Pub Date : 2024-08-17DOI: 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.
{"title":"Prevalence and trends of suspected cannabinoid hyperemesis syndrome over an 11-year period in Northern California: An electronic health record study","authors":"Brianna Costales , Yun Lu , Kelly C. Young-Wolff , Dale M. Cotton , Cynthia I. Campbell , Esti Iturralde , Stacy A. Sterling","doi":"10.1016/j.drugalcdep.2024.112418","DOIUrl":"10.1016/j.drugalcdep.2024.112418","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Findings</h3><p>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).</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"263 ","pages":"Article 112418"},"PeriodicalIF":3.9,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-17DOI: 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.
{"title":"An observational cohort study of alcohol use and cognitive difficulties among post-9/11 veterans with and without TBI and PTSD","authors":"April C. May , Rebecca C. Hendrickson , Kathleen F. Pagulayan , Abigail G. Schindler","doi":"10.1016/j.drugalcdep.2024.112419","DOIUrl":"10.1016/j.drugalcdep.2024.112419","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"263 ","pages":"Article 112419"},"PeriodicalIF":3.9,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-15DOI: 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.
{"title":"Drug use practices and wound care experiences in the age of xylazine adulteration","authors":"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","doi":"10.1016/j.drugalcdep.2024.112390","DOIUrl":"10.1016/j.drugalcdep.2024.112390","url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"263 ","pages":"Article 112390"},"PeriodicalIF":3.9,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0376871624013152/pdfft?md5=0e0822019e504275b6708ee404a15501&pid=1-s2.0-S0376871624013152-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-15DOI: 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.
{"title":"Polygenic risk scores for nicotine use and family history of smoking are associated with smoking behaviour","authors":"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","doi":"10.1016/j.drugalcdep.2024.112415","DOIUrl":"10.1016/j.drugalcdep.2024.112415","url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>SI-PRS explained 10.56% of variance (Nagelkerke-R<sup>2</sup>) in smoking status (p=6.45x10<sup><em>−</em>30</sup>). In individuals who smoke, CpD-PRS was associated with FTND score (R<sup>2</sup>=5.03%, p=1.88x10<sup><em>–</em>12</sup>). Parental smoking alone explained R<sup>2</sup>=3.06% (p=2.43×10<sup>−12</sup>) of smoking status, and 0.96% when added to the most informative SI-PRS model (total R²=11.52%).</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"263 ","pages":"Article 112415"},"PeriodicalIF":3.9,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0376871624013401/pdfft?md5=07785b4116088d737363aea286342ea5&pid=1-s2.0-S0376871624013401-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142084141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-15DOI: 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.
{"title":"Decrease in injection and rise in smoking and snorting of heroin and synthetic opioids, 2000–2021","authors":"George Karandinos , Jay Unick , Jeff Ondocsin , Nicole Holm , Sarah Mars , Fernando Montero , Daniel Rosenblum , Daniel Ciccarone","doi":"10.1016/j.drugalcdep.2024.111419","DOIUrl":"10.1016/j.drugalcdep.2024.111419","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>Using 2000–2021 admissions data from SAMHSA TEDS-A, we analyzed trends in heroin/synthetic opioid ROA preferences and factors associated with these preferences.</p></div><div><h3>Results</h3><p>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).</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"263 ","pages":"Article 111419"},"PeriodicalIF":3.9,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-14DOI: 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.
{"title":"Within-person and between-person associations of access to environmental reward with alcohol and cannabis use and consequences among young adults","authors":"Sophie G. Coelho , Christian S. Hendershot , Jeffrey D. Wardell","doi":"10.1016/j.drugalcdep.2024.112417","DOIUrl":"10.1016/j.drugalcdep.2024.112417","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Method</h3><p>Young adults (<em>N</em> = 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).</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"263 ","pages":"Article 112417"},"PeriodicalIF":3.9,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0376871624013425/pdfft?md5=8551b7c574778c0a7fd76afcf8cc76bf&pid=1-s2.0-S0376871624013425-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142044777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13DOI: 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.
