Journal of Addiction Medicine最新文献

Background: Alternative models for methadone delivery outside of federal and state-regulated opioid treatment programs may improve access. We determined factors associated with clinician support for continuing office-based methadone.

Methods: We used data from the electronic Opioid Use Disorder Provider COVID-19 Survey conducted among X-waivered clinicians who were providing outpatient, longitudinal treatment of opioid use disorder (OUD) from July 2020 to August 2020. The outcome variable was selecting "The opportunity for patients to receive office-based methadone" when asked "Which pandemic-related policy changes or new policy changes would you like to be continued or started after the pandemic?" Using sequential multivariable logistic regression modeling, we estimated the association between clinician and practice characteristics and support for office-based methadone.

Results: Of 1900 respondents, 728 met the inclusion criteria. Twenty-eight percent indicated support for office-based methadone. Clinician characteristics associated with support for office-based methadone were being Black or African American versus White (adjusted odds ratio [AOR] [95% confidence interval (CI)], 2.88 [1.19-6.98]), having provided medications for OUD (MOUD) for >15 years versus ≤15 years (AOR [95% CI], 1.66 [1.02-2.68]), treating 51 to 100 patients with MOUD monthly versus <25 patients (AOR [95% CI], 1.79 [1.04-3.09]), providing methadone (AOR [95% CI], 1.71 [1.03-2.85]) versus not providing MOUD previously, and working in an academic medical center versus other settings (AOR [95% CI], 1.88 [1.11-3.16]).

Conclusions: A minority of surveyed X-waivered clinicians supported office-based methadone. Efforts to expand access to methadone via office-based settings should address implementation barriers.

Background: Questions remain on the relationship between pain and hepatitis C virus cure among persons who inject drugs (PWID). This study aimed to explore whether achieving hepatitis C virus cure reduced pain severity.

Methods: Prespecified secondary analysis utilized data from a pragmatic clinical trial of care delivery models that enrolled PWIDs between 2016 and 2018 and treated with sofosbuvir/velpatasvir. Current pain severity (0-100) was assessed before and after treatment and 5-point Likert pain scales were used to determine moderate or greater current pain at baseline; the duration and etiology of current pain were not assessed. We used generalized mixed-effects linear models to test whether achieving sustained virologic response (SVR), that is, cure, was associated with lower numeric pain scores (primary outcome) posttreatment, adjusting for potential confounders (age, sex, intervention assignment, time/visit, and baseline pain severity category) and to examine changes in pain over time. Adjusted means estimated from a fitted model for pain severity at each visit were compared between participants who did and did not achieve SVR, both for the sample overall and for the subsample of participants who reported moderate or greater pain at baseline.

Results: Of the 501 participants who were randomized, treated with DAAs and had SVR data, moderate or greater pain was reported at baseline in 174 (34.7%) of participants. Numeric pain severity did not significantly differ by SVR status at any study visit except for the week 48 visit from baseline, when the estimated pain score was significantly higher for those who failed treatment (38.0 vs 26.3, P = 0.033). Among the subsample with baseline moderate or greater pain, pain severity scores were significantly lower in subsequent visits compared to the baseline visit, with the exception of week 48 among participants who did not achieve SVR.

Conclusions: Among PWID, achieving SVR did not improve pain severity. However, participants who failed treatment had significantly greater pain at the visit immediately following visit for SVR, which may relate to adverse psychological effects of treatment failure. Among those with baseline moderate or greater pain, pain scores declined post treatment, suggesting that treatment itself (irrespective of SVR) may be associated with improved pain.

Objectives: Substance use disorder has been associated with increased morbidity in COVID-19 infection. However, less is known about the impact of active substance use and medications for opioid use disorder (MOUD) on COVID-19 outcomes. We conducted a retrospective cohort study to evaluate the impact of substance use, namely, cannabis, cocaine, alcohol, sedative and opioid use; and buprenorphine or methadone on COVID-19 morbidity and mortality.

