Journal of Addiction Medicine最新文献

Objectives: With emerging novel adulterants in the unregulated US drug supply, people who use drugs (PWUD) bear the downstream consequences of unpredictable effects and increased health risks. Xylazine, a veterinary sedative, is associated with severe sedation and chronic ulcerations. To better understand PWUD perspectives on xylazine adulteration, we interviewed individuals with xylazine-associated wounds in Pittsburgh, Pennsylvania.

Methods: From March to April 2024, we conducted semi-structured interviews with adult PWUD with at least 1 current or prior xylazine-associated wound and past-90-day xylazine exposure confirmed by urine toxicology or xylazine test strip. We thematically analyzed a subset of the data focused on xylazine experiences.

Results: Five major themes emerged from 20 interviews. First, PWUD recognition of xylazine developed only after experiencing its negative effects, including wounds. Second, xylazine was an unwanted adulterant with PWUD, citing its sedating effects and associated wounds as barriers to daily functioning. Third, xylazine wounds imposed significant physical, emotional, and social challenges. Fourth, PWUD found it challenging to avoid xylazine given the saturated supply and employ traditional harm reduction strategies such as transitioning routes of use. Lastly, PWUD felt unable to stop using the xylazine-adulterated opioid supply due to worsening withdrawal symptoms, uncontrolled pain from xylazine wounds, and difficulty with initiating and continuing medications for opioid use disorder.

Conclusions: Overall, PWUD with xylazine-associated wounds perceived xylazine as harmful and undesired, yet difficult to avoid, highlighting the urgent need for adaptive harm reduction strategies, accessible drug checking services, tailored clinical interventions, and supportive policies to promote a safer drug supply.

Objectives: To evaluate types of substance use disorder (SUD), recommended medications, and implementation of a new SUD eConsult offering asynchronous chart review and recommendations for primary care clinicians at an academic medical center. In addition, to understand contextual factors that affected program implementation, as identified by the Practical, Robust Implementation and Sustainability (PRISM) model.

Methods: A retrospective analysis of SUD eConsults between December 1, 2020 and September 30, 2024 was performed, using SUD eConsult orders and electronic medical record chart review. The PRISM model was applied to understand contextual factors affecting the implementation of the eConsult program.

Results: There were 103 completed SUD eConsults. The most common reasons for eConsult were alcohol use disorder (46.6%), followed by opioid use disorder (37.9%), tobacco use disorder (4.9%), stimulant use disorder (3.9%), cannabis use disorder (1.9%), and benzodiazepine use disorder (1.0%). In total, 65.1% of eConsults recommended new prescriptions. Recommended medications were prescribed for 58.2% of patients, and 82.1% of these patients continued the medications for the study period. Utilizing the PRISM model, key factors that facilitated the SUD eConsult program include an existing eConsult infrastructure, a team of specialists available to review eConsults, a low threshold substance use disorder treatment clinic, and incentive pay for completed eConsults. Factors that hindered program implementation include competing demands within primary care, clinician hesitancy to use eConsults for SUD, stigma related to SUD, difficulty advertising, and reliance upon internal incentive pay.

Conclusions: The SUD eConsult program extends addiction medicine expertise to and supports pharmacotherapy initiation by primary care providers.

Background: The rise of high-potency synthetic opioids such as fentanyl in the illicit opioid supply has contributed to increased overdose deaths and complicated methadone initiation for opioid use disorder (OUD). Traditional methadone initiation protocols may be insufficient in the context of fentanyl's high potency and pharmacokinetics. This systematic review evaluates current evidence on accelerated (≥60 mg within the first 7 d of treatment) methadone initiation strategies.

Methods: Following PRISMA guidelines, we conducted a comprehensive search of databases for studies from 2013 to June 16, 2025, reporting on methadone initiation in fentanyl-exposed patients. Key outcomes included patient selection, dosing, retention, and adverse events.

Results: Ten observational studies met the inclusion criteria, with 8 inpatient, 2 outpatient, and 2 studies focused on pregnant individuals. Studies selected for 18- to 65-year-olds without end-organ failure, QTc prolongation, or medications affecting methadone metabolism. The mean and median dose on day 1 ranged from 30 to 53.4 mg (pooled weighted mean=40.7 mg). By day 5, doses increased to 59.2-90 mg (pooled weighted mean=70.2 mg), and by day 7 to 65-100 mg (pooled weighted mean=81.9 mg). Patient-directed discharge occurred in 0%-31% of patients. Sedation occurred in 0%-28.6% of patients, while severe adverse events (requiring naloxone, ICU admission, intubation, or death) occurred in 1.08% of treatment episodes. The certainty of evidence was very low using a GRADE framework.

