Journal of Addiction Medicine最新文献

Medetomidine has been increasingly found in the illegal opioid supply across the country over the last few years. In 2024, it replaced xylazine as the most common adulterant of the illegal opioid supply in the Philadelphia area. Medetomidine is estimated to be over 100 times as potent and selective for the alpha-2 receptor than xylazine. This leads to increased sedative effects compared with other alpha-2 agonists and in some patients, a severe autonomic withdrawal syndrome when medetomidine is abruptly stopped. Severe hypertension, tachycardia, vomiting, and tremors have been seen, often requiring hospital admission and critical care. As a result, the capacity of local health systems and ability to accurately triage patients to the proper level of care have been stretched. Drug checking and testing of biospecimens for medetomidine remains limited. Clinician and public health awareness of this new entity will be foundational to robust responses to this next adulterant threat.

Objectives: Little is known about the demographic and clinical features of patients with xylazine-related wounds. We sought to characterize hospitalized patients with substance use disorder (SUD) and xylazine-related wounds seen for infectious diseases consultation.

Methods: We retrospectively reviewed the medical records of 193 patients diagnosed with SUD at 3 Philadelphia hospitals between October 2023 and January 2024. Patients were identified as either being diagnosed with (n=73) or without (n=120) xylazine-related wounds. We compared the demographic and clinical features between the 2 groups.

Results: Patients diagnosed with wounds were younger ( P <0.001), more likely to be White or Hispanic and less likely to be Black/AA ( P <0.001), more likely to have tested positive for fentanyl ( P <0.001), amphetamines ( P <0.001), and cocaine ( P 0.001), more likely to acknowledge injection ( P <0.001), and more likely to leave the hospital by patient-directed discharge (PDD) ( P <0.001). Most patients had multiple wounds (75%), and more than half (53%) had at least one wound greater than 10 cm at its widest dimension. Although most patients diagnosed with wounds received antibiotics, many did not have symptoms or signs of infection.

Conclusions: Xylazine-related wounds are highly associated with illicitly manufactured fentanyl (IMF) use and with drug injection in the city of Philadelphia. Many patients with xylazine-associated wounds do not have signs of infection and may not benefit from antibiotics. Understanding precisely how xylazine is responsible for wound development and how to best manage the wounds, including wound care and the role of antibiotics, is urgent.

Objectives: Private methadone treatment paid for by the Department of Veterans Affairs (VA), called community care (CC), and mobile opioid treatment programs (OTPs) are strategies to expand Veteran access to methadone treatment for opioid use disorder. The purpose of this evaluation was to investigate leader and clinician perspectives on these modalities compared with treatment provided directly by VA OTPs.

Methods: Semi-structured interviews were conducted with VA OTP leaders and clinicians from 12 of the 33 VA OTP sites nationwide. Participants (N=24) were asked to compare access, quality, and cost of methadone treatment between VA OTPs and CC and asked about the feasibility of deploying mobile OTP services. Two analysts independently coded the transcribed data and used thematic analysis to identify salient themes and representative quotes.

Results: VA leaders and clinicians perceived CC to have longer wait times and lower quality care, but expected these services to be less expensive than VA OTPs. Mobile OTP services were viewed as a potential solution to improve access, though concerns were raised about staffing and the reduced availability of wrap-around services. Key considerations for successful mobile OTP implementation included identifying high-need localities, addressing patient needs, and ensuring financial viability.

Conclusions: Within and outside VA, there is growing interest in expanding access to medications for OUD, such as methadone. Leaders and clinicians highlighted important access, quality, and cost considerations when exploring innovative treatment modalities for methadone, such as mobile OTP services and CC. Findings from this VA evaluation may guide methadone treatment improvement in other health systems.

Objectives: Opioid use during pregnancy is a critical public health concern that has given rise to significant treatment needs throughout the perinatal period. The purpose of this study was to gather perspectives of pregnant and parenting individuals in recovery from opioid use disorder (OUD) to better understand their needs and identify ways to improve care and support parenting.

Methods: We conducted semi-structured interviews with 18 pregnant and postpartum people receiving medication for opioid use disorder (MOUD) at an outpatient buprenorphine clinic. The coding team developed a codebook using both inductive and deductive methods that was applied to all interviews. Key topics and trends were identified using thematic analysis.

