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Examining the Impact of the Innovative Opioid Court Model on Treatment Access and Court Outcomes for Court Participants. 研究创新型阿片类药物法庭模式对法庭参与者获得治疗和法庭结果的影响。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-06-24 DOI: 10.1097/ADM.0000000000001330
Katherine S Elkington, Margaret E Ryan, Cale Basaraba, Renald Dambreville, Dan Alschuler, Melanie M Wall, Alejandra Garcia, Monica Christofferson, Howard F Andrews, Edward V Nunes

Objective: The opioid intervention court (OIC) is an innovative, pre-plea treatment court to facilitate rapid linkage to medications for opioid use disorder (MOUD) for people at risk of overdose. This study compares participants in OIC and participants with opioid use problems in a traditional drug treatment court model on (i) initiation for any substance use (SU) treatment, (ii) initiation of MOUD, (iii) number of days to MOUD initiation, and (iv) retention in the OIC program/retention on MOUD.

Methods: We used administrative court records from n = 389 OIC and n = 229 drug court participants in 2 counties in New York State. Differences in outcomes by court were assessed using logistic, multinomial, or linear regressions.

Results: After adjusting for current charge severity, gender, race/ethnicity, age, and county, OIC participants were no more likely to initiate any SU treatment but were significantly more likely to initiate MOUD (81.2% OIC vs 45.9% drug court, P < 0.001) and were more quickly linked to any SU treatment (hazard ratio = 1.68, 95% confidence interval = 1.35-2.08) and MOUD (hazard ratio = 4.25, 95% confidence interval = 3.23-5.58) after starting the court. Retention in court/MOUD was higher among drug court participants and may speak to the immediate sanctions (eg, jail) for noncompliance with drug court directives as compared with opioid court, which does not carry such immediate sanctions for noncompliance.

Conclusions: These analyses suggest that the new OIC model can more rapidly link participants to treatment, including MOUD, as compared with traditional drug court model, and may demonstrate improved ability to immediately stabilize and reduce overdose risk in court participants.

目标:阿片类药物干预法庭(OIC)是一种创新性的诉前治疗法庭,旨在帮助有用药过量风险的人快速获得治疗阿片类药物使用障碍(MOUD)的药物。本研究比较了 OIC 参与者和传统戒毒法庭模式下有阿片类药物使用问题的参与者在以下方面的情况:(i) 开始接受任何药物使用(SU)治疗,(ii) 开始接受 MOUD 治疗,(iii) 开始接受 MOUD 治疗的天数,(iv) 在 OIC 项目中的保留时间/在 MOUD 治疗中的保留时间:我们使用了纽约州 2 个县的 389 名 OIC 和 229 名毒品法庭参与者的法庭行政记录。我们使用逻辑、多项式或线性回归评估了不同法院的结果差异:在对当前指控的严重程度、性别、种族/民族、年龄和郡县进行调整后,OIC 参与者启动任何 SU 治疗的可能性并不大,但启动 MOUD 治疗的可能性明显更大(81.2% 的 OIC 与 45.9% 的毒品法庭相比,P < 0.001),而且在开始接受法庭治疗后,他们更快地接受任何 SU 治疗(危险比 = 1.68,95% 置信区间 = 1.35-2.08)和 MOUD 治疗(危险比 = 4.25,95% 置信区间 = 3.23-5.58)。与阿片类药物法庭相比,毒品法庭的参与者在法庭/MOUD中的保留率更高,这可能与不遵守毒品法庭指令会受到立即制裁(如监禁)有关,而阿片类药物法庭不会对不遵守指令的行为进行立即制裁:这些分析表明,与传统的毒品法庭模式相比,新的 OIC 模式能更快地将参与者与治疗(包括 MOUD)联系起来,并能更好地立即稳定和降低法庭参与者的用药过量风险。
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引用次数: 0
Methamphetamine Use in Psychiatric Emergency Services and Among Asian American and Pacific Islander Populations. 精神科急诊服务中的甲基苯丙胺使用情况以及亚裔美国人和太平洋岛民中的甲基苯丙胺使用情况。
IF 5.5 3区 医学 Q2 Medicine Pub Date : 2024-06-13 DOI: 10.1097/ADM.0000000000001335
Max Nakamoto, Jane Onoye, Miki Kiyokawa, Junji Takeshita, Brett Lu

Objectives: Addressing the methamphetamine epidemic will require a more complete understanding of its effect on healthcare systems and of the populations at risk. The objective of the study was to assess the impact of methamphetamine use on psychiatric emergency services outcomes and on Asian American (AA) and Pacific Islander (PI) populations, a historically overlooked population in substance use research.

Methods: A retrospective chart review was performed for all visits to a large level I trauma center in urban Hawaii from 2007 to 2019 that required psychiatric emergency services and in which urine drug screening was completed (N = 44,658). Demographic characteristics and emergency room courses were compared between amphetamine-positive and amphetamine-negative visits.

