片类药物都与独特的健康风险相关。目前尚不清楚在阿片类药物流行期间给药途径（ROA）的偏好发生了怎样的变化。方法利用2000-2021年SAMHSA TEDS-A的入院数据，我们分析了海洛因/合成阿片类药物ROA偏好的趋势以及与这些偏好相关的因素。结果7,881,318名海洛因/合成阿片类药物入院者报告了注射、吸食或鼻吸偏好。在全国范围内，注射在 2014 年达到峰值（69.9%），2021 年达到峰值（52.2%）；吸食在 2014 年达到峰值（24.9%），2021 年达到峰值（36.4%）；吸烟从 2005 年的 2.5%稳步上升到 2021 年的 11.4%。2000-2021年，吸烟率≥10%的州从2个增加到27个（最高：2021年亚利桑那州为57.0%）。2021 年，非注射与注射使用的调整流行率（APR）的增加与首次使用阿片类药物的年龄较大有关（30 岁以上相对于≤20 岁的调整流行率为 1.52 [95 % CI：1.51, 1.54]），以及所有种族/族裔相对于非拉丁裔白人的调整流行率（最高：黑人，调整流行率为 1.77 [1.75, 1.78]）。地理位置对吸烟与吸食有很大的影响（山区 APR 6.91 [6.64, 7.19]，太平洋地区 APR 6.61 [6.35, 6.88]，参考新英格兰地区）：结论自 2000 年以来，ROA 对海洛因/合成阿片类药物的偏好发生了很大变化，其中包括1）最近全国注射量减少；2）吸食量增加，尤其是在美国西部；3）最近美国东部吸食量增加。吸烟现象现在很普遍，而且还在不断增加。对公共健康的影响包括：与吸烟有关的致命过量吸毒人数增加，注射吸毒的发病率可能下降，而吸烟的发病率可能上升。

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引用次数: 0

Within-person and between-person associations of access to environmental reward with alcohol and cannabis use and consequences among young adults 人内和人与人之间获得环境奖励与年轻人使用酒精和大麻及其后果的关系

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-08-14 DOI: 10.1016/j.drugalcdep.2024.112417

Sophie G. Coelho , Christian S. Hendershot , Jeffrey D. Wardell

Background

Recent behavioural economic models of substance use suggest that low access to environmental reward may increase risk for heavy substance use and associated harms. Most prior studies of these associations have been cross-sectional and have focused on alcohol. The current study extends this research using longitudinal data to examine the within-person and between-person associations of environmental reward access with both alcohol and cannabis outcomes.

Method

Young adults (N = 119, 64.71 % female) completed an online survey at three time points, spaced six months apart. The survey included measures of alcohol and cannabis use and consequences, and two facets of environmental reward access: reward probability (i.e., likelihood of experiencing environmental reward) and environmental suppression (i.e., diminished availability of environmental reward).

Results

Multilevel models revealed that at the between-person level (i.e., averaged across time points), greater environmental suppression (but not reward probability) was significantly associated with more frequent cannabis use, and greater reward probability (but not environmental suppression) was significantly associated with heavier alcohol use. Higher environmental suppression (but not reward probability) was also associated with greater alcohol and cannabis consequences at the between-person level, over and above level of use. A significant within-person association also was observed, wherein participants reported relative increases in cannabis consequences during time periods when they also reported relative decreases in the availability of environmental reward.

Conclusions

Results highlight environmental suppression as a risk factor for more frequent cannabis use and for both alcohol and cannabis consequences, and provide novel support for a within-person association between environmental suppression and cannabis consequences over time. Findings may inform contextual interventions for young adult substance use.

背景最近的药物使用行为经济模型表明，获得环境奖励的机会少可能会增加大量使用药物的风险和相关危害。以前对这些关联的研究大多是横断面研究，而且主要集中在酒精方面。本研究利用纵向数据对这一研究进行了扩展，研究了环境奖励的获取与酒精和大麻使用结果之间的人内和人际关联。方法年轻人（N = 119，64.71 % 为女性）在三个时间点完成了一项在线调查，时间间隔为六个月。结果多层次模型显示，在人与人之间的水平上（即各时间点的平均值），更高的环境抑制（而非奖励概率）与更频繁地使用大麻显著相关，而更高的奖励概率（而非环境抑制）与更大量地使用酒精显著相关。在人与人之间，较高的环境抑制（而非奖励概率）也与较高的酒精和大麻使用后果有关，超过了使用水平。结论研究结果突出表明，环境抑制是导致更频繁使用大麻以及造成酒精和大麻后果的风险因素，并为环境抑制与大麻后果之间的人际关系提供了新的支持。研究结果可为针对青壮年药物使用的情境干预提供参考。

