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Malignant Catatonia in the Setting of Acute Methamphetamine and Cocaine Intoxication. 急性甲基苯丙胺和可卡因中毒时的恶性紧张症。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-01 Epub Date: 2024-07-23 DOI: 10.1097/ADM.0000000000001353
Nicholas J Mullen, VaKara M Meyer Karre, Alëna A Balasanova

Background: Malignant catatonia is a potentially lethal neuropsychiatric syndrome characterized by psychomotor abnormalities and autonomic instability. Patients with this syndrome require immediate treatment. Various psychiatric conditions and nonpsychiatric medical problems can trigger malignant catatonia. Use of psychostimulant drugs, including methamphetamine and cocaine, has not been previously reported to precipitate malignant catatonia.

Case summary: This case concerns a 35-year-old man hospitalized for psychosis due to methamphetamine and cocaine intoxication. He developed malignant catatonia the day after admission. He was treated with lorazepam for malignant catatonia, and his blood pressure was controlled with clonidine. Over 7 days, his condition resolved, and his mental status and vital signs returned to baseline. He was discharged to the community in stable condition and has returned to his baseline functional status. He remains free of catatonia and has maintained abstinence from methamphetamine and cocaine.

Conclusions: Acute intoxication with psychostimulant drugs is a possible trigger for malignant catatonia, and administration of high potency first-generation antipsychotics in this setting may increase the risk. Patients hospitalized for stimulant intoxication should be monitored for signs and symptoms of catatonia, and D 2 receptor antagonist medications should be used with caution in this population. Our case supports the potential role of altered dopamine and norepinephrine signaling in the pathogenesis of malignant catatonia. The patient provided written and verbal consent to publish the information in this case report.

背景:恶性紧张症是一种可能致命的神经精神综合征,以精神运动异常和自主神经不稳定为特征。患有这种综合征的患者需要立即接受治疗。各种精神疾病和非精神疾病都可能引发恶性紧张症。病例摘要:本病例涉及一名因甲基苯丙胺和可卡因中毒导致精神错乱而住院治疗的 35 岁男子。入院第二天,他出现了恶性紧张症。他因恶性紧张症接受了劳拉西泮治疗,并用氯硝安定控制血压。7 天后,他的病情得到缓解,精神状态和生命体征恢复到基线水平。他出院回到社区时病情稳定,功能也恢复到基线状态。他目前仍未出现紧张性精神障碍,并一直保持对甲基苯丙胺和可卡因的戒断:结论:精神兴奋剂药物急性中毒可能会引发恶性紧张症,在这种情况下使用高效力的第一代抗精神病药物可能会增加风险。因兴奋剂中毒住院的患者应注意观察紧张症的体征和症状,在此类人群中应慎用 D2 受体拮抗剂药物。我们的病例证实了多巴胺和去甲肾上腺素信号改变在恶性紧张症发病机制中的潜在作用。患者书面和口头同意发表本病例报告中的信息。
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引用次数: 0
Experience Starting an Addiction Medicine Practice-based Research Network. 创建成瘾医学实践研究网络的经验。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-01 Epub Date: 2024-07-30 DOI: 10.1097/ADM.0000000000001354
Adila Ibrahim, Diana E Clarke, Debbie Gibson, Barbara Casanova, Anna Pagano, Frank J Vocci, Amy Goldstein, Sejal Patel, Nusrat Rahman, Robert P Schwartz

Objectives: This paper outlines the experience developing Addiction Medicine Practice-Based Research Network (AMNet), which promotes the adoption of patient-reported outcome measures (PROMs) and measurement-based care in outpatient addiction treatment practices and creates a platform for quality improvement and research.

Methods: From August 2019 to July 2023, the AMNet team selected patient-reported outcome measures for implementation in the American Psychiatric Association's clinical data registry (PsychPRO), recruited addiction medicine providers, and collected PROMs data.

Results: AMNet selected 12 PROMs for implementation in PsychPRO. Through July 2023, 1565 providers expressed interest, of whom 216 of the 929 eligible providers (23%) attended an onboarding call/webinar. Two hundred six providers (95%) from 54 practices returned Participation Agreements. Subsequently, 65 providers (32%) from 39 practices withdrew, resulting in 141 (68%) providers from 15 practices. From November 2020 to July 2023, 38 providers submitted PROMs data using 1 of 3 PsychPRO patient portals. Sixteen of the 53 providers (30%) who signed up for the initial portal collected data from 468 patients. As of July 2023, 83 of the 141 providers (59%) opted to submit PROMs data from their own portal or electronic health record.

Conclusions: Next steps will include continued recruitment of providers, addressing barriers to data transfer and integrating data from providers' portals into the registry to create a platform for future research.