Results: The proportion of amphetamine-positive visits approximately doubled from 13.3% in 2007 to 25.5% in 2019. Amphetamine-positive visits were more likely to involve arrival by law enforcement (38.3% vs 27.2.%, P < 0.001), require intramuscular psychotropic medications (17.3% vs 12.3%, P < 0.001), and have longer emergency department lengths of stay (median, 420 vs 372 minutes, P < 0.001). Visits by Native Hawaiian and Hispanic/Latino patients had the highest rate of amphetamine positivity, while visits by Chinese and Korean patients had the lowest.

Conclusions: The findings reveal a concerning rise in amphetamine positivity that is associated with increased resource utilization. There was also significant variability in the rate of amphetamine positivity within the AA and PI population, a group of ethnicities often analyzed as a single entity in previous studies. Culturally sensitive interventions may curb the methamphetamine epidemic's effect on healthcare systems and vulnerable populations.

目标:应对甲基苯丙胺的流行需要更全面地了解其对医疗保健系统和高危人群的影响。本研究的目的是评估甲基苯丙胺的使用对精神科急诊服务结果的影响,以及对亚裔美国人(AA)和太平洋岛民(PI)人群的影响,亚裔美国人和太平洋岛民是药物使用研究中历来被忽视的人群:方法:对 2007 年至 2019 年期间夏威夷市区一家大型一级创伤中心所有需要精神科急诊服务并完成尿液药物筛查的就诊病例(N = 44658)进行了回顾性病历审查。对苯丙胺阳性和苯丙胺阴性就诊者的人口统计学特征和急诊过程进行了比较:苯丙胺阳性就诊者的比例从2007年的13.3%上升到2019年的25.5%,增加了约一倍。苯丙胺呈阳性的就诊者更有可能需要执法人员到场(38.3% vs 27.2.%,P <0.001),需要肌肉注射精神药物(17.3% vs 12.3%,P <0.001),急诊科住院时间更长(中位数为 420 分钟 vs 372 分钟,P <0.001)。夏威夷原住民和西班牙/拉美裔患者的安非他明阳性率最高,而华裔和韩裔患者的阳性率最低:研究结果表明,苯丙胺阳性率的上升令人担忧,这与资源利用率的增加有关。在 AA 和 PI 人口中,苯丙胺阳性率也存在很大差异,而在以往的研究中,这两个种族往往被作为一个整体进行分析。对文化敏感的干预措施可能会抑制甲基苯丙胺流行病对医疗系统和弱势群体的影响。
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引用次数: 0
Integration of a Community Opioid Treatment Program into a Federally Qualified Health Center. 将社区阿片类药物治疗计划纳入联邦合格医疗中心。
IF 5.5 3区 医学 Q2 Medicine Pub Date : 2024-06-13 DOI: 10.1097/ADM.0000000000001336
Christine Neeb, Brianna M McQuade, Linda Lesondak, Samantha Madrid, Judith M Schlaeger, Dennis P Watson, Niranjan Karnik, Noami Huerta, Simar Bhatia, Judes Fleurimont, Nicole Li, Elsa Hammerdahl, Ricky Pesantez, Nicole Gastala

Objectives: With the increasing rates of opioid overdose deaths in the United States, barriers to treatment access for patients seeking medications for opioid use disorder (OUD), and challenges of initiating buprenorphine in patients who use fentanyl, it is essential to explore novel approaches to expanding access to methadone treatment. An opioid treatment program (OTP) and a federally qualified health center (FQHC) partnered to develop and implement an innovative integrated methadone and primary care treatment model. The process for integrating an OTP and FQHC to provide methadone treatment in the primary care setting will be discussed.

Methods: An OTP methadone dispensing site was co-located in the FQHC, utilizing a staffing matrix built on the expertise of each stakeholder. The OTP managed DEA and state regulatory processes, whereas the FQHC physicians provided medical treatment, including methadone treatment protocols, treatment plans, and primary care. Patient demographics, medical history, and retention data for those who entered the program between January 2021 and February 2023 were collected through chart review and analyzed with descriptive statistics.

Results: A total of 288 OTP-FHQC patients were enrolled during the study. Retention rates in methadone treatment at 90 and 180 days were similar to partner clinics.

Conclusions: Collaboration between FQHCs and OTPs is operationally feasible and can be achieved utilizing the current staffing model of the FQHC and OTP. This model can increase access to treatment for OUD and primary care for an urban, underserved patient population.

