Pub Date : 2022-09-01DOI: 10.1016/j.jsat.2022.108787
Farwah Zaidi , Micah E. Johnson , Zahra Akbari , Enya B. Vroom , Skye C. Bristol
Introduction
Opioid misuse remains a chief public health concern in the United States, especially among justice-involved children and adolescents (JIC). Adverse childhood experiences (ACEs) are prevalent among JIC and are associated with a higher risk for opioid misuse. Justice involvement can be harsher for females, who tend to have higher ACE scores and experience more physiological and psychological risk factors than males. However, this study was the first to examine how sex may moderate the link between ACEs and opioid misuse. This study hypothesized that females will have higher odds of opioid misuse than males with equivalent ACEs.
Methods
The study team examined cross-sectional data on 79,960 JIC in the Florida Department of Juvenile Justice from 2007 to 2015. The study measured ACEs using 10 questions from the Positive Achievement Change Tool. Opioid misuse was reported by either self-disclosure, positive urinalysis, or other evidence of opioid consumption within the past 30 days. The team estimated logistic regression, marginal effects, and multiplicative interaction terms to test the hypotheses.
Results
JIC with an ACE score of 4 or higher were 2.59 times more likely to misuse opioids than JIC with lower ACE scores. Among JIC with 4 or more ACEs, females had significantly higher odds of opioid misuse than males.
Conclusion
Reducing exposure to ACEs may decrease the risk for opioid misuse, particularly among females. These findings corroborate trauma-informed and sex-responsive prevention programs in the juvenile justice system.
{"title":"Sex differences in the association of adverse childhood experiences on past 30-day opioid misuse among Florida justice-involved children","authors":"Farwah Zaidi , Micah E. Johnson , Zahra Akbari , Enya B. Vroom , Skye C. Bristol","doi":"10.1016/j.jsat.2022.108787","DOIUrl":"10.1016/j.jsat.2022.108787","url":null,"abstract":"<div><h3>Introduction</h3><p>Opioid misuse remains a chief public health<span> concern in the United States, especially among justice-involved children and adolescents (JIC). Adverse childhood experiences (ACEs) are prevalent among JIC and are associated with a higher risk for opioid misuse. Justice involvement can be harsher for females, who tend to have higher ACE scores and experience more physiological and psychological risk factors than males. However, this study was the first to examine how sex may moderate the link between ACEs and opioid misuse. This study hypothesized that females will have higher odds of opioid misuse than males with equivalent ACEs.</span></p></div><div><h3>Methods</h3><p>The study team examined cross-sectional data on 79,960 JIC in the Florida Department of Juvenile Justice from 2007 to 2015. The study measured ACEs using 10 questions from the Positive Achievement Change Tool. Opioid misuse was reported by either self-disclosure, positive urinalysis<span>, or other evidence of opioid consumption within the past 30 days. The team estimated logistic regression, marginal effects, and multiplicative interaction terms to test the hypotheses.</span></p></div><div><h3>Results</h3><p>JIC with an ACE score of 4 or higher were 2.59 times more likely to misuse opioids than JIC with lower ACE scores. Among JIC with 4 or more ACEs, females had significantly higher odds of opioid misuse than males.</p></div><div><h3>Conclusion</h3><p>Reducing exposure to ACEs may decrease the risk for opioid misuse, particularly among females. These findings corroborate trauma-informed and sex-responsive prevention programs in the juvenile justice system.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"140 ","pages":"Article 108787"},"PeriodicalIF":3.9,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45773474","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}
Pub Date : 2022-09-01DOI: 10.1016/j.jsat.2022.108828
Margaret M. Paschen-Wolff , Rachel Velasquez , Nicole Aydinoglo , Aimee N.C. Campbell
Introduction
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations experience opioid-related disparities compared to heterosexual and cisgender populations. LGBTQ-specific services are needed within opioid use disorder (OUD) treatment settings to minimize treatment barriers; research on the availability and accessibility of such services is limited. The purpose of the current study was to mimic the experience of an LGBTQ-identified individual searching for LGBTQ-specific OUD treatment services, using the SAMHSA National Directory of Drug and Alcohol Abuse Treatment Facilities - 2018 (Treatment Directory).
Methods
We contacted treatment facilities listed in the Treatment Directory as providing both medications for OUD (MOUD) and “special programs/groups” for LGBTQ clients within states with the top 20 highest national opioid overdose rates. We used descriptive statistics to characterize the outcome of calls; and the overall number of facilities offering LGBTQ-specific services, MOUD, and both LGBTQ-specific services and MOUD in each state by 100,000 state population and in relation to opioid overdose mortality rates (programs-per-death rate).
