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"Coke in the Dope": The Underrecognized Complications of a Cocaine-Adulterated Fentanyl Supply. "毒品中的可卡因":可卡因掺假芬太尼供应的并发症未被充分认识。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-05-31 DOI: 10.1097/ADM.0000000000001319
Vincent Mariano, Justin Berk

Abstract: The opioid crisis, particularly the "fourth wave" involving fentanyl and stimulants, has been responsible for an alarming increase in overdose deaths in the United States. Although fentanyl contamination in cocaine has gained significant attention, the converse-cocaine-adulterated fentanyl-has been largely overlooked despite its health implications. The rise in concurrent cocaine and fentanyl overdose deaths could be attributed to various factors, from intentional polysubstance use to unintentional adulterations. Cocaine-related health issues may amplify the problem. Four potential pathways for the increased risk of overdose with cocaine-adulterated opioids include enhanced drug reinforcement, potential overdose risk with switching drug samples, altered metabolism of medications used for opioid use disorder, and increased myocardial demand juxtaposed with opioid-induced respiratory depression. With these risks, the importance of drug testing becomes paramount in the unregulated drug market. As polysubstance use overdoses surge, there is an urgent need to understand how drug supplies are changing in order to effectively identify appropriate harm reduction strategies. Specifically, further research is needed evaluating complications of low-level cocaine exposure with chronic/persistent opioid use. The hazards associated with cocaine-adulterated fentanyl emphasize the significance of understanding not only fentanyl's presence in cocaine but also cocaine's role in the fentanyl supply.

摘要:阿片类药物危机,特别是涉及芬太尼和兴奋剂的 "第四次浪潮",导致美国因吸毒过量而死亡的人数急剧增加。尽管可卡因中的芬太尼污染已引起人们的极大关注,但可卡因中掺杂芬太尼的反面却在很大程度上被忽视,尽管它对健康有影响。可卡因和芬太尼同时过量致死人数的增加可归因于各种因素,从有意使用多种物质到无意掺杂。与可卡因相关的健康问题可能会加剧这一问题。掺入可卡因的阿片类药物会增加用药过量的风险,这可能有四种途径,包括药物强化作用增强、更换药物样本可能带来用药过量风险、治疗阿片类药物使用障碍的药物代谢发生改变,以及心肌需求增加与阿片类药物引起的呼吸抑制并存。有了这些风险,在无管制的毒品市场中,药物检测就变得至关重要。随着多种物质使用过量的激增,迫切需要了解毒品供应是如何变化的,以便有效地确定适当的减低伤害策略。具体而言,需要进一步研究评估低水平可卡因暴露与长期/持久使用阿片类药物的并发症。与掺杂可卡因的芬太尼相关的危害强调了了解芬太尼在可卡因中的存在以及可卡因在芬太尼供应中的作用的重要性。
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引用次数: 0
Early Long-Acting Buprenorphine for Opioid Use Disorder in the Setting of Acute Pain. 早期长效丁丙诺啡治疗急性疼痛情况下的阿片类药物使用障碍。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-05-31 DOI: 10.1097/ADM.0000000000001333
Mason Schindle, Landon Berger
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引用次数: 0
Receipt of Medications for Alcohol Use Disorder in the Veterans Health Administration: Comparison of Rates at the Intersections of Racialized and Ethnic Identity With Both Sex and Transgender Status. 退伍军人健康管理局中接受酒精使用障碍药物治疗的情况:种族和民族身份与性别和变性身份交叉点的比率比较。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-06-05 DOI: 10.1097/ADM.0000000000001323
Rachel L Bachrach, Madeline C Frost, Olivia V Fletcher, Jessica A Chen, Matthew Chinman, Robert Ellis, Emily C Williams

Objectives: Medications for alcohol use disorder (MAUDs) are recommended for patients with alcohol use disorder yet are underprescribed. Consistent with Minority Stress and Intersectionality theories, persons with multiple sociodemographically marginalized identities (eg, Black women) often experience greater barriers to care and have poorer health outcomes. We use data from the Veterans Health Administration to assess disparities in Federal Drug Administration (FDA)-approved MAUDs and all effective MAUDs between the following groups: racialized and ethnic identity, sex, transgender status, and their intersections.