目标:随着美国阿片类药物过量致死率的不断上升,阿片类药物使用障碍(OUD)患者在寻求药物治疗时面临障碍,以及使用芬太尼的患者在开始使用丁丙诺啡时面临挑战,因此探索新方法以扩大美沙酮治疗的可及性至关重要。一个阿片类药物治疗项目(OTP)和一个联邦合格医疗中心(FQHC)合作开发并实施了一种创新的美沙酮和初级保健综合治疗模式。本文将讨论整合 OTP 和 FQHC,在初级保健环境中提供美沙酮治疗的过程:方法:在 FQHC 内设立了一个 OTP 美沙酮配药点,利用各利益相关方的专业知识建立了一个人员配置矩阵。OTP 负责管理 DEA 和州监管流程,而 FQHC 的医生则提供医疗服务,包括美沙酮治疗方案、治疗计划和初级保健。通过病历审查收集了在 2021 年 1 月至 2023 年 2 月期间进入项目的患者的人口统计学特征、病史和保留数据,并进行了描述性统计分析:研究期间,共有 288 名 OTP-FHQC 患者加入。美沙酮治疗 90 天和 180 天的保留率与合作诊所相似:FQHC和OTP之间的合作在操作上是可行的,可以利用FQHC和OTP目前的人员配置模式来实现。这种模式可以增加城市中服务不足的患者群体获得 OUD 治疗和初级保健的机会。
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引用次数: 0
Internet Gaming Disorder and the Incidence of Suicide-Related Ideation and Behaviors in College Students. 网络游戏障碍与大学生自杀意念和行为的发生率。
IF 5.5 3区 医学 Q2 Medicine Pub Date : 2024-06-04 DOI: 10.1097/ADM.0000000000001331
Ricardo Orozco, Guilherme Borges, José Miguel Caldas-de-Almeida, Raúl A Gutiérrez-García, Yesica Albor, Ana Lucía Jiménez Pérez, Karla Patricia Valdés-García, Patricia M Baez Mansur, María Anabell Covarrubias Díaz Couder, Praxedis Cristina Hernández Uribe, Corina Benjet

Objectives: The longitudinal associations between DSM-5 Internet Gaming Disorder (IGD) and suicide-related ideation and behaviors have not been explored. In this study, we therefore seek to examine the association between baseline IGD and incident suicide ideation, plans, and attempts.

Methods: This is a prospective cohort study of 2586 Mexican college students followed up from September 2018 to June 2022. We estimated hazards ratios modeling incidence of suicide ideation, plans, and attempts by fitting proportional hazards Cox models with person-time scaled in years.

Results: Among 2140 students without suicide ideation at baseline, there were 467 incident cases in 3987.6 person-years; ideation incidence rates were 179 cases per 1000 person-years among students with IGD and 114 cases per 1000 person-years among those without IGD. Incidence rates for suicide plans were 67 and 39 per 1000 among IGD and non-IGD students, and 15 and 10 per 1000, respectively for attempts. After controlling for age, sex, and mood, anxiety, and substance use disorders, IGD was associated with an 83% increased risk of suicide ideation. Although incidence rate estimates for plans and attempts were higher among students with IGD, results were not statistically significant.

Conclusions: This study helps to raise awareness of the increased risk of at least suicidal ideation in people experiencing IGD. Clinicians treating patients with IGD may encounter complaints of suicide ideation over time, and even reports of suicidal behavior that should not be disregarded. Identifying these patients and treating/referring them for underlying suicidality should form part of IGD treatment.

研究目的DSM-5网络游戏障碍(IGD)与自杀相关意念和行为之间的纵向关联尚未得到探讨。因此,在本研究中,我们试图研究基线 IGD 与自杀意念、自杀计划和自杀未遂事件之间的关联:这是一项前瞻性队列研究,从 2018 年 9 月到 2022 年 6 月对 2586 名墨西哥大学生进行了随访。我们通过拟合以年为单位的人时比例危害 Cox 模型,估算了自杀意念、自杀计划和自杀未遂发生率的危害比模型:在基线时没有自杀意念的 2140 名学生中,3987.6 人年中发生了 467 起自杀事件;在有 IGD 的学生中,意念发生率为 179 例/1000 人年,而在没有 IGD 的学生中,意念发生率为 114 例/1000 人年。在 IGD 和非 IGD 学生中,自杀计划发生率分别为每 1000 人中 67 例和 39 例,自杀未遂发生率分别为每 1000 人中 15 例和 10 例。在控制了年龄、性别、情绪、焦虑和药物使用障碍等因素后,IGD 与自杀意念风险增加 83% 相关。虽然患有 IGD 的学生中计划自杀和企图自杀的发生率估计值较高,但结果在统计学上并不显著:这项研究有助于提高人们对 IGD 患者至少会增加自杀意念风险的认识。治疗 IGD 患者的临床医生可能会在一段时间内遇到自杀意念的主诉,甚至是自杀行为的报告,这些都不应被忽视。识别这些患者并治疗/转介他们潜在的自杀倾向应成为 IGD 治疗的一部分。
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引用次数: 0
Sociodemographic and Health Factors of the Alcohol Treatment-seeking Population in New South Wales, Australia. 澳大利亚新南威尔士州寻求酒精治疗人群的社会人口和健康因素。
IF 5.5 3区 医学 Q2 Medicine Pub Date : 2024-06-03 DOI: 10.1097/ADM.0000000000001311
Nathan Heijstee, Eleanor Black, Emma Black, Apo Demirkol, Kristie Mammen, Llewellyn Mills, Rachel Deacon, Nadine Ezard, Mark Montebello, David Reid, Raimondo Bruno, Anthony Shakeshaft, Krista J Siefried, Michael Farrell, Nicholas Lintzeris

Objectives: Although factors associated with alcohol use have been researched at a population level, descriptions of the alcohol and other drug (AOD) treatment-seeking population in New South Wales (NSW), Australia, are limited. This study addresses this gap by analyzing sociodemographic and health characteristics in the NSW AOD treatment-seeking population.