目标:本文概述了开发成瘾医学基于实践的研究网络(AMNet)的经验,该网络促进在门诊成瘾治疗实践中采用患者报告的结果测量(PROMs)和基于测量的护理,并为质量改进和研究创建了一个平台:从 2019 年 8 月到 2023 年 7 月,AMNet 团队在美国精神病学协会的临床数据登记处(PsychPRO)中选择了患者报告结果测量方法,招募了成瘾医学提供者,并收集了 PROMs 数据:结果:AMNet 选择了 12 个 PROMs 在 PsychPRO 中实施。截至 2023 年 7 月,共有 1565 名医疗服务提供者表示有兴趣,其中 929 名符合条件的医疗服务提供者中有 216 人(23%)参加了入职电话会议/网络研讨会。来自 54 家医疗机构的 26 名医疗服务提供者(95%)交回了参与协议。随后,39 家医疗机构的 65 名医疗服务提供者(32%)退出,最终有 15 家医疗机构的 141 名医疗服务提供者(68%)退出。从 2020 年 11 月到 2023 年 7 月,38 家医疗服务提供者使用 3 个 PsychPRO 患者门户网站中的 1 个提交了 PROMs 数据。在注册了初始门户网站的 53 位医疗服务提供者中,有 16 位(30%)收集了 468 名患者的数据。截至 2023 年 7 月,141 家医疗服务提供者中有 83 家(59%)选择通过自己的门户网站或电子健康记录提交 PROMs 数据:接下来的步骤将包括继续招募医疗服务提供者、解决数据传输障碍以及将医疗服务提供者门户网站的数据整合到注册表中,从而为未来的研究创建一个平台。
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引用次数: 0
"If You Plant That Seed, It Will Grow": A Qualitative Study to Improve Linkage to Care Among Patients With Methamphetamine Use Disorder in Emergency Department Settings. "如果你种下那颗种子,它就会长大":一项定性研究,旨在改善急诊科甲基苯丙胺使用障碍患者的护理联系。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-01 Epub Date: 2024-05-27 DOI: 10.1097/ADM.0000000000001315
Deborah J Rinehart, Karina G Duarte, Aiden Gilbert, Alia Al-Tayyib, Katherine Camfield, Scott A Simpson

Objectives: Methamphetamine addiction is a serious and difficult-to-treat disorder. Existing treatment options are limited, and patient perspectives on effective strategies are lacking. Emergency departments (EDs) may be a critical entry point for individuals with methamphetamine use disorder (MUD) to be identified and linked to treatment. We aimed to understand patients' perspectives regarding their methamphetamine use and related ED experiences and how to improve linkage to substance treatment.

Methods: Between July and November 2022, semistructured qualitative interviews were conducted with adult patients with MUD in an urban safety-net healthcare setting in Denver, Colorado. Interviews were recorded, summarized, and analyzed using the Rapid Assessment Process.

Results: During the interviews, 18 patients shared their experiences. Participants described feeling stigmatized and experiencing a lack of communication from ED staff during their visit. Additionally, participants shared the perception that ED staff often did not take their health concerns seriously once substance use was identified. Participants were uncertain about overdose risk and felt that their psychiatric symptoms complicated treatment. Referrals to treatment were lacking, and participants supported a care navigation intervention that incorporates elements of contingency management. Participants also shared the importance of ED staff recognizing their social needs and being empathetic, trauma-informed, and flexible to meet patients where they are regardless of their readiness to seek treatment.

Conclusions: Treatment options and entry points for individuals with MUD are currently limited. The patient perspectives described here are helpful in developing services to support, engage, and link individuals to MUD services after discharge from ED services.

目标:甲基苯丙胺成瘾是一种严重且难以治疗的疾病。现有的治疗方案很有限,而且缺乏患者对有效策略的看法。急诊科(ED)可能是识别甲基苯丙胺使用障碍(MUD)患者并将其与治疗联系起来的关键切入点。我们旨在了解患者对其甲基苯丙胺使用和相关急诊室经历的看法,以及如何改善与药物治疗的联系:2022 年 7 月至 11 月期间,我们在科罗拉多州丹佛市的一个城市安全网医疗机构中对患有 MUD 的成年患者进行了半结构化定性访谈。采用快速评估流程对访谈进行记录、总结和分析:在访谈过程中,18 名患者分享了他们的经历。参与者描述了他们在就诊期间感到被污名化以及急诊室工作人员缺乏沟通的经历。此外,参与者还认为,一旦发现使用药物,急诊室工作人员往往不会认真对待他们的健康问题。参与者对用药过量的风险不确定,并认为他们的精神症状使治疗变得复杂。缺乏治疗转介,参与者支持结合应急管理元素的护理导航干预。参与者还认为,急诊室工作人员必须认识到患者的社会需求,并以同理心、创伤意识和灵活性来满足患者的需求,无论他们是否准备寻求治疗:目前,针对 MUD 患者的治疗方案和切入点非常有限。本文所描述的患者观点有助于开发相关服务,以支持、吸引患者并在他们从急诊室出院后将其与 MUD 服务联系起来。
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引用次数: 0
Internet Gaming Disorder and the Incidence of Suicide-related Ideation and Behaviors in College Students. 网络游戏障碍与大学生自杀意念和行为的发生率。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-01 Epub Date: 2024-06-04 DOI: 10.1097/ADM.0000000000001331
Ricardo Orozco, Guilherme Borges, José Miguel Caldas-de-Almeida, Raúl A Gutiérrez-García, Yesica Albor, Ana Lucía Jiménez Pérez, Karla Patricia Valdés-García, Patricia M Baez Mansur, María Anabell Covarrubias Díaz Couder, Praxedis Cristina Hernández Uribe, Corina Benjet

