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Could the link between drug addiction in adulthood and substance use in adolescence result from a blurring of the boundaries between incentive and hedonic processes? 成年期的毒瘾和青春期的药物使用之间的联系是否是由于激励和享乐过程之间的界限模糊造成的?
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2019-07-12 DOI: 10.2147/SAR.S202996
F. Kehinde, Opeoluwa Oduyeye, Raihan Mohammed
Abstract There is a broad consensus that the development of drug addiction in adulthood is closely linked to the onset of drug use in adolescence. However, the relationship between drug exposure during adolescence and subsequent vulnerability to addiction is yet to be fully understood. This review will first use evidence from adult studies on reward and addiction to give an up-to-date reference point of normal reward-circuitry and the maladaptive changes that later occur in addiction. This will then be compared with current evidence from adolescent studies on reward-circuitry. Similarities between the reward processes governing characteristic behavioral traits in adolescence and the reward profile in adult addiction could help to explain why the risk of later developing addiction is increased when substance use is initiated in adolescence. We argue that the age of onset is a major risk factor in the development of substance use disorder due to a blurring of the boundaries between incentive and hedonic processes, which occurs during adolescence. A deeper understanding of the processes that mediate this blurring could open new avenues for the prevention and treatment of adult drug addiction.
人们普遍认为,成年期药物成瘾的发展与青少年期药物使用的开始密切相关。然而,青少年时期的药物暴露与随后的成瘾脆弱性之间的关系尚不完全清楚。本综述将首先使用成人奖励和成瘾研究的证据,为正常奖励回路和后来在成瘾中发生的不适应变化提供最新的参考点。然后,这将与目前来自青少年奖励回路研究的证据进行比较。控制青少年行为特征的奖励过程与成人成瘾的奖励特征之间的相似性可以帮助解释为什么当青少年开始使用物质时,后来发展成成瘾的风险会增加。我们认为,发病年龄是物质使用障碍发展的一个主要风险因素,因为青春期发生的激励和享乐过程之间的界限模糊。更深入地了解调解这种模糊的过程可能为预防和治疗成人吸毒成瘾开辟新的途径。
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引用次数: 4
Current perspectives on the impact of Kratom use 桔井使用影响的当前观点
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2019-07-01 DOI: 10.2147/SAR.S164261
Charles A. Veltri, O. Grundmann
Abstract The leaves from the tree Mitragyna speciosa, commonly known as Kratom, in the coffee plant family (Rubiaceae) are commonly used in their native habitat of Southeast Asia as a stimulant to sustain energy during hard day labor and as an opioid-like analgesic and sedative. Traditional and modern uses overlap based on the effects of the leaf extract which has also gained popularity in the United States and Europe in the last two decades. Kratom has and is being used for the mitigation of opioid withdrawal symptoms and as a harm reduction agent with a minority of users subsequently developing a dependence on the extract. The respective demographic use patterns of Kratom differ between Southeast Asia and the Western world. While pure Kratom is primarily used by day laborers and misused in conjunction with cough medicine by youth in Southeast Asia, a majority of users in the United States is middle-aged, has at least middle income, private health insurance, and completed some college. Deaths attributed to the use of Kratom have been reported in Europe and the United States but not in Southeast Asia. Although Kratom was detected as the alkaloid mitragynine in the blood of the decedents, causality could not be established in almost all cases because of poly-drug exposures. It is notable that Kratom can cause herb–drug interactions, especially with other central nervous system -active substances. Given the mostly unregulated market for Kratom products in Western countries, consumers may be exposed to adulterated or contaminated products, especially if purchased through websites or the darknet. A number of countries have scheduled Kratom because of its stimulant- and opioid-like effects and the established interaction of the alkaloid mitragynine with opioid receptors.
摘要咖啡科植物Mitragyna speciosa的叶子,通常被称为桔梗,在东南亚的原生栖息地被广泛用作在艰苦的白天劳动中维持能量的兴奋剂,以及阿片类止痛药和镇静剂。基于叶提取物的作用,传统和现代用途重叠,过去二十年来,叶提取物在美国和欧洲也越来越受欢迎。Kratom已经并正在用于缓解阿片类药物戒断症状,并作为一种减少伤害的药物,少数使用者随后对该提取物产生依赖。Kratom的人口使用模式在东南亚和西方世界各不相同。虽然纯奎托姆主要由日工使用,东南亚的年轻人将其与咳嗽药一起滥用,但美国的大多数使用者都是中年人,至少有中等收入,有私人医疗保险,并完成了一些大学学业。欧洲和美国都有报告称使用奎托姆导致死亡,但东南亚没有。尽管在死者血液中检测到奎托姆是生物碱mitragynine,但由于接触了多种药物,几乎所有病例都无法确定因果关系。值得注意的是,桔梗可以引起草药和药物的相互作用,尤其是与其他中枢神经系统活性物质的相互作用。鉴于西方国家的Kratom产品市场大多不受监管,消费者可能会接触到掺假或受污染的产品,尤其是通过网站或暗网购买的产品。许多国家已经将奎托姆列为候选药物,因为它具有类似兴奋剂和阿片类药物的作用,并且生物碱米特拉甘碱与阿片受体之间存在既定的相互作用。
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引用次数: 88
Measuring recovery in opioid use disorder: clinical utility and psychometric properties of the Treatment Effectiveness Assessment. 测量阿片类药物使用障碍的恢复:治疗效果评估的临床效用和心理测量学特性。
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2019-06-05 eCollection Date: 2019-01-01 DOI: 10.2147/SAR.S198361
Walter Ling, Vijay R Nadipelli, Caitlyn T Solem, David Farabee, Naoko A Ronquest, Brian Perrochet, Susan M Learned, Chinmay G Deshpande, Christian Heidbreder

