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The Associations of Kratom (Mitragynine), Opioids, Other Substances, and Sociodemographic Variables to Drug Intoxication-related Mortality. Kratom (Mitragynine)、阿片类药物、其他物质和社会人口变量与药物中毒相关死亡率的关系。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-19 DOI: 10.1097/ADM.0000000000001417
Armiel A Suriaga, Ruth M Tappen, Christopher R McCurdy, David Newman, Oliver Grundmann, John F Kelly

Introduction: The US age-adjusted drug overdose rate increased by 298%, with fentanyl being the main contributor to drug overdose deaths. The contribution of kratom to drug overdoses or intoxication is seldom reported despite its increasing use and detection among overdose decedents.

Methods: Our cross-sectional study utilized deidentified data from the Florida Department of Law Enforcement, 2020-2021 (N = 30,845). The medical examiners ascertained the exposures of interest (kratom, opioids, and other substances) and the outcome variable of drug intoxication-related mortality (DIRM) through autopsies and toxicology results. DIRM refers to any death from a substance identified as drug toxicity or intoxication. We used regression modeling to examine the association of exposure with DIRM.

Results: Five hundred fifty-one cases were confirmed kratom (mitragynine) exposures. More males died of DIRM (81.5%), primarily White (95.1%) and 35-44 years old (40.5%). Among mitragynine exposures, 484 (87.8%) died of DIRM; 36 decedents (6.5%) used kratom as the sole substance, and 515 (93%) used multiple substances; 437 (79.3%) used at least 1 opioid. The odds of dying of DIRM were 7.6 times higher among those mitragynine exposed compared with non-mitragynine exposed (univariate model) and 5.6 times higher after adjusting for confounders (multivariate model) (adjusted odds ratio = 5.6; 95% confidence interval, 4.1-7; P < 0.001). Opioid use increased the odds of dying of DIRM (adjusted odds ratio = 11.7; 95% confidence interval, 10.9-12.7; P < 0.001).

Conclusion: Our results indicate that dozens of decedents died of kratom (mitragynine) exposures alone, which has safety implications. Co-using opioids with kratom further increased the odds of dying of DIRM, indicating that kratom may not always work as a harm-reduction agent.

简介美国经年龄调整后的吸毒过量率上升了 298%,其中芬太尼是导致吸毒过量死亡的主要原因。尽管桔梗的使用越来越多,而且在用药过量死亡者中也发现了桔梗,但关于桔梗对用药过量或中毒的影响却鲜有报道:我们的横断面研究采用了佛罗里达州执法部门 2020-2021 年的去身份数据(N = 30,845)。法医通过尸检和毒理学结果确定了相关暴露(桔梗、阿片类药物和其他物质)以及药物中毒相关死亡率(DIRM)这一结果变量。药物中毒相关死亡率指的是任何被确定为药物毒性或药物中毒的物质导致的死亡。我们使用回归模型来研究暴露与 DIRM 的关系:结果:551 个病例被证实接触过克瑞托姆(mitragynine)。死于 DIRM 的男性较多(81.5%),主要是白人(95.1%)和 35-44 岁的男性(40.5%)。在米曲碱接触者中,有 484 人(87.8%)死于 DIRM;36 名死者(6.5%)只使用了一种药物,515 人(93%)使用了多种药物;437 人(79.3%)至少使用了一种阿片类药物。与未接触过二尖杉酯碱的人相比,接触过二尖杉酯碱的人死于 DIRM 的几率高出 7.6 倍(单变量模型),调整混杂因素后高出 5.6 倍(多变量模型)(调整后的几率比 = 5.6;95% 置信区间,4.1-7;P < 0.001)。使用阿片类药物会增加死于 DIRM 的几率(调整后的几率比 = 11.7;95% 置信区间,10.9-12.7;P < 0.001):我们的研究结果表明,数十名死者仅死于克拉托姆(mitragynine)暴露,这对安全性有一定影响。同时使用阿片类药物和 kratom 会进一步增加死于 DIRM 的几率,这表明 kratom 并不总能起到减少伤害的作用。
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引用次数: 0
The Impact of Telehealth on Buprenorphine Prescribing at a Large Federally Qualified Health Center during COVID-19. 在 COVID-19 期间,远程医疗对一家大型联邦合格医疗中心丁丙诺啡处方的影响。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-19 DOI: 10.1097/ADM.0000000000001397
Ann Winters, Eve Walter

Objectives: This study aims to explore the impact of telehealth on buprenorphine prescribing and retention in care for patients with opioid use disorder (OUD) seen at a large federally qualified health center (FQHC) the year prior to and following the start of the COVID-19 pandemic.

Methods: We conducted a retrospective study of patients with OUD and at least one medical visit to the FQHC between March 1, 2019, and February 28, 2021. This study utilized March 1, 2020, to delineate the beginning of COVID as the FQHC widely instituted telehealth during the month in response to the pandemic. We examined buprenorphine prescribing before and during year 1 of the pandemic; we applied logistic regression to estimate the association between telehealth and buprenorphine prescribing and we assessed buprenorphine retention through survival analysis.

