Substance Abuse Treatment, Prevention, and Policy最新文献

Introduction: Global demand for the treatment of cannabis use disorder has increased significantly, prompting a need to understand effective strategies for addressing concurrent cannabis and tobacco use. This study focuses on clinicians' experiences and perceptions in delivering tobacco cessation services to people who use cannabis.

Methods: Fifteen participants (12 females, 3 males) participated in three homogenous focus groups, including two groups with extensive experience in providing tobacco cessation among the substance use population in Catalonia, Spain, and one group of clinicians without such experience. Thematic analysis was conducted to identify key patterns and insights in their discourse, focusing on shared themes and divergences across groups.

Results: Five main themes and 17 subthemes emerged: Individual characteristics, Clinician characteristics, Models of intervention, Organizational healthcare models, and Health policies. Clinicians stressed the importance of intervention models and the active role of professionals in addressing tobacco use within routine care, as tobacco cessation could mitigate social and chronic stigma among people who use cannabis, especially those engaged in polydrug use.

Discussion and conclusions: Recommendations included integrating tobacco cessation into all services, reducing healthcare service fragmentation, improving resource accessibility, enhancing clinical documentation, and advocating for stronger population-level tobacco control policies.

Trial registration: The ACT-ATAC project has been successfully registered at Clinicaltrials.gov [NCT04841655].

Background: Legitimate androgen use, such as testosterone replacement therapy, requires a legal prescription. Off-label use for reasons like wellness and aesthetics continues to grow. Recent regulatory changes in Australia aim to curb non-prescribed androgen use, potentially intensifying stigma, however seeking prescriptions through legal channels persists. This study aimed to explore community pharmacists' knowledge, attitudes, and practices regarding individuals who use androgens.

Methods: We conducted semi-structured interviews with 15 community pharmacists, to explore knowledge and experiences related to the dispensing of androgens. The data analysis followed an iterative process, developing a codebook for thematic analysis and aligning findings with relevant literature.

Results: Pharmacists face challenges when meeting the needs of individuals using androgens. They often made judgments based on appearance, leading to stigmatisation and potential refusal of prescription supply. However, this is tempered by the complex environment that pharmacists work in with respect to professional and legal requirements. Limited knowledge about androgens and varying exposure to people who use androgens were evident, prompting a unanimous desire for tailored training, especially in communication skills and interaction strategies.

Conclusions: Facilitating androgen use within regulated healthcare settings, under professional medical supervision, is crucial to mitigating health risks. Varied pharmacist knowledge underscores the urgent need for targeted training, emphasising education initiatives to address structural stigma and inform healthcare policies globally.

Objective: Given the changes in trends of cannabis use (e.g., product types), this study examined latent classes of young adult use and associations with use-related outcomes.

Methods: We analyzed 2023 survey data among 4,031 US young adults (M_age=26.29, 59.4% female, 19.0% Hispanic, 13.5% Black, 13.6% Asian). Among those reporting past-month use (48.8%), latent class analysis (LCA) indicators included: days used (1-5; 6-20; 21-30), use/day (1; 2-4; ≥5), and type usually used (herb/flower; edibles; oils/vape; concentrates/other). Multivariable regressions examined class in relation to problematic use, quitting-related factors, and mental health, controlling for sociodemographics and state non-medical cannabis laws.

