Journal of Addiction Medicine最新文献

Background: People who inject drugs (PWID) are at increased risk for human immunodeficiency virus (HIV). Women who inject are a particularly vulnerable group. Preexposure prophylaxis (PrEP) is effective, but access and uptake has been limited. This study evaluated interest and concerns around oral and injectable PrEP among PWID based on gender.

Methods: This cross-sectional analysis of survey data from 8 sites in the United States (n = 284) assessed attitudes and interest in PrEP. Demographics, HIV risk behaviors, and attitudes toward PrEP were described overall and by self-identified gender (female vs male).

Results: Participants completed the PrEP survey between 2019 and 2021. The mean (standard deviation) age was 44.6 (11.4) years, 29% female, and 66% White. Mean self-perceived HIV risk score (0-10) was 2.3 (standard deviation 2.0). Interest in injectable PrEP (49.5%) was significantly higher than interest in daily oral PrEP (20.1%) (P ≤ 0.001). The most cited concerns were medication side effects (53%) and medication interactions (39.2%). Perceived HIV risk and PrEP concerns were not significantly different between genders.

Conclusions: There was high interest in injectable PrEP, particularly among females. The top concerns were medication side effects and medication interactions. These results suggest high acceptability of injectable PrEP among PWID. Future research could explore the advantages identified by female participants as well as implementation strategies for access and uptake among this vulnerable population.

Stimulant use disorder (StUD) is a rapidly growing concern in the United States, with escalating rates of death attributed to amphetamines and cocaine. No medications are currently approved for StUD treatment, leaving clinicians to navigate off-label medication options. Recent studies suggest that controlled prescription psychostimulants such as dextroamphetamine, methylphenidate, and modafinil are associated with reductions in self-reported stimulant use, craving, and depressive symptoms. Despite this positive initial evidence, prescribing rates of these medications for StUD treatment remain low, possibly because some clinicians believe that they are subject to the restrictions federal law imposes on medications for opioid use disorder. This is not the case. Rather, at the federal level, these medications are subject only to the general requirement that prescriptions be issued for a legitimate medical purpose within the usual course of professional practice, criteria that are buttressed by recent national guidelines that include controlled prescription psychostimulants as an option within a comprehensive treatment plan for StUD. In this commentary, we review the federal legal landscape regarding the prescription of psychostimulants for StUD and recommend strategies for increasing the utilization of this promising approach. Professional organizations, addiction clinicians, and researchers can reinforce this practice through publishing expert recommendations, developing clinician education materials, and disseminating their real-world experiences and well-documented treatment plans.

Objectives: Stigma is known to be a major barrier to treatment for people who use drugs (PWUD). This study uses the Stigma and Health Discrimination Framework to analyze how different forms of stigma shape experiences in the wake of an overdose incident, and perceptions of the efficacy and utility of postoverdose interventions among a sample of PWUD in Dayton, Ohio-a location with a high overdose rate.

Methods: Interviews were conducted with 23 individuals who self-reported past-month illicit opioid, crack/cocaine, or methamphetamine use who had experienced or witnessed a drug overdose in the past 6 months. Interviews were recorded, transcribed, and thematically analyzed using Taguette software.

Results: Discrete forms of stigma were identified as barriers to postoverdose interventions intended to link PWUD with support and services to help them access treatment. Individuals identified experiences of enacted stigma through medical mistreatment, exploitation, and judgment. They identified anticipated stigma through mistrust and unsustainable treatment. Internalized stigma was identified through the effect of loss on mental health, feeling "stuck," and the role of race on support-seeking behaviors. Experiences of structural stigma included desensitization of addiction as a disease and lack of feasible, long-term treatment options.

Conclusions: The results suggest that enacted, anticipated, internalized, and structural forms of stigma act as barriers to the efficacy of postoverdose outreach programs, and the initiation and sustainability of treatment. Understanding how each form of stigma adversely impacts PWUD can improve public health and clinical interventions to reduce stigma and overdose death.

Abstract: The decriminalization of tetrahydrocannabinol (THC)-containing products has resulted in an increased presence of these products in households. This increased presence, along with frequent use of product packaging that mimics recognizable and appealing treats, has led to a rise in accidental ingestions of THC-containing substances by children. Some clinicians and child protective services (CPS) professionals have recommended that every accidental THC ingestion by a child, irrespective of the circumstances, should be reported for investigation by CPS. We argue that this recommendation has the potential to waste scarce resources, harm families, and worsen current inequities in CPS reporting. We offer an alternative framework to this blanket recommendation that clinicians can employ when providing care to a child who has ingested THC.

Objectives: This study explores trends in buprenorphine availability at substance use disorder treatment facilities (SUDTFs) and by waivered clinicians during the pandemic. We also examined whether there were differences in access based on a county's metropolitan status and annual fatal drug poisoning rate.

Methods: Data from the Substance Abuse and Mental Health Services Administration' Behavioral Health Treatment Locator between July 2019 and May 2021 were used to calculate trends in SUDTFs offering buprenorphine and the number of waivered clinicians per 10,000 population. We calculated unadjusted trends over time, stratified by whether a county was above or below the annual median age-adjusted fatal drug overdose rate in that year and the county's metropolitan status.

