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Trend in Prescription Medication Utilization for Opioid Use Disorder and Alcohol Use Disorder From 2015 to 2021: A Population-wide Study in a Canadian Province. 2015 年至 2021 年阿片类药物使用障碍和酒精使用障碍的处方药使用趋势:加拿大某省的全民研究。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-16 DOI: 10.1097/ADM.0000000000001348
Kearley Abbott, Rachel Hyrsak, James M Bolton, Jitender Sareen, Murray W Enns, Geoffrey Konrad, Erin Knight, Sherif Eltonsy, Kaarina Kowalec, Jamison Falk, Silvia Alessi-Severini, Kun Liu, Heather Prior, Christine Leong

Objective: To examine the quarterly incidence and prevalence of medications for opioid use disorder (OUD) and alcohol use disorder (AUD) from 2015 to 2021.

Methods: A retrospective population-wide observational study in Manitoba, Canada, was conducted using administrative claims data from the Manitoba Centre for Health Policy to examine the incidence and prevalence of OUD (methadone, buprenorphine-naloxone, buprenorphine) or AUD medications (naltrexone, acamprosate, disulfiram) per 10,000 individuals in each quarter between January 1, 2015, and December 31, 2021.

Results: There were 1179 and 451 individuals who received at least one prescription for OUD and AUD, respectively, in the first quarter of 2020. The prevalence of OUD medications more than doubled from 6.3 to 14.3 per 10,000 from January 1, 2015, to December 31, 2021. Likewise, AUD medication prevalence increased almost 10-fold from 0.68 to 6.5 per 10,000 from January 1, 2015, to December 31, 2021, primarily due to naltrexone. The incidence of AUD prescription use increased 8.6-fold from 0.29 to 2.51 per 10,000 during the study period. In contrast, the incidence of opioid agonist therapy declined from 2.1 per 10,000 in the first quarter of 2015 to 0.53 per 10,000 the first quarter of 2016, primarily due to methadone. Whereas methadone incidence declined, buprenorphine-naloxone incidence increased almost 15-fold during the study period.

Conclusion: An increase in both AUD medication prevalence and incidence in addition to an increase in buprenorphine-naloxone incidence was observed. These findings reflect an increase in the uptake of medications for treating AUD and OUD following changes to improve coverage and access to these medications.

目的研究 2015 年至 2021 年阿片类药物使用障碍(OUD)和酒精使用障碍(AUD)的季度发病率和流行率:方法:利用马尼托巴省卫生政策中心提供的行政报销数据,在加拿大马尼托巴省开展了一项全人口范围的回顾性观察研究,以检查 2015 年 1 月 1 日至 2021 年 12 月 31 日期间每个季度每 10,000 人中阿片类药物使用障碍(美沙酮、丁丙诺啡-纳洛酮、丁丙诺啡)或酒精使用障碍药物(纳曲酮、阿坎酸盐、双硫仑)的发生率和流行率:在 2020 年第一季度,分别有 1179 人和 451 人接受了至少一种治疗 OUD 和 AUD 的处方。从 2015 年 1 月 1 日到 2021 年 12 月 31 日,每 10,000 人中的 OUD 药物流行率从 6.3 增至 14.3,增加了一倍多。同样,从 2015 年 1 月 1 日到 2021 年 12 月 31 日,AUD 药物流行率从每 10,000 人中 0.68 例增加到 6.5 例,几乎增加了 10 倍,这主要归功于纳曲酮。在研究期间,AUD 处方使用的发生率从万分之 0.29 增加到万分之 2.51,增加了 8.6 倍。相比之下,阿片类激动剂治疗的发生率从 2015 年第一季度的万分之 2.1 降至 2016 年第一季度的万分之 0.53,这主要是美沙酮造成的。虽然美沙酮的使用率有所下降,但丁丙诺啡-纳洛酮的使用率在研究期间却增加了近15倍:结论:除丁丙诺啡-纳洛酮发病率增加外,还观察到 AUD 药物流行率和发病率均有所增加。这些研究结果反映出,随着治疗 AUD 和 OUD 的药物覆盖面和可及性的扩大,这些药物的使用率也在增加。
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引用次数: 0
Diagnosis and Treatment of Presumed Naltrexone-XR-precipitated Opioid Withdrawal in a Patient Chronically Treated With Buprenorphine-XR: A Case Report. 一名长期接受丁丙诺啡-XR 治疗的患者因服用纳曲酮-XR 而出现阿片类药物戒断的诊断和治疗:病例报告。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-05 DOI: 10.1097/ADM.0000000000001342
Jessica Moore, Kalvin Foo, Ernest Egu, Xin Gao, Rachel Ehrman-Dupre, Matthew Salzman