Results: In the year before COVID, 24% of patients (502/2090) received buprenorphine compared with 31% (656/2110) during the first year of COVID (P < 0.01). Patients with at least one telehealth visit were three times more likely to receive buprenorphine compared to those without telehealth (odds ratio: 3.2, confidence interval: 2.1-5.0). Among those who received buprenorphine, those with at least one telehealth visit were retained in buprenorphine care longer (hazard ratio: 2.7, confidence interval: 1.8-3.9).

Conclusions: During the first year of COVID, telehealth was associated with increased likelihood that patients received buprenorphine; those who had telehealth remained in buprenorphine care longer compared to those who only had office-based visits. Increasing buprenorphine access through telehealth can play a significant role in retention in care for OUD.

研究目的本研究旨在探讨在 COVID-19 大流行开始的前一年和之后,远程医疗对在一家大型联邦合格医疗中心(FQHC)就诊的阿片类药物使用障碍(OUD)患者的丁丙诺啡处方和保留治疗的影响:我们对 OUD 患者进行了一项回顾性研究,这些患者在 2019 年 3 月 1 日至 2021 年 2 月 28 日期间至少在 FQHC 就诊过一次。本研究以 2020 年 3 月 1 日为 COVID 的起始日,因为 FQHC 为应对大流行在该月广泛开展了远程医疗。我们检查了大流行之前和第一年期间的丁丙诺啡处方情况;我们应用逻辑回归估算了远程保健与丁丙诺啡处方之间的关联,并通过生存分析评估了丁丙诺啡的保留情况:在 COVID 前一年,24% 的患者(502/2090)接受了丁丙诺啡治疗,而在 COVID 第一年,31% 的患者(656/2110)接受了丁丙诺啡治疗(P < 0.01)。至少接受过一次远程医疗的患者接受丁丙诺啡的几率是没有接受过远程医疗的患者的三倍(几率比:3.2,置信区间:2.1-5.0)。在接受丁丙诺啡治疗的患者中,至少接受过一次远程医疗就诊的患者接受丁丙诺啡治疗的时间更长(危险比:2.7,置信区间:1.8-3.9):结论:在 COVID 实施的第一年,远程医疗与患者接受丁丙诺啡治疗的可能性增加有关;与仅在诊室就诊的患者相比,接受远程医疗的患者接受丁丙诺啡治疗的时间更长。通过远程保健增加丁丙诺啡的使用机会,可在保留对 OUD 的护理方面发挥重要作用。
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引用次数: 0
Recommendations for the Design and Implementation of Alcohol Pharmacotherapy Trials: Perspectives of Women With HIV Participating in the WHAT-IF Study. 酒精药物治疗试验的设计和实施建议:参与 WHAT-IF 研究的女性艾滋病感染者的观点。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-19 DOI: 10.1097/ADM.0000000000001410
Rebecca J Fisk-Hoffman, Sashaun Ranger, Abigail Gracy, Nanyangwe Siuluta, Christina E Parisi, Isaac Payton, Robert L Cook, Shantrel Canidate

Objectives: Naltrexone for alcohol reduction has been poorly studied in women with HIV (WWH), for whom heavy alcohol use is associated with negative HIV outcomes. This study offers recommendations for researchers conducting alcohol pharmacotherapy trials among PWH as suggested by WWH who participated in an alcohol pharmacotherapy trial in Florida.

Methods: The WHAT-IF? Study enrolled WWH with a history of heavy alcohol use in Miami, Florida, into a clinical trial where participants were randomized to receive naltrexone or placebo to assess effectiveness among WWH. Twenty participants (mean age, 49 years; 85% Black/African American) completed interviews that included questions about barriers to participation and recommendations for future researchers and WWH. Interviews were analyzed using a reflexive thematic approach.

Results: We identified six recommendations: 1) increasing opportunities for study engagement, 2) fostering positive relationships to support change, 3) addressing medication concerns, 4) considering structural barriers to participation, 5) improving alcohol-related education, and 6) preventing fraudulent participation. Positive relationships included both study staff and external support. Medication concerns included cost, accessibility, and adherence. Structural barriers included transportation, substance use, and mental health conditions. Better education included information on the risks of alcohol use and encouraging women to quit. Overall, women reported having positive experiences in the WHAT-IF? trial, and many recommended that the study continue.

Conclusion: Future alcohol pharmacotherapy studies could consider these recommendations when working with women from underserved communities, including WWH. Additionally, these recommendations could be applied to increase alcohol pharmacotherapy uptake and adherence in clinical practice.

