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Sleep as an Important Target or Modifier in Alcohol Use Disorder Clinical Treatment: Example From a Recent Gabapentin Randomized Clinical Trial. 睡眠是酒精使用障碍临床治疗的重要目标或调节因素:以最近的加巴喷丁随机临床试验为例。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-05-31 DOI: 10.1097/ADM.0000000000001316
Michaela Hoffman, Konstantin Voronin, Sarah W Book, James Prisciandaro, Emily J Bristol, Raymond F Anton

Objectives: Alcohol consumption affects sleep both in healthy populations and in patients with alcohol use disorder (AUD). However, sleep has typically not been considered within AUD pharmacotherapy trials. We used data from a completed gabapentin clinical treatment trial to explore the medication's effect on patient-rated insomnia measured by a standard insomnia rating (Insomnia Severity Index [ISI]) and whether this influenced gabapentin's effects on alcohol consumption.

Methods: This study included 90 individuals with current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition AUD criteria reporting current or past alcohol withdrawal. Participants were assigned to placebo or gabapentin (up to 1200 mg/day) for a 16-week randomized controlled trial with percent heavy drinking days (PHDD) and percent abstinent days (PDA) as outcomes. Utilizing mixed-effects models, this study assessed medication effects on ISI over the trial. We then examined the interaction of baseline ISI and medication on drinking. Finally, given our previous finding of alcohol withdrawal influencing gabapentin efficacy, we added change in ISI as a potential "moderator" of the interaction of medication effects and alcohol withdrawal on drinking.

Results: Sleep (ISI) improved more in those treated with gabapentin (60.6% reduction) compared with placebo (37.8% reduction; P = 0.013). Higher baseline ISI predicted drinking in gabapentin-treated individuals (lower PHDD [ P = 0.026] and higher (PDA [ P = 0.047]). ISI was an independent predictor of PHDD decrease and PDA increase ( P < 0.001; P = 0.002), but this did not significantly moderate gabapentin's effectiveness.

Conclusions: Although gabapentin positively impacts both alcohol use and sleep, its effect on drinking is not fully dependent on sleep improvement, implying a direct biological mechanism on alcohol use.

目标:无论是健康人群还是酒精使用障碍(AUD)患者,饮酒都会影响睡眠。然而,酒精中毒性障碍药物治疗试验通常不考虑睡眠问题。我们利用一项已完成的加巴喷丁临床治疗试验的数据,探讨了该药物对以标准失眠评分(失眠严重程度指数[ISI])衡量的患者失眠的影响,以及这是否会影响加巴喷丁对饮酒的影响:这项研究包括 90 名目前符合《精神疾病诊断与统计手册》第五版 AUD 标准并报告当前或过去曾戒酒的患者。在为期 16 周的随机对照试验中,参与者被分配到安慰剂或加巴喷丁(最多 1200 毫克/天),并以大量饮酒天数百分比(PHDD)和戒酒天数百分比(PDA)作为试验结果。本研究利用混合效应模型评估了试验期间药物对 ISI 的影响。然后,我们研究了基线 ISI 和药物对饮酒的交互作用。最后,鉴于我们之前发现酒精戒断会影响加巴喷丁的疗效,我们增加了ISI的变化,作为药物作用和酒精戒断对饮酒的交互作用的潜在 "调节因子":与安慰剂(减少 37.8%;P = 0.013)相比,接受加巴喷丁治疗者的睡眠(ISI)改善幅度更大(减少 60.6%)。较高的基线 ISI 预测了接受加巴喷丁治疗者的饮酒情况(较低的 PHDD [P = 0.026] 和较高的 PDA [P = 0.047])。ISI是PHD降低和PDA升高的独立预测因子(P < 0.001; P = 0.002),但这并没有显著降低加巴喷丁的疗效:结论:虽然加巴喷丁对饮酒和睡眠都有积极影响,但其对饮酒的影响并不完全依赖于睡眠的改善,这意味着其对饮酒有直接的生物学机制。
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引用次数: 0
Provider Perceptions Toward Extended-Release Buprenorphine for Treatment of Opioid Use Disorder. 提供者对用于治疗阿片类药物使用障碍的缓释丁丙诺啡的看法。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-05-31 DOI: 10.1097/ADM.0000000000001320
India A Reddy, Carolyn M Audet, Thomas J Reese, Grayson Peek, David Marcovitz

Objectives: The persistence of the opioid crisis and the proliferation of synthetic fentanyl have heightened the demand for the implementation of novel delivery mechanisms of pharmacotherapy for the treatment of opioid use disorder, including injectable extended-release buprenorphine (buprenorphine-ER). The purpose of this study was to understand provider-level barriers to prescribing buprenorphine in order to facilitate targeted strategies to improve implementation for patients who would benefit from this novel formulation.