Results: LCA identified 4 classes of cannabis use frequency and types used: 'infrequent-herb/edibles' (41.4%), 'frequent-herb' (16.8%), 'moderate-herb' (28.0%), and 'moderate-oil/other' (13.8%). In multivariable analyses (referent group: 'moderate-herb' class), 'frequent-herb' reported less problematic use (B=-0.18, 95%CI=-0.30, -0.07), while 'moderate-oil/other' reported greater (B = 0.39, 95%CI = 0.27, 0.51). 'Infrequent-herb/edibles' had lower odds of driving post-use of cannabis (aOR = 0.28, 95%CI = 0.22, 0.37) and cannabis/alcohol (aOR = 0.52, 95%CI = 0.35, 0.76), whereas 'frequent-herb' (aOR = 1.52, 95%CI = 1.02, 2.28) and 'moderate-oil/other' (aOR = 3.98, 95%CI = 2.72, 5.82) reported greater odds of driving post-cannabis/alcohol use. 'Moderate-oil/other' reported higher quitting importance (B = 0.59, 95%CI = 0.17, 1.01), while 'frequent-herb' reported lower (B=-0.33, 95%CI=-0.99, -0.18). 'Infrequent-herb/edibles' reported higher quitting confidence (B = 0.56, 95%CI = 0.20, 0.92), whereas 'frequent-herb' (B=-1.01, 95%CI=-1.45, -0.57) and 'moderate-oil/other' (B=-1.27, 95%CI=-1.74, -0.81) reported lower. 'Infrequent-herb/edibles' reported fewer mental health symptoms (B=-0.55, 95%CI=-0.93, -0.17), while 'moderate-oil/other' reported more (B = 1.03, 95%CI = 0.53, 1.52).

Conclusions: Preventing frequent and moderate use of cannabis, particularly of oils/concentrates, is crucial given the potential negative implications for problematic use, quitting, and mental health.

Background: The widely implemented prevention program in Brazil, PROERD (a translated version of the DARE-kiR program), showed no evidence of effect in preventing drug use in a recent trial. The lack of cultural adaptation and instructors' deviations from the curriculum were identified as potential reasons for its ineffectiveness. This study aims to identify points of inadequacy of the PROERD program for the Brazilian culture, suggesting strategies for revising the curriculum to improve implementation.

Methods: We triangulated data obtained from three different groups of study participants: semi-structured interviews with the law enforcement officer who implemented the program, focus groups with students who participated in the program, and questionnaires completed by external experts in the prevention field who evaluated the program's manuals. Data was analyzed using thematic analysis based on the Ecological Validity Model theory, which encompasses three main axes: methodology, content, and language to identify the main points for cultural adaptation.

Results: Regarding the program's methodology, there is an excess of activities with little interactivity involving literacy skills that do not match Brazilian students' cognitive development and require equipment unavailable in Brazilian public schools. Regarding content, activities were considered appropriate for evidence-based prevention; however, there were some contradictions related to the drug content. The language presented in the program's manuals was considered inappropriate for the culture of Brazilian youth (vocabulary, examples, and images).

Conclusions: In conclusion, this study strongly recommends revising the PROERD curriculum Caindo na Real, ensuring it will align with the international prevention standards and Brazilian Culture.

Background: Section 1262 Consolidated Appropriations Act of 2023 eliminates the federal DATA waiver registration requirement to prescribe buprenorphine for opioid use disorder (OUD), along with patient limits, perhaps as a way to increase provider capacity to prescribe buprenorphine. Understanding the factors that influence provider capacity, patient access, and whether community need for MAT is met could inform how to capitalize on DATA waiver eliminations in the United States.

Methods: This observational study utilized required reporting from two cohorts of the Rural Communities Opioid Response Program (RCORP). Consortia (N = 80) provided data on OUD/SUD-related services, service area information, consortium membership, and grant progress, including barriers to and facilitators of achievements. These data were combined with National Survey of Drug Use and Health (NSDUH) and U.S. Census Bureau's 2016-2020 American Community Survey (ACS) 5-Year Estimates Data to examine MAT capacity, access, and service area need.

Results: A 79% increase in potential buprenorphine prescribers from 2019 to 2022 resulted in 1,060 rural providers with the ability to prescribe buprenorphine. The number of individuals who received MAT increased by 42% over the same three years, with over 20,000 individuals receiving MAT by the end of the funding period. While both capacity and access did increase, an additional 11,454 individuals could have potentially received buprenorphine if all waivered providers prescribed to a conservative patient limit of thirty patients. 70% of consortia provided MAT to at least 11.5% of their estimated service area need (national rate of MAT provision among individuals 18 years and older with an OUD), indicating unused MAT capacity was not related to lack of service area need. Provider (e.g., concerns of clinical complexity), patient (e.g., mistrust of the healthcare system), pharmacy (e.g., cost concerns), and pharmacist (e.g., stigma) barriers impacted MAT provision and availability.