Purpose: The Treatment Effectiveness Assessment (TEA) is a patient-centered instrument for evaluating treatment progress and recovery from substance use disorders, including opioid use disorder (OUD). We assessed the TEA's reliability and validity and determined minimal clinically important differences (MIDs) in participants with moderate to severe OUD. Patients and methods: The TEA measures change in four single-item domains (substance use, health, lifestyle, community involvement) from treatment initiation across the duration of a treatment program. Self-reported responses range from 1 ("none or not much") to 10 ("much better") with items summed to a total score ranging from 4-40. We assessed floor and ceiling effects, internal consistency, test-retest reliability, known-groups validity (ANOVA stratified by current health status [36-Item Short Form Health Survey item 1]), convergent/divergent validity, and MIDs using data from a phase 3, open-label clinical trial of buprenorphine extended-release monthly injection for subcutaneous use (BUP-XR). Participants with OUD completed the TEA at screening and before monthly injections for up to 12 months. Results: Among 410 participants (mean age 38 years; 64% male), the mean baseline (pre-injection 1) TEA total score was 25.4 (SD 9.7), with <10% of participants at the measure floor and 10%-20% at the ceiling across domains. Internal consistency was high (Cronbach's α=0.90), with marginal test-retest reliability (intraclass correlation coefficient =0.69). Mean TEA total score consistently increased from baseline (n=410; mean 25.4 [SD 9.7]) to end of study (n=337; 35.0 [6.7]) and differentiated between current health status groups (P<0.001); it was weakly correlated with other measures of health-related quality of life/severity. MIDs ranged from 5-8 for the TEA total score across anchor- and distribution-based approaches. Conclusion: The TEA exhibited acceptable reliability and validity in a cohort of participants with moderate to severe OUD treated with BUP-XR. Given its brevity and psychometric properties, the TEA is a promising tool for use in clinical practice and research.

目的:治疗效果评估(TEA)是一种以患者为中心的评估药物使用障碍(包括阿片类药物使用障碍(OUD))治疗进展和恢复的工具。我们评估了TEA的可靠性和有效性,并确定了中度至重度OUD参与者的最小临床重要差异(MIDs)。患者和方法:TEA测量从治疗开始到整个治疗过程中四个单项领域(物质使用、健康、生活方式、社区参与)的变化。自我报告的回答范围从1(“没有或不多”)到10(“好多了”),各个项目的总分在4-40之间。我们评估了地板效应和上限效应、内部一致性、测试-重测信度、已知组效度(按当前健康状况分层的方差分析[36-Item Short Form health Survey item 1])、趋同/发散效度,以及使用丁丙诺啡每月皮下注射缓释(BUP-XR)的3期开放临床试验数据的mid。患有OUD的参与者在筛查时和每月注射前完成TEA长达12个月。结果:410名参与者(平均年龄38岁;平均基线(注射前1)TEA总分为25.4 (SD 9.7), p < 0.05。结论:TEA在BUP-XR治疗的中重度OUD患者队列中显示出可接受的信度和效度。由于其简洁和心理测量的特性,TEA在临床实践和研究中是一个很有前途的工具。
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引用次数: 2
The association between perceived stigma and substance use disorder treatment outcomes: a review. 感知耻辱与物质使用障碍治疗结果之间的关系:综述。
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2018-12-27 eCollection Date: 2019-01-01 DOI: 10.2147/SAR.S183252
Kathleen A Crapanzano, Rebecca Hammarlund, Bilal Ahmad, Natalie Hunsinger, Rumneet Kullar

