Substance Abuse and Rehabilitation最新文献

Individuals with Opioid Use Disorder (OUD) who use fentanyl are at high risk of mortality due to opioid-related overdose. While buprenorphine extended-release (BUP-XR) may reduce this risk, there is a need to optimize clinical practice with BUP-XR to overcome barriers to treatment initiation and retention in patients who use fentanyl. Through a narrative review of evidence from peer-reviewed publications and conference abstracts, this article provides an overview of current novel initiation and dosing strategies for BUP-XR in patient populations with confirmed or presumed use of fentanyl. Evidence in this area is rapidly emerging with multiple studies describing BUP-XR initiation prior to 7-day stabilization on transmucosal buprenorphine (TM-BUP). Results from a randomized controlled study indicate that initiating BUP-XR following a single TM-BUP dose is noninferior to standard initiation in terms of treatment retention at injection 2, with similar rates of precipitated withdrawal and adverse events, and this protocol is now included in the approved prescribing information in the USA. While additional "macro/high-dose" or "micro/low-dose" and "direct dose" induction approaches have also been reported, evidence for these is limited to small uncontrolled studies or case reports. Consistent with evidence from studies of TM-BUP, which suggests individuals who use fentanyl may require higher maintenance doses in order to be retained in treatment, administrative and observational data suggests that use of the 300-mg maintenance dose, shortened intervals between doses, and supplemental TM-BUP may be feasible approaches to increase buprenorphine exposure in patients with ongoing symptoms and improve retention. Evidence in this area is rapidly evolving, and many of these strategies are increasingly being adopted clinically and incorporated into clinical guidelines. Further research should incorporate increased sample sizes, broader and more consistent outcome measurement, and increased duration of follow-up to facilitate more robust evaluation of efficacy and safety as well as increase comparability between studies.

This study aimed to evaluate the use of prehospital medication-assisted treatment (MAT) administration by Emergency Medical Services for opioid use disorder (OUD) through a review of literature published between 2014-2024. A search of the NCBI repository using selected keywords returned N=28 results; articles meeting the inclusion criteria (n=13) were reviewed and analyzed. Heterogeneity among studies was assessed using the Chi-squared test and I² statistic. Studies were categorized into two primary domains: implementation and protocols or patient outcomes. Findings suggest that while MAT administration extends on-scene time, it significantly improves patient retention in OUD treatment. However, operational challenges, including geographical disparities in access and racial inequities in retention, limit widespread implementation. This review underscores the consistent safety of prehospital MAT administration, specifically by EMS personnel outside of an emergency department, yet highlights the need for addressing these barriers to optimize its effectiveness as a critical intervention in managing OUD in the prehospital setting.

Alcohol use is a primarily social behavior, and marriage is an important aspect of social relationships. This article reviews alcohol use and its impact on several facets of the marital relationship, including the impact of alcohol use on intimate partner violence (IPV), marital satisfaction, marital functioning, and divorce. There is considerable evidence of the role alcohol plays in IPV and recent research identifies moderators of the alcohol-IPV relationship. These include personality constructs, social pressure, marital satisfaction, and traits, such as hostility and impulsivity. Marital satisfaction and alcohol use demonstrate bidirectional causality, whereas marital satisfaction predicts alcohol use behaviors, and alcohol use also predicts marital satisfaction. Longitudinal studies provide evidence that divorce is temporally associated with alcohol use, including Alcohol Use Disorder. Finally, there are a number of causative factors that interplay in the dissolution of marriage; alcohol use is one of these factors. Excessive alcohol consumption is a common reason for divorce among many couples. Across all associations between alcohol use and IPV, marital satisfaction, marital functioning, and divorce, sex and gender consistently appear as a moderator in these relationships. Another consistent finding is in respect to concordant drinking, such that marital partners who have similar patterns of alcohol consumption fare better than those with discrepant patterns of consumption. Future research should focus on greater inclusion of same-sex, LGBTQQ+, and socio-culturally diverse couples. Additionally, future studies should use Actor-Partner Interdependence Modeling (APIM) to effectively examine non-independent partner data.

Background: The COVID-19 pandemic led to increased loneliness, emotional stress, and idleness due to job losses and school closures which can drive substance use among vulnerable populations like youths. Uganda has been identified as one of the countries with the highest alcohol consumption in Africa. Alcohol predisposes to a number of health concerns including mental health disorders, cardiovascular diseases among others. This study assessed the impact of the COVID-19 lockdown on alcohol consumption among youths in Kampala, Uganda.

