首页 > 最新文献

Journal of Addiction Medicine最新文献

英文 中文
High Hepatitis C Cure Rates Among Patients With Alcohol Use at a Safety-Net Hepatitis C Clinic. 在一家安全网丙型肝炎诊所就诊的酗酒患者中,丙型肝炎治愈率较高。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-03-26 DOI: 10.1097/ADM.0000000000001307
Erica Heiman, Meghan Alexander, Rebecca Zhang, Ziduo Zheng, Lesley S Miller

Objectives: We set out to examine several aspects of the relationship between alcohol use and hepatitis C virus (HCV) among a cohort of patients treated at an HCV clinic within a safety net hospital. We examined (1) the prevalence of alcohol use among patients treated for HCV, (2) the likelihood of being started on treatment among patients who reported drinking alcohol compared with those who did not, and (3) the associations between alcohol use and HCV cure.

Methods: We performed a retrospective chart abstraction study using data from the Grady Liver Clinic, a specialty HCV clinic colocated in Grady Memorial Hospital's primary care clinic and run by general internists.

Results: Nine hundred fifty-four patients were included. The sustained virologic response rate among those with 12-week posttreatment measurement was 99.2%, with only 5 patients experiencing virologic failure. None of the alcohol use indicators significantly impacted sustained virologic response or loss to follow-up. Estimates of alcohol use ranged from 28.9% (by International Classification of Diseases, Tenth Revision , code) to 48.9% (clinician documentation). Treatment initiation rates were the same among those who did and did not report alcohol use.

Conclusions: Alcohol use was not associated with decreased HCV cure rates. Our findings validate the inclusion of patients with alcohol use in HCV treatment programs.

研究目的我们研究了在一家安全网医院的 HCV 诊所接受治疗的一组患者中饮酒与丙型肝炎病毒(HCV)之间关系的几个方面。我们研究了(1)接受 HCV 治疗的患者中饮酒的流行率;(2)与不饮酒的患者相比,饮酒的患者开始接受治疗的可能性;以及(3)饮酒与 HCV 治愈之间的关系:我们利用格雷迪肝病门诊的数据进行了一项回顾性病历摘要研究,格雷迪肝病门诊是设在格雷迪纪念医院初级保健门诊内的一家 HCV 专科门诊,由普通内科医生负责管理:研究共纳入 954 名患者。治疗后 12 周的持续病毒学应答率为 99.2%,仅有 5 名患者出现病毒学失败。酗酒指标均未对持续病毒学应答或随访失败产生重大影响。估计的饮酒率从 28.9%(按国际疾病分类第十版编码)到 48.9%(临床医生记录)不等。在报告和未报告饮酒的人群中,开始治疗的比例相同:酗酒与 HCV 治愈率下降无关。我们的研究结果验证了将酗酒患者纳入 HCV 治疗项目的可行性。
{"title":"High Hepatitis C Cure Rates Among Patients With Alcohol Use at a Safety-Net Hepatitis C Clinic.","authors":"Erica Heiman, Meghan Alexander, Rebecca Zhang, Ziduo Zheng, Lesley S Miller","doi":"10.1097/ADM.0000000000001307","DOIUrl":"10.1097/ADM.0000000000001307","url":null,"abstract":"<p><strong>Objectives: </strong>We set out to examine several aspects of the relationship between alcohol use and hepatitis C virus (HCV) among a cohort of patients treated at an HCV clinic within a safety net hospital. We examined (1) the prevalence of alcohol use among patients treated for HCV, (2) the likelihood of being started on treatment among patients who reported drinking alcohol compared with those who did not, and (3) the associations between alcohol use and HCV cure.</p><p><strong>Methods: </strong>We performed a retrospective chart abstraction study using data from the Grady Liver Clinic, a specialty HCV clinic colocated in Grady Memorial Hospital's primary care clinic and run by general internists.</p><p><strong>Results: </strong>Nine hundred fifty-four patients were included. The sustained virologic response rate among those with 12-week posttreatment measurement was 99.2%, with only 5 patients experiencing virologic failure. None of the alcohol use indicators significantly impacted sustained virologic response or loss to follow-up. Estimates of alcohol use ranged from 28.9% (by International Classification of Diseases, Tenth Revision , code) to 48.9% (clinician documentation). Treatment initiation rates were the same among those who did and did not report alcohol use.</p><p><strong>Conclusions: </strong>Alcohol use was not associated with decreased HCV cure rates. Our findings validate the inclusion of patients with alcohol use in HCV treatment programs.</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":"140293496","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
Piloting a Hospital-Based Rapid Methadone Initiation Protocol for Fentanyl. 在医院试行快速美沙酮芬太尼启动方案。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-06-03 DOI: 10.1097/ADM.0000000000001324
Patricia Liu, Brian Chan, Eleasa Sokolski, Alisa Patten, Honora Englander

Objectives: Treating acute opioid withdrawal and offering medications for opioid use disorder (OUD) is critical. Hospitalization offers a unique opportunity to rapidly initiate methadone for OUD; however, little clinical guidance exists. This report describes our experience during the first 9 months following introduction of a hospital-based rapid methadone initiation protocol.

Methods: We conducted a retrospective chart review of hospitalized patients with OUD seen by our interprofessional addiction medicine consult service at an urban academic center between December 2022 and August 2023. We identified patients who initiated methadone using the rapid methadone initiation protocol, which includes dose recommendations (maximum 60 mg day 1, 70 mg day 2, 80 mg day 3, 100 mg days 4-7) and strict inclusion and exclusion criteria (end organ failure, arrhythmia, concurrent benzodiazepine or alcohol use, age >65).

Results: There were 171 patients that received methadone for OUD during the study period. Of those, 25 patients (15%) received rapid methadone initiation. The average total daily dose of methadone on days 1-7 was 53.0 mg, 69.2 mg, 75.4 mg, 79.5 mg, 87.1 mg, 92.2 mg, and 96.6 mg, respectively. There were no adverse events requiring holding a dose of scheduled methadone, naloxone administration, or transfer to higher level of care.

Conclusions: A rapid methadone initiation protocol for OUD can be implemented in the inpatient setting. Patients up-titrated their methadone doses quicker than with traditional induction methods, and there were no serious adverse events. Appropriate patient selection may be important to avoid harms.