Abstract: Naltrexone, buprenorphine, and methadone are Food and Drug Administration-approved medications for the treatment of opioid use disorder in the United States. Naltrexone, an opioid antagonist, can precipitate opioid withdrawal if administered too quickly after the use of full or partial opioid agonists for those with either dependence or use disorder. We describe a case of severe precipitated opioid withdrawal syndrome after reported buprenorphine extended-release (XR) administration, despite the patient having been stable on buprenorphine-XR for several years, with no missed doses or recent opioid use. Naltrexone levels were sent and helped to diagnose suspected inadvertent naltrexone-XR administration in this patient, which was likely the etiology of his precipitated opioid withdrawal syndrome. We suggest the use of high-dose buprenorphine, as well as adjunctive medications including benzodiazepines, as a treatment strategy for naltrexone-XR precipitated withdrawal in the setting of chronic buprenorphine-XR treatment.

摘要:纳曲酮、丁丙诺啡和美沙酮是美国食品和药物管理局批准用于治疗阿片类药物使用障碍的药物。纳曲酮是一种阿片类药物拮抗剂,如果在有阿片类药物依赖或使用障碍的患者使用完全或部分阿片类药物激动剂后过早给药,可能会诱发阿片类药物戒断。我们描述了一例在使用丁丙诺啡缓释剂(XR)后出现严重阿片类药物戒断综合征的病例,尽管患者使用丁丙诺啡缓释剂(XR)已有数年,病情稳定,没有漏服或近期使用过阿片类药物。送检的纳曲酮水平有助于诊断该患者疑似无意中服用了纳曲酮-XR,这很可能是导致其阿片类药物戒断综合征的病因。我们建议使用大剂量丁丙诺啡以及包括苯二氮卓类药物在内的辅助药物,作为慢性丁丙诺啡-XR 治疗背景下纳曲酮-XR 诱发戒断的治疗策略。
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引用次数: 0
Jenna's Project: Preventing Overdose and Improving Recovery Outcomes for Women Leaving Incarcerated Settings during Pregnancy and Postpartum Periods. 珍娜的项目:预防吸毒过量,改善孕期和产后离开监禁环境的妇女的康复效果。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-03 DOI: 10.1097/ADM.0000000000001341
Essence Hairston, Hendrée E Jones, Elisabeth Johnson, James Alexander, Kimberly R Andringa, Kevin E O'Grady, Andrea K Knittel

Objectives: For people with opioid use disorder (OUD), transitioning from pregnancy to postpartum and from incarceration to the community is a time of increased risk for opioid overdose. This prospective project evaluated the extent of Jenna's Project's success in preventing overdoses and improving recovery outcomes by coordinating postrelease care in incarcerated OUD perinatal patients.

Methods: Participants (N = 132) were pregnant or postpartum (1 year postdelivery) with OUD during incarceration and self-referred for postrelease services. From March 2020 to October 2021, participants could receive up to 6 months of postincarceration care coordination services (eg, regular communication, transportation, emergency housing, SUD treatment), medication to treat OUD (MOUD) and other treatment services. Outcomes included verified overdose (fatal), self-reported nonfatal overdose, reincarceration, active Medicaid, receipt of MOUD, presence of children living with participants, open Child Protective Services cases, and number of referrals for services.

Results: There were 0 nonfatal and 0 fatal overdoses at both 1 and 6 months postrelease, and 3 of 132 (2%) returned to incarceration. Significantly fewer participants had Medicaid at release (36%) and at 6 months postrelease (60%) than before incarceration (87%) (P < 0.001 for all 3 pairwise comparisons). At 6 months postrelease, significantly more participants reported MOUD receipt (51%) compared with before incarceration (39%) (P < 0.001). There was no significant change in the number of open Child Protective Services cases. Referrals for childcare or parenting services were the most common referrals provided.

Conclusion: Immediate postrelease care coordination for pregnant and postpartum women with OUD was feasible and effective in preventing overdose, reincarceration, and promoting recovery outcomes.

