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Naloxone Use During Pregnancy-Data From 26 US Jurisdictions, 2019-2020. 妊娠期纳洛酮使用情况--来自美国 26 个辖区的数据,2019-2020 年。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-01 Epub Date: 2024-06-24 DOI: 10.1097/ADM.0000000000001337
Amy Board, Denise V D'Angelo, Kathryn Miele, Alice Asher, Beatriz Salvesen von Essen, Clark H Denny, Mishka Terplan, Janae Dunkley, Shin Y Kim

Objectives: We aimed to determine the prevalence of self-reported naloxone use during pregnancy among people in the United States with a recent live birth. A secondary objective was to characterize people at increased risk of overdose who did and did not use naloxone.

Methods: We analyzed data from the Pregnancy Risk Assessment Monitoring System from 26 US jurisdictions that conducted an opioid supplement survey from 2019 to 2020. Respondents with increased risk of experiencing an opioid overdose were identified based on self-reported use of illicit amphetamines, heroin, cocaine, or receiving medication for opioid use disorder (MOUD) during pregnancy. Weighted prevalence estimates and 95% confidence intervals were calculated for reported naloxone use at any point during pregnancy among people with an increased risk of overdose.

Results: Naloxone use during pregnancy was reported by <1% of the overall study population (unweighted N = 88/34,528). Prevalence of naloxone use was 5.0% (95% CI: 0.0-10.6) among respondents who reported illicit amphetamine use, 15.2% (1.8-28.6) among those who reported heroin use, and 17.6% (0.0-38.1) among those who reported cocaine use. Naloxone use was 14.5% (8.4-20.6) among those who reported taking MOUD. Among people with increased risk of overdose, no significant differences in naloxone use were observed by age, race/ethnicity, education level, residential metropolitan status, or insurance status.

Conclusions: Prevalence of naloxone use among people with an increased risk of overdose during pregnancy ranged from 5.0% to 17.6%. Access to naloxone, overdose prevention education, and treatment for substance use disorders may help reduce morbidity and mortality.

摘要:目的:我们旨在确定美国最近活产的人群在怀孕期间自我报告使用纳洛酮的比例。次要目标是确定使用和未使用纳洛酮的用药过量风险增加人群的特征:我们分析了来自美国 26 个辖区的妊娠风险评估监测系统的数据,这些辖区在 2019 年至 2020 年期间开展了阿片类药物补充调查。根据自我报告的孕期使用非法苯丙胺、海洛因、可卡因或接受阿片类药物使用障碍(MOUD)药物治疗的情况,确定了阿片类药物过量风险增加的受访者。计算了用药过量风险增加人群在怀孕期间任何时间使用纳洛酮的加权流行率估计值和 95% 的置信区间:结论:据报告,在怀孕期间使用纳洛酮的比例较高:在妊娠期间用药过量风险增加的人群中,使用纳洛酮的比例从 5.0% 到 17.6% 不等。获得纳洛酮、预防用药过量教育和药物使用障碍治疗可能有助于降低发病率和死亡率。
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引用次数: 0
Trend in Prescription Medication Utilization for Opioid Use Disorder and Alcohol Use Disorder From 2015 to 2021: A Population-wide Study in a Canadian Province. 2015 年至 2021 年阿片类药物使用障碍和酒精使用障碍的处方药使用趋势:加拿大某省的全民研究。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-01 Epub Date: 2024-07-16 DOI: 10.1097/ADM.0000000000001348
Kearley Abbott, Rachel Hyrsak, James M Bolton, Jitender Sareen, Murray W Enns, Geoffrey Konrad, Erin Knight, Sherif Eltonsy, Kaarina Kowalec, Jamison Falk, Silvia Alessi-Severini, Kun Liu, Heather Prior, Christine Leong

Objective: To examine the quarterly incidence and prevalence of medications for opioid use disorder (OUD) and alcohol use disorder (AUD) from 2015 to 2021.

Methods: A retrospective population-wide observational study in Manitoba, Canada, was conducted using administrative claims data from the Manitoba Centre for Health Policy to examine the incidence and prevalence of OUD (methadone, buprenorphine-naloxone, buprenorphine) or AUD medications (naltrexone, acamprosate, disulfiram) per 10,000 individuals in each quarter between January 1, 2015, and December 31, 2021.