Methods: Using an interview template adapted from the Consolidated Framework for Implementation Research (CFIR), we conducted structured focus group interviews with 20 providers in an outpatient addiction clinic across 4 sessions to assess providers' perceptions of buprenorphine-ER. Ninety-four unique comments were identified and deductively coded using standardized CFIR constructs.

Results: Providers expressed mixed receptivity and confidence in using buprenorphine-ER. Although providers could identify a number of theoretical advantages to the injectable formulation over sublingual buprenorphine, many expressed reservations about using it due to inexperience, negative patient experiences, uncertainties about patient candidacy, cost, and logistical constraints.

Conclusions: Provider concerns about buprenorphine-ER may limit utilization. Some concerns may be mitigated through improved education, research, and logistical support. Given the putative benefits of buprenorphine-ER, future research should target barriers to implementation, in part based on hypotheses generated by these findings.

目标:阿片类药物危机的持续存在和合成芬太尼的扩散提高了对新型给药机制治疗阿片类药物使用障碍的需求,其中包括注射用缓释丁丙诺啡(buprenorphine-ER)。本研究旨在了解医疗服务提供者在开具丁丙诺啡处方时遇到的障碍,以便采取有针对性的策略,改善这种新型制剂对患者的治疗效果:我们使用改编自实施研究综合框架(CFIR)的访谈模板,对一家戒毒门诊的 20 名医疗服务提供者进行了结构化焦点小组访谈,共分 4 次进行,以评估医疗服务提供者对丁丙诺啡-ER 的看法。我们确定了 94 条独特的意见,并使用标准化的 CFIR 结构对其进行了演绎编码:结果:医疗服务提供者对使用丁丙诺啡-ER的接受程度和信心参差不齐。尽管医疗服务提供者可以发现注射制剂与丁丙诺啡舌下含服相比有许多理论上的优势,但许多人表示由于缺乏经验、病人的负面经历、不确定病人是否适合、成本和后勤限制等原因而对使用丁丙诺啡-ER持保留态度:结论:提供者对丁丙诺啡-ER 的担忧可能会限制其使用。结论:医疗服务提供者对丁丙诺啡-ER 的顾虑可能会限制其使用。通过加强教育、研究和后勤支持,可以减轻一些顾虑。鉴于丁丙诺啡-ER 可能带来的益处,未来的研究应针对实施障碍,部分研究应基于这些发现所提出的假设。
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引用次数: 0
The Efficacy of GLP-1 Agonists in Treating Substance Use Disorder in Patients: A Scoping Review. GLP-1 激动剂治疗药物滥用障碍患者的疗效:范围综述》。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-08-01 DOI: 10.1097/ADM.0000000000001347
Mary R Shen, Kwadwo Owusu-Boaitey, Laura M Holsen, Joji Suzuki

Abstract: Substance use disorder (SUD) continues to be a leading cause of morbidity and mortality with limited treatments. There is interest in expanding the use of GLP-1 agonists in treating SUD. However, evidence for safety and efficacy in humans is limited. This review aims to bridge the existing knowledge gap by establishing a baseline of literature in this area to inform future trials and clinical practice. Our inclusion criteria were English peer-reviewed manuscripts reporting on use of GLP-1, GIP, and/or glucagon receptor agonists in treatment of SUDs, excluding case studies. The literature search was performed in accordance to PRISMA guidelines. Five studies were included in this review examining the use of this medication in tobacco use disorder, alcohol use disorder, and cocaine use disorder. No studies regarding substance withdrawal syndrome were identified. The included studies varied widely in terms of patient selection, dose/formulation of GLP-1 agonists, and follow-up. The results of this scoping review are mixed, with 3 studies demonstrating positive results and 2 studies finding no efficacy of this medication on SUD outcomes. It is premature to prescribe this medication off-label to patients. Further research is needed to determine the efficacy of GLP-1 agonists in treating SUD.