Methods: Among all Veterans Health Administration outpatients between August 1, 2015, and July 31, 2017, with documented alcohol screenings and an International Classification of Diseases diagnosis for alcohol use disorder in the 0-365 days prior (N = 308,238), we estimated the prevalence and 95% confidence intervals of receiving FDA-approved MAUDs and any MAUDs in the following year and compared them using χ2 or Fisher's exact test. Analyses are unadjusted to present true prevalence and group differences.

Results: The overall prevalence for MAUDs was low (FDA-MAUDs = 8.7%, any MAUDs = 20.0%). Within sex, Black males had the lowest rate of FDA-MAUDs (7.3%, [7.1-7.5]), whereas American Indian/Alaskan Native females had the highest (18.4%, [13.8-23.0]). Among those identified as transgender, Asian and Black transgender persons had the lowest rates of FDA-MAUDs (0%; 4.3%, [1.8-8.5], respectively), whereas American Indian/Alaskan Native transgender patients had the highest (33.3%, [2.5-64.1]). Similar patterns were observed for any MAUDs, with higher rates overall.

Conclusions: Substantial variation exists in MAUD prescribing, with marginalized veterans disproportionately receiving MAUDs at lower and higher rates than average. Implementation and quality improvement efforts are needed to improve MAUD prescribing practices and reduce disparities.

目的:建议酒精使用障碍(MAUDs)患者服用治疗酒精使用障碍的药物,但这些药物的处方量不足。根据少数群体压力和交叉性理论,具有多重社会经济边缘化身份的人(如黑人妇女)通常会遇到更多的护理障碍,健康状况也会更差。我们利用退伍军人健康管理局(Veterans Health Administration)的数据来评估联邦药物管理局(FDA)批准的MAUDs和所有有效的MAUDs在以下群体之间的差异:种族和民族身份、性别、变性身份及其交叉:在 2015 年 8 月 1 日至 2017 年 7 月 31 日期间的所有退伍军人健康管理局门诊患者中,在之前的 0-365 天内有记录的酒精筛查和国际疾病分类中的酒精使用障碍诊断(N = 308,238 例),我们估算了次年接受 FDA 批准的 MAUDs 和任何 MAUDs 的患病率和 95% 置信区间,并使用 χ2 或费雪精确检验对其进行比较。分析未经调整,以呈现真实的流行率和组间差异:MAUDs的总体流行率较低(FDA-MAUDs = 8.7%,任何MAUDs = 20.0%)。就性别而言,黑人男性的 FDA-MAUDs 感染率最低(7.3%,[7.1-7.5]),而美国印第安人/阿拉斯加原住民女性的感染率最高(18.4%,[13.8-23.0])。在变性人中,亚裔和黑人变性人的 FDA-MAUDs 感染率最低(分别为 0%;4.3%,[1.8-8.5]),而美国印第安人/阿拉斯加原住民变性人感染率最高(33.3%,[2.5-64.1])。任何一种MAUDs都有类似的模式,总体比例较高:结论:MAUDs 处方存在巨大差异,边缘化退伍军人接受 MAUDs 的比例过高,低于平均水平,也高于平均水平。需要开展实施和质量改进工作,以改善 MAUD 处方实践并减少差异。
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引用次数: 0
Low Risk of Cardiac Complications During Long-Term Follow-Up of Opioid Dependence. 阿片类药物依赖长期随访期间心脏并发症风险较低
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-06-05 DOI: 10.1097/ADM.0000000000001317
Chris Tremonti, David S Celemajer, Christina Marel, Katherine Mills, Shawn Foo, Jack Wilson, Tim Slade, Maree Teesson, Paul Haber

Objectives: To prospectively assess rates of QT prolongation, arrhythmia, syncope, and sudden cardiac death (SCD) in a cohort of people with heroin dependence.