Results: There were 1179 and 451 individuals who received at least one prescription for OUD and AUD, respectively, in the first quarter of 2020. The prevalence of OUD medications more than doubled from 6.3 to 14.3 per 10,000 from January 1, 2015, to December 31, 2021. Likewise, AUD medication prevalence increased almost 10-fold from 0.68 to 6.5 per 10,000 from January 1, 2015, to December 31, 2021, primarily due to naltrexone. The incidence of AUD prescription use increased 8.6-fold from 0.29 to 2.51 per 10,000 during the study period. In contrast, the incidence of opioid agonist therapy declined from 2.1 per 10,000 in the first quarter of 2015 to 0.53 per 10,000 the first quarter of 2016, primarily due to methadone. Whereas methadone incidence declined, buprenorphine-naloxone incidence increased almost 15-fold during the study period.

Conclusion: An increase in both AUD medication prevalence and incidence in addition to an increase in buprenorphine-naloxone incidence was observed. These findings reflect an increase in the uptake of medications for treating AUD and OUD following changes to improve coverage and access to these medications.

目的研究 2015 年至 2021 年阿片类药物使用障碍(OUD)和酒精使用障碍(AUD)的季度发病率和流行率:方法:利用马尼托巴省卫生政策中心提供的行政报销数据,在加拿大马尼托巴省开展了一项全人口范围的回顾性观察研究,以检查 2015 年 1 月 1 日至 2021 年 12 月 31 日期间每个季度每 10,000 人中阿片类药物使用障碍(美沙酮、丁丙诺啡-纳洛酮、丁丙诺啡)或酒精使用障碍药物(纳曲酮、阿坎酸盐、双硫仑)的发生率和流行率:在 2020 年第一季度,分别有 1179 人和 451 人接受了至少一种治疗 OUD 和 AUD 的处方。从 2015 年 1 月 1 日到 2021 年 12 月 31 日,每 10,000 人中的 OUD 药物流行率从 6.3 增至 14.3,增加了一倍多。同样,从 2015 年 1 月 1 日到 2021 年 12 月 31 日,AUD 药物流行率从每 10,000 人中 0.68 例增加到 6.5 例,几乎增加了 10 倍,这主要归功于纳曲酮。在研究期间,AUD 处方使用的发生率从万分之 0.29 增加到万分之 2.51,增加了 8.6 倍。相比之下,阿片类激动剂治疗的发生率从 2015 年第一季度的万分之 2.1 降至 2016 年第一季度的万分之 0.53,这主要是美沙酮造成的。虽然美沙酮的使用率有所下降,但丁丙诺啡-纳洛酮的使用率在研究期间却增加了近15倍:结论:除丁丙诺啡-纳洛酮发病率增加外,还观察到 AUD 药物流行率和发病率均有所增加。这些研究结果反映出,随着治疗 AUD 和 OUD 的药物覆盖面和可及性的扩大,这些药物的使用率也在增加。
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引用次数: 0
Use of Cannabinoids by People Who Consume Kratom in the United States. 美国服用 Kratom 的人使用大麻素的情况。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-01 Epub Date: 2024-07-16 DOI: 10.1097/ADM.0000000000001346
Katherine Hill, Oliver Grundmann, Leigh V Panlilio, David H Epstein, Kirsten E Smith

Objectives: To estimate lifetime, past-year, and past-month prevalence of kratom, cannabis, and cannabidiol-only product use among adults 18 years and older in the United States, using 2 independent datasets.

Methods: Utilizing ( a ) the 2022 National Survey on Drug Use and Health (NSDUH) and ( b ) a 2022 online national convenience sample of adults who use kratom regularly (from our research group at the National Institute on Drug Abuse [NIDA]), we examined key demographic information as well as lifetime, past-year, and past-month substance use and preferences.

Results: Among the full sample of adults from the 2022 NSDUH, the prevalence of lifetime use was 49.69% for cannabis, 34.09% for cannabidiol-only products, and 1.93% for kratom. When solely examining participants who have used kratom, both independent datasets showed higher proportions of cannabis use over the lifetime-92.81% (95% confidence interval: 90.31-95.31) in the NSDUH subset and 92.16% (95% confidence interval: 89.37-94.95) in our NIDA sample.