Methods: Self-reported Australian Treatment Outcomes Profile data on substance use, health ratings, and sociodemographic factors were acquired from public AOD services (offering services from counseling to ambulatory/inpatient withdrawal management) in 6 administrative health districts from 2016 to 2019 (n = 14,287). Gaussian and multiple logistic regressions were conducted to examine associations between these factors and alcohol consumption quantity.

Results: Data were analyzed for patients seeking treatment for alcohol consumption specifically (n = 5929; median age, 44 years; 65% male). Valid alcohol consumption data were available for 5460 patients, among whom the mean volume of alcohol consumed was 311 standard drinks (3110 grams of ethanol) over the past 28 days and 15 standard drinks (150 grams of ethanol) per occasion. Higher volumes were consumed by males and those with recent experiences of violence and/or injecting drug use. Caring for children younger than 5 years and having above-median health ratings were associated with lower alcohol consumption.

Conclusions: This study contributes to the characterization of the NSW public AOD treatment population and identifies associations between alcohol consumption, sociodemographic factors, and health ratings among people seeking treatment for alcohol consumption. Findings point towards multilevel assessment and comprehensive interventions for people engaging in treatment for alcohol use. Future research should address barriers to treatment.

研究目的:尽管对与饮酒有关的因素进行了人群层面的研究,但对澳大利亚新南威尔士州(NSW)寻求酒精和其他药物(AOD)治疗人群的描述却很有限。本研究通过分析新南威尔士州寻求酒精和其他药物治疗人群的社会人口学和健康特征,填补了这一空白:从2016年到2019年,从6个行政卫生区的公共AOD服务机构(提供从咨询到门诊/住院戒断管理等服务)获得了关于药物使用、健康评分和社会人口因素的自我报告的澳大利亚治疗结果档案数据(n = 14,287)。研究人员对这些因素与饮酒量之间的关系进行了高斯和多元逻辑回归分析:对专门因饮酒寻求治疗的患者(n = 5929;年龄中位数为 44 岁;65% 为男性)进行了数据分析。有 5460 名患者的有效饮酒数据,其中过去 28 天的平均饮酒量为 311 标准杯(3110 克乙醇),每次 15 标准杯(150 克乙醇)。男性和近期有暴力和/或注射毒品经历的人饮酒量更高。照顾5岁以下儿童和健康评分高于中位数与较低的酒精消费量有关:这项研究有助于描述新南威尔士州公共酒精与药物滥用治疗人群的特征,并确定因饮酒而寻求治疗的人群中饮酒量、社会人口因素和健康评分之间的关联。研究结果表明,应该对接受酒精使用治疗的人群进行多层次评估和综合干预。未来的研究应解决治疗障碍问题。
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引用次数: 0
"If You Plant That Seed, It Will Grow": A Qualitative Study to Improve Linkage to Care among Patients with Methamphetamine Use Disorder in Emergency Department Settings. "如果你种下那颗种子,它就会长大":一项定性研究,旨在改善急诊科甲基苯丙胺使用障碍患者的护理联系。
IF 5.5 3区 医学 Q2 Medicine Pub Date : 2024-05-27 DOI: 10.1097/ADM.0000000000001315
Deborah J Rinehart, Karina G Duarte, Aiden Gilbert, Alia Al-Tayyib, Katherine Camfield, Scott A Simpson

Objectives: Methamphetamine addiction is a serious and difficult-to-treat disorder. Existing treatment options are limited, and patient perspectives on effective strategies are lacking. Emergency departments (EDs) may be a critical entry point for individuals with methamphetamine use disorder (MUD) to be identified and linked to treatment. We aimed to understand patients' perspectives regarding their methamphetamine use and related ED experiences and how to improve linkage to substance treatment.

Methods: Between July and November 2022, semistructured qualitative interviews were conducted with adult patients with MUD in an urban safety-net healthcare setting in Denver, Colorado. Interviews were recorded, summarized, and analyzed using the Rapid Assessment Process.

Results: During the interviews, 18 patients shared their experiences. Participants described feeling stigmatized and experiencing a lack of communication from ED staff during their visit. Additionally, participants shared the perception that ED staff often did not take their health concerns seriously once substance use was identified. Participants were uncertain about overdose risk and felt that their psychiatric symptoms complicated treatment. Referrals to treatment were lacking, and participants supported a care navigation intervention that incorporates elements of contingency management. Participants also shared the importance of ED staff recognizing their social needs and being empathetic, trauma-informed, and flexible to meet patients where they are regardless of their readiness to seek treatment.

Conclusions: Treatment options and entry points for individuals with MUD are currently limited. The patient perspectives described here are helpful in developing services to support, engage, and link individuals to MUD services after discharge from ED services.

