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Contemporary Management and Outcomes of Veterans Hospitalized With Alcohol Withdrawal: A Multicenter Retrospective Cohort Study. 因酗酒而住院的退伍军人的现代管理和疗效:多中心回顾性队列研究。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-03-06 DOI: 10.1097/ADM.0000000000001297
Matthew V Ronan, Kirsha S Gordon, Melissa Skanderson, Michael Krug, Patrick Godwin, Daniel Heppe, Matthew Hoegh, Joel C Boggan, Jeydith Gutierrez, Peter Kaboli, Micah Pescetto, Michelle Guidry, Peter Caldwell, Christine Mitchell, Erik Ehlers, Nazima Allaudeen, Jessica Cyr, Andrea Smeraglio, Peter Yarbrough, Richard Rose, Anand Jagannath, Jaclyn Vargas, Paul B Cornia, Meghna Shah, Matthew Tuck, Cherinne Arundel, James Laudate, Joel Elzweig, Benjamin Rodwin, Joyce Akwe, Meredith Trubitt, Craig G Gunderson

Objectives: Few studies describe contemporary alcohol withdrawal management in hospitalized settings or review current practices considering the guidelines by the American Society of Addiction Medicine (ASAM).

Methods: We conducted a retrospective cohort study of patients hospitalized with alcohol withdrawal on medical or surgical wards in 19 Veteran Health Administration (VHA) hospitals between October 1, 2018, and September 30, 2019. Demographic and comorbidity data were obtained from the Veteran Health Administration Corporate Data Warehouse. Inpatient management and hospital outcomes were obtained by chart review. Factors associated with treatment duration and complicated withdrawal were examined.

Results: Of the 594 patients included in this study, 51% were managed with symptom-triggered therapy alone, 26% with fixed dose plus symptom-triggered therapy, 10% with front loading regimens plus symptom-triggered therapy, and 3% with fixed dose alone. The most common medication given was lorazepam (87%) followed by chlordiazepoxide (33%), diazepam (14%), and phenobarbital (6%). Symptom-triggered therapy alone (relative risk [RR], 0.68; 95% confidence interval [CI], 0.57-0.80) and front loading with symptom-triggered therapy (RR, 0.75; 95% CI, 0.62-0.92) were associated with reduced treatment duration. Lorazepam (RR, 1.20; 95% CI, 1.02-1.41) and phenobarbital (RR, 1.28; 95% CI, 1.06-1.54) were associated with increased treatment duration. Lorazepam (adjusted odds ratio, 4.30; 95% CI, 1.05-17.63) and phenobarbital (adjusted odds ratio, 6.51; 95% CI, 2.08-20.40) were also associated with complicated withdrawal.

Conclusions: Overall, our results support guidelines by the ASAM to manage patients with long-acting benzodiazepines using symptom-triggered therapy. Health care systems that are using shorter acting benzodiazepines and fixed-dose regimens should consider updating alcohol withdrawal management pathways to follow ASAM recommendations.

目标:很少有研究描述住院环境中的当代戒酒管理,也很少有研究根据美国成瘾医学会(ASAM)的指导方针对当前的做法进行回顾:很少有研究描述住院环境中的当代酒精戒断管理,也很少有研究根据美国成瘾医学会(ASAM)的指南回顾当前的实践:我们对 2018 年 10 月 1 日至 2019 年 9 月 30 日期间在 19 家退伍军人健康管理局(VHA)医院内科或外科病房住院的酒精戒断患者进行了一项回顾性队列研究。人口统计学和合并症数据来自退伍军人健康管理局企业数据仓库。住院管理和住院结果通过病历审查获得。研究了与治疗持续时间和复杂停药相关的因素:在纳入本研究的 594 名患者中,51% 的患者仅接受了症状触发疗法,26% 的患者接受了固定剂量加症状触发疗法,10% 的患者接受了前负荷疗法加症状触发疗法,3% 的患者仅接受了固定剂量疗法。最常用的药物是劳拉西泮(87%),其次是氯氮卓(33%)、地西泮(14%)和苯巴比妥(6%)。单纯症状触发疗法(相对风险 [RR],0.68;95% 置信区间 [CI],0.57-0.80)和前负荷与症状触发疗法(RR,0.75;95% 置信区间 [CI],0.62-0.92)与治疗时间缩短有关。劳拉西泮(RR,1.20;95% CI,1.02-1.41)和苯巴比妥(RR,1.28;95% CI,1.06-1.54)与治疗时间延长有关。劳拉西泮(调整后的几率比为4.30;95% CI为1.05-17.63)和苯巴比妥(调整后的几率比为6.51;95% CI为2.08-20.40)也与复杂的戒断有关:总体而言,我们的研究结果支持美国医学会的指导方针,即使用症状触发疗法来管理使用长效苯二氮卓类药物的患者。使用短效苯二氮卓类药物和固定剂量方案的医疗系统应考虑更新酒精戒断管理路径,以遵循 ASAM 的建议。
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引用次数: 0
Z-Drug Use and Benzodiazepine Use and Misuse Among LGB Populations: The Role of Psychological Distress. 女同性恋、男同性恋、双性恋和变性者群体中 Z 类药物的使用和苯并二氮杂卓的使用与滥用:心理压力的作用。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-03-29 DOI: 10.1097/ADM.0000000000001309
Vitor S Tardelli, Thiago M Fidalgo, Silvia S Martins

Background: Z-drugs (hypnotics such as zolpidem, zopiclone, and zaleplon) and benzodiazepines (BZDs) are sedative medications with misuse liability. The goals of this study are to report the (1) prevalence of past-year any Z-drug use, any BZD use, and any BZD misuse by sexual identity category and psychological distress; (2) associations among these 3 categories between sexual identity and past-year psychological distress; (3) associations among these 3 categories with sexual identity by past-year psychological distress status.