Conclusions: Our study demonstrates that people are co-using kratom with cannabis and/or cannabidiol-only products at the same time or during the same time period, though more research is needed to understand people's motivations and practices for such co-use. Co-use might result in herb-herb interactions that may impact research findings and clinical outcomes for people who use kratom.

摘要:目的:利用两个独立的数据集估算美国 18 岁及以上成年人一生中、过去一年中和过去一个月中使用桔梗、大麻和纯大麻二酚产品的流行率:我们利用(a)2022 年全国药物使用和健康调查(NSDUH)和(b)2022 年经常使用 kratom 的成年人在线全国便利抽样(来自我们在美国国家药物滥用研究所 [NIDA] 的研究小组),研究了主要人口统计学信息以及终生、过去一年和过去一个月的药物使用情况和偏好:在 2022 年国家统计与人口普查的全部成人样本中,大麻的终生使用率为 49.69%,纯大麻二酚产品的终生使用率为 34.09%,桔梗的终生使用率为 1.93%。如果只研究使用过 kratom 的参与者,两个独立的数据集都显示终生使用大麻的比例较高--在 NSDUH 子集中为 92.81%(95% 置信区间:90.31-95.31),在我们的 NIDA 样本中为 92.16%(95% 置信区间:89.37-94.95):我们的研究表明,人们在同一时间或同一时期内将桔梗与大麻和/或仅含大麻二酚的产品混合使用,但还需要进行更多的研究来了解人们混合使用的动机和做法。同时使用可能会导致草药之间的相互作用,从而影响使用 kratom 的研究结果和临床疗效。
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引用次数: 0
Supervised Disulfiram Should Be Considered First-line Treatment for Alcohol Use Disorder. 监督下的双硫仑应被视为酒精使用障碍的一线治疗方法。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-01 Epub Date: 2024-08-16 DOI: 10.1097/ADM.0000000000001345
Stephen R Holt

Abstract: Despite the prevalence of alcohol use disorder (AUD) in the United States, the armamentarium of FDA-approved medications available for AUD treatment is remarkably small. Disulfiram, 1 of only 3 approved medications, is consistently designated as a second-line option in national treatment guidelines, citing inconsistent evidence, lack of patient preference, and safety concerns. These concerns, however, stem from a misguided interpretation of the evidence that exclusively relies upon double-blind randomized controlled trials (RCT). When viewed instead as both a medication and a behavioral intervention, open-label RCTs become a more appropriate research method, yielding overwhelmingly favorable efficacy data for disulfiram, and supervised disulfiram, in particular. With these data in mind, supervised disulfiram should be redesignated as a first-line intervention in both treatment guideline creation and clinical pathway tools. The addiction medicine community can no longer afford to neglect this critical therapeutic resource.

摘要:尽管酒精使用障碍(AUD)在美国非常普遍,但美国食品及药物管理局(FDA)批准用于治疗酒精使用障碍的药物却少得可怜。二硫仑是仅有的 3 种获批药物之一,在国家治疗指南中一直被指定为二线选择,理由是证据不一致、患者缺乏偏好以及安全性问题。然而,这些担忧源于对证据的错误解读,即完全依赖于双盲随机对照试验(RCT)。如果将双硫仑视为一种药物和一种行为干预措施,那么开放标签随机对照试验则是一种更为合适的研究方法。考虑到这些数据,在制定治疗指南和临床路径工具时,都应将监督下的双硫仑重新指定为一线干预措施。成瘾医学界再也不能忽视这一重要的治疗资源了。
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引用次数: 0
Sociodemographic and Health Factors of the Alcohol Treatment-seeking Population in New South Wales, Australia. 澳大利亚新南威尔士州寻求酒精治疗人群的社会人口和健康因素。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-01 Epub Date: 2024-06-03 DOI: 10.1097/ADM.0000000000001311
Nathan Heijstee, Eleanor Black, Emma Black, Apo Demirkol, Kristie Mammen, Llewellyn Mills, Rachel Deacon, Nadine Ezard, Mark Montebello, David Reid, Raimondo Bruno, Anthony Shakeshaft, Krista J Siefried, Michael Farrell, Nicholas Lintzeris

Objectives: Although factors associated with alcohol use have been researched at a population level, descriptions of the alcohol and other drug (AOD) treatment-seeking population in New South Wales (NSW), Australia, are limited. This study addresses this gap by analyzing sociodemographic and health characteristics in the NSW AOD treatment-seeking population.