Methods: To estimate rates of QT prolongation, arrhythmia, and syncope, a subcohort (n = 130) from the Australian Treatment Outcomes Study, a prospective longitudinal cohort study of 615 people with heroin dependence, underwent medical history, venepuncture, and ECG at the 18- to 20-year follow-up.To estimate rates of SCD, probabilistic matching for the entire cohort was undertaken with the Australian Institute of Health and Welfare National Death Index. Deaths were classified into suicide, accidental overdose, trauma, unknown, and disease, which were then further subclassified by probability of SCD. SCD rate was the number of possible or probable SCDs divided by total patient years from the cohort.

Results: From the subcohort, 4 participants (3%) met the criteria for QT prolongation; 3 were prescribed methadone. Seven participants (5%) reported history of arrhythmia, including 2 transferred from methadone to buprenorphine. Thirty participants (23%) reported a previous syncopal event-14 diagnosed as nonarrhythmic syncope and 13 not investigated. In the previous 12 months, 66 participants (51%) reported heroin use; 55 participants (42%) were prescribed methadone. No participant had QTc greater than 500 milliseconds.There were 3 possible SCDs, translating to an estimated SCD rate of 0.29 (CI: 0.05, 0.8) events per 1000 patient years. More cohort members died of overdose (n = 50), suicide (n = 11), and hepatitis C (n = 4).

Conclusions: Low rates of QT prolongation, arrhythmia, syncope, and SCD in the cohort despite high rates of heroin use and methadone treatment.

目的前瞻性评估海洛因依赖者队列中QT延长、心律失常、晕厥和心脏性猝死(SCD)的发生率:澳大利亚治疗结果研究是一项对 615 名海洛因依赖者进行的前瞻性纵向队列研究,为了估算 QT 间期延长、心律失常和晕厥的发生率,对该研究的一个子队列(n = 130)进行了病史、静脉穿刺和 18-20 年随访时的心电图检查。死亡分为自杀、意外用药过量、外伤、未知和疾病,然后根据 SCD 的概率进一步细分。SCD率是可能或疑似SCD的数量除以队列中患者的总年数:子队列中有 4 名参与者(3%)符合 QT 间期延长的标准;其中 3 人服用了美沙酮。7名参与者(5%)报告有心律失常病史,其中包括2名从美沙酮转用丁丙诺啡的患者。30 名参与者(23%)报告曾发生过晕厥事件,其中 14 人被诊断为非心律失常性晕厥,13 人未接受调查。在过去 12 个月中,66 名参与者(51%)报告使用过海洛因;55 名参与者(42%)被处方美沙酮。没有人的 QTc 超过 500 毫秒。有 3 例可能的 SCD,估计每 1000 患者年的 SCD 发生率为 0.29(CI:0.05,0.8)次。更多队列成员死于用药过量(50 人)、自杀(11 人)和丙型肝炎(4 人):尽管使用海洛因和接受美沙酮治疗的比例较高,但队列中QT延长、心律失常、晕厥和SCD的发生率较低。
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引用次数: 0
Revisiting Preaddiction. 重新审视 "先入为主"。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-08-10 DOI: 10.1097/ADM.0000000000001357
Shannon C Miller, Sharon Levy, Andrew J Saxon, Jeanette M Tetrault, Richard N Rosenthal, Sarah Wakeman, Frank Vocci

Abstract: The directors of the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism have proposed new efforts to enable earlier identification and intervention for harmful substance use and its consequences. As editors of The ASAM Principles of Addiction Medicine, we fully support this goal. The word "preaddiction" has been suggested as a diagnostic label to describe individuals who would be targeted for early intervention. In this commentary, we offer that "unhealthy substance use" would be a better descriptor than "preaddiction" and review several potential barriers to be addressed in order to maximize the impact of introducing this new paradigm.

