Journal of Addiction Medicine最新文献

Objectives: To assess patients' demographic factors associated with declination of recommended American Society of Addiction Medicine (ASAM) Continuum levels of care and analyze patients' self-reported reasons for declination.

Methods: This cross-sectional observational study examined data collected during clinical care delivery in a safety net health system's primary care setting for patients receiving medication treatment and recovery support services for opioid and/or alcohol use disorder (OUD, AUD). We evaluated intake assessments to identify recommended levels of care, acceptance or declination of the recommendation, and self-reported reasons for declination. We stratified the acceptance data by demographic factors and analyzed reasons for declination to identify themes.

Results: Of 1399 completed intakes, 42% declined all ASAM levels of care as a complement to medication and within-clinic recovery support services. Patients who identified as non-White, male, and/or 60 years or older were significantly more likely to decline all levels of care. Among the 125 patients who provided a documented reason for declining, 26% endorsed work, financial, or family obligations; 26% indicated a preference for alternative forms of psychosocial support; and 14% indicated possible interest in the future.

Conclusions: It is important for substance use disorder treatment providers and policymakers to understand the barriers patients face regarding engagement in treatment and reasons for the declination of services. Recognizing variations in care acceptance by demographic factors can help us understand common barriers and guide future directions to address health inequities.

With the expansion of the "medical cannabis" or "medical marijuana" market, there is significant confusion surrounding cannabinoid terminology. This commentary provides definitions for cannabinoid terminology, examines US Food and Drug Administration (FDA)-approved and non-FDA-approved medications with cannabinoids as the main ingredient, and discusses how vague terminology may lead to a public misperception regarding the lack of evidence-based medical indications for cannabis.

Objectives: The objective of the study was to conduct a systematic review of the available literature on non-medical use of mephentermine, including its pattern of use, associated complications, and treatment approaches.

Methods: We conducted a systematic search across PubMed, Scopus, EMBASE, Web of Science, and EBSCO, to identify studies reporting non-medical mephentermine use. Two independent reviewers screened the studies, and methodological quality was assessed using the Joanna Briggs Institute tools. Extracted data included demographics, use patterns, psychiatric and physical complications, cooccurring substance use, and treatment approaches.

Results: Of 695 retrieved studies, 23 full-text studies met inclusion criteria (4 case series, 19 case reports, 30 cases). The majority (n = 28, 93.3%) were from India, all male (age: 19-39 y, mean = 27.9). Most used mephentermine for performance enhancement (63%), primarily through intravenous injection (77.8%). Psychiatric comorbidities were reported in 60%, with psychosis (43.3%) being the most common. Cooccurring substance use (40%) included alcohol, tobacco, and anabolic steroids. Treatment was largely symptomatic, with antipsychotics and benzodiazepines being most frequently prescribed.

Conclusions: Non-medical mephentermine use appears to be rising, particularly among athletes and bodybuilders, with notable psychiatric complications. Targeted education and clinical awareness are needed. Further research should explore addiction potential, long-term effects, and treatment strategies.

Objectives: People with childbearing potential and opioid use disorder (OUD) have high rates of unintended pregnancies. Addiction medicine providers occupy an important role in diagnosing and counseling those who become pregnant; however, no guidelines exist to facilitate these conversations. We sought to explore participant experiences with pregnancy options counseling while in opioid use disorder treatment clinics.

Methods: We conducted semistructured interviews with people who became pregnant while in OUD treatment, regardless of pregnancy outcome. The interview domains included (1) interactions with health care upon pregnancy discovery, (2) pregnancy options counseling provision, and (3) factors affecting pregnancy decision. A codebook was formulated through an iterative process using a P3 framework (practice, provider, patient). All interviews were double-coded and analyzed for content and themes.

Results: Eighteen participants completed interviews between December 2022 and April 2023. Participants reported valuing nonjudgmental communication when providers disclose unexpected pregnancy results, as well as the need for unbiased and trustworthy information regarding the impact of OUD and OUD treatment on their options. They also identified the unique stigma and bias experienced by pregnant people with OUD.

