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Receipt of Medications for Alcohol Use Disorder in the Veterans Health Administration: Comparison of Rates at the Intersections of Racialized and Ethnic Identity With Both Sex and Transgender Status. 退伍军人健康管理局中接受酒精使用障碍药物治疗的情况:种族和民族身份与性别和变性身份交叉点的比率比较。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-06-05 DOI: 10.1097/ADM.0000000000001323
Rachel L Bachrach, Madeline C Frost, Olivia V Fletcher, Jessica A Chen, Matthew Chinman, Robert Ellis, Emily C Williams

Objectives: Medications for alcohol use disorder (MAUDs) are recommended for patients with alcohol use disorder yet are underprescribed. Consistent with Minority Stress and Intersectionality theories, persons with multiple sociodemographically marginalized identities (eg, Black women) often experience greater barriers to care and have poorer health outcomes. We use data from the Veterans Health Administration to assess disparities in Federal Drug Administration (FDA)-approved MAUDs and all effective MAUDs between the following groups: racialized and ethnic identity, sex, transgender status, and their intersections.

Methods: Among all Veterans Health Administration outpatients between August 1, 2015, and July 31, 2017, with documented alcohol screenings and an International Classification of Diseases diagnosis for alcohol use disorder in the 0-365 days prior (N = 308,238), we estimated the prevalence and 95% confidence intervals of receiving FDA-approved MAUDs and any MAUDs in the following year and compared them using χ2 or Fisher's exact test. Analyses are unadjusted to present true prevalence and group differences.

Results: The overall prevalence for MAUDs was low (FDA-MAUDs = 8.7%, any MAUDs = 20.0%). Within sex, Black males had the lowest rate of FDA-MAUDs (7.3%, [7.1-7.5]), whereas American Indian/Alaskan Native females had the highest (18.4%, [13.8-23.0]). Among those identified as transgender, Asian and Black transgender persons had the lowest rates of FDA-MAUDs (0%; 4.3%, [1.8-8.5], respectively), whereas American Indian/Alaskan Native transgender patients had the highest (33.3%, [2.5-64.1]). Similar patterns were observed for any MAUDs, with higher rates overall.

Conclusions: Substantial variation exists in MAUD prescribing, with marginalized veterans disproportionately receiving MAUDs at lower and higher rates than average. Implementation and quality improvement efforts are needed to improve MAUD prescribing practices and reduce disparities.

目的:建议酒精使用障碍(MAUDs)患者服用治疗酒精使用障碍的药物,但这些药物的处方量不足。根据少数群体压力和交叉性理论,具有多重社会经济边缘化身份的人(如黑人妇女)通常会遇到更多的护理障碍,健康状况也会更差。我们利用退伍军人健康管理局(Veterans Health Administration)的数据来评估联邦药物管理局(FDA)批准的MAUDs和所有有效的MAUDs在以下群体之间的差异:种族和民族身份、性别、变性身份及其交叉:在 2015 年 8 月 1 日至 2017 年 7 月 31 日期间的所有退伍军人健康管理局门诊患者中,在之前的 0-365 天内有记录的酒精筛查和国际疾病分类中的酒精使用障碍诊断(N = 308,238 例),我们估算了次年接受 FDA 批准的 MAUDs 和任何 MAUDs 的患病率和 95% 置信区间,并使用 χ2 或费雪精确检验对其进行比较。分析未经调整,以呈现真实的流行率和组间差异:MAUDs的总体流行率较低(FDA-MAUDs = 8.7%,任何MAUDs = 20.0%)。就性别而言,黑人男性的 FDA-MAUDs 感染率最低(7.3%,[7.1-7.5]),而美国印第安人/阿拉斯加原住民女性的感染率最高(18.4%,[13.8-23.0])。在变性人中,亚裔和黑人变性人的 FDA-MAUDs 感染率最低(分别为 0%;4.3%,[1.8-8.5]),而美国印第安人/阿拉斯加原住民变性人感染率最高(33.3%,[2.5-64.1])。任何一种MAUDs都有类似的模式,总体比例较高:结论:MAUDs 处方存在巨大差异,边缘化退伍军人接受 MAUDs 的比例过高,低于平均水平,也高于平均水平。需要开展实施和质量改进工作,以改善 MAUD 处方实践并减少差异。
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引用次数: 0
Revisiting Preaddiction. 重新审视 "先入为主"。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-08-10 DOI: 10.1097/ADM.0000000000001357
Shannon C Miller, Sharon Levy, Andrew J Saxon, Jeanette M Tetrault, Richard N Rosenthal, Sarah Wakeman, Frank Vocci