Objectives: The longitudinal associations between DSM-5 Internet Gaming Disorder (IGD) and suicide-related ideation and behaviors have not been explored. In this study, we therefore seek to examine the association between baseline IGD and incident suicide ideation, plans, and attempts.

Methods: This is a prospective cohort study of 2586 Mexican college students followed up from September 2018 to June 2022. We estimated hazards ratios modeling incidence of suicide ideation, plans, and attempts by fitting proportional hazards Cox models with person-time scaled in years.

Results: Among 2140 students without suicide ideation at baseline, there were 467 incident cases in 3987.6 person-years; ideation incidence rates were 179 cases per 1000 person-years among students with IGD and 114 cases per 1000 person-years among those without IGD. Incidence rates for suicide plans were 67 and 39 per 1000 among IGD and non-IGD students, and 15 and 10 per 1000, respectively for attempts. After controlling for age, sex, and mood, anxiety, and substance use disorders, IGD was associated with an 83% increased risk of suicide ideation. Although incidence rate estimates for plans and attempts were higher among students with IGD, results were not statistically significant.

Conclusions: This study helps to raise awareness of the increased risk of at least suicidal ideation in people experiencing IGD. Clinicians treating patients with IGD may encounter complaints of suicide ideation over time, and even reports of suicidal behavior that should not be disregarded. Identifying these patients and treating/referring them for underlying suicidality should form part of IGD treatment.

研究目的DSM-5网络游戏障碍(IGD)与自杀相关意念和行为之间的纵向关联尚未得到探讨。因此,在本研究中,我们试图研究基线 IGD 与自杀意念、自杀计划和自杀未遂事件之间的关联:这是一项前瞻性队列研究,从 2018 年 9 月到 2022 年 6 月对 2586 名墨西哥大学生进行了随访。我们通过拟合以年为单位的人时比例危害 Cox 模型,估算了自杀意念、自杀计划和自杀未遂发生率的危害比模型:在基线时没有自杀意念的 2140 名学生中,3987.6 人年中发生了 467 起自杀事件;在有 IGD 的学生中,意念发生率为 179 例/1000 人年,而在没有 IGD 的学生中,意念发生率为 114 例/1000 人年。在 IGD 和非 IGD 学生中,自杀计划发生率分别为每 1000 人中 67 例和 39 例,自杀未遂发生率分别为每 1000 人中 15 例和 10 例。在控制了年龄、性别、情绪、焦虑和药物使用障碍等因素后,IGD 与自杀意念风险增加 83% 相关。虽然患有 IGD 的学生中计划自杀和企图自杀的发生率估计值较高,但结果在统计学上并不显著:这项研究有助于提高人们对 IGD 患者至少会增加自杀意念风险的认识。治疗 IGD 患者的临床医生可能会在一段时间内遇到自杀意念的主诉,甚至是自杀行为的报告,这些都不应被忽视。识别这些患者并治疗/转介他们潜在的自杀倾向应成为 IGD 治疗的一部分。
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引用次数: 0
Expert Panel Consensus on the Effectiveness and Implementation of Models to Support Posthospitalization Care Transitions for People With Substance Use Disorders. 专家小组就支持药物使用失调患者住院后护理过渡模式的有效性和实施达成共识。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-01 Epub Date: 2024-09-02 DOI: 10.1097/ADM.0000000000001369
Michael A Incze, Sophia Huebler, Kathryn Szczotka, Sean Grant, Stefan G Kertesz, Adam J Gordon

Objectives: Hospitals are increasingly offering treatment for substance use disorders (SUDs) during medical admissions. However, there is a lack of consensus on the best approach to facilitating a successful transition to long-term medical and SUD care after hospitalization. We aimed to establish a hierarchy of existing SUD care transition models in 2 categories-effectiveness and implementation-using an expert consensus approach.