目标:甲基苯丙胺成瘾是一种严重且难以治疗的疾病。现有的治疗方案很有限,而且缺乏患者对有效策略的看法。急诊科(ED)可能是识别甲基苯丙胺使用障碍(MUD)患者并将其与治疗联系起来的关键切入点。我们旨在了解患者对其甲基苯丙胺使用和相关急诊室经历的看法,以及如何改善与药物治疗的联系:2022 年 7 月至 11 月期间,我们在科罗拉多州丹佛市的一个城市安全网医疗机构中对患有 MUD 的成年患者进行了半结构化定性访谈。采用快速评估流程对访谈进行记录、总结和分析:在访谈过程中,18 名患者分享了他们的经历。参与者描述了他们在就诊期间感到被污名化以及急诊室工作人员缺乏沟通的经历。此外,参与者还认为,一旦发现使用药物,急诊室工作人员往往不会认真对待他们的健康问题。参与者对用药过量的风险不确定,并认为他们的精神症状使治疗变得复杂。缺乏治疗转介,参与者支持结合应急管理元素的护理导航干预。参与者还认为,急诊室工作人员必须认识到患者的社会需求,并以同理心、创伤意识和灵活性来满足患者的需求,无论他们是否准备寻求治疗:目前,针对 MUD 患者的治疗方案和切入点非常有限。本文所描述的患者观点有助于开发相关服务,以支持、吸引患者并在他们从急诊室出院后将其与 MUD 服务联系起来。
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引用次数: 0
Intersectional Risk and the Significant Gap in Care for Persons With Co-occurring Chronic Pain and Opioid Withdrawal. 慢性疼痛和阿片类药物戒断并发症患者的交叉风险和护理方面的巨大差距。
IF 5.5 3区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2024-02-05 DOI: 10.1097/ADM.0000000000001278
Orrin D Ware, Andrew S Huhn, Jennifer D Ellis, H Elizabeth Bird, Chung Jung Mun, Kelly E Dunn

Objectives: Persons with chronic pain and women tend to enter treatment for opioid use disorder with greater opioid withdrawal severity than persons without chronic pain and men, respectively. This study examined characteristics of facilities with opioid withdrawal treatment, including gender-based services, as a function of whether they reported having a tailored pain management program.

Methods: The National Survey of Substance Abuse Treatment Services 2020 was used to examine 3942 facilities with opioid withdrawal treatment in the United States. Using a multivariable binary logistic regression model, facilities were examined for the presence of a tailored program for individuals with co-occurring pain. Regional location of the facility, ownership status, and availability of tailored gender programs, nonhospital residential services, and outpatient services served as independent variables in the analysis.

Results: A slight majority of the sample had a program for both adult men and adult women ( n = 2010, 51.0%). Most facilities had outpatient services ( n = 3289, 83.4%) and did not have a tailored program for addressing co-occurring pain ( n = 2756, 69.9%). Binary logistic regression analysis showed that among opioid withdrawal facilities, programs with nonhospital residential services, government or private nonprofit funding, or tailored gender programming had higher odds of reporting having a tailored program for pain and substance use disorder. Facilities in the Western United States were most likely to have tailored programs for pain and substance use disorder.

Conclusions: Future research should investigate what support patients may receive and how to better scale access to pain management during opioid withdrawal treatment.

目标:慢性疼痛患者和女性在接受阿片类药物使用障碍治疗时,其阿片类药物戒断的严重程度往往分别高于无慢性疼痛患者和男性。本研究考察了提供阿片类药物戒断治疗(包括基于性别的服务)的机构的特点,以及这些机构是否报告有量身定制的疼痛管理计划:2020年全国药物滥用治疗服务调查》对美国3942家提供阿片类药物戒断治疗的机构进行了调查。利用多变量二元逻辑回归模型,对机构是否为并发疼痛患者量身定制了治疗方案进行了研究。分析中的自变量包括医疗机构的地区位置、所有权状况以及是否有针对性别的项目、非医院住宿服务和门诊服务:略占多数的样本同时为成年男性和成年女性提供项目(n = 2010,51.0%)。大多数机构提供门诊服务(n = 3289,83.4%),但没有针对并发疼痛的定制计划(n = 2756,69.9%)。二元逻辑回归分析表明,在阿片类药物戒断机构中,拥有非医院住宿服务、政府或私人非营利性资金、或量身定制的性别方案的机构报告拥有针对疼痛和药物使用障碍的量身定制方案的几率更高。美国西部的机构最有可能拥有针对疼痛和药物使用障碍的定制计划:未来的研究应调查患者可获得哪些支持,以及如何在阿片类药物戒断治疗期间更好地扩大疼痛管理的范围。
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引用次数: 0
Prevalence of Kratom Use Disorder Among Kratom Consumers. 桔梗消费者中桔梗使用障碍的流行率。
IF 5.5 3区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2024-03-05 DOI: 10.1097/ADM.0000000000001290
Katherine Hill, Oliver Grundmann, Kirsten E Smith, Corneliu N Stanciu

Objectives: Kratom leaf products are increasingly consumed in the United States, with many consumers reporting they experience beneficial effects from kratom use. However, there is a growing concern for kratom's potential to result in dependence when used regularly. As such, we sought to assess, using Diagnostic and Statistical Manual of Mental Disorders , (DSM-5) , diagnostic criteria for substance use disorder, the prevalence of "kratom use disorder" (KUD) among kratom consumers.