目标:治疗阿片类药物急性戒断和提供治疗阿片类药物使用障碍(OUD)的药物至关重要。住院治疗为快速启动美沙酮治疗 OUD 提供了一个独特的机会;然而,目前几乎没有临床指南。本报告介绍了我们在引入基于医院的美沙酮快速启动方案后前 9 个月的经验:我们对 2022 年 12 月至 2023 年 8 月期间在一家城市学术中心接受跨专业成瘾医学咨询服务的 OUD 住院患者进行了回顾性病历审查。我们确定了使用美沙酮快速起始方案开始使用美沙酮的患者,该方案包括剂量建议(第 1 天最多 60 毫克,第 2 天 70 毫克,第 3 天 80 毫克,第 4-7 天 100 毫克)和严格的纳入和排除标准(终末器官衰竭、心律失常、同时使用苯二氮卓类药物或饮酒、年龄大于 65 岁):在研究期间,共有 171 名患者接受了美沙酮治疗 OUD。其中,25 名患者(15%)接受了美沙酮快速起始治疗。第 1-7 天的美沙酮日平均总剂量分别为 53.0 毫克、69.2 毫克、75.4 毫克、79.5 毫克、87.1 毫克、92.2 毫克和 96.6 毫克。没有发生需要暂停美沙酮计划剂量、使用纳洛酮或转到更高级护理的不良事件:结论:针对 OUD 的美沙酮快速启动方案可以在住院环境中实施。与传统的诱导方法相比,患者能更快地增加美沙酮剂量,而且没有出现严重的不良反应。适当选择患者对于避免伤害可能很重要。
{"title":"Piloting a Hospital-Based Rapid Methadone Initiation Protocol for Fentanyl.","authors":"Patricia Liu, Brian Chan, Eleasa Sokolski, Alisa Patten, Honora Englander","doi":"10.1097/ADM.0000000000001324","DOIUrl":"10.1097/ADM.0000000000001324","url":null,"abstract":"<p><strong>Objectives: </strong>Treating acute opioid withdrawal and offering medications for opioid use disorder (OUD) is critical. Hospitalization offers a unique opportunity to rapidly initiate methadone for OUD; however, little clinical guidance exists. This report describes our experience during the first 9 months following introduction of a hospital-based rapid methadone initiation protocol.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of hospitalized patients with OUD seen by our interprofessional addiction medicine consult service at an urban academic center between December 2022 and August 2023. We identified patients who initiated methadone using the rapid methadone initiation protocol, which includes dose recommendations (maximum 60 mg day 1, 70 mg day 2, 80 mg day 3, 100 mg days 4-7) and strict inclusion and exclusion criteria (end organ failure, arrhythmia, concurrent benzodiazepine or alcohol use, age >65).</p><p><strong>Results: </strong>There were 171 patients that received methadone for OUD during the study period. Of those, 25 patients (15%) received rapid methadone initiation. The average total daily dose of methadone on days 1-7 was 53.0 mg, 69.2 mg, 75.4 mg, 79.5 mg, 87.1 mg, 92.2 mg, and 96.6 mg, respectively. There were no adverse events requiring holding a dose of scheduled methadone, naloxone administration, or transfer to higher level of care.</p><p><strong>Conclusions: </strong>A rapid methadone initiation protocol for OUD can be implemented in the inpatient setting. Patients up-titrated their methadone doses quicker than with traditional induction methods, and there were no serious adverse events. Appropriate patient selection may be important to avoid harms.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11290994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141236663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Benzodiazepine Discharge Prescriptions From Emergency Departments Across the United States Between 2012 and 2019: A National Analysis. 2012 年至 2019 年全美急诊科苯二氮卓类药物出院处方:全国分析。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-05-22 DOI: 10.1097/ADM.0000000000001310
Christine Ramdin, George Mina, Lewis Nelson, Maryann Mazer-Amirshahi

Objectives: Benzodiazepines are commonly misused medications frequently implicated in overdose deaths. Data show that benzodiazepine prescribing is associated with increased misuse. We sought to determine national trends in benzodiazepine prescribing from the emergency department (ED).

Methods: This is a retrospective review of the National Hospital Ambulatory Medical Care Survey from 2012 to 2019. Our primary outcome was to evaluate trends in ED visits where a benzodiazepine was prescribed at discharge. Secondarily, we identified commonly prescribed benzodiazepines and assessed trends over time. We examined demographic data and used descriptive statistics and Spearman rho or Pearson correlation coefficient as applicable.

Results: Between 2012 and 2019, there were 13,848,578 visits where benzodiazepines were prescribed at ED discharge. In 2012 and 2019, there were 1,407,478 visits (1.1% of all ED visits) and 1,361,372 visits (0.9%), respectively, where benzodiazepines were prescribed (mean [SD], 1,731,072 [287,623] [1.26%]), with no trend ( P = 0.31). Common benzodiazepines prescribed were diazepam (5,980,279 visits, 43.2% of all prescriptions), alprazolam (3,306,549, 23.9%), and clonazepam (2,105,963, 15.2%), with no changes over time. Fifteen percent of prescriptions were for patients 65 years or older.

Conclusion: Despite reports of increased misuse, there was no change in ED discharge benzodiazepine prescribing. Concerningly, alprazolam, a benzodiazepine with high misuse potential, was frequently prescribed despite limited ED indications, and there was a large percentage of visits where benzodiazepines were prescribed to older adults despite warnings for adverse effects in this population. Future studies should assess rational prescribing and the role of targeted interventions to curb inappropriate use.