Results
Of the N = 570 treatment facilities contacted, n = 446 (78.25 %) were reached and answered our questions. Of n = 446 reached (all of which advertised both MOUD and LGBTQ-specific services), n = 366 (82.06 %) reported offering MOUD, n = 125 (28.03 %) reported offering special programs or groups for LGBTQ clients, and n = 107 (23.99 %) reported offering both MOUD and LGBTQ-specific services. Apart from Washington, DC, New Mexico, South Carolina, and West Virginia, which did not have any facilities that reported offering both MOUD and LGBTQ-specific services, Illinois had the lowest, and Michigan had the highest programs-per-death rate. Most of the northeastern states on our list (all but New Hampshire) clustered in the top two quarters of programs-per-death rates, while most of southeastern states (all but North Carolina) clustered in the bottom two quarters of programs-per-death rates.
Conclusions
The lack of LGBTQ-specific OUD treatment services may lead to missed opportunities for supporting LGBTQ people most in need of treatment; such treatment is especially crucial to prevent overdose mortality and improve the health of LGBTQ populations across the United States, particularly in the southeast.
{"title":"Simulating the experience of searching for LGBTQ-specific opioid use disorder treatment in the United States","authors":"Margaret M. Paschen-Wolff , Rachel Velasquez , Nicole Aydinoglo , Aimee N.C. Campbell","doi":"10.1016/j.jsat.2022.108828","DOIUrl":"10.1016/j.jsat.2022.108828","url":null,"abstract":"<div><h3>Introduction</h3><p>Lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations experience opioid-related disparities compared to heterosexual and cisgender populations. LGBTQ-specific services are needed within opioid use disorder (OUD) treatment settings to minimize treatment barriers; research on the availability and accessibility of such services is limited. The purpose of the current study was to mimic the experience of an LGBTQ-identified individual searching for LGBTQ-specific OUD treatment services, using the SAMHSA National Directory of Drug and Alcohol Abuse Treatment Facilities - 2018 (Treatment Directory).</p></div><div><h3>Methods</h3><p>We contacted treatment facilities listed in the Treatment Directory as providing both medications for OUD (MOUD) and “special programs/groups” for LGBTQ clients within states with the top 20 highest national opioid overdose rates. We used descriptive statistics to characterize the outcome of calls; and the overall number of facilities offering LGBTQ-specific services, MOUD, and both LGBTQ-specific services and MOUD in each state by 100,000 state population and in relation to opioid overdose mortality rates (programs-per-death rate).</p></div><div><h3>Results</h3><p>Of the N = 570 treatment facilities contacted, n = 446 (78.25 %) were reached and answered our questions. Of n = 446 reached (all of which advertised both MOUD and LGBTQ-specific services), n = 366 (82.06 %) reported offering MOUD, n = 125 (28.03 %) reported offering special programs or groups for LGBTQ clients, and n = 107 (23.99 %) reported offering both MOUD and LGBTQ-specific services. Apart from Washington, DC, New Mexico, South Carolina, and West Virginia, which did not have any facilities that reported offering both MOUD and LGBTQ-specific services, Illinois had the lowest, and Michigan had the highest programs-per-death rate. Most of the northeastern states on our list (all but New Hampshire) clustered in the top two quarters of programs-per-death rates, while most of southeastern states (all but North Carolina) clustered in the bottom two quarters of programs-per-death rates.</p></div><div><h3>Conclusions</h3><p>The lack of LGBTQ-specific OUD treatment services may lead to missed opportunities for supporting LGBTQ people most in need of treatment; such treatment is especially crucial to prevent overdose mortality and improve the health of LGBTQ populations across the United States, particularly in the southeast.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"140 ","pages":"Article 108828"},"PeriodicalIF":3.9,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0740547222001106/pdfft?md5=910e45f42440aecde8196a28e6154789&pid=1-s2.0-S0740547222001106-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40397313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.1016/j.jsat.2022.108799
Jacques Gaume , Nick Heather , Gillian Tober , Joseph Studer , André Bedendo , Duncan Raistrick , Jim McCambridge
Introduction
This study explored whether treatment-specific processes linking therapist behaviors, post-session client ratings, and 3-month proximal outcomes (i.e., end of treatment) can explain 12-month outcomes for two contrasting alcohol treatment conditions with equivalent overall outcomes.