研究目的:纳曲酮对女性艾滋病病毒感染者(WWH)的减酒研究较少,而对她们来说,大量饮酒与艾滋病的不良后果相关。本研究根据参与佛罗里达州酒精药物治疗试验的女性艾滋病感染者的建议,为在女性艾滋病感染者中开展酒精药物治疗试验的研究人员提供建议:WHAT-IF?研究在佛罗里达州迈阿密市招募了有大量饮酒史的 WWH 参与临床试验,参与者被随机分配接受纳曲酮或安慰剂治疗,以评估在 WWH 中的有效性。20 名参与者(平均年龄 49 岁;85% 为黑人/非裔美国人)完成了访谈,访谈内容包括参与障碍问题以及对未来研究人员和 WWH 的建议。访谈采用反思性主题方法进行分析:我们提出了六项建议:1) 增加参与研究的机会;2) 培养积极的关系以支持变革;3) 解决用药问题;4) 考虑参与的结构性障碍;5) 改进酒精相关教育;6) 防止欺诈性参与。积极的关系包括研究人员和外部支持。药物问题包括成本、可及性和依从性。结构性障碍包括交通、药物使用和精神健康状况。更好的教育包括提供有关饮酒风险的信息和鼓励妇女戒酒。总体而言,妇女们在 WHAT-IF? 试验中获得了积极的体验,许多妇女建议继续开展这项研究:结论:未来的酒精药物治疗研究在与服务不足社区(包括 WWH)的妇女合作时,可以考虑这些建议。此外,这些建议还可应用于临床实践中,以提高酒精药物治疗的吸收率和依从性。
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引用次数: 0
Characterizing Individuals Who Elect and Decline Opioid Overdose Education and Naloxone Distribution to Tailor Programs and Expand Impact. 确定选择和拒绝阿片类药物过量教育和纳洛酮发放的个人特征,以调整计划并扩大影响。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-08 DOI: 10.1097/ADM.0000000000001407
Michelle L Sisson, Andres Azuero, Elizabeth Hawes, Keith R Chichester, Matthew J Carpenter, Michael S Businelle, Richard C Shelton, Karen L Cropsey

Background: In response to the opioid epidemic, federal agencies have stressed the importance of targeted naloxone distribution through avenues such as Opioid Overdose Education and Naloxone Distribution (OEND). OEND effectively reduces mortality by training laypersons to respond to overdose situations. Despite demonstrated effectiveness, OEND remains underutilized. This project aimed to characterize those who illicitly use opioids to determine avenues for future tailoring of OEND programs.

Methods: Individuals who illicitly used opioids within the past 6 months were recruited via online social media. Participants completed an online questionnaire that assessed history of opioid use and were given the option to receive opioid overdose and naloxone administration training. Those who elected training (n = 111) and those who declined (n = 193) were compared on opioid use, severity of use, and overdose experiences.

Results: Participants (N = 304) were 47% male and 83% White. Tests of between group differences with measures of effect size were used for analyses. Those who elected training endorsed greater intravenous administration (χ2 = 4.18, P = 0.041, Cramer's V = 0.12). Individuals who declined training reported more frequent nonprescribed methadone use (χ2 = 7.51, P = 0.006, Cramer's V = 0.16), overdose hospitalizations (t(298) = 2.13, P = 0.034, Cohen's d = 0.26), and observed overdoses (t(300) = 3.01, P = 0.003, Cohen's d = 0.36). After adjusting for multiple comparisons, only the differences in nonprescribed methadone use and observed overdoses remained statistically significant.

Conclusions: Individuals who declined training were more likely to report ever use of nonprescribed methadone and having witnessed others overdose. They may have had greater exposure to naloxone, hence decreasing perceived need for training. Understanding characteristics of those who elect and refuse training could inform structuring of programs and recruitment approaches.

背景:为应对阿片类药物的流行,联邦机构强调了通过阿片类药物过量教育和纳洛酮分发(OEND)等途径有针对性地分发纳洛酮的重要性。OEND 通过培训非专业人员应对用药过量情况,有效降低了死亡率。尽管效果显著,但 OEND 仍未得到充分利用。本项目旨在了解非法使用阿片类药物者的特征,以确定未来调整 OEND 项目的途径:方法:通过在线社交媒体招募在过去 6 个月内非法使用过阿片类药物的个人。参与者填写了一份评估阿片类药物使用史的在线问卷,并可选择接受阿片类药物过量和纳洛酮管理培训。对选择培训者(n = 111)和拒绝培训者(n = 193)进行了阿片类药物使用、使用严重程度和用药过量经历方面的比较:结果:参与者(N = 304)中 47% 为男性,83% 为白人。分析采用了组间差异检验和效应大小测量。选择接受培训的人认可更多的静脉注射(χ2 = 4.18,P = 0.041,Cramer's V = 0.12)。拒绝培训的人报告了更频繁的非处方美沙酮使用(χ2 = 7.51,P = 0.006,Cramer's V = 0.16)、用药过量住院(t(298) = 2.13,P = 0.034,Cohen's d = 0.26)和观察到的用药过量(t(300) = 3.01,P = 0.003,Cohen's d = 0.36)。经多重比较调整后,只有非处方美沙酮使用量和观察到的过量用药量的差异仍具有统计学意义:结论:拒绝接受培训的人更有可能报告曾经使用过无处方美沙酮和目睹过他人用药过量。他们可能接触过更多纳洛酮,因此对培训的需求减少。了解选择和拒绝培训者的特征可以为计划的构建和招募方法提供参考。
{"title":"Characterizing Individuals Who Elect and Decline Opioid Overdose Education and Naloxone Distribution to Tailor Programs and Expand Impact.","authors":"Michelle L Sisson, Andres Azuero, Elizabeth Hawes, Keith R Chichester, Matthew J Carpenter, Michael S Businelle, Richard C Shelton, Karen L Cropsey","doi":"10.1097/ADM.0000000000001407","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001407","url":null,"abstract":"<p><strong>Background: </strong>In response to the opioid epidemic, federal agencies have stressed the importance of targeted naloxone distribution through avenues such as Opioid Overdose Education and Naloxone Distribution (OEND). OEND effectively reduces mortality by training laypersons to respond to overdose situations. Despite demonstrated effectiveness, OEND remains underutilized. This project aimed to characterize those who illicitly use opioids to determine avenues for future tailoring of OEND programs.</p><p><strong>Methods: </strong>Individuals who illicitly used opioids within the past 6 months were recruited via online social media. Participants completed an online questionnaire that assessed history of opioid use and were given the option to receive opioid overdose and naloxone administration training. Those who elected training (n = 111) and those who declined (n = 193) were compared on opioid use, severity of use, and overdose experiences.</p><p><strong>Results: </strong>Participants (N = 304) were 47% male and 83% White. Tests of between group differences with measures of effect size were used for analyses. Those who elected training endorsed greater intravenous administration (χ2 = 4.18, P = 0.041, Cramer's V = 0.12). Individuals who declined training reported more frequent nonprescribed methadone use (χ2 = 7.51, P = 0.006, Cramer's V = 0.16), overdose hospitalizations (t(298) = 2.13, P = 0.034, Cohen's d = 0.26), and observed overdoses (t(300) = 3.01, P = 0.003, Cohen's d = 0.36). After adjusting for multiple comparisons, only the differences in nonprescribed methadone use and observed overdoses remained statistically significant.</p><p><strong>Conclusions: </strong>Individuals who declined training were more likely to report ever use of nonprescribed methadone and having witnessed others overdose. They may have had greater exposure to naloxone, hence decreasing perceived need for training. Understanding characteristics of those who elect and refuse training could inform structuring of programs and recruitment approaches.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604576","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
An Urgent Need to Promote Equitable Buprenorphine Administration for Opioid Use Disorder in the Emergency Department. 急需在急诊科推广平等的丁丙诺啡治疗阿片类药物使用障碍。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-08 DOI: 10.1097/ADM.0000000000001409
Edouard Coupet, E Jennifer Edelman