{"title":"Buprenorphine treatment and clinical outcomes under the opioid use disorder cascade of care","authors":"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","doi":"10.1016/j.drugalcdep.2024.112389","DOIUrl":"10.1016/j.drugalcdep.2024.112389","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"263 ","pages":"Article 112389"},"PeriodicalIF":3.9,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13DOI: 10.1016/j.drugalcdep.2024.112402
Joseph J. Palamar , Nicole D. Fitzgerald , Bruce A. Goldberger , Linda B. Cottler
Background
Pentobarbital is a Schedule II/III short-acting barbiturate with limited medical use in humans. Veterinary professionals use pentobarbital to euthanize dogs, cats, and other companion animals. Pentobarbital is also utilized in capital punishment and small amounts are illegally shipped or diverted to assist in suicides. However, five kilograms of pentobarbital smuggled in from Mexico was recently seized by an organized crime drug enforcement task force (along with fentanyl, heroin, and cocaine), which may suggest a shift in illicit supply. We investigated potential indicators of illicit pentobarbital use or availability in the US to help determine whether this drug is becoming an emerging public health concern.
Methods
The National Drug Early Warning System requested information on pentobarbital from its sentinel surveillance sites and collaborators and conducted a search of current literature.
Results
In early 2024, multiple batches of counterfeit pills (e.g., pressed as “M30s” to represent oxycodone) confiscated near the Southwest border tested positive for pentobarbital plus combinations of fentanyl, fentanyl analogs, and xylazine. Other indicators suggest pentobarbital is being smuggled in powder form and possibly sold as another drug such as heroin. One national drug analysis program detected pentobarbital in 217 drug submissions from 2020 to 2023, and there were at least 12 fatal exposures linked to use from 2020 to 2022.
Conclusion
Continued monitoring of illicit use and availability is needed as pentobarbital may continue to appear on the illicit market. Unknown exposure can occur if the drug is mixed into counterfeit pills or sold in powder form represented to be another drug.
{"title":"Monitoring illicit pentobarbital availability in the United States: A National Drug Early Warning System briefing","authors":"Joseph J. Palamar , Nicole D. Fitzgerald , Bruce A. Goldberger , Linda B. Cottler","doi":"10.1016/j.drugalcdep.2024.112402","DOIUrl":"10.1016/j.drugalcdep.2024.112402","url":null,"abstract":"<div><h3>Background</h3><p>Pentobarbital is a Schedule II/III short-acting barbiturate with limited medical use in humans. Veterinary professionals use pentobarbital to euthanize dogs, cats, and other companion animals. Pentobarbital is also utilized in capital punishment and small amounts are illegally shipped or diverted to assist in suicides. However, five kilograms of pentobarbital smuggled in from Mexico was recently seized by an organized crime drug enforcement task force (along with fentanyl, heroin, and cocaine), which may suggest a shift in illicit supply. We investigated potential indicators of illicit pentobarbital use or availability in the US to help determine whether this drug is becoming an emerging public health concern.</p></div><div><h3>Methods</h3><p>The National Drug Early Warning System requested information on pentobarbital from its sentinel surveillance sites and collaborators and conducted a search of current literature.</p></div><div><h3>Results</h3><p>In early 2024, multiple batches of counterfeit pills (e.g., pressed as “M30s” to represent oxycodone) confiscated near the Southwest border tested positive for pentobarbital plus combinations of fentanyl, fentanyl analogs, and xylazine. Other indicators suggest pentobarbital is being smuggled in powder form and possibly sold as another drug such as heroin. One national drug analysis program detected pentobarbital in 217 drug submissions from 2020 to 2023, and there were at least 12 fatal exposures linked to use from 2020 to 2022.</p></div><div><h3>Conclusion</h3><p>Continued monitoring of illicit use and availability is needed as pentobarbital may continue to appear on the illicit market. Unknown exposure can occur if the drug is mixed into counterfeit pills or sold in powder form represented to be another drug.</p></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"263 ","pages":"Article 112402"},"PeriodicalIF":3.9,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142021553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13DOI: 10.1016/j.drugalcdep.2024.111407
Shane Darke , Johan Duflou , Skye McDonald , Amy Peacock , Michael Farrell , Julia Lappin
Background
A major alcohol-related harm is structural pathology affecting the brain. The study aimed to: 1. Determine the frequency and nature of neuropathology amongst cases of death due to acute alcohol toxicity; 2. Compare diagnoses of brain atrophy with pathology in other organs; 3. Determine the demographic, clinical and organ pathology correlates of brain atrophy.
