Journal of Addiction Medicine最新文献

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.

Objectives: Loneliness is a pervasive public health problem, especially among individuals with problematic substance use (PSU). To date, however, scarce research has examined the prevalence and correlates of loneliness in vulnerable segments of the population, such as US military veterans.

Methods: Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of US veterans. The Three-Item Loneliness Scale was used to assess clinically significant loneliness (≥6). Multivariable logistic regression and relative importance analyses were conducted to identify correlates of loneliness in 593 veterans with PSU.

Results: Nearly half of US veterans with PSU (47.4%) reported clinically significant loneliness. In a multivariable analysis, loneliness was independently associated with being unmarried/unpartnered, greater current psychological distress (depressive and posttraumatic stress symptoms), lifetime suicide attempt, and physical disability, smaller social network size, and lower levels of purpose in life and optimism. In a relative importance analysis, major depressive and posttraumatic stress symptoms (35.4%), smaller social network size (16.7%), and lower purpose in life (15.0%) and optimism (13.6%) explained the majority of the variance in loneliness. Purpose in life also moderated the link between depressive symptoms and loneliness: among veterans with depressive symptoms, those with higher purpose in life had a lower likelihood of loneliness.

Conclusions: Nearly half of US veterans with PSU report significant loneliness. Prevention and treatment strategies that address psychological distress, foster meaningful social connections, and enhance veterans' sense of purpose may help mitigate the burden of loneliness in this population.

Objectives: Opioid overdose deaths among youth (those 24 y of age and younger) significantly increased in recent years despite a decline in the overall prevalence of substance use. The 2 key objectives of this study were (1) to identify and summarize existing youth overdose prevention interventions and (2) to delineate what is needed to refine, implement, and disseminate this critical information to prevent youth overdose.

Methods: Using the adapted PRISMA Checklist for Scoping Reviews, we searched PubMed, Embase, and Web of Science for peer-reviewed descriptions of youth overdose prevention education interventions from 2010 to 2023. We searched US government institutions and news outlets to identify youth overdose prevention interventions in the gray literature. We synthesized key characteristics of programs.

Results: We identified a total of 16 unique programs that fit our inclusion criteria, 9 from the peer-reviewed literature and 7 from the gray literature. Half of the studies (n=8) described overdose prevention interventions with some evaluation component that indicated an improvement in overdose prevention knowledge. However, most programs do not have evaluation data available on whether they are effective in reducing opioid overdoses.

Conclusions: In this scoping review, we identified a small number of youth-specific overdose prevention interventions. There is an urgent need to develop, implement, and test interventions that address gaps in the youth overdose prevention landscape.

Objectives: Despite the efficacy of medications for opioid use disorder (MOUD), return to illegal opioid use remains common. Cannabidiol (CBD) may reduce craving and improve outcomes. This pilot trial evaluated the safety and preliminary efficacy of CBD as adjunctive therapy to buprenorphine in an inpatient setting.

Methods: Adults (≥18 years), who met DSM-5 criteria for opioid use disorder and were admitted to an inpatient addiction treatment center between May 2022 and March 2024, were enrolled in a randomized, double-blind, placebo-controlled trial. Participants received oral CBD (600 mg/day) or placebo for 28 days alongside buprenorphine. Primary outcomes were safety and tolerability, monitored via adverse events and clinical laboratory tests. Efficacy was assessed as effects on opioid craving and withdrawal, and affective symptoms (anxiety, negative affect, and positive affect).

Results: Of 35 enrolled participants, 30 received at least one dose of study medication (CBD: n=18; placebo: n=12) and were included in the safety analysis. CBD was well tolerated; no serious adverse events or deaths occurred. Gastrointestinal symptoms occurred in both groups and were the most common adverse event. No significant pharmacokinetic interaction was observed between CBD and buprenorphine. Both groups showed reductions in opioid craving and negative affect over time, with mixed group-by time interactions (most favoring placebo, but cue-induced craving trending toward greater improvement with CBD).