目标:苯二氮卓类药物是常见的滥用药物,经常与用药过量致死有关。数据显示,苯二氮卓类药物的处方与滥用增加有关。我们试图确定全国急诊科(ED)开具苯二氮卓类药物处方的趋势:这是一项对 2012 年至 2019 年全国医院非住院医疗护理调查的回顾性研究。我们的主要结果是评估出院时开具苯二氮卓类药物的急诊就诊趋势。其次,我们确定了常用的苯二氮卓类药物处方,并评估了其随时间变化的趋势。我们检查了人口统计学数据,并酌情使用了描述性统计和Spearman rho或Pearson相关系数:2012 年至 2019 年间,急诊室出院时开具苯二氮卓类药物处方的就诊人次为 13,848,578 次。2012年和2019年,分别有1,407,478人次(占所有急诊室就诊人次的1.1%)和1,361,372人次(0.9%)开出了苯二氮卓类药物处方(平均值[标度],1,731,072 [287,623] [1.26%]),且无趋势(P = 0.31)。常见的苯二氮卓类药物处方为地西泮(5,980,279 人次,占所有处方的 43.2%)、阿普唑仑(3,306,549 人次,占 23.9%)和氯硝西泮(2,105,963 人次,占 15.2%),这些处方没有随时间发生变化。15%的处方用于 65 岁或以上的患者:结论:尽管有滥用增加的报道,但急诊室出院苯二氮卓类药物的处方量没有变化。令人担忧的是,阿普唑仑这种苯二氮卓类药物的滥用可能性很高,尽管急诊室的适应症有限,但却经常被开出处方,而且尽管有警告称苯二氮卓类药物对老年人群有不良影响,但还是有很大比例的就诊处方被开给了老年人。未来的研究应评估合理处方以及有针对性的干预措施在遏制不当使用方面的作用。
{"title":"Benzodiazepine Discharge Prescriptions From Emergency Departments Across the United States Between 2012 and 2019: A National Analysis.","authors":"Christine Ramdin, George Mina, Lewis Nelson, Maryann Mazer-Amirshahi","doi":"10.1097/ADM.0000000000001310","DOIUrl":"10.1097/ADM.0000000000001310","url":null,"abstract":"<p><strong>Objectives: </strong>Benzodiazepines are commonly misused medications frequently implicated in overdose deaths. Data show that benzodiazepine prescribing is associated with increased misuse. We sought to determine national trends in benzodiazepine prescribing from the emergency department (ED).</p><p><strong>Methods: </strong>This is a retrospective review of the National Hospital Ambulatory Medical Care Survey from 2012 to 2019. Our primary outcome was to evaluate trends in ED visits where a benzodiazepine was prescribed at discharge. Secondarily, we identified commonly prescribed benzodiazepines and assessed trends over time. We examined demographic data and used descriptive statistics and Spearman rho or Pearson correlation coefficient as applicable.</p><p><strong>Results: </strong>Between 2012 and 2019, there were 13,848,578 visits where benzodiazepines were prescribed at ED discharge. In 2012 and 2019, there were 1,407,478 visits (1.1% of all ED visits) and 1,361,372 visits (0.9%), respectively, where benzodiazepines were prescribed (mean [SD], 1,731,072 [287,623] [1.26%]), with no trend ( P = 0.31). Common benzodiazepines prescribed were diazepam (5,980,279 visits, 43.2% of all prescriptions), alprazolam (3,306,549, 23.9%), and clonazepam (2,105,963, 15.2%), with no changes over time. Fifteen percent of prescriptions were for patients 65 years or older.</p><p><strong>Conclusion: </strong>Despite reports of increased misuse, there was no change in ED discharge benzodiazepine prescribing. Concerningly, alprazolam, a benzodiazepine with high misuse potential, was frequently prescribed despite limited ED indications, and there was a large percentage of visits where benzodiazepines were prescribed to older adults despite warnings for adverse effects in this population. Future studies should assess rational prescribing and the role of targeted interventions to curb inappropriate use.</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":"141081364","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
Addressing Confusion and Inconsistencies Surrounding the Provider Role in Medical Cannabis Programs. 解决围绕医用大麻计划中提供者角色的混乱和不一致问题。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 DOI: 10.1097/ADM.0000000000001338
Yi-Lang Tang, Elizabeth McCord, Paul H Earley, Karen Drexler

Abstract: More than 40 states in the United States have established medical Cannabis programs that authorize the use of Cannabis for specific medical conditions. Initially, these medical Cannabis programs aimed to offer compassionate care primarily for terminal or rare, untreatable conditions. However, the scope of these programs has broadened to include nonterminal and more common conditions, including various medical and mental disorders. This expansion introduces several health care challenges: a lack of robust research evidence for many listed conditions, a sense of unpreparedness among providers, and a disparity in provider roles, expectations, and responsibilities across different states, leading to potential confusion. To address these issues, medical organizations need to develop expert consensus or guidelines that underscore evidence-based shared decision-making and patient monitoring standards. Medical education should also include such training. Concurrently, medical providers must prioritize evidence-based treatment over public opinion, exercise clinical judgment, and take responsibility for their recommendations.

摘要: 美国已有 40 多个州制定了医用大麻计划,授权使用大麻治疗特定病症。起初,这些医用大麻计划主要针对绝症或罕见、无法治疗的病症提供同情关怀。然而,这些计划的范围已经扩大到非绝症和更常见的病症,包括各种医疗和精神障碍。这种扩大带来了一些医疗保健方面的挑战:许多列出的病症缺乏有力的研究证据,医疗服务提供者缺乏准备,不同州的医疗服务提供者在角色、期望和责任方面存在差异,从而导致潜在的混乱。为解决这些问题,医疗组织需要制定专家共识或指南,强调以证据为基础的共同决策和患者监测标准。医学教育也应包括此类培训。同时,医疗服务提供者必须优先考虑循证治疗,而不是公众舆论,行使临床判断力,并对自己的建议负责。
{"title":"Addressing Confusion and Inconsistencies Surrounding the Provider Role in Medical Cannabis Programs.","authors":"Yi-Lang Tang, Elizabeth McCord, Paul H Earley, Karen Drexler","doi":"10.1097/ADM.0000000000001338","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001338","url":null,"abstract":"<p><strong>Abstract: </strong>More than 40 states in the United States have established medical Cannabis programs that authorize the use of Cannabis for specific medical conditions. Initially, these medical Cannabis programs aimed to offer compassionate care primarily for terminal or rare, untreatable conditions. However, the scope of these programs has broadened to include nonterminal and more common conditions, including various medical and mental disorders. This expansion introduces several health care challenges: a lack of robust research evidence for many listed conditions, a sense of unpreparedness among providers, and a disparity in provider roles, expectations, and responsibilities across different states, leading to potential confusion. To address these issues, medical organizations need to develop expert consensus or guidelines that underscore evidence-based shared decision-making and patient monitoring standards. Medical education should also include such training. Concurrently, medical providers must prioritize evidence-based treatment over public opinion, exercise clinical judgment, and take responsibility for their recommendations.</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":"141468062","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
Global and Regional Burden and Trend of Neoplasms Attributable to Alcohol Consumption in the Past 3 Decades. 过去三十年全球和地区因饮酒导致的肿瘤负担和趋势。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-02-24 DOI: 10.1097/ADM.0000000000001288
Hui-Wen Song, Jin-Hua Ge, Bi-Xia Xie, Mei-Ting Jiang, Jin-Shui Pan

Objectives: To provide valuable insights for targeted cancer screening among high-risk patients, we analyzed the global and regional burden of neoplasms resulting from alcohol consumption between 1990 and 2019.

Methods: The information used in this study was collected from the Global Burden of Disease 2019 dataset. Initially, the database was used to extract details of mortality rates, disability-adjusted life years (DALYs), and the number of individuals affected by alcohol-related neoplasms (ARNs). Subsequently, the data were compared by cancer type, sex, age, region, and sociodemographic index. Furthermore, the study involved the calculation and comparison of estimated annual percentage changes in age-standardized DALYs rates (ASDRs) and mortality rates.

