Journal of Addiction Medicine最新文献

Objectives: Cocaine use disorder (CUD) is a chronic condition, often associated with attention deficit hyperactivity disorder (ADHD). No medications have been approved for the treatment of CUD, but methylphenidate (MPH) has been explored as a potential candidate. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of MPH in patients with CUD with and without ADHD.

Methods: Following PRISMA guidelines, we developed a search string for PubMed, ISI Web of Science, and Scopus databases. We included randomized and nonrandomized clinical studies that used MPH in CUD treatment.

Results: Twenty studies were included in the systematic review, 6 of them were included in the meta-analysis. In the meta-analysis, MPH did not reduce craving (ES: -0.33, 95% CI: 1.69 to 1.03; Z = -0.473; P = 0.636) or cocaine use (ES: -0.01, 95% CI: -0.35 to 0.33) (Z= -0.084; P = 0.933) compared with placebo. However, the route of administration and the presence of ADHD associated with CUD influenced the outcomes on cocaine craving measures. Similarly, although the results were inconclusive, a trend toward the reduction of cocaine consumption was observed in patients with ADHD treated with MPH. Regarding safety, MPH can be used in patients with CUD up to 90 mg/d and monitoring the cardiovascular parameters is strictly required.

Conclusions: Evidence on the efficacy of MPH for the treatment of CUD is still limited and inconclusive. However, there might be a rationale for its use in patients with both CUD and ADHD, therefore, further clinical studies are needed in this particular category.

Objectives: Alcohol use and pain are both prevalent public health concerns, yet their associations at the population level remain understudied. This study examines the relationship between alcohol consumption and self-reported pain among US adults.

Methods: A cross-sectional analysis was conducted using data from the 2020 National Health Interview Survey, a nationally representative data set by the National Center for Health Statistics. The analytic sample included 24,499 adults aged ≥18 years (mean age=51.6, SD=18.0). Alcohol consumption in the past 12 months was categorized as nondrinking (<1 drink ever), light (≤3 drinks/wk), moderate (males: 4-14; females: 4-7 drinks/wk), and heavy (males: >14; females: >7 drinks/wk) drinking. Pain (acute or chronic) frequency, severity, and interference over the past 3 months were assessed via self-report. Adjusted logistic regression models were used to estimate associations.

Results: A dose-response relationship was observed: compared with nondrinkers, odds of experiencing pain were higher among heavy drinkers (aOR=1.76; 95% CI: 1.30-2.37), moderate (aOR=1.39; 95% CI: 1.10-1.76), and light (aOR=1.32; 95% CI: 1.10-1.60). Our analyses further revealed that while pain frequency and severity were significantly associated with the severity of alcohol use, pain-related interference with daily life and family functioning did not differ significantly by drinking status. Opioid use was also more common among moderate and heavy drinkers.

Conclusions: Higher alcohol consumption is significantly associated with increased likelihood of pain, with a clear dose-response pattern. Findings underscore the need for integrated screening and intervention targeting both alcohol use and pain.

Objectives: People who inject drugs are at an increased risk of infectious complications. Certain injection practices can lead to bacterial complications from oral flora, including licking needles or using saliva to clean the skin. We report the first case in the literature of a patient licking the syringe plunger and present a scoping review to identify other injection practices associated with oropharyngeal bacterial complications from injecting drugs.

Methods: The authors searched OVID Medline, Embase, and APA PsycINFO to identify case reports and case series of patients with infections related to salivary contamination in the injection process. Studies with suspected unsafe injection practices based on the pathogen, but with no specific injection practices reported, were excluded. Artificial intelligence (AI) was utilized to augment the traditional scoping review by refining search criteria for a repeated traditional search and conducting iterative AI literature searches using embedded links.

Results: Nine sources were identified with AI-augmented embedded article searching that were not identified in the traditional scoping review. One source was identified with AI-augmented search criteria. If only the traditional scoping review had been used, 3 of the 13 articles would have been identified.

