Journal of psychoactive drugs最新文献

Emerging evidence indicates that ayahuasca consumption may have beneficial mental health effects. This study undertakes the largest analysis to date of associations between naturalistic ayahuasca use and current mental health status via an online cross-sectional survey. The sample included 7,576 participants (average age 41, 47% female) who had consumed ayahuasca in religious, traditional, or non-traditional settings in over 50 countries. Bivariate analysis, multivariate linear regressions and generalized structural equation modeling were used to explore associations between ayahuasca use variables, current mental health (K10, SF-12 MCS), and psychological well-being change (PWG). The number of ayahuasca uses was found to be positively associated with current mental health status (all measures), and this remained highly significant in multivariate models, with little evidence of associations diminishing over time. Variables such as the strength of the mystical experience, self-insights, and community/social variables were also positively associated with current mental health and PWG, while acute extreme fear and integration difficulties were negatively associated. Findings suggest that naturalistic ayahuasca use is associated with better current mental health status and enhanced psychological wellbeing for individuals with and without a history of mental illness, independent of community effects, with certain variables contributing positively or negatively to these effects.

Evidence suggests that individuals who use methamphetamine are at a significantly higher risk of developing psychosis compared to non-users. This study aims to examine the rate of psychosis among methamphetamine users and to investigate factors related to methamphetamine-associated psychosis (MAP). Two thousand ninety-eight (2,098) individuals with methamphetamine use were admitted to outpatient care. Available admissions data included clinical interviews, the Addiction Profile Index (API), and API-clinical forms. MAP was identified in 267 (12.7%) participants. Our data analysis found significant sociodemographic, clinical, and personality differences between MAP and non-MAP cohorts on admission. Multivariate regression analysis revealed that older age (OR = 1.049), younger age of substance use onset (OR = 0.960), more frequent MA use (OR = 1.622), being single (OR = 1.974), lower education (OR = 0.46), increased number of withdrawal symptoms (OR = 1.100), higher lack of anger control scores (OR = 1.422), higher lack of assertiveness scores (OR = 1.396), and higher anxiety scores (OR = 1.715) were significantly associated with MAP. Although factors identified in this study represent state (on admission) rather than stable characterological traits, these results may nonetheless help us better characterize contextual factors associated with MAP in an outpatient population.

The use of ketamine and ketamine-assisted psychotherapy (KAP) for treatment of depression has grown dramatically, though much of these data are short term. The clinical profile of maintenance treatment remains poorly characterized. We assessed maintenance KAP for efficacy, tolerability, and reasons for dropout. This observational study retrospectively analyzed electronic health records from an addiction psychiatry practice offering intramuscular ketamine with contemporaneous psychotherapy for the treatment of depression. All patients receiving treatment between January 2016 and September 2022 were included, yielding 1,114 sessions from 70 patients. The response was quantified via the clinical global impression-severity scale. Side effects and reasons for dropout were extracted from charts. Comorbidities include an anxiety disorder (79%) or substance use disorder (49%). The induction yielded 82% response, maintained above 80% after six months (sessions q21 days, 1.13 mg/kg mean dose). Many (38%) remained in treatment for at least one year. Nausea management accounted for nearly all as-needed medication use. Antihypertensives were seldom utilized. Chronic side effects were notable for one case of ketamine use disorder, resulting in residential treatment. Dropouts cited logistical reasons half the time and side effects only 9.7% of the time. KAP yielded robust improvements in mood, anxiety, and substance use. Maintenance sessions effectively extended benefit and were largely well tolerated.

Presently, 24 states have legalized adult use (recreational) cannabis, each following medical-only access. Although states that pass adult use laws report substantial declines in the number of registered medical patients, these laws expand the market, potentially enhancing patient benefits. However, research on federal adult use cannabis legislation in Canada suggests that adult use laws negatively impact medical patients. The purpose of this mixed-methods study was to examine medical cannabis patients' perceptions of the impact of adult use cannabis laws in the US. We conducted an online survey with forced choice and open-ended questions in a convenience sample of 505 medical cannabis patients. Quantitative analysis indicated that adult use laws decreased stress and legal concerns, and that patient perceptions of cannabis product quality and availability were higher, but prices were also higher. Qualitative analysis largely aligned with quantitative findings, however data were somewhat divergent on price and product availability (with some patients reporting lower prices and accessibility issues). Mixed-methods analysis revealed that legalization also reduced patients' experience of social stigma. Addressing the patient concerns revealed by these data may help to restore or maintain patient access to affordable, medically relevant cannabis products as additional states merge medical cannabis programs into adult use paradigms.

Buprenorphine is an effective treatment for opioid use disorder but can be slow when using a standard low-dose titration protocol to avoid precipitated withdrawal. This presents a substantial practical barrier in clinical practice. Recent low-dose induction strategies have attempted to simplify and shorten the process required for successful induction, including our own transdermal buprenorphine method, which achieves induction to sublingual buprenorphine/naloxone after 48 h. Here, we present two inpatients with active unregulated fentanyl use that were successfully initiated on buprenorphine extended-release with a novel 24-h transdermal buprenorphine protocol without precipitating withdrawal. This protocol may represent a substantial improvement in the practical feasibility of initiating buprenorphine for patients and providers, although further study is required to confirm efficacy and tolerability.