Methods: Data were collected from the National Survey on Drug Use and Health (years 2015-2019 [n = 210,392]), a yearly representative national household survey of the American population. We report prevalences of any Z-drug use, any BZD use, and any BZD misuse by sexual identity and past-year psychological distress status. We ran logistic regressions with complex survey design with the 3 dichotomous variables described above as the dependent variables, stratified and not-stratified by psychological distress.

Results: Prevalence of any Z-drug an BZD use and any BZD misuse were higher among LGB (lesbian/gay/bisexual) populations, especially gay men and bisexual women. Psychological distress was positively associated with any Z-drug and BZD use and any BZD misuse. Women were at higher risk of Z-drug (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.18-1.37) and BZD use (OR, 1.64; 95% CI, 1.55-1.73), but lower risk of BZD misuse (OR, 0.82; 95% CI, 0.76-0.88). When stratifying by psychological distress, differences between LGB and heterosexuals were more pronounced among those without past-year psychological distress, especially gay men and bisexual women.

Conclusions: The presence of psychological distress attenuates the disparities between LGB and heterosexual individuals in Z-drug use and BZD use and misuse.

背景:Z类药物(唑吡坦、佐匹克隆和扎来普隆等催眠药)和苯二氮卓类药物(BZD)是有滥用风险的镇静药物。本研究的目的是报告:(1) 按性身份类别和心理困扰分类,过去一年中使用任何 Z 类药物、使用任何 BZD 和滥用任何 BZD 的流行率;(2) 性身份与过去一年心理困扰之间这 3 个类别的关联;(3) 按过去一年心理困扰状况分类,这 3 个类别与性身份之间的关联:数据收集自全国药物使用和健康调查(2015-2019 年 [n = 210,392] ),这是一项针对美国人口的年度代表性全国家庭调查。我们按性身份和过去一年的心理困扰状况报告了任何 Z 类药物使用、任何 BZD 使用和任何 BZD 滥用的流行率。我们采用复杂的调查设计,以上述 3 个二分变量为因变量,按心理困扰进行分层和非分层,进行了逻辑回归:结果:在 LGB(女同性恋/男同性恋/双性恋)人群中,尤其是男同性恋和双性恋女性中,任何 Z 类药物和 BZD 的使用率以及任何 BZD 的滥用率都较高。心理困扰与使用 Z-药物和 BZD 以及滥用 BZD 呈正相关。女性使用 Z-drug(赔率 [OR],1.27;95% 置信区间 [CI],1.18-1.37)和 BZD(赔率,1.64;95% 置信区间 [CI],1.55-1.73)的风险较高,但滥用 BZD 的风险较低(赔率,0.82;95% 置信区间 [CI],0.76-0.88)。根据心理困扰进行分层时,过去一年没有心理困扰的男女同性恋者和异性恋者之间的差异更为明显,尤其是男同性恋者和双性恋女性:结论:心理困扰的存在缩小了男女同性恋、双性恋和变性者与异性恋之间在使用 Z 药物和 BZD 以及滥用 BZD 方面的差异。
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引用次数: 0
High-Dose Buprenorphine Initiation: A Scoping Review. 大剂量丁丙诺啡的启动:范围审查。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-05-16 DOI: 10.1097/ADM.0000000000001296
Stanley Wong, Nicholas Fabiano, Declan Webber, Robert A Kleinman

Objective: The aim of the study is to review and synthesize the literature on high-dose buprenorphine initiation (>12-mg total dose on day of initiation).

Methods: A scoping review of literature about high-dose buprenorphine initiation was conducted. MEDLINE, Embase, PsycINFO, and Cochrane Central were searched. Randomized controlled trials, prospective and retrospective cohort studies, and case studies/reports published in English before February 13, 2023, were included.

Results: Fifteen studies reporting outcomes from 580 high-dose buprenorphine initiations were included. Eight studies were in inpatient settings, 3 in emergency departments, 3 in outpatient settings, and 1 in a first-responder setting. Four studies reported high-dose initiations among individuals exposed to fentanyl. There were no reported events of fatal or nonfatal overdose or respiratory depression, although adverse event reporting was inconsistent in published reports. The most reported side effects with high-dose buprenorphine initiation were nausea or vomiting (n = 17) and precipitated withdrawal (n = 7). The most serious reported adverse event was hypotension requiring oral hydration (n = 2). Most studies reported improvements in subjective or objective withdrawal symptoms. The duration of follow-up ranged from none to 8 months.

Conclusions: High-dose buprenorphine initiation has not been associated with reported cases of overdose or respiratory depression. However, the current literature about high-dose buprenorphine is limited by inconsistent side effect reporting, limited power to detect rare safety events such as respiratory depression, limited follow-up data, and few comparison studies between high-dose and regular initiation protocols. Further prospective data are needed to evaluate the safety and effectiveness of this initiation strategy.