Methods
This study is a secondary analysis of the UK Alcohol Treatment Trial (UKATT), a multi-center randomized controlled trial of treatment for alcohol problems comparing 3-session motivational enhancement therapy (MET) to 8-session social behaviour and network therapy (SBNT). Among 742 adult clients included in UKATT, 351 had one treatment session recorded and coded and were followed-up 3 and 12 months after baseline. The study team conducted serial mediation analyses to test whether the frequency and quality of MET and SBNT skills were related to 12-month alcohol outcomes (drinks per drinking day) through postsession client ratings of treatment progress (Processes of Change Questionnaire, PCQ), readiness to change (RTC) and social support for drinking after 3-months.
Results
Higher quality of MET skills was related to higher PCQ scores, which were in turn related to greater post-treatment RTC, and subsequently to better alcohol outcomes. Total indirect effect was consistently significant. In contrast, only PCQ was predictive of treatment outcome in the SBNT portion of the model.
Conclusions
This study provides evidence from a large pragmatic trial that the quality of MET skills positively influences alcohol outcomes in part through improvements in motivation during treatment and actively trying to change when treatment ends. Research should explore the ways in which SBNT secured outcomes that were equivalent to MET.
{"title":"Serial mediation analysis of treatment-specific processes in two contrasting alcohol treatments","authors":"Jacques Gaume , Nick Heather , Gillian Tober , Joseph Studer , André Bedendo , Duncan Raistrick , Jim McCambridge","doi":"10.1016/j.jsat.2022.108799","DOIUrl":"10.1016/j.jsat.2022.108799","url":null,"abstract":"<div><h3>Introduction</h3><p>This study explored whether treatment-specific processes linking therapist behaviors, post-session client ratings, and 3-month proximal outcomes (i.e., end of treatment) can explain 12-month outcomes for two contrasting alcohol treatment conditions with equivalent overall outcomes.</p></div><div><h3>Methods</h3><p>This study is a secondary analysis of the UK Alcohol Treatment Trial (UKATT), a multi-center randomized controlled trial of treatment for alcohol problems comparing 3-session motivational enhancement therapy (MET) to 8-session social behaviour and network therapy (SBNT). Among 742 adult clients included in UKATT, 351 had one treatment session recorded and coded and were followed-up 3 and 12 months after baseline. The study team conducted serial mediation analyses to test whether the frequency and quality of MET and SBNT skills were related to 12-month alcohol outcomes (drinks per drinking day) through postsession client ratings of treatment progress (Processes of Change Questionnaire, PCQ), readiness to change (RTC) and social support for drinking after 3-months.</p></div><div><h3>Results</h3><p>Higher quality of MET skills was related to higher PCQ scores, which were in turn related to greater post-treatment RTC, and subsequently to better alcohol outcomes. Total indirect effect was consistently significant. In contrast, only PCQ was predictive of treatment outcome in the SBNT portion of the model.</p></div><div><h3>Conclusions</h3><p>This study provides evidence from a large pragmatic trial that the quality of MET skills positively influences alcohol outcomes in part through improvements in motivation during treatment and actively trying to change when treatment ends. Research should explore the ways in which SBNT secured outcomes that were equivalent to MET.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"140 ","pages":"Article 108799"},"PeriodicalIF":3.9,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0740547222000812/pdfft?md5=0f1d0dbc71818beda96ac240eee20c46&pid=1-s2.0-S0740547222000812-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47590934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01DOI: 10.1016/j.jsat.2022.108765
Davida M. Schiff , Erin C. Work , Serra Muftu , Shayla Partridge , Kathryn Dee L. MacMillan , Jessica R. Gray , Bettina B. Hoeppner , John F. Kelly , Shelly F. Greenfield , Hendrée E. Jones , Timothy E. Wilens , Mishka Terplan , Judith Bernstein
Introduction
Medications to treat opioid use disorder (MOUD) during pregnancy and in the postpartum period remain underutilized. A need exists to enhance our understanding of modifiable factors, facilitators, and barriers to MOUD utilization and adherence in the perinatal period to improve maternal and child outcomes.
Methods
The study conducted semi-structured qualitative interviews with recently pregnant people with opioid use disorder (OUD) to explore experiences as a pregnant and/or parenting person with OUD, perceptions of enabling factors and barriers to treatment utilization, incentivizing factors for maintaining adherence, and acceptability of ongoing supports to sustain treatment adherence. The study team used constant comparative methods to analyze transcripts and develop the codebook. The team double coded the transcripts, with an overall kappa coefficient of 0.88.