摘要:药物使用障碍(SUD)仍然是发病和死亡的主要原因,但治疗方法有限。人们有兴趣扩大 GLP-1 激动剂在治疗 SUD 方面的应用。然而,在人体中的安全性和有效性证据有限。本综述旨在通过建立该领域的文献基线来弥补现有的知识差距,为未来的试验和临床实践提供参考。我们的纳入标准是报道使用 GLP-1、GIP 和/或胰高血糖素受体激动剂治疗 SUD 的英文同行评审稿件,不包括病例研究。文献检索按照 PRISMA 指南进行。本综述共纳入了五项研究,探讨了该药物在烟草使用障碍、酒精使用障碍和可卡因使用障碍中的应用。未发现有关药物戒断综合征的研究。所纳入的研究在患者选择、GLP-1 促效剂的剂量/剂型以及随访方面存在很大差异。本次范围界定审查的结果喜忧参半,其中 3 项研究显示了积极的结果,2 项研究发现这种药物对 SUD 结果没有疗效。在标签外为患者开具这种药物还为时过早。要确定 GLP-1 激动剂治疗 SUD 的疗效,还需要进一步的研究。
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引用次数: 0
Induction to Methadone 80 mg in the First Week of Treatment of Patients Who Use Fentanyl: A Case Series From an Outpatient Opioid Treatment Program. 使用芬太尼的患者在治疗第一周开始使用美沙酮 80 毫克:一个阿片类药物门诊治疗项目的病例系列。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-08-15 DOI: 10.1097/ADM.0000000000001362
Scott Steiger, Caravella McCuistian, Leslie W Suen, Brad Shapiro, D Andrew Tompkins, Alexander R Bazazi

Objectives: Current guidelines for methadone titration may unnecessarily delay reaching effective doses for patients using fentanyl, resulting in an increased risk of ongoing fentanyl use, dissatisfaction with treatment, and early dropout. Development and evaluation of rapid methadone induction protocols may improve treatment for patients using fentanyl.

Methods: Retrospective chart review was conducted for patients admitted in 2022 to a single licensed opioid treatment program (OTP) where a rapid induction protocol provides methadone 40 mg on day 1, 60 mg on day 2, and 80 mg on day 3 to patients using fentanyl <65 years old without significant medical comorbidities. The primary feasibility outcome was completion of the protocol, defined by receipt of methadone dose 80 mg or more on treatment day 7. The primary safety outcomes were oversedation, nonfatal overdose, and death. A secondary outcome was retention in treatment at 30 days.

Results: Rapid induction was ordered for 93 patients and completed by 65 (70%). Average dose on day 7 for patients who completed was 89 mg (SD 9.5 mg) versus 49 mg (SD 14.0 mg) for those who did not. No episodes of oversedation, nonfatal overdose, or death were observed. At 30 days, 85% of the patients who had the rapid protocol ordered (79/93) were retained, with 88% (57/65) who completed the protocol retained versus 79% (22/28) who did not complete (OR 1.9, 95% CI 0.6-6.2).

Conclusions: Rapid induction to methadone 80 mg by day 7 was feasible for outpatients using fentanyl in this study at a single OTP. No significant safety events were identified.

目标:目前的美沙酮滴定指南可能会不必要地延迟使用芬太尼的患者达到有效剂量的时间,从而导致持续使用芬太尼、对治疗不满意以及过早退出治疗的风险增加。制定和评估美沙酮快速诱导方案可改善对使用芬太尼患者的治疗:方法: 对 2022 年入住一家获得许可的阿片类药物治疗项目(OTP)的患者进行了回顾性病历审查,该项目采用快速诱导方案,在第 1 天为使用芬太尼的患者提供 40 毫克、第 2 天 60 毫克、第 3 天 80 毫克的美沙酮:93 名患者接受了快速诱导,其中 65 人(70%)完成了快速诱导。完成诱导的患者第 7 天的平均剂量为 89 毫克(标清 9.5 毫克),而未完成诱导的患者为 49 毫克(标清 14.0 毫克)。没有观察到过度镇静、非致命性用药过量或死亡事件。30 天后,85% 的患者(79/93)接受了快速方案治疗,其中 88% 的患者(57/65)完成了方案治疗,而 79% 的患者(22/28)未完成方案治疗(OR 1.9,95% CI 0.6-6.2):结论:在这项研究中,对于在单个 OTP 使用芬太尼的门诊患者来说,在第 7 天前快速诱导服用美沙酮 80 毫克是可行的。未发现重大安全事件。
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引用次数: 0
The Concept of Treatment-Refractory Addiction: A Call to the Field. 难治性成瘾的概念:对该领域的呼吁。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-08-10 DOI: 10.1097/ADM.0000000000001349
Eric C Strain

