Substance Abuse Treatment, Prevention, and Policy最新文献

Introduction: Opioid agonist treatment (OAT) is an evidence-based intervention that reduces harms associated with heroin use. Ambulance services often serve as the first point of contact for people experiencing these acute harms. OAT access relies on dosing points and prescribers, which may be unevenly distributed geographically. This study examines the geographical distribution of heroin-related ambulance attendances across Victoria and assesses whether the presence, availability, and number of OAT service providers are associated with these harms.

Method: We merged 2023/24 Victorian heroin-related ambulance attendance from the National Ambulance Surveillance System with Victorian OAT service availability data from a statewide helpline. Three negative binomial regression models tested associations between OAT availability and heroin-related ambulance attendances at the local government area (LGA) level.

Results: Fourteen LGAs had higher than average, population-adjusted, heroin-related ambulance attendances. In Model 2, LGAs with more pharmacies offering OAT vacancies than those without had a 50% lower risk of heroin-related harms (IRR = 0.52, p = 0.014). Model 3 found that every 10% increase in the proportion of OAT doctors with current availability was associated with a 9% reduction in heroin harms (IRR = 0.91, p = 0.04). A similar trend was observed for pharmacists (IRR = 0.90, p = 0.08). All models found heroin harms to be approximately 70% lower in regional versus metropolitan LGAs.

Discussion and conclusions: The availability and geographic distribution of OAT providers-especially those with current capacity-are linked to reduced heroin-related ambulance attendances. Strategic placement and resourcing of OAT services could better align with population need and target hotspots. The metropolitan-regional differences warrant further investigation.

Background: This study is original in that it identified the care trajectories of patients with substance-related disorders (SRDs) over a 9-year period, and associated these trajectories with the patients' sociodemographic and clinical characteristics, quality of care received, and subsequent adverse outcomes (high emergency department use, repeated hospitalizations, suicidal behaviors, death).

Methods: Health administrative databases from Quebec, Canada (1996-2022) were used to investigate a cohort of 4075 patients with SRDs. Group-based multi-trajectory modeling was produced to identify profiles of care trajectories from April 1st 2012 to March 31st 2021. Multinomial regressions and survival analysis were conducted to associate profiles to patient characteristics, and adverse outcomes over the following year.

Results: Five profiles of care trajectories were identified: "Low overall but increasing care use" (Profile 1, 30% of sample); "High, increasing outpatient physical health care use" (Profile 2, 26%); "High, increasing outpatient SRD care use" (Profile 3, 15%); "High overall care use" (Profile 4, 14%); and "Increasing but moderate outpatient care use" (Profile 5, 15%). Profiles 3 and 4 used substantially more SRD outpatient care. Patients in Profiles 4 and 5 had more complex health conditions and engaged in more varied, sustained care over time, but subsequently experienced the worst adverse outcomes. In contrast, Profile 1 patients had better overall health conditions, followed by Profile 2 (older at SRD onset, less materially deprived) and 3 (more SRD issues), which both exhibited higher continuity of care than Profile 1. Profile 3 had the lowest rate of treatment dropouts.

Conclusion: Use of care and adverse outcomes were strongly linked to the patients' clinical conditions. Tailored interventions may be recommended for each profile: outreach and motivational interventions for Profile 1; applying the chronic care model for Profile 2; high continuity of physician and SRD care for Profile 3; assertive community treatment for Profile 4; and intensive case management for Profile 5. To better address the unmet needs of patients with SRDs, overall outpatient services may be substantially consolidated and improved. Acute care providers and general practitioners may also play a key role in identifying patients with SRDs and referring them to appropriate outpatient services.

Background: Comparative risk assessments (CRAs) provide important information for shaping alcohol control policies. Underlying their CRAs, the WHO uses a standardised methodology to assess and detail the levels of alcohol use for all countries and for various regions. This publication uses a case study approach on the member states of the Association of South East Asian Nations (ASEAN) to examine potential biases resulting from the methodology employed by the WHO in calculating exposure values for their CRAs.

Methods: Researchers from each of the 10 ASEAN member states identified large population surveys to improve upon the data collected by the WHO monitoring systems to estimate exposure between 2000 and 2022. From these surveys and aggregate data, key indicators were created for each Member State using WHO standardised methodology. Steps were defined to test for implausible values, particularly for the indicator for average level of alcohol consumption among drinkers. Sensitivity analyses were undertaken to identify possible causes of these values. Finally, we compared the results of the implausibility checks with two other regions, the European Union (EU) and the East African Community (EAC), based on data collected by the WHO.

Results: The indicator for average volume of alcohol consumption among drinkers showed implausibly high values for three ASEAN countries, Lao PDR, Thailand and Viet Nam. Further simulations based on assumptions regarding the prevalence of people with heavy or very heavy drinking levels further corroborated a likely bias. An examination of the constituents of the indicator revealed that the bias for Thailand could be due to responses received to survey questions regarding alcohol abstention, in which a high number of respondents claimed no consumption of alcohol over the past year. For the Lao PDR and Viet Nam, the same problem with survey respondent self-reports on alcohol consumption may exist, but we cannot exclude the possibility that answers to the survey question regarding unrecorded alcohol may also have contributed. Investigations of two further regions of the world also showed some implausible values, albeit to a smaller degree for the EU.

Conclusions: Plausibility testing of key monitoring indicators is important and yields important information for improving future monitoring efforts.

Engaging parents in substance and alcohol use prevention programs could play a key role in delaying the onset of use among adolescents. This research analyzes parents' perceptions of substance use prevention programs (tobacco, marijuana, vaping, and alcohol) implemented in private schools in the northern area of Santiago, Chile. Using a qualitative design, we conducted 15 semi-structured interviews with parents of adolescents attending four private schools. Our findings reveal limited parental knowledge and understanding of the risks of adolescent substance use and prevention or harm reduction strategies. Most interviewees approach prevention through monitoring and control of their children. They suggest incorporating government prevention strategies into private schools. Our findings underscore the importance of including families in the design of adolescent substance use prevention programs and highlight the urgent need to implement such strategies in private schools.