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Prescribing buprenorphine for opioid use disorder in primary care: A survey of French general practitioners in the Sentinelles network 处方丁丙诺啡阿片类药物使用障碍在初级保健:在哨兵网络法国全科医生的调查
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-12-01 DOI: 10.1016/j.jsat.2022.108891
Barbara Lépine , Marion Debin , Lise Dassieu , Laetitia Gimenez , Aurore Palmaro , Camille Ponté , Morgane Swital , Maryse Lapeyre-Mestre , Thierry Blanchon , Julie Dupouy

Introduction

Although opioid substitution coverage in France is high and patient care with buprenorphine is mainly managed by general practitioners (GPs), buprenorphine sales have been decreasing since 2011, suggesting that French GPs are prescribing less buprenorphine. Yet this possible change in GP practices has not yet been investigated. This study aimed to examine primary care GPs' opinions about buprenorphine and habits related to prescribing buprenorphine.

Methods

The study team conducted a cross-sectional survey from March 2021 to July 2021 among a sample of GPs in the Sentinelles network, a French epidemiologic surveillance system based on primary care practitioners. The study collected information about substance use disorder (SUD) training, opinions on buprenorphine, and habits related to buprenorphine prescription were collected (initiation and renewal within the past two years).

Findings

Among the 237 participants (34 % response rate), 15.2 % reported having had specific training for SUD management. A majority reported a very positive (16 %) or positive (63.7 %) opinion of buprenorphine. Most participants agreed (61.2 %) or strongly agreed (31.2 %) that buprenorphine was efficacious in the treatment of illicit opioid use disorder. Of the 206 GPs who reported having treated patients with opioid use disorder in the past two years, 47 (22.8 %) had initiated a buprenorphine prescription, whereas 177 (85.9 %) had renewed a buprenorphine prescription. Previous SUD training was associated with initiating buprenorphine (OR 4.66; 95 % CI [2.15–10.08]), while female gender was associated with not initiating buprenorphine prescribing (OR 0.46; 95 % CI [0.22–0.98]).

Conclusion

A sample of French GPs who work in primary care has a positive view of buprenorphine, but the absence of SUD training among this population may be a barrier to their prescribing buprenorphine.

虽然法国的阿片类药物替代覆盖率很高,丁丙诺啡的患者护理主要由全科医生(gp)管理,但自2011年以来,丁丙诺啡的销售一直在下降,这表明法国全科医生开的丁丙诺啡较少。然而,全科医生实践中这种可能的变化尚未得到调查。本研究旨在探讨基层医师对丁丙诺啡的看法及开具丁丙诺啡的相关习惯。方法研究小组于2021年3月至2021年7月对哨兵网络(基于初级保健从业人员的法国流行病学监测系统)中的全科医生样本进行了横断面调查。本研究收集药物使用障碍(SUD)培训信息、丁丙诺啡意见、丁丙诺啡处方相关习惯(两年内开始和更新)。在237名参与者中(34%的回复率),15.2%的人报告接受过SUD管理的专门培训。大多数人对丁丙诺啡持非常肯定(16%)或肯定(63.7%)的看法。大多数参与者同意(61.2%)或强烈同意(31.2%)丁丙诺啡对治疗非法阿片类药物使用障碍有效。在过去两年中报告治疗过阿片类药物使用障碍患者的206名全科医生中,47名(22.8%)开始使用丁丙诺啡处方,177名(85.9%)重新使用丁丙诺啡处方。既往SUD培训与开始使用丁丙诺啡相关(OR 4.66;95% CI[2.15-10.08]),而女性与未开始丁丙诺啡处方相关(OR 0.46;95% ci[0.22-0.98])。结论法国基层医生对丁丙诺啡持积极态度,但缺乏SUD培训可能是其开具丁丙诺啡处方的障碍。
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引用次数: 1
OUD MEETS: A novel program to increase initiation of medications for opioid use disorder and improve outcomes for hospitalized patients being discharged to skilled nursing facilities OUD MEETS:一项新计划,增加阿片类药物使用障碍的起始治疗,改善出院到熟练护理机构的住院患者的预后
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-12-01 DOI: 10.1016/j.jsat.2022.108895
Theresa E. Tassey , Geoffrey E. Ott , Anika A.H. Alvanzo , Jessica M. Peirce , Denis Antoine , Megan E. Buresh

Introduction

Rates of hospitalizations from medical complications of opioid use disorder (OUD) are rising and many of these patients require post–acute care at skilled nursing facilities (SNFs). However, access to medication for OUD (MOUD) at SNFs remains low and patients with OUD have high rates of patient-directed discharge (PDD) and hospital readmissions.