Results
The study team interviewed twenty-six women on average 10.1 months after delivery. All women had some prior experience using MOUD. Four unique themes emerged as barriers to medication utilization and adherence in the perinatal period: 1) Lack of agency and autonomy surrounding medication decisions because pregnancy or parenting status affected treatment adherence; 2) Hesitancy to use MOUD to minimize risk of newborn withdrawal; 3) Concern about increased scrutiny and potential loss of custody due to mandated child protective services reporting for opioid-exposure at delivery in Massachusetts; and 4) Perception that treatment environments, particularly methadone clinics, did not provide gender-responsive or equitable care, and standardized, inflexible visit regulations were particularly difficult to comply with in the early postpartum period.
Conclusions
Women with OUD experienced a double bind when making perinatal treatment decisions, describing pressure to use MOUD with negative consequences after delivery. Key areas for possible intervention emerged from interviews. These areas include improving uptake of shared decision-making to increase patient autonomy and agency, particularly among those in the earliest stages of recovery during pregnancy; ongoing education around perinatal MOUD safety and efficacy; detangling MOUD and neonatal withdrawal signs from mandated child protective services reporting; and improving gender-responsive and equitable care in substance use disorder treatment programs, including incorporating the utilization of home visiting services for dosing assessments and administration in the early postpartum period.
{"title":"“You have to take this medication, but then you get punished for taking it:” lack of agency, choice, and fear of medications to treat opioid use disorder across the perinatal period","authors":"Davida M. Schiff , Erin C. Work , Serra Muftu , Shayla Partridge , Kathryn Dee L. MacMillan , Jessica R. Gray , Bettina B. Hoeppner , John F. Kelly , Shelly F. Greenfield , Hendrée E. Jones , Timothy E. Wilens , Mishka Terplan , Judith Bernstein","doi":"10.1016/j.jsat.2022.108765","DOIUrl":"10.1016/j.jsat.2022.108765","url":null,"abstract":"<div><h3>Introduction</h3><p><span>Medications to treat opioid use disorder (MOUD) during pregnancy and in the postpartum period remain underutilized. A need exists to enhance our understanding of modifiable factors, facilitators, and barriers to MOUD utilization and adherence in the </span>perinatal period to improve maternal and child outcomes.</p></div><div><h3>Methods</h3><p>The study conducted semi-structured qualitative interviews with recently pregnant people with opioid use disorder (OUD) to explore experiences as a pregnant and/or parenting person with OUD, perceptions of enabling factors and barriers to treatment<span> utilization, incentivizing factors for maintaining adherence, and acceptability of ongoing supports to sustain treatment adherence. The study team used constant comparative methods to analyze transcripts and develop the codebook. The team double coded the transcripts, with an overall kappa coefficient of 0.88.</span></p></div><div><h3>Results</h3><p>The study team interviewed twenty-six women on average 10.1 months after delivery. All women had some prior experience using MOUD. Four unique themes emerged as barriers to medication utilization and adherence in the perinatal period: 1) Lack of agency and autonomy surrounding medication decisions because pregnancy or parenting status affected treatment adherence; 2) Hesitancy to use MOUD to minimize risk of newborn<span> withdrawal; 3) Concern about increased scrutiny and potential loss of custody due to mandated child protective services reporting for opioid-exposure at delivery in Massachusetts; and 4) Perception that treatment environments, particularly methadone clinics, did not provide gender-responsive or equitable care, and standardized, inflexible visit regulations were particularly difficult to comply with in the early postpartum period.</span></p></div><div><h3>Conclusions</h3><p>Women with OUD experienced a double bind when making perinatal treatment decisions, describing pressure to use MOUD with negative consequences after delivery. Key areas for possible intervention emerged from interviews. These areas include improving uptake of shared decision-making to increase patient autonomy and agency, particularly among those in the earliest stages of recovery during pregnancy; ongoing education around perinatal MOUD safety and efficacy; detangling MOUD and neonatal withdrawal signs from mandated child protective services reporting; and improving gender-responsive and equitable care in substance use disorder treatment programs, including incorporating the utilization of home visiting services for dosing assessments and administration in the early postpartum period.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"139 ","pages":"Article 108765"},"PeriodicalIF":3.9,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9904115","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}
Pub Date : 2022-08-01DOI: 10.1016/j.jsat.2022.108780
Mir M. Ali, Robin Ghertner
Objectives
Buprenorphine utilization is an effective treatment for opioid use disorder (OUD). Given the recent increase in child maltreatment reports related to parental substance use, research should explore the correlation between buprenorphine treatment and child maltreatment–related outcomes.