Methods: Using electronic health record data at a large urban hospital system, patients who tested positive for COVID-19 between January 1, 2020, and December 31, 2021, were included. Substance use was identified from urine toxicology and MOUD prescriptions within 90 days prior to admission. COVID-19 outcomes included mortality, ICU admission, need for intubation, and number and duration of hospitalizations. Multivariable logistic regression was performed controlling for variables such as age, sex, medical comorbidity, tobacco use, and social disadvantage.

Results: Among COVID-19-positive patients (n = 17,423), sedative, cannabis, cocaine, and opioid use was associated with statistically significant increases in need for ICU care, need for ventilatory support, number of hospitalizations, and duration of hospitalization. Substance use was not associated with an increase in all-cause mortality. There were no statistically significant differences between methadone, buprenorphine, and other opioids on COVID-19 outcomes.

Conclusions: Active substance use was associated with increased morbidity in COVID-19 infection. MOUD was not associated with worse COVID-19 outcomes compared to other opioids. Future studies focused on MOUD treatments that reduce morbidity may help improve clinical outcomes in COVID-19.

Objectives: Adolescents are experiencing an increase in substance-related overdose fatalities, with most attributed to fentanyl and an increase in the prevalence of opioid use disorder (OUD). We know little about the characteristics of adolescents who use fentanyl, develop OUD, and seek addiction treatment. Here, we present demographic data and retention data on adolescent patients (≤18 years) who were treated at a pediatric addiction clinic.

Methods: We included all patients who presented to an intake appointment at the pediatric addiction clinic between January 3, 2023, and October 17, 2023, and were diagnosed with OUD. We collected data on demographics, decision to start medicine for OUD (MOUD), choice of MOUD, and retention in treatment based on clinic visits at 1 month and 3 months postintake.

Results: Patients are consisted of 24 adolescents (Mage at intake = 16.8 ± 1.0 years, 67% Hispanic/Latinx, 75% public insurance) who met the criteria for moderate to severe OUD with known fentanyl use. All were offered MOUD, and 21 patients agreed to MOUD treatment; 16 adolescents selected buprenorphine/naloxone, and 5 selected naltrexone. At 3 months postintake, 14 patients (58%) were retained in treatment.

Conclusions: Adolescent and family acceptance of MOUD treatment was high, and most patients were retained in treatment at 3 months postintake. More studies are needed to understand how to retain and support adolescent patients in outpatient treatment for OUD given the emergence of fentanyl.

Background: Although previous studies have reported the variables that influence opioid use or dropout among participants receiving methadone treatment, limited attention has been given to the variables related to transitions among no opioid use, opioid use, and dropout.

Methods: This retrospective study utilized data collected from June 2010 to June 2022 at 11 methadone treatment clinics in Guangdong Province, China. Two transient states (no opioid use and opioid use) and 1 absorbing state (dropout) were defined based on monthly urine morphine test results and daily methadone intake records. We used a multistate model to explore the variables associated with transitions among no opioid use, opioid use, and dropout among participants.

Results: Among 3136 participants, with an average treatment duration of 497 days, 1646 (52.49%) underwent at least 1 period of opioid use, resulting in 3283 transitions from no opioid use to opioid use. The transitions between no opioid use and opioid use were significantly associated with variables such as age, gender, employment status, marital status, living situation, travel time to the clinic, human immunodeficiency virus and hepatitis C virus infection statuses, average methadone dosage, and attendance rates. The variables influencing participants' dropout varied depending on their opioid use behaviors. Additionally, the probability of a specified opioid use state remaining unchanged or transitioning to a different state at a defined time point would change over time.

Conclusions: The opioid use behaviors of participants are dynamic. Methadone providers should offer targeted interventions based on participants' opioid use behaviors to effectively decrease rates of opioid use and improve retention.