Substance use disorders (SUDs) take a heavy toll on those who have them and on society more broadly. These disorders are often difficult to treat, and relapse is common. Perhaps, because of these factors, these disorders are highly stigmatized worldwide. The purpose of this study is to examine empirical work intended to determine the impact of perceived social stigma and self-stigma on the process of recovering from SUDs with the assistance of formal treatment services. Qualitative studies confirmed that stigma experiences are common among those with these disorders and that these experiences can negatively impact feelings and beliefs about treatment. One quantitative study provided good statistical support for a direct effect of stigma on outcomes, but this was contradicted by other longitudinal data. In general, quantitative articles suggested an indirect effect of stigma on treatment outcomes, via negative emotions and cognitive mechanisms such as feelings of self-efficacy. However, it was notable that there was little consistency in the literature as to definitions and measurement of the constructs of recovery, perceived social stigma, and self-stigma. Future work should focus on bringing clarity, and validated measures, to this problem in order to better determine the nature of these relationships.

物质使用障碍(SUDs)给患者和更广泛的社会造成了沉重的代价。这些疾病通常难以治疗,而且复发很常见。也许,由于这些因素,这些疾病在世界范围内被高度污名化。本研究的目的是检验实证工作,旨在确定感知社会耻辱和自我耻辱对在正式治疗服务的帮助下从sud中恢复的过程的影响。定性研究证实,耻辱经历在这些疾病患者中很常见,这些经历会对治疗的感受和信念产生负面影响。一项定量研究为病耻感对结果的直接影响提供了良好的统计支持,但这与其他纵向数据相矛盾。总体而言,定量文章表明,耻辱感通过负面情绪和认知机制(如自我效能感)间接影响治疗结果。然而,值得注意的是,关于康复、感知社会污名和自我污名的定义和测量,文献中几乎没有一致性。未来的工作应侧重于为这一问题带来清晰和有效的措施,以便更好地确定这些关系的性质。
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引用次数: 107
Adapting substance use brief interventions for adolescents: perspectives of adolescents living with adults in substance use disorder treatment. 适应青少年物质使用简短干预:青少年与成人生活在物质使用障碍治疗的观点。
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2018-12-05 eCollection Date: 2018-01-01 DOI: 10.2147/SAR.S177865
Howard Padwa, Erick G Guerrero, Veronica Serret, Melvin Rico, Lillian Gelberg

Background: Brief interventions (BIs) have shown potential to reduce both alcohol and drug use. Although BIs for adults have been studied extensively, little is known about how to adapt them to meet the needs and preferences of adolescents. This article examines adolescents' preferences to consider when adapting BIs for use with adolescents.

Methods: Eighteen adolescents (age 9-17 years) living in Los Angeles County with adults receiving substance use disorder treatment were interviewed and asked about their perspectives on how to adapt a BI originally developed for adults for use with adolescents. Questions focused on adolescents' preferences for who should deliver BIs, how BIs should be delivered, and what content they would want to be included in BIs. Interviews were recorded, transcribed, and coded using summative content analysis.

Results: Adolescents did not express any discernable opinions concerning who delivers BIs or what content they would want to be included, but they did share perspectives on how BIs should be delivered. Most adolescents did not endorse incorporating text messaging or social media into BIs. Instead they preferred having BIs delivered face-to-face or over the telephone. They reported that they did not want BIs to incorporate text messaging or social media due to concerns about trust, the quality of information they would receive, and challenges communicating in writing instead of speaking.

Conclusion: Although the study has limitations because of its small sample size, findings indicate that adolescents may not want text messaging or social media to be incorporated into BIs for substance use. These findings warrant further research and consideration, particularly as work to enhance BIs for adolescents continues.