Abstract: The directors of the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism have proposed new efforts to enable earlier identification and intervention for harmful substance use and its consequences. As editors of The ASAM Principles of Addiction Medicine, we fully support this goal. The word "preaddiction" has been suggested as a diagnostic label to describe individuals who would be targeted for early intervention. In this commentary, we offer that "unhealthy substance use" would be a better descriptor than "preaddiction" and review several potential barriers to be addressed in order to maximize the impact of introducing this new paradigm.

摘要:美国国家药物滥用研究所(National Institute on Drug Abuse)和美国国家酒精滥用与酗酒研究所(National Institute on Alcohol Abuse and Alcoholism)的所长们提出了新的努力方向,以便更早地识别和干预有害物质的使用及其后果。作为《ASAM成瘾医学原则》的编辑,我们完全支持这一目标。有人建议将 "成瘾前期"(pre-addiction)作为诊断标签,用来描述那些将成为早期干预目标的个体。在这篇评论中,我们认为 "不健康的药物使用 "比 "成瘾前 "更适合描述,并回顾了几个需要解决的潜在障碍,以便最大限度地发挥引入这一新模式的影响。
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引用次数: 0
Early Long-Acting Buprenorphine for Opioid Use Disorder in the Setting of Acute Pain. 早期长效丁丙诺啡治疗急性疼痛情况下的阿片类药物使用障碍。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-05-31 DOI: 10.1097/ADM.0000000000001333
Mason Schindle, Landon Berger
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引用次数: 0
Parosmia Is Positively Associated With Problematic Drinking, as Is Phantosmia With Depressive Symptoms. 幻觉与问题性饮酒呈正相关,幻觉与抑郁症状也呈正相关。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-05-22 DOI: 10.1097/ADM.0000000000001332
Khushbu Agarwal, Jeremy W Luk, Bethany L Stangl, Melanie L Schwandt, Reza Momenan, David Goldman, Nancy Diazgranados, David A Kareken, Lorenzo Leggio, Vijay A Ramchandani, Paule V Joseph

Objectives: Alcohol use disorder (AUD) is a global health problem with significant negative consequences, including preventable deaths. Although olfactory dysfunction is associated with chronic alcohol drinking, the relationship among specific types of olfactory deficits, depressive symptoms, and problematic drinking remains to be explored. Here, we examined the prevalence of olfactory distortion (parosmia) and hallucination (phantosmia) and assessed their associations with problematic drinking and depressive symptoms.

Methods: In April-June 2022, 250 participants across the spectrum of AUD were recruited for assessment in the National Institute on Alcohol Abuse and Alcoholism COVID-19 Pandemic Impact on Alcohol study. Surveys covered self-reported olfactory function, depressive symptoms, and problematic drinking, with key measures assessed, including the Alcohol Use Disorders Identification Test and the Patient Health Questionnaire. Predictors in the analysis included parosmia and phantosmia, with covariates comprising age, sex, socioeconomic status, race, ethnicity, COVID-19 infection status, and smoking status.

Results: Among 250 individuals, 5.2% experienced parosmia and 4.4% reported phantosmia. Parosmia was associated with higher Alcohol Use Disorders Identification Test scores (β = 7.14; 95% confidence interval = 3.31, 10.96; P < 0.001), whereas phantosmia was linked to higher Patient Health Questionnaire scores (β = 3.32; 95% confidence interval = 0.22, 6.42; P = 0.03). These associations persisted in both the full sample and the subset of participants without COVID-19.

Conclusions: Our study highlights strong existing links among olfactory deficits, problem drinking, and depressive symptoms, underscoring the need to assess smell impairments in clinical settings. Future research should explore these connections further to develop new treatments for individuals with AUD and depression.