Conclusions: Although no guidelines exist to guide pregnancy options counseling in addiction medicine settings, efforts should be made to integrate all pregnancy options counseling-parenting, adoption, and abortion-and/or referrals into the care of pregnant patients at OUD treatment centers. Effective discussions should be conducted in a nonbiased and nonjudgmental fashion. Our findings can be used to develop patient-centered counseling aimed at improving pregnancy decision-making while in treatment for OUD.

Objectives: CAM2038 weekly and monthly extended-release buprenorphine (BPN) formulations are effective for treating opioid use disorder (OUD). Little is known about the effect of dose on patient outcomes, particularly under blinded and flexible dosing conditions. We evaluated the number of dose changes and the impact of (1) dose on treatment outcomes and (2) baseline primary opioid use (heroin vs prescription opioids) and route of use (injection or not) on the dose.

Methods: This was a post hoc analysis of an outpatient randomized double-blind, double-dummy trial comparing weekly (first 12 wk) and monthly (second 12 wk) CAM2038 to SL-BPN (24 wk) for OUD treatment. Dosing was flexible and guided by clinical response. Maximum doses were 32 mg weekly/160 mg monthly CAM2038 and 24 mg/32 mg SL-BPN in the first and second 12 weeks, respectively. Effect of each dose was evaluated using four outcomes: urine drug test (UDT) opioid results, Clinical Opiate Withdrawal Scale scores, Subjective Opiate Withdrawal Scale scores, and need- and desire-to-use opioid visual analogue scales. Associations between baseline route of use and primary opioid used and study dose were investigated.

Results: After titration to 16 mg SL-BPN/24 mg weekly CAM2038, most participants had 0-1 dose adjustments in both first and second 12 weeks. All doses were utilized. Number of adjustments was not associated with retention. Withdrawal, craving, and opioid-positive UDTs decreased for all CAM2038 and SL-BPN doses. There were few clinically significant associations between dose and primary opioid used/route of use.

Conclusions: Results support current practice guidelines, emphasizing the importance of individualized dosing based on patient response.

Objectives: Alcohol use is one of the leading causes of death and disability globally; however, access to evidence-based care for alcohol use disorder (AUD) is limited. Although telemedicine-based interventions promise to expand treatment access, there are no validated telemedicine-based interventions for alcohol withdrawal management. In this single-arm study, we sought to determine the feasibility of delivering symptom-triggered alcohol withdrawal management over telemedicine.

Methods: Thirty actively drinking participants with AUD and a history of alcohol withdrawal were recruited to participate. Participants were scheduled for 3 days of symptom-triggered withdrawal management using the Clinical Institute Withdrawal Assessment for Alcohol Scale Revised delivered by a trained clinician over a telemedicine platform. Primary outcomes were retention in treatment and need for transfer to a higher level of care (eg, the emergency room). Satisfaction with the treatment protocol and relapse to any alcohol use 30 days following treatment initiation were also assessed.

Results: In total, 93.3% of participants completed all 3 days of alcohol withdrawal management. No participants required transfer to a higher level of care. Satisfaction with treatment was high, with an average Client Satisfaction Questionnaire-8 score of 30.9 (SD = 1.5) out of 32. After the follow-up period, 56.7% of participants remained abstinent from alcohol.

Conclusions: Our study provides preliminary evidence that symptom-triggered alcohol withdrawal management over telemedicine is feasible and satisfactory for patients. If these findings are replicated, they could have important implications for access to alcohol withdrawal management services, especially in remote, rural, and underserved regions that lack specialized withdrawal management facilities.

Purpose: Youth (children and adolescents under 18 yrs) exposed to parental substance use disorder (SUD) are at high risk for poor outcomes that include substance use, psychopathology, and child welfare involvement. With the changing SUD criteria from DSM-IV to DSM-5, revised estimates of youth exposed to parental SUD in the home are needed to provide more recent estimates and investigate whether the change from DSM-IV to DSM-5 may change estimated SUD exposure.

Methods: Nationally representative data from the 2020 National Survey on Drug Use and Health were used. Weighted counts of youth exposed to parental nonnicotine SUD in the home were estimated using both DSM-IV and DSM-5 criteria, which were assessed for every substance used by the parent in the past year; further analyses estimated counts by parental race/ethnicity, sex, household income, urbanicity, and substance leading to the SUD diagnosis.

