Journal of Addiction Medicine最新文献

Objectives: To compare the effects of different interventions for maintaining smoking abstinence in postpartum individuals.

Methods: We searched PubMed, EMBASE, CENTRAL, CINAHL, PsycINFO, and ProQuest up to February 2024. Randomized controlled trials (RCTs) that studied the effects of any interventions on maintaining smoking abstinence in postpartum individuals who quit smoking before delivery were included. A frequentist network meta-analysis using a random-effect model was performed to compare the efficacy of interventions cognitive behavioral therapy (CBT) and motivational interviewing (MI). The surface under the cumulative ranking curve was used to rank the intervention effects. The GRADE approach assessed evidence certainty.

Results: We included 11 studies from 10 RCTs (3365 participants). Comparisons with standard care revealed that CBT [relative risk (RR) = 1.03; 95% CI: 0.86, 1.19], CBT-MI (RR = 1.41; 95% CI: 0.87, 2.27), and MI (RR = 1.06; 95% CI: 0.90, 1.24) failed to maintain smoking abstinence at 12 months postpartum. The absolute differences were imprecise, with wide CIs encompassing both potential increases and decreases in smoking abstinence: 7 more per 1000 (95% CI: -31, 43) for CBT, 92 more per 1000 (95% CI: -29, 284) for CBT-MI, and 13 more per 1000 (95% CI: -22, 54) for MI, all with moderate certainty evidence. Subgroup analyses for follow-up periods of <12 months indicated that CBT-MI (RR = 1.67; 95% CI: 1.08, 2.60) and MI (RR = 1.16; 95% CI: 1.01, 1.33) may improve the maintenance of smoking abstinence over the short term.

Conclusions: CBT-MI and MI appear promising in improving the maintenance of smoking abstinence within 12 months postpartum, though further research is needed to enhance long-term abstinence.

Background: Drug use-related stigma amplifies the harms faced by people who use drugs (PWUD). Media often dehumanizes PWUD, particularly those using xylazine, a veterinary sedative and opioid adulterant, by labeling them with terms like "zombie." This perpetuates discrimination and stigma, distracting from the public health crisis. To assess this, we conducted a content analysis to quantify the prevalence of stigmatizing terms like "zombie" and related imagery in xylazine-related web-based media.

Methods: We analyzed web-based news media reporting on xylazine from October 1, 2022, to September 30, 2023, using Google News. "Stigmatizing term" was defined as the use of the word "zombie," and "stigmatizing imagery" was defined as an embedded image of nonsterile or discarded drug use supplies, visibly intoxicated individuals, unhoused persons, or necrotic wounds. Two trained reviewers followed a standardized protocol to examine article titles, text, and images. Articles using stigmatizing term and/or imagery were coded as stigmatizing; and data were aggregated by month to assess any temporal changes in relation to federal xylazine alerts.

Results: In a 12-month period, 910 news articles mentioned xylazine, 23.9% featured stigmatizing content, of which 57% (124/217) used "zombie" only, 26.3% (57/217) had stigmatizing imagery only, and 16.6% (36/217) had both. Stigmatizing articles peaked in March and July 2023, coinciding with federal alerts about xylazine in the opioid supply. Of the 601 articles with embedded images, 15% had stigmatizing imagery.

Conclusions: Stigmatizing content in web-based news media about xylazine continues to proliferate, highlighting the need for more efforts to challenge these narratives.

Objectives: Prior studies have documented rising rates of referrals to skilled nursing facilities (SNFs) for hospitalized patients with opioid use disorder (OUD). However, the care transitions and survival of people with OUD who enter SNFs have not been evaluated. We examined differences in hospital readmissions and mortality between individuals with and without OUD discharged to SNFs.

Methods: Using 2016-2020 100% Medicare inpatient claims, we identified acute hospitalizations with discharge to SNFs. We matched each beneficiary with OUD with up to 5 without OUD based on age, sex, low-income subsidy status, and residential county. Outcomes were hospital readmissions and all-cause mortality within 180 days following hospital discharge. Inverse-probability weighting (IPW) covariates included demographics, state of residence, year of SNF admission, intensive care use, Gagne comorbidity score, and conditions associated with SNF admission or that disproportionately affect people with OUD. Unadjusted and IPW-adjusted risk differences were calculated.

Results: There were 30,922 fee-for-service beneficiaries with OUD and 137,454 matched beneficiaries without OUD, with a mean age of ~71 years. Of those with OUD, 5.3% had evidence of receiving medications for OUD. In unadjusted analyses, beneficiaries with OUD had higher readmission risk (44.5% vs 27.9%) and comparable mortality risk (17.8% vs 16.5%) relative to beneficiaries without OUD. After adjustment through IPW, there were minimal differences in mortality; however, beneficiaries with OUD remained at a greater risk for readmissions than those without OUD.