目标:酒精使用障碍(AUD)是一个全球性的健康问题,具有严重的负面影响,包括可预防的死亡。虽然嗅觉功能障碍与长期饮酒有关,但特定类型的嗅觉障碍、抑郁症状和问题性饮酒之间的关系仍有待探讨。在此,我们研究了嗅觉失真(parosmia)和幻觉(phantosmia)的发生率,并评估了它们与问题性饮酒和抑郁症状之间的关系:2022年4月至6月,美国国家酒精滥用和酒精中毒研究所(National Institute on Alcohol Abuse and Aloholism COVID-19 Pandemic Impact on Alcohol)招募了250名不同程度的AUD参与者进行评估。调查内容包括自我报告的嗅觉功能、抑郁症状和问题性饮酒,主要评估指标包括酒精使用障碍鉴定测试和患者健康问卷。分析中的预测因素包括副嗅和幻嗅,协变量包括年龄、性别、社会经济地位、种族、民族、COVID-19 感染状况和吸烟状况:结果:在 250 人中,5.2% 的人有肤浅感觉,4.4% 的人有幻觉。嗜酒与较高的酒精使用障碍鉴定测试得分相关(β = 7.14;95% 置信区间 = 3.31,10.96;P < 0.001),而幻视与较高的患者健康问卷得分相关(β = 3.32;95% 置信区间 = 0.22,6.42;P = 0.03)。这些关联在全样本和无 COVID-19 的参与者子集中均持续存在:我们的研究强调了嗅觉障碍、问题饮酒和抑郁症状之间的密切联系,突出了在临床环境中评估嗅觉障碍的必要性。未来的研究应进一步探索这些联系,以便为患有 AUD 和抑郁症的人开发新的治疗方法。
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引用次数: 0
Comparison of Treatment Receipt and Hospitalization Among Patients With Stimulant Use Disorder and/or Opioid Use Disorder in the Veterans Health Administration. 退伍军人健康管理局中的兴奋剂使用障碍和/或阿片类药物使用障碍患者接受治疗和住院情况的比较。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-06-03 DOI: 10.1097/ADM.0000000000001329
Madeline C Frost, Lara N Coughlin, Lan Zhang, Lewei Allison Lin

Objectives: Stimulant use is a growing problem, but little is known about service utilization among patients with stimulant use disorder (StUD). In the context of the overdose crisis, much research has focused on patients with opioid use disorder (OUD). It is unclear how the characteristics, treatment receipt, and hospitalization of patients with StUD differ from patients with OUD.

Methods: Electronic health record data were extracted for national Veterans Health Administration patients with a visit from March 1, 2020, to February 28, 2021 with StUD and/or OUD (N = 132,273). We compared patients with StUD without OUD to those with (1) co-occurring StUD + OUD and (2) OUD without StUD. Patient characteristics, substance use disorder treatment, and hospitalizations in the year following patients' first study period visit were descriptively compared. Treatment and hospitalization were also compared in adjusted regression models.

Results: Compared with patients with OUD + StUD, those with StUD without OUD were less likely to receive outpatient (adjusted odds ratio [aOR] 0.49, 95% confidence interval [CI] 0.47-0.50) or any treatment (aOR 0.47, 95% CI 0.46-0.49). Compared with patients with OUD without StUD, those with StUD without OUD were less likely to receive outpatient (aOR 0.51, 95% CI 0.49-0.52) or any treatment (aOR 0.56, 95% CI 0.54-0.58) and more likely to receive residential treatment (aOR 2.18, 95% 2.05-2.30) and to be hospitalized (aOR 1.62, 95% 1.56-1.69).

Conclusions: Patients with StUD may be less likely to receive treatment and more likely to be hospitalized than patients with OUD. Efforts focused on mitigating hospitalization and increasing treatment receipt for patients with StUD are needed.