研究目的本研究旨在回顾和总结有关大剂量丁丙诺啡起始治疗(起始治疗当天总剂量大于 12 毫克)的文献:方法: 对有关大剂量丁丙诺啡起始治疗的文献进行了范围界定审查。检索了 MEDLINE、Embase、PsycINFO 和 Cochrane Central。纳入了 2023 年 2 月 13 日之前用英语发表的随机对照试验、前瞻性和回顾性队列研究以及病例研究/报告:结果:共纳入了 15 项研究,报告了 580 例开始使用大剂量丁丙诺啡的结果。其中 8 项研究在住院环境中进行,3 项在急诊室进行,3 项在门诊环境中进行,1 项在第一反应环境中进行。四项研究报告了暴露于芬太尼的患者开始使用大剂量丁丙诺啡的情况。尽管不良事件报告在已发表的报告中并不一致,但没有关于致命或非致命过量或呼吸抑制事件的报告。报告最多的大剂量丁丙诺啡副作用是恶心或呕吐(17 例)和骤停(7 例)。最严重的不良反应是低血压,需要口服补液(2 例)。大多数研究报告了主观或客观戒断症状的改善情况。随访时间从零到 8 个月不等:结论:开始使用大剂量丁丙诺啡时,并没有出现用药过量或呼吸抑制的报道。然而,目前有关大剂量丁丙诺啡的文献受到以下因素的限制:副作用报告不一致;检测呼吸抑制等罕见安全事件的能力有限;随访数据有限;大剂量和常规启动方案之间的比较研究很少。需要进一步的前瞻性数据来评估这种起始策略的安全性和有效性。
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引用次数: 0
High Hepatitis C Cure Rates Among Patients With Alcohol Use at a Safety-Net Hepatitis C Clinic. 在一家安全网丙型肝炎诊所就诊的酗酒患者中,丙型肝炎治愈率较高。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-03-26 DOI: 10.1097/ADM.0000000000001307
Erica Heiman, Meghan Alexander, Rebecca Zhang, Ziduo Zheng, Lesley S Miller

Objectives: We set out to examine several aspects of the relationship between alcohol use and hepatitis C virus (HCV) among a cohort of patients treated at an HCV clinic within a safety net hospital. We examined (1) the prevalence of alcohol use among patients treated for HCV, (2) the likelihood of being started on treatment among patients who reported drinking alcohol compared with those who did not, and (3) the associations between alcohol use and HCV cure.

Methods: We performed a retrospective chart abstraction study using data from the Grady Liver Clinic, a specialty HCV clinic colocated in Grady Memorial Hospital's primary care clinic and run by general internists.

Results: Nine hundred fifty-four patients were included. The sustained virologic response rate among those with 12-week posttreatment measurement was 99.2%, with only 5 patients experiencing virologic failure. None of the alcohol use indicators significantly impacted sustained virologic response or loss to follow-up. Estimates of alcohol use ranged from 28.9% (by International Classification of Diseases, Tenth Revision , code) to 48.9% (clinician documentation). Treatment initiation rates were the same among those who did and did not report alcohol use.

Conclusions: Alcohol use was not associated with decreased HCV cure rates. Our findings validate the inclusion of patients with alcohol use in HCV treatment programs.

研究目的我们研究了在一家安全网医院的 HCV 诊所接受治疗的一组患者中饮酒与丙型肝炎病毒(HCV)之间关系的几个方面。我们研究了(1)接受 HCV 治疗的患者中饮酒的流行率;(2)与不饮酒的患者相比,饮酒的患者开始接受治疗的可能性;以及(3)饮酒与 HCV 治愈之间的关系:我们利用格雷迪肝病门诊的数据进行了一项回顾性病历摘要研究,格雷迪肝病门诊是设在格雷迪纪念医院初级保健门诊内的一家 HCV 专科门诊,由普通内科医生负责管理:研究共纳入 954 名患者。治疗后 12 周的持续病毒学应答率为 99.2%,仅有 5 名患者出现病毒学失败。酗酒指标均未对持续病毒学应答或随访失败产生重大影响。估计的饮酒率从 28.9%(按国际疾病分类第十版编码)到 48.9%(临床医生记录)不等。在报告和未报告饮酒的人群中,开始治疗的比例相同:酗酒与 HCV 治愈率下降无关。我们的研究结果验证了将酗酒患者纳入 HCV 治疗项目的可行性。
{"title":"High Hepatitis C Cure Rates Among Patients With Alcohol Use at a Safety-Net Hepatitis C Clinic.","authors":"Erica Heiman, Meghan Alexander, Rebecca Zhang, Ziduo Zheng, Lesley S Miller","doi":"10.1097/ADM.0000000000001307","DOIUrl":"10.1097/ADM.0000000000001307","url":null,"abstract":"<p><strong>Objectives: </strong>We set out to examine several aspects of the relationship between alcohol use and hepatitis C virus (HCV) among a cohort of patients treated at an HCV clinic within a safety net hospital. We examined (1) the prevalence of alcohol use among patients treated for HCV, (2) the likelihood of being started on treatment among patients who reported drinking alcohol compared with those who did not, and (3) the associations between alcohol use and HCV cure.</p><p><strong>Methods: </strong>We performed a retrospective chart abstraction study using data from the Grady Liver Clinic, a specialty HCV clinic colocated in Grady Memorial Hospital's primary care clinic and run by general internists.</p><p><strong>Results: </strong>Nine hundred fifty-four patients were included. The sustained virologic response rate among those with 12-week posttreatment measurement was 99.2%, with only 5 patients experiencing virologic failure. None of the alcohol use indicators significantly impacted sustained virologic response or loss to follow-up. Estimates of alcohol use ranged from 28.9% (by International Classification of Diseases, Tenth Revision , code) to 48.9% (clinician documentation). Treatment initiation rates were the same among those who did and did not report alcohol use.</p><p><strong>Conclusions: </strong>Alcohol use was not associated with decreased HCV cure rates. Our findings validate the inclusion of patients with alcohol use in HCV treatment programs.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"463-465"},"PeriodicalIF":4.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140293496","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
Piloting a Hospital-Based Rapid Methadone Initiation Protocol for Fentanyl. 在医院试行快速美沙酮芬太尼启动方案。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-06-03 DOI: 10.1097/ADM.0000000000001324
Patricia Liu, Brian Chan, Eleasa Sokolski, Alisa Patten, Honora Englander