目标:对于阿片类药物使用障碍(OUD)患者来说,从怀孕到产后以及从监禁到社区的过渡时期是阿片类药物过量风险增加的时期。本前瞻性项目评估了珍娜项目通过协调对被监禁的 OUD 围产期患者的释放后护理,在预防用药过量和改善康复效果方面的成功程度:参与者(N = 132)在监禁期间怀孕或产后(分娩后 1 年)患有 OUD,并自我转介接受释放后服务。从 2020 年 3 月到 2021 年 10 月,参与者可接受长达 6 个月的监禁后护理协调服务(例如,定期沟通、交通、紧急住房、SUD 治疗)、药物治疗 OUD (MOUD) 和其他治疗服务。结果包括经证实的用药过量(致命)、自我报告的非致命用药过量、再监禁、有效的医疗补助、接受 MOUD 治疗、是否有子女与参与者同住、儿童保护服务机构的未结案件以及转介服务的数量:在释放后的 1 个月和 6 个月内,非致命和致命吸毒过量的人数分别为 0 人和 0 人,132 人中有 3 人(2%)重返监狱。获释时(36%)和获释后 6 个月时(60%)拥有医疗补助计划的参与者人数明显少于入狱前(87%)(所有三项成对比较的结果均小于 0.001)。与入狱前(39%)相比,入狱 6 个月后报告领取 MOUD(51%)的人数明显增多(P < 0.001)。儿童保护服务机构的未决案件数量没有明显变化。最常见的转介服务是儿童保育或育儿服务:为患有 OUD 的孕妇和产后妇女提供释放后即时护理协调服务是可行的,并能有效预防用药过量、重新入狱和促进康复结果。
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引用次数: 0
Hospitalists' Attitudes and Experiences With Posthospitalization Care Transitions for Patients With Substance Use Disorders: A Cross-sectional Analysis. 住院医生对药物使用障碍患者住院后护理过渡的态度和经验:横断面分析。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-03-15 DOI: 10.1097/ADM.0000000000001305
Michael A Incze, Sophia Huebler, David Chen, Andrea Stofko, Chaorong Wu, Jacob D Baylis, Chesley Wells, Danielle Babbel

Background: Medical hospitalizations are relatively common among individuals who have substance use disorders (SUDs) and represent opportunities for patient engagement and treatment. Posthospitalization transitions of care are an important element of providing full-spectrum inpatient SUD care; however, little is known about clinicians' experiences with postdischarge care transitions.

Methods: We conducted a cross-sectional study surveying hospital-based medical clinicians (ie, "hospitalists") across 2 large health systems in the state of Utah to assess current practices, barriers, facilitators, and perceptions toward posthospitalization care transitions for patients with SUDs. We used Wilcoxon signed-rank tests to identify the most impactful barriers and facilitators among all respondents. We used logistic regression models to explore the influence of hospitalists' attitudes toward providing SUD care on perceived barriers and facilitators.

Results: The survey was distributed to 429 individuals across 15 hospitals. Eighty-two hospitalists responded to the survey (response rate, 21.4%). Most respondents frequently cared for hospitalized patients with SUDs (n = 63, 77%) and prescribed medications for SUDs (n = 44, 56%). Four respondents (5%) felt that patients received adequate support during care transitions. Lack of social support ( P < 0.001) and social factors such as lack of transportation ( P < 0.001) were perceived as the largest barriers to successful care transitions. Conversely, a partnering outpatient clinic/clinician ( P < 0.001) and outpatient-based care coordination ( P < 0.001) were perceived as the strongest facilitators. Respondents' attitudes toward people with SUDs had a modest effect on perceived barriers and facilitators.

Conclusions: Hospitalists perceived increased outpatient SUD treatment infrastructure and transitional care supports as most important in facilitating posthospitalization care transitions for patients with SUDs.

背景:住院治疗在药物使用障碍(SUD)患者中较为常见,是患者参与和治疗的机会。住院后的护理过渡是提供全方位住院 SUD 护理的一个重要因素;然而,人们对临床医生在出院后护理过渡方面的经验知之甚少:我们对犹他州两家大型医疗系统的医院临床医生(即 "住院医生")进行了一项横断面研究调查,以评估针对 SUD 患者的出院后护理过渡的当前实践、障碍、促进因素和看法。我们使用 Wilcoxon 符号秩检验在所有受访者中找出影响最大的障碍和促进因素。我们使用逻辑回归模型探讨了住院医生提供 SUD 护理的态度对感知到的障碍和促进因素的影响:我们向 15 家医院的 429 人发放了调查问卷。82名医院医生对调查做出了回复(回复率为21.4%)。大多数受访者经常护理患有药物依赖性精神障碍的住院病人(63 人,77%),并开具治疗药物依赖性精神障碍的处方(44 人,56%)。四名受访者(5%)认为患者在护理过渡期间得到了足够的支持。缺乏社会支持(P < 0.001)和交通不便等社会因素(P < 0.001)被认为是成功完成护理过渡的最大障碍。相反,合作门诊/临床医生(P < 0.001)和门诊护理协调(P < 0.001)被认为是最大的促进因素。受访者对 SUD 患者的态度对所感知的障碍和促进因素影响不大:住院医生认为,增加门诊 SUD 治疗基础设施和过渡性护理支持对促进 SUD 患者住院后的护理过渡最为重要。
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引用次数: 0
The American Society of Addiction Medicine Clinical Practice Guideline Development Methodology. 美国成瘾医学会临床实践指南制定方法。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-05-16 DOI: 10.1097/ADM.0000000000001312
Melissa B Weimer, Amanda Devoto, Devan Kansagara, Taleen Safarian, Emily Brunner, Audra Stock, Darius A Rastegar, Lewis S Nelson, Carlos F Tirado, P Todd Korthuis, Maureen P Boyle