Conclusions: The scoping review identified unexpected etiologies of oropharyngeal bacterial contamination, not limited to licking needles, illustrating the importance of gaining an in-depth, step-by-step understanding of how each patient with intravenous drug use injects to identify potential modes of infection. This case also provides an example of potential advancements in artificial intelligence to augment research by improving search strategies, such as MeSH terms and identifying articles.

Background: The United States continues to experience an opioid overdose epidemic with mortality patterns that reflect existing social and environmental inequities. Although research has examined various factors associated with opioid-related mortality, the relationships between social-environmental vulnerability (SEV), health care presence, and geography remain poorly characterized.

Purpose: To explore whether SEV accelerates opioid overdose rates and to assess how the presence of health care services-specifically opioid treatment programs (OTPs) and primary care providers (PCPs)-modifies these patterns across rural and urban contexts.

Methods: A retrospective ecological analysis using hierarchical linear modeling was conducted from January 2020 to December 2022, analyzing 172,359 observations across 57,453 census tracts within 1219 US counties. The primary exposure was census-tract-level SEV, operationalized using the CDC Environmental Justice Index. Health care indicators included county-level presence of OTPs and PCPs.

Results: Areas in the highest quartile of SEV demonstrated elevated acceleration coefficients (β=3.224; SE=0.803; P<.001), with pronounced patterns observed in rural areas, though ecological design limitations preclude individual-level causal inference. Interaction analyses suggested that high-SEV counties containing both OTP and primary care resources demonstrate lower acceleration coefficients (β= -11.478, SE=5.429, P=0.035). Areas without health care presence showed higher baseline rates in overdose acceleration, particularly in urban high-vulnerability settings.

Conclusions: High SEV was associated with accelerated opioid overdose rates during 2020-2022, particularly in rural areas. The presence of OTPs and primary care services within counties was associated with attenuated acceleration in high-vulnerability areas. This may indicate that policies prioritizing comprehensive health care services in high-SEV communities could address opioid overdose disparities.

Objectives: Diseases, injuries, and death attributable to drug use are a major global public health problem.

Methods: This was a cross-sectional study that used data from the Global Burden of Diseases (GBD) 2021. Data on years of life lost (YLLs), years lived with disability (YLDs), disability adjusted life years (DALY), and deaths from HIV/AIDS, acute hepatitis B, acute hepatitis C, cirrhosis, liver cancer, drug use disorders, and self-harm attributable to drug use in 204 countries and territories from 1990 to 2021 were retrieved from the GBD 2021.

Results: Globally, drug use accounted for 463.4 thousand deaths, 18.0 million YLLs, 9.6 million YLDs, and 27.7 million DALYs in 2021. Globally, 0.96% of all DALYs (95% uncertainty intervals 0.85% to 1.07%) were attributable to drug use in 2021, and 71.82% of age-standardized rates of DALYs attributed to drug use disorders were due to opioid use disorders. High-income North America (2117.6), Eastern Europe (911.1), and Australasia (559.4) had the highest DALYs attributable to drug use in 2021. Globally there was not a nonsignificant annual trend [estimated annual percentage change (EAPC) 0.16, 95% CI: -0.16 to 0.47] in age-standardised DALYs attributable to drug use from 1990 to 2021; however, there were regional increases during this period, with the largest increases seen in High-income North America (4.83, 4.52 to 5.14), Western sub-Saharan Africa (1.84, -0.79 to 4.55), and Eastern Europe (1.07, 0.21 to 1.93).

Conclusions: Burdens attributable to drug use were high and continued to grow rapidly in some regions, particularly high-income North America.