Methods
The study team drew the data for the study from 2016 to 2018 administrative records on buprenorphine waivered providers and child welfare caseloads in 25 states. Multivariable linear regression models with county and year fixed effects were estimated to examine the correlation between changes in buprenorphine treatment capacity (defined as the total patient limit of all providers with a buprenorphine waiver in a county) and the total number of children reported for maltreatment in a county, and the case determinations of those children.
Results
An increase in buprenorphine treatment capacity did not have a significant impact on the total number of children reported to child welfare agencies for maltreatment but was associated with a reduction in the number of substantiated cases. Specifically, an increase in capacity of 1 patient per 100 residents was associated with a −0.9% decrease in the probability that a report will be substantiated following an investigation.
Conclusions
Increased buprenorphine treatment capacity was correlated with lower rates of substantiated cases of maltreatment, suggesting that OUD treatment is effective in reducing immediate risk to children. Increased treatment for OUD has a positive externality in the child welfare context. Increases in buprenorphine treatment are likely to provide parents not only with the needed treatment for their OUD but also act as a support mechanism to fulfill their parental roles.
{"title":"Is buprenorphine treatment availability associated with decreases in substantiated cases of child maltreatment?","authors":"Mir M. Ali, Robin Ghertner","doi":"10.1016/j.jsat.2022.108780","DOIUrl":"10.1016/j.jsat.2022.108780","url":null,"abstract":"<div><h3>Objectives</h3><p>Buprenorphine<span> utilization is an effective treatment for opioid use disorder (OUD). Given the recent increase in child maltreatment reports related to parental substance use, research should explore the correlation between buprenorphine treatment and child maltreatment–related outcomes.</span></p></div><div><h3>Methods</h3><p>The study team drew the data for the study from 2016 to 2018 administrative records on buprenorphine waivered providers and child welfare caseloads in 25 states. Multivariable linear regression models with county and year fixed effects were estimated to examine the correlation between changes in buprenorphine treatment capacity (defined as the total patient limit of all providers with a buprenorphine waiver in a county) and the total number of children reported for maltreatment in a county, and the case determinations of those children.</p></div><div><h3>Results</h3><p>An increase in buprenorphine treatment capacity did not have a significant impact on the total number of children reported to child welfare agencies for maltreatment but was associated with a reduction in the number of substantiated cases. Specifically, an increase in capacity of 1 patient per 100 residents was associated with a −0.9% decrease in the probability that a report will be substantiated following an investigation.</p></div><div><h3>Conclusions</h3><p>Increased buprenorphine treatment capacity was correlated with lower rates of substantiated cases of maltreatment, suggesting that OUD treatment is effective in reducing immediate risk to children. Increased treatment for OUD has a positive externality in the child welfare context. Increases in buprenorphine treatment are likely to provide parents not only with the needed treatment for their OUD but also act as a support mechanism to fulfill their parental roles.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"139 ","pages":"Article 108780"},"PeriodicalIF":3.9,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46979487","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}
Pub Date : 2022-08-01DOI: 10.1016/j.jsat.2022.108770
Arthur Robin Williams , Christine M. Mauro , Tianshu Feng , Amanda Wilson , Angelo Cruz , Mark Olfson , Stephen Crystal , Hillary Samples , Lisa Chiodo
Objective
Successful retention on buprenorphine improves outcomes for opioid use disorder (OUD); however, we know little about associations between use of non–prescribed buprenorphine (NPB) preceding treatment intake and clinical outcomes.
Methods
The study conducted observational retrospective analysis of abstracted electronic health record (EHR) data from a multi-state nationwide office-based opioid treatment program. The study observed a random sample of 1000 newly admitted patients with OUD for buprenorphine maintenance (2015–2018) for up to 12 months following intake. We measured use of NPB by mandatory intake drug testing and manual EHR coding. Outcomes included hazards of treatment discontinuation and rates of opioid use.