Methods

Opioid Use Disorder Medical Patient Engagement, Enrollment in treatment and Transitional Supports (OUD MEETS) program was a clinical pilot designed to increase initiation of buprenorphine and methadone for hospitalized patients with OUD requiring post–acute care. The program comprises a hospital partnership with two SNFs and two opioid treatment programs (OTPs) to improve recovery supports and access to MOUD for patients discharged to SNF.

Results

Between August 2019 and August 2020, study staff approached 49 hospitalized patients with OUD for participation in OUD MEETS. Twenty-eight of 30 eligible patients enrolled in the program and initiated buprenorphine or methadone. Twenty-seven (96 %) enrolled patients successfully completed hospital treatment. Twenty-three (85 %) patients successfully completed medical treatment at SNF. Thirteen (46 %) enrolled patients had confirmed linkage to OUD treatment post-SNF. One patient left the hospital (4 %) and four patients left SNF (15 %) via PDD.

Conclusion

OUD MEETS demonstrates feasibility of hospital, SNF, and OTP partnership to integrate MOUD treatment into SNFs, with high rates of completion of medical treatment and low rates of PDD. Future research should find sustainable ways to improve access to MOUD at post–acute care facilities, including through regulatory and policy changes.

阿片类药物使用障碍(OUD)的医疗并发症住院率正在上升,其中许多患者需要在熟练护理机构(snf)进行急性后护理。然而,在snf获得OUD (mod)药物的机会仍然很低,OUD患者的患者自行出院(PDD)和再入院率很高。方法类药物使用障碍医疗患者参与、治疗登记和过渡性支持(OUD MEETS)项目是一项临床试点项目,旨在增加需要急性后护理的OUD住院患者开始使用丁丙诺啡和美沙酮。该方案包括一项医院与两个SNF和两个阿片类药物治疗方案的伙伴关系,以改善对SNF出院患者的康复支持和获得mod的机会。在2019年8月至2020年8月期间,研究人员接触了49名OUD住院患者,要求他们参加OUD MEETS。30名符合条件的患者中有28人参加了该项目,并开始服用丁丙诺啡或美沙酮。27例(96%)入组患者成功完成住院治疗。23名(85%)患者成功地在SNF完成了治疗。13例(46%)入组患者确认与snf后OUD治疗相关。1名患者(4%)通过PDD离开医院,4名患者(15%)通过PDD离开SNF。结论oud MEETS证明了医院、SNF和OTP合作将mod治疗纳入SNF的可行性,其医疗完成率高,PDD发生率低。未来的研究应该找到可持续的方法来改善急性后护理机构对mod的获取,包括通过监管和政策变化。
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引用次数: 0
Patterns and contexts of polysubstance use among young and older adults who are involved in the criminal legal system and use opioids: A mixed methods study 参与刑事法律系统并使用阿片类药物的年轻人和老年人多物质使用的模式和背景:一项混合方法研究。
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-12-01 DOI: 10.1016/j.jsat.2022.108864
Corianna E. Sichel , Daniel Winetsky , Stephanie Campos , Megan A. O'Grady , Susan Tross , Jane Kim , Alwyn Cohall , Renee Cohall , Katherine S. Elkington

Introduction

Opioid prevention and treatment programs tailored to young adults involved in the criminal legal system are rare. We examined profiles of polysubstance use among younger and older adults involved in the criminal legal system who use opioids, and explored their experiences and motivations related to substance use. Information gleaned can inform the adaptation of existing programs and the development of novel approaches for young adults in the criminal legal system.