Abstract: Not all patients respond to effective and approved treatment interventions, and there has been growing recognition in the medical field of these "resistant" or refractory illnesses (eg, treatment-resistant depression, resistant hypertension). In the field of substance use disorders, there has not been an explicit acknowledgement of treatment-refractory addiction (TRA) despite substantial evidence that many patients do not respond to standard-of-care treatment interventions. This article provides a justification for TRA as a critically important condition to recognize and define. TRA is not conceptualized as a diagnosis, but as a signal that a current treatment approach has not worked. The article addresses areas in need of research and consensus in order to ensure the approach to TRA is uniform, thoughtfully addressed, and data-driven. By explicitly acknowledging TRA, clinicians, researchers, and patients and their families can begin to explore the unique features of this population and find ways in which substance use disorders for persons with TRA can be more effectively addressed, which in turn will help to expand remission for persons who suffer from these devastating conditions.

摘要:并不是所有患者都对有效和经批准的治疗干预措施有反应,医学界对这些 "抵抗性 "或难治性疾病(如治疗抵抗性抑郁症、抵抗性高血压)的认识也在不断提高。在药物使用障碍领域,尽管有大量证据表明许多患者对标准治疗干预措施没有反应,但治疗难治性成瘾(TRA)尚未得到明确承认。本文为 TRA 提供了正当理由,认为 TRA 是一种需要认识和定义的极其重要的病症。TRA 并不是一种诊断,而是当前治疗方法无效的信号。文章探讨了需要研究和达成共识的领域,以确保治疗 TRA 的方法是统一的、经过深思熟虑的和以数据为导向的。通过明确承认 TRA,临床医生、研究人员和患者及其家属可以开始探索这一人群的独特特征,并找到可以更有效地解决 TRA 患者药物使用障碍的方法,这反过来将有助于扩大这些毁灭性疾病患者的缓解范围。
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引用次数: 0
The Impact of High-Potency Synthetic Opioids on Pharmacotherapies for Opioid Use Disorder: A Scoping Review. 高能合成类阿片对阿片类药物使用障碍药物疗法的影响:范围综述》。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-08-10 DOI: 10.1097/ADM.0000000000001356
Oluwole Jegede, Joao P De Aquino, Connie Hsaio, Ebony Caldwell, Melissa C Funaro, Ismene Petrakis, Srinivas B Muvvala

Background: The clinical implications of high potency synthetic opioids (HPSO) on medications for opioid use disorder (MOUDs) are not well understood. Although pharmacological interactions are plausible, the clinical significance of such interaction has not been systematically elucidated. This scoping review investigates the relationship between HPSO exposure and various MOUD treatment outcomes.

Methods: We followed PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews) for scoping reviews with extensive a priori search strategy of databases: MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL, and Cochrane.

Results: From 9149 studies, 34 fulfilled the inclusion criteria. Synthesized data reveal several critical insights: First, there is a variable but high occurrence (38%-80%) of HPSO usage among individuals with MOUDs. Second, MOUDs are linked to a decreased risk of overdoses and deaths associated with HPSO. Third, HPSO consumption is correlated with the risk of precipitated withdrawal when starting buprenorphine. Fourth, low-dose buprenorphine is being recognized as one method to avoid moderate withdrawal symptoms prior to treatment. Lastly, significant gaps exist in human experimental data concerning the effects of HPSO on key factors critical for treating OUD-craving, withdrawal symptoms, and pain.