摘要:美国国家药物滥用研究所(National Institute on Drug Abuse)和美国国家酒精滥用与酗酒研究所(National Institute on Alcohol Abuse and Alcoholism)的所长们提出了新的努力方向,以便更早地识别和干预有害物质的使用及其后果。作为《ASAM成瘾医学原则》的编辑,我们完全支持这一目标。有人建议将 "成瘾前期"(pre-addiction)作为诊断标签,用来描述那些将成为早期干预目标的个体。在这篇评论中,我们认为 "不健康的药物使用 "比 "成瘾前 "更适合描述,并回顾了几个需要解决的潜在障碍,以便最大限度地发挥引入这一新模式的影响。
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引用次数: 0
The Concept of Treatment-Refractory Addiction: Implications for Addiction Treatment Systems and Research. 难治性成瘾的概念:对成瘾治疗系统和研究的影响。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-08-10 DOI: 10.1097/ADM.0000000000001350
Edward V Nunes, A Thomas McLellan

Abstract: The concept of treatment-refractory addiction, proposed by Eric Strain in this edition of the Journal, has the potential to invigorate the field of addiction treatment and research by focusing on a phenomenon that is familiar to any clinician treating patients with substance use disorders, namely, the patient who does not experience sufficient improvement from standard treatments. An analogy is drawn to the concept of treatment-resistant depression and the STAR*D study, which demonstrated an algorithmic approach to treatment, where if the first antidepressant medication tried did not result in remission from depression, subsequent trials of medications or cognitive behavioral therapy doubled the proportion of patients achieving remission. Recognizing treatment-refractory addiction challenges our field to develop analogous, stepwise, algorithmic approaches to treatment of substance use disorders, moving away from siloed treatment programs toward integrated treatment systems where alternative treatments are available, offering the kind of personalized, tailored forms of care used in the treatment of most other chronic illnesses. Like in STAR*D, research could focus on samples of patients who have not benefitted from initial trials of standard addiction treatments, addressing the key clinical question of what to do next when previous treatments fail.

摘要:埃里克-斯特恩(Eric Strain)在本期期刊中提出的 "难治性成瘾"(treatment-refractory addiction)概念,通过关注治疗药物使用障碍患者的临床医生所熟悉的一种现象,即患者在接受标准治疗后病情未得到充分改善,有可能为成瘾治疗和研究领域注入新的活力。该研究展示了一种算法治疗方法,即如果首次尝试的抗抑郁药物治疗未能使抑郁症得到缓解,那么后续的药物治疗或认知行为疗法试验可使获得缓解的患者比例增加一倍。认识到难治性成瘾对我们的领域提出了挑战,我们需要开发类似的、循序渐进的、算法化的方法来治疗药物使用障碍,从孤立的治疗方案转向综合治疗系统,在综合治疗系统中提供可供选择的治疗方法,提供用于治疗大多数其他慢性疾病的个性化、量身定制的护理形式。与 STAR*D 项目一样,研究也可以侧重于那些在标准成瘾治疗的初步试验中未能获益的患者样本,以解决临床上的一个关键问题,即当之前的治疗失败时,下一步该怎么做。
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引用次数: 0
Comparison of Treatment Receipt and Hospitalization Among Patients With Stimulant Use Disorder and/or Opioid Use Disorder in the Veterans Health Administration. 退伍军人健康管理局中的兴奋剂使用障碍和/或阿片类药物使用障碍患者接受治疗和住院情况的比较。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-06-03 DOI: 10.1097/ADM.0000000000001329
Madeline C Frost, Lara N Coughlin, Lan Zhang, Lewei Allison Lin

Objectives: Stimulant use is a growing problem, but little is known about service utilization among patients with stimulant use disorder (StUD). In the context of the overdose crisis, much research has focused on patients with opioid use disorder (OUD). It is unclear how the characteristics, treatment receipt, and hospitalization of patients with StUD differ from patients with OUD.

Methods: Electronic health record data were extracted for national Veterans Health Administration patients with a visit from March 1, 2020, to February 28, 2021 with StUD and/or OUD (N = 132,273). We compared patients with StUD without OUD to those with (1) co-occurring StUD + OUD and (2) OUD without StUD. Patient characteristics, substance use disorder treatment, and hospitalizations in the year following patients' first study period visit were descriptively compared. Treatment and hospitalization were also compared in adjusted regression models.