Conclusions: The current observational literature is limited, with some support for accelerated methadone initiation in inpatient and outpatient settings for appropriately selected patients exposed to fentanyl.

Objectives: This study examined changes in social media use among adults with past-year treatment for substance use disorder (SUD) in New England, focusing on the prevalence of such changes, reasons for modifying social media habits, perceived success, and factors associated with attempts to change social media use.

Methods: Participants [N = 255; 45% female, 85% white, mean age = 41.4 (9.6)] recently treated for SUD completed an online survey. The survey gathered demographics, SUD histories, and social media use data. We report descriptive statistics and logistic regression models testing relationships between attempts to change social media use while in treatment and individual factors.

Results: Overall, 62% of respondents reduced or stopped social media use during SUD treatment. A substantial minority (34%) viewed their attempts as unsuccessful or neutral. Logistic regressions indicated that having alcohol as one's drug of choice and having previously sought drugs on social media were both positively associated with attempting to reduce or quit social media. People who reported being motivated to avoid social media to reduce drug/alcohol triggers also reported being more successful in changing their social media use.

Conclusions: Many individuals in SUD treatment actively limit social media to reduce exposure to substance-related triggers, yet success varies. Future research should explore how digital environments might be reshaped to support treatment goals, balancing the risk of exposure to substance use content with the potential benefits of online resources.

Objective: We examined the association between alcohol consumption and mortality among people living with HIV (PWH).

Methods: We included individuals aged ≥18 years, enrolled between 2004 and 2022 in CoRIS, a Spanish multicenter cohort study of ART-naive PWH at enrolment. We calculated mortality rates per 100 persons-year (p-y) of follow-up, and used multivariable Cox models to estimate hazard ratio (HR) (95% confidence interval [CI]) for the association between alcohol consumption at enrolment and mortality after controlling for confounders (sex at birth, age, mode of HIV infection, education level, region of origin, HCV infection [EIA+], CD4 cell count and HIV-RNA load at enrolment).

Findings: We included 6087 participants (14% women); median age 36 years (interquartile range [IQR]: 29-45). Men who had sex with men were 63.2% of the participants, 27.9% were heterosexuals, and 4.9% were persons who inject drugs. Prevalence of HCV was 7.5%, median RNA-HIV load was 70,431 copies/mL (IQR: 16,982-261,000), and median CD4 count was 363 cells/mm3 (IQR: 196-547). Two hundred seventy participants (4.4%) reported alcohol consumption of ≥40 g/d. Over 31,171 p-y of follow-up, 240 participants (3.9%) died. The mortality rate among individuals who drank ≥40 g/d was 2.13 (95% CI: 1.56-2.93) per 100 p-y compared with 0.68 (95% CI: 0.60-0.79) per 100 p-y among those who drank <40 g/d. After adjustment, alcohol consumption of ≥40 g/d was associated with increased mortality (adjusted HR: 1.54 [95% CI: 1.06-3.42], P =0.02).

Conclusion: In this cohort of PWH, excessive alcohol use was associated with a higher risk of death.

Objectives: Treatment recommendations for substance use disorder (SUD) emphasize medication as a key component of optimal care. Nonetheless, US Food and Drug Administration (FDA)-approved options for adolescents with SUD are limited. The purpose of this study was to systematically assess the number and characteristics of clinical trials testing medications for SUD in adolescent populations (aged <18) during the past 25 years.

Methods: We performed a scoping review to identify randomized-controlled trials of medications for SUD that were available in Cochrane CENTRAL or clinicaltrials.gov, active between January 1, 1999 and December 4, 2024, and included at least one participant aged 13-17, with none aged 26 years or older. Key study characteristics were extracted and analyzed to identify trends in design, medications tested, and participant diversity.

Results: Thirty-six trials of 15 unique medications met the inclusion criteria. Of these, 26 had published results, one was currently active, 3 had reported results on clinicaltrials.gov but lacked a publication, and 6 had not yet reported their results in any form. Medications for nicotine use disorder were most commonly studied (41.7%, N = 15), while stimulant use disorder (2.7%, N = 1) and benzodiazepine use disorder (N = 0) were the least represented. Although the collection and reporting of demographic-related factors were inconsistent, the demographic data available demonstrated low participation of individuals aged younger than 18, racial/ethnic minorities, and gender-diverse youth.

Conclusions: The current evidence base informing medications to treat SUD in adolescents is small. Additional research is urgently needed to address knowledge gaps, enhance participant diversity, and promote access to evidence-based SUD treatment for youth.

Objectives: To describe the clinical contexts, population characteristics, and outcomes of extended-release buprenorphine (CAM2038 7-day depot formulation) administration in emergency department and hospitalized patients with opioid use disorder primarily using fentanyl.