Purpose: To assess both the short- and longer-term impact of offering medications for opioid use disorder (MOUD, ie, methadone, buprenorphine, or naltrexone) on rates of all-cause emergency department (ED) visits and acute inpatient admissions (IP) over a 30-month period among Medicaid enrollees with opioid use disorder (OUD) residing in rural communities.

Methods: A quasi-experimental retrospective analysis of longitudinal Medicaid claims data among continuously enrolled adult patients with OUD residing in 71 predominantly rural counties in the United States between 2018 and 2020. A cohort of patients receiving MOUD treatment was compared against a contemporaneous propensity score-matched comparison group consisting of those who received no MOUD during the period.

Findings: The sample included 5370 patients with OUD in each group. At the index period (ie, the month in which any MOUD was used for the first time), buprenorphine was the most commonly used MOUD (82% of the MOUD treatment group). By the eighth month since the index period, MOUD use dropped below 60% among the MOUD treatment group. Over the 30-month post-MOUD period, MOUD treatment was associated with 24% (112 vs 148 per 1000 per month) and 52% (21 vs 44) lower rates of ED visit and IP admission rates, respectively (P < 0.001), relative to the comparison group. Moreover, the reductions persisted well after the 18th month period.

Conclusions: Receipt of MOUD was associated with both immediate- and long-term lower rates in acute care utilization rates among adult Medicaid beneficiaries with OUD residing in rural communities despite significant treatment discontinuation.

Objectives: Xylazine is a rapidly spreading adulterant in the United States' drug supply and is increasingly associated with overdoses and severe wounds, but there is a dearth of information about the clinical presentation or means of treatment for human xylazine exposure. The objective of this study was to explore personal attitudes about xylazine in the drug supply and experiences with xylazine-related use among people who reported using drugs and contributed content to social media site Reddit.

Methods: To conduct a retrospective qualitative content analysis, the study team extracted all posts and comments from Reddit, which mentioned the terms "xylazine" or "tranq." Content was extracted from 10 Reddit forums, or subreddits, specific to drug use, and included content created on or before the extraction date of January 2023. In total, 3284 posts were identified and 1803 were qualitatively coded using an inductive approach until meaning saturation was reached.

Results: Three themes emerged across comments and posts: (1) personal experiences with xylazine, including a negative impact on overdose, withdrawal, and wounds; (2) behavior changes in response to xylazine in the drug supply, including devising and sharing new harm reduction and detection tips, and reducing or abstaining from drug use altogether; (3) a perceived lack of treatment options for xylazine withdrawal and information sharing to help others self-treat withdrawal symptoms, most often with clonidine.

Conclusions: This study of people who reported using drugs with xylazine provides new insights into how xylazine is perceived, possible treatment modalities, and potential clinical research approaches.

Background: Injectable extended-release buprenorphine (XR-Bup) addresses several barriers to the implementation of treatment with medications for opioid use disorder (MOUD) in carceral settings due to lower risk of diversion and reduced operational procedures. However, there is no standardized approach or guideline for initiating sublingual buprenorphine (SL-Bup) and transitioning to XR-Bup in persons with opioid use disorder (OUD) who are not actively using opioids, a clinical scenario commonly encountered in carceral settings.

Methods: We conducted a retrospective case series of non-opioid-tolerant men with OUD at a Montana Department of Corrections facility who initiated XR-Bup using a 5-day induction protocol between May 1, 2023, and November 1, 2023. Primary outcome was receipt of the initial XR-Bup injection. Secondary outcomes were toleration of SL-Bup induction protocol and active continuation of XR-Bup at time of discharge.

Results: Sixteen individuals initiated the SL-Bup induction protocol, and all were successfully transitioned to XR-Bup with no severe adverse effects. There were no required dose changes or severe adverse effects from SL-Bup induction. Two (12%) elected to discontinue XR-Bup due to commonly reported adverse effects. Fourteen (88%) remained on XR-Bup at discharge.

Conclusions: Five-day induction of SL-Bup and transition to XR-Bup may be considered for non-opioid-tolerant individuals with OUD in carceral settings.