Abstract: In recent years, there has been a marked surge in opioid overdose deaths among Black, Latino, and Native American populations. The emergency department (ED) represents a crucial opportunity to address these racial and ethnic inequities by initiating buprenorphine and providing referral for ongoing addiction treatment. Yet Black, Latino, and Native American populations encounter substantial inequities in ED-based addiction treatment access. Within this context, Koeber et al conducted their cross-sectional study of ED patients who screened positive for opioid misuse to evaluate inequities in buprenorphine administration. The authors found that Black ED patients were less likely (odds ratio, 0.56; 95% confidence interval, 0.35-0.88) to receive buprenorphine. There is an urgent need for mixed methods research to understand the drivers of these inequities and interventions to address the multilevel factors across the opioid use disorder care continuum to promote equitable, accessible, person-centered opioid use disorder treatment.

摘要:近年来,黑人、拉丁裔和美国原住民中阿片类药物过量死亡的人数明显激增。急诊科(ED)是解决这些种族和民族不平等问题的一个重要机会,它可以启动丁丙诺啡并为持续的成瘾治疗提供转诊服务。然而,黑人、拉丁裔和美国原住民在获得基于急诊科的戒毒治疗方面遇到了严重的不平等。在此背景下,Koeber 等人对阿片类药物滥用筛查呈阳性的急诊室患者进行了横断面研究,以评估丁丙诺啡用药方面的不公平现象。作者发现,急诊室黑人患者接受丁丙诺啡治疗的可能性较低(几率比为 0.56;95% 置信区间为 0.35-0.88)。目前迫切需要开展混合方法研究,以了解造成这些不平等现象的原因,并采取干预措施来解决阿片类药物使用障碍治疗过程中的多层次因素,从而促进公平、可及、以人为本的阿片类药物使用障碍治疗。
{"title":"An Urgent Need to Promote Equitable Buprenorphine Administration for Opioid Use Disorder in the Emergency Department.","authors":"Edouard Coupet, E Jennifer Edelman","doi":"10.1097/ADM.0000000000001409","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001409","url":null,"abstract":"<p><strong>Abstract: </strong>In recent years, there has been a marked surge in opioid overdose deaths among Black, Latino, and Native American populations. The emergency department (ED) represents a crucial opportunity to address these racial and ethnic inequities by initiating buprenorphine and providing referral for ongoing addiction treatment. Yet Black, Latino, and Native American populations encounter substantial inequities in ED-based addiction treatment access. Within this context, Koeber et al conducted their cross-sectional study of ED patients who screened positive for opioid misuse to evaluate inequities in buprenorphine administration. The authors found that Black ED patients were less likely (odds ratio, 0.56; 95% confidence interval, 0.35-0.88) to receive buprenorphine. There is an urgent need for mixed methods research to understand the drivers of these inequities and interventions to address the multilevel factors across the opioid use disorder care continuum to promote equitable, accessible, person-centered opioid use disorder treatment.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604563","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
Xylazine Positivity in Opioid-Positive Drug Screens on an Inpatient Labor Unit. 住院产科阿片阳性药物筛查中的异丙嗪阳性反应。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-08 DOI: 10.1097/ADM.0000000000001396
Cassandra Trammel, Vahid Azimi, Bridgit Crews, Stephen Roper, Nandini Raghuraman, Ebony B Carter, Antonina Frolova, Anthony O Odibo, Megan Lawlor, Jeannie C Kelly

Objective: Untreated opioid use disorder (OUD) is associated with significant morbidity in pregnancy. Recent reports have highlighted the rise of xylazine in the nonprescribed fentanyl supply. The frequency with which pregnant people with OUD are exposed to xylazine has not been characterized. We sought to describe the rate of xylazine detection in urine drug screens (UDS) from pregnant people admitted to a labor unit.