Methods: Our cross-sectional study used an online, anonymous survey between February and May 2023. Through nonprobability sampling, we recruited people older than 18 years who currently consume kratom. Participants were asked about their kratom consumption patterns, adverse effects perceived to stem from kratom consumption, comorbid diagnoses, and components for a DSM-5 , substance use disorder, adapted for kratom.

Results: Among the total sample ( N = 2061), KUD criteria were met by 25.5% of participants ( n = 525); the most commonly reported symptoms were tolerance ( n = 427, 81.3%) and withdrawal ( n = 357, 68.0%). After adjusting for age, gender, daily frequency of kratom consumption, and history of either a substance use disorder or a mental health condition, those with a concurrent diagnosis of another substance use disorder had 2.83 times higher odds of meeting KUD criteria (95% CI, 2.19-3.67) compared with those without one.

Conclusions: In this large cross-sectional study, most participants who met the criteria for a KUD diagnosis were categorized as having a mild or moderate KUD. Individual characteristics associated with KUD were related to being male, young, consuming kratom frequently, and having psychiatric and substance use disorder comorbidities.

目的:在美国,桔梗叶产品的消费量越来越大,许多消费者表示他们从使用桔梗中体验到了有益的效果。然而,人们越来越担心经常使用 Kratom 可能会产生依赖性。因此,我们试图使用《精神疾病诊断与统计手册》(DSM-5)中的药物使用障碍诊断标准,评估 "kratom 使用障碍"(KUD)在 kratom 消费者中的流行率:我们的横断面研究在 2023 年 2 月至 5 月期间进行了在线匿名调查。通过非概率抽样调查,我们招募了 18 岁以上、目前食用 kratom 的人群。调查询问了参与者的克瑞托姆消费模式、认为克瑞托姆消费产生的不良影响、合并诊断以及根据克瑞托姆改编的 DSM-5 物质使用障碍的组成部分:在所有样本(样本数 = 2061)中,25.5% 的参与者(样本数 = 525)符合 KUD 标准;最常报告的症状是耐受(样本数 = 427,81.3%)和戒断(样本数 = 357,68.0%)。在对年龄、性别、每天服用克拉托姆的频率以及药物使用障碍或精神疾病史进行调整后,同时被诊断为另一种药物使用障碍的人与未被诊断为另一种药物使用障碍的人相比,符合 KUD 标准的几率高出 2.83 倍(95% CI,2.19-3.67):在这项大型横断面研究中,大多数符合 KUD 诊断标准的参与者被归类为轻度或中度 KUD。与 KUD 相关的个体特征包括男性、年轻、经常服用 kratom 以及合并有精神病和药物使用障碍。
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引用次数: 0
Buprenorphine Receipt and Retention for Opioid Use Disorder Following an Initiative to Increase Access in Primary Care. 在提高初级医疗服务可及性的倡议之后,接受和保留丁丙诺啡治疗阿片类药物使用障碍。
IF 5.5 3区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2024-02-08 DOI: 10.1097/ADM.0000000000001275
Eric J Hawkins, Carol A Malte, Hildi J Hagedorn, Adam J Gordon, Emily C Williams, Ryan S Trim, Brittany E Blanchard, Aline Lott, Anissa N Danner, Andrew J Saxon

Objectives: Buprenorphine, a medication for opioid use disorder (OUD), is underutilized in general medical settings. Further, it is inequitably received by racialized groups and persons with comorbidities. The Veterans Health Administration launched an initiative to increase buprenorphine receipt in primary care. The project's objective was to identify patient-related factors associated with buprenorphine receipt and retention in primary care clinics (n = 18) participating in the initiative.

Methods: Retrospective cohort quality improvement evaluation of patients 18 years or older with 2 or more primary care visits in a 1-year period and an OUD diagnosis in the year before the first primary care visit (index date). Buprenorphine receipt was the proportion of patients with OUD who received 1 or more buprenorphine prescriptions from primary care providers during the post-index year and retention the proportion who received buprenorphine for 180 days or longer.

Results: Of 2880 patients with OUD seen in primary care, 11.7% (95% confidence interval [CI], 10.6%-12.9%) received buprenorphine in primary care, 58.2% (95% CI, 52.8%-63.3%) of whom were retained on buprenorphine for 180 days or longer. Patients with alcohol use disorder (adjusted odds ratio [AOR], 0.39; 95% CI, 0.27-0.57), nonopioid drug use disorder (AOR, 0.64; 95% CI, 0.45-0.93), and serious mental illness (AOR, 0.60; 95% CI, 0.37-0.97) had lower buprenorphine receipt. Those with an anxiety disorder had higher buprenorphine receipt (AOR, 1.42; 95% CI, 1.04-1.95). Buprenorphine receipt (AOR, 0.55; 95% CI, 0.35-0.87) and 180-day retention (AOR, 0.40; 95% CI, 0.19-0.84) were less likely among non-Hispanic Black patients.

Conclusions: Further integration of addiction services in primary care may be needed to enhance buprenorphine receipt for patients with comorbid substance use disorders, and interventions are needed to address disparities in receipt and retention among non-Hispanic Black patients.