Abstract: The American Society of Addiction Medicine (ASAM) has published clinical practice guidelines (CPGs) since 2015. As ASAM's CPG work continues to develop, it maintains an organizational priority to establish rigorous standards for the trustworthy production of these important documents. In keeping with ASAM's mission to define and promote evidence-based best practices in addiction prevention, treatment, and recovery, ASAM has rigorously updated its CPG methodology to be in line with evolving international standards. The CPG Methodology and Oversight Subcommittee was formed to establish and publish a methodology for the development of ASAM CPGs and to develop an ASAM CPG strategic plan. This article provides a focused overview of the ASAM CPG methodology.

摘要:美国成瘾医学会(ASAM)自 2015 年起开始发布临床实践指南(CPG)。随着美国成瘾医学会 CPG 工作的不断发展,该学会始终将建立严格的标准作为组织优先事项,以确保这些重要文件的制作值得信赖。ASAM 的使命是定义和推广以证据为基础的成瘾预防、治疗和康复最佳实践,为了与不断发展的国际标准保持一致,ASAM 严格更新了 CPG 方法。成立了 CPG 方法和监督小组委员会,以建立和发布 ASAM CPG 的开发方法,并制定 ASAM CPG 战略计划。本文重点概述了 ASAM CPG 方法。
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引用次数: 0
Impact of Nicotine Replacement Therapy Sampling on Cessation-Related Processes. 尼古丁替代疗法取样对戒烟相关过程的影响。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-03-06 DOI: 10.1097/ADM.0000000000001298
Michelle L Sisson, Jamie M Gajos, Caitlin Wolford-Clevenger, Keith R Chichester, Elizabeth S Hawes, Samantha V Hill, Richard C Shelton, Peter S Hendricks, Michael S Businelle, Matthew J Carpenter, Karen L Cropsey

Objectives: Smoking prevalence remains high among low-income smokers. Understanding processes (eg, withdrawal, craving, motivation) in early smoking cessation is crucially important for designing effective interventions for this population.

Methods: This is a secondary analysis of a novel, in-session sampling intervention (ie, In Vivo) as compared with standard care behavioral smoking cessation counseling (SC) among community-dwelling low-income smokers (n = 83). This analysis examined the effect of 5 in-session sampling interventions on cessation-related processes and perceived advantages or disadvantages of nicotine replacement therapy (NRT) products over time using daily diaries.

Results: The In Vivo treatment had an early positive impact in terms of decreasing withdrawal symptoms and cravings, and increasing perceived advantages to NRT, with moderate to large effect sizes. Results also showed that the treatment effectively reduced withdrawal symptoms and cravings in-session, with small-to-medium and medium-to-large effect sizes, respectively. In-session reduction of withdrawal symptoms and cravings did not occur for the SC group, with the exception of decreased withdrawal symptoms occurring during week 4. The In Vivo treatment did not impact quit goal, desire to quit, abstinence self-efficacy, perceived difficulty in quitting, motivational engagement, or perceived disadvantages to NRT. The In Vivo group reported less daily cigarette use relative to the SC group, in addition to reporting less cigarette use on days they reported greater combination NRT use.

Conclusions: There is preliminary support for this In Vivo treatment over SC in reducing withdrawal, craving, and the number of cigarettes smoked per day, as well as promoting perceived advantages of NRT among low-income smokers.