Methods: A quantitative cross-sectional study among randomly selected youth aged 18-35 years living in the five divisions of Kampala. Participation was strictly after informed consent was obtained. 381 youths were interviewed, both students and non-students were included in the study. The AUDIT-C questionnaire was used to measure the frequency and quantity. Frequent was defined as six or more drinks a week.

Results: We enrolled 381 participants in the study with a mean age of 26±4.6 years. More than half (60%) of the participants were male. 71% lived with family during the lockdown. Of the 64% that were employed before the lockdown, 54% lost their jobs. At least 42.5% of the participants reported alcohol consumption during the lockdown. Males consumed twice as much alcohol as females. Generally, the level of alcohol consumption decreased during the COVID-19 pandemic as the percentage of participants consuming alcohol dropped from 47.5% to 42.8%. Despite the overall decrease in the number of participants consuming alcohol, there was an increase in the frequency and amount of alcohol consumed on occasion during the pandemic.

Conclusion: Fewer youths consumed alcohol during the COVID-19 lockdown in Kampala, Uganda. However, those who did significantly increased their drinking amount and frequency. Male youths, those living with friends, and those with poor self-perceived mental health were more likely to increase their alcohol intake. Further investigation into increased alcohol consumption among youths post-COVID is necessary to understand the extent and long-term health implications.

Background: Datura metel is reported to induce hallucinations and mental disorders.

Objective: This study investigates the neurotoxic effects of Datura metel stramonium hydroethanolic root extract on the hippocampus and cerebral cortex of adult rats using biochemical, histological and immunohistochemical techniques.

Methodology: Twenty five adult rats were assigned to 5 groups (n = 5 each). Group A - negative control, group B (lead positive control). Groups C, D, and E exposed to 150 mg/kg, 300 mg/kg and 600 mg/kg body weight of extracts for 14 days once daily, respectively. Histology, biochemistry and immunohistochemical techniques were used to study cell injury in the brain tissue.

Results: Biochemical alterations were observed in superoxide dismutase (SOD), Malondialdehyde (MDA), Glutathionine S-transferase (GST) and Catalase among the experimental groups. Catalase was statistically significant at P<0.05. Histology reveals neurons damage, depletion and vacuolation. NFP and NSE were over expressed in the experimental groups.

Discussion: Oral administration of Datura metel root extracts at high concentration alters the antioxidant enzymes activity and body weight. Extracts cause cortex and hippocampus neurotoxicity through heightened oxidative stress.

Conclusion: Datura metel root extract is a neurotoxic agent and causes depopulation of hippocampus and cerebral cortex neurons. The use of this plant should be highly regulated to reduce neuropathies associated with consumption.

Background: Many studies indicate that high and multiple doses of anabolic-androgenic steroids (AAS) for athletic enhancement can result in serious and irreversible adverse effects. A study that includes laboratory blood testing to evaluate the direct effects of AAS agents among users has not been previously undertaken. The purpose of this study was to investigate the adverse effects of the use of AAS by athletes and to determine whether AAS use leads to changes in certain blood parameters.

Methods: This is an observational study consisting of two stages. First, the participants completed an online questionnaire assessing sociodemographic characteristics, and knowledge and attitudes towards AAS. Second, volunteers underwent laboratory blood testing. Analysis was conducted using frequency distributions and percentages of responses across various variables.

Results: Thirty-one individuals completed the online questionnaire, 18 of whom continued to stage 2, where blood samples were taken to trace any changes in blood parameters. All the participants were male, with an age range of 24-45 years. The results showed that 94% of the participants used AAS for nontherapeutic purposes. Most participants reported that they take a combination of AAS (96%), as well as in combination with other supplements (74%). The most used combination was testosterone plus growth hormone (45%), and the most used supplements were liver protectors (84%). Seventy-four percent of the participants reported side effects, and 28% had received a medical diagnosis, such as hypertension, hyperlipidemia or an infertility. High levels of testosterone, prolactin, alanine transaminase (ALT), aspartate transferase (AST) and lipid profile, and low luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were observed.

Conclusion: The unsupervised use of AAS alone or in combination with other hormones and/or supplements may lead to adverse effects. Further studies with larger samples are needed to draw significant conclusions about the safety of using AAS.

Background: Opioid-based medications are powerful analgesics commonly prescribed for pain management, but they are also highly addictive. The over-prescription of opioids analgesics has triggered current opioid crisis, which now has expanded to heroin and illicit synthetic opioids like fentanyl and its analogues. The side effects of fentanyl abuse have been well recognized, yet the underlying molecular adaptations across brain regions upon fentanyl exposure remain elusive.

Methods: The transmission electron microscopy (TEM) and next-generation RNA-sequencing (RNA-seq) were used to investigate the ultrastructure synaptic alterations and transcriptional profiling changes of reward and sensory brain regions in mice after fentanyl exposure.