Methods

Using a sequential mixed methods design we 1) quantitatively identified typologies of polysubstance users among adults aged 18–24 (n = 92) and those age 25 and over (n = 27) involved in the criminal legal system who use opioids, using latent class analysis and 2) qualitatively explored differences in personal motivations, cultural influences, and psychosocial contexts of substance use by class.

Results

Our quantitative results supported a three-class typology: the majority of participants were in Class I (73 %, n = 87) and reported using primarily alcohol and marijuana. Participants in Classes II (15 %, n = 18) and III (12 %, n = 14) endorsed distinct and complicated polysubstance use profiles. Further, participants in Classes I and III were significantly younger than those in Class II. Qualitative analysis allowed us to understand associations between patterns of use, motivations, and contexts among young and older adults, comparing across classes.

Conclusions

Our results highlight the importance of attending to the needs of subpopulations based on age and use patterns to adapt and develop targeted treatment and prevention programs for high-risk adults involved in the criminal legal system.

简介:为参与刑事法律系统的年轻人量身定制的阿片类药物预防和治疗计划很少。我们调查了刑事法律系统中使用阿片类药物的年轻人和老年人的多物质使用情况,并探讨了他们与药物使用相关的经历和动机。收集到的信息可以为调整现有方案和为刑事法律系统中的年轻人制定新方法提供信息。方法:使用顺序混合方法设计,我们1)使用潜在类别分析,定量确定了刑事法律系统中18-24岁(n=92)和25岁及以上(n=27)使用阿片类药物的成年人中多物质使用者的类型,以及按阶级划分的物质使用的心理社会背景。结果:我们的定量结果支持三类类型:大多数参与者属于I类(73%,n=87),并报告主要使用酒精和大麻。第二类(15%,n=18)和第三类(12%,n=14)的参与者认可不同且复杂的多物质使用情况。此外,第一班和第三班的参与者明显比第二班的参与者年轻。定性分析使我们能够了解年轻人和老年人的使用模式、动机和环境之间的关联,并在不同类别之间进行比较。结论:我们的研究结果强调了根据年龄和使用模式满足亚人群需求的重要性,以适应和制定针对刑事法律系统中高危成年人的有针对性的治疗和预防计划。
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引用次数: 2
Disease and decision 疾病和决策。
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-11-01 DOI: 10.1016/j.jsat.2022.108874
Kirsten E. Smith

At age 16, I injected morphine for the first time, and then started injecting heroin. By most standards, I was highly functioning, although I eventually became addicted. I was and remain socioeconomically privileged, but my relationship to heroin resulted in behaviors and consequences that I never could have conceived of, and which I sometimes strain to remember occurred. My life now is stable and conventional. Some aspects of my past addiction are unerasable, but the most salient of those are the social and legal consequences of having a criminal record—not any hallmarks of a chronic brain disease or disorder. I do not consider myself “in recovery.” Rather, I am recovered, by standards both my own and derived from clinical nosology. I have been in sustained remission for over a decade. Yet feelings are not facts, as is often said. I still use alcohol, and occasionally (though not recently) I have used other drugs, so there remains the possibility that my brain is indeed “diseased” and I am not objectively recovered, my self-assessment notwithstanding. My aim in writing about my lived experience of drug use, addiction, and recovery is to highlight the heterogeneity of people's experiences and the insight that personal narratives can provide. Debates about the brain disease model of addiction are often confined to academia, with the real-world, unintended consequences of the “disease” label seldom considered. Stigmatization of people with addiction comes from moralizing about drug use but may also originate from well-intended labels. I posit that we should not need labels to care about addicted people and make scientifically informed treatment accessible. Addicted people deserve help because they either need or want it, regardless of labels that presume to describe the etiology or likely trajectory of their problems. I conclude that some labels, even those needed for clinical classification of human behavior, may be pernicious. Clinicians and researchers have an obligation to reflect more deeply on the implications of the disease conceptualization of complex human behaviors such as addiction.