Results: Parents with DSM-IV SUD had an estimated 9,341,336 youth in their households, versus an estimated 16,937,783 using DSM-5 criteria (81.3% greater). Larger increases were observed in Asian (262.9%) or multiracial (161.9%) parents versus parents of other racial/ethnic groups and in parents with cannabis use disorder (246.4%), with smaller increases observed in parents with alcohol use disorder (71.2%).

Discussion: The change from DSM-IV to DSM-5 criteria resulted in a large increase in youth exposed to parental SUD. The health needs of these youth will require large-scale planning to limit poor outcomes in the roughly 17 million exposed youth; family-based interventions may help limit harms to all members of the family.

Background: 7-Hydroxymitragynine (7-OH) is a highly selective mu opioid receptor agonist with binding affinity greater than morphine. Although trace amounts of 7-OH are found in kratom, it is formed by metabolism in humans after kratom ingestion. Novel semi-synthetic 7-OH products are manufactured by mono-oxidation of kratom's primary alkaloid, mitragynine. Formulations include sublingual tablets, powders, and liquid shots. We report a case of a study participant with self-reported 7-OH use.

Case presentation: A 23-year-old man using kratom for 3 years was enrolled into a clinical trial evaluating kratom pharmacokinetics, behavioral pharmacology, and withdrawal. He typically used 1.5-2g of kratom whole-leaf powder 6 times/day. Following scheduled kratom product self-administration during the study, several outcomes were atypical, including blunted subjective kratom effects. He reported recent initiation of a "new kratom product" ("Opia") identified as semi-synthetic 7-OH; he was using 20 mg 3 times/day for 4 days before study admission. Mitragynine (29.7 ng/mL) plasma concentration peaked at 1.5 hours post kratom self-administration, while 7-OH Cmax (11.7 ng/mL) occurred before self-administration, confirming prior ingestion of 7-OH. The participant reported withdrawal symptoms and requested early discharge from the study, but refused the study protocol kratom "rescue dose," stating he preferred to take his "stronger" product.

Discussion: Clinicians must obtain detailed self-reports from patients who report any kratom use. As 7-OH products are misleadingly marketed as kratom, and as both long-time kratom consumers and kratom-naive individuals may experiment with these novel products, improved assessment methods are urgently needed in the absence of real-time confirmatory testing.

Objective: Although 11% of all US drug overdose deaths have been attributed to methamphetamine, there are limited treatments for it that have a substantial impact on clinical outcomes. Online access to the community-based fellowship Narcotics Anonymous (NA) may offer support for remission for some persons with methamphetamine use disorder (MUD). Our objective was to characterize the role that online NA participation can play in remission of MUD.

Methods: Persons who accessed a website for participating in online NA meetings were offered the option of participating in an anonymous, structured survey consisting of items related to their clinical status, substance use, and prior experience with the website. Responses of those who designated their primary drug problem as methamphetamine were analyzed.

Results: Of the 1645 respondents who accessed the NA online meeting site in 2023, 356 indicated that methamphetamine was their principal drug problem. Levels of remission by respondents who reported turning to the website primarily for MUD were analyzed for those: (1) new to the online site (44%), (2) longtime abstinent (mean 2.3 y), or (3) still using methamphetamine (13%). Respondents' subjective experiences, such as their belief in the 12 Steps, spiritual awakening, and level of relief provided from distress, were also associated with remission.

Conclusions: Online NA meetings can provide support for promoting abstinence for some persons with MUD, and can be studied relative to their clinical status. Such meetings can therefore be useful for professional referral, and their function and utility merit further investigation.

The emergence of medetomidine, a potent veterinary alpha-2 adrenergic receptor agonist, as a common fentanyl adulterant in many areas of the United States poses new threats to pregnant women who use illicit opioids and their neonates. We present a case of severe withdrawal seen in a postpartum woman and her neonate after exposure to fentanyl adulterated with medetomidine up to the time of delivery. The case demonstrates the need for obstetric and pediatric providers to be aware of this emerging trend to allow for early recognition and prompt treatment of the potentially life-threatening symptoms of medetomidine withdrawal, which differs from traditional withdrawal patterns, and highlights the importance of communication and coordination between obstetric and pediatric teams caring for this population.