目标:低收入吸烟者的吸烟率仍然很高。了解早期戒烟的过程(如戒断、渴求、动机)对于为这一人群设计有效的干预措施至关重要:这是一项针对社区低收入吸烟者(n = 83)的二次分析,比较了一种新颖的会期抽样干预(即 In Vivo)与标准护理行为戒烟咨询(SC)。这项分析采用每日日记的方式,考察了5种会话采样干预对戒烟相关过程的影响,以及随着时间的推移,对尼古丁替代疗法(NRT)产品的优缺点的感知:In Vivo疗法在减少戒断症状和渴求感以及增加对尼古丁替代疗法优势的感知方面产生了早期积极影响,效果大小为中等至较大。结果还显示,该疗法在治疗过程中有效减少了戒断症状和渴求感,效果大小分别为中-小和中-大。除第 4 周戒断症状减轻外,SC 组的戒断症状和渴求在治疗过程中均未减轻。In Vivo 治疗对戒烟目标、戒烟愿望、戒烟自我效能、戒烟难度感知、戒烟动机参与度或对 NRT 的不利感知均无影响。In Vivo治疗组报告的每日吸烟量少于SC治疗组,此外,In Vivo治疗组还报告,在他们报告更多地联合使用NRT的日子里,吸烟量减少了:在减少戒断、渴求和每天吸烟数量方面,In Vivo疗法优于SC疗法,以及在提高低收入吸烟者对NRT的认知优势方面,In Vivo疗法得到了初步支持。
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引用次数: 0
E-cigarettes and Youth: The Known, the Unknown, and Implications for Stakeholders. 电子烟与青少年:已知、未知以及对利益相关者的影响。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-03-15 DOI: 10.1097/ADM.0000000000001304
Luba Yammine, Maria Tovar, Nastassia Anna Yammine, Cabrina Becker, Michael F Weaver

Abstract: Despite the decline in the prevalence of e-cigarette use among youth during the coronavirus disease 2019 pandemic, more than 2.5 million of US high and middle schoolers are still using e-cigarettes. Furthermore, those who use e-cigarettes are starting at a younger age and are using them more intensely, reflecting, at least in part, a high addiction liability of modern e-cigarettes. Beyond addiction, accumulating evidence suggests that, in the short-term, e-cigarettes are associated with cardiovascular and pulmonary effects, whereas the long-term effects of e-cigarette use are yet to be established. The aim of this review is to synthesize current knowledge on e-cigarette use among youth, including established and potential risks and efforts to date to curb youth exposure to e-cigarettes. In addition, we provide recommendations for health care providers, researchers, and other stakeholders to address this significant public health issue.

摘要:尽管在2019年冠状病毒疾病大流行期间,青少年使用电子烟的流行率有所下降,但仍有250多万美国高中生和初中生在使用电子烟。此外,使用电子烟的青少年开始使用电子烟的年龄越来越小,使用强度也越来越大,这至少在一定程度上反映了现代电子烟的高成瘾性。除了上瘾之外,越来越多的证据表明,电子烟在短期内与心血管和肺部的影响有关,而使用电子烟的长期影响尚未确定。本综述旨在综合当前有关青少年使用电子烟的知识,包括已确定的和潜在的风险,以及迄今为止为遏制青少年接触电子烟所做的努力。此外,我们还为医疗服务提供者、研究人员和其他利益相关者提供了解决这一重大公共卫生问题的建议。
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引用次数: 0
Contemporary Management and Outcomes of Veterans Hospitalized With Alcohol Withdrawal: A Multicenter Retrospective Cohort Study. 因酗酒而住院的退伍军人的现代管理和疗效:多中心回顾性队列研究。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-03-06 DOI: 10.1097/ADM.0000000000001297
Matthew V Ronan, Kirsha S Gordon, Melissa Skanderson, Michael Krug, Patrick Godwin, Daniel Heppe, Matthew Hoegh, Joel C Boggan, Jeydith Gutierrez, Peter Kaboli, Micah Pescetto, Michelle Guidry, Peter Caldwell, Christine Mitchell, Erik Ehlers, Nazima Allaudeen, Jessica Cyr, Andrea Smeraglio, Peter Yarbrough, Richard Rose, Anand Jagannath, Jaclyn Vargas, Paul B Cornia, Meghna Shah, Matthew Tuck, Cherinne Arundel, James Laudate, Joel Elzweig, Benjamin Rodwin, Joyce Akwe, Meredith Trubitt, Craig G Gunderson

Objectives: Few studies describe contemporary alcohol withdrawal management in hospitalized settings or review current practices considering the guidelines by the American Society of Addiction Medicine (ASAM).

Methods: We conducted a retrospective cohort study of patients hospitalized with alcohol withdrawal on medical or surgical wards in 19 Veteran Health Administration (VHA) hospitals between October 1, 2018, and September 30, 2019. Demographic and comorbidity data were obtained from the Veteran Health Administration Corporate Data Warehouse. Inpatient management and hospital outcomes were obtained by chart review. Factors associated with treatment duration and complicated withdrawal were examined.

Results: Of the 594 patients included in this study, 51% were managed with symptom-triggered therapy alone, 26% with fixed dose plus symptom-triggered therapy, 10% with front loading regimens plus symptom-triggered therapy, and 3% with fixed dose alone. The most common medication given was lorazepam (87%) followed by chlordiazepoxide (33%), diazepam (14%), and phenobarbital (6%). Symptom-triggered therapy alone (relative risk [RR], 0.68; 95% confidence interval [CI], 0.57-0.80) and front loading with symptom-triggered therapy (RR, 0.75; 95% CI, 0.62-0.92) were associated with reduced treatment duration. Lorazepam (RR, 1.20; 95% CI, 1.02-1.41) and phenobarbital (RR, 1.28; 95% CI, 1.06-1.54) were associated with increased treatment duration. Lorazepam (adjusted odds ratio, 4.30; 95% CI, 1.05-17.63) and phenobarbital (adjusted odds ratio, 6.51; 95% CI, 2.08-20.40) were also associated with complicated withdrawal.