目的:使用兴奋剂是一个日益严重的问题,但人们对兴奋剂使用障碍(StUD)患者的服务利用情况知之甚少。在用药过量危机的背景下,许多研究都集中在阿片类药物使用障碍(OUD)患者身上。目前还不清楚 StUD 患者与 OUD 患者在特征、接受治疗和住院治疗方面有何不同:提取了 2020 年 3 月 1 日至 2021 年 2 月 28 日期间就诊的全国退伍军人健康管理局 StUD 和/或 OUD 患者(N = 132,273 人)的电子健康记录数据。我们将没有 OUD 的 StUD 患者与 (1) 合并 StUD + OUD 和 (2) 没有 StUD 的 OUD 患者进行了比较。我们对患者的特征、药物使用障碍治疗以及患者首次就诊后一年内的住院情况进行了描述性比较。在调整回归模型中还对治疗和住院情况进行了比较:结果:与患有 OUD + StUD 的患者相比,患有 StUD 而未患有 OUD 的患者接受门诊治疗(调整赔率 [aOR] 0.49,95% 置信区间 [CI] 0.47-0.50)或任何治疗(aOR 0.47,95% CI 0.46-0.49)的可能性较低。与未患有 StUD 的 OUD 患者相比,患有 StUD 的 OUD 患者接受门诊治疗(aOR 0.51,95% CI 0.49-0.52)或任何治疗(aOR 0.56,95% CI 0.54-0.58)的可能性较低,而接受住院治疗(aOR 2.18,95% 2.05-2.30)和住院治疗(aOR 1.62,95% 1.56-1.69)的可能性较高:结论:与 OUD 患者相比,StUD 患者接受治疗的可能性更小,住院的可能性更大。有必要努力减少 StUD 患者住院治疗的情况,并增加其接受治疗的机会。
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引用次数: 0
Substance Use Disorder Care in Skilled Nursing Facilities: Characterizing Resident Experiences. 护理机构中的药物使用障碍护理:描述住院患者的经历。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-06-05 DOI: 10.1097/ADM.0000000000001318
Arianna Parkhideh, Kimberly J Beiting, Meredith Yang, A Justine Landi, Stacie Levine

Objectives: Patients with substance use disorder (SUD) may face many challenges when being cared for in skilled nursing facilities (SNFs), such as stigma and inadequate access to treatment. This study aims to learn from the perspectives of SNF residents with SUD.

Methods: Nineteen semistructured interviews were conducted at 5 SNFs in the Chicago Metropolitan Area. Additionally, Likert-type responses and substance use screening tests were collected. Qualitative data were analyzed using Dedoose version 9.0.107 (Sociocultural Research Consultants, LLC, Los Angeles, CA).

Results: Qualitative analyses identified 4 themes: (1) the SNF can be a positive site for recovery, (2) barriers to recovery in SNFs are variable, (3) lived experiences with SUD care and harm reduction are heterogeneous, and (4) the needs of residents with SUD encompass multiple domains. Results highlighted the variability of access to counseling and SUD treatment, as well as the prevalence of stigma, substance use, and overdose in SNFs. Results revealed the need for access to social work support, activities, counseling services, and improved staff knowledge of treating SUD.

Conclusions: SNF residents living with SUD experience variable quality of care and may have difficulty accessing counseling and medical treatments for SUD, depending on the available resources in the facility to which they were admitted. The quality of care for residents living with SUD requires further study as more patients with SUD require SNF care.

目标:在专业护理机构(SNFs)接受护理时,药物使用障碍(SUD)患者可能会面临许多挑战,例如污名化和治疗途径不足。本研究旨在从患有药物滥用性精神障碍的专业护理机构住院患者的角度了解他们的情况:在芝加哥大都会区的 5 家专业护理机构进行了 19 次半结构式访谈。此外,还收集了李克特类型的回答和药物使用筛查测试。定性数据使用 Dedoose 9.0.107 版(Sociocultural Research Consultants, LLC, Los Angeles, CA)进行分析:定性分析确定了 4 个主题:(1)SNF 可以成为积极的康复场所;(2)SNF 中的康复障碍各不相同;(3)在 SUD 护理和减低伤害方面的生活经验各不相同;以及(4)患有 SUD 的居民的需求涵盖多个领域。研究结果突显了获得咨询和 SUD 治疗方面的差异,以及在 SNF 中污名化、药物使用和用药过量的普遍性。结果表明,有必要提供社会工作支持、活动、咨询服务,并提高员工对治疗 SUD 的认识:患有药物滥用症的 SNF 住户所获得的护理质量参差不齐,他们可能难以获得药物滥用症的咨询和医疗服务,这取决于他们入住的护理机构的可用资源。随着越来越多的 SUD 患者需要 SNF 护理,需要对 SUD 居民的护理质量进行进一步研究。
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引用次数: 0
Sleep as an Important Target or Modifier in Alcohol Use Disorder Clinical Treatment: Example From a Recent Gabapentin Randomized Clinical Trial. 睡眠是酒精使用障碍临床治疗的重要目标或调节因素:以最近的加巴喷丁随机临床试验为例。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-05-31 DOI: 10.1097/ADM.0000000000001316
Michaela Hoffman, Konstantin Voronin, Sarah W Book, James Prisciandaro, Emily J Bristol, Raymond F Anton

Objectives: Alcohol consumption affects sleep both in healthy populations and in patients with alcohol use disorder (AUD). However, sleep has typically not been considered within AUD pharmacotherapy trials. We used data from a completed gabapentin clinical treatment trial to explore the medication's effect on patient-rated insomnia measured by a standard insomnia rating (Insomnia Severity Index [ISI]) and whether this influenced gabapentin's effects on alcohol consumption.