Conclusions: Hospital readmissions were dramatically higher among Medicare beneficiaries with OUD than those without OUD, suggesting that important gaps in OUD care exist in SNFs.

Objective: This study investigated community bystander presence and naloxone administrations by location type during accidental fatal opioid-involved overdoses in Rhode Island.

Methods: We analyzed accidental opioid-involved overdose fatalities among adults in Rhode Island between 2020 and 2022, obtained from the State's Unintentional Drug Overdose Reporting System (SUDORS). Variables of interest included location of death, community bystander presence, and naloxone administration. We calculated the proportion of overdose deaths where community bystanders were present and naloxone was administered. Using multivariable Poisson regression with robust standard errors, we identified statistically significant ( P <0.05) correlates of naloxone administration by any responder during fatal overdose events.

Results: Of 1084 opioid-involved overdose fatalities analyzed, bystanders were present in 44.7% of cases. Most fatal overdoses occurred in housing environments (84.5%), where the widest disparity between bystander presence (61.1%) and naloxone administration (29.0%) was observed. In multivariable analysis, naloxone was more likely to be administered in overdoses occurring in outdoor spaces (adjusted prevalence ratio [adjPR] = 1.50, 95% CI: 1.07-2.02), hotels/motels (adjPR=1.57, CI: 1.12-2.21), businesses (adjPR=1.89, CI: 1.14-3.12), and motor vehicles (adjPR=2.00, CI: 1.18-3.38), relative to overdoses in housing environments. Naloxone administration clustered in younger decedents (10-year decrements: adjPR=1.10, CI: 1.01-1.20) and persons experiencing homelessness (adjPR=1.67, CI: 1.23-2.26).

Conclusion: Fatal opioid-involved overdoses in housing environments were more likely to have community bystanders present but less likely to have responders intervene with naloxone. Equipping families and cohabitants with the tools, resources, and self-efficacy for earlier, timelier naloxone intervention may address overdose fatalities in Rhode Island.

Objectives: Individuals receiving treatment for opioid use disorder (OUD) represent a key population for hepatitis C diagnosis and treatment. Integrating hepatitis C treatment within telemedicine addiction care offers a new opportunity to reach this population.

Methods: We conducted a chart review of individuals prescribed hepatitis C treatment within a telemedicine treatment program for OUD. Patient medical records were reviewed to extract details on demographics, hepatitis C history, medication prior authorization, initiation and completion, and viral clearance testing.

Results: Sixty-three treatment-naïve patients were prescribed antiviral therapy for hepatitis C by their addiction treatment medical providers with a median age of 36, 41% of patients identifying as female, and 57% insured by Medicaid. Approximately 1 in 5 patients were denied prior authorization for antiviral therapy. Among 63 patients initially prescribed medication, 33 (52%) completed treatment.

Conclusions: Telehealth programs for addiction are a feasible platform for expanding hepatitis C treatment to patients with OUD. Policies to reduce restrictions on antiviral coverage by payers could increase medication access through telehealth.

Introduction: Xylazine is a veterinary anesthetic increasingly present alongside illicit fentanyl in the United States and Canada, presenting novel health risks. Although xylazine remains less common in the Western US, Mexican border cities serve as key trafficking hubs and may have a higher prevalence of novel substances, but surveillance there has been limited.

Methods: We examined deidentified records from the Prevencasa free clinic in Tijuana, describing urine and paraphernalia testing from patients reporting using illicit opioids within the past 24 hours. Xylazine (Wisebatch and Safelife brands), fentanyl, opiate, methamphetamine, amphetamine, benzodiazepine, and nitazene test strips were used to test urine and paraphernalia samples. Paraphernalia samples were also analyzed with mass spectrometry.

Results: Of n=23 participants providing urine and paraphernalia samples concurrently, 100%, 91.3%, and 69.6% reported using China White/fentanyl, methamphetamine, and tar heroin, respectively. The mean age was 41.7 years, 95.7% were male, 65.2% were unhoused, and 30.4% had skin wounds currently. Xylazine positivity in urine for the 2 strip types used was 82.6% and 65.2%. For paraphernalia testing, the xylazine positivity was 65.2% and 47.8%. Confirmatory testing of paraphernalia samples by mass spectrometry indicated a 52.2% xylazine positivity, as well as fentanyl (73.9%), fluorofentanyl (30.4%), tramadol (30.4%), and lidocaine (30.4%). Mass spectrometry suggested lidocaine triggered n=3 and n=0 false positives among the xylazine test strip types.