Results: Results showed an increase in SUDTFs and waivered clinicians offering buprenorphine before the pandemic, but the rate leveled off during the pandemic. On average, the increase in facilities was about 8 percentage points per year, and the increase in waivered clinicians was 0.29 per year. The percentage of SUDTFs offering buprenorphine peaked at 47%, and the number of waivered clinicians leveled off at 1.61 per 10,000 population.There were more SUDTFs and clinicians offering buprenorphine in metropolitan versus nonmetropolitan counties. There were also more SUDTFs and clinicians offering buprenorphine in counties above versus below median poisoning rates.

Conclusions: This study provides insights into how buprenorphine availability changed during the COVID-19 pandemic and before the removal of the X-waiver in 2023. More outreach will be needed to encourage the offering of buprenorphine by SUDTFs and office-based clinicians.

Objective: The aim of the study was to examine the relationship between opioid use disorder (OUD)-related service trajectories during pregnancy and postpartum emergency department (ED) and hospitalizations.

Methods: We used the Merative MarketScan Commercial Claims and Encounters Database (2013-2021) to identify a cohort of pregnant individuals with OUD. We used group-based multitrajectory modeling to identify opioid-related treatment and service trajectories during pregnancy and examined their association with postpartum ED and hospital utilization.

Results: Seven opioid-related treatment and service trajectories were identified in our cohort of 2,531 pregnant individuals with OUD. Compared to individuals initiating medications for OUD (MOUD) halfway through pregnancy but maintaining high adherence without ancillary services, those receiving only services throughout pregnancy had a higher risk of postpartum ED visits (HRED = 1.34). This latter group also faced significantly higher risks of postpartum hospitalizations, compared to adherent MOUD use (proportion of days covered ≥80%) alone, both throughout or in the latter half of pregnancy (HRHOS = 1.93; HRHOS = 1.60), and patients without MOUD or services (HRHOS = 1.43). Individuals initiating MOUD late in pregnancy with poor adherence and infrequent service use faced significantly higher risks of postdelivery hospitalization compared to consistent MOUD users throughout pregnancy (HRHOS = 2.33), or in the latter half, with or without services (HRHOS = 2.02; HRHOS = 1.93), and those not receiving MOUD or services (HRHOS = 1.73).

Conclusions: Adherent MOUD use either throughout pregnancy or the latter half of pregnancy, irrespective of other service use, was associated with better postpartum outcomes defined by fewer ED visits and hospitalizations.

Abstract: Buprenorphine has superior safety in opioid use disorder compared with alternatives due to its action as a partial opioid agonist, which limits its ability to cause respiratory depression. There is a risk of precipitated opioid withdrawal after buprenorphine exposure in someone using full opioid agonists. Buprenorphine induction strategies that avoid precipitated withdrawal remain a crucial component for starting buprenorphine in individuals actively using opioids. These strategies start with low doses of buprenorphine increasing over time, which may avoid precipitated withdrawal at the cost of an extended initiation period, potentially discouraging patients and increasing healthcare costs.A 55-year-old male with severe opioid use disorder and unregulated fentanyl use presented after an overdose, was admitted due to a cerebral venous sinus thrombosis and anemia (hemoglobin of 4.4 g/dL), and was given 300 mg of buprenorphine injection depot subcutaneously without any prior buprenorphine stabilization. Prior to injection, he was taking 30 mg of methadone and 96 mg of oral hydromorphone equivalents daily. Over the 6 hours after injection, he received another 272 mg oral hydromorphone equivalents and experienced a maximum Clinical Opiate Withdrawal Scale score of 7. Over the next 18 hours, he received no additional hydromorphone, and his Clinical Opiate Withdrawal Scale was a maximum of 1.This case illustrates a buprenorphine induction method without precipitated withdrawal by relying on the elution of buprenorphine from the subcutaneous depot alongside full agonist opioids that are given as needed. If these results are readily replicable, this approach may have significant implications for the accessibility and acceptability of buprenorphine for patients and providers.

Objectives: Sudden unexpected infant death (SUID) occurs disproportionately among opioid exposed newborns (OENs) compared to those unexposed. The extent that primary caregivers of OENs adhere to SUID-reducing infant care practices is unknown. We examined rates of SUID-reducing practices (smoking cessation, breastfeeding, and safe sleep [supine sleep, room-sharing not bed-sharing, nonuse of soft bedding or objects]) in a pilot sample of caregivers of OENs.

Methods: We surveyed 50 English-speaking mothers and other primary caregivers of OENs 1-6 months old between 02/2022 and 10/2023. We examined prenatal and postnatal cigarette smoking exposure, breastfeeding initiation and duration, and sleep position (side, back, or stomach), sleep location (bed-sharing, room-sharing not bed-sharing, or separate room), and soft bedding or objects in the infant sleep space.

Results: Thirty-six (72%) of 50 respondents were birth mothers and 14/50 (28%) were other caregivers. Sixty-one percent of infants were exposed to cigarette smoking prenatally (mothers only) and 34% postnatally (41% mothers vs 14% other caregivers). Sixty percent of infants received breast milk ≤4 weeks. Among respondents, 32% placed infants in nonsupine sleep position (36% mothers vs 21% other caregivers), 38% shared a bed with their infant for sleep (47% mothers vs 14% other caregivers), and 30% used soft bedding in the infant sleep space (33% among mothers vs 21% among other caregivers).

Conclusions: Infant care practices associated with SUID were highly prevalent in our pilot sample of OENs and differed among mothers versus other caregivers. Further investigation and tailored approaches to this population are needed.