Results: Compared with patients with OUD + StUD, those with StUD without OUD were less likely to receive outpatient (adjusted odds ratio [aOR] 0.49, 95% confidence interval [CI] 0.47-0.50) or any treatment (aOR 0.47, 95% CI 0.46-0.49). Compared with patients with OUD without StUD, those with StUD without OUD were less likely to receive outpatient (aOR 0.51, 95% CI 0.49-0.52) or any treatment (aOR 0.56, 95% CI 0.54-0.58) and more likely to receive residential treatment (aOR 2.18, 95% 2.05-2.30) and to be hospitalized (aOR 1.62, 95% 1.56-1.69).

Conclusions: Patients with StUD may be less likely to receive treatment and more likely to be hospitalized than patients with OUD. Efforts focused on mitigating hospitalization and increasing treatment receipt for patients with StUD are needed.

目的:使用兴奋剂是一个日益严重的问题,但人们对兴奋剂使用障碍(StUD)患者的服务利用情况知之甚少。在用药过量危机的背景下,许多研究都集中在阿片类药物使用障碍(OUD)患者身上。目前还不清楚 StUD 患者与 OUD 患者在特征、接受治疗和住院治疗方面有何不同:提取了 2020 年 3 月 1 日至 2021 年 2 月 28 日期间就诊的全国退伍军人健康管理局 StUD 和/或 OUD 患者(N = 132,273 人)的电子健康记录数据。我们将没有 OUD 的 StUD 患者与 (1) 合并 StUD + OUD 和 (2) 没有 StUD 的 OUD 患者进行了比较。我们对患者的特征、药物使用障碍治疗以及患者首次就诊后一年内的住院情况进行了描述性比较。在调整回归模型中还对治疗和住院情况进行了比较:结果:与患有 OUD + StUD 的患者相比,患有 StUD 而未患有 OUD 的患者接受门诊治疗(调整赔率 [aOR] 0.49,95% 置信区间 [CI] 0.47-0.50)或任何治疗(aOR 0.47,95% CI 0.46-0.49)的可能性较低。与未患有 StUD 的 OUD 患者相比,患有 StUD 的 OUD 患者接受门诊治疗(aOR 0.51,95% CI 0.49-0.52)或任何治疗(aOR 0.56,95% CI 0.54-0.58)的可能性较低,而接受住院治疗(aOR 2.18,95% 2.05-2.30)和住院治疗(aOR 1.62,95% 1.56-1.69)的可能性较高:结论:与 OUD 患者相比,StUD 患者接受治疗的可能性更小,住院的可能性更大。有必要努力减少 StUD 患者住院治疗的情况,并增加其接受治疗的机会。
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引用次数: 0
Parosmia Is Positively Associated With Problematic Drinking, as Is Phantosmia With Depressive Symptoms. 幻觉与问题性饮酒呈正相关,幻觉与抑郁症状也呈正相关。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-05-22 DOI: 10.1097/ADM.0000000000001332
Khushbu Agarwal, Jeremy W Luk, Bethany L Stangl, Melanie L Schwandt, Reza Momenan, David Goldman, Nancy Diazgranados, David A Kareken, Lorenzo Leggio, Vijay A Ramchandani, Paule V Joseph

Objectives: Alcohol use disorder (AUD) is a global health problem with significant negative consequences, including preventable deaths. Although olfactory dysfunction is associated with chronic alcohol drinking, the relationship among specific types of olfactory deficits, depressive symptoms, and problematic drinking remains to be explored. Here, we examined the prevalence of olfactory distortion (parosmia) and hallucination (phantosmia) and assessed their associations with problematic drinking and depressive symptoms.

Methods: In April-June 2022, 250 participants across the spectrum of AUD were recruited for assessment in the National Institute on Alcohol Abuse and Alcoholism COVID-19 Pandemic Impact on Alcohol study. Surveys covered self-reported olfactory function, depressive symptoms, and problematic drinking, with key measures assessed, including the Alcohol Use Disorders Identification Test and the Patient Health Questionnaire. Predictors in the analysis included parosmia and phantosmia, with covariates comprising age, sex, socioeconomic status, race, ethnicity, COVID-19 infection status, and smoking status.

