Journal of Addiction Medicine最新文献

Objectives: To describe the clinical contexts, population characteristics, and outcomes of extended-release buprenorphine (CAM2038 7-day depot formulation) administration in emergency department and hospitalized patients with opioid use disorder primarily using fentanyl.

Methods: We conducted a retrospective case series of patients who received CAM2038 at an urban safety-net hospital between June 2024 and June 2025. We collected data from electronic health records, including demographics, clinical characteristics, and outcomes. Outcomes included opioid withdrawal severity, buprenorphine-precipitated withdrawal, patient-directed discharge, and 30-day linkage to care within our health care system.

Results: Thirty-seven patients received CAM2038, with 33 utilizing CAM2038 to initiate buprenorphine and 4 transitioning from another formulation of therapeutic buprenorphine. Most patients (91.9%) primarily used fentanyl. Among patients using CAM2038 to initiate buprenorphine, 25 patients (75.8%) received pretreatment of opioid withdrawal with short-acting full agonist opioids. Two patients (6%) had suspected precipitated withdrawal. Among patients with documented Clinical Opiate Withdrawal Scale scores post-injection (n=24), 91.7% experienced minimal-to-mild withdrawal (score <12). Patient-directed discharge was uncommon (10.8%), and 47% of patients linked to buprenorphine treatment within 30 days.

Conclusions: CAM2038 administration, including for the initiation of therapeutic buprenorphine, seems to be feasible and well-tolerated in inpatient and emergency department settings, with low rates of precipitated withdrawal and patient-directed discharge. The use of short-acting opioids for initial withdrawal management may contribute to successful outcomes. These findings support CAM2038 as a valuable option for treating opioid use disorder in the emergency department and hospital settings, particularly among patients who use fentanyl.

Objectives: Adolescents with substance use disorder report high rates of tobacco use. Despite recommendations for counseling and pharmacotherapies for tobacco cessation among adolescents, their use remains low. The objective of this study was to characterize the availability of tobacco cessation counseling and pharmacotherapies, as well as smoking and vaping policies, in adolescent-serving substance use treatment facilities in the United States.

Methods: The present study analyzed facility-reported data from the 2023 National Substance Use and Mental Health Services Survey. Substance use treatment facilities serving adolescents only (ages 11-21) were compared with those serving both adolescents and adults on tobacco use screening, availability of tobacco cessation education/counseling and pharmacotherapies (nicotine replacement therapy, bupropion, and varenicline), and smoking and vaping policies.

Results: Most adolescent-only facilities offered tobacco use screening (82.6% vs 82.8% in adult/adolescent facilities) and education/counseling for tobacco cessation (71.9% vs 70.0% in adult/adolescent facilities). Adolescent-only facilities were more likely than adult/adolescent facilities to prohibit onsite smoking (84.7% vs 33.1%, respectively, P < 0.001) or vaping (87.7% vs 41.9%, respectively, P < 0.001), yet less likely to offer tobacco cessation pharmacotherapies to patients (20.7% vs 45.5%, respectively, P < 0.001).

Conclusions: While most adolescent-only substance use treatment facilities offered tobacco cessation education or counseling and restricted tobacco use at their sites, they were less likely than adult/adolescent facilities to offer pharmacotherapy for tobacco cessation. This reflects a missed opportunity to offer robust options to treat tobacco use among adolescents with substance use disorders.

Objectives: Contingency management (CM) is the most effective intervention for stimulant use disorder (StUD) but is underutilized. This study examined the feasibility and acceptability of a novel mobile app-based CM intervention for patients with StUD during and after hospitalization.

Methods: We recruited hospitalized patients with moderate to severe StUD and an expected hospital length of stay of >2 weeks or a heart failure diagnosis. Patients received gift cards for participating in incentivized activities (counseling, drug testing, and recovery-oriented reflections) through the mobile app. Patients could participate for 2 months (including after hospital discharge), earning up to $330. An in-person nurse supported implementation. We collected intervention engagement data (app usage, rewards earned) and conducted qualitative interviews on participants' experiences.

Results: Fifty-six participants (68% male, 70% with unstable housing) completed intake. The average hospital length of stay was 33 days, with 64% admitted for infection. Participants engaged for an average of 33.9 days. Engagement varied widely-those in the top quartile earned $173.31 on average, while those in the bottom quartile earned $6.27 on average. Eighty-nine percent of submitted drug tests were negative for stimulants. Participants felt the "positivity" of CM helped them stay "motivated" and "focused" on recovery instead of being "bored" or stressed in the hospital. Thirty-nine (69.6%) patients continued engaging after hospital discharge. Barriers to engagement included physical limitations, feeling overwhelmed, competing priorities, and technological challenges.

Conclusions: A novel hospital-based mobile app CM intervention helped patients with StUD cope with hospitalization and supported recovery goals, although program engagement varied widely.