Objectives: Treating acute opioid withdrawal and offering medications for opioid use disorder (OUD) is critical. Hospitalization offers a unique opportunity to rapidly initiate methadone for OUD; however, little clinical guidance exists. This report describes our experience during the first 9 months following introduction of a hospital-based rapid methadone initiation protocol.

Methods: We conducted a retrospective chart review of hospitalized patients with OUD seen by our interprofessional addiction medicine consult service at an urban academic center between December 2022 and August 2023. We identified patients who initiated methadone using the rapid methadone initiation protocol, which includes dose recommendations (maximum 60 mg day 1, 70 mg day 2, 80 mg day 3, 100 mg days 4-7) and strict inclusion and exclusion criteria (end organ failure, arrhythmia, concurrent benzodiazepine or alcohol use, age >65).

Results: There were 171 patients that received methadone for OUD during the study period. Of those, 25 patients (15%) received rapid methadone initiation. The average total daily dose of methadone on days 1-7 was 53.0 mg, 69.2 mg, 75.4 mg, 79.5 mg, 87.1 mg, 92.2 mg, and 96.6 mg, respectively. There were no adverse events requiring holding a dose of scheduled methadone, naloxone administration, or transfer to higher level of care.

Conclusions: A rapid methadone initiation protocol for OUD can be implemented in the inpatient setting. Patients up-titrated their methadone doses quicker than with traditional induction methods, and there were no serious adverse events. Appropriate patient selection may be important to avoid harms.

目标:治疗阿片类药物急性戒断和提供治疗阿片类药物使用障碍(OUD)的药物至关重要。住院治疗为快速启动美沙酮治疗 OUD 提供了一个独特的机会;然而,目前几乎没有临床指南。本报告介绍了我们在引入基于医院的美沙酮快速启动方案后前 9 个月的经验:我们对 2022 年 12 月至 2023 年 8 月期间在一家城市学术中心接受跨专业成瘾医学咨询服务的 OUD 住院患者进行了回顾性病历审查。我们确定了使用美沙酮快速起始方案开始使用美沙酮的患者,该方案包括剂量建议(第 1 天最多 60 毫克,第 2 天 70 毫克,第 3 天 80 毫克,第 4-7 天 100 毫克)和严格的纳入和排除标准(终末器官衰竭、心律失常、同时使用苯二氮卓类药物或饮酒、年龄大于 65 岁):在研究期间,共有 171 名患者接受了美沙酮治疗 OUD。其中,25 名患者(15%)接受了美沙酮快速起始治疗。第 1-7 天的美沙酮日平均总剂量分别为 53.0 毫克、69.2 毫克、75.4 毫克、79.5 毫克、87.1 毫克、92.2 毫克和 96.6 毫克。没有发生需要暂停美沙酮计划剂量、使用纳洛酮或转到更高级护理的不良事件:结论:针对 OUD 的美沙酮快速启动方案可以在住院环境中实施。与传统的诱导方法相比,患者能更快地增加美沙酮剂量,而且没有出现严重的不良反应。适当选择患者对于避免伤害可能很重要。
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引用次数: 0
Benzodiazepine Discharge Prescriptions From Emergency Departments Across the United States Between 2012 and 2019: A National Analysis. 2012 年至 2019 年全美急诊科苯二氮卓类药物出院处方:全国分析。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-05-22 DOI: 10.1097/ADM.0000000000001310
Christine Ramdin, George Mina, Lewis Nelson, Maryann Mazer-Amirshahi

Objectives: Benzodiazepines are commonly misused medications frequently implicated in overdose deaths. Data show that benzodiazepine prescribing is associated with increased misuse. We sought to determine national trends in benzodiazepine prescribing from the emergency department (ED).

Methods: This is a retrospective review of the National Hospital Ambulatory Medical Care Survey from 2012 to 2019. Our primary outcome was to evaluate trends in ED visits where a benzodiazepine was prescribed at discharge. Secondarily, we identified commonly prescribed benzodiazepines and assessed trends over time. We examined demographic data and used descriptive statistics and Spearman rho or Pearson correlation coefficient as applicable.