Objectives: Buprenorphine (BUP), a partial mu-opioid receptor (MOR) agonist, is an effective analgesic and is standard-of-care for treating opioid use disorder (OUD). Transitioning from full MOR agonists to stable BUP dosing can be challenging as some patients experience BUP-precipitated opioid withdrawal (BPOW) due to its ability to displace full MOR agonists. To improve patient tolerability low-dose BUP initiation protocols deliver small, progressively escalating BUP doses, allowing gradual displacement of other opioids and replacement with BUP. We describe a case series using a novel intravenous BUP "micro-infusion" protocol for rapid medication transition with no patients meeting the operational criteria for BPOW.

Methods: A retrospective case series of patients who received an 8-hour 1200 mcg BUP infusion (150 mcg/hr) and one (or more) sublingual BUP doses after medical or nonmedical full MOR agonist administration. Variables included demographic characteristics, presence of OUD, opioid medications, BUP continuation/prescription fill rates, and evidence of BPOW based on Clinical Opiate Withdrawal Scale (COWS) scores.

Results: Of 23 patients included, 8 presented with current OUD (34.8%) and 15 were treated with full MOR agonists for analgesia (65.2%) before BUP micro-infusion. There were no instances of BPOW. Among the 8 patients with OUD, 5 (62.5%) continued sublingual BUP and filled their prescription for BUP upon discharge.

Conclusions: Overall, the 8-hour intravenous 1200 mcg BUP micro-infusion protocol was well-tolerated with no clinically apparent cases of BPOW and similar rates of continued sublingual BUP treatment post-discharge among patients with OUD compared with other low-dose BUP initiation protocols.

Objectives: Hospitalization and emergency department (ED) visits are an underutilized opportunity to reach high-risk patients with opioid use disorder (OUD) with buprenorphine (BUP) treatment and reduce the ongoing and widespread treatment gap. Monthly extended-release BUP (XR-BUP) potentially facilitates successful initiation and delivers sustained treatment. XR-BUP provides up to 30 days of medication for opioid use disorder (MOUD) with each administration and could improve retention in care during transition to outpatient addiction treatment. We aim to describe the patient characteristics and clinical outcomes of hospitalized and ED patients with OUD treated with monthly XR-BUP.

Methods: We conducted a retrospective chart review of a cohort of ED or hospitalized patients who received monthly XR-BUP at an urban, safety-net hospital over a 6-month period from September 2023 through March 2024.

Results: There were 61 patient encounters where XR-BUP was administered. Within 30 days of discharge, 40/61 (65.6%) patients who received XR-BUP engaged in outpatient addiction treatment through an in-person or telemedicine provider visit; within 45 days, 29/61 (47.5%) patients received a subsequent XR-BUP. Thirty-eight (62.3%) initiated XR-BUP with low-dose initiation of sublingual buprenorphine with full agonist opioid continuation, 20 (32.8%) started after high-dose sublingual buprenorphine, 2 (3.3%) after low-dose initiation of IV buprenorphine, and 1 (1.6%) received "direct to inject" XR-BUP.

Conclusions: In this observational retrospective study, rates of engagement in addiction treatment after discharge among patients with OUD receiving XR-BUP were high. Clinical teams utilized novel strategies to initiate XR-BUP during ED and hospital-based encounters.

Objectives: Racial inequities in substance use disorder treatment, and specifically buprenorphine treatment, contribute to overdose inequities. Bridge Clinics are a low-threshold, transitional treatment model that may improve treatment access. This report assesses the change in visit volume for Black and Hispanic patients and those with limited English proficiency (LEP) after the implementation of the Bridge Clinic expansion across 4 distinct sites.

Methods: Between October 2021 and 2023, 3 hospital-based Bridge Clinics were expanded, and a community-based Bridge Clinic was established, all in regions with high racial and language inequities in overdose mortality. Implementation included creating Bridge Clinic performance measures, which were reviewed with clinic leadership monthly, developing a toolkit, and launching mobile services. We present Bridge Clinic visit volume aggregated by calendar year for Black-non Hispanic, Hispanic (any race), and LEP patients. We calculated the percent of total visits for each patient group and assessed the change over time.