目标:丁丙诺啡是一种治疗阿片类药物使用障碍(OUD)的药物,但在普通医疗机构中使用不足。此外,种族群体和合并症患者接受丁丙诺啡的比例也不平等。退伍军人健康管理局发起了一项倡议,以增加初级保健中丁丙诺啡的使用。该项目的目标是确定与参与该计划的初级保健诊所(n = 18)接受和保留丁丙诺啡有关的患者相关因素:方法:对 1 年内接受过 2 次或 2 次以上初级保健就诊且在首次初级保健就诊前一年(索引日期)诊断出 OUD 的 18 岁或 18 岁以上患者进行回顾性队列质量改进评估。接受丁丙诺啡的比例是指在指数日期后的一年内从初级保健提供者处获得 1 张或 1 张以上丁丙诺啡处方的 OUD 患者的比例,保留比例是指接受丁丙诺啡 180 天或更长时间的患者的比例:在初级医疗机构就诊的 2880 名 OUD 患者中,11.7%(95% 置信区间 [CI],10.6%-12.9%)的患者在初级医疗机构接受了丁丙诺啡治疗,其中 58.2%(95% 置信区间 [CI],52.8%-63.3%)的患者接受了 180 天或更长时间的丁丙诺啡治疗。酒精使用障碍(调整后的几率比 [AOR],0.39;95% CI,0.27-0.57)、非阿片类药物使用障碍(AOR,0.64;95% CI,0.45-0.93)和严重精神疾病(AOR,0.60;95% CI,0.37-0.97)患者接受丁丙诺啡治疗的比例较低。焦虑症患者接受丁丙诺啡治疗的比例较高(AOR,1.42;95% CI,1.04-1.95)。在非西班牙裔黑人患者中,接受丁丙诺啡治疗(AOR,0.55;95% CI,0.35-0.87)和 180 天保留治疗(AOR,0.40;95% CI,0.19-0.84)的可能性较低:结论:可能需要进一步整合初级保健中的成瘾服务,以提高合并药物使用障碍患者接受丁丙诺啡治疗的机会,同时需要采取干预措施,解决非西班牙裔黑人患者接受和保留丁丙诺啡治疗方面的差异。
{"title":"Buprenorphine Receipt and Retention for Opioid Use Disorder Following an Initiative to Increase Access in Primary Care.","authors":"Eric J Hawkins, Carol A Malte, Hildi J Hagedorn, Adam J Gordon, Emily C Williams, Ryan S Trim, Brittany E Blanchard, Aline Lott, Anissa N Danner, Andrew J Saxon","doi":"10.1097/ADM.0000000000001275","DOIUrl":"10.1097/ADM.0000000000001275","url":null,"abstract":"<p><strong>Objectives: </strong>Buprenorphine, a medication for opioid use disorder (OUD), is underutilized in general medical settings. Further, it is inequitably received by racialized groups and persons with comorbidities. The Veterans Health Administration launched an initiative to increase buprenorphine receipt in primary care. The project's objective was to identify patient-related factors associated with buprenorphine receipt and retention in primary care clinics (n = 18) participating in the initiative.</p><p><strong>Methods: </strong>Retrospective cohort quality improvement evaluation of patients 18 years or older with 2 or more primary care visits in a 1-year period and an OUD diagnosis in the year before the first primary care visit (index date). Buprenorphine receipt was the proportion of patients with OUD who received 1 or more buprenorphine prescriptions from primary care providers during the post-index year and retention the proportion who received buprenorphine for 180 days or longer.</p><p><strong>Results: </strong>Of 2880 patients with OUD seen in primary care, 11.7% (95% confidence interval [CI], 10.6%-12.9%) received buprenorphine in primary care, 58.2% (95% CI, 52.8%-63.3%) of whom were retained on buprenorphine for 180 days or longer. Patients with alcohol use disorder (adjusted odds ratio [AOR], 0.39; 95% CI, 0.27-0.57), nonopioid drug use disorder (AOR, 0.64; 95% CI, 0.45-0.93), and serious mental illness (AOR, 0.60; 95% CI, 0.37-0.97) had lower buprenorphine receipt. Those with an anxiety disorder had higher buprenorphine receipt (AOR, 1.42; 95% CI, 1.04-1.95). Buprenorphine receipt (AOR, 0.55; 95% CI, 0.35-0.87) and 180-day retention (AOR, 0.40; 95% CI, 0.19-0.84) were less likely among non-Hispanic Black patients.</p><p><strong>Conclusions: </strong>Further integration of addiction services in primary care may be needed to enhance buprenorphine receipt for patients with comorbid substance use disorders, and interventions are needed to address disparities in receipt and retention among non-Hispanic Black patients.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":null,"pages":null},"PeriodicalIF":5.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11150106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139706802","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
Case Series of Individuals Treated With Naltrexone During Pregnancy for Opioid and/or Alcohol Use Disorder. 妊娠期因阿片类药物和/或酒精使用障碍而接受纳曲酮治疗的病例系列。
IF 5.5 3区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2024-02-14 DOI: 10.1097/ADM.0000000000001293
Elisha M Wachman, Kelley Saia, Jonathan Bressler, Martha Werler, Ginny Carter, Hendree E Jones

Objective: There is a lack of knowledge about the relative safety and efficacy of naltrexone for the treatment of pregnant individuals with opioid and/or alcohol use disorder, including the range of outcomes, in both the pregnant individual and the infant, over the course of peripartum period. Our objective was to describe these outcomes in a cohort of pregnant individuals on naltrexone.