Methods: We conducted a modified online Delphi study that convened 25 interdisciplinary clinicians with experience facilitating posthospitalization care transitions for patients with SUD. Panelists rated 10 prespecified posthospitalization care transition models according to 6 criteria concerning each model's anticipated effectiveness (eg, linkage to care, treatment retention) and implementation (eg, feasibility, acceptability). Ratings were made on a 9-point bidirectional scale. Group consensus was determined using the interpercentile range adjusted for symmetry.

Results: After 3 rounds of the Delphi process (96% retention across all 3 rounds), consensus was reached on all 60 rating criteria. Interdisciplinary addiction consult teams (ACTs) and in-reach from partnering outpatient clinics were rated highest for effectiveness. Interdisciplinary ACTs and bridge clinics were rated highest for implementation. Screening, brief intervention, and referral to treatment; protocol implementation; and postdischarge outreach received the lowest ratings overall. Feasibility of implementation was perceived as the largest challenge for all highly rated models.

Conclusions: An expert consensus approach including diverse clinician stakeholders found that interdisciplinary ACT, in-reach from partnering outpatient clinics, and bridge clinics had the greatest potential to enhance posthospitalization care transitions for patients with SUD when considering both perceived effectiveness and implementation.

目的:越来越多的医院在病人住院期间提供药物使用障碍 (SUD) 治疗。然而,对于促进住院后成功过渡到长期医疗和药物滥用治疗的最佳方法,目前还缺乏共识。我们的目标是采用专家共识法,将现有的 SUD 护理过渡模式分为有效性和实施性两个类别,并建立一个层次结构:我们开展了一项经过修改的在线德尔菲研究,召集了 25 名具有促进 SUD 患者住院后护理过渡经验的跨学科临床医生。专家组成员根据每种模式的预期效果(如与护理的联系、治疗的保持)和实施情况(如可行性、可接受性)等 6 项标准,对 10 种预先指定的入院后护理过渡模式进行评分。评分采用 9 分双向量表。根据对称性调整后的百分位间范围确定小组共识:经过三轮德尔菲程序(三轮程序的保留率均为 96%),就所有 60 项评分标准达成了共识。跨学科戒毒咨询小组(ACTs)和合作门诊诊所的内联有效性被评为最高。跨学科戒毒咨询小组和桥接诊所的实施率最高。筛查、简单干预和转诊治疗、协议实施和出院后外联的总体评分最低。在所有评分较高的模式中,实施的可行性被认为是最大的挑战:通过专家共识法(包括不同的临床医生利益相关者)发现,跨学科 ACT、合作门诊诊所的内联和桥梁诊所在加强 SUD 患者出院后的护理过渡方面具有最大的潜力,这要同时考虑到感知效果和实施情况。
{"title":"Expert Panel Consensus on the Effectiveness and Implementation of Models to Support Posthospitalization Care Transitions for People With Substance Use Disorders.","authors":"Michael A Incze, Sophia Huebler, Kathryn Szczotka, Sean Grant, Stefan G Kertesz, Adam J Gordon","doi":"10.1097/ADM.0000000000001369","DOIUrl":"10.1097/ADM.0000000000001369","url":null,"abstract":"<p><strong>Objectives: </strong>Hospitals are increasingly offering treatment for substance use disorders (SUDs) during medical admissions. However, there is a lack of consensus on the best approach to facilitating a successful transition to long-term medical and SUD care after hospitalization. We aimed to establish a hierarchy of existing SUD care transition models in 2 categories-effectiveness and implementation-using an expert consensus approach.</p><p><strong>Methods: </strong>We conducted a modified online Delphi study that convened 25 interdisciplinary clinicians with experience facilitating posthospitalization care transitions for patients with SUD. Panelists rated 10 prespecified posthospitalization care transition models according to 6 criteria concerning each model's anticipated effectiveness (eg, linkage to care, treatment retention) and implementation (eg, feasibility, acceptability). Ratings were made on a 9-point bidirectional scale. Group consensus was determined using the interpercentile range adjusted for symmetry.</p><p><strong>Results: </strong>After 3 rounds of the Delphi process (96% retention across all 3 rounds), consensus was reached on all 60 rating criteria. Interdisciplinary addiction consult teams (ACTs) and in-reach from partnering outpatient clinics were rated highest for effectiveness. Interdisciplinary ACTs and bridge clinics were rated highest for implementation. Screening, brief intervention, and referral to treatment; protocol implementation; and postdischarge outreach received the lowest ratings overall. Feasibility of implementation was perceived as the largest challenge for all highly rated models.</p><p><strong>Conclusions: </strong>An expert consensus approach including diverse clinician stakeholders found that interdisciplinary ACT, in-reach from partnering outpatient clinics, and bridge clinics had the greatest potential to enhance posthospitalization care transitions for patients with SUD when considering both perceived effectiveness and implementation.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"696-704"},"PeriodicalIF":4.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107595","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
Clinician and Practice Characteristics Associated With Support of Office-Based Methadone: Findings From a National Survey. 与支持办公室美沙酮有关的临床医生和实践特征:一项全国调查的结果。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-10-30 DOI: 10.1097/ADM.0000000000001388
Minhee L Sung, Anne C Black, Derek Blevins, Brandy F Henry, Kathryn Cates-Wessel, Michael A Dawes, Holly Hagle, Paul J Joudrey, Todd Molfenter, Frances R Levin, David A Fiellin, E Jennifer Edelman

Background: Alternative models for methadone delivery outside of federal and state-regulated opioid treatment programs may improve access. We determined factors associated with clinician support for continuing office-based methadone.