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引用次数: 0

Buprenorphine treatment and clinical outcomes under the opioid use disorder cascade of care 丁丙诺啡治疗和阿片类药物使用障碍级联护理的临床结果

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-08-13 DOI: 10.1016/j.drugalcdep.2024.112389

Arthur Robin Williams , Christine M. Mauro , Lisa Chiodo , Ben Huber , Angelo Cruz , Stephen Crystal , Hillary Samples , Molly Nowels , Amanda Wilson , Peter D. Friedmann , Robert H. Remien , Mark Olfson

Background

Challenges to engagement and retention on buprenorphine undermine treatment of individuals with opioid use disorder (OUD). Under the OUD Cascade of Care framework, we sought to identify patient characteristics and treatment response associated with superior clinical outcomes.

Methods

A retrospective cohort study of specialty buprenorphine treatment patients entering treatment (n=19,487) based on EHR records from a large multi-state buprenorphine treatment network (2011–2019). Person-level care episodes were evaluated across treatment intake, engagement (i.e. 2+ visits in the month following intake), and retention at 6, 12, and 24 months. Time to achieving 90 days of continuous opioid abstinence was assessed using Cox proportional hazards regressions models and also assessed as a predictor of long-term retention.

Results

Most patients engaged (82.4 %), but retention steadily declined over 6-month (38.7 %), 12-month (26.2 %), and 24-month (17.1 %) timepoints. Opioid-positive baseline tests were associated with lower hazards of achieving continuous abstinence for both buprenorphine-positive (aHR=0.33, p<.001) and buprenorphine-negative (aHR=0.49,p<.001) intakes. Opioid abstinence was associated with buprenorphine-positive baseline testing (aHR=1.59,p<.001), especially for those testing opioid-negative (aHR=1.82,p<.001). Patients who achieved and sustained abstinence at 6 months in care were 4.1 and 5.5 times as likely to achieve 12-month and 24-month retention, respectively, compared to patients with intermittent opioid use.

Conclusion

Treatment discontinuation was concentrated early in care and buprenorphine and opioid status at intake were prognostic of achieving and sustaining abstinence. Early abstinence was associated with higher likelihood of subsequent stage progression. Implementing interventions to support early clinical stability for high-risk patients is critical to improve clinical outcomes.

背景使用丁丙诺啡治疗阿片类药物使用障碍（OUD）患者在参与和保留治疗方面遇到的挑战破坏了治疗效果。在阿片类药物使用障碍级联护理框架下，我们试图确定与优异临床结果相关的患者特征和治疗反应。方法根据一个大型多州丁丙诺啡治疗网络的电子病历记录，对进入治疗的专业丁丙诺啡治疗患者（n=19,487）进行回顾性队列研究（2011-2019 年）。在接受治疗、参与治疗（即在接受治疗后的一个月内进行 2 次以上的就诊）以及 6、12 和 24 个月的保留治疗期间，对个人层面的护理事件进行了评估。使用 Cox 比例危险度回归模型对实现连续戒断阿片类药物 90 天的时间进行了评估，并将其作为长期保留率的预测因素。对于丁丙诺啡阳性（aHR=0.33, p<.001）和丁丙诺啡阴性（aHR=0.49, p<.001）摄入者而言，阿片类药物阳性基线测试与较低的持续戒断危险相关。阿片类药物戒断与丁丙诺啡基线检测呈阳性有关（aHR=1.59,p<.001），尤其是那些阿片类药物检测呈阴性的患者（aHR=1.82,p<.001）。与间断使用阿片类药物的患者相比，在接受护理 6 个月时实现并维持戒断的患者在 12 个月和 24 个月的保留率分别是前者的 4.1 倍和 5.5 倍。早期戒断与随后阶段进展的可能性较高有关。实施干预措施以支持高危患者的早期临床稳定，对于改善临床结果至关重要。

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引用次数: 0