Methods:
Retrospective study of 500 cases of death attributed to acute alcohol toxicity in Australia, 2011–2022. Data on clinical characteristics, toxicology, neuropathology and other organ pathology were retrieved from police reports, autopsies, toxicology and coronial findings.
Results
Mean age was 49.5 years, 69.4 % were male, with alcohol use problems documented in 70.2 %. Brain atrophy was diagnosed in 60 cases (12.0 %), most commonly in the cerebellum (32 cases, 6.4 %). Atrophy at other sites was present in 37 (7.4 %). The presence of brain atrophy was lower than other major pathologies: cardiomegaly (32.6 %, p<.001), nephro/arteriosclerosis (30.2 %, p<.001), and chronic obstructive pulmonary disease (21.8 %, p<.001) but not hepatic cirrhosis (11.9 % p=1.0). Those diagnosed with atrophy were older (53.4 v 49.0 years, p<.001), more likely to have documented alcohol problems (85.0 v 68.2 %, Odds ratio: OR 2.53) and seizure history (10.0 v 3.0 %, OR 2.92), to have cardiomegaly (43.3 v 31.0 %, OR 1.90, COPD (48.3 v 18.2 %, 3.57) and nephro/arteriosclerosis (50.0 v 27.4 %, OR 2.27).
Conclusions:
Despite the majority of cases having a history of alcohol problems, the level of neuropathology amongst cases of death due to acute alcohol toxicity was comparatively low.
背景与酒精有关的主要危害是影响大脑的结构性病变。本研究旨在1.方法：对 2011-2022 年澳大利亚 500 例急性酒精中毒死亡病例进行回顾性研究。结果：平均年龄为49.5岁，69.4%为男性，70.2%有饮酒问题记录。诊断出脑萎缩的有 60 例（12.0%），最常见的是小脑（32 例，6.4%）。其他部位出现萎缩的有 37 例（7.4%）。脑萎缩发生率低于其他主要病症：心脏肥大（32.6%，p<.001）、肾/动脉硬化（30.2%，p<.001）和慢性阻塞性肺病（21.8%，p<.001），但不包括肝硬化（11.9%，p=1.0）。被诊断为萎缩症的患者年龄更大（53.4 v 49.0 岁，p< .001），更有可能有酗酒问题记录（85.0 v 68.2 %，Odds ratio: OR 2.53）和癫痫发作史（10.0 v 3.0 %，OR 2.92），有心脏肥大（43.3 v 31.0 %，OR 1.90）、慢性阻塞性肺病（48.结论：尽管大多数病例有酗酒史，但急性酒精中毒致死病例的神经病理学水平相对较低。
{"title":"Neuropathology of deaths due to acute alcohol toxicity in Australia, 2011–2022","authors":"Shane Darke , Johan Duflou , Skye McDonald , Amy Peacock , Michael Farrell , Julia Lappin","doi":"10.1016/j.drugalcdep.2024.111407","DOIUrl":"10.1016/j.drugalcdep.2024.111407","url":null,"abstract":"<div><h3>Background</h3><p>A major alcohol-related harm is structural pathology affecting the brain. The study aimed to: 1. Determine the frequency and nature of neuropathology amongst cases of death due to acute alcohol toxicity; 2. Compare diagnoses of brain atrophy with pathology in other organs; 3. Determine the demographic, clinical and organ pathology correlates of brain atrophy.</p></div><div><h3>Methods:</h3><p>Retrospective study of 500 cases of death attributed to acute alcohol toxicity in Australia, 2011–2022. Data on clinical characteristics, toxicology, neuropathology and other organ pathology were retrieved from police reports, autopsies, toxicology and coronial findings.</p></div><div><h3>Results</h3><p>Mean age was 49.5 years, 69.4 % were male, with alcohol use problems documented in 70.2 %. Brain atrophy was diagnosed in 60 cases (12.0 %), most commonly in the cerebellum (32 cases, 6.4 %). Atrophy at other sites was present in 37 (7.4 %). The presence of brain atrophy was lower than other major pathologies: cardiomegaly (32.6 %, p<.001), nephro/arteriosclerosis (30.2 %, p<.001), and chronic obstructive pulmonary disease (21.8 %, p<.001) but not hepatic cirrhosis (11.9 % p=1.0). Those diagnosed with atrophy were older (53.4<!