16岁时,我第一次注射吗啡,然后开始注射海洛因。按照大多数标准,我的机能很好,尽管我最终上瘾了。我过去和现在都享有社会经济特权,但我与海洛因的关系导致了我从未想过的行为和后果,有时我会竭力回忆。我现在的生活是稳定的和传统的。我过去成瘾的某些方面是无法消除的,但其中最突出的是有犯罪记录的社会和法律后果,而不是慢性脑疾病或障碍的任何特征。我并不认为自己“正在康复”。相反,我已经康复了,无论是按照我自己的标准还是根据临床疾病学的标准。十多年来,我一直处于持续缓解状态。然而,正如人们常说的那样,感情并不是事实。我仍然饮酒,偶尔(尽管不是最近)我也使用过其他药物,所以尽管我进行了自我评估,但我的大脑仍有可能确实“生病”,而且我还没有客观地康复。我写吸毒、成瘾和康复的生活经历的目的是强调人们经历的异质性以及个人叙事所能提供的洞察力。关于成瘾的大脑疾病模型的争论通常局限于学术界,很少考虑“疾病”标签在现实世界中的意外后果。对吸毒者的污名化来自于对吸毒的道德说教,但也可能源于善意的标签。我认为,我们不应该需要标签来关心上瘾的人,并让科学知情的治疗变得容易。上瘾的人应该得到帮助,因为他们要么需要帮助,要么想要帮助,不管标签上是用来描述他们问题的病因还是可能的发展轨迹的。我的结论是,一些标签,甚至是人类行为临床分类所需的标签,可能是有害的。临床医生和研究人员有义务更深入地反思成瘾等复杂人类行为对疾病概念化的影响。
{"title":"Disease and decision","authors":"Kirsten E. Smith","doi":"10.1016/j.jsat.2022.108874","DOIUrl":"10.1016/j.jsat.2022.108874","url":null,"abstract":"<div><p><span><span>At age 16, I injected morphine for the first time, and then started injecting heroin. By most standards, I was highly functioning, although I eventually became addicted. I was and remain socioeconomically privileged, but my relationship to heroin resulted in behaviors and consequences that I never could have conceived of, and which I sometimes strain to remember occurred. My life now is stable and conventional. Some aspects of my past addiction are unerasable, but the most salient of those are the social and legal consequences of having a criminal record—not any hallmarks of a </span>chronic brain disease or disorder. I do not consider myself “in recovery.” Rather, I am recovered, by standards both my own and derived from clinical </span>nosology<span>. I have been in sustained remission for over a decade. Yet feelings are not facts, as is often said. I still use alcohol, and occasionally (though not recently) I have used other drugs<span><span>, so there remains the possibility that my brain is indeed “diseased” and I am not objectively recovered, my self-assessment notwithstanding. My aim in writing about my lived experience of drug use, addiction, and recovery is to highlight the heterogeneity of people's experiences and the insight that personal narratives can provide. Debates about the brain disease model of addiction are often confined to academia, with the real-world, unintended consequences of the “disease” label seldom considered. Stigmatization of people with addiction comes from moralizing about drug use but may also originate from well-intended labels. I posit that we should not need labels to care about addicted people and make scientifically informed </span>treatment<span> accessible. Addicted people deserve help because they either need or want it, regardless of labels that presume to describe the etiology or likely trajectory of their problems. I conclude that some labels, even those needed for clinical classification of human behavior, may be pernicious. Clinicians and researchers have an obligation to reflect more deeply on the implications of the disease conceptualization of complex human behaviors such as addiction.</span></span></span></p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"142 ","pages":"Article 108874"},"PeriodicalIF":3.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10321286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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: 7
Multimorbidity classes indicate differential patterns of health care engagement among people who inject drugs 多发病类别表明注射药物的人参与医疗保健的模式不同。
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-11-01 DOI: 10.1016/j.jsat.2022.108806
Omeid Heidari , Becky L. Genberg , Nancy Perrin , Derek T. Dangerfield II , Jason E. Farley , Gregory Kirk , Shruti H. Mehta

Background

Aging people who inject drugs (PWID) have complex health needs. Health care management could be complicated by persistent substance use, multiple health challenges, and inconsistent access to care. However, we know little about the relationship between chronic multimorbidity and health care engagement in this population. The purpose of this study is to characterize patterns and correlates of chronic disease multimorbidity among PWID.