Results: Between 2012 and 2019, there were 13,848,578 visits where benzodiazepines were prescribed at ED discharge. In 2012 and 2019, there were 1,407,478 visits (1.1% of all ED visits) and 1,361,372 visits (0.9%), respectively, where benzodiazepines were prescribed (mean [SD], 1,731,072 [287,623] [1.26%]), with no trend ( P = 0.31). Common benzodiazepines prescribed were diazepam (5,980,279 visits, 43.2% of all prescriptions), alprazolam (3,306,549, 23.9%), and clonazepam (2,105,963, 15.2%), with no changes over time. Fifteen percent of prescriptions were for patients 65 years or older.

Conclusion: Despite reports of increased misuse, there was no change in ED discharge benzodiazepine prescribing. Concerningly, alprazolam, a benzodiazepine with high misuse potential, was frequently prescribed despite limited ED indications, and there was a large percentage of visits where benzodiazepines were prescribed to older adults despite warnings for adverse effects in this population. Future studies should assess rational prescribing and the role of targeted interventions to curb inappropriate use.

目标:苯二氮卓类药物是常见的滥用药物,经常与用药过量致死有关。数据显示,苯二氮卓类药物的处方与滥用增加有关。我们试图确定全国急诊科(ED)开具苯二氮卓类药物处方的趋势:这是一项对 2012 年至 2019 年全国医院非住院医疗护理调查的回顾性研究。我们的主要结果是评估出院时开具苯二氮卓类药物的急诊就诊趋势。其次,我们确定了常用的苯二氮卓类药物处方,并评估了其随时间变化的趋势。我们检查了人口统计学数据,并酌情使用了描述性统计和Spearman rho或Pearson相关系数:2012 年至 2019 年间,急诊室出院时开具苯二氮卓类药物处方的就诊人次为 13,848,578 次。2012年和2019年,分别有1,407,478人次(占所有急诊室就诊人次的1.1%)和1,361,372人次(0.9%)开出了苯二氮卓类药物处方(平均值[标度],1,731,072 [287,623] [1.26%]),且无趋势(P = 0.31)。常见的苯二氮卓类药物处方为地西泮(5,980,279 人次,占所有处方的 43.2%)、阿普唑仑(3,306,549 人次,占 23.9%)和氯硝西泮(2,105,963 人次,占 15.2%),这些处方没有随时间发生变化。15%的处方用于 65 岁或以上的患者:结论:尽管有滥用增加的报道,但急诊室出院苯二氮卓类药物的处方量没有变化。令人担忧的是,阿普唑仑这种苯二氮卓类药物的滥用可能性很高,尽管急诊室的适应症有限,但却经常被开出处方,而且尽管有警告称苯二氮卓类药物对老年人群有不良影响,但还是有很大比例的就诊处方被开给了老年人。未来的研究应评估合理处方以及有针对性的干预措施在遏制不当使用方面的作用。
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引用次数: 0
Fentanyl Test Strips for Harm Reduction: A Scoping Review. 用于减少危害的芬太尼试纸:范围审查。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-05-31 DOI: 10.1097/ADM.0000000000001321
Eric Kutscher, Marco Barber Grossi, Fred LaPolla, Joshua D Lee

Background: High potency synthetic opioids like fentanyl have continued to replace or contaminate the supply of illicit drugs in North America, with fentanyl test strips (FTSs) often used as a harm reduction tool for overdose prevention. The available evidence to support FTS for harm reduction has yet to be summarized.

Methods: A search of PubMed, Ovid Embase, and Web of Science was conducted in March 2023. A 2-stage review was conducted to screen by title and abstract and then by full text by 2 reviewers. Data were extracted from each study using a standardized template.

Results: A total of 91 articles were included, mostly from North America, predominantly reporting on FTS along with other harm reduction tools, and all conducted after 2016. No randomized controlled trials are reported. Robust evidence exists supporting the sensitivity and specificity of FTS, along with their acceptability and feasibility of use for people who use drugs and as a public health intervention. However, limited research is available on the efficacy of FTS as a harm reduction tool for behavior change, engagement in care, or overdose prevention.

Conclusions: Though FTSs are highly sensitive and specific for point of care testing, further research is needed to assess the association of FTS use with overdose prevention. Differences in FTS efficacy likely exist between people who use opioids and nonopioid drugs, with additional investigation strongly needed. As drug testing with point-of-care immunoassays is embraced for nonfentanyl contaminants such as xylazine and benzodiazepines, increased investment in examining overdose prevention is necessary.