Conclusions: Overall, our results support guidelines by the ASAM to manage patients with long-acting benzodiazepines using symptom-triggered therapy. Health care systems that are using shorter acting benzodiazepines and fixed-dose regimens should consider updating alcohol withdrawal management pathways to follow ASAM recommendations.

目标:很少有研究描述住院环境中的当代戒酒管理,也很少有研究根据美国成瘾医学会(ASAM)的指导方针对当前的做法进行回顾:很少有研究描述住院环境中的当代酒精戒断管理,也很少有研究根据美国成瘾医学会(ASAM)的指南回顾当前的实践:我们对 2018 年 10 月 1 日至 2019 年 9 月 30 日期间在 19 家退伍军人健康管理局(VHA)医院内科或外科病房住院的酒精戒断患者进行了一项回顾性队列研究。人口统计学和合并症数据来自退伍军人健康管理局企业数据仓库。住院管理和住院结果通过病历审查获得。研究了与治疗持续时间和复杂停药相关的因素:在纳入本研究的 594 名患者中,51% 的患者仅接受了症状触发疗法,26% 的患者接受了固定剂量加症状触发疗法,10% 的患者接受了前负荷疗法加症状触发疗法,3% 的患者仅接受了固定剂量疗法。最常用的药物是劳拉西泮(87%),其次是氯氮卓(33%)、地西泮(14%)和苯巴比妥(6%)。单纯症状触发疗法(相对风险 [RR],0.68;95% 置信区间 [CI],0.57-0.80)和前负荷与症状触发疗法(RR,0.75;95% 置信区间 [CI],0.62-0.92)与治疗时间缩短有关。劳拉西泮(RR,1.20;95% CI,1.02-1.41)和苯巴比妥(RR,1.28;95% CI,1.06-1.54)与治疗时间延长有关。劳拉西泮(调整后的几率比为4.30;95% CI为1.05-17.63)和苯巴比妥(调整后的几率比为6.51;95% CI为2.08-20.40)也与复杂的戒断有关:总体而言,我们的研究结果支持美国医学会的指导方针,即使用症状触发疗法来管理使用长效苯二氮卓类药物的患者。使用短效苯二氮卓类药物和固定剂量方案的医疗系统应考虑更新酒精戒断管理路径,以遵循 ASAM 的建议。
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引用次数: 0
Z-Drug Use and Benzodiazepine Use and Misuse Among LGB Populations: The Role of Psychological Distress. 女同性恋、男同性恋、双性恋和变性者群体中 Z 类药物的使用和苯并二氮杂卓的使用与滥用:心理压力的作用。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-03-29 DOI: 10.1097/ADM.0000000000001309
Vitor S Tardelli, Thiago M Fidalgo, Silvia S Martins

Background: Z-drugs (hypnotics such as zolpidem, zopiclone, and zaleplon) and benzodiazepines (BZDs) are sedative medications with misuse liability. The goals of this study are to report the (1) prevalence of past-year any Z-drug use, any BZD use, and any BZD misuse by sexual identity category and psychological distress; (2) associations among these 3 categories between sexual identity and past-year psychological distress; (3) associations among these 3 categories with sexual identity by past-year psychological distress status.

Methods: Data were collected from the National Survey on Drug Use and Health (years 2015-2019 [n = 210,392]), a yearly representative national household survey of the American population. We report prevalences of any Z-drug use, any BZD use, and any BZD misuse by sexual identity and past-year psychological distress status. We ran logistic regressions with complex survey design with the 3 dichotomous variables described above as the dependent variables, stratified and not-stratified by psychological distress.

Results: Prevalence of any Z-drug an BZD use and any BZD misuse were higher among LGB (lesbian/gay/bisexual) populations, especially gay men and bisexual women. Psychological distress was positively associated with any Z-drug and BZD use and any BZD misuse. Women were at higher risk of Z-drug (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.18-1.37) and BZD use (OR, 1.64; 95% CI, 1.55-1.73), but lower risk of BZD misuse (OR, 0.82; 95% CI, 0.76-0.88). When stratifying by psychological distress, differences between LGB and heterosexuals were more pronounced among those without past-year psychological distress, especially gay men and bisexual women.