Conclusions: Current evidence supports MOUD safety and effectiveness in reducing nonmedical opioid use. Further research is needed to explore HPSO's influence on the acute factors preceding nonmedical opioid use, such as cravings, withdrawal symptoms, and pain. This research could inform the optimization of MOUD dosing strategies. Achieving consensus and harmonizing data across clinical and research protocols could diminish variability, enhancing our understanding of HPSOs effect on MOUD treatment outcomes.

背景:高活性合成阿片类药物(HPSO)对阿片类药物使用障碍(MOUDs)的临床影响尚不十分清楚。虽然药理相互作用是合理的,但这种相互作用的临床意义尚未得到系统阐明。本范围综述调查了 HPSO 暴露与各种 MOUD 治疗结果之间的关系:方法:我们按照 PRISMA-ScR(系统性综述和荟萃分析扩展范围综述的首选报告项目)进行范围综述,并事先对数据库进行了广泛的检索:MEDLINE、EMBASE、PsycINFO、Web of Science、CINAHL 和 Cochrane:从 9149 项研究中,有 34 项符合纳入标准。综合数据揭示了几个重要的观点:首先,MOUD 患者使用 HPSO 的情况各不相同,但发生率很高(38%-80%)。其次,MOUDs 与 HPSO 相关的过量使用和死亡风险降低有关。第三,在开始使用丁丙诺啡时,服用 HPSO 与骤然戒断的风险相关。第四,低剂量丁丙诺啡被认为是避免治疗前出现中度戒断症状的一种方法。最后,关于 HPSO 对治疗 OUD 关键因素--渴求、戒断症状和疼痛--的影响,人类实验数据还存在很大差距:目前的证据支持 MOUD 在减少非医疗阿片类药物使用方面的安全性和有效性。需要进一步研究 HPSO 对非医疗使用阿片类药物前的急性因素(如渴望、戒断症状和疼痛)的影响。这项研究可为 MOUD 剂量策略的优化提供依据。在临床和研究方案中达成共识并统一数据可以减少变异性,从而加深我们对 HPSOs 对 MOUD 治疗结果影响的理解。
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引用次数: 0
Perceptions of Overdose Response Hotlines and Phone Application Services Among Women and Gender-diverse Individuals Who Use Drugs in Canada: A Qualitative Study. 加拿大女性和不同性别吸毒者对用药过量应对热线和电话申请服务的看法:定性研究。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-05-23 DOI: 10.1097/ADM.0000000000001325
Amanda Lee, Farah Jafri, Dylan Viste, Boogyung Seo, Darci Skiber, Marguerite Medwid, S Monty Ghosh

Objectives: In 2021, opioid-related deaths have increased by 96% and continue to be higher than prepandemic levels. In particular, women and gender-diverse individuals face numerous challenges when assessing harm reduction supports, including physical supervised consumption sites, compared with male counterparts. Mobile overdose response services (MORSs) including overdose response hotlines and phone-based overdose response applications are novel virtual overdose response technologies that may help mitigate this issue. This study aims to explore how women and gender-diverse individuals engage with and perceive these services.

Methods: A qualitative study using grounded theory was conducted. Using existing peer networks and purposive and snowball sampling between March and July 2023, 19 semistructured interviews were conducted with women and gender-diverse individuals in Canada who have lived experience using substances. NVivo was used for thematic analysis, which continued until saturation was reached.

Results: The interviews elucidated the following 5 themes: Overdose response hotlines and applications were generally preferred over supervised consumption sites due to (1) perceived gender-based safety; (2) better accommodation for mothers concerned with stigma, childcare, and child welfare systems; and (3) eased accessibility for those involved in sex work. It was also noted that (4) judgment-free spaces and trauma-informed care provided by staff with lived experiences were invaluable, and (5) decriminalization of illicit substances will encourage uptake of these harm reduction services.

Conclusion: This study found that women and gender-diverse individuals felt positively toward overdose response hotlines and applications with the potential to fill a need in providing harm reduction services that create feelings of safety, support roles of motherhood and sex work, and generate nonstigmatizing spaces.