Methods: Self-reported Australian Treatment Outcomes Profile data on substance use, health ratings, and sociodemographic factors were acquired from public AOD services (offering services from counseling to ambulatory/inpatient withdrawal management) in 6 administrative health districts from 2016 to 2019 (n = 14,287). Gaussian and multiple logistic regressions were conducted to examine associations between these factors and alcohol consumption quantity.

Results: Data were analyzed for patients seeking treatment for alcohol consumption specifically (n = 5929; median age, 44 years; 65% male). Valid alcohol consumption data were available for 5460 patients, among whom the mean volume of alcohol consumed was 311 standard drinks (3110 grams of ethanol) over the past 28 days and 15 standard drinks (150 grams of ethanol) per occasion. Higher volumes were consumed by males and those with recent experiences of violence and/or injecting drug use. Caring for children younger than 5 years and having above-median health ratings were associated with lower alcohol consumption.

Conclusions: This study contributes to the characterization of the NSW public AOD treatment population and identifies associations between alcohol consumption, sociodemographic factors, and health ratings among people seeking treatment for alcohol consumption. Findings point towards multilevel assessment and comprehensive interventions for people engaging in treatment for alcohol use. Future research should address barriers to treatment.

研究目的:尽管对与饮酒有关的因素进行了人群层面的研究,但对澳大利亚新南威尔士州(NSW)寻求酒精和其他药物(AOD)治疗人群的描述却很有限。本研究通过分析新南威尔士州寻求酒精和其他药物治疗人群的社会人口学和健康特征,填补了这一空白:从2016年到2019年,从6个行政卫生区的公共AOD服务机构(提供从咨询到门诊/住院戒断管理等服务)获得了关于药物使用、健康评分和社会人口因素的自我报告的澳大利亚治疗结果档案数据(n = 14,287)。研究人员对这些因素与饮酒量之间的关系进行了高斯和多元逻辑回归分析:对专门因饮酒寻求治疗的患者(n = 5929;年龄中位数为 44 岁;65% 为男性)进行了数据分析。有 5460 名患者的有效饮酒数据,其中过去 28 天的平均饮酒量为 311 标准杯(3110 克乙醇),每次 15 标准杯(150 克乙醇)。男性和近期有暴力和/或注射毒品经历的人饮酒量更高。照顾5岁以下儿童和健康评分高于中位数与较低的酒精消费量有关:这项研究有助于描述新南威尔士州公共酒精与药物滥用治疗人群的特征,并确定因饮酒而寻求治疗的人群中饮酒量、社会人口因素和健康评分之间的关联。研究结果表明,应该对接受酒精使用治疗的人群进行多层次评估和综合干预。未来的研究应解决治疗障碍问题。
{"title":"Sociodemographic and Health Factors of the Alcohol Treatment-seeking Population in New South Wales, Australia.","authors":"Nathan Heijstee, Eleanor Black, Emma Black, Apo Demirkol, Kristie Mammen, Llewellyn Mills, Rachel Deacon, Nadine Ezard, Mark Montebello, David Reid, Raimondo Bruno, Anthony Shakeshaft, Krista J Siefried, Michael Farrell, Nicholas Lintzeris","doi":"10.1097/ADM.0000000000001311","DOIUrl":"10.1097/ADM.0000000000001311","url":null,"abstract":"<p><strong>Objectives: </strong>Although factors associated with alcohol use have been researched at a population level, descriptions of the alcohol and other drug (AOD) treatment-seeking population in New South Wales (NSW), Australia, are limited. This study addresses this gap by analyzing sociodemographic and health characteristics in the NSW AOD treatment-seeking population.</p><p><strong>Methods: </strong>Self-reported Australian Treatment Outcomes Profile data on substance use, health ratings, and sociodemographic factors were acquired from public AOD services (offering services from counseling to ambulatory/inpatient withdrawal management) in 6 administrative health districts from 2016 to 2019 (n = 14,287). Gaussian and multiple logistic regressions were conducted to examine associations between these factors and alcohol consumption quantity.</p><p><strong>Results: </strong>Data were analyzed for patients seeking treatment for alcohol consumption specifically (n = 5929; median age, 44 years; 65% male). Valid alcohol consumption data were available for 5460 patients, among whom the mean volume of alcohol consumed was 311 standard drinks (3110 grams of ethanol) over the past 28 days and 15 standard drinks (150 grams of ethanol) per occasion. Higher volumes were consumed by males and those with recent experiences of violence and/or injecting drug use. Caring for children younger than 5 years and having above-median health ratings were associated with lower alcohol consumption.</p><p><strong>Conclusions: </strong>This study contributes to the characterization of the NSW public AOD treatment population and identifies associations between alcohol consumption, sociodemographic factors, and health ratings among people seeking treatment for alcohol consumption. Findings point towards multilevel assessment and comprehensive interventions for people engaging in treatment for alcohol use. Future research should address barriers to treatment.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"619-627"},"PeriodicalIF":4.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141199896","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
Disulfiram Should Remain Second-line Treatment for Most Patients With Alcohol Use Disorder. 对大多数酒精使用障碍患者而言,双硫仑仍应是二线治疗方法。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-01 Epub Date: 2024-08-16 DOI: 10.1097/ADM.0000000000001360
Sarah Axelrath