Methods: In this prospective case series, 7 pregnant individuals with opioid use disorder (OUD) or alcohol use disorder (AUD) treated with naltrexone were followed from pregnancy through 12 months after delivery. Clinical treatment protocols and outcomes related to safety and efficacy during pregnancy, delivery, and the postpartum period are described.

Results: There were 4 pregnant individuals with OUD and 3 with AUD, of which 3 were managed with oral and 4 with extended-release naltrexone. The mean gestational age at study enrollment was 21.7 (SD, 12) weeks. Of the 7 participants, there was no return to nonprescribed opioid use and 2 who experienced a return to alcohol use over the course of the study. All individuals delivered vaginally at a mean of 37 weeks gestation without any peripartum pain difficulties. Five of the individuals (71.4%) remained on naltrexone 12 months after delivery. There were no reported fetal anomalies and one preterm delivery. None of the infants developed neonatal opioid withdrawal syndrome.

Conclusions: For pregnant individuals with OUD or AUD treated with naltrexone, there were low rates of return to nonprescribed use and reassuring pregnant person and infant outcomes to 12 months postpartum.

目的:对于纳曲酮治疗患有阿片类药物和/或酒精使用障碍的孕妇的相对安全性和疗效,包括孕妇和婴儿在围产期的一系列结果,还缺乏了解。我们的目标是描述使用纳曲酮的孕妇群体的这些结果:在这项前瞻性病例系列研究中,我们对 7 名接受纳曲酮治疗的阿片类药物使用障碍(OUD)或酒精使用障碍(AUD)孕妇进行了从孕期到产后 12 个月的跟踪随访。报告介绍了临床治疗方案以及与妊娠、分娩和产后期间的安全性和有效性相关的结果:共有 4 名 OUD 孕妇和 3 名 AUD 孕妇,其中 3 人接受了口服纳曲酮治疗,4 人接受了缓释纳曲酮治疗。参加研究时的平均孕龄为 21.7 周(标准差,12 周)。在 7 名参与者中,没有人再次使用非处方阿片类药物,2 人在研究过程中再次酗酒。所有参与者均在平均妊娠 37 周时经阴道分娩,未出现任何围产期疼痛问题。其中 5 人(71.4%)在产后 12 个月仍在服用纳曲酮。没有关于胎儿畸形和早产的报道。没有一名婴儿出现新生儿阿片戒断综合征:结论:对于接受纳曲酮治疗的患有阿片类药物依赖性成瘾或阿片类药物依赖性增高的孕妇来说,产后 12 个月内恢复非处方用药的比例较低,孕妇和婴儿的结局令人欣慰。
{"title":"Case Series of Individuals Treated With Naltrexone During Pregnancy for Opioid and/or Alcohol Use Disorder.","authors":"Elisha M Wachman, Kelley Saia, Jonathan Bressler, Martha Werler, Ginny Carter, Hendree E Jones","doi":"10.1097/ADM.0000000000001293","DOIUrl":"10.1097/ADM.0000000000001293","url":null,"abstract":"<p><strong>Objective: </strong>There is a lack of knowledge about the relative safety and efficacy of naltrexone for the treatment of pregnant individuals with opioid and/or alcohol use disorder, including the range of outcomes, in both the pregnant individual and the infant, over the course of peripartum period. Our objective was to describe these outcomes in a cohort of pregnant individuals on naltrexone.</p><p><strong>Methods: </strong>In this prospective case series, 7 pregnant individuals with opioid use disorder (OUD) or alcohol use disorder (AUD) treated with naltrexone were followed from pregnancy through 12 months after delivery. Clinical treatment protocols and outcomes related to safety and efficacy during pregnancy, delivery, and the postpartum period are described.</p><p><strong>Results: </strong>There were 4 pregnant individuals with OUD and 3 with AUD, of which 3 were managed with oral and 4 with extended-release naltrexone. The mean gestational age at study enrollment was 21.7 (SD, 12) weeks. Of the 7 participants, there was no return to nonprescribed opioid use and 2 who experienced a return to alcohol use over the course of the study. All individuals delivered vaginally at a mean of 37 weeks gestation without any peripartum pain difficulties. Five of the individuals (71.4%) remained on naltrexone 12 months after delivery. There were no reported fetal anomalies and one preterm delivery. None of the infants developed neonatal opioid withdrawal syndrome.</p><p><strong>Conclusions: </strong>For pregnant individuals with OUD or AUD treated with naltrexone, there were low rates of return to nonprescribed use and reassuring pregnant person and infant outcomes to 12 months postpartum.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":null,"pages":null},"PeriodicalIF":5.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11150101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139735192","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
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Journal of Addiction Medicine
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