Methods

We conducted a latent class analysis (LCA) using data from the AIDS Linked to the IntraVenous Experience (ALIVE) Study, a community-based observational cohort, to determine classes of multimorbid chronic diseases. We then conducted regressions to determine factors associated with class membership and the impact of each multimorbid class on health events and utilization.

Results

Of 1387 individuals included, the majority were male (67%) and Black (81%), with a mean age of 53 years. We identified four classes of multimorbidity: Low Multimorbidity (54%), and Low Multimorbidity Including Psychiatric Comorbidity (26%), Multimorbidity (12%), and Multimorbidity Including Psychiatric Comorbidity (7%). Female sex, baseline age, and receipt of disability were factors significantly associated with membership in all three classes compared to the Low Multimorbidity class. Additionally, PWID in these three classes were significantly more likely to utilize emergency room and outpatient health care. Membership in both classes with psychiatric comorbidity was associated with significantly higher adjusted odds of receiving medication for opioid use disorder.

Discussion

Holistic health care systems can best address the needs of aging PWID with integrated care that provides harm reduction, substance use and mental health treatment together, and wrap around services.

背景:注射毒品的老年人有复杂的健康需求。持续使用药物、多重健康挑战和不一致的医疗服务可能会使医疗管理变得复杂。然而,我们对这一人群中慢性多发病与医疗保健参与之间的关系知之甚少。本研究的目的是描述PWID中慢性病多发病的模式和相关性。方法:我们使用来自艾滋病与静脉内体验相关研究(ALIVE)的数据进行了潜在类别分析(LCA),该研究是一个基于社区的观察队列,以确定多发病慢性病的类别。然后,我们进行了回归,以确定与班级成员资格相关的因素,以及每个多目标班级对健康事件和利用率的影响。结果:在纳入的1387人中,大多数是男性(67%)和黑人(81%),平均年龄为53岁。我们确定了四类多发病:低多发病(54%)、低多发病包括精神病合并症(26%)、多发病(12%)和多发病包括精神病学合并症(7%)。与低多发病率类别相比,女性、基线年龄和残疾是与所有三个类别的成员资格显著相关的因素。此外,这三个类别的PWID更有可能使用急诊室和门诊医疗服务。这两个类别中有精神共病的成员与接受阿片类药物使用障碍药物治疗的调整后几率显著较高相关。讨论:整体医疗保健系统可以通过提供减少伤害、药物使用和心理健康治疗以及综合服务的综合护理,最好地满足老年残疾人的需求。
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引用次数: 5
Use of long-acting injectable buprenorphine in the correctional setting 在惩教环境中使用长效注射丁丙诺啡。
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-11-01 DOI: 10.1016/j.jsat.2022.108851
Rosemarie A. Martin , Justin Berk , Josiah D. Rich , Augustine Kang , John Fritsche , Jennifer G. Clarke

Background

As overdoses due to opioids rise, medications for opioid use disorder (MOUD) continue to be underemployed, resulting in limited access to potentially life-saving treatment. Substance use disorders are prevalent in individuals who are incarcerated, and these individuals are at increased risk for death postrelease due to overdose. Few jails and prisons offer MOUD and most limit access. Extended-release buprenorphine (XR-BUP), a novel monthly injectable MOUD formulation, could be uniquely poised to address treatment access in correctional settings.

Methods

This study linked a retrospective cohort design of statewide datasets to evaluate the real-world use of XR-BUP. The study included individuals (N = 54) who received XR-BUP while incarcerated from January 2019 through February 2022. The study was conducted at the Rhode Island Department of Corrections, with the nation's first comprehensive statewide correctional MOUD program.

Results

Fifty-four individuals received a combined total of 162 injections during the study period. The study found no evidence of tampering with the injection site, indicating no attempts by participants to remove, hoard, or divert the medication. Sixty-one percent reported at least one adverse effect after injections were received, with an average of 2.8 side effects. Sixty-one percent of those released on XR-BUP engaged in MOUD after release, 30 % continued with XR-BUP.