Objectives: Pre-exposure prophylaxis (PrEP) is a critical strategy for HIV prevention in women who inject drugs (WWID); however, only 1%-2% of WWID use PrEP. We aim to characterize factors associated with longitudinal PrEP eligibility in women with a history of injection drug use to inform optimization of PrEP implementation strategies.

Methods: Women who did not have HIV and were participating in the AIDS Linked to the Intravenous Experience (ALIVE) Cohort between 2014 and 2020 were included. Data on sociodemographic characteristics, substance use, depressive symptoms, and HIV risk behaviors were collected at semiannual visits. PrEP-eligibility was defined as sex-related (>1 partner with condomless sex, partner with HIV or who injects drugs, transactional sex or sexually transmitted infection) or injection-related (sharing drug use equipment) in the past 6 months. Associations between individual factors and PrEP eligibility were estimated using unadjusted and adjusted logistic regression with generalized estimating equations.

Results: Among 382 women, the average follow-up was 3.2 years, and 41% were PrEP-eligible. At baseline, among PrEP-eligible women, 89% met sex-related, 41% met injection-related, and 30% met both sex-related and injection-related criteria; women were eligible for PrEP during 58% of follow-up. Periods of PrEP-eligibility were longitudinally associated with younger age [adjusted odds ratio (95% CI): 0.92 (0.90-0.94)], recent incarceration [aOR=2.29 (1.17-4.50)], severe depression [aOR=1.31 (1.06-1.62)], and recent overdose [aOR=1.56 (1.07-2.28)].

Conclusions: PrEP implementation efforts that incorporate strategies to support the needs of women with recent incarceration, severe depression, and recent overdose have the potential to maximize outcomes for WWID.

Objectives: People who inject drugs (PWID) have higher mortality risks and excessive alcohol use compared with the general population. However, long-term alcohol usage trajectories' impacts on mortality outcomes among PWID are not well-established. We aim to characterize different longitudinal alcohol use patterns and evaluate their mortality outcomes among lifetime PWID.

Methods: Data are from our community-based, prospective cohort study of PWID in Baltimore, Maryland, United States. The analysis included participants from January 1, 2005, through February 29, 2020, who answered alcohol use screening questions at least once. We first performed group-based trajectory modeling to identify longitudinal patterns of alcohol use. Next, we applied time-to-event methods to assess the mortality risks associated with these patterns.

Results: The analysis included 1935 participants. Five alcohol use patterns emerged: consistent high-risk use (7.1%), gradual decline from moderate-risk to lower-risk use (25.8%), faster decline from moderate-risk to minimal use (10.4%), consistent lower-risk use (28.6%), and minimal use (28.1%). Compared with high-risk use, faster decline [adjusted hazard ratio (aHR): 0.44 (95% CI: 0.30, 0.65)], lower-risk [aHR: 0.54 (95% CI: 0.39, 0.74)], and minimal [aHR: 0.58 (95% CI: 0.42, 0.80)] use each had a lower all-cause mortality risk. Furthermore, these 3 comparison groups also showed reduced noncommunicable disease-related mortality risks.

Conclusions: Relative to consistent high-risk alcohol use, alcohol reduction/cessation and long-term lower-risk or minimal alcohol use have lower all-cause and noncommunicable disease-related mortality risks. Our findings highlight the importance of alcohol use treatment services as a preventive health care strategy among lifetime PWID and other high-risk populations.

Objectives: Preclinical studies indicate that neuroactive steroids mediate some effects of alcohol. Dutasteride is an inhibitor of 5-alpha reductase enzymes, which play a central role in the production of 5α-reduced neuroactive steroids. A prior randomized clinical trial in men found that dutasteride reduced drinking compared with placebo. The purpose of this study was to examine dutasteride's tolerability and efficacy for reducing drinking in a sample of men and women.

Methods: A total of 167 participants who were current heavy drinkers and had a goal to stop or reduce drinking to nonhazardous levels were randomized to placebo or 1 mg dutasteride daily for 12 weeks. We hypothesized that both dutasteride-treated men and women would be more successful in reducing drinking compared with placebo.

Results: Dutasteride was well tolerated. Generalized linear mixed models identified significant effects of medication such that dutasteride-treated participants reduced drinking and heavy drinking more than placebo-treatment. During the last month of treatment, dutasteride-treated participants had reduced heavy drinking days by 40% versus 23% for placebo-treated participants (P=0.041, Cohen's d=0.48) and the number of drinks per week by 32% versus 16% for placebo participants (P=0.016, Cohen's d=0.42). When the sample was stratified by sex, a significant effect of medication compared with placebo was evident for men (n=88) but not for women (n=67) due to a large placebo response rate in women.