Alcohol use disorder (AUD) is responsible for a significant burden of medical, economic, and social harm globally and across the United States. Currently, only three FDA-approved medications for AUD are available, and most patients with AUD never receive pharmacotherapy. Disulfiram, the first medication that FDA approved for treatment of AUD, is recommended as a second-line treatment option by several national treatment guidelines citing safety concerns and lack of high-quality comparative studies. In this issue, Holt argues that disulfiram should be reclassified as a first-line treatment for AUD based on promising open-label randomized controlled trials (RCTs) for disulfiram as a behavioral intervention. Review of the literature suggests that disulfiram can be a useful treatment for a highly selected group of patients with no medical or psychiatric contraindications, high motivation for abstinence, and adequate family support. Unfortunately, many patients with AUD, a disorder characterized by high rates of medical and psychiatric multimorbidity and social vulnerability, fall outside of this narrow selection criteria. Prescribers should consider other FDA-approved medications as first-line treatment options for most patients with AUD, reserving disulfiram for the rare patients in whom the potential for benefit clearly outweighs risk of harm.

酒精使用障碍(AUD)给全球和美国造成了巨大的医疗、经济和社会负担。目前,美国食品和药物管理局仅批准了三种治疗 AUD 的药物,而大多数 AUD 患者从未接受过药物治疗。二硫仑是美国食品及药物管理局批准用于治疗 AUD 的第一种药物,但由于安全性问题和缺乏高质量的对比研究,一些国家的治疗指南建议将其作为二线治疗方案。在本期杂志中,霍尔特认为,基于双硫仑作为一种行为干预药物的开放标签随机对照试验(RCT)前景看好,双硫仑应被重新归类为治疗 AUD 的一线药物。文献综述表明,对于经过严格筛选、没有医疗或精神禁忌症、戒酒动机高且家庭支持充分的患者群体而言,双硫仑是一种有效的治疗方法。不幸的是,许多 AUD 患者都不在这一狭窄的选择标准范围内,因为 AUD 是一种以高发的医疗和精神疾病多发病和社会脆弱性为特征的疾病。对于大多数 AUD 患者,处方医生应考虑将其他经 FDA 批准的药物作为一线治疗选择,而将双硫仑保留给那些潜在获益明显大于危害风险的极少数患者。
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引用次数: 0
Wound Care Capacity of the Addiction Workforce in the Setting of Xylazine. 在使用赛拉嗪的情况下,戒毒人员的伤口护理能力。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-01 Epub Date: 2024-07-23 DOI: 10.1097/ADM.0000000000001352
Raagini Jawa, Samantha Blakemore, Stephen Murray, Alicia S Ventura, Tavita Hristova, Alexa Wilder, Margaret Shang, Tehya Johnson, Colleen LaBelle

Objectives: As xylazine increasingly adulterates the unregulated opioid supply, people who use drugs (PWUD) are more likely to experience sequalae from xylazine. Given xylazine exposure is consistently associated with development of wounds which can heal with medically directed wound care, we sought to understand the level of preparedness and ability of front-line addiction professionals who interact with PWUD to provide wound care treatment.