Conclusions

XR-BUP is feasible and acceptable in correctional settings. XR-BUP addresses administrative concerns of diversion that obstruct lifesaving MOUD and offers another safe and effective treatment option. Further studies and trials should continue to assess this novel medication's ability to treat opioid addiction in the correctional setting and upon release to the community.

背景:随着阿片类药物过量使用的增加,治疗阿片类使用障碍(MOUD)的药物继续使用不足,导致获得潜在救命治疗的机会有限。药物使用障碍在被监禁的人中普遍存在,这些人因服药过量而在释放后死亡的风险增加。很少有监狱和监狱提供MOUD,大多数监狱限制出入。缓释丁丙诺啡(XR-BUP)是一种新型的每月注射MOUD制剂,可以独特地解决惩教环境中的治疗问题。方法:本研究将全州数据集的回顾性队列设计联系起来,以评估XR-BUP在现实世界中的使用情况。该研究包括在2019年1月至2022年2月被监禁期间接受XR-BUP的个人(N=54)。这项研究是在罗德岛州惩教部进行的,这是美国第一个全面的全州惩教MOUD项目。结果:54名患者在研究期间总共接受了162次注射。该研究没有发现篡改注射部位的证据,表明参与者没有试图移除、囤积或转移药物。61%的患者在接受注射后报告至少有一次不良反应,平均有2.8次副作用。使用XR-BUP释放的人中,61%在释放后参与了MOOD,30%继续使用XR-BUP.结论:XR-BUP在惩教环境中是可行和可接受的。XR-BUP解决了阻碍救生MOOD的分流管理问题,并提供了另一种安全有效的治疗选择。应继续进行进一步的研究和试验,以评估这种新型药物在惩教环境中和释放到社区后治疗阿片类药物成瘾的能力。
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引用次数: 3
Kindness, connection, and science 善良、联系和科学
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-11-01 DOI: 10.1016/j.jsat.2022.108888
Kimberly C. Kirby
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引用次数: 0
Opioid relapse and MOUD outcomes following civil commitment for opioid use 民事承诺阿片类药物使用后阿片类药物复发和mod结果
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-11-01 DOI: 10.1016/j.jsat.2022.108873
Jumi Hayaki , Haley Cinq-Mars , Paul P. Christopher , Bradley J. Anderson , Michael D. Stein

Introduction

Opioid use disorder (OUD) continues to present a major public health problem in the United States. Civil commitment for substance use is one mandatory form of treatment for severe opioid use that has become increasingly available in recent years, but empirical data on this approach are lacking. This study examines clinical outcomes of civil commitment in a sample of adults with severe opioid use.

Methods

Participants were 121 persons with opioid use who were interviewed at the point of entry into civil commitment, then followed for 12 weeks after their release.

Results

Prior to civil commitment, this sample exhibited serious substance use characteristics (including high rates of illicit opioid use, other substance use, and injection drug use), as well as mental health problems (diagnoses of depression and anxiety disorders). During follow-up, approximately 41 % of the sample reported at least one illicit opioid use day. More than 64 % of the sample reported at least one day of medication for opioid use disorder (MOUD) receipt, and participants were significantly less likely to use illicit opioids on days that they received MOUDs. No participants died during the follow-up period.

Conclusions

In this sample of persons with severe opioid use, clinical outcomes of civil commitment included illicit opioid relapse as well as varying levels of MOUD uptake. Civil commitment may be a viable method for short-term prevention of overdose for a subset of this vulnerable patient population.