Results: Comparing 2021 to 2023, total visits increased from 5323 to 10,350, and unique patients increased from 1893 to 3316. Annual visits increased from 437 to 1151 visits for Black patients; 566 to 1609 for Hispanic patients; and 96 to 265 for LEP patients. The percent of visits grew significantly for Black (8.21% vs. 10.24%, P<0.001), Hispanic (10.63% vs. 15.55%, P<0.001) and LEP patients (1.80% vs. 2.56%, P=0.003) from 2021 to 2023.

Conclusions: Expanding low-barrier Bridge Clinics may increase substance use disorder (SUD) treatment visits for Black and Hispanic patients and those with LEP.

Objectives: As a prominent concern for addiction medicine, illicit fentanyl and its analogues have been implicated in numerous poisonings among people. Many households in Canada and the United States include cats or dogs as pets who may be exposed to substances such as fentanyl.

Methods: This case-series examined data from the American Society for the Prevention of Cruelty to Animals' Poison Control, a 24-hour call center for animal poison-related emergencies. Descriptive statistics were used on records in which cats or dogs had a reported exposure to illicit fentanyl between 2019 and 2023.

Results: The sample included 117 animals (n=4 cats and n=113 dogs). Breeds most identified in this sample were Chihuahuas (n=21) and American Pit Bull Terriers (n=14). Among dogs, the average age was 1.9 (SD=2.8) years and the average weight was 10.5 (SD=11.1) kg. Among cats, the average age was 2.0 (SD=1.2) years and the average weight was 6.0 (SD=2.8) kg. Among dogs, the most reported illicit fentanyl exposure formulation included powder/crystals (n=34; 30.1%). Hypersalivation was reported as a clinical sign for n=2 (50.0%) cats in the sample. The top clinical signs reported among dogs in the sample include lethargy (n=39; 34.5%), vocalization (n=37; 32.7%), and ataxia (n=27; 23.9%).

Conclusions: Impacts of illicit fentanyl and its analogues on society extend to 2 common household animals, cats and dogs. Any potential exposure to illicit fentanyl among cats or dogs should promptly seek emergency veterinarian services for reversal with naloxone and supportive care.

Objectives: To evaluate trends in newly filled GLP-1 receptor agonist (GLP-1RA) prescriptions among U.S. adults with type 2 diabetes (T2DM) and/or obesity, comparing those with and without comorbid alcohol use disorder (AUD), and to assess differences in their demographic and clinical characteristics.

Methods: We used national claims data from Optum Labs Data Warehouse, which includes de-identified administrative and pharmacy claims from commercially insured and Medicare Advantage (MA) enrollees throughout the U.S., to identify adults who newly filled GLP-1RA-based prescriptions between April 1, 2016, and March 31, 2024. We calculated quarterly rates of new GLP-1RA fills per 100 person-years and compared the characteristics of individuals with T2DM and/or obesity with and without comorbid AUD.

Results: From 2016 to 2024, 555,224 individuals with T2DM and/or obesity newly filled prescriptions for GLP-1RAs, of whom 6606 had comorbid AUD. The rate of new GLP-1RA fills for individuals with comorbid AUD increased from 1.27 to 6.02 per 100 person-years between 2016-2024 [incident rate ratio (IRR): 4.73 (95% CI 3.38, 6.79)], compared with an increase of 2.21 to 6.55 per 100 person-years among individuals without comorbid AUD [IRR: 2.96 (95% CI 2.88, 3.05)]. Individuals with AUD were more likely to be MA enrollees under age 65, male, have had a recent emergency department visit, and have co-occurring psychiatric and medical conditions compared with those without comorbid AUD.

Conclusions: From 2016 to 2024, the rate of newly filled GLP-1RA prescriptions increased among individuals with T2DM and/or obesity and comorbid AUD. Individuals with comorbid AUD were more likely to be male and to have clinical characteristics linked to greater AUD severity. Additional clinical studies on the efficacy and safety of GLP-1RAs for AUD are needed to guide their appropriate use.