Methods: This study included 90 individuals with current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition AUD criteria reporting current or past alcohol withdrawal. Participants were assigned to placebo or gabapentin (up to 1200 mg/day) for a 16-week randomized controlled trial with percent heavy drinking days (PHDD) and percent abstinent days (PDA) as outcomes. Utilizing mixed-effects models, this study assessed medication effects on ISI over the trial. We then examined the interaction of baseline ISI and medication on drinking. Finally, given our previous finding of alcohol withdrawal influencing gabapentin efficacy, we added change in ISI as a potential "moderator" of the interaction of medication effects and alcohol withdrawal on drinking.

Results: Sleep (ISI) improved more in those treated with gabapentin (60.6% reduction) compared with placebo (37.8% reduction; P = 0.013). Higher baseline ISI predicted drinking in gabapentin-treated individuals (lower PHDD [ P = 0.026] and higher (PDA [ P = 0.047]). ISI was an independent predictor of PHDD decrease and PDA increase ( P < 0.001; P = 0.002), but this did not significantly moderate gabapentin's effectiveness.

Conclusions: Although gabapentin positively impacts both alcohol use and sleep, its effect on drinking is not fully dependent on sleep improvement, implying a direct biological mechanism on alcohol use.

目标:无论是健康人群还是酒精使用障碍(AUD)患者,饮酒都会影响睡眠。然而,酒精中毒性障碍药物治疗试验通常不考虑睡眠问题。我们利用一项已完成的加巴喷丁临床治疗试验的数据,探讨了该药物对以标准失眠评分(失眠严重程度指数[ISI])衡量的患者失眠的影响,以及这是否会影响加巴喷丁对饮酒的影响:这项研究包括 90 名目前符合《精神疾病诊断与统计手册》第五版 AUD 标准并报告当前或过去曾戒酒的患者。在为期 16 周的随机对照试验中,参与者被分配到安慰剂或加巴喷丁(最多 1200 毫克/天),并以大量饮酒天数百分比(PHDD)和戒酒天数百分比(PDA)作为试验结果。本研究利用混合效应模型评估了试验期间药物对 ISI 的影响。然后,我们研究了基线 ISI 和药物对饮酒的交互作用。最后,鉴于我们之前发现酒精戒断会影响加巴喷丁的疗效,我们增加了ISI的变化,作为药物作用和酒精戒断对饮酒的交互作用的潜在 "调节因子":与安慰剂(减少 37.8%;P = 0.013)相比,接受加巴喷丁治疗者的睡眠(ISI)改善幅度更大(减少 60.6%)。较高的基线 ISI 预测了接受加巴喷丁治疗者的饮酒情况(较低的 PHDD [P = 0.026] 和较高的 PDA [P = 0.047])。ISI是PHD降低和PDA升高的独立预测因子(P < 0.001; P = 0.002),但这并没有显著降低加巴喷丁的疗效:结论:虽然加巴喷丁对饮酒和睡眠都有积极影响,但其对饮酒的影响并不完全依赖于睡眠的改善,这意味着其对饮酒有直接的生物学机制。
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引用次数: 0
Kava Withdrawal Treated With Phenobarbital-A Case Report and Literature Review. 用苯巴比妥治疗卡瓦戒断--病例报告和文献综述。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-05-31 DOI: 10.1097/ADM.0000000000001314
Ryan Michael Cassidy, Kalli Burdick, Trevor Anesi, Daniel Daunis