Methods: We used data from the electronic Opioid Use Disorder Provider COVID-19 Survey conducted among X-waivered clinicians who were providing outpatient, longitudinal treatment of opioid use disorder (OUD) from July 2020 to August 2020. The outcome variable was selecting "The opportunity for patients to receive office-based methadone" when asked "Which pandemic-related policy changes or new policy changes would you like to be continued or started after the pandemic?" Using sequential multivariable logistic regression modeling, we estimated the association between clinician and practice characteristics and support for office-based methadone.

Results: Of 1900 respondents, 728 met the inclusion criteria. Twenty-eight percent indicated support for office-based methadone. Clinician characteristics associated with support for office-based methadone were being Black or African American versus White (adjusted odds ratio [AOR] [95% confidence interval (CI)], 2.88 [1.19-6.98]), having provided medications for OUD (MOUD) for >15 years versus ≤15 years (AOR [95% CI], 1.66 [1.02-2.68]), treating 51 to 100 patients with MOUD monthly versus <25 patients (AOR [95% CI], 1.79 [1.04-3.09]), providing methadone (AOR [95% CI], 1.71 [1.03-2.85]) versus not providing MOUD previously, and working in an academic medical center versus other settings (AOR [95% CI], 1.88 [1.11-3.16]).

Conclusions: A minority of surveyed X-waivered clinicians supported office-based methadone. Efforts to expand access to methadone via office-based settings should address implementation barriers.

背景:在联邦和州监管的阿片类药物治疗项目之外提供美沙酮的替代模式可能会提高美沙酮的可及性。我们确定了临床医生支持继续在诊室提供美沙酮的相关因素:我们使用了来自阿片类药物使用障碍提供者 COVID-19 电子调查的数据,调查对象是 2020 年 7 月至 2020 年 8 月期间提供阿片类药物使用障碍(OUD)门诊纵向治疗的 X-waivered 临床医生。当被问及 "您希望在大流行后继续或开始哪些与大流行相关的政策变化或新的政策变化?"时,结果变量为选择 "患者有机会在门诊接受美沙酮治疗"。我们使用顺序多变量逻辑回归模型估算了临床医生和诊所特征与支持诊所美沙酮之间的关系:在 1900 名受访者中,有 728 人符合纳入标准。28%的受访者表示支持办公室美沙酮。与支持诊室美沙酮有关的临床医生特征包括:黑人或非裔美国人与白人(调整后的几率比[AOR][95% 置信区间 (CI)],2.88 [1.19-6.98]),提供 OUD(MOUD)药物治疗时间大于 15 年与小于 15 年(AOR [95% CI],1.66 [1.02-2.68]),每月治疗 51 至 100 名 MOUD 患者与结论:少数接受调查的 X-Waivered 临床医生支持在诊室使用美沙酮。通过诊室环境扩大美沙酮使用范围的努力应解决实施障碍。
{"title":"Clinician and Practice Characteristics Associated With Support of Office-Based Methadone: Findings From a National Survey.","authors":"Minhee L Sung, Anne C Black, Derek Blevins, Brandy F Henry, Kathryn Cates-Wessel, Michael A Dawes, Holly Hagle, Paul J Joudrey, Todd Molfenter, Frances R Levin, David A Fiellin, E Jennifer Edelman","doi":"10.1097/ADM.0000000000001388","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001388","url":null,"abstract":"<p><strong>Background: </strong>Alternative models for methadone delivery outside of federal and state-regulated opioid treatment programs may improve access. We determined factors associated with clinician support for continuing office-based methadone.</p><p><strong>Methods: </strong>We used data from the electronic Opioid Use Disorder Provider COVID-19 Survey conducted among X-waivered clinicians who were providing outpatient, longitudinal treatment of opioid use disorder (OUD) from July 2020 to August 2020. The outcome variable was selecting \"The opportunity for patients to receive office-based methadone\" when asked \"Which pandemic-related policy changes or new policy changes would you like to be continued or started after the pandemic?\" Using sequential multivariable logistic regression modeling, we estimated the association between clinician and practice characteristics and support for office-based methadone.</p><p><strong>Results: </strong>Of 1900 respondents, 728 met the inclusion criteria. Twenty-eight percent indicated support for office-based methadone. Clinician characteristics associated with support for office-based methadone were being Black or African American versus White (adjusted odds ratio [AOR] [95% confidence interval (CI)], 2.88 [1.19-6.98]), having provided medications for OUD (MOUD) for >15 years versus ≤15 years (AOR [95% CI], 1.66 [1.02-2.68]), treating 51 to 100 patients with MOUD monthly versus <25 patients (AOR [95% CI], 1.79 [1.04-3.09]), providing methadone (AOR [95% CI], 1.71 [1.03-2.85]) versus not providing MOUD previously, and working in an academic medical center versus other settings (AOR [95% CI], 1.88 [1.11-3.16]).</p><p><strong>Conclusions: </strong>A minority of surveyed X-waivered clinicians supported office-based methadone. Efforts to expand access to methadone via office-based settings should address implementation barriers.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545569","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
Current Self-reported Pain Before and After Cure of Hepatitis C Among Persons Who Actively Inject Drugs. 积极注射毒品者在丙型肝炎治愈前后自我报告的当前疼痛情况。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-10-30 DOI: 10.1097/ADM.0000000000001398
Judith I Tsui, Natasha T Ludwig-Barron, Jocelyn R James, Moonseong Heo, Laksika B Sivaraj, Julia Arnsten, Paula J Lum, Lynn E Taylor, Shruti H Mehta, Oluwaseun Falade-Nwulia, Judith Feinberg, Arthur Y Kim, Brianna Norton, Kimberly Page, Alain H Litwin