Results: The impact of alcohol on the burden of cancer varied by type of cancer, sex, age, and geographical location. Notably, males exhibited significantly higher ASDRs compared with females. Specifically, in 2019, alcohol emerged as the primary contributor to the number of DALYs associated with esophageal cancer, followed by liver cancer and colorectal cancer in men. Patients aged 50+ years exhibited a heightened rate of DALYs associated with ARNs. From 1990 to 2019, ASDRs among individuals with ARNs did not exhibit a decline in low-middle and low sociodemographic index regions.

Conclusions: Alcohol consumption represents a significant risk factor for the burden of cancer, particularly within the realm of digestive system malignancies. Consequently, targeted cancer screening efforts should be directed toward the population that engages in alcohol drinking, with a particular focus on men aged 50 years and older, residing in economically disadvantaged areas.

目的为了给高危患者的针对性癌症筛查提供有价值的见解,我们分析了 1990 年至 2019 年间全球和地区因饮酒导致的肿瘤负担:本研究使用的信息来自 2019 年全球疾病负担数据集。首先,利用该数据库提取了死亡率、残疾调整生命年(DALYs)和受酒精相关肿瘤(ARNs)影响的人数等详细信息。随后,按癌症类型、性别、年龄、地区和社会人口指数对数据进行了比较。此外,研究还包括计算和比较年龄标准化残疾调整寿命年数(ASDRs)和死亡率的估计年度百分比变化:结果:酒精对癌症负担的影响因癌症类型、性别、年龄和地理位置而异。值得注意的是,男性的ASDRs明显高于女性。具体而言,在2019年,酒精是造成食道癌相关残疾调整寿命年数的主要因素,其次是肝癌和男性结肠直肠癌。50 岁以上患者与急性淋巴细胞白血病相关的残疾调整寿命年数增加。从1990年到2019年,在中低社会人口指数地区和低社会人口指数地区,ARN患者的ASDR并没有下降:结论:饮酒是造成癌症负担的一个重要风险因素,尤其是在消化系统恶性肿瘤领域。因此,应针对饮酒人群开展有针对性的癌症筛查工作,重点关注居住在经济落后地区的 50 岁及以上男性。
{"title":"Global and Regional Burden and Trend of Neoplasms Attributable to Alcohol Consumption in the Past 3 Decades.","authors":"Hui-Wen Song, Jin-Hua Ge, Bi-Xia Xie, Mei-Ting Jiang, Jin-Shui Pan","doi":"10.1097/ADM.0000000000001288","DOIUrl":"10.1097/ADM.0000000000001288","url":null,"abstract":"<p><strong>Objectives: </strong>To provide valuable insights for targeted cancer screening among high-risk patients, we analyzed the global and regional burden of neoplasms resulting from alcohol consumption between 1990 and 2019.</p><p><strong>Methods: </strong>The information used in this study was collected from the Global Burden of Disease 2019 dataset. Initially, the database was used to extract details of mortality rates, disability-adjusted life years (DALYs), and the number of individuals affected by alcohol-related neoplasms (ARNs). Subsequently, the data were compared by cancer type, sex, age, region, and sociodemographic index. Furthermore, the study involved the calculation and comparison of estimated annual percentage changes in age-standardized DALYs rates (ASDRs) and mortality rates.</p><p><strong>Results: </strong>The impact of alcohol on the burden of cancer varied by type of cancer, sex, age, and geographical location. Notably, males exhibited significantly higher ASDRs compared with females. Specifically, in 2019, alcohol emerged as the primary contributor to the number of DALYs associated with esophageal cancer, followed by liver cancer and colorectal cancer in men. Patients aged 50+ years exhibited a heightened rate of DALYs associated with ARNs. From 1990 to 2019, ASDRs among individuals with ARNs did not exhibit a decline in low-middle and low sociodemographic index regions.</p><p><strong>Conclusions: </strong>Alcohol consumption represents a significant risk factor for the burden of cancer, particularly within the realm of digestive system malignancies. Consequently, targeted cancer screening efforts should be directed toward the population that engages in alcohol drinking, with a particular focus on men aged 50 years and older, residing in economically disadvantaged areas.</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":"139971949","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
Estimating the Prevalence of Using Suspected Counterfeit Medications in the General Population. 估算普通人群中使用疑似假药的普遍程度。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-06-03 DOI: 10.1097/ADM.0000000000001326
Jennifer S Jewell, Elizabeth A Bemis, Joshua C Black

Introduction: Counterfeit medications, sometimes referred to as "fake" or falsified drugs or pills, are drugs that are illicitly manufactured but designed to look like legitimate pharmaceuticals. Counterfeit medications are a growing public health concern. This study estimated the prevalence of self-reported use of suspected counterfeit medications by adults in the US and to assess what ingredients these individuals suspected were in the counterfeit medications.

Methods: This general population survey, drawn from an online panel, was administered across 2 waves in 2022 (15 April 3 June and 9 September 21 October) to 59,041 adults aged 18 and older. Statistical calibration weighting was used to calculate estimates representative of the national adult population.

Results: An estimated 1.8% (95% CI 1.7%-1.9%) of respondents, corresponding to approximately 4.6 million adults, suspected past 12-month use of counterfeit medications. Fentanyl was the most commonly suspected ingredient in the counterfeit product (16.1%, 95% CI 12.8%-19.3%). The next most prevalent response was "I don't know" (15.0%, 95% CI 11.0%-18.9%) followed by methamphetamine (14.9%, 95% CI 11.4%-18.4%).

Conclusions: These data show the scale of the issue in relation to other well established drug use data points in the US. System-level methods, such as drug scanning software, should be implemented to reduce the likelihood that counterfeit drugs end up in the hands of individuals.