Results
Compared to patients testing negative for buprenorphine at intake, those testing positive (59.6%) had lower hazards of treatment discontinuation (HR = 0.52, 95% CI: 0.44, 0.60, p < 0.01). Results were little changed following adjustment for baseline opioid use and other patient characteristics (aHR: 0.60, 95% CI: 0.51, 0.70, p < 0.01). Risk of discontinuation did not significantly differ between patients by buprenorphine source: prescribed v. NPB (reference) at admission (HR = 1.15, 95% CI: 0.90, 1.46). Opioid use was lower in the buprenorphine positive group at admission (25.0% vs. 53.1%, p < 0.0001) and throughout early months of treatment but converged after 7 months for those remaining in care (17.1% vs. 16.5%, p = 0.89).
Conclusion
NPB preceding treatment intake was associated with decreased hazards of treatment discontinuation and lower opioid use. These findings suggest use of NPB may be a marker of treatment readiness and that buprenorphine testing at intake may have predictive value for clinical assessments regarding risk of early treatment discontinuation.
目的丁丙诺啡的成功保留可改善阿片类药物使用障碍(OUD)的预后;然而，我们对治疗前使用非处方丁丙诺啡(NPB)与临床结果之间的关系知之甚少。方法:本研究对来自多个州的全国性阿片类药物治疗项目的电子健康记录(EHR)数据进行了观察性回顾性分析。该研究随机抽样了1000名新入院的OUD患者，在服用丁丙诺啡后维持(2015-2018)长达12个月。我们通过强制摄入药物测试和手工电子病历编码来测量NPB的使用。结果包括治疗中断的危险和阿片类药物的使用率。结果与服用丁丙诺啡时检测阴性的患者相比，检测阳性的患者(59.6%)停药风险较低(HR = 0.52, 95% CI: 0.44, 0.60, p <0.01)。调整基线阿片类药物使用和其他患者特征后，结果变化不大(aHR: 0.60, 95% CI: 0.51, 0.70, p <0.01)。入院时丁丙诺啡来源不同的患者停药风险无显著差异:处方与NPB(参考)(HR = 1.15, 95% CI: 0.90, 1.46)。丁丙诺啡阳性组入院时阿片类药物使用较低(25.0%比53.1%，p <0.0001)，在治疗的最初几个月，但在7个月后，继续接受治疗的患者的死亡率趋于一致(17.1% vs. 16.5%， p = 0.89)。结论治疗前服用npb可降低停药风险和阿片类药物使用。这些发现表明，使用NPB可能是治疗准备就绪的标志，并且在摄入丁丙诺啡时检测丁丙诺啡可能对早期停药风险的临床评估具有预测价值。
{"title":"Non–prescribed buprenorphine preceding treatment intake and clinical outcomes for opioid use disorder","authors":"Arthur Robin Williams , Christine M. Mauro , Tianshu Feng , Amanda Wilson , Angelo Cruz , Mark Olfson , Stephen Crystal , Hillary Samples , Lisa Chiodo","doi":"10.1016/j.jsat.2022.108770","DOIUrl":"10.1016/j.jsat.2022.108770","url":null,"abstract":"<div><h3>Objective</h3><p>Successful retention on buprenorphine<span> improves outcomes for opioid use disorder (OUD); however, we know little about associations between use of non–prescribed buprenorphine (NPB) preceding treatment intake and clinical outcomes.</span></p></div><div><h3>Methods</h3><p>The study conducted observational retrospective analysis of abstracted electronic health record (EHR) data from a multi-state nationwide office-based opioid treatment program. The study observed a random sample of 1000 newly admitted patients with OUD for buprenorphine maintenance (2015–2018) for up to 12 months following intake. We measured use of NPB by mandatory intake drug testing and manual EHR coding. Outcomes included hazards of treatment discontinuation and rates of opioid use.</p></div><div><h3>Results</h3><p>Compared to patients testing negative for buprenorphine at intake, those testing positive (59.6%) had lower hazards of treatment discontinuation (HR = 0.52, 95% CI: 0.44, 0.60, <em>p</em><span> < 0.01). Results were little changed following adjustment for baseline opioid use and other patient characteristics (aHR: 0.60, 95% CI: 0.51, 0.70, p < 0.01). Risk of discontinuation did not significantly differ between patients by buprenorphine source: prescribed v. NPB (reference) at admission (HR = 1.15, 95% CI: 0.90, 1.46). Opioid use was lower in the buprenorphine positive group at admission (25.0% vs. 53.1%, </span><em>p</em> < 0.0001) and throughout early months of treatment but converged after 7 months for those remaining in care (17.1% vs. 16.5%, <em>p</em> = 0.89).</p></div><div><h3>Conclusion</h3><p>NPB preceding treatment intake was associated with decreased hazards of treatment discontinuation and lower opioid use. These findings suggest use of NPB may be a marker of treatment readiness and that buprenorphine testing at intake may have predictive value for clinical assessments regarding risk of early treatment discontinuation.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"139 ","pages":"Article 108770"},"PeriodicalIF":3.9,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9904114","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}
Pub Date : 2022-08-01DOI: 10.1016/j.jsat.2022.108786
Ariel Asper, Elishav Binenfeld, Harel Pshitizky, Daniel Feingold
Introduction
Cannabis is one of the most widely used addictive substances globally. Its use increases the risk for various physical and psychological problems and some cannabis users may develop cannabis dependence. Researchers have explored risk factors for transition to cannabis dependence. Military veterans, and in particular, combat veterans, have an elevated risk for cannabis dependence and several emotional disorders. To date, the field lacks knowledge regarding possible risk factors for the development of cannabis dependence among combat military veterans.