Background: Questions remain on the relationship between pain and hepatitis C virus cure among persons who inject drugs (PWID). This study aimed to explore whether achieving hepatitis C virus cure reduced pain severity.

Methods: Prespecified secondary analysis utilized data from a pragmatic clinical trial of care delivery models that enrolled PWIDs between 2016 and 2018 and treated with sofosbuvir/velpatasvir. Current pain severity (0-100) was assessed before and after treatment and 5-point Likert pain scales were used to determine moderate or greater current pain at baseline; the duration and etiology of current pain were not assessed. We used generalized mixed-effects linear models to test whether achieving sustained virologic response (SVR), that is, cure, was associated with lower numeric pain scores (primary outcome) posttreatment, adjusting for potential confounders (age, sex, intervention assignment, time/visit, and baseline pain severity category) and to examine changes in pain over time. Adjusted means estimated from a fitted model for pain severity at each visit were compared between participants who did and did not achieve SVR, both for the sample overall and for the subsample of participants who reported moderate or greater pain at baseline.

Results: Of the 501 participants who were randomized, treated with DAAs and had SVR data, moderate or greater pain was reported at baseline in 174 (34.7%) of participants. Numeric pain severity did not significantly differ by SVR status at any study visit except for the week 48 visit from baseline, when the estimated pain score was significantly higher for those who failed treatment (38.0 vs 26.3, P = 0.033). Among the subsample with baseline moderate or greater pain, pain severity scores were significantly lower in subsequent visits compared to the baseline visit, with the exception of week 48 among participants who did not achieve SVR.

Conclusions: Among PWID, achieving SVR did not improve pain severity. However, participants who failed treatment had significantly greater pain at the visit immediately following visit for SVR, which may relate to adverse psychological effects of treatment failure. Among those with baseline moderate or greater pain, pain scores declined post treatment, suggesting that treatment itself (irrespective of SVR) may be associated with improved pain.