Conclusions: The presence of psychological distress attenuates the disparities between LGB and heterosexual individuals in Z-drug use and BZD use and misuse.

背景:Z类药物(唑吡坦、佐匹克隆和扎来普隆等催眠药)和苯二氮卓类药物(BZD)是有滥用风险的镇静药物。本研究的目的是报告:(1) 按性身份类别和心理困扰分类,过去一年中使用任何 Z 类药物、使用任何 BZD 和滥用任何 BZD 的流行率;(2) 性身份与过去一年心理困扰之间这 3 个类别的关联;(3) 按过去一年心理困扰状况分类,这 3 个类别与性身份之间的关联:数据收集自全国药物使用和健康调查(2015-2019 年 [n = 210,392] ),这是一项针对美国人口的年度代表性全国家庭调查。我们按性身份和过去一年的心理困扰状况报告了任何 Z 类药物使用、任何 BZD 使用和任何 BZD 滥用的流行率。我们采用复杂的调查设计,以上述 3 个二分变量为因变量,按心理困扰进行分层和非分层,进行了逻辑回归:结果:在 LGB(女同性恋/男同性恋/双性恋)人群中,尤其是男同性恋和双性恋女性中,任何 Z 类药物和 BZD 的使用率以及任何 BZD 的滥用率都较高。心理困扰与使用 Z-药物和 BZD 以及滥用 BZD 呈正相关。女性使用 Z-drug(赔率 [OR],1.27;95% 置信区间 [CI],1.18-1.37)和 BZD(赔率,1.64;95% 置信区间 [CI],1.55-1.73)的风险较高,但滥用 BZD 的风险较低(赔率,0.82;95% 置信区间 [CI],0.76-0.88)。根据心理困扰进行分层时,过去一年没有心理困扰的男女同性恋者和异性恋者之间的差异更为明显,尤其是男同性恋者和双性恋女性:结论:心理困扰的存在缩小了男女同性恋、双性恋和变性者与异性恋之间在使用 Z 药物和 BZD 以及滥用 BZD 方面的差异。
{"title":"Z-Drug Use and Benzodiazepine Use and Misuse Among LGB Populations: The Role of Psychological Distress.","authors":"Vitor S Tardelli, Thiago M Fidalgo, Silvia S Martins","doi":"10.1097/ADM.0000000000001309","DOIUrl":"10.1097/ADM.0000000000001309","url":null,"abstract":"<p><strong>Background: </strong>Z-drugs (hypnotics such as zolpidem, zopiclone, and zaleplon) and benzodiazepines (BZDs) are sedative medications with misuse liability. The goals of this study are to report the (1) prevalence of past-year any Z-drug use, any BZD use, and any BZD misuse by sexual identity category and psychological distress; (2) associations among these 3 categories between sexual identity and past-year psychological distress; (3) associations among these 3 categories with sexual identity by past-year psychological distress status.</p><p><strong>Methods: </strong>Data were collected from the National Survey on Drug Use and Health (years 2015-2019 [n = 210,392]), a yearly representative national household survey of the American population. We report prevalences of any Z-drug use, any BZD use, and any BZD misuse by sexual identity and past-year psychological distress status. We ran logistic regressions with complex survey design with the 3 dichotomous variables described above as the dependent variables, stratified and not-stratified by psychological distress.</p><p><strong>Results: </strong>Prevalence of any Z-drug an BZD use and any BZD misuse were higher among LGB (lesbian/gay/bisexual) populations, especially gay men and bisexual women. Psychological distress was positively associated with any Z-drug and BZD use and any BZD misuse. Women were at higher risk of Z-drug (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.18-1.37) and BZD use (OR, 1.64; 95% CI, 1.55-1.73), but lower risk of BZD misuse (OR, 0.82; 95% CI, 0.76-0.88). When stratifying by psychological distress, differences between LGB and heterosexuals were more pronounced among those without past-year psychological distress, especially gay men and bisexual women.</p><p><strong>Conclusions: </strong>The presence of psychological distress attenuates the disparities between LGB and heterosexual individuals in Z-drug use and BZD use and misuse.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140335712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
High-Dose Buprenorphine Initiation: A Scoping Review. 大剂量丁丙诺啡的启动:范围审查。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-05-16 DOI: 10.1097/ADM.0000000000001296
Stanley Wong, Nicholas Fabiano, Declan Webber, Robert A Kleinman

Objective: The aim of the study is to review and synthesize the literature on high-dose buprenorphine initiation (>12-mg total dose on day of initiation).

Methods: A scoping review of literature about high-dose buprenorphine initiation was conducted. MEDLINE, Embase, PsycINFO, and Cochrane Central were searched. Randomized controlled trials, prospective and retrospective cohort studies, and case studies/reports published in English before February 13, 2023, were included.