Abstract: Kava consumption is a traditional practice in Polynesian and Micronesian cultures. It has recently gained popularity in the United States for therapeutic and recreational use. We report the following case. A man presented to the emergency department after a fall while intoxicated on kava. He was medically admitted for altered mental status, facial and clavicle fractures, and hyponatremia. Psychiatry was consulted for management of delirium. On interview, he reported consuming escalating amounts of kava for weeks despite attempts to stop. He was diagnosed with acute kava withdrawal with hyperactive delirium, treated with phenobarbital load (860 mg) and taper (390 mg). Continuous dexmedetomidine drip to hospital day 3 treated sympathetic activation and breakthrough agitation. By day 4, his delirium resolved and remained in remission until discharge. We performed a systematic review for reports of kava withdrawal, returning 9 studies. Eight assessed withdrawal symptoms after cessation of a low controlled dose of kava extract with no symptoms noted. One reported a case series of heavy kava users with seizure-like events. No publications discussed treatment of kava withdrawal. To our knowledge, this is the first publication to describe kava withdrawal syndrome and its effective treatment with phenobarbital.

摘要:食用卡瓦是波利尼西亚和密克罗尼西亚文化中的一种传统习俗。最近,卡瓦在美国越来越流行,用于治疗和娱乐。我们报告了以下病例。一名男子在服用卡瓦酒后摔倒,随后被送往急诊科。他因精神状态改变、面部和锁骨骨折以及低钠血症而入院。精神科对他进行了谵妄治疗。在面谈时,他说尽管曾试图停止服用卡瓦,但连续数周都在不断增加卡瓦的摄入量。他被诊断为急性卡瓦戒断伴多动谵妄,接受了苯巴比妥负荷(860 毫克)和减量(390 毫克)治疗。在住院第 3 天,连续使用右美托咪定滴注治疗交感神经激活和突破性躁动。第 4 天,他的谵妄症状得到缓解,直到出院。我们对有关卡瓦戒断的报告进行了系统回顾,共返回了 9 项研究。其中 8 项研究评估了停用低控制剂量卡瓦提取物后的戒断症状,结果未发现任何症状。一项研究报告了大量卡瓦使用者出现癫痫发作的系列病例。没有任何文献讨论了卡瓦戒断的治疗方法。据我们所知,这是第一份描述卡瓦戒断综合征及其苯巴比妥有效治疗方法的出版物。
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引用次数: 0
Provider Perceptions Toward Extended-Release Buprenorphine for Treatment of Opioid Use Disorder. 提供者对用于治疗阿片类药物使用障碍的缓释丁丙诺啡的看法。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-05-31 DOI: 10.1097/ADM.0000000000001320
India A Reddy, Carolyn M Audet, Thomas J Reese, Grayson Peek, David Marcovitz

Objectives: The persistence of the opioid crisis and the proliferation of synthetic fentanyl have heightened the demand for the implementation of novel delivery mechanisms of pharmacotherapy for the treatment of opioid use disorder, including injectable extended-release buprenorphine (buprenorphine-ER). The purpose of this study was to understand provider-level barriers to prescribing buprenorphine in order to facilitate targeted strategies to improve implementation for patients who would benefit from this novel formulation.

Methods: Using an interview template adapted from the Consolidated Framework for Implementation Research (CFIR), we conducted structured focus group interviews with 20 providers in an outpatient addiction clinic across 4 sessions to assess providers' perceptions of buprenorphine-ER. Ninety-four unique comments were identified and deductively coded using standardized CFIR constructs.

Results: Providers expressed mixed receptivity and confidence in using buprenorphine-ER. Although providers could identify a number of theoretical advantages to the injectable formulation over sublingual buprenorphine, many expressed reservations about using it due to inexperience, negative patient experiences, uncertainties about patient candidacy, cost, and logistical constraints.

Conclusions: Provider concerns about buprenorphine-ER may limit utilization. Some concerns may be mitigated through improved education, research, and logistical support. Given the putative benefits of buprenorphine-ER, future research should target barriers to implementation, in part based on hypotheses generated by these findings.