--> <!-->v 49.0 years, p<.001)<strong>,</strong> more likely to have documented alcohol problems (85.0<!--> <!-->v 68.2 %, Odds ratio: OR 2.53) and seizure history (10.0<!--> <!-->v 3.0 %, OR 2.92), to have cardiomegaly (43.3<!--> <!-->v 31.0 %, OR 1.90, COPD (48.3<!--> <!-->v 18.2 %, 3.57) and nephro/arteriosclerosis (50.0 <!--> <!-->v 27.4 %, OR 2.27).</p></div><div><h3>Conclusions:</h3><p>Despite the majority of cases having a history of alcohol problems, the level of neuropathology amongst cases of death due to acute alcohol toxicity was comparatively low.</p></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"263 ","pages":"Article 111407"},"PeriodicalIF":3.9,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0376871624003302/pdfft?md5=6550cec1650d59f40a564e1fc2c23d21&pid=1-s2.0-S0376871624003302-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141990622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-12DOI: 10.1016/j.drugalcdep.2024.112410
Roman Ivasiy , Lynn M. Madden , Elizabeth DiDomizio , Kimberly A. Johnson , Eteri Machavariani , Bachar Ahmad , David Oliveros , A. Ram , Natalie Kil , Frederick L. Altice
Background
Opioid use disorder (OUD) significantly impacts individual and public health and exacerbated further by concurrent infectious diseases. A syndemic approach is needed to address the intertwined OUD, HIV, and HCV epidemics, including the expanded use of medications for opioid use disorder (MOUD).
Methods
To identify MOUD scale-up opportunities, we conducted a retrospective cohort study, representing commercially insured persons, and created the OUD care continuum, including HIV and HCV influences in adults (18–64 years) newly diagnosed with OUD in 2019 using Merative MarketSan data.
Results
Among 124,467,633 individuals, the prevalence of OUD was 0.4 % (95 % CI: 0.36 %-0.46 %; N = 497,871), with 327,277 (65.7 %, 95 % CI: 65.60 %-65.87 %) newly diagnosed in 2019. Among these newly diagnosed individuals (54 % men, mean age 44±0.01), 53,568 (27.0 %, 95 % CI: 26.4 %-27.5 %) were prescribed MOUD, with retention rates at 1, 3, and 6 months being 89.0 % (95 % CI: 88.2 %-89.8 %), 66.0 % (95 % CI: 64.8 %-67.2 %), and 50.3 % (95 % CI: 48.3 %-51.6 %), respectively. Buprenorphine was the most prescribed MOUD (79.6 %, 95 % CI: 78.6 %-80.7 %), followed by XR-NTX (14.9 %, 95 % CI:14.0 %-15.8 %) and methadone (5.5 %, 95 % CI: 4.9 %-6.1 %). Six-month retention was highest for methadone (73.4 %, 95 % CI: 73.0 %-73.8 %), however, followed by buprenorphine (55.7 %, 95 % CI: 55.3 %-57.1 %) and substantially lower for XR-NTX (12.6 %, 95 % CI: 10.6 %-14.6 %). Screening for HIV and HCV was low among OUD enrollees (11.1 %, 14.4 %), slightly higher for MOUD initiators (18.0 %, 21.6 %). Being prescribed MOUD was correlated with HCV infection (AOR: 2.54; 95 % CI: 2.41–2.68), HCV/HIV coinfection (AOR: 1.89; 95 % CI: 1.41–2.53), and hospitalization for OUD-related services (AOR: 1.14; 95 % CI: 1.11–1.17), yet hospitalization for OUD-related services was positively correlated with XR-NTX (AOR: 2.72; 95 % CI: 2.56–2.85) prescription and negatively with methadone (AOR: 0.19; 95 % CI: 0.16–0.23) prescription. Having HIV was negatively correlated with being prescribed methadone (AOR: 0.33; 95 % CI: 0.13–0.86).