Results: Fifteen studies reporting outcomes from 580 high-dose buprenorphine initiations were included. Eight studies were in inpatient settings, 3 in emergency departments, 3 in outpatient settings, and 1 in a first-responder setting. Four studies reported high-dose initiations among individuals exposed to fentanyl. There were no reported events of fatal or nonfatal overdose or respiratory depression, although adverse event reporting was inconsistent in published reports. The most reported side effects with high-dose buprenorphine initiation were nausea or vomiting (n = 17) and precipitated withdrawal (n = 7). The most serious reported adverse event was hypotension requiring oral hydration (n = 2). Most studies reported improvements in subjective or objective withdrawal symptoms. The duration of follow-up ranged from none to 8 months.

Conclusions: High-dose buprenorphine initiation has not been associated with reported cases of overdose or respiratory depression. However, the current literature about high-dose buprenorphine is limited by inconsistent side effect reporting, limited power to detect rare safety events such as respiratory depression, limited follow-up data, and few comparison studies between high-dose and regular initiation protocols. Further prospective data are needed to evaluate the safety and effectiveness of this initiation strategy.

研究目的本研究旨在回顾和总结有关大剂量丁丙诺啡起始治疗(起始治疗当天总剂量大于 12 毫克)的文献:方法: 对有关大剂量丁丙诺啡起始治疗的文献进行了范围界定审查。检索了 MEDLINE、Embase、PsycINFO 和 Cochrane Central。纳入了 2023 年 2 月 13 日之前用英语发表的随机对照试验、前瞻性和回顾性队列研究以及病例研究/报告:结果:共纳入了 15 项研究,报告了 580 例开始使用大剂量丁丙诺啡的结果。其中 8 项研究在住院环境中进行,3 项在急诊室进行,3 项在门诊环境中进行,1 项在第一反应环境中进行。四项研究报告了暴露于芬太尼的患者开始使用大剂量丁丙诺啡的情况。尽管不良事件报告在已发表的报告中并不一致,但没有关于致命或非致命过量或呼吸抑制事件的报告。报告最多的大剂量丁丙诺啡副作用是恶心或呕吐(17 例)和骤停(7 例)。最严重的不良反应是低血压,需要口服补液(2 例)。大多数研究报告了主观或客观戒断症状的改善情况。随访时间从零到 8 个月不等:结论:开始使用大剂量丁丙诺啡时,并没有出现用药过量或呼吸抑制的报道。然而,目前有关大剂量丁丙诺啡的文献受到以下因素的限制:副作用报告不一致;检测呼吸抑制等罕见安全事件的能力有限;随访数据有限;大剂量和常规启动方案之间的比较研究很少。需要进一步的前瞻性数据来评估这种起始策略的安全性和有效性。
{"title":"High-Dose Buprenorphine Initiation: A Scoping Review.","authors":"Stanley Wong, Nicholas Fabiano, Declan Webber, Robert A Kleinman","doi":"10.1097/ADM.0000000000001296","DOIUrl":"10.1097/ADM.0000000000001296","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study is to review and synthesize the literature on high-dose buprenorphine initiation (>12-mg total dose on day of initiation).</p><p><strong>Methods: </strong>A scoping review of literature about high-dose buprenorphine initiation was conducted. MEDLINE, Embase, PsycINFO, and Cochrane Central were searched. Randomized controlled trials, prospective and retrospective cohort studies, and case studies/reports published in English before February 13, 2023, were included.</p><p><strong>Results: </strong>Fifteen studies reporting outcomes from 580 high-dose buprenorphine initiations were included. Eight studies were in inpatient settings, 3 in emergency departments, 3 in outpatient settings, and 1 in a first-responder setting. Four studies reported high-dose initiations among individuals exposed to fentanyl. There were no reported events of fatal or nonfatal overdose or respiratory depression, although adverse event reporting was inconsistent in published reports. The most reported side effects with high-dose buprenorphine initiation were nausea or vomiting (n = 17) and precipitated withdrawal (n = 7). The most serious reported adverse event was hypotension requiring oral hydration (n = 2). Most studies reported improvements in subjective or objective withdrawal symptoms. The duration of follow-up ranged from none to 8 months.</p><p><strong>Conclusions: </strong>High-dose buprenorphine initiation has not been associated with reported cases of overdose or respiratory depression. However, the current literature about high-dose buprenorphine is limited by inconsistent side effect reporting, limited power to detect rare safety events such as respiratory depression, limited follow-up data, and few comparison studies between high-dose and regular initiation protocols. Further prospective data are needed to evaluate the safety and effectiveness of this initiation strategy.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140957388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Addiction Medicine
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