Methods: We performed a cross sectional study of all UDS results from an inpatient obstetric unit at an urban tertiary care center from December 2022, when xylazine was added to the detection panel, through July 2023. We perform universal verbal drug screening, with subsequent urine drug screening only performed after a positive verbal screen and consent. The trend of opioid-positive urine drug screens also positive for xylazine from December to July was measured with the Cochran-Armitage test.

Results: Of 5662 people admitted to Labor and Delivery during the study period, 138 UDS were sent for 123 unique individuals. Ninety-eight (71%) of UDS were positive for nonprescribed substances. Of positive UDS, 36 (37%) were positive for nonprescribed opioids, and of these, 17 (47.2%) were positive for xylazine among 14 pregnant people. The trend of UDS positive for opioids that were also positive for xylazine increased significantly over time (P = 0.030), from 0% in December 2022 to 100% in July 2023.

Conclusions: Over 8 months, xylazine positivity significantly increased in UDSs positive for nonprescribed opioids in an urban Midwestern hospital. These results underscore the critical need to study the impact of xylazine on obstetric outcomes.

目的:未经治疗的阿片类药物使用障碍(OUD)与妊娠期的严重发病率有关。最近的报告强调,在非处方芬太尼供应中,异丙嗪的用量有所增加。患有阿片类药物滥用症的孕妇接触异丙嗪的频率尚无定论。我们试图描述在产科住院的孕妇尿液药物筛查(UDS)中检测到异丙嗪的比率:我们对一家城市三级医疗中心产科住院病人的所有 UDS 结果进行了横断面研究,研究时间为 2022 年 12 月,当时检测面板中加入了二甲苯嗪,研究时间为 2023 年 7 月。我们普遍进行口头药物筛查,只有在口头筛查呈阳性并征得同意后才进行后续的尿液药物筛查。用 Cochran-Armitage 检验法测量了从 12 月到 7 月阿片类药物阳性的尿液药物筛查结果与二甲嗪同时阳性的趋势:在研究期间,产科共接收了 5662 人,其中 123 人接受了 138 次尿液药物筛查。98份(71%)UDS对非处方药物呈阳性反应。在呈阳性的 UDS 中,有 36 份(37%)对非处方类阿片呈阳性反应,其中有 17 份(47.2%)对 14 名孕妇服用的甲苯噻嗪呈阳性反应。随着时间的推移,UDS 中阿片类药物阳性同时也是异丙嗪阳性的趋势显著增加(P = 0.030),从 2022 年 12 月的 0% 增加到 2023 年 7 月的 100%:在 8 个月的时间里,一家中西部城市医院的非处方阿片类药物 UDS 阳性患者中的异丙嗪阳性率明显增加。这些结果突显了研究异丙嗪对产科结果影响的迫切需要。
{"title":"Xylazine Positivity in Opioid-Positive Drug Screens on an Inpatient Labor Unit.","authors":"Cassandra Trammel, Vahid Azimi, Bridgit Crews, Stephen Roper, Nandini Raghuraman, Ebony B Carter, Antonina Frolova, Anthony O Odibo, Megan Lawlor, Jeannie C Kelly","doi":"10.1097/ADM.0000000000001396","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001396","url":null,"abstract":"<p><strong>Objective: </strong>Untreated opioid use disorder (OUD) is associated with significant morbidity in pregnancy. Recent reports have highlighted the rise of xylazine in the nonprescribed fentanyl supply. The frequency with which pregnant people with OUD are exposed to xylazine has not been characterized. We sought to describe the rate of xylazine detection in urine drug screens (UDS) from pregnant people admitted to a labor unit.</p><p><strong>Methods: </strong>We performed a cross sectional study of all UDS results from an inpatient obstetric unit at an urban tertiary care center from December 2022, when xylazine was added to the detection panel, through July 2023. We perform universal verbal drug screening, with subsequent urine drug screening only performed after a positive verbal screen and consent. The trend of opioid-positive urine drug screens also positive for xylazine from December to July was measured with the Cochran-Armitage test.</p><p><strong>Results: </strong>Of 5662 people admitted to Labor and Delivery during the study period, 138 UDS were sent for 123 unique individuals. Ninety-eight (71%) of UDS were positive for nonprescribed substances. Of positive UDS, 36 (37%) were positive for nonprescribed opioids, and of these, 17 (47.2%) were positive for xylazine among 14 pregnant people. The trend of UDS positive for opioids that were also positive for xylazine increased significantly over time (P = 0.030), from 0% in December 2022 to 100% in July 2023.</p><p><strong>Conclusions: </strong>Over 8 months, xylazine positivity significantly increased in UDSs positive for nonprescribed opioids in an urban Midwestern hospital. These results underscore the critical need to study the impact of xylazine on obstetric outcomes.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603724","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
Leveraging Implementation Factors and Policy to Improve the Effectiveness of Naloxone. 利用实施因素和政策提高纳洛酮的有效性。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-08 DOI: 10.1097/ADM.0000000000001406
Ashly E Jordan, Mary Brewster, Pamela Mund, Grace Hennessy, Chinazo O Cunningham

Abstract: More than 50 years of high-quality data demonstrate that naloxone is an efficacious and cost-effective overdose reversal agent. Intranasal naloxone is now available in the United States as an over-the-counter and generic medication for the first time since the start of the overdose crisis more than 20 years ago. As the overdose crisis continues to contribute to substantial loss of life, there is an historic opportunity for jurisdictions to expand equitable and sustained access to intranasal naloxone. Further, through simultaneously enacting and expanding effective Naloxone Access and Good Samaritan laws, and equitably implementing these laws, there is the potential to maximize the population-level effectiveness of naloxone to sustainably reduce overdose mortality.