Methods: We administered a 26-item online survey assessing participant and organizational characteristics, level of wound care training, ability to test for xylazine and treat xylazine-associated wounds, and funding and billing characteristics to a national sample of addiction professionals using a listserv of over 11,000 individuals.

Results: We had a response rate of 12.8% in which 1,280 met eligibility criteria and completed the survey, with the majority (23.7%) being nurses. While nearly all participants had cared for patients who had experienced any xylazine-associated harms, less than half (43.6%) had cared for patients with xylazine wounds and 43.4% had any training or certification in wound care, including 26.9% of physicians. Although 75.9% of participants had access to wound care supplies, just 19.5% provided wound care services onsite.

Conclusions: Most addiction professionals, especially physicians, lack wound care training and do not provide onsite treatment for drug-associated wounds at the organizational level. There is a critical need to bridge this gap in knowledge and build capacity to provide evidence-based wound care services to PWUD in areas impacted by xylazine adulteration.

目标:由于不受管制的阿片类药物供应中越来越多地掺入了异丙嗪,吸毒者(PWUD)更有可能出现异丙嗪后遗症。鉴于接触异丙嗪通常会导致伤口愈合,而医学指导下的伤口护理可使伤口愈合,因此我们试图了解与吸毒者(PWUD)打交道的一线戒毒专业人员在提供伤口护理治疗方面的准备程度和能力:方法:我们通过一个包含 11000 多人的列表服务器,对全国戒毒专业人员样本进行了一项包含 26 个项目的在线调查,评估参与者和组织特征、伤口护理培训水平、检测氯丙嗪和治疗氯丙嗪相关伤口的能力,以及资金和账单特征:我们的回复率为 12.8%,其中有 1,280 人符合资格标准并完成了调查,大部分(23.7%)是护士。虽然几乎所有参与者都护理过曾遭受过任何异丙嗪相关伤害的患者,但只有不到一半(43.6%)的人护理过异丙嗪伤口患者,43.4%的人接受过伤口护理培训或获得过相关证书,其中包括26.9%的医生。虽然 75.9% 的参与者可以获得伤口护理用品,但只有 19.5% 的人在现场提供伤口护理服务:结论:大多数戒毒专业人员,尤其是医生,缺乏伤口护理培训,也没有在组织层面为药物相关伤口提供现场治疗。在受异丙嗪掺假影响的地区,亟需弥合这一知识鸿沟并提高为吸毒者提供循证伤口护理服务的能力。
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引用次数: 0
Integration of a Community Opioid Treatment Program Into a Federally Qualified Health Center. 将社区阿片类药物治疗计划纳入联邦合格医疗中心。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-01 Epub Date: 2024-06-13 DOI: 10.1097/ADM.0000000000001336
Christine Neeb, Brianna M McQuade, Linda Lesondak, Samantha Madrid, Judith M Schlaeger, Dennis P Watson, Niranjan Karnik, Noami Huerta, Simar Bhatia, Judes Fleurimont, Nicole Li, Elsa Hammerdahl, Ricky Pesantez, Nicole Gastala

Objectives: With the increasing rates of opioid overdose deaths in the United States, barriers to treatment access for patients seeking medications for opioid use disorder (OUD), and challenges of initiating buprenorphine in patients who use fentanyl, it is essential to explore novel approaches to expanding access to methadone treatment. An opioid treatment program (OTP) and a federally qualified health center (FQHC) partnered to develop and implement an innovative integrated methadone and primary care treatment model. The process for integrating an OTP and FQHC to provide methadone treatment in the primary care setting will be discussed.

Methods: An OTP methadone dispensing site was co-located in the FQHC, utilizing a staffing matrix built on the expertise of each stakeholder. The OTP managed DEA and state regulatory processes, whereas the FQHC physicians provided medical treatment, including methadone treatment protocols, treatment plans, and primary care. Patient demographics, medical history, and retention data for those who entered the program between January 2021 and February 2023 were collected through chart review and analyzed with descriptive statistics.

Results: A total of 288 OTP-FHQC patients were enrolled during the study. Retention rates in methadone treatment at 90 and 180 days were similar to partner clinics.

Conclusions: Collaboration between FQHCs and OTPs is operationally feasible and can be achieved utilizing the current staffing model of the FQHC and OTP. This model can increase access to treatment for OUD and primary care for an urban, underserved patient population.