简介:假药,有时也被称为 "伪造 "或篡改的药品或药片,是指非法生产的药品,但在设计上却与合法药品相似。假药是一个日益严重的公共卫生问题。本研究估计了美国成年人自我报告使用疑似假药的普遍程度,并评估这些人怀疑假药中含有哪些成分:这项普通人群调查来自一个在线小组,于 2022 年分两次(4 月 15 日至 6 月 3 日和 9 月 9 日至 10 月 21 日)对 59,041 名 18 岁及以上的成年人进行了调查。采用统计校准加权法计算出代表全国成人人口的估计值:估计有 1.8%(95% CI 1.7%-1.9%)的受访者(相当于约 460 万成年人)怀疑在过去 12 个月中使用过假药。芬太尼是最常被怀疑的假药成分(16.1%,95% CI 12.8%-19.3%)。其次是 "我不知道"(15.0%,95% CI 11.0%-18.9%),然后是甲基苯丙胺(14.9%,95% CI 11.4%-18.4%):这些数据表明,与美国其他成熟的毒品使用数据点相比,这一问题的严重性不言而喻。应采用药物扫描软件等系统级方法来降低假药落入个人手中的可能性。
{"title":"Estimating the Prevalence of Using Suspected Counterfeit Medications in the General Population.","authors":"Jennifer S Jewell, Elizabeth A Bemis, Joshua C Black","doi":"10.1097/ADM.0000000000001326","DOIUrl":"10.1097/ADM.0000000000001326","url":null,"abstract":"<p><strong>Introduction: </strong>Counterfeit medications, sometimes referred to as \"fake\" or falsified drugs or pills, are drugs that are illicitly manufactured but designed to look like legitimate pharmaceuticals. Counterfeit medications are a growing public health concern. This study estimated the prevalence of self-reported use of suspected counterfeit medications by adults in the US and to assess what ingredients these individuals suspected were in the counterfeit medications.</p><p><strong>Methods: </strong>This general population survey, drawn from an online panel, was administered across 2 waves in 2022 (15 April 3 June and 9 September 21 October) to 59,041 adults aged 18 and older. Statistical calibration weighting was used to calculate estimates representative of the national adult population.</p><p><strong>Results: </strong>An estimated 1.8% (95% CI 1.7%-1.9%) of respondents, corresponding to approximately 4.6 million adults, suspected past 12-month use of counterfeit medications. Fentanyl was the most commonly suspected ingredient in the counterfeit product (16.1%, 95% CI 12.8%-19.3%). The next most prevalent response was \"I don't know\" (15.0%, 95% CI 11.0%-18.9%) followed by methamphetamine (14.9%, 95% CI 11.4%-18.4%).</p><p><strong>Conclusions: </strong>These data show the scale of the issue in relation to other well established drug use data points in the US. System-level methods, such as drug scanning software, should be implemented to reduce the likelihood that counterfeit drugs end up in the hands of individuals.</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":"141236349","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
Fentanyl Test Strips for Harm Reduction: A Scoping Review. 用于减少危害的芬太尼试纸:范围审查。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-05-31 DOI: 10.1097/ADM.0000000000001321
Eric Kutscher, Marco Barber Grossi, Fred LaPolla, Joshua D Lee

Background: High potency synthetic opioids like fentanyl have continued to replace or contaminate the supply of illicit drugs in North America, with fentanyl test strips (FTSs) often used as a harm reduction tool for overdose prevention. The available evidence to support FTS for harm reduction has yet to be summarized.

Methods: A search of PubMed, Ovid Embase, and Web of Science was conducted in March 2023. A 2-stage review was conducted to screen by title and abstract and then by full text by 2 reviewers. Data were extracted from each study using a standardized template.

Results: A total of 91 articles were included, mostly from North America, predominantly reporting on FTS along with other harm reduction tools, and all conducted after 2016. No randomized controlled trials are reported. Robust evidence exists supporting the sensitivity and specificity of FTS, along with their acceptability and feasibility of use for people who use drugs and as a public health intervention. However, limited research is available on the efficacy of FTS as a harm reduction tool for behavior change, engagement in care, or overdose prevention.

Conclusions: Though FTSs are highly sensitive and specific for point of care testing, further research is needed to assess the association of FTS use with overdose prevention. Differences in FTS efficacy likely exist between people who use opioids and nonopioid drugs, with additional investigation strongly needed. As drug testing with point-of-care immunoassays is embraced for nonfentanyl contaminants such as xylazine and benzodiazepines, increased investment in examining overdose prevention is necessary.

背景:芬太尼等高效力合成阿片类药物不断取代或污染北美的非法药物供应,芬太尼试纸(FTS)经常被用作预防用药过量的减毒工具。支持芬太尼试纸用于减少伤害的现有证据尚有待总结:方法:2023 年 3 月对 PubMed、Ovid Embase 和 Web of Science 进行了检索。由两名审稿人对研究进行了两阶段审查,首先通过标题和摘要进行筛选,然后通过全文进行筛选。使用标准化模板从每项研究中提取数据:共收录了 91 篇文章,大部分来自北美,主要报告了 FTS 以及其他减低伤害的工具,并且都是在 2016 年之后进行的。未报告随机对照试验。有大量证据支持FTS的灵敏度和特异性,以及其对吸毒者和作为公共卫生干预措施的可接受性和可行性。然而,关于 FTS 作为减少危害的工具在改变行为、参与护理或预防用药过量方面的有效性的研究还很有限:结论:尽管FTS在护理点检测中具有高度灵敏性和特异性,但仍需进一步研究以评估FTS的使用与用药过量预防之间的关联。在使用阿片类药物和非阿片类药物的人群中,FTS 的有效性可能存在差异,因此亟需开展更多调查。随着对非芬太尼污染物(如甲苯噻嗪和苯并二氮杂卓)采用床旁免疫测定进行药物检测,有必要增加对预防用药过量的投资。
{"title":"Fentanyl Test Strips for Harm Reduction: A Scoping Review.","authors":"Eric Kutscher, Marco Barber Grossi, Fred LaPolla, Joshua D Lee","doi":"10.1097/ADM.0000000000001321","DOIUrl":"10.1097/ADM.0000000000001321","url":null,"abstract":"<p><strong>Background: </strong>High potency synthetic opioids like fentanyl have continued to replace or contaminate the supply of illicit drugs in North America, with fentanyl test strips (FTSs) often used as a harm reduction tool for overdose prevention. The available evidence to support FTS for harm reduction has yet to be summarized.</p><p><strong>Methods: </strong>A search of PubMed, Ovid Embase, and Web of Science was conducted in March 2023. A 2-stage review was conducted to screen by title and abstract and then by full text by 2 reviewers. Data were extracted from each study using a standardized template.</p><p><strong>Results: </strong>A total of 91 articles were included, mostly from North America, predominantly reporting on FTS along with other harm reduction tools, and all conducted after 2016. No randomized controlled trials are reported. Robust evidence exists supporting the sensitivity and specificity of FTS, along with their acceptability and feasibility of use for people who use drugs and as a public health intervention. However, limited research is available on the efficacy of FTS as a harm reduction tool for behavior change, engagement in care, or overdose prevention.</p><p><strong>Conclusions: </strong>Though FTSs are highly sensitive and specific for point of care testing, further research is needed to assess the association of FTS use with overdose prevention. Differences in FTS efficacy likely exist between people who use opioids and nonopioid drugs, with additional investigation strongly needed. As drug testing with point-of-care immunoassays is embraced for nonfentanyl contaminants such as xylazine and benzodiazepines, increased investment in examining overdose prevention is necessary.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11290989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141199890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treating Benzodiazepine Withdrawal in a Bridge Clinic. 在桥梁诊所治疗苯二氮卓类药物戒断。
IF 4.2 3区 医学 Q2 Medicine Pub Date : 2024-06-26 DOI: 10.1097/ADM.0000000000001334
Jordana Laks, Theresa W Kim, Paul J Christine, James Evans, Natalija M Farrell, Jessica Kehoe, Morgan Younkin, Jessica L Taylor

Background: Benzodiazepine-involved overdose deaths are rising, driven by increasing use of nonprescribed benzodiazepine pills. For patients who wish to stop nonprescribed benzodiazepine use, rapid inpatient tapers are typically the only option to treat benzodiazepine withdrawal. Substance use disorder bridge clinics can provide the high-touch care needed to manage outpatient benzodiazepine tapers in patients at high risk due to other substance use disorders.