摘要:50 多年的高质量数据表明,纳洛酮是一种有效且具有成本效益的用药过量逆转剂。自 20 多年前吸毒过量危机爆发以来,美国首次以非处方药和普通药的形式提供鼻内注射纳洛酮。由于用药过量危机继续造成大量人员伤亡,各辖区面临着扩大鼻内纳洛酮公平、持续获取途径的历史性机遇。此外,通过同时颁布和扩大有效的纳洛酮使用和好撒玛利亚人法律,并公平地实施这些法律,有可能最大限度地提高纳洛酮在人群中的有效性,从而持续降低用药过量死亡率。
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引用次数: 0
Systematic Review of Obstetric and Child Outcomes of Prenatal Exposure to Inhalants in the Context of a Use Disorder. 产前接触吸入剂导致使用障碍的产科和儿童结果的系统性回顾。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-08 DOI: 10.1097/ADM.0000000000001382
Emily Southida Kounlavong, Charles W Schauberger, Jamie L Conklin, Hendree E Jones

Objectives: Inhalants are often used for their psychoactive effects, producing feelings of euphoria. Inhalant and solvent use is a serious public health concern, yet little is known about their effects on perinatal, fetal, and child outcomes. The aim of our review is to evaluate the impact of inhalant use by pregnant people on maternal, fetal, neonatal, and early childhood outcomes.

Methods: A systematic review was conducted on March 1, 2023, in 6 databases using relevant keywords. Bias assessment was performed using JBI Critical Appraisal Tools. Studies were included if they described a prenatal exposure to an inhalant; focused on maternal, fetal, neonatal, or early childhood outcomes; and were published as peer-reviewed reports in English.

Results: The search yielded 1101 unique references with 22 studies meeting eligibility criteria and representing 205 pregnancies and 171 infants.The most common symptom of inhalant use reported in pregnant people was altered mentation, followed by renal tubular acidosis (RTA) reported with toluene use. Most common fetal outcomes included fetal growth restriction and preterm delivery (<37 weeks), while neonatal outcomes were withdrawal symptoms, such as jitteriness, trouble feeding, and dystonia. Child outcomes included developmental delays, including cognitive and speech impairments, and postnatal growth restriction, including microcephaly.

Conclusion: Perinatal, fetal, and child outcomes associated with inhalant use among pregnant individuals are largely based on case reports and series. Prospective studies are needed to better characterize these outcomes, reduce stigma, increase equitable access to treatment, and identify potential interventions to reduce use and potential harm.

目的:吸入剂通常会产生精神作用,使人产生兴奋感。吸入剂和溶剂的使用是一个严重的公共健康问题,但人们对其对围产期、胎儿和儿童结局的影响却知之甚少。我们的综述旨在评估孕妇使用吸入剂对孕产妇、胎儿、新生儿和儿童早期结局的影响:方法:2023 年 3 月 1 日,我们使用相关关键词在 6 个数据库中进行了系统综述。使用 JBI Critical Appraisal Tools 进行了偏倚评估。如果研究描述了产前接触吸入剂的情况;重点关注孕产妇、胎儿、新生儿或儿童早期的结果;并以同行评审报告的形式用英语发表,则纳入研究:据报道,孕妇使用吸入剂后最常见的症状是精神改变,其次是使用甲苯后出现肾小管酸中毒(RTA)。最常见的胎儿结局包括胎儿生长受限和早产(结论:胎儿生长受限和早产是最常见的胎儿结局):与孕妇使用吸入剂有关的围产期、胎儿和儿童结局主要基于病例报告和系列研究。需要进行前瞻性研究,以更好地确定这些结果的特征,减少耻辱感,增加公平获得治疗的机会,并确定减少使用和潜在危害的潜在干预措施。
{"title":"Systematic Review of Obstetric and Child Outcomes of Prenatal Exposure to Inhalants in the Context of a Use Disorder.","authors":"Emily Southida Kounlavong, Charles W Schauberger, Jamie L Conklin, Hendree E Jones","doi":"10.1097/ADM.0000000000001382","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001382","url":null,"abstract":"<p><strong>Objectives: </strong>Inhalants are often used for their psychoactive effects, producing feelings of euphoria. Inhalant and solvent use is a serious public health concern, yet little is known about their effects on perinatal, fetal, and child outcomes. The aim of our review is to evaluate the impact of inhalant use by pregnant people on maternal, fetal, neonatal, and early childhood outcomes.</p><p><strong>Methods: </strong>A systematic review was conducted on March 1, 2023, in 6 databases using relevant keywords. Bias assessment was performed using JBI Critical Appraisal Tools. Studies were included if they described a prenatal exposure to an inhalant; focused on maternal, fetal, neonatal, or early childhood outcomes; and were published as peer-reviewed reports in English.</p><p><strong>Results: </strong>The search yielded 1101 unique references with 22 studies meeting eligibility criteria and representing 205 pregnancies and 171 infants.The most common symptom of inhalant use reported in pregnant people was altered mentation, followed by renal tubular acidosis (RTA) reported with toluene use. Most common fetal outcomes included fetal growth restriction and preterm delivery (<37 weeks), while neonatal outcomes were withdrawal symptoms, such as jitteriness, trouble feeding, and dystonia. Child outcomes included developmental delays, including cognitive and speech impairments, and postnatal growth restriction, including microcephaly.</p><p><strong>Conclusion: </strong>Perinatal, fetal, and child outcomes associated with inhalant use among pregnant individuals are largely based on case reports and series. Prospective studies are needed to better characterize these outcomes, reduce stigma, increase equitable access to treatment, and identify potential interventions to reduce use and potential harm.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603518","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
Buprenorphine Administration and Prescribing at Emergency Departments: A National Analysis from 2014-2021. 急诊科的丁丙诺啡管理和处方:2014-2021 年全国分析。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-08 DOI: 10.1097/ADM.0000000000001402
Christine Ramdin, Tanner McGowan, Jeanmarie Perrone, Maryann Mazer-Amirshahi, Lewis S Nelson