Conclusions
Substantial gaps in the OUD cascade persist, underscoring better implementation opportunities for MOUD prescription in hospital-based settings and expanding access to methadone beyond highly regulated sites given its low coverage yet high treatment retention.
{"title":"The cascade of care for commercially-insured persons with opioid use disorder and comorbid HIV and HCV infections","authors":"Roman Ivasiy , Lynn M. Madden , Elizabeth DiDomizio , Kimberly A. Johnson , Eteri Machavariani , Bachar Ahmad , David Oliveros , A. Ram , Natalie Kil , Frederick L. Altice","doi":"10.1016/j.drugalcdep.2024.112410","DOIUrl":"10.1016/j.drugalcdep.2024.112410","url":null,"abstract":"<div><h3>Background</h3><p>Opioid use disorder (OUD) significantly impacts individual and public health and exacerbated further by concurrent infectious diseases. A syndemic approach is needed to address the intertwined OUD, HIV, and HCV epidemics, including the expanded use of medications for opioid use disorder (MOUD).</p></div><div><h3>Methods</h3><p>To identify MOUD scale-up opportunities, we conducted a retrospective cohort study, representing commercially insured persons, and created the OUD care continuum, including HIV and HCV influences in adults (18–64 years) newly diagnosed with OUD in 2019 using Merative MarketSan data.</p></div><div><h3>Results</h3><p>Among 124,467,633 individuals, the prevalence of OUD was 0.4 % (95 % CI: 0.36 %-0.46 %; N = 497,871), with 327,277 (65.7 %, 95 % CI: 65.60 %-65.87 %) newly diagnosed in 2019. Among these newly diagnosed individuals (54 % men, mean age 44±0.01), 53,568 (27.0 %, 95 % CI: 26.4 %-27.5 %) were prescribed MOUD, with retention rates at 1, 3, and 6 months being 89.0 % (95 % CI: 88.2 %-89.8 %), 66.0 % (95 % CI: 64.8 %-67.2 %), and 50.3 % (95 % CI: 48.3 %-51.6 %), respectively. Buprenorphine was the most prescribed MOUD (79.6 %, 95 % CI: 78.6 %-80.7 %), followed by XR-NTX (14.9 %, 95 % CI:14.0 %-15.8 %) and methadone (5.5 %, 95 % CI: 4.9 %-6.1 %). Six-month retention was highest for methadone (73.4 %, 95 % CI: 73.0 %-73.8 %), however, followed by buprenorphine (55.7 %, 95 % CI: 55.3 %-57.1 %) and substantially lower for XR-NTX (12.6 %, 95 % CI: 10.6 %-14.6 %). Screening for HIV and HCV was low among OUD enrollees (11.1 %, 14.4 %), slightly higher for MOUD initiators (18.0 %, 21.6 %). Being prescribed MOUD was correlated with HCV infection (AOR: 2.54; 95 % CI: 2.41–2.68), HCV/HIV coinfection (AOR: 1.89; 95 % CI: 1.41–2.53), and hospitalization for OUD-related services (AOR: 1.14; 95 % CI: 1.11–1.17), yet hospitalization for OUD-related services was positively correlated with XR-NTX (AOR: 2.72; 95 % CI: 2.56–2.85) prescription and negatively with methadone (AOR: 0.19; 95 % CI: 0.16–0.23) prescription. Having HIV was negatively correlated with being prescribed methadone (AOR: 0.33; 95 % CI: 0.13–0.86).</p></div><div><h3>Conclusions</h3><p>Substantial gaps in the OUD cascade persist, underscoring better implementation opportunities for MOUD prescription in hospital-based settings and expanding access to methadone beyond highly regulated sites given its low coverage yet high treatment retention.</p></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"263 ","pages":"Article 112410"},"PeriodicalIF":3.9,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142002359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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