Results: Four themes emerged from participants' reflections on their experiences with health care as pregnant and parenting people in recovery: (1) need for support with parenting, (2) concerns about MOUD, (3) difficulty accessing resources, and (4) value of peer support and options for receiving information.

Conclusions: There is a need to prioritize support with parenting, understanding MOUD, and accessing basic needs to better prepare pregnant and early postpartum individuals for parenting in recovery from OUD. It is also important to incorporate peer support into services to better support pregnant and parenting people in recovery.

Objectives: To describe the validity of alcohol use disorder (AUD), the International Classification of Diseases (ICD) codes for alcohol use and repeated or harm-associated use in pregnancy.

Methods: We conducted a retrospective study of pregnancies in individuals who sought care at a medical center from May 2014 to August 2023. We selected all pregnancies with an ICD 9th (ICD-9) or 10th (ICD-10) revision AUD code (ICD-9: 303.9x and 305.x; ICD-10: F10.x and O99.31x) and calculated their positive predictive value (PPV) for capturing alcohol use and repeated or harm-associated use in pregnancy using review of health record as the reference standard. We defined alcohol use as any alcohol consumption during pregnancy and repeated or harm-associated alcohol use as a repeated pattern associated with adverse consequences.

Results: AUD ICD codes were associated with 305 unique pregnancies. The most common AUD ICD code group was 305.x (n=177, 56.4%), followed by F10.x (n=105, 33.4%), O99.31x (n=25, 8.0%), and 303.9x (n=7, 2.2%). The PPV of AUD codes for capturing alcohol use in pregnancy ranged from 10.0% (95% confidence interval [CI], 8.9%-11.2%) for 305.x to 100% (95% CI, 80.9%-99.5%) for O99.31x. The PPV of AUD codes for capturing repeated or harm-associated use in pregnancy ranged from 1.7% (95% CI, 1.6%-1.8%) for 305.x to 28.0% (95% CI, 21.3%-35.9%) for O99.31x.

Conclusions: The PPV of AUD codes for identifying alcohol use and repeated or harm-associated use in pregnancy varies widely across ICD-9 and ICD-10 code groups. These results should be considered when estimating alcohol exposure in pregnancy from administrative data.

Sex differences in the prevalence of substance use disorders (SUD) are well recognized. While a greater proportion of males endorse consuming substances and SUDs, the gap between the sexes has been narrowing over time, due to an increased rate of substance use among females. Yet, the mechanisms underlying sex differences in SUD are unclear, and evidence is lacking to inform the development of personalised preventions and treatment for males and females. The neuroscientific evidence to date is inadequate to explain sex differences in SUD, due to a range of methodological issues (eg, study design, recruitment, and statistical modelling). A harmonised multidisciplinary approach that considers sex at each stage of the research cycle is required to create new mechanistic knowledge and to inform the identification of prevention and treatment targets for males and females with an SUD.

Objectives: The Mainstreaming Addiction Treatment Act removed the separate registration requirement to prescribe scheduled medications for maintenance or detoxification treatment, creating an opportunity to utilize community pharmacists' expertise and accessibility to expand access to medications for opioid use disorder (MOUD). This study aimed to develop pharmacist prescribing models of care within community pharmacies.

Methods: Data were collected via interviews with community pharmacists and pharmacy technicians, treatment providers, and people with lived experience in Washington State from January to May 2024. Interviews were analyzed using a rapid content analysis approach guided by the Practice, Robust Implementation and Sustainability Model and existing evidence-based models of care for MOUD in primary care settings. The research team utilized the themes to develop models of care with input from an interdisciplinary advisory panel.

Results: Thirty-one interviews were conducted with 9 community pharmacy staff, 11 treatment providers, and 11 people with lived experience. In total, 21 themes were identified, including 8 themes regarding intervention characteristics, 5 regarding recipients, 5 regarding implementation and sustainability infrastructure, and 3 regarding external environment. Within intervention characteristics, 3 themes were identified regarding medication therapy, 3 regarding education, 1 regarding coordination of care, and 1 regarding psychosocial services. Two models of care were developed: one for MOUD initiation and another for maintenance or ongoing treatment.

Conclusions: This study resulted in the development of models of care for MOUD initiation and maintenance at community pharmacies. Future research is needed to evaluate the effectiveness of these models of care.

Objectives: Attitudes about alcohol misuse influence help-seeking behaviors. We assessed attitudes among Alaska Native/American Indian (AN/AI) patients, providers, and leaders to inform outreach, prevention, and treatment.