Results: The naloxone-precipitated acute withdrawal symptoms were observed in mice exposed to fentanyl. Results of TEM showed an increase in the number of synapses, widening of synaptic gaps, and thickening of postsynaptic density in the NAc of the fentanyl addiction mice, accompanied by obvious mitochondrial swelling. RNA-seq identified differentially expressed genes (DEGs) in prefrontal cortex of mice brains after fentanyl exposure, and the expression of some addiction-related genes such as Calm4, Cdh1, Drd1/2/3/4, F2rl2, Gabra6, Ht2cr, Oprk1 and Rxfp3 showed the most striking changes among experimental groups. KEGG enrichment analysis indicated that these DEGs were related to the development of addiction behavior, dopaminergic/GABAergic/serotonergic synapse, synapse assembly/synaptic plasticity/synaptic vesicle cycle, cAMP/MAPK signaling pathway, neuroactive ligand-receptor interactions. These transcriptomic changes may be correlated with the structural and behavioral changes observed in fentanyl-exposed mice.

Discussion: The findings of this study contribute to a better understanding of the molecular mechanism of addiction behavior, which is essential for the development of optimized therapy strategies for addicts.

Purpose: Telehealth use has grown tremendously since the onset of the COVID-19 pandemic. While the benefits of virtual care delivery are numerous, little is known about patient experiences in group treatment settings when members join both virtually and in person with the counselor (a hybrid model). We sought to fill this gap by comparing patient survey data across care delivery models.

Patients and methods: Adult patients with a substance use disorder enrolled at one of seven intensive outpatient (IOP) programs in rural Minnesota voluntarily completed a questionnaire assessing patient satisfaction, perceived therapeutic alliance, group cohesion, and insight gained from treatment. Starting 7/1/2021, groups were either all virtual, all in-person, or a hybrid model. The survey began on 1/1/2022. Analysis of covariance (ANCOVA) tested for differences among treatment groups. Separate models were used for each survey question, where the dependent variable was the survey response, the test of interest being treatment group-type, with covariates of length of stay and age. Model estimates and model-based standard deviations were used to calculate the Cohen's d effect size.

Results: Survey results from a total of 1037 individuals were included, one survey per respondent. Data was deidentified upon receipt of the survey, preventing specific demographic comparisons. For the hybrid groups, no significant differences were noted with survey responses relative to in-person, with negligible to small effect sizes seen. When comparing virtual to in-person, virtual was rated as significantly worse than in-person on 6 of the 8 questions; effect size estimates exceeded the small effect size cut-off, and the 95% CI exceeded the moderate cut-off.

Conclusion: Creating a group model where patients can attend both virtually and in-person together appears to improve perceived therapeutic alliance, group cohesion, and treatment insight, compared to virtual-only groups, which may have a negative effect relative to in-person.

Background: The opioid epidemic has severely impacted the US over the last 15 years. Buprenorphine is a partial opioid agonist indicated for the treatment of opioid use disorder (OUD) and is recognized as an effective treatment when taken as prescribed. However, adherence rates have been low in real-world settings. Blister-packaging has been shown to promote medication adherence across a variety of disease states, although it has never been studied in OUD.

Methods: An economic analysis was conducted to assess the impact of increased adherence of blister-packaged buprenorphine on health care resource utilization (HCRU) and health care costs for 10,000 patients initiating therapy for OUD. The model analyzed a commercially insured population within the US over a one-year time horizon. Medication adherence was defined in the model as proportion of days covered (PDC) of at least 80%. Literature-based references were used to inform both the impact of blister-packaging on the number of patients who became adherent as well as the impact of medication adherence on HCRU and health care costs. Model input uncertainty was assessed in one-way sensitivity analyses.

Results: With the implementation of blister-packaging buprenorphine, adherence rates increased from 37.1% of patients in the pre-intervention period to 45.3%, resulting in an additional 818 patients becoming adherent post-intervention. The increase in adherence led to a reduction of medical costs of $12,138,757 (-$1,214 per-patient (PP)). Specifically, inpatient costs decreased by $7,127,073 (-$713 PP) while outpatient costs decreased by $5,013,319 (-$501 PP). Pharmacy costs increased by $3,432,705 ($343 PP). Despite the increase in pharmacy costs, total health care costs saw a reduction of $8,559,684 (-$856 PP).

Conclusion: Blister-packaging buprenorphine for treatment of OUD has potential to improve medication adherence and health outcomes while reducing HCRU and health care costs. Future studies are necessary to assess the real-world application and impact of blister-packaging buprenorphine for OUD across various patient populations and health care settings.