背景:在注射吸毒者(PWID)中,疼痛与丙型肝炎病毒治愈之间的关系仍存在疑问。本研究旨在探讨丙型肝炎病毒治愈是否会减轻疼痛的严重程度:预设的二次分析利用了2016年至2018年间入组并接受索非布韦/韦帕他韦治疗的PWID的护理提供模式的实用临床试验数据。在治疗前后评估了当前疼痛的严重程度(0-100),并使用 5 点 Likert 疼痛量表确定基线时的中度或更严重的当前疼痛;未评估当前疼痛的持续时间和病因。我们使用广义混合效应线性模型来检验获得持续病毒学应答(SVR)(即治愈)是否与治疗后较低的疼痛数字评分(主要结果)相关,并对潜在的混杂因素(年龄、性别、干预分配、时间/就诊情况和基线疼痛严重程度类别)进行调整,同时检验疼痛随时间的变化情况。通过拟合模型估算出的每次就诊时疼痛严重程度的调整均值,对达到和未达到 SVR 的参与者进行了比较,既包括总体样本,也包括基线时报告有中度或更严重疼痛的参与者子样本:在 501 名接受随机分组、DAAs 治疗并获得 SVR 数据的参与者中,有 174 人(34.7%)在基线时报告有中度或更严重的疼痛。除第 48 周基线访视外,在任何研究访视中,不同 SVR 状态下的数字疼痛严重程度均无显著差异,在第 48 周访视中,治疗失败者的估计疼痛评分显著更高(38.0 vs 26.3,P = 0.033)。在基线疼痛程度为中度或更严重的子样本中,除第 48 周未获得 SVR 的参与者外,其后各次检查的疼痛严重程度评分均显著低于基线检查:在感染者中,获得 SVR 并未改善疼痛的严重程度。然而,治疗失败的参与者在紧接着 SVR 访视后的访视中疼痛明显加剧,这可能与治疗失败的不良心理影响有关。在基线疼痛程度为中度或更严重的人群中,治疗后疼痛评分有所下降,这表明治疗本身(无论 SVR 与否)可能与疼痛的改善有关。
{"title":"Current Self-reported Pain Before and After Cure of Hepatitis C Among Persons Who Actively Inject Drugs.","authors":"Judith I Tsui, Natasha T Ludwig-Barron, Jocelyn R James, Moonseong Heo, Laksika B Sivaraj, Julia Arnsten, Paula J Lum, Lynn E Taylor, Shruti H Mehta, Oluwaseun Falade-Nwulia, Judith Feinberg, Arthur Y Kim, Brianna Norton, Kimberly Page, Alain H Litwin","doi":"10.1097/ADM.0000000000001398","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001398","url":null,"abstract":"<p><strong>Background: </strong>Questions remain on the relationship between pain and hepatitis C virus cure among persons who inject drugs (PWID). This study aimed to explore whether achieving hepatitis C virus cure reduced pain severity.</p><p><strong>Methods: </strong>Prespecified secondary analysis utilized data from a pragmatic clinical trial of care delivery models that enrolled PWIDs between 2016 and 2018 and treated with sofosbuvir/velpatasvir. Current pain severity (0-100) was assessed before and after treatment and 5-point Likert pain scales were used to determine moderate or greater current pain at baseline; the duration and etiology of current pain were not assessed. We used generalized mixed-effects linear models to test whether achieving sustained virologic response (SVR), that is, cure, was associated with lower numeric pain scores (primary outcome) posttreatment, adjusting for potential confounders (age, sex, intervention assignment, time/visit, and baseline pain severity category) and to examine changes in pain over time. Adjusted means estimated from a fitted model for pain severity at each visit were compared between participants who did and did not achieve SVR, both for the sample overall and for the subsample of participants who reported moderate or greater pain at baseline.</p><p><strong>Results: </strong>Of the 501 participants who were randomized, treated with DAAs and had SVR data, moderate or greater pain was reported at baseline in 174 (34.7%) of participants. Numeric pain severity did not significantly differ by SVR status at any study visit except for the week 48 visit from baseline, when the estimated pain score was significantly higher for those who failed treatment (38.0 vs 26.3, P = 0.033). Among the subsample with baseline moderate or greater pain, pain severity scores were significantly lower in subsequent visits compared to the baseline visit, with the exception of week 48 among participants who did not achieve SVR.</p><p><strong>Conclusions: </strong>Among PWID, achieving SVR did not improve pain severity. However, participants who failed treatment had significantly greater pain at the visit immediately following visit for SVR, which may relate to adverse psychological effects of treatment failure. Among those with baseline moderate or greater pain, pain scores declined post treatment, suggesting that treatment itself (irrespective of SVR) may be associated with improved pain.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545570","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
Effects of Buprenorphine, Methadone, and Substance-Use on COVID-19 Morbidity and Mortality. 丁丙诺啡、美沙酮和药物滥用对 COVID-19 发病率和死亡率的影响。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-10-30 DOI: 10.1097/ADM.0000000000001386
Nicholaus J Christian, Xin Zhou, Rajiv Radhakrishnan

Objectives: Substance use disorder has been associated with increased morbidity in COVID-19 infection. However, less is known about the impact of active substance use and medications for opioid use disorder (MOUD) on COVID-19 outcomes. We conducted a retrospective cohort study to evaluate the impact of substance use, namely, cannabis, cocaine, alcohol, sedative and opioid use; and buprenorphine or methadone on COVID-19 morbidity and mortality.

Methods: Using electronic health record data at a large urban hospital system, patients who tested positive for COVID-19 between January 1, 2020, and December 31, 2021, were included. Substance use was identified from urine toxicology and MOUD prescriptions within 90 days prior to admission. COVID-19 outcomes included mortality, ICU admission, need for intubation, and number and duration of hospitalizations. Multivariable logistic regression was performed controlling for variables such as age, sex, medical comorbidity, tobacco use, and social disadvantage.