Method
The current study examined sociodemographic and clinical variables associated with cannabis dependence among combat military veterans using SPSS software.
Results
Results indicate that participants who screened positive for cannabis dependence had reported using a significantly higher dosage of cannabis (in grams) per week and scored significantly higher in the moral injury “other” subscale and in the moral injury “betrayal” subscale compared to those who did not screen positive for cannabis dependence. In addition, after controlling for confounding factors, depression, but not PTSD, was significantly associated with cannabis dependence (AOR = 1.98, CI = 1.05–3.72, p < .05. and AOR = 1.19, 95% CI = 0.56–2.54, p = n.s., respectively).
Conclusion
This study sheds light on the correlates of cannabis dependence among combat veterans that should be further studied in future research.
大麻是全球使用最广泛的成瘾物质之一。它的使用增加了各种身体和心理问题的风险，一些大麻使用者可能会产生大麻依赖。研究人员探索了过渡到大麻依赖的风险因素。退伍军人，特别是战斗退伍军人，对大麻依赖和一些情绪障碍的风险更高。迄今为止，该领域缺乏关于在战斗退伍军人中发展大麻依赖的可能风险因素的知识。方法采用SPSS统计分析软件对退伍军人大麻依赖相关的社会人口学和临床变量进行分析。结果表明，与大麻依赖筛查呈阳性的参与者相比，大麻依赖筛查呈阳性的参与者报告每周使用的大麻剂量(以克为单位)明显更高，在道德伤害“其他”亚量表和道德伤害“背叛”亚量表中得分明显更高。此外，在控制混杂因素后，抑郁症与大麻依赖显著相关，而PTSD与大麻依赖无关(AOR = 1.98, CI = 1.05-3.72, p <. 05。和AOR = 1.19, 95% CI -2.54 = 0.56, p = n。)。结论本研究揭示了战斗退伍军人大麻依赖的相关因素，值得进一步研究。
{"title":"Sociodemographic and clinical correlates of cannabis dependence among Israeli combat veterans","authors":"Ariel Asper, Elishav Binenfeld, Harel Pshitizky, Daniel Feingold","doi":"10.1016/j.jsat.2022.108786","DOIUrl":"10.1016/j.jsat.2022.108786","url":null,"abstract":"<div><h3>Introduction</h3><p><span>Cannabis is one of the most widely used addictive substances globally. Its use increases the risk for various physical and psychological problems and some cannabis users may develop </span>cannabis dependence. Researchers have explored risk factors for transition to cannabis dependence. Military veterans, and in particular, combat veterans, have an elevated risk for cannabis dependence and several emotional disorders. To date, the field lacks knowledge regarding possible risk factors for the development of cannabis dependence among combat military veterans.</p></div><div><h3>Method</h3><p>The current study examined sociodemographic and clinical variables associated with cannabis dependence among combat military veterans using SPSS software.</p></div><div><h3>Results</h3><p><span>Results indicate that participants who screened positive for cannabis dependence had reported using a significantly higher dosage of cannabis (in grams) per week and scored significantly higher in the moral injury “other” subscale and in the moral injury “betrayal” subscale compared to those who did not screen positive for cannabis dependence. In addition, after controlling for confounding factors, depression, but not PTSD, was significantly associated with cannabis dependence (AOR = 1.98, CI = 1.05–3.72, </span><em>p</em> < .05. and AOR = 1.19, 95% CI = 0.56–2.54, p = n.s., respectively).</p></div><div><h3>Conclusion</h3><p>This study sheds light on the correlates of cannabis dependence among combat veterans that should be further studied in future research.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"139 ","pages":"Article 108786"},"PeriodicalIF":3.9,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44218388","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}
Pub Date : 2022-08-01DOI: 10.1016/j.jsat.2022.108781
Catriona Matheson, Rebecca Foster, Joe Schofield, Tania Browne
Introduction
People experiencing homelessness often experience intersecting mental and physical health problems, alongside problem substance use and a range of overlapping challenges, including access to appropriate treatment. New long-acting opioid replacement therapies (ORT) offer potential benefits for this group. This study explored the views of people who are homeless and dependent on prescribed or illicit opiates/opioids on the range of ORT delivery options, including long-acting buprenorphine (LAB) depot injection, methadone liquid, and sublingual/wafer buprenorphine.