Objective: Describe the implementation and short-term outcomes of an outpatient benzodiazepine taper protocol to treat benzodiazepine withdrawal in a substance use disorder bridge clinic.

Methods: The clinical team developed a 4- to 6-week intensive outpatient taper protocol using diazepam. Patients with benzodiazepine use disorder were eligible if they had benzodiazepine withdrawal, lacked a prescriber, wanted to stop benzodiazepines completely, and agreed to daily visits. For patients who initiated a taper between April 2021 and December 2022, we evaluated the proportion of patients who completed a taper (i.e., tapered to a last prescribed dose of diazepam 10 mg/d or less); likelihood of remaining on the taper over time; and seizure, overdose, or death documented at the study institution during or within 1 month of taper completion or discontinuation. Other secondary outcomes included HIV testing and prevention, hepatitis C testing, and referrals to recovery coaching or psychiatry.

Results: Fifty-four patients initiated a total of 60 benzodiazepine tapers. The population was mostly male (61%) and non-Hispanic White (85%). Nearly all patients had opioid use disorder (96%), and most (80%) were taking methadone or buprenorphine for opioid use disorder before starting the taper. Patients reported using multiple substances in addition to benzodiazepines, most commonly fentanyl (75%), followed by cocaine (41%) and methamphetamine (21%). Fourteen patients (23%) completed a taper with a median duration of 34 days (IQR 27.8-43.5). Most tapers were stopped when the patient was lost to follow-up (57%), or the team recommended inpatient care (18%). Two patients had a seizure, and 4 had a presumed opioid-involved overdose during or within 1 month after the last taper visit, all individuals who did not complete a taper. No deaths occurred during or within 1 month of taper completion or discontinuation. Challenges included frequent loss to follow-up in the setting of other unstable substance use. Patients received other high-priority care during the taper including HIV testing (32%), PrEP initiation (6.7%), hepatitis C testing (30%), and referrals to recovery coaches (18%) and psychiatry (6.7%).

Conclusions: Managing benzodiazepine withdrawal with a 4- to 6-week intensive outpatient taper in patients with benzodiazepine and opioid use disorders is challenging. More work is needed to refine pati

背景:由于越来越多地使用非处方苯并二氮杂卓药片,苯并二氮杂卓导致的过量用药死亡人数正在上升。对于希望停止使用非处方苯二氮卓的患者来说,快速住院减量通常是治疗苯二氮卓戒断的唯一选择。药物使用障碍桥接诊所可以为因其他药物使用障碍而面临高风险的患者提供所需的高接触护理,以管理苯二氮卓类药物的门诊减量:描述在药物使用障碍桥梁诊所治疗苯二氮卓戒断的苯二氮卓门诊减量方案的实施情况和短期疗效:方法:临床团队使用地西泮制定了一个为期 4 到 6 周的门诊强化减量方案。苯并二氮杂卓使用障碍患者只要有苯并二氮杂卓戒断症状、没有处方医生、希望完全停用苯并二氮杂卓并同意每天出诊,就符合条件。对于在 2021 年 4 月至 2022 年 12 月期间开始减量的患者,我们评估了完成减量(即减量至最后处方剂量为地西泮 10 毫克/天或更少)的患者比例;随着时间推移继续减量的可能性;以及在减量完成或停药期间或 1 个月内研究机构记录的癫痫发作、用药过量或死亡情况。其他次要结果包括艾滋病检测和预防、丙型肝炎检测以及转诊至康复指导或精神科:54名患者共开始了60次苯二氮卓类药物减量治疗。患者大多为男性(61%)和非西班牙裔白人(85%)。几乎所有患者都患有阿片类药物使用障碍(96%),大多数患者(80%)在开始减量治疗前正在服用美沙酮或丁丙诺啡治疗阿片类药物使用障碍。除苯二氮卓类药物外,患者还报告使用了多种药物,其中最常见的是芬太尼(75%),其次是可卡因(41%)和甲基苯丙胺(21%)。14 名患者(23%)完成了减药,中位持续时间为 34 天(IQR 27.8-43.5)。大多数减量治疗在患者失去随访(57%)或治疗小组建议住院治疗(18%)时停止。在最后一次减量就诊期间或之后的 1 个月内,有 2 名患者出现癫痫发作,4 名患者出现推测的阿片类药物过量,所有这些患者都没有完成减量。在完成或停止减量治疗期间或 1 个月内没有发生死亡病例。面临的挑战包括在使用其他不稳定药物的情况下经常失去随访。患者在减量期间还接受了其他优先护理,包括 HIV 检测(32%)、PrEP 启动(6.7%)、丙型肝炎检测(30%)、转诊至康复指导员(18%)和精神病科(6.7%):对于苯并二氮杂卓和阿片类药物使用失调的患者来说,通过 4 到 6 周的门诊强化减量来管理苯并二氮杂卓戒断是一项挑战。还需要做更多的工作来完善患者选择、平衡安全风险与可行性,并研究以患者为中心的长期疗效。
{"title":"Treating Benzodiazepine Withdrawal in a Bridge Clinic.","authors":"Jordana Laks, Theresa W Kim, Paul J Christine, James Evans, Natalija M Farrell, Jessica Kehoe, Morgan Younkin, Jessica L Taylor","doi":"10.1097/ADM.0000000000001334","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001334","url":null,"abstract":"<p><strong>Background: </strong>Benzodiazepine-involved overdose deaths are rising, driven by increasing use of nonprescribed benzodiazepine pills. For patients who wish to stop nonprescribed benzodiazepine use, rapid inpatient tapers are typically the only option to treat benzodiazepine withdrawal. Substance use disorder bridge clinics can provide the high-touch care needed to manage outpatient benzodiazepine tapers in patients at high risk due to other substance use disorders.</p><p><strong>Objective: </strong>Describe the implementation and short-term outcomes of an outpatient benzodiazepine taper protocol to treat benzodiazepine withdrawal in a substance use disorder bridge clinic.</p><p><strong>Methods: </strong>The clinical team developed a 4- to 6-week intensive outpatient taper protocol using diazepam. Patients with benzodiazepine use disorder were eligible if they had benzodiazepine withdrawal, lacked a prescriber, wanted to stop benzodiazepines completely, and agreed to daily visits. For patients who initiated a taper between April 2021 and December 2022, we evaluated the proportion of patients who completed a taper (i.e., tapered to a last prescribed dose of diazepam 10 mg/d or less); likelihood of remaining on the taper over time; and seizure, overdose, or death documented at the study institution during or within 1 month of taper completion or discontinuation. Other secondary outcomes included HIV testing and prevention, hepatitis C testing, and referrals to recovery coaching or psychiatry.</p><p><strong>Results: </strong>Fifty-four patients initiated a total of 60 benzodiazepine tapers. The population was mostly male (61%) and non-Hispanic White (85%). Nearly all patients had opioid use disorder (96%), and most (80%) were taking methadone or buprenorphine for opioid use disorder before starting the taper. Patients reported using multiple substances in addition to benzodiazepines, most commonly fentanyl (75%), followed by cocaine (41%) and methamphetamine (21%). Fourteen patients (23%) completed a taper with a median duration of 34 days (IQR 27.8-43.5). Most tapers were stopped when the patient was lost to follow-up (57%), or the team recommended inpatient care (18%). Two patients had a seizure, and 4 had a presumed opioid-involved overdose during or within 1 month after the last taper visit, all individuals who did not complete a taper. No deaths occurred during or within 1 month of taper completion or discontinuation. Challenges included frequent loss to follow-up in the setting of other unstable substance use. Patients received other high-priority care during the taper including HIV testing (32%), PrEP initiation (6.7%), hepatitis C testing (30%), and referrals to recovery coaches (18%) and psychiatry (6.7%).</p><p><strong>Conclusions: </strong>Managing benzodiazepine withdrawal with a 4- to 6-week intensive outpatient taper in patients with benzodiazepine and opioid use disorders is challenging. More work is needed to refine pati","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450502","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
Standard Versus Rapid Inpatient Methadone Titration for Pregnant Patients With Opioid Use Disorder: A Retrospective Cohort Study. 阿片类药物使用失调妊娠患者的标准美沙酮与快速住院美沙酮滴定:一项回顾性队列研究。
IF 4.2 3区 医学 Q2 Medicine Pub Date : 2024-06-24 DOI: 10.1097/ADM.0000000000001339
Neel S Iyer, Emily B Ferguson, Vivian Z Yan, Dennis J Hand, Diane J Abatemarco, Rupsa C Boelig