Results: Among COVID-19-positive patients (n = 17,423), sedative, cannabis, cocaine, and opioid use was associated with statistically significant increases in need for ICU care, need for ventilatory support, number of hospitalizations, and duration of hospitalization. Substance use was not associated with an increase in all-cause mortality. There were no statistically significant differences between methadone, buprenorphine, and other opioids on COVID-19 outcomes.

Conclusions: Active substance use was associated with increased morbidity in COVID-19 infection. MOUD was not associated with worse COVID-19 outcomes compared to other opioids. Future studies focused on MOUD treatments that reduce morbidity may help improve clinical outcomes in COVID-19.

目的:物质使用障碍与 COVID-19 感染的发病率增加有关。然而,人们对主动使用药物和阿片类药物使用障碍(MOUD)对 COVID-19 结果的影响知之甚少。我们开展了一项回顾性队列研究,以评估药物使用(即大麻、可卡因、酒精、镇静剂和阿片类药物的使用)以及丁丙诺啡或美沙酮对 COVID-19 发病率和死亡率的影响:利用一家大型城市医院系统的电子健康记录数据,纳入 2020 年 1 月 1 日至 2021 年 12 月 31 日期间 COVID-19 检测呈阳性的患者。根据入院前90天内的尿液毒理学和MOUD处方确定药物使用情况。COVID-19 结果包括死亡率、入住 ICU、插管需求、住院次数和住院时间。在控制了年龄、性别、医疗合并症、烟草使用和社会不利条件等变量后,进行了多变量逻辑回归:结果:在 COVID-19 阳性患者(n = 17,423)中,镇静剂、大麻、可卡因和阿片类药物的使用与重症监护室护理需求、呼吸支持需求、住院次数和住院时间的增加有统计学意义。使用药物与全因死亡率的增加无关。在 COVID-19 结果方面,美沙酮、丁丙诺啡和其他阿片类药物之间没有明显的统计学差异:结论:积极使用药物与 COVID-19 感染的发病率增加有关。与其他阿片类药物相比,MOUD 与 COVID-19 的恶化结果无关。未来对降低发病率的MOUD治疗方法的研究可能有助于改善COVID-19的临床治疗效果。
{"title":"Effects of Buprenorphine, Methadone, and Substance-Use on COVID-19 Morbidity and Mortality.","authors":"Nicholaus J Christian, Xin Zhou, Rajiv Radhakrishnan","doi":"10.1097/ADM.0000000000001386","DOIUrl":"10.1097/ADM.0000000000001386","url":null,"abstract":"<p><strong>Objectives: </strong>Substance use disorder has been associated with increased morbidity in COVID-19 infection. However, less is known about the impact of active substance use and medications for opioid use disorder (MOUD) on COVID-19 outcomes. We conducted a retrospective cohort study to evaluate the impact of substance use, namely, cannabis, cocaine, alcohol, sedative and opioid use; and buprenorphine or methadone on COVID-19 morbidity and mortality.</p><p><strong>Methods: </strong>Using electronic health record data at a large urban hospital system, patients who tested positive for COVID-19 between January 1, 2020, and December 31, 2021, were included. Substance use was identified from urine toxicology and MOUD prescriptions within 90 days prior to admission. COVID-19 outcomes included mortality, ICU admission, need for intubation, and number and duration of hospitalizations. Multivariable logistic regression was performed controlling for variables such as age, sex, medical comorbidity, tobacco use, and social disadvantage.</p><p><strong>Results: </strong>Among COVID-19-positive patients (n = 17,423), sedative, cannabis, cocaine, and opioid use was associated with statistically significant increases in need for ICU care, need for ventilatory support, number of hospitalizations, and duration of hospitalization. Substance use was not associated with an increase in all-cause mortality. There were no statistically significant differences between methadone, buprenorphine, and other opioids on COVID-19 outcomes.</p><p><strong>Conclusions: </strong>Active substance use was associated with increased morbidity in COVID-19 infection. MOUD was not associated with worse COVID-19 outcomes compared to other opioids. Future studies focused on MOUD treatments that reduce morbidity may help improve clinical outcomes in COVID-19.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545571","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
Chronic Pain Associated Alcohol Use Disorder among Participants in a Small Clinical Trial. 小型临床试验参与者中与慢性疼痛相关的酒精使用障碍。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-10-24 DOI: 10.1097/ADM.0000000000001393
Dale Terasaki, Joseph W Frank, Joseph Schacht
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引用次数: 0
Response to: "Chronic Pain Associated Alcohol Use Disorder among Participants in a Small Clinical Trial". 回应:"小型临床试验参与者中与慢性疼痛相关的酒精使用障碍"。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-10-24 DOI: 10.1097/ADM.0000000000001394
Nicholas J Bush, Erin Ferguson, Emily Zale, Jeff Boissoneault
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引用次数: 0
期刊
Journal of Addiction Medicine
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