阿片类药物使用障碍(OUD)在美国仍然是一个主要的公共卫生问题。药物使用民事承诺是近年来日益普及的严重阿片类药物使用的一种强制性治疗形式,但缺乏关于这种方法的经验数据。本研究考察了严重阿片类药物使用成人样本中民事承诺的临床结果。研究对象是121名阿片类药物使用者,他们在民事承诺进入时接受了采访,然后在他们释放后进行了12周的随访。结果在民事承诺之前,该样本表现出严重的物质使用特征(包括非法阿片类药物使用,其他物质使用和注射药物使用的高比例),以及精神健康问题(诊断为抑郁症和焦虑症)。在随访期间,约41%的样本报告至少有一天非法使用阿片类药物。超过64%的样本报告了至少一天的阿片类药物使用障碍(mod)收据,参与者在接受mod的日子里使用非法阿片类药物的可能性显着降低。在随访期间没有参与者死亡。结论:在严重阿片类药物使用人群中,民事承诺的临床结果包括非法阿片类药物复发以及不同程度的mod摄取。民事承诺可能是短期预防这一弱势患者群体过量的可行方法。
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引用次数: 1
Influences of poly-victimization on adolescents' pre-treatment cognitive motivations and post-treatment outcomes 多重受害对青少年治疗前认知动机和治疗后结果的影响
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-11-01 DOI: 10.1016/j.jsat.2022.108856
Nina C. Christie , Graham DiGuiseppi , Sheila Pakdaman , Daniel S. Lee , Duyen Pham , Shaddy K. Saba , Jordan P. Davis

Introduction

Substance use treatment outcomes are challenging to predict: myriad potentially relevant factors influence outcomes, including age, sex, motivations, and history of victimization.

Methods

The current study seeks to assess these factors in adolescents through an evaluation of the relationship between distinct victimization profiles, sex, and cognitive factors related to substance use treatment outcomes—specifically motivation, self-efficacy, and reasons for quitting—and the relationship between these factors and posttreatment outcomes. We report sex differences in the prevalence of specific types of victimization; females are more likely than males to report poly-victimization alongside higher levels of traumagenic characteristics such as fearing for your life, chronic abuse, abuse by a trusted individual, or negative reactions to disclosure.

Results

Adolescents who endorsed high levels of poly-victimization and high traumagenic characteristics reported a) higher motivation for treatment, b) more reasons for quitting substance use, c) lower self-efficacy, and d) fewer adjusted days abstinent posttreatment relative to their peers. We report several sex differences: emergent poly-victimization profiles are different for males and females, class membership has a differential proportion, and, last, associations between class membership and pre-treatment cognitive motivations and posttreatment outcomes vary by sex.

Conclusion

Clinicians working with adolescents who report poly-victimization should aim to leverage their motivation and reasons for quitting, as these factors are traditionally associated with positive outcomes. Last, interventions aimed at fostering self-efficacy may also be particularly important to improve long-term outcomes, specifically among adolescents with a history of poly-victimization.

药物使用治疗结果难以预测:无数潜在的相关因素影响结果,包括年龄、性别、动机和受害史。方法目前的研究试图通过评估不同的受害概况、性别和与药物使用治疗结果相关的认知因素之间的关系来评估青少年的这些因素,特别是动机、自我效能和戒烟的原因,以及这些因素与治疗后结果之间的关系。我们报告了特定类型的受害发生率的性别差异;女性比男性更有可能报告多重受害以及更高水平的创伤特征,如担心自己的生命,长期虐待,被信任的人虐待,或对披露的负面反应。结果:与同龄人相比,具有高水平多重受害和高创伤性特征的青少年报告了a)更高的治疗动机,b)更多的放弃物质使用的原因,c)更低的自我效能感,d)更少的治疗后调整戒断天数。我们报告了几个性别差异:男性和女性的紧急多重受害概况不同,班级成员的比例不同,最后,班级成员与治疗前认知动机和治疗后结果之间的关联因性别而异。结论:临床医生与报告多次受害的青少年一起工作,应该致力于利用他们戒烟的动机和原因,因为这些因素通常与积极的结果相关。最后,旨在培养自我效能感的干预措施对于改善长期结果也可能特别重要,特别是在有多次受害史的青少年中。
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引用次数: 0
C2: editorial board C2:编委会
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-11-01 DOI: 10.1016/S0740-5472(22)00165-9
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引用次数: 0
期刊
Journal of Substance Abuse Treatment
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