Methods: We conducted a retrospective case series of patients who received CAM2038 at an urban safety-net hospital between June 2024 and June 2025. We collected data from electronic health records, including demographics, clinical characteristics, and outcomes. Outcomes included opioid withdrawal severity, buprenorphine-precipitated withdrawal, patient-directed discharge, and 30-day linkage to care within our health care system.

Results: Thirty-seven patients received CAM2038, with 33 utilizing CAM2038 to initiate buprenorphine and 4 transitioning from another formulation of therapeutic buprenorphine. Most patients (91.9%) primarily used fentanyl. Among patients using CAM2038 to initiate buprenorphine, 25 patients (75.8%) received pretreatment of opioid withdrawal with short-acting full agonist opioids. Two patients (6%) had suspected precipitated withdrawal. Among patients with documented Clinical Opiate Withdrawal Scale scores post-injection (n=24), 91.7% experienced minimal-to-mild withdrawal (score <12). Patient-directed discharge was uncommon (10.8%), and 47% of patients linked to buprenorphine treatment within 30 days.

Conclusions: CAM2038 administration, including for the initiation of therapeutic buprenorphine, seems to be feasible and well-tolerated in inpatient and emergency department settings, with low rates of precipitated withdrawal and patient-directed discharge. The use of short-acting opioids for initial withdrawal management may contribute to successful outcomes. These findings support CAM2038 as a valuable option for treating opioid use disorder in the emergency department and hospital settings, particularly among patients who use fentanyl.

Objectives: Adolescents with substance use disorder report high rates of tobacco use. Despite recommendations for counseling and pharmacotherapies for tobacco cessation among adolescents, their use remains low. The objective of this study was to characterize the availability of tobacco cessation counseling and pharmacotherapies, as well as smoking and vaping policies, in adolescent-serving substance use treatment facilities in the United States.

Methods: The present study analyzed facility-reported data from the 2023 National Substance Use and Mental Health Services Survey. Substance use treatment facilities serving adolescents only (ages 11-21) were compared with those serving both adolescents and adults on tobacco use screening, availability of tobacco cessation education/counseling and pharmacotherapies (nicotine replacement therapy, bupropion, and varenicline), and smoking and vaping policies.

Results: Most adolescent-only facilities offered tobacco use screening (82.6% vs 82.8% in adult/adolescent facilities) and education/counseling for tobacco cessation (71.9% vs 70.0% in adult/adolescent facilities). Adolescent-only facilities were more likely than adult/adolescent facilities to prohibit onsite smoking (84.7% vs 33.1%, respectively, P < 0.001) or vaping (87.7% vs 41.9%, respectively, P < 0.001), yet less likely to offer tobacco cessation pharmacotherapies to patients (20.7% vs 45.5%, respectively, P < 0.001).

Conclusions: While most adolescent-only substance use treatment facilities offered tobacco cessation education or counseling and restricted tobacco use at their sites, they were less likely than adult/adolescent facilities to offer pharmacotherapy for tobacco cessation. This reflects a missed opportunity to offer robust options to treat tobacco use among adolescents with substance use disorders.

Objectives: Contingency management (CM) is the most effective intervention for stimulant use disorder (StUD) but is underutilized. This study examined the feasibility and acceptability of a novel mobile app-based CM intervention for patients with StUD during and after hospitalization.

Methods: We recruited hospitalized patients with moderate to severe StUD and an expected hospital length of stay of >2 weeks or a heart failure diagnosis. Patients received gift cards for participating in incentivized activities (counseling, drug testing, and recovery-oriented reflections) through the mobile app. Patients could participate for 2 months (including after hospital discharge), earning up to $330. An in-person nurse supported implementation. We collected intervention engagement data (app usage, rewards earned) and conducted qualitative interviews on participants' experiences.

Results: Fifty-six participants (68% male, 70% with unstable housing) completed intake. The average hospital length of stay was 33 days, with 64% admitted for infection. Participants engaged for an average of 33.9 days. Engagement varied widely-those in the top quartile earned $173.31 on average, while those in the bottom quartile earned $6.27 on average. Eighty-nine percent of submitted drug tests were negative for stimulants. Participants felt the "positivity" of CM helped them stay "motivated" and "focused" on recovery instead of being "bored" or stressed in the hospital. Thirty-nine (69.6%) patients continued engaging after hospital discharge. Barriers to engagement included physical limitations, feeling overwhelmed, competing priorities, and technological challenges.

Conclusions: A novel hospital-based mobile app CM intervention helped patients with StUD cope with hospitalization and supported recovery goals, although program engagement varied widely.