Methods
The research team conducted three focus groups (n = 9 participants) and individual interviews (n = 20) with people living in Scotland and Wales. We sought to explore participants' experiences and views on a range of ORT options, and to explore experiences and perceptions of the acceptability and utility of LAB for this group.
Results
Twenty-nine people participated (8 women, 21 men) and described experiences of poor mental health and interaction with the criminal justice system, including prison. All had experience of ORT and some had a preference for the “comfort” of methadone while others liked the clear headedness of buprenorphine. Participants saw LAB as a valuable addition to the treatment options. Potential benefits included freedom from the challenges associated with daily dispensing and the freedom to be able to attend to their priorities and regain control over their day-to-day lives. LAB naïve participants required reassurance regarding the duration of effect and wanted information and evidence from both their health care providers and their peers.
Conclusion
Participants generally recognized the potential of LAB. The research team identified crucial themes for those experiencing homelessness: emotions, trust, and time. A move to LAB represents a shift in the locus of control to the individual, which, for some is exciting, but for others is daunting. Providers should address this shift in control, and it must to be central to joint decision-making on whether someone is ready for LAB, the information they require to help them decide, and the support they will require during treatment.
{"title":"Long-acting depot buprenorphine in people who are homeless: Views and experiences","authors":"Catriona Matheson, Rebecca Foster, Joe Schofield, Tania Browne","doi":"10.1016/j.jsat.2022.108781","DOIUrl":"10.1016/j.jsat.2022.108781","url":null,"abstract":"<div><h3>Introduction</h3><p>People experiencing homelessness often experience intersecting mental and physical health problems, alongside problem substance use and a range of overlapping challenges, including access to appropriate treatment. New long-acting opioid replacement therapies (ORT) offer potential benefits for this group. This study explored the views of people who are homeless and dependent on prescribed or illicit opiates/opioids on the range of ORT delivery options, including long-acting buprenorphine (LAB) depot injection, methadone liquid, and sublingual/wafer buprenorphine.</p></div><div><h3>Methods</h3><p>The research team conducted three focus groups (<em>n</em> = 9 participants) and individual interviews (<em>n</em> = 20) with people living in Scotland and Wales. We sought to explore participants' experiences and views on a range of ORT options, and to explore experiences and perceptions of the acceptability and utility of LAB for this group.</p></div><div><h3>Results</h3><p>Twenty-nine people participated (8 women, 21 men) and described experiences of poor mental health and interaction with the criminal justice system, including prison. All had experience of ORT and some had a preference for the “comfort” of methadone while others liked the clear headedness of buprenorphine. Participants saw LAB as a valuable addition to the treatment options. Potential benefits included freedom from the challenges associated with daily dispensing and the freedom to be able to attend to their priorities and regain control over their day-to-day lives. LAB naïve participants required reassurance regarding the duration of effect and wanted information and evidence from both their health care providers and their peers.</p></div><div><h3>Conclusion</h3><p>Participants generally recognized the potential of LAB. The research team identified crucial themes for those experiencing homelessness: emotions, trust, and time. A move to LAB represents a shift in the locus of control to the individual, which, for some is exciting, but for others is daunting. Providers should address this shift in control, and it must to be central to joint decision-making on whether someone is ready for LAB, the information they require to help them decide, and the support they will require during treatment.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"139 ","pages":"Article 108781"},"PeriodicalIF":3.9,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0740547222000630/pdfft?md5=b66b2e2f70d9b99dc3bab535fd7263c3&pid=1-s2.0-S0740547222000630-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44067309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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