目标:随着美国阿片类药物过量致死率的不断上升,阿片类药物使用障碍(OUD)患者在寻求药物治疗时面临障碍,以及使用芬太尼的患者在开始使用丁丙诺啡时面临挑战,因此探索新方法以扩大美沙酮治疗的可及性至关重要。一个阿片类药物治疗项目(OTP)和一个联邦合格医疗中心(FQHC)合作开发并实施了一种创新的美沙酮和初级保健综合治疗模式。本文将讨论整合 OTP 和 FQHC,在初级保健环境中提供美沙酮治疗的过程:方法:在 FQHC 内设立了一个 OTP 美沙酮配药点,利用各利益相关方的专业知识建立了一个人员配置矩阵。OTP 负责管理 DEA 和州监管流程,而 FQHC 的医生则提供医疗服务,包括美沙酮治疗方案、治疗计划和初级保健。通过病历审查收集了在 2021 年 1 月至 2023 年 2 月期间进入项目的患者的人口统计学特征、病史和保留数据,并进行了描述性统计分析:研究期间,共有 288 名 OTP-FHQC 患者加入。美沙酮治疗 90 天和 180 天的保留率与合作诊所相似:FQHC和OTP之间的合作在操作上是可行的,可以利用FQHC和OTP目前的人员配置模式来实现。这种模式可以增加城市中服务不足的患者群体获得 OUD 治疗和初级保健的机会。
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引用次数: 0
Addressing Confusion and Inconsistencies Surrounding the Provider Role in Medical Cannabis Programs. 解决围绕医用大麻计划中提供者角色的混乱和不一致问题。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-01 Epub Date: 2024-07-01 DOI: 10.1097/ADM.0000000000001338
Yi-Lang Tang, Elizabeth McCord, Paul H Earley, Karen Drexler

Abstract: More than 40 states in the United States have established medical cannabis programs that authorize the use of cannabis for specific medical conditions. Initially, these medical cannabis programs aimed to offer compassionate care primarily for terminal or rare, untreatable conditions. However, the scope of these programs has broadened to include nonterminal and more common conditions, including various medical and mental disorders. This expansion introduces several health care challenges: a lack of robust research evidence for many listed conditions, a sense of unpreparedness among providers, and a disparity in provider roles, expectations, and responsibilities across different states, leading to potential confusion. To address these issues, medical organizations need to develop expert consensus or guidelines that underscore evidence-based shared decision-making and patient monitoring standards. Medical education should also include such training. Concurrently, medical providers must prioritize evidence-based treatment over public opinion, exercise clinical judgment, and take responsibility for their recommendations.

摘要: 美国已有 40 多个州制定了医用大麻计划,授权使用大麻治疗特定病症。起初,这些医用大麻计划主要针对绝症或罕见、无法治疗的病症提供同情关怀。然而,这些计划的范围已经扩大到非绝症和更常见的病症,包括各种医疗和精神障碍。这种扩大带来了一些医疗保健方面的挑战:许多列出的病症缺乏有力的研究证据,医疗服务提供者缺乏准备,不同州的医疗服务提供者在角色、期望和责任方面存在差异,从而导致潜在的混乱。为解决这些问题,医疗组织需要制定专家共识或指南,强调以证据为基础的共同决策和患者监测标准。医学教育也应包括此类培训。同时,医疗服务提供者必须优先考虑循证治疗,而不是公众舆论,行使临床判断力,并对自己的建议负责。
{"title":"Addressing Confusion and Inconsistencies Surrounding the Provider Role in Medical Cannabis Programs.","authors":"Yi-Lang Tang, Elizabeth McCord, Paul H Earley, Karen Drexler","doi":"10.1097/ADM.0000000000001338","DOIUrl":"10.1097/ADM.0000000000001338","url":null,"abstract":"<p><strong>Abstract: </strong>More than 40 states in the United States have established medical cannabis programs that authorize the use of cannabis for specific medical conditions. Initially, these medical cannabis programs aimed to offer compassionate care primarily for terminal or rare, untreatable conditions. However, the scope of these programs has broadened to include nonterminal and more common conditions, including various medical and mental disorders. This expansion introduces several health care challenges: a lack of robust research evidence for many listed conditions, a sense of unpreparedness among providers, and a disparity in provider roles, expectations, and responsibilities across different states, leading to potential confusion. To address these issues, medical organizations need to develop expert consensus or guidelines that underscore evidence-based shared decision-making and patient monitoring standards. Medical education should also include such training. Concurrently, medical providers must prioritize evidence-based treatment over public opinion, exercise clinical judgment, and take responsibility for their recommendations.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"611-613"},"PeriodicalIF":4.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468062","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
Diagnosis and Treatment of Presumed Naltrexone-XR-precipitated Opioid Withdrawal in a Patient Chronically Treated With Buprenorphine-XR: A Case Report. 一名长期接受丁丙诺啡-XR 治疗的患者因服用纳曲酮-XR 而出现阿片类药物戒断的诊断和治疗:病例报告。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-01 Epub Date: 2024-07-05 DOI: 10.1097/ADM.0000000000001342
Jessica Moore, Kalvin Foo, Ernest Egu, Xin Gao, Rachel Ehrman-Dupre, Matthew Salzman