Results: Among 250 individuals, 5.2% experienced parosmia and 4.4% reported phantosmia. Parosmia was associated with higher Alcohol Use Disorders Identification Test scores (β = 7.14; 95% confidence interval = 3.31, 10.96; P < 0.001), whereas phantosmia was linked to higher Patient Health Questionnaire scores (β = 3.32; 95% confidence interval = 0.22, 6.42; P = 0.03). These associations persisted in both the full sample and the subset of participants without COVID-19.

Conclusions: Our study highlights strong existing links among olfactory deficits, problem drinking, and depressive symptoms, underscoring the need to assess smell impairments in clinical settings. Future research should explore these connections further to develop new treatments for individuals with AUD and depression.

目标:酒精使用障碍(AUD)是一个全球性的健康问题,具有严重的负面影响,包括可预防的死亡。虽然嗅觉功能障碍与长期饮酒有关,但特定类型的嗅觉障碍、抑郁症状和问题性饮酒之间的关系仍有待探讨。在此,我们研究了嗅觉失真(parosmia)和幻觉(phantosmia)的发生率,并评估了它们与问题性饮酒和抑郁症状之间的关系:2022年4月至6月,美国国家酒精滥用和酒精中毒研究所(National Institute on Alcohol Abuse and Aloholism COVID-19 Pandemic Impact on Alcohol)招募了250名不同程度的AUD参与者进行评估。调查内容包括自我报告的嗅觉功能、抑郁症状和问题性饮酒,主要评估指标包括酒精使用障碍鉴定测试和患者健康问卷。分析中的预测因素包括副嗅和幻嗅,协变量包括年龄、性别、社会经济地位、种族、民族、COVID-19 感染状况和吸烟状况:结果:在 250 人中,5.2% 的人有肤浅感觉,4.4% 的人有幻觉。嗜酒与较高的酒精使用障碍鉴定测试得分相关(β = 7.14;95% 置信区间 = 3.31,10.96;P < 0.001),而幻视与较高的患者健康问卷得分相关(β = 3.32;95% 置信区间 = 0.22,6.42;P = 0.03)。这些关联在全样本和无 COVID-19 的参与者子集中均持续存在:我们的研究强调了嗅觉障碍、问题饮酒和抑郁症状之间的密切联系,突出了在临床环境中评估嗅觉障碍的必要性。未来的研究应进一步探索这些联系,以便为患有 AUD 和抑郁症的人开发新的治疗方法。
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引用次数: 0
Substance Use Disorder Care in Skilled Nursing Facilities: Characterizing Resident Experiences. 护理机构中的药物使用障碍护理:描述住院患者的经历。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-06-05 DOI: 10.1097/ADM.0000000000001318
Arianna Parkhideh, Kimberly J Beiting, Meredith Yang, A Justine Landi, Stacie Levine

Objectives: Patients with substance use disorder (SUD) may face many challenges when being cared for in skilled nursing facilities (SNFs), such as stigma and inadequate access to treatment. This study aims to learn from the perspectives of SNF residents with SUD.

Methods: Nineteen semistructured interviews were conducted at 5 SNFs in the Chicago Metropolitan Area. Additionally, Likert-type responses and substance use screening tests were collected. Qualitative data were analyzed using Dedoose version 9.0.107 (Sociocultural Research Consultants, LLC, Los Angeles, CA).

Results: Qualitative analyses identified 4 themes: (1) the SNF can be a positive site for recovery, (2) barriers to recovery in SNFs are variable, (3) lived experiences with SUD care and harm reduction are heterogeneous, and (4) the needs of residents with SUD encompass multiple domains. Results highlighted the variability of access to counseling and SUD treatment, as well as the prevalence of stigma, substance use, and overdose in SNFs. Results revealed the need for access to social work support, activities, counseling services, and improved staff knowledge of treating SUD.

Conclusions: SNF residents living with SUD experience variable quality of care and may have difficulty accessing counseling and medical treatments for SUD, depending on the available resources in the facility to which they were admitted. The quality of care for residents living with SUD requires further study as more patients with SUD require SNF care.