Discussion: Xylazine is present on the US-Mexico border, requiring public health intervention. High lidocaine positivity complicates the clinical detection of xylazine via testing strips. Routine urine testing for xylazine in clinical scenarios is likely feasible, yet confirmatory urine studies are needed.

Objectives: Ongoing high rates of opioid use and overdose death have prompted expansion of care options for people with substance use disorder (SUD), including medications for opioid use disorder (MOUD) and diverse forms of care linkage and support. The utilization of Certified Peer Recovery Supporters (CPRS) in the recovery field is an evidence-based practice to improve the continuum of care for SUD and has been increasingly incorporated into the recovery field. This study examines perceptions of MOUD among CPRS and how this shapes the collaborative provision of care within local treatment and recovery ecosystems.

Methods: Qualitative interviews were conducted with CPRS (n=22) who were recruited via snowball sampling. Eligible participants were above 18 years old and had CPRS certification and self-reported work experience in treatment ecosystems in Dayton, OH. Interviews were transcribed and uploaded to Taguette software for coding and analysis. Select codes were analyzed using Iterative Categorization for further thematic analysis and data interpretation. All 22 participants were included in the analysis.

Results: Three key findings pertaining to perceptions of MOUD among CPRS were identified, including stigma against MOUD within treatment and recovery ecosystems, the value of MOUD as treatment and harm reduction, and structural frustrations within the health care system. Participants expressed multiple, complex viewpoints surrounding the utilization of MOUD, specifically related to treatment, work environments, and health care settings.

Conclusions: Results indicate that while many CPRS believe MOUD to be a successful treatment, stigma and institutional mistrust remain as barriers to both collaboration with medical providers and utilization of MOUD.

Objectives: Psychedelics may be promising treatments for substance use disorders (SUD). This study aims to understand how individuals with alcohol use disorder (AUD), opioid use disorder (OUD), and psychiatric disorders perceive and experience psychedelics for both nonmedical and medical use.

Methods: Data for this cross-sectional survey study were collected from June 2023 to February 2024 at a large, tertiary hospital through the hospital's patient portal, inpatient floors, and flyers. English-speaking adults with AUD, OUD, and psychiatric disorders were recruited. The response rate was 1.9% and the cooperation rate was 13.7%. The survey collected participants' demographic information, substance use treatment and history, and perceived risks and harms associated with psychedelics and psychedelic treatment.

Results: Of 192 participants surveyed, 66% had previously tried psychedelics, 72.4% believed psychedelics could help patients with SUD or psychiatric disorders, and 69.8% said they would personally try psychedelic-assisted treatment for a SUD or psychiatric condition. Participants were significantly more likely to want to try psychedelic treatment for their own SUD or psychiatric disorder if they had previously used psilocybin (90.0% vs. 47.8%, P <0.001), MDMA (89.7% vs. 61.2%, P <0.001), or ketamine (100% vs. 65.7%, P =0.003). Participants against psychedelic treatment were significantly more likely to think that the risks associated with using a psychedelic included depression, anxiety, heart damage, brain damage, addiction, and more.

Conclusion: A majority of participants supported psychedelics as a treatment and would accept receiving psychedelics as a treatment. However, further safety trials and educational interventions to best understand the benefits and risks of psychedelic-assisted therapy need to be completed.

Background: Cannabis use among perinatal individuals has dramatically increased. Thus, it is crucial to understand postpartum individuals' experiences with cannabis use, particularly during breastfeeding, and desired postpartum interventions to improve the care and well-being of parents and their children. We aimed to understand motivations for postpartum cannabis use and desired interventions for new parents who frequently used cannabis in early pregnancy.

Methods: We conducted semistructured interviews from April to May 2022 with postpartum patients who were first-time parents and endorsed daily or weekly cannabis use during early pregnancy on a universally administered, self-reported screener at prenatal care entry in a large integrated health care system in Northern California. We analyzed the professionally transcribed interviews using thematic analysis.

Results: Our sample included 17 interviews with Black (n=4), Hispanic (n=4), and White (n=9) postpartum patients. Most participants (n=15) reported at least some postpartum cannabis use, two thirds of whom (n=10) reported use during breastfeeding. We identified 4 themes concerning postpartum cannabis use behaviors: (1) cannabis use to cope with mental health and physical pain postpartum, (2) minimal knowledge of cannabis risks with which to make decisions about postpartum use, (3) responsible cannabis use and concern about child's health and safety, and (4) desire for nonjudgmental postpartum supportive services to manage new parenthood.

Conclusions: Findings highlight the need for supportive services for new parents and education on cannabis use while breastfeeding. Health care settings should equip their perinatal care teams with information on how to discuss the current evidence and potential harms and provide appropriate counseling regarding postpartum cannabis use.