Psilocybin-containing mushrooms, commonly known as magic mushrooms, drastically affect mental processing, cognitive functioning, and the mood state. In the present study, we investigated the effect of the Psilocybe cubensis extract on spatial memory and the brain-derived neurotrophic factor (BDNF) in rats exposed to chronic unpredictable mild stress (CUMS). The duration of CUMS was 4 weeks. Spatial learning and memory were measured using the Morris water maze apparatus. The Psilocybe cubensis extract was intraperitoneally injected (20 mg/kg) in different time periods: 5 min before training, 24 h before training, 48 h before training, 5 min after training, and 5 min before the probe test. Results showed that CUMS impaired spatial learning and memory, and decreased BDNF in the hippocampus. Psilocybe cubensis (24 and 48 h before training) restored spatial learning, while (48 h before training) restored spatial memory impairment in CUMS rats. Psilocybe cubensis (24 and 48 h before training) increased BDNF in CUMS rats. Psilocybe cubensis administrations (expect 48 h before training) impaired spatial learning and memory and decreased BDNF levels in controls. In conclusion, we suggested that Psilocybe cubensis may be beneficial for the improvement of memory deficits induced by CUMS, while the time of injection seems to be an important factor in its final effect.

Alcohol misuse is common in persons on opioid agonist maintenance treatment (OAMT). We tested the efficacy of screening and brief intervention (SBI) for harmful/hazardous alcohol use in buprenorphine/naloxone (BNX)-assisted OAMT. It was a double-blind, parallel-group, randomized trial, where 150 participants with alcohol misuse (Alcohol Use Disorder Identification Test - AUDIT 8-19) on BNX were allocated equally to receive either a single session SBI or screening and brief advice (control). Participants were followed up at three months. The primary outcome was the change in AUDIT; other outcomes were risk transition, change in the frequency of heavy drinking, days of abstinence from alcohol, Gamma-glutamyl transferase (GGT) levels, non-prescription opioid use, and adherence to BNX. Follow-up data was gathered from 138 participants. SBI participants had a higher reduction in AUDIT scores at the follow-up (F = 129. 173, df = 1, p < .001, η_p² =.469). A higher proportion of participants transitioned to a low-risk category in the SBI group. The SBI group showed a higher reduction in heavy drinking and days of alcohol abstinence. Although the proportion of persons with normal serum GGT increased in both groups, the difference was not significant at the follow-up. The SBI group performed better in non-prescription opioid use and BNX adherence.

Esketamine, the isolated S-enantiomer of ketamine, has been a recent breakthrough as a non-monoaminergic treatment for treatment-resistant depression (TRD). This case report explores a rare adverse event in a 41-year-old female with TRD, who, despite experiencing significant depressive improvement with esketamine, encountered a severe dissociative episode accompanied by hallucinogenic-like phenomena. While esketamine's efficacy in TRD is well-documented, this pronounced dissociation should be taken into consideration by researchers and clinicians before prescribing. As esketamine continues to aid TRD treatment, comprehension of its safety profile becomes essential for informed decision-making, ensuring optimized patient care in the vast development of antidepressant therapies.

Many methadone maintenance treatment (MMT) participants experienced a tapering phase. The benefit of tapering is based on a balance between meeting the desire to reduce methadone dose and reduction in relapse. We aimed to develop and validate a nomogram to assess relapse risk after dose tapering. We developed and internally validated a nomogram for risk assessment before dose tapering in 432 participants with dose tapering in the non-Guangzhou region of Guangdong, China, and externally validated it in 117 participants with dose tapering in Guangzhou. Cox regression analysis showed that the taper start week (HR = 0.14, [0.08-0.22]) was an independent risk predictor of the relapse risk after tapering. The C-index of the nomogram was 0.76 (95%CI: 0.73-0.79) in the training cohort, 0.76 (95%CI: 0.72-0.80) in the testing cohort, and 0.84 (95%CI: 0.80-0.88) in the validation cohort. Decision curve analysis showed that the nomogram had better discriminative ability than other predictors. The nomogram was developed to assess the risk of relapse for MMT participants who volunteer a tapering phase and may help participants better make decisions about whether and how to reduce the dose to minimize the harm of relapse.

Psychedelic use has been increasingly accepted socially and legally. However, there is a gap in understanding how religion can influence the relationship between psychedelics and mental health. This study aims to explore this relationship by examining the impact of lifetime classic psychedelic use (LCPU), religious attendance, and religious salience on monthly psychological distress, using the K6 scale. The data for this project is sourced from the National Survey of Drug Use and Health (NSDUH) from 2008 to 2019, with a sample size of 458,372. The analysis utilizes several Ordinary Least Square regression models conducted in Stata 17. The results indicate that both religion and psychedelic use are associated with lower levels of psychological distress. While increased religious salience is linked to reduced distress, this effect is weakened by psychedelic use, as higher salience is associated with higher levels of distress among individuals who have used psychedelics. However, a three-way interaction analysis reveals that individuals with high religious salience and attendance experience the lowest levels of distress.