目标:2021 年,与阿片类药物相关的死亡人数增加了 96%,并继续高于流行前的水平。与男性相比,女性和性别多元化人群在评估减低伤害支持(包括实际监督消费场所)时尤其面临诸多挑战。包括用药过量响应热线和基于电话的用药过量响应应用程序在内的移动用药过量响应服务(MORS)是一种新型的虚拟用药过量响应技术,可能有助于缓解这一问题。本研究旨在探讨女性和性别多元化人群如何参与和感知这些服务:方法:采用基础理论进行定性研究。在 2023 年 3 月至 7 月期间,利用现有的同伴网络和有目的的滚雪球式抽样,对加拿大有药物使用经历的女性和性别多元化人士进行了 19 次半结构式访谈。采用 NVivo 进行主题分析,直到达到饱和为止:访谈阐明了以下 5 个主题:过量反应热线和应用程序通常比监督消费场所更受青睐,原因是:(1)基于性别的安全感;(2)为担心耻辱、儿童保育和儿童福利制度的母亲提供更好的便利;以及(3)方便从事性工作的人使用。还有人指出:(4) 无评判空间和由有生活经验的工作人员提供的创伤知情护理非常宝贵;(5) 非法药物非刑罪化将鼓励人们接受这些减少伤害的服务:本研究发现,女性和性别多元化人群对药物过量响应热线和应用程序持积极态度,认为它们有可能满足提供减低伤害服务的需求,从而创造安全感、支持母亲角色和性工作,并提供无污名化的空间。
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引用次数: 0
The Pharmacological Management of Ketamine Use Disorder: A Systematic Review. 氯胺酮使用障碍的药物治疗:系统性综述。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-06-26 DOI: 10.1097/ADM.0000000000001340
Emmert Roberts, Elizabeth Sanderson, Irene Guerrini

Objectives: There has been limited evidence synthesis examining treatment of ketamine use disorder. We aimed to conduct a systematic review to assess the efficacy and tolerability of pharmacological interventions in the management of ketamine use disorder.

Methods: We searched MEDLINE, EMBASE, PsychINFO, and CENTRAL (Cochrane Central Register of Controlled Trials) from database inception to November 14, 2023, for studies of any design that reported on any pharmacological intervention in the management of ketamine use disorder. We extracted any reported measure of efficacy or tolerability and assessed outcome quality using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. We planned to combine outcomes using random-effects meta-analysis, where this was not possible results were reported narratively.

Results: Twelve studies met the inclusion criteria reporting on 368 participants. These comprised 1 controlled trial, 2 retrospective case series, and 9 case reports. Two studies reported on ketamine intoxication, 6 on withdrawal, and 4 on craving/relapse prevention. All studies reported only descriptive outcomes, and all evidence was of very low quality. Benzodiazepine regimens and haloperidol were reported to have potential utility in intoxication and withdrawal, whereas naltrexone, lamotrigine, and a combination of paliperidone palmitate and bupropion were reported to have potential utility in craving/relapse prevention.

Conclusions: There is a paucity of research into pharmacological management of ketamine use disorder. The limited very low-quality evidence suggests benzodiazepine regimens may be most salient for future exploration in management of ketamine intoxication and withdrawal, whereas case reports suggest naltrexone, lamotrigine, and paliperidone palmitate plus bupropion may potentially merit further investigation with regard to craving/relapse prevention.

目的:有关氯胺酮使用障碍治疗的证据综述十分有限。我们旨在开展一项系统性综述,评估药物干预治疗氯胺酮使用障碍的疗效和耐受性:我们检索了MEDLINE、EMBASE、PsychINFO和CENTRAL(Cochrane对照试验中央注册中心)从数据库建立到2023年11月14日期间的资料,以查找在氯胺酮使用障碍的治疗中报告任何药物干预的任何设计的研究。我们提取了所有报告的疗效或耐受性指标,并采用 GRADE(建议评估、开发和评价分级)框架对结果质量进行了评估。我们计划采用随机效应荟萃分析法合并研究结果,如果无法合并,则以叙述方式报告结果:有 12 项研究符合纳入标准,报告了 368 名参与者的情况。其中包括 1 项对照试验、2 项回顾性系列病例和 9 项病例报告。2 项研究报告了氯胺酮中毒情况,6 项报告了戒断情况,4 项报告了渴求/复吸预防情况。所有研究都只报告了描述性结果,所有证据的质量都很低。据报道,苯二氮卓类药物治疗方案和氟哌啶醇对氯胺酮中毒和戒断有潜在作用,而纳曲酮、拉莫三嗪和帕利哌酮棕榈酸酯与安非他酮的组合对渴求/复吸预防有潜在作用:关于氯胺酮使用障碍的药物治疗研究很少。有限的极低质量证据表明,苯二氮卓类药物治疗方案可能是今后探索氯胺酮中毒和戒断管理的重点,而病例报告表明,纳曲酮、拉莫三嗪和帕利哌酮棕榈酸酯加丁丙酮可能在渴望/复吸预防方面值得进一步研究。
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引用次数: 0
Isolated Kratom Use Disorder Treated With Extended-Release Buprenorphine Taper. 用缓释丁丙诺啡减量治疗孤立的 Kratom 使用障碍。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-09-01 Epub Date: 2024-05-22 DOI: 10.1097/ADM.0000000000001328
Benjamin B Swart, Charles Reznikoff, Katie Steen