目标:阿片类药物危机的持续存在和合成芬太尼的扩散提高了对新型给药机制治疗阿片类药物使用障碍的需求,其中包括注射用缓释丁丙诺啡(buprenorphine-ER)。本研究旨在了解医疗服务提供者在开具丁丙诺啡处方时遇到的障碍,以便采取有针对性的策略,改善这种新型制剂对患者的治疗效果:我们使用改编自实施研究综合框架(CFIR)的访谈模板,对一家戒毒门诊的 20 名医疗服务提供者进行了结构化焦点小组访谈,共分 4 次进行,以评估医疗服务提供者对丁丙诺啡-ER 的看法。我们确定了 94 条独特的意见,并使用标准化的 CFIR 结构对其进行了演绎编码:结果:医疗服务提供者对使用丁丙诺啡-ER的接受程度和信心参差不齐。尽管医疗服务提供者可以发现注射制剂与丁丙诺啡舌下含服相比有许多理论上的优势,但许多人表示由于缺乏经验、病人的负面经历、不确定病人是否适合、成本和后勤限制等原因而对使用丁丙诺啡-ER持保留态度:结论:提供者对丁丙诺啡-ER 的担忧可能会限制其使用。结论:医疗服务提供者对丁丙诺啡-ER 的顾虑可能会限制其使用。通过加强教育、研究和后勤支持,可以减轻一些顾虑。鉴于丁丙诺啡-ER 可能带来的益处,未来的研究应针对实施障碍,部分研究应基于这些发现所提出的假设。
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引用次数: 0
Induction to Methadone 80 mg in the First Week of Treatment of Patients Who Use Fentanyl: A Case Series From an Outpatient Opioid Treatment Program. 使用芬太尼的患者在治疗第一周开始使用美沙酮 80 毫克:一个阿片类药物门诊治疗项目的病例系列。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-08-15 DOI: 10.1097/ADM.0000000000001362
Scott Steiger, Caravella McCuistian, Leslie W Suen, Brad Shapiro, D Andrew Tompkins, Alexander R Bazazi

Objectives: Current guidelines for methadone titration may unnecessarily delay reaching effective doses for patients using fentanyl, resulting in an increased risk of ongoing fentanyl use, dissatisfaction with treatment, and early dropout. Development and evaluation of rapid methadone induction protocols may improve treatment for patients using fentanyl.

Methods: Retrospective chart review was conducted for patients admitted in 2022 to a single licensed opioid treatment program (OTP) where a rapid induction protocol provides methadone 40 mg on day 1, 60 mg on day 2, and 80 mg on day 3 to patients using fentanyl <65 years old without significant medical comorbidities. The primary feasibility outcome was completion of the protocol, defined by receipt of methadone dose 80 mg or more on treatment day 7. The primary safety outcomes were oversedation, nonfatal overdose, and death. A secondary outcome was retention in treatment at 30 days.

Results: Rapid induction was ordered for 93 patients and completed by 65 (70%). Average dose on day 7 for patients who completed was 89 mg (SD 9.5 mg) versus 49 mg (SD 14.0 mg) for those who did not. No episodes of oversedation, nonfatal overdose, or death were observed. At 30 days, 85% of the patients who had the rapid protocol ordered (79/93) were retained, with 88% (57/65) who completed the protocol retained versus 79% (22/28) who did not complete (OR 1.9, 95% CI 0.6-6.2).

Conclusions: Rapid induction to methadone 80 mg by day 7 was feasible for outpatients using fentanyl in this study at a single OTP. No significant safety events were identified.

目标:目前的美沙酮滴定指南可能会不必要地延迟使用芬太尼的患者达到有效剂量的时间,从而导致持续使用芬太尼、对治疗不满意以及过早退出治疗的风险增加。制定和评估美沙酮快速诱导方案可改善对使用芬太尼患者的治疗:方法: 对 2022 年入住一家获得许可的阿片类药物治疗项目(OTP)的患者进行了回顾性病历审查,该项目采用快速诱导方案,在第 1 天为使用芬太尼的患者提供 40 毫克、第 2 天 60 毫克、第 3 天 80 毫克的美沙酮:93 名患者接受了快速诱导,其中 65 人(70%)完成了快速诱导。完成诱导的患者第 7 天的平均剂量为 89 毫克(标清 9.5 毫克),而未完成诱导的患者为 49 毫克(标清 14.0 毫克)。没有观察到过度镇静、非致命性用药过量或死亡事件。30 天后,85% 的患者(79/93)接受了快速方案治疗,其中 88% 的患者(57/65)完成了方案治疗,而 79% 的患者(22/28)未完成方案治疗(OR 1.9,95% CI 0.6-6.2):结论:在这项研究中,对于在单个 OTP 使用芬太尼的门诊患者来说,在第 7 天前快速诱导服用美沙酮 80 毫克是可行的。未发现重大安全事件。
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Journal of Addiction Medicine
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