Journal of Addiction Medicine最新文献

Objective: We examined the association between alcohol consumption and mortality among people living with HIV (PWH).

Methods: We included individuals aged ≥18 years, enrolled between 2004 and 2022 in CoRIS, a Spanish multicenter cohort study of ART-naive PWH at enrolment. We calculated mortality rates per 100 persons-year (p-y) of follow-up, and used multivariable Cox models to estimate hazard ratio (HR) (95% confidence interval [CI]) for the association between alcohol consumption at enrolment and mortality after controlling for confounders (sex at birth, age, mode of HIV infection, education level, region of origin, HCV infection [EIA+], CD4 cell count and HIV-RNA load at enrolment).

Findings: We included 6087 participants (14% women); median age 36 years (interquartile range [IQR]: 29-45). Men who had sex with men were 63.2% of the participants, 27.9% were heterosexuals, and 4.9% were persons who inject drugs. Prevalence of HCV was 7.5%, median RNA-HIV load was 70,431 copies/mL (IQR: 16,982-261,000), and median CD4 count was 363 cells/mm3 (IQR: 196-547). Two hundred seventy participants (4.4%) reported alcohol consumption of ≥40 g/d. Over 31,171 p-y of follow-up, 240 participants (3.9%) died. The mortality rate among individuals who drank ≥40 g/d was 2.13 (95% CI: 1.56-2.93) per 100 p-y compared with 0.68 (95% CI: 0.60-0.79) per 100 p-y among those who drank <40 g/d. After adjustment, alcohol consumption of ≥40 g/d was associated with increased mortality (adjusted HR: 1.54 [95% CI: 1.06-3.42], P =0.02).

Conclusion: In this cohort of PWH, excessive alcohol use was associated with a higher risk of death.

Objectives: Treatment recommendations for substance use disorder (SUD) emphasize medication as a key component of optimal care. Nonetheless, US Food and Drug Administration (FDA)-approved options for adolescents with SUD are limited. The purpose of this study was to systematically assess the number and characteristics of clinical trials testing medications for SUD in adolescent populations (aged <18) during the past 25 years.

Methods: We performed a scoping review to identify randomized-controlled trials of medications for SUD that were available in Cochrane CENTRAL or clinicaltrials.gov, active between January 1, 1999 and December 4, 2024, and included at least one participant aged 13-17, with none aged 26 years or older. Key study characteristics were extracted and analyzed to identify trends in design, medications tested, and participant diversity.

Results: Thirty-six trials of 15 unique medications met the inclusion criteria. Of these, 26 had published results, one was currently active, 3 had reported results on clinicaltrials.gov but lacked a publication, and 6 had not yet reported their results in any form. Medications for nicotine use disorder were most commonly studied (41.7%, N = 15), while stimulant use disorder (2.7%, N = 1) and benzodiazepine use disorder (N = 0) were the least represented. Although the collection and reporting of demographic-related factors were inconsistent, the demographic data available demonstrated low participation of individuals aged younger than 18, racial/ethnic minorities, and gender-diverse youth.

Conclusions: The current evidence base informing medications to treat SUD in adolescents is small. Additional research is urgently needed to address knowledge gaps, enhance participant diversity, and promote access to evidence-based SUD treatment for youth.

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.