Methods: Participants included a cross-sectional sample of 72 AN/AI providers/leaders and 704 AN/AI adult patients in randomly selected clinics within a tribal health care system. Attitudes associated with addiction models (Psychosocial, Moral, Disease, Environment, Nature) were assessed using a survey developed for AN/AI people. Independent variables included role (patient, provider/leader), sex, age, residence type (urban, rural, mixed, other), alcohol misuse or behavioral health issue in self, family, or friends, and alcohol or behavioral health help-seeking.

Results: Attitudes corresponding to Psychosocial and Disease models were more highly endorsed than Nature or Moral models. The Environment model was moderately endorsed. The Disease model was more highly endorsed by AN/AI patients with alcohol help-seeking but less endorsed by providers/leaders. AN/AI patients who were male, had rural residence, and a self-reported behavioral health issue had higher endorsement of the Moral model. Male patients and providers/leaders more highly endorsed the Nature model. Roughly one-third (35%) of patient participants were men.

Conclusions: Efforts to counteract moralistic attitudes about alcohol misuse among male and rural AN/AI people, as well as beliefs that alcohol misuse will spontaneously resolve, may facilitate prevention and treatment efforts. Leaders should also be aware of the potential negative impacts of local laws restricting alcohol. Holistic treatment approaches that address psychosocial factors and contextual issues are indicated. Oversampling of male AN/AI patients may also be warranted.

Objectives: Waterpipe smoking is increasingly becoming a public health threat due to its appealing features and misperceptions of its harmful effects. Tools assessing waterpipe addiction are essential for understanding waterpipe smokers' behaviors and designing effective smoking cessation plans. This study aimed to develop and validate the Waterpipe Addiction, Craving, and Anticipation Scale (WACAS) and describe the specific patterns and multidimensional aspects of waterpipe smoking behavior.

Methods: A cross-sectional study was conducted to develop the WACAS based on previously published smoking assessment tools. Snowball sampling was used to recruit 107 waterpipe smokers. Several procedures were performed to examine the scale's validity, including construct and convergent validity. Known-group validity was examined using trend analysis, while path analysis was conducted to confirm the theoretical framework.

Results: The WACAS showed high construct validity (generating 6 factors) and internal consistency, with excellent convergent and known-group validity. It could distinguish between various behavioral expressions of waterpipe smoking, that is, addiction, craving, and anticipation of smoking outcomes, which were initially conceptualized in the theoretical framework.

Conclusions: The WACAS developed in this study is a comprehensive scale comprising 6 factors that distinguish between different behavioral expressions among waterpipe smokers. It captures a unique waterpipe-specific mode of craving explained by anticipation of outcomes and addictive behaviors, confirming the theoretical framework. The scale demonstrated strong validity and reliability. Nevertheless, further refinement and external validation are recommended to establish WACAS as a robust tool for a broad-scope evaluation of waterpipe smoking.

Objectives: Azapirone-class drugs are partial 5-HT1A receptor agonists commonly used to treat anxiety disorders. Prior experimental studies have so far demonstrated that these drugs have low potential for dependence and problematic use and are considered safe treatment options compared with benzodiazepines. However, recent evidence suggesting the contrary raises concerns about their safety. This review examines current evidence on problematic azapirone use.

Methods: This study was conducted in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. Major databases, including MEDLINE/PubMed, PsycInfo, and EMBASE, were searched to identify eligible papers. Additional searches were conducted to supplement. Article selection and data extraction were completed by at least 2 independent reviewers.

Results: Thirteen reports made up of clinical studies (n = 9) and case reports (n = 4) were included. All abuse liability studies comparing azapirones (buspirone and tandospirone), benzodiazepines, and placebo reported no association of buspirone and tandospirone with key features of problematic use. Conversely, all case reports (n = 4) described problematic use, involving patients with a history of incarceration or substance use disorder (SUD) who insufflated buspirone to achieve a sedative effect.

Conclusions: Findings highlight a discrepancy in the primary literature. Specifically, experimental studies conclude that so far, buspirone and tandospirone have a low potential for problematic use. However, more recent case reports document instances of nonprescribed buspirone misuse, particularly among individuals with a history of incarceration or SUD, possibly stemming from a complex interplay of biopsychosocial-behavioral rather than purely pharmacological factors. Further research is needed to guide strategies for preventing problematic azapirone use while ensuring effective anxiety treatment in high-risk populations.