Abstract: This case report highlights a 36-year-old male without history of psychiatric disease, chronic pain, or substance use disorder who developed severe substance use disorder per Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition criteria to kratom. He was successfully treated with sublingual buprenorphine after a 3-year period of intermittent withdrawal management and trials of oral and extended-release injectable naltrexone. After a period of abstinence from kratom, he was tapered from buprenorphine using 2 monthly injections of 100 mg extended-release buprenorphine. His case underscores some of the current uncertainties around kratom use disorder diagnosis and treatment.

摘要:本病例报告重点介绍了一名没有精神病史、慢性疼痛史或药物使用障碍史的 36 岁男性,根据《精神障碍诊断与统计手册》第五版的标准,他因服用桔梗而患上了严重的药物使用障碍。经过 3 年的间歇性戒断治疗以及口服和缓释注射纳曲酮试验后,他成功接受了舌下含服丁丙诺啡的治疗。在戒断 kratom 一段时间后,他开始逐渐停用丁丙诺啡,每月注射 2 次 100 毫克的缓释丁丙诺啡。他的病例凸显了目前关于克瑞托啡使用障碍诊断和治疗的一些不确定性。
{"title":"Isolated Kratom Use Disorder Treated With Extended-Release Buprenorphine Taper.","authors":"Benjamin B Swart, Charles Reznikoff, Katie Steen","doi":"10.1097/ADM.0000000000001328","DOIUrl":"10.1097/ADM.0000000000001328","url":null,"abstract":"<p><strong>Abstract: </strong>This case report highlights a 36-year-old male without history of psychiatric disease, chronic pain, or substance use disorder who developed severe substance use disorder per Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition criteria to kratom. He was successfully treated with sublingual buprenorphine after a 3-year period of intermittent withdrawal management and trials of oral and extended-release injectable naltrexone. After a period of abstinence from kratom, he was tapered from buprenorphine using 2 monthly injections of 100 mg extended-release buprenorphine. His case underscores some of the current uncertainties around kratom use disorder diagnosis and treatment.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"602-604"},"PeriodicalIF":4.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081366","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
Barriers and Facilitators to Accessing Opioid Agonist Therapy for Street-involved Adolescents and Young Adults in Vancouver. 温哥华街头青少年获得阿片类激动剂治疗的障碍和促进因素。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-08-27 DOI: 10.1097/ADM.0000000000001361
Kat Gallant, Preety Nijjar, Kora DeBeck, Michelle Cui, Thomas Kerr

Objective: Opioid agonist therapy (OAT) remains the first-line therapy for people with opioid use disorder. Whereas overdose rates among adolescents and young adults (AYAs) remain high, little is known about their access to OAT. Therefore, we sought to evaluate factors that shape access to OAT among AYAs aged 14 to 26 years.

Methods: Data were derived from the At-Risk Youth Study, a prospective cohort study that involves street-involved AYAs who use illicit substances in Vancouver, Canada. Generalized estimating equations were used to identify factors associated with OAT enrollment from September 2005 to October 2021.