Background: Emergency department (ED)-initiated buprenorphine provides a low barrier access point and safety net to mitigate opioid overdose risk and increase treatment engagement. We sought to describe trends and patterns of buprenorphine utilization from the ED using national data.

Methods: This is a retrospective review of the National Hospital Ambulatory Medical Care Survey between 2014 and 2021. Our primary outcomes were trends in ED buprenorphine utilization. We described patient demographics, visit characteristics, and conducted trend analyses. We utilized logistic regression to determine predictors of buprenorphine prescribing.

Results: Between 2014 and 2021, there were 341,875 ED visits in which buprenorphine was administered, with no change over time (P = 0.08). There were 392,031 visits where buprenorphine was prescribed at ED discharge, with an increase over time (P = 0.01). The largest rise in rate for discharge prescriptions occurred between 2019 and 2020 (37,737 [0.03%] visits vs 126,041 [0.10%]) (233% increase in rate, P < 0.0001).

Conclusions: Although there was an increase in buprenorphine prescribing at ED discharge, there was no increase in administration. The acceleration in prescribing between 2019 and 2020 suggests that the ED may have been a safety net for patients who lost access to addiction care during COVID-19. Future studies should explore reasons for disparities and barriers to buprenorphine utilization.

背景:急诊科(ED)启动的丁丙诺啡为降低阿片类药物过量风险和提高治疗参与度提供了一个低门槛的接入点和安全网。我们试图利用全国数据描述急诊科使用丁丙诺啡的趋势和模式:这是一项对 2014 年至 2021 年间全国医院非住院医疗护理调查的回顾性研究。我们的主要结果是急诊室丁丙诺啡使用的趋势。我们描述了患者的人口统计学特征、就诊特征,并进行了趋势分析。我们利用逻辑回归来确定丁丙诺啡处方的预测因素:2014 年至 2021 年期间,有 341875 次急诊就诊使用了丁丙诺啡,且随时间推移没有变化(P = 0.08)。有 392,031 人次在急诊室出院时开具了丁丙诺啡处方,且随时间推移有所增加(P = 0.01)。出院处方率的最大增幅出现在 2019 年至 2020 年期间(37737 [0.03%] 人次 vs 126041 [0.10%])(增幅为 233%,P < 0.0001):虽然急诊室出院时的丁丙诺啡处方量有所增加,但用药量并未增加。2019 年至 2020 年期间处方量的增加表明,对于在 COVID-19 期间失去成瘾治疗机会的患者来说,急诊室可能是一个安全网。未来的研究应探讨丁丙诺啡使用方面存在差异和障碍的原因。
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引用次数: 0
Promoting Race and Ethnic Diversity in a Hospital-Based Randomized Clinical Trial to Address Untreated Alcohol Use Disorder: Initial Lessons Learned. 在以医院为基础的随机临床试验中促进种族和民族多样性,以解决未经治疗的酒精使用障碍:初步经验教训。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-08 DOI: 10.1097/ADM.0000000000001400
E Jennifer Edelman, Tami Frankforter, Oscar F Rojas-Perez, Karen Ablondi, Carla Castro, Joanne Corvino, Isabel Garcia, Derrick M Gordon, Yudilyn Jaramillo, Natrina L Johnson, Ayana Jordan, Charla Nich, Manuel Paris, David Pagano, Melissa B Weimer, Emily C Williams, Brian D Kiluk

Objective: This study aimed to describe initial experiences and lessons learned conducting a trial focused on recruiting racially and ethnically diverse hospitalized patients with untreated alcohol use disorder (AUD).

Methods: The parent trial is comparing the effectiveness of strategies including Brief Negotiation Interview (BNI), facilitated initiation of medications for AUD, and computer-based training for cognitive behavioral therapy (CBT4CBT) on AUD treatment engagement post-hospitalization. Guided by the Framework for Reporting Adaptations and Modifications-Enhanced, we catalogued protocol changes and evaluated outcomes using study and electronic medical record data during the first 18 months of recruitment.