Abstract: Naltrexone, buprenorphine, and methadone are Food and Drug Administration-approved medications for the treatment of opioid use disorder in the United States. Naltrexone, an opioid antagonist, can precipitate opioid withdrawal if administered too quickly after the use of full or partial opioid agonists for those with either dependence or use disorder. We describe a case of severe precipitated opioid withdrawal syndrome after reported buprenorphine extended-release (XR) administration, despite the patient having been stable on buprenorphine-XR for several years, with no missed doses or recent opioid use. Naltrexone levels were sent and helped to diagnose suspected inadvertent naltrexone-XR administration in this patient, which was likely the etiology of his precipitated opioid withdrawal syndrome. We suggest the use of high-dose buprenorphine, as well as adjunctive medications including benzodiazepines, as a treatment strategy for naltrexone-XR precipitated withdrawal in the setting of chronic buprenorphine-XR treatment.

摘要:纳曲酮、丁丙诺啡和美沙酮是美国食品和药物管理局批准用于治疗阿片类药物使用障碍的药物。纳曲酮是一种阿片类药物拮抗剂,如果在有阿片类药物依赖或使用障碍的患者使用完全或部分阿片类药物激动剂后过早给药,可能会诱发阿片类药物戒断。我们描述了一例在使用丁丙诺啡缓释剂(XR)后出现严重阿片类药物戒断综合征的病例,尽管患者使用丁丙诺啡缓释剂(XR)已有数年,病情稳定,没有漏服或近期使用过阿片类药物。送检的纳曲酮水平有助于诊断该患者疑似无意中服用了纳曲酮-XR,这很可能是导致其阿片类药物戒断综合征的病因。我们建议使用大剂量丁丙诺啡以及包括苯二氮卓类药物在内的辅助药物,作为慢性丁丙诺啡-XR 治疗背景下纳曲酮-XR 诱发戒断的治疗策略。
{"title":"Diagnosis and Treatment of Presumed Naltrexone-XR-precipitated Opioid Withdrawal in a Patient Chronically Treated With Buprenorphine-XR: A Case Report.","authors":"Jessica Moore, Kalvin Foo, Ernest Egu, Xin Gao, Rachel Ehrman-Dupre, Matthew Salzman","doi":"10.1097/ADM.0000000000001342","DOIUrl":"10.1097/ADM.0000000000001342","url":null,"abstract":"<p><strong>Abstract: </strong>Naltrexone, buprenorphine, and methadone are Food and Drug Administration-approved medications for the treatment of opioid use disorder in the United States. Naltrexone, an opioid antagonist, can precipitate opioid withdrawal if administered too quickly after the use of full or partial opioid agonists for those with either dependence or use disorder. We describe a case of severe precipitated opioid withdrawal syndrome after reported buprenorphine extended-release (XR) administration, despite the patient having been stable on buprenorphine-XR for several years, with no missed doses or recent opioid use. Naltrexone levels were sent and helped to diagnose suspected inadvertent naltrexone-XR administration in this patient, which was likely the etiology of his precipitated opioid withdrawal syndrome. We suggest the use of high-dose buprenorphine, as well as adjunctive medications including benzodiazepines, as a treatment strategy for naltrexone-XR precipitated withdrawal in the setting of chronic buprenorphine-XR treatment.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"727-729"},"PeriodicalIF":4.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534469","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
期刊
Journal of Addiction Medicine
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