背景:芬太尼等高效力合成阿片类药物不断取代或污染北美的非法药物供应,芬太尼试纸(FTS)经常被用作预防用药过量的减毒工具。支持芬太尼试纸用于减少伤害的现有证据尚有待总结:方法:2023 年 3 月对 PubMed、Ovid Embase 和 Web of Science 进行了检索。由两名审稿人对研究进行了两阶段审查,首先通过标题和摘要进行筛选,然后通过全文进行筛选。使用标准化模板从每项研究中提取数据:共收录了 91 篇文章,大部分来自北美,主要报告了 FTS 以及其他减低伤害的工具,并且都是在 2016 年之后进行的。未报告随机对照试验。有大量证据支持FTS的灵敏度和特异性,以及其对吸毒者和作为公共卫生干预措施的可接受性和可行性。然而,关于 FTS 作为减少危害的工具在改变行为、参与护理或预防用药过量方面的有效性的研究还很有限:结论:尽管FTS在护理点检测中具有高度灵敏性和特异性,但仍需进一步研究以评估FTS的使用与用药过量预防之间的关联。在使用阿片类药物和非阿片类药物的人群中,FTS 的有效性可能存在差异,因此亟需开展更多调查。随着对非芬太尼污染物(如甲苯噻嗪和苯并二氮杂卓)采用床旁免疫测定进行药物检测,有必要增加对预防用药过量的投资。
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引用次数: 0
Estimating the Prevalence of Using Suspected Counterfeit Medications in the General Population. 估算普通人群中使用疑似假药的普遍程度。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-06-03 DOI: 10.1097/ADM.0000000000001326
Jennifer S Jewell, Elizabeth A Bemis, Joshua C Black

Introduction: Counterfeit medications, sometimes referred to as "fake" or falsified drugs or pills, are drugs that are illicitly manufactured but designed to look like legitimate pharmaceuticals. Counterfeit medications are a growing public health concern. This study estimated the prevalence of self-reported use of suspected counterfeit medications by adults in the US and to assess what ingredients these individuals suspected were in the counterfeit medications.

Methods: This general population survey, drawn from an online panel, was administered across 2 waves in 2022 (15 April 3 June and 9 September 21 October) to 59,041 adults aged 18 and older. Statistical calibration weighting was used to calculate estimates representative of the national adult population.

Results: An estimated 1.8% (95% CI 1.7%-1.9%) of respondents, corresponding to approximately 4.6 million adults, suspected past 12-month use of counterfeit medications. Fentanyl was the most commonly suspected ingredient in the counterfeit product (16.1%, 95% CI 12.8%-19.3%). The next most prevalent response was "I don't know" (15.0%, 95% CI 11.0%-18.9%) followed by methamphetamine (14.9%, 95% CI 11.4%-18.4%).

Conclusions: These data show the scale of the issue in relation to other well established drug use data points in the US. System-level methods, such as drug scanning software, should be implemented to reduce the likelihood that counterfeit drugs end up in the hands of individuals.

简介:假药,有时也被称为 "伪造 "或篡改的药品或药片,是指非法生产的药品,但在设计上却与合法药品相似。假药是一个日益严重的公共卫生问题。本研究估计了美国成年人自我报告使用疑似假药的普遍程度,并评估这些人怀疑假药中含有哪些成分:这项普通人群调查来自一个在线小组,于 2022 年分两次(4 月 15 日至 6 月 3 日和 9 月 9 日至 10 月 21 日)对 59,041 名 18 岁及以上的成年人进行了调查。采用统计校准加权法计算出代表全国成人人口的估计值:估计有 1.8%(95% CI 1.7%-1.9%)的受访者(相当于约 460 万成年人)怀疑在过去 12 个月中使用过假药。芬太尼是最常被怀疑的假药成分(16.1%,95% CI 12.8%-19.3%)。其次是 "我不知道"(15.0%,95% CI 11.0%-18.9%),然后是甲基苯丙胺(14.9%,95% CI 11.4%-18.4%):这些数据表明,与美国其他成熟的毒品使用数据点相比,这一问题的严重性不言而喻。应采用药物扫描软件等系统级方法来降低假药落入个人手中的可能性。
{"title":"Estimating the Prevalence of Using Suspected Counterfeit Medications in the General Population.","authors":"Jennifer S Jewell, Elizabeth A Bemis, Joshua C Black","doi":"10.1097/ADM.0000000000001326","DOIUrl":"10.1097/ADM.0000000000001326","url":null,"abstract":"<p><strong>Introduction: </strong>Counterfeit medications, sometimes referred to as \"fake\" or falsified drugs or pills, are drugs that are illicitly manufactured but designed to look like legitimate pharmaceuticals. Counterfeit medications are a growing public health concern. This study estimated the prevalence of self-reported use of suspected counterfeit medications by adults in the US and to assess what ingredients these individuals suspected were in the counterfeit medications.</p><p><strong>Methods: </strong>This general population survey, drawn from an online panel, was administered across 2 waves in 2022 (15 April 3 June and 9 September 21 October) to 59,041 adults aged 18 and older. Statistical calibration weighting was used to calculate estimates representative of the national adult population.</p><p><strong>Results: </strong>An estimated 1.8% (95% CI 1.7%-1.9%) of respondents, corresponding to approximately 4.6 million adults, suspected past 12-month use of counterfeit medications. Fentanyl was the most commonly suspected ingredient in the counterfeit product (16.1%, 95% CI 12.8%-19.3%). The next most prevalent response was \"I don't know\" (15.0%, 95% CI 11.0%-18.9%) followed by methamphetamine (14.9%, 95% CI 11.4%-18.4%).</p><p><strong>Conclusions: </strong>These data show the scale of the issue in relation to other well established drug use data points in the US. System-level methods, such as drug scanning software, should be implemented to reduce the likelihood that counterfeit drugs end up in the hands of individuals.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"466-469"},"PeriodicalIF":4.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141236349","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
Global and Regional Burden and Trend of Neoplasms Attributable to Alcohol Consumption in the Past 3 Decades. 过去三十年全球和地区因饮酒导致的肿瘤负担和趋势。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-02-24 DOI: 10.1097/ADM.0000000000001288
Hui-Wen Song, Jin-Hua Ge, Bi-Xia Xie, Mei-Ting Jiang, Jin-Shui Pan

Objectives: To provide valuable insights for targeted cancer screening among high-risk patients, we analyzed the global and regional burden of neoplasms resulting from alcohol consumption between 1990 and 2019.