Conclusions: Adjunctive CBD was safe and well tolerated in combination with buprenorphine. No clear advantage over placebo was observed. Larger trials are needed to determine clinical utility in MOUD treatment.

Objectives: We examine temporal trends in methamphetamine-related mortality across the 9 US Census Divisions from 2005 to 2023.

Methods: We leveraged data from the CDC WONDER multiple causes of death database to identify methamphetamine-related deaths among US residents aged older than or equal to 15 years from 2005 to 2023. Mortality rates were calculated per 100,000 population and stratified by Census Division. We used Joinpoint regression to estimate annual percent changes in mortality and identify statistically significant inflection points in mortality rates over time.

Results: From 2005 to 2023, methamphetamine-related deaths increased across all divisions, with the highest cumulative deaths in the Pacific, South Atlantic, and Mountain divisions. Mortality rates were lowest in New England and Middle Atlantic but grew rapidly in recent years. Several divisions demonstrated sharp increases during the 2010s (eg, East North Central and East South Central), followed by stabilization in some regions after 2021. By 2023, the highest mortality rates were observed in the Pacific, East South Central, and Mountain divisions.

Conclusions: Methamphetamine-related mortality has intensified nationally, with pronounced geographic variation in timing and magnitude. Recent indications of stabilization in some divisions have occurred at historically high levels. These patterns underscore the need for regionally tailored harm reduction, treatment, and prevention strategies.

Background: The contamination of non-opioid drugs with fentanyl presents a risk at US music festivals, where environmental factors exacerbate overdose-related risks. Naloxone is an opioid antagonist medication that can be used by festival attendees to reverse opioid overdose.

Methods: We conducted a field survey at a 4-day Colorado music festival (N=227) to characterize attendees' prior experience with naloxone and to investigate whether attendees carry naloxone with them in both festival and non-festival settings. We also assessed attendees' level of confidence in responding to an overdose with naloxone and asked attendees to report any barriers they experienced to carrying naloxone at festivals.

Results: Prevalence of carrying naloxone in any context was 55.5% (N=126). Festival carriage was more common than carriage in non-festival settings, with 55.1% reporting at least "sometimes" carrying at festivals compared with 32.7% outside festival settings. In addition, 8.4% had used naloxone to respond to an overdose, and 4.4% had personally been administered naloxone. Among participants who reported carrying naloxone, 65.3% had never received training. Regarding confidence in overdose response, 29.9% of naloxone carriers reported being only "slightly confident" or "not at all confident." Barriers included access, festival restrictions and legal concerns, lack of education, training, and awareness, convenience factors, and perceived responsibility of carrying naloxone.

Conclusions: Findings highlight the need for increased naloxone access, training, and awareness among festival attendees. Actionable recommendations include free or low-cost naloxone distribution, on-site training, and transparent entry policies to reduce barriers and promote overdose response as a community responsibility.

Buprenorphine is a prescribed controlled substance that effectively treats opioid use disorder. Fear of federal prosecution contributes to buprenorphine's under-prescribing. Such fears may be heightened in jurisdictions that follow a "disjunctive standard" of prosecution under the federal Controlled Substances Act (CSA). In jurisdictions with a "disjunctive standard," clinicians can be prosecuted for either (a) lack of a legitimate medical practice (eg, to improve the health of the patient) or (b) deviating from the "usual" course of professional practice. Problematically, the disjunctive standard could allow for the prosecution of clinicians even when no harm results and the clinician's deviation from usual practice was intended to improve the patient's health. This Commentary argues that the "conjunctive standard" is more approrpiate than the "disjunctive standard" for prosecution under the CSA. The conjunctive standard would require prosecutors to additionally prove the clinician lacked a legitimate medical purpose when prescribing. Therefore, federal prosecutors could focus on truly bad actors-those who clearly lack a legitimate medical purpose, such as those prescribing merely for profit to patients without health conditions that would benefit from the prescription. Ultimately, by decreasing fears of prosecution, a conjunctive standard might contribute to an increased buprenorphine treatment supply during the ongoing overdose crisis.