Results: Recipients: (1) Selected entry criterion to intentionally include individuals most likely impacted by structural racism, (2) developed multipronged recruitment approaches, and (3) selected bilingual, multicultural, and ethnically diverse research staff. Intervention: (1) Added scripts in the BNI to consider how cultural factors influence and how racism may impact, alcohol use, and AUD treatment engagement, (2) offered tablets as a compensation alternative with support for CBT4CBT initiation (as relevant), and (3) anticipate and troubleshoot internet access challenges. Setting: (1) Identified community-based AUD treatment options with Spanish-speaking services and (2) identified resources to address social determinants of health. Study: (1) Audited data to monitor whether diverse enrollment is occurring. Among n = 132 randomized as of March 1, 2024, 25% endorsed Black, 24% endorsed Latine, 58% endorsed White, 1% endorsed Indigenous, and 15% endorsed race not listed or declined to disclose. We observed no difference by race or ethnicity in recruitment or retention experiences.

Conclusions: Multilevel practices within a hospital-based AUD-focused trial can promote recruitment and retention of a racially and ethnically diverse sample.

目的:本研究旨在描述一项试验的初步经验和教训:本研究旨在介绍一项试验的初步经验和教训,该试验的重点是招募不同种族和族裔的未经治疗的酒精使用障碍(AUD)住院患者:该母体试验正在比较包括简短谈判访谈(BNI)、促进酒精使用障碍药物治疗启动和基于计算机的认知行为疗法培训(CBT4CBT)在内的各种策略对酒精使用障碍住院后治疗参与的有效性。在 "改编和修改报告框架-增强版 "的指导下,我们对方案修改进行了编目,并利用招募后前 18 个月的研究和电子病历数据对结果进行了评估:接受者(1) 选择了入选标准,有意将最有可能受到结构性种族主义影响的人纳入其中;(2) 制定了多管齐下的招募方法;(3) 选择了双语、多元文化和种族多样化的研究人员。干预措施:(1)在 BNI 中添加脚本,以考虑文化因素如何影响以及种族主义可能如何影响酒精使用和 AUD 治疗参与度,(2)提供药片作为补偿替代方案,并支持 CBT4CBT 启动(如相关),以及(3)预测互联网访问挑战并排除故障。环境:(1)确定了以社区为基础、提供西班牙语服务的 AUD 治疗方案;(2)确定了解决健康的社会决定因素的资源。研究:(1)审计数据,以监控是否有不同的注册情况。截至 2024 年 3 月 1 日,在 n = 132 名随机注册者中,25% 的人认可黑人,24% 的人认可拉丁人,58% 的人认可白人,1% 的人认可土著人,15% 的人认可未列出或拒绝披露的种族。我们观察到,不同种族或族裔在招募或留用经验方面没有差异:结论:在以医院为基础、以 AUD 为重点的试验中,多层次的实践可以促进种族和民族多元化样本的招募和保留。
{"title":"Promoting Race and Ethnic Diversity in a Hospital-Based Randomized Clinical Trial to Address Untreated Alcohol Use Disorder: Initial Lessons Learned.","authors":"E Jennifer Edelman, Tami Frankforter, Oscar F Rojas-Perez, Karen Ablondi, Carla Castro, Joanne Corvino, Isabel Garcia, Derrick M Gordon, Yudilyn Jaramillo, Natrina L Johnson, Ayana Jordan, Charla Nich, Manuel Paris, David Pagano, Melissa B Weimer, Emily C Williams, Brian D Kiluk","doi":"10.1097/ADM.0000000000001400","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001400","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to describe initial experiences and lessons learned conducting a trial focused on recruiting racially and ethnically diverse hospitalized patients with untreated alcohol use disorder (AUD).</p><p><strong>Methods: </strong>The parent trial is comparing the effectiveness of strategies including Brief Negotiation Interview (BNI), facilitated initiation of medications for AUD, and computer-based training for cognitive behavioral therapy (CBT4CBT) on AUD treatment engagement post-hospitalization. Guided by the Framework for Reporting Adaptations and Modifications-Enhanced, we catalogued protocol changes and evaluated outcomes using study and electronic medical record data during the first 18 months of recruitment.</p><p><strong>Results: </strong>Recipients: (1) Selected entry criterion to intentionally include individuals most likely impacted by structural racism, (2) developed multipronged recruitment approaches, and (3) selected bilingual, multicultural, and ethnically diverse research staff. Intervention: (1) Added scripts in the BNI to consider how cultural factors influence and how racism may impact, alcohol use, and AUD treatment engagement, (2) offered tablets as a compensation alternative with support for CBT4CBT initiation (as relevant), and (3) anticipate and troubleshoot internet access challenges. Setting: (1) Identified community-based AUD treatment options with Spanish-speaking services and (2) identified resources to address social determinants of health. Study: (1) Audited data to monitor whether diverse enrollment is occurring. Among n = 132 randomized as of March 1, 2024, 25% endorsed Black, 24% endorsed Latine, 58% endorsed White, 1% endorsed Indigenous, and 15% endorsed race not listed or declined to disclose. We observed no difference by race or ethnicity in recruitment or retention experiences.</p><p><strong>Conclusions: </strong>Multilevel practices within a hospital-based AUD-focused trial can promote recruitment and retention of a racially and ethnically diverse sample.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602069","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
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Journal of Addiction Medicine
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