Abstract:

Objectives: Our study evaluated if rapid inpatient titration of methadone for pregnant patients with opioid use disorder (OUD) improved outcomes without increasing the risk for overdose.

Methods: This is a retrospective cohort study of pregnant patients admitted for inpatient methadone titration from January 2020 to June 2022. Outcomes were compared between standard versus rapid titration protocols. Standard titration involved an initial methadone dose with additional doses every 6 hours if clinical opiate withdrawal score (COWS) is >9. Rapid titration involved an initial methadone dose with additional doses every 4 hours if COWS is >9. The primary outcome was time required to achieve stable dose. Secondary outcomes included elopement prior to achieving stable dose, methadone-related readmission, opioid overdose, and final dose.

Results: There were 97 patients in the standard titration (STP) and 97 patients in the rapid titration (RTP) groups. Demographic characteristics and substance use history did not differ between the 2 groups. Time to stable dose did not differ between the 2 groups (RTP, 5.0 days ±4.0; STP, 4.0 days ±3.0; P = 0.08). Patients in the rapid titration group were less likely to elope from the hospital prior to stabilization (RTP 23.0% vs STP 37.9%, P = 0.03) and had fewer methadone-related readmissions (P < 0.001). One patient (1.0%) in the RTP group required naloxone treatment while inpatient for concern for overdose, while none did in the STP group (P = 0.32). There was no difference in median final stable dose between the 2 groups (P = 0.07).

Conclusions: Rapid titration of methadone for pregnant patients with OUD was associated with decreased medical elopement and methadone-related readmission, without increasing the risk for overdose.

摘要:目的:我们的研究评估了对妊娠期阿片类药物使用障碍(OUD)患者进行美沙酮快速住院滴定是否能在不增加用药过量风险的情况下改善治疗效果:我们的研究评估了妊娠期阿片类药物使用障碍(OUD)患者在住院期间快速滴定美沙酮是否能在不增加用药过量风险的情况下改善治疗效果:这是一项回顾性队列研究,研究对象是 2020 年 1 月至 2022 年 6 月期间住院接受美沙酮滴定治疗的妊娠患者。比较了标准滴定方案和快速滴定方案的结果。标准滴注包括初始美沙酮剂量,如果临床鸦片制剂戒断评分(COWS)大于 9 分,则每 6 小时追加一次剂量。快速滴注包括初始美沙酮剂量,如果 COWS >9 则每 4 小时追加一次剂量。主要结果是达到稳定剂量所需的时间。次要结果包括达到稳定剂量前的脱逃、美沙酮相关再入院、阿片类药物过量和最终剂量:标准滴定(STP)组和快速滴定(RTP)组各有 97 名患者。两组患者的人口统计学特征和药物使用史无差异。两组患者达到稳定剂量的时间没有差异(RTP,5.0 天 ±4.0;STP,4.0 天 ±3.0;P = 0.08)。快速滴定组患者在剂量稳定前私自出院的可能性较小(RTP 23.0% vs STP 37.9%,P = 0.03),与美沙酮相关的再住院率较低(P < 0.001)。RTP 组中有一名患者(1.0%)在住院期间因担心用药过量而需要纳洛酮治疗,而 STP 组中则没有(P = 0.32)。两组的最终稳定剂量中位数没有差异(P = 0.07):结论:对妊娠合并 OUD 患者快速滴定美沙酮与减少逃医和美沙酮相关再入院有关,但不会增加用药过量的风险。
{"title":"Standard Versus Rapid Inpatient Methadone Titration for Pregnant Patients With Opioid Use Disorder: A Retrospective Cohort Study.","authors":"Neel S Iyer, Emily B Ferguson, Vivian Z Yan, Dennis J Hand, Diane J Abatemarco, Rupsa C Boelig","doi":"10.1097/ADM.0000000000001339","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001339","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Objectives: </strong>Our study evaluated if rapid inpatient titration of methadone for pregnant patients with opioid use disorder (OUD) improved outcomes without increasing the risk for overdose.</p><p><strong>Methods: </strong>This is a retrospective cohort study of pregnant patients admitted for inpatient methadone titration from January 2020 to June 2022. Outcomes were compared between standard versus rapid titration protocols. Standard titration involved an initial methadone dose with additional doses every 6 hours if clinical opiate withdrawal score (COWS) is >9. Rapid titration involved an initial methadone dose with additional doses every 4 hours if COWS is >9. The primary outcome was time required to achieve stable dose. Secondary outcomes included elopement prior to achieving stable dose, methadone-related readmission, opioid overdose, and final dose.</p><p><strong>Results: </strong>There were 97 patients in the standard titration (STP) and 97 patients in the rapid titration (RTP) groups. Demographic characteristics and substance use history did not differ between the 2 groups. Time to stable dose did not differ between the 2 groups (RTP, 5.0 days ±4.0; STP, 4.0 days ±3.0; P = 0.08). Patients in the rapid titration group were less likely to elope from the hospital prior to stabilization (RTP 23.0% vs STP 37.9%, P = 0.03) and had fewer methadone-related readmissions (P < 0.001). One patient (1.0%) in the RTP group required naloxone treatment while inpatient for concern for overdose, while none did in the STP group (P = 0.32). There was no difference in median final stable dose between the 2 groups (P = 0.07).</p><p><strong>Conclusions: </strong>Rapid titration of methadone for pregnant patients with OUD was associated with decreased medical elopement and methadone-related readmission, without increasing the risk for overdose.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442699","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
Naloxone Use During Pregnancy-Data from 26 US Jurisdictions, 2019-2020. 妊娠期纳洛酮使用情况--来自美国 26 个辖区的数据,2019-2020 年。
IF 4.2 3区 医学 Q2 Medicine Pub Date : 2024-06-24 DOI: 10.1097/ADM.0000000000001337
Amy Board, Denise V D'Angelo, Kathryn Miele, Alice Asher, Beatriz Salvesen von Essen, Clark H Denny, Mishka Terplan, Janae Dunkley, Shin Y Kim