目标:在专业护理机构(SNFs)接受护理时,药物使用障碍(SUD)患者可能会面临许多挑战,例如污名化和治疗途径不足。本研究旨在从患有药物滥用性精神障碍的专业护理机构住院患者的角度了解他们的情况:在芝加哥大都会区的 5 家专业护理机构进行了 19 次半结构式访谈。此外,还收集了李克特类型的回答和药物使用筛查测试。定性数据使用 Dedoose 9.0.107 版(Sociocultural Research Consultants, LLC, Los Angeles, CA)进行分析:定性分析确定了 4 个主题:(1)SNF 可以成为积极的康复场所;(2)SNF 中的康复障碍各不相同;(3)在 SUD 护理和减低伤害方面的生活经验各不相同;以及(4)患有 SUD 的居民的需求涵盖多个领域。研究结果突显了获得咨询和 SUD 治疗方面的差异,以及在 SNF 中污名化、药物使用和用药过量的普遍性。结果表明,有必要提供社会工作支持、活动、咨询服务,并提高员工对治疗 SUD 的认识:患有药物滥用症的 SNF 住户所获得的护理质量参差不齐,他们可能难以获得药物滥用症的咨询和医疗服务,这取决于他们入住的护理机构的可用资源。随着越来越多的 SUD 患者需要 SNF 护理,需要对 SUD 居民的护理质量进行进一步研究。
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引用次数: 0
Kava Withdrawal Treated With Phenobarbital-A Case Report and Literature Review. 用苯巴比妥治疗卡瓦戒断--病例报告和文献综述。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-05-31 DOI: 10.1097/ADM.0000000000001314
Ryan Michael Cassidy, Kalli Burdick, Trevor Anesi, Daniel Daunis

Abstract: Kava consumption is a traditional practice in Polynesian and Micronesian cultures. It has recently gained popularity in the United States for therapeutic and recreational use. We report the following case. A man presented to the emergency department after a fall while intoxicated on kava. He was medically admitted for altered mental status, facial and clavicle fractures, and hyponatremia. Psychiatry was consulted for management of delirium. On interview, he reported consuming escalating amounts of kava for weeks despite attempts to stop. He was diagnosed with acute kava withdrawal with hyperactive delirium, treated with phenobarbital load (860 mg) and taper (390 mg). Continuous dexmedetomidine drip to hospital day 3 treated sympathetic activation and breakthrough agitation. By day 4, his delirium resolved and remained in remission until discharge. We performed a systematic review for reports of kava withdrawal, returning 9 studies. Eight assessed withdrawal symptoms after cessation of a low controlled dose of kava extract with no symptoms noted. One reported a case series of heavy kava users with seizure-like events. No publications discussed treatment of kava withdrawal. To our knowledge, this is the first publication to describe kava withdrawal syndrome and its effective treatment with phenobarbital.

摘要:食用卡瓦是波利尼西亚和密克罗尼西亚文化中的一种传统习俗。最近,卡瓦在美国越来越流行,用于治疗和娱乐。我们报告了以下病例。一名男子在服用卡瓦酒后摔倒,随后被送往急诊科。他因精神状态改变、面部和锁骨骨折以及低钠血症而入院。精神科对他进行了谵妄治疗。在面谈时,他说尽管曾试图停止服用卡瓦,但连续数周都在不断增加卡瓦的摄入量。他被诊断为急性卡瓦戒断伴多动谵妄,接受了苯巴比妥负荷(860 毫克)和减量(390 毫克)治疗。在住院第 3 天,连续使用右美托咪定滴注治疗交感神经激活和突破性躁动。第 4 天,他的谵妄症状得到缓解,直到出院。我们对有关卡瓦戒断的报告进行了系统回顾,共返回了 9 项研究。其中 8 项研究评估了停用低控制剂量卡瓦提取物后的戒断症状,结果未发现任何症状。一项研究报告了大量卡瓦使用者出现癫痫发作的系列病例。没有任何文献讨论了卡瓦戒断的治疗方法。据我们所知,这是第一份描述卡瓦戒断综合征及其苯巴比妥有效治疗方法的出版物。
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引用次数: 0
期刊
Journal of Addiction Medicine
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