Conclusion: MAT treatment capacity is a necessary but not exclusive requirement for increasing access to MAT. Addressing the multi-faceted barriers to prescribing MAT, particularly buprenorphine, will be critical to ensure the Consolidated Appropriations Act of 2023 does in fact result in a larger workforce that actually prescribes buprenorphine and a pharmacy system that stocks these medications.

Background: There is an increased demand for quality treatment and rehabilitation services for people who use drugs (PWUDs) in the Philippines. In response, the Philippines Government's Department of Health (DOH) has established a new residential treatment model, Intensive Treatment and Rehabilitation Program for Residential Treatment and Rehabilitation Centers (INTREPRET), and integrated it into the existing treatment service platform of 21 DOH-owned Treatment and Rehabilitation Centers (TRCs). We conducted a qualitative study to identify the changes engendered by the implementation of this treatment model.

Methods: Data were collected through individual face-to-face interviews. We interviewed purposefully selected 29 patients and 35 facilitators of INTREPRET group sessions in seven TRCs. We transcribed the interview records and organized the narrative information into key themes using thematic analysis during the coding process.

Results: The changes perceived by the study participants included the attitude and behavior of patients, attitude and competency of facilitators, relationship between facilitators and patients, treatment planning and review process, efficient and standardized treatment services, and monitoring mechanisms of the patient's recovery process. Participants also noted challenges in INTREPRET implementation, including family participation in therapy sessions, lack of facilitators, securing a conducive place for conducting sessions, and reproducing workbooks.

Conclusions: The results imply that the introduction of INTREPRET could improve treatment service quality and the effectiveness of treatment, which were primarily associated with behavioral changes in patients, improved relationship between patients and facilitators, and INTREPRET's alignment with key international treatment standards. However, despite the positive changes perceived by the participants, certain challenges pertaining to family participation in therapy sessions and the lack of resources were identified. These criticisms must be addressed by DOH, along with an integration of INTREPRET into its policy and strategic framework, to ensure the effectiveness and sustainability of the new treatment model.

Background: With the broad recognition of increased U.S. opioid overdose (OOD) rates between 2020 and 2021, media, public health, and healthcare organizations have raised significant concerns over the emergence of a simultaneous COVID-19-opioid "twindemic." Research in this area has explored the possible relationships between negative externalities associated with the pandemic and/or COVID-19 public health interventions and increased risks for opioid use and overdose alongside diminished outcomes following OOD events.

Methods: The study offers a summative content analysis of Emergency Medical Service (EMS) responses to opioid overdose (OOD) events before and after the institution of COVID-19 restrictions. Specifically, the study investigates three Texas counties to evaluate changing OOD rates, patient demographics, and OOD event features. The analysis uses a previously validated machine learning tool to identify OOD events and conducted a summative content analysis of identified events.

Results: A total of 1170 OOD responses events were identified in the three-county dataset. This includes 874 in Travis County, 242 in El Paso County, and 54 in Williamson County. Each county experienced modest changes in EMS calls for OOD events between the pre-restriction and public health restriction time periods. Travis County's OOD event rate declined from 454 to 420. El Paso's increased from 103 to 139, and Williamson County's increased from 23 to 31. These changes were not significant as percentage of possible OOD events or based on by-month comparison. The notable differences between pre-restriction and public health restriction periods were significant decreases in documentation of patient race/ethnicity in Travis and Williamson Counties, significant decreases in housing insecurity and use alone in Travis County, and an increase in transport refusal after treatment in the field in Travis County.

Conclusions: Ultimately the results presented here problematize prevailing analyses about the so-called opioid-COVID-19 "twindemic." The data further support emerging trends about substantial geographic variation and show some ways that COVID-19 mitigation measures may have improved conditions for some populations, particularly in terms of housing security. Additionally, the results presented here indicate that further attention should be paid to the effects of first responder stress on documentation quality.