Conclusion: Dutasteride 1 mg daily was efficacious in reducing the number of heavy drinking days and drinks per week in treatment-seeking men, confirming findings from a prior RCT involving 142 men.

Objectives: Functional magnetic resonance imaging studies have shown that smoking cues activate reward-related brain regions, with activation intensity increasing with smoking addiction severity. A recent study on cocaine addiction reported increased striatal glutamatergic tone in response to cocaine-associated cues; however, the role of glutamate in smoking cue-induced brain activation and its relationship with addiction severity remain unclear.

Methods: This study investigated glutamate modulation in the anterior striatum and dorsal anterior cingulate cortex (ACC) of male participants, comprising smokers (n = 38) and healthy controls (n = 48), exposed to smoking cues. Magnetic resonance spectroscopy (MRS) was used to measure glutamate levels at baseline (neutral images) and during smoking cue (smoking images) presentation.

Results: A mixed-model ANOVA followed by post hoc paired t tests revealed a significant increase in striatal glutamate levels in smokers exposed to smoking cues, whereas no changes were observed in controls. This effect on striatal glutamate in smokers remained significant after controlling for age. No significant changes were observed in the ACC in either smokers or controls. Although a positive association trend was found between smoking severity, as measured by the Fagerström Test for Nicotine Dependence (FTND) scores, and striatal cue-induced glutamate changes, it was not statistically significant.

Conclusions: These findings suggested that smoking cue-induced increases in striatal glutamate tone may reflect the neurochemical mechanisms underlying cue-induced phenomena in humans.

Background: Products containing semi-synthetic 7-hydroxymitragynine (7-OH), a potent mu-opioid receptor (MOR) agonist, have proliferated in the United States. In kratom leaf, trace amounts of 7-OH are formed by spontaneous oxidization of kratom's primary alkaloid, mitragynine. Hepatic and intestinal microsomes also convert mitragynine to 7-OH. Some products have sublingual and nasal administration routes that circumvent hepatic first-pass metabolism, increasing bioavailability and accelerating effect onset, features that increase risk. We report a patient who developed substance use disorder (SUD) related to a 7-OH sublingual film.

Case presentation: A 35-year-old man with supraventricular tachycardia and profound urinary retention described using "Hydroxie," a novel, semi-synthetic 7-OH product. He currently vaped cannabis and nicotine, and reported injection heroin addiction a decade prior. He used kratom 6 months before trying Hydroxie, which began 10 weeks before hospitalization. Within days of initiating use, he noticed tolerance; within 2 weeks, he was using one film every 1-2 hours. The patient met criteria for severe SUD related to Hydroxie and was inducted onto buprenorphine. Analysis confirmed 7-OH in the product and blood.

Discussion: The MOR selectivity and brief duration of action of some 7-OH formulations support our observation that repeated use may lead to physical dependence. Standard laboratory testing can detect mitragynine but not 7-OH due to its relatively shorter half-life, an issue that may confuse semi-synthetic 7-OH use with kratom. Novel 7-OH products are not kratom. The potency of 7-OH places unwitting consumers who may believe they are using kratom, not a partial MOR agonist, at risk.

Objectives: Following ST-elevation myocardial infarction (STEMI), there are standard guideline-indicated therapies including revascularization (percutaneous coronary intervention or coronary artery bypass surgery), medications (aspirin, angiotensin converting enzyme [ACE] inhibitors and angiotensin receptor blockers [ARBs], beta-blockers, high-intensity statins, P2Y12 inhibitors], and outpatient rehabilitation (cardiac rehabilitation [CR]). Those with substance use disorder (SUD), including cocaine use disorder (CUD), have been shown to be less likely to receive certain medical treatments, but the effect of SUD history on receipt of post-STEMI therapies is not well known.

Methods: The TriNetX Research database was used to identify adults aged 18 years or older hospitalized with STEMI between 2014 and 2024. Patients were divided into two groups: those with and without a history of CUD. After 1:1 propensity score matching for demographic, psychosocial, and medical characteristics, differences in receipt of guideline-indicated therapies by CUD history were examined.

Results: After propensity matching, 1366 patients were identified in each group. Those with a history of CUD were more likely to be prescribed ACE/ARBs [OR: 1.22, 95% CI: 1.05-1.41] or statins [OR: 1.19, 95% CI: 1.03-1.39], less likely to receive revascularization [OR: 0.69, 95% CI: 0.51-0.94] and much less likely to attend CR [OR: 0.41, 95% CI: 0.28-0.61] as compared with those without. No differences were seen by group in prescription of other medications.

Conclusions: History of CUD was associated with modest effects on receipt of prescriptions post-STEMI. However, revascularization and attendance at CR were much lower in those with CUD. There is a need for more targeted, individualized, and supportive treatment plans in patients with CUD who present with STEMI.