Results: A total of 759 AYAs reported at least weekly opioid or OAT use, with a median age of 23 years and 65.7% self-identifying as male. At baseline, 147 participants (19.4%) were on OAT, and another 199 (26.2%) initiated OAT during study follow-up (median number of follow-up visits, 5 [Q1-Q3, 2.5-8]). In a multivariable analysis, being <19 years old (adjusted odds ratio [AOR], 0.40; 95% confidence interval [CI], 0.23-0.71), Indigenous ancestry (OR, 0.72; 95% CI, 0.52-1.00), homelessness (AOR, 0.65; 95% CI, 0.54-0.77), drug dealing (AOR, 0.73; 95% CI, 0.61-0.87), daily opioid use (AOR, 0.47; 95% CI, 0.40-0.55), and nonfatal overdose (AOR, 0.73; 95% CI, 0.60-0.89) were negatively associated with OAT use.

Conclusions: This study identified a low rate of OAT access among AYAs. Adolescents and young adults were less likely to be on OAT if they were <19 years old, Indigenous, and possessed certain risk markers. These findings highlight the need for mitigation strategies to facilitate OAT access for this population and for additional harm reduction measures to support AYAs who do not want to use OAT.

目的:阿片类药物激动剂疗法(OAT)仍然是阿片类药物使用障碍患者的一线疗法。虽然青少年和年轻成年人(AYAs)的用药过量率居高不下,但人们对他们获得 OAT 的情况却知之甚少。因此,我们试图评估影响 14 至 26 岁青少年获得 OAT 的因素:数据来源于 "高危青少年研究"(At-Risk Youth Study),该研究是一项前瞻性队列研究,涉及加拿大温哥华地区使用非法药物的街头青少年。研究采用了广义估计方程来确定与 2005 年 9 月至 2021 年 10 月期间加入 OAT 的相关因素:共有 759 名亚裔报告至少每周使用一次阿片类药物或 OAT,年龄中位数为 23 岁,65.7% 自认为是男性。基线时,147 名参与者(19.4%)服用了 OAT,另有 199 名参与者(26.2%)在研究随访期间开始服用 OAT(随访次数中位数为 5 [Q1-Q3, 2.5-8])。在一项多变量分析中,得出结论:本研究发现,青壮年接受 OAT 的比例较低。如果青少年和年轻成人是以下情况,他们服用 OAT 的可能性较低
{"title":"Barriers and Facilitators to Accessing Opioid Agonist Therapy for Street-involved Adolescents and Young Adults in Vancouver.","authors":"Kat Gallant, Preety Nijjar, Kora DeBeck, Michelle Cui, Thomas Kerr","doi":"10.1097/ADM.0000000000001361","DOIUrl":"10.1097/ADM.0000000000001361","url":null,"abstract":"<p><strong>Objective: </strong>Opioid agonist therapy (OAT) remains the first-line therapy for people with opioid use disorder. Whereas overdose rates among adolescents and young adults (AYAs) remain high, little is known about their access to OAT. Therefore, we sought to evaluate factors that shape access to OAT among AYAs aged 14 to 26 years.</p><p><strong>Methods: </strong>Data were derived from the At-Risk Youth Study, a prospective cohort study that involves street-involved AYAs who use illicit substances in Vancouver, Canada. Generalized estimating equations were used to identify factors associated with OAT enrollment from September 2005 to October 2021.</p><p><strong>Results: </strong>A total of 759 AYAs reported at least weekly opioid or OAT use, with a median age of 23 years and 65.7% self-identifying as male. At baseline, 147 participants (19.4%) were on OAT, and another 199 (26.2%) initiated OAT during study follow-up (median number of follow-up visits, 5 [Q1-Q3, 2.5-8]). In a multivariable analysis, being <19 years old (adjusted odds ratio [AOR], 0.40; 95% confidence interval [CI], 0.23-0.71), Indigenous ancestry (OR, 0.72; 95% CI, 0.52-1.00), homelessness (AOR, 0.65; 95% CI, 0.54-0.77), drug dealing (AOR, 0.73; 95% CI, 0.61-0.87), daily opioid use (AOR, 0.47; 95% CI, 0.40-0.55), and nonfatal overdose (AOR, 0.73; 95% CI, 0.60-0.89) were negatively associated with OAT use.</p><p><strong>Conclusions: </strong>This study identified a low rate of OAT access among AYAs. Adolescents and young adults were less likely to be on OAT if they were <19 years old, Indigenous, and possessed certain risk markers. These findings highlight the need for mitigation strategies to facilitate OAT access for this population and for additional harm reduction measures to support AYAs who do not want to use OAT.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107574","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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