Abstract:

Objectives: We aimed to determine the prevalence of self-reported naloxone use during pregnancy among people in the United States with a recent live birth. A secondary objective was to characterize people at increased risk of overdose who did and did not use naloxone.

Methods: We analyzed data from the Pregnancy Risk Assessment Monitoring System from 26 US jurisdictions that conducted an opioid supplement survey from 2019 to 2020. Respondents with increased risk of experiencing an opioid overdose were identified based on self-reported use of illicit amphetamines, heroin, cocaine, or receiving medication for opioid use disorder (MOUD) during pregnancy. Weighted prevalence estimates and 95% confidence intervals were calculated for reported naloxone use at any point during pregnancy among people with an increased risk of overdose.

Results: Naloxone use during pregnancy was reported by <1% of the overall study population (unweighted N = 88/34,528). Prevalence of naloxone use was 5.0% (95% CI: 0.0-10.6) among respondents who reported illicit amphetamine use, 15.2% (1.8-28.6) among those who reported heroin use, and 17.6% (0.0-38.1) among those who reported cocaine use. Naloxone use was 14.5% (8.4-20.6) among those who reported taking MOUD. Among people with increased risk of overdose, no significant differences in naloxone use were observed by age, race/ethnicity, education level, residential metropolitan status, or insurance status.

Conclusions: Prevalence of naloxone use among people with an increased risk of overdose during pregnancy ranged from 5.0% to 17.6%. Access to naloxone, overdose prevention education, and treatment for substance use disorders may help reduce morbidity and mortality.

摘要:目的:我们旨在确定美国最近活产的人群在怀孕期间自我报告使用纳洛酮的比例。次要目标是确定使用和未使用纳洛酮的用药过量风险增加人群的特征:我们分析了来自美国 26 个辖区的妊娠风险评估监测系统的数据,这些辖区在 2019 年至 2020 年期间开展了阿片类药物补充调查。根据自我报告的孕期使用非法苯丙胺、海洛因、可卡因或接受阿片类药物使用障碍(MOUD)药物治疗的情况,确定了阿片类药物过量风险增加的受访者。计算了用药过量风险增加人群在怀孕期间任何时间使用纳洛酮的加权流行率估计值和 95% 的置信区间:结论:据报告,在怀孕期间使用纳洛酮的比例较高:在妊娠期间用药过量风险增加的人群中,使用纳洛酮的比例从 5.0% 到 17.6% 不等。获得纳洛酮、预防用药过量教育和药物使用障碍治疗可能有助于降低发病率和死亡率。
{"title":"Naloxone Use During Pregnancy-Data from 26 US Jurisdictions, 2019-2020.","authors":"Amy Board, Denise V D'Angelo, Kathryn Miele, Alice Asher, Beatriz Salvesen von Essen, Clark H Denny, Mishka Terplan, Janae Dunkley, Shin Y Kim","doi":"10.1097/ADM.0000000000001337","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001337","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Objectives: </strong>We aimed to determine the prevalence of self-reported naloxone use during pregnancy among people in the United States with a recent live birth. A secondary objective was to characterize people at increased risk of overdose who did and did not use naloxone.</p><p><strong>Methods: </strong>We analyzed data from the Pregnancy Risk Assessment Monitoring System from 26 US jurisdictions that conducted an opioid supplement survey from 2019 to 2020. Respondents with increased risk of experiencing an opioid overdose were identified based on self-reported use of illicit amphetamines, heroin, cocaine, or receiving medication for opioid use disorder (MOUD) during pregnancy. Weighted prevalence estimates and 95% confidence intervals were calculated for reported naloxone use at any point during pregnancy among people with an increased risk of overdose.</p><p><strong>Results: </strong>Naloxone use during pregnancy was reported by <1% of the overall study population (unweighted N = 88/34,528). Prevalence of naloxone use was 5.0% (95% CI: 0.0-10.6) among respondents who reported illicit amphetamine use, 15.2% (1.8-28.6) among those who reported heroin use, and 17.6% (0.0-38.1) among those who reported cocaine use. Naloxone use was 14.5% (8.4-20.6) among those who reported taking MOUD. Among people with increased risk of overdose, no significant differences in naloxone use were observed by age, race/ethnicity, education level, residential metropolitan status, or insurance status.</p><p><strong>Conclusions: </strong>Prevalence of naloxone use among people with an increased risk of overdose during pregnancy ranged from 5.0% to 17.6%. Access to naloxone, overdose prevention education, and treatment for substance use disorders may help reduce morbidity and mortality.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442698","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
期刊
Journal of Addiction Medicine
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1