Methods: The information used in this study was collected from the Global Burden of Disease 2019 dataset. Initially, the database was used to extract details of mortality rates, disability-adjusted life years (DALYs), and the number of individuals affected by alcohol-related neoplasms (ARNs). Subsequently, the data were compared by cancer type, sex, age, region, and sociodemographic index. Furthermore, the study involved the calculation and comparison of estimated annual percentage changes in age-standardized DALYs rates (ASDRs) and mortality rates.

Results: The impact of alcohol on the burden of cancer varied by type of cancer, sex, age, and geographical location. Notably, males exhibited significantly higher ASDRs compared with females. Specifically, in 2019, alcohol emerged as the primary contributor to the number of DALYs associated with esophageal cancer, followed by liver cancer and colorectal cancer in men. Patients aged 50+ years exhibited a heightened rate of DALYs associated with ARNs. From 1990 to 2019, ASDRs among individuals with ARNs did not exhibit a decline in low-middle and low sociodemographic index regions.

Conclusions: Alcohol consumption represents a significant risk factor for the burden of cancer, particularly within the realm of digestive system malignancies. Consequently, targeted cancer screening efforts should be directed toward the population that engages in alcohol drinking, with a particular focus on men aged 50 years and older, residing in economically disadvantaged areas.

目的为了给高危患者的针对性癌症筛查提供有价值的见解,我们分析了 1990 年至 2019 年间全球和地区因饮酒导致的肿瘤负担:本研究使用的信息来自 2019 年全球疾病负担数据集。首先,利用该数据库提取了死亡率、残疾调整生命年(DALYs)和受酒精相关肿瘤(ARNs)影响的人数等详细信息。随后,按癌症类型、性别、年龄、地区和社会人口指数对数据进行了比较。此外,研究还包括计算和比较年龄标准化残疾调整寿命年数(ASDRs)和死亡率的估计年度百分比变化:结果:酒精对癌症负担的影响因癌症类型、性别、年龄和地理位置而异。值得注意的是,男性的ASDRs明显高于女性。具体而言,在2019年,酒精是造成食道癌相关残疾调整寿命年数的主要因素,其次是肝癌和男性结肠直肠癌。50 岁以上患者与急性淋巴细胞白血病相关的残疾调整寿命年数增加。从1990年到2019年,在中低社会人口指数地区和低社会人口指数地区,ARN患者的ASDR并没有下降:结论:饮酒是造成癌症负担的一个重要风险因素,尤其是在消化系统恶性肿瘤领域。因此,应针对饮酒人群开展有针对性的癌症筛查工作,重点关注居住在经济落后地区的 50 岁及以上男性。
{"title":"Global and Regional Burden and Trend of Neoplasms Attributable to Alcohol Consumption in the Past 3 Decades.","authors":"Hui-Wen Song, Jin-Hua Ge, Bi-Xia Xie, Mei-Ting Jiang, Jin-Shui Pan","doi":"10.1097/ADM.0000000000001288","DOIUrl":"10.1097/ADM.0000000000001288","url":null,"abstract":"<p><strong>Objectives: </strong>To provide valuable insights for targeted cancer screening among high-risk patients, we analyzed the global and regional burden of neoplasms resulting from alcohol consumption between 1990 and 2019.</p><p><strong>Methods: </strong>The information used in this study was collected from the Global Burden of Disease 2019 dataset. Initially, the database was used to extract details of mortality rates, disability-adjusted life years (DALYs), and the number of individuals affected by alcohol-related neoplasms (ARNs). Subsequently, the data were compared by cancer type, sex, age, region, and sociodemographic index. Furthermore, the study involved the calculation and comparison of estimated annual percentage changes in age-standardized DALYs rates (ASDRs) and mortality rates.</p><p><strong>Results: </strong>The impact of alcohol on the burden of cancer varied by type of cancer, sex, age, and geographical location. Notably, males exhibited significantly higher ASDRs compared with females. Specifically, in 2019, alcohol emerged as the primary contributor to the number of DALYs associated with esophageal cancer, followed by liver cancer and colorectal cancer in men. Patients aged 50+ years exhibited a heightened rate of DALYs associated with ARNs. From 1990 to 2019, ASDRs among individuals with ARNs did not exhibit a decline in low-middle and low sociodemographic index regions.</p><p><strong>Conclusions: </strong>Alcohol consumption represents a significant risk factor for the burden of cancer, particularly within the realm of digestive system malignancies. Consequently, targeted cancer screening efforts should be directed toward the population that engages in alcohol drinking, with a particular focus on men aged 50 years and older, residing in economically disadvantaged areas.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"381-388"},"PeriodicalIF":4.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971949","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
Prevalence of Kratom Use Disorder Among Kratom Consumers. 桔梗消费者中桔梗使用障碍的流行率。
IF 5.5 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-05-01 Epub Date: 2024-03-05 DOI: 10.1097/ADM.0000000000001290
Katherine Hill, Oliver Grundmann, Kirsten E Smith, Corneliu N Stanciu

Objectives: Kratom leaf products are increasingly consumed in the United States, with many consumers reporting they experience beneficial effects from kratom use. However, there is a growing concern for kratom's potential to result in dependence when used regularly. As such, we sought to assess, using Diagnostic and Statistical Manual of Mental Disorders , (DSM-5) , diagnostic criteria for substance use disorder, the prevalence of "kratom use disorder" (KUD) among kratom consumers.

