Journal of Addiction Medicine最新文献

Objectives: This study aimed to compare participants' experiences on two different formulations of extended-release buprenorphine.

Methods: Participants were part of a larger parent study comparing Brixadi™ (extended-release buprenorphine), hereafter called Brixadi, to extended-release naltrexone. At the time, Brixadi, was not fully FDA approved, and because of medication supply issues, 12 individuals were switched to Sublocade™ (a different formulation of extended-release buprenorphine), hereafter called Sublocade, for one dose and then back to Brixadi. Ten of those individuals completed semistructured interviews regarding their experiences with each medication.

Results: In general, most participants preferred Brixadi, and most found Sublocade to cause more injection site pain/discomfort. Participants' experiences with respect to cravings, medication wearing off too soon, withdrawal symptoms, and perceived helpfulness with recovery are also discussed.

Conclusions: Patients may prefer Brixadi to Sublocade because of injection site pain/discomfort. This could be mitigated with topical or subcutaneous anesthetics. Findings are mixed with respect to the effect of the medications on cravings, withdrawal symptoms, and the medication wearing off too soon. To address feelings of the medication wearing off too soon, patients could be given additional weekly doses of Brixadi (for patients on monthly doses of Brixadi) or supplemental sublingual buprenorphine (for patients on either Brixadi or Sublocade).

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.

Background: Ketamine is a dissociative anesthetic increasingly utilized in United States medical settings for the treatment of mental health conditions. Additionally, it is increasingly used in nonmedical settings for its dissociative properties. While nonmedical ketamine use and ketamine use disorder (KUD) have been observed internationally, KUD, and approaches to its treatment, have not been previously described in the US.

Case presentation: We present the case of a 32-year-old man with KUD who experienced severe cravings despite receipt of residential and intensive outpatient substance use disorder treatment. He resumed use after an initial period of abstinence and was subsequently started on lamotrigine and naltrexone for treatment of depressive symptoms and cravings. This combination altered his experience while on ketamine, resulting in nausea and decreased hallucinogenic effects. In addition, it substantially decreased his cravings, aiding him in achieving longer-term abstinence in combination with receipt of dialectical behavioral therapy, familial support, and involvement in 12-step programming.

Discussion: KUD is a poorly described condition that may become more prevalent as US ketamine use increases. Combining treatment of depressive symptoms and cravings, in this case with lamotrigine and naltrexone, may be a promising pharmacotherapeutic strategy. Lamotrigine, an antiepileptic with glutamate modulating effects, has been utilized to decrease cravings in a variety of substance use disorders. Naltrexone is an opioid antagonist approved for alcohol use disorder and opioid use disorder and is used off-label for stimulant use disorder. This combination offers a possible pharmacotherapeutic option for KUD with more research needed to further evaluate.

Objectives: The aim of this study was to identify distinct trajectories of prescription opioid exposure in pregnancy-encompassing both medication for opioid use disorder (MOUD) and opioid analgesics-and explore their associations with birth outcomes.

Methods: Trajectories were identified using latent class analysis among Wisconsin Medicaid-insured live births 2011-2019. Logistic regression estimated associations between these trajectories and neonatal opioid withdrawal syndrome (NOWS), small for gestational age, preterm birth, birth weight, and gestational age.

Results: Of 138,123 births, 27,293 (19.8%) had prenatal opioid exposure. Five trajectory classes were identified: (1) stable MOUD treatment (5.8%), (2) inconsistent MOUD treatment (3.9%), (3) chronic analgesic use (4.2%), (4) intermittent analgesic use (7.8%), and (5) low-level use of MOUD and analgesics (78.3%). NOWS incidence per 1000 infants was 667 for class 1 (adjusted odds ratio [aOR]: 21.74, 95% confidence interval [CI]: 17.89, 26.41), 570 for class 2 (aOR: 15.35, 95% CI: 12.49, 18.87), 235 for class 3 (aOR: 19.42, 95% CI: 15.93, 23.68), 67 for class 4 (aOR: 6.23, 95% CI: 4.99, 7.76), and 12 for class 5 (aOR: 1.73, 95% CI: 1.47, 2.02). Classes 1-4 had elevated risk of small for gestational age, preterm birth, lower birth weight, and shorter gestational age, with no significant differences among these classes. Among individuals with opioid use disorder, stable MOUD treatment was associated with higher birth weights and longer gestational ages compared to inconsistent treatment, despite higher odds of NOWS.

Conclusions: Early initiation and consistent MOUD treatment may improve birth weight and gestational age. For pregnant individuals with opioid use disorder using chronic analgesics, transition to MOUD may promote birth outcomes.

Objective: This analysis evaluated the validation results of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) tool for older adults.

Methods: We performed a subgroup analysis of older adults aged ≥65 (n = 184) from the TAPS tool validation study conducted in 5 primary care clinics. We compared the interviewer and self-administered versions of the TAPS tool at a cutoff of ≥1 for identifying problem use with a reference standard measure, the modified World Mental Health Composite International Diagnostic Interview.

Results: The mean age was 70.6 ± 5.9 years, 52.7% were female, and 49.5% were non-Hispanic Black. For identifying problem use, the self-administered TAPS tool had sensitivity of 0.91 (95% CI: 0.75-0.98) and specificity of 0.91 (95% CI: 0.85-0.95) for tobacco; sensitivity of 0.68 (95% CI: 0.45-0.86) and specificity of 0.88 (95% CI: 0.82-0.93) for alcohol; and sensitivity 0.86 (95% CI: 0.42-1.00) and specificity 0.94 (95% CI: 0.90-0.97) for cannabis. The interviewer-administered TAPS tool had similar results. We were unable to evaluate its performance for identifying problem use of individual classes of drugs other than cannabis in this population due to small sample sizes.

Conclusions: While the TAPS had excellent sensitivity and specificity for identifying tobacco use among older adults, the results for other substances lack precision, and we were unable to evaluate its performance for prescription medications and individual illicit drugs in this sample. This analysis underlines the critical need to adapt and validate screening tools for unhealthy substance use, specifically for older populations who have unique risks.

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.