Methods: Our cross-sectional study used an online, anonymous survey between February and May 2023. Through nonprobability sampling, we recruited people older than 18 years who currently consume kratom. Participants were asked about their kratom consumption patterns, adverse effects perceived to stem from kratom consumption, comorbid diagnoses, and components for a DSM-5 , substance use disorder, adapted for kratom.

Results: Among the total sample ( N = 2061), KUD criteria were met by 25.5% of participants ( n = 525); the most commonly reported symptoms were tolerance ( n = 427, 81.3%) and withdrawal ( n = 357, 68.0%). After adjusting for age, gender, daily frequency of kratom consumption, and history of either a substance use disorder or a mental health condition, those with a concurrent diagnosis of another substance use disorder had 2.83 times higher odds of meeting KUD criteria (95% CI, 2.19-3.67) compared with those without one.

Conclusions: In this large cross-sectional study, most participants who met the criteria for a KUD diagnosis were categorized as having a mild or moderate KUD. Individual characteristics associated with KUD were related to being male, young, consuming kratom frequently, and having psychiatric and substance use disorder comorbidities.

目的:在美国,桔梗叶产品的消费量越来越大,许多消费者表示他们从使用桔梗中体验到了有益的效果。然而,人们越来越担心经常使用 Kratom 可能会产生依赖性。因此,我们试图使用《精神疾病诊断与统计手册》(DSM-5)中的药物使用障碍诊断标准,评估 "kratom 使用障碍"(KUD)在 kratom 消费者中的流行率:我们的横断面研究在 2023 年 2 月至 5 月期间进行了在线匿名调查。通过非概率抽样调查,我们招募了 18 岁以上、目前食用 kratom 的人群。调查询问了参与者的克瑞托姆消费模式、认为克瑞托姆消费产生的不良影响、合并诊断以及根据克瑞托姆改编的 DSM-5 物质使用障碍的组成部分:在所有样本(样本数 = 2061)中,25.5% 的参与者(样本数 = 525)符合 KUD 标准;最常报告的症状是耐受(样本数 = 427,81.3%)和戒断(样本数 = 357,68.0%)。在对年龄、性别、每天服用克拉托姆的频率以及药物使用障碍或精神疾病史进行调整后,同时被诊断为另一种药物使用障碍的人与未被诊断为另一种药物使用障碍的人相比,符合 KUD 标准的几率高出 2.83 倍(95% CI,2.19-3.67):在这项大型横断面研究中,大多数符合 KUD 诊断标准的参与者被归类为轻度或中度 KUD。与 KUD 相关的个体特征包括男性、年轻、经常服用 kratom 以及合并有精神病和药物使用障碍。
{"title":"Prevalence of Kratom Use Disorder Among Kratom Consumers.","authors":"Katherine Hill, Oliver Grundmann, Kirsten E Smith, Corneliu N Stanciu","doi":"10.1097/ADM.0000000000001290","DOIUrl":"10.1097/ADM.0000000000001290","url":null,"abstract":"<p><strong>Objectives: </strong>Kratom leaf products are increasingly consumed in the United States, with many consumers reporting they experience beneficial effects from kratom use. However, there is a growing concern for kratom's potential to result in dependence when used regularly. As such, we sought to assess, using Diagnostic and Statistical Manual of Mental Disorders , (DSM-5) , diagnostic criteria for substance use disorder, the prevalence of \"kratom use disorder\" (KUD) among kratom consumers.</p><p><strong>Methods: </strong>Our cross-sectional study used an online, anonymous survey between February and May 2023. Through nonprobability sampling, we recruited people older than 18 years who currently consume kratom. Participants were asked about their kratom consumption patterns, adverse effects perceived to stem from kratom consumption, comorbid diagnoses, and components for a DSM-5 , substance use disorder, adapted for kratom.</p><p><strong>Results: </strong>Among the total sample ( N = 2061), KUD criteria were met by 25.5% of participants ( n = 525); the most commonly reported symptoms were tolerance ( n = 427, 81.3%) and withdrawal ( n = 357, 68.0%). After adjusting for age, gender, daily frequency of kratom consumption, and history of either a substance use disorder or a mental health condition, those with a concurrent diagnosis of another substance use disorder had 2.83 times higher odds of meeting KUD criteria (95% CI, 2.19-3.67) compared with those without one.</p><p><strong>Conclusions: </strong>In this large cross-sectional study, most participants who met the criteria for a KUD diagnosis were categorized as having a mild or moderate KUD. Individual characteristics associated with KUD were related to being male, young, consuming kratom frequently, and having psychiatric and substance use disorder comorbidities.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"306-312"},"PeriodicalIF":5.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140028041","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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