背景:短期干预(BIs)已显示出减少酒精和药物使用的潜力。尽管对成人的BIs进行了广泛的研究,但对如何使其适应青少年的需求和偏好知之甚少。这篇文章探讨了青少年在使用BIs时要考虑的偏好。方法:对洛杉矶县18名青少年(9-17岁)和接受药物使用障碍治疗的成年人进行访谈,并询问他们对如何将最初为成年人开发的BI用于青少年的看法。问题集中在青少年对谁应该提供BIs、如何提供BIs以及他们希望在BIs中包含哪些内容的偏好上。使用总结性内容分析对访谈进行记录、转录和编码。结果:青少年没有表达任何关于谁提供BIs或他们希望包含什么内容的明显意见,但他们确实分享了应该如何提供BIs的观点。大多数青少年不赞成将短信或社交媒体纳入自己的生活。相反,他们更喜欢面对面或通过电话进行BIs。他们报告说,他们不希望BIs加入短信或社交媒体,因为他们担心信任,他们收到的信息的质量,以及用书面而不是口头沟通的挑战。结论:尽管该研究因样本量小而存在局限性,但研究结果表明,青少年可能不希望将短信或社交媒体纳入其物质使用的BIs中。这些发现值得进一步的研究和考虑,特别是在提高青少年BIs的工作继续进行的情况下。
{"title":"Adapting substance use brief interventions for adolescents: perspectives of adolescents living with adults in substance use disorder treatment.","authors":"Howard Padwa,&nbsp;Erick G Guerrero,&nbsp;Veronica Serret,&nbsp;Melvin Rico,&nbsp;Lillian Gelberg","doi":"10.2147/SAR.S177865","DOIUrl":"https://doi.org/10.2147/SAR.S177865","url":null,"abstract":"<p><strong>Background: </strong>Brief interventions (BIs) have shown potential to reduce both alcohol and drug use. Although BIs for adults have been studied extensively, little is known about how to adapt them to meet the needs and preferences of adolescents. This article examines adolescents' preferences to consider when adapting BIs for use with adolescents.</p><p><strong>Methods: </strong>Eighteen adolescents (age 9-17 years) living in Los Angeles County with adults receiving substance use disorder treatment were interviewed and asked about their perspectives on how to adapt a BI originally developed for adults for use with adolescents. Questions focused on adolescents' preferences for who should deliver BIs, how BIs should be delivered, and what content they would want to be included in BIs. Interviews were recorded, transcribed, and coded using summative content analysis.</p><p><strong>Results: </strong>Adolescents did not express any discernable opinions concerning who delivers BIs or what content they would want to be included, but they did share perspectives on how BIs should be delivered. Most adolescents did not endorse incorporating text messaging or social media into BIs. Instead they preferred having BIs delivered face-to-face or over the telephone. They reported that they did not want BIs to incorporate text messaging or social media due to concerns about trust, the quality of information they would receive, and challenges communicating in writing instead of speaking.</p><p><strong>Conclusion: </strong>Although the study has limitations because of its small sample size, findings indicate that adolescents may not want text messaging or social media to be incorporated into BIs for substance use. These findings warrant further research and consideration, particularly as work to enhance BIs for adolescents continues.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":"9 ","pages":"137-142"},"PeriodicalIF":1.8,"publicationDate":"2018-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S177865","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36813508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Review of the effects of self-stigma and perceived social stigma on the treatment-seeking decisions of individuals with drug- and alcohol-use disorders. 回顾自我耻辱和感知社会耻辱对药物和酒精使用障碍患者寻求治疗决定的影响。
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2018-11-23 eCollection Date: 2018-01-01 DOI: 10.2147/SAR.S183256
R Hammarlund, K A Crapanzano, L Luce, L Mulligan, K M Ward

Substance-use disorders are a public health crisis globally and carry with them significant morbidity and mortality. Stigma toward people who abuse these substances, as well as the internalization of that stigma by substance users, is widespread. In this review, we synthesized the available evidence for the role of perceived social stigma and self-stigma in people's willingness to seek treatment. While stigma may be frequently cited as a barrier to treatment in some samples, the degree of its impact on decision-making regarding treatment varied widely. More research needs to be done to standardize the definition and measurement of self- and perceived social stigma to fully determine the magnitude of their effect on treatment-seeking decisions.

药物使用障碍是全球性的公共卫生危机,伴随而来的是很高的发病率和死亡率。对滥用这些物质的人的耻辱感,以及物质使用者对这种耻辱感的内化,是普遍存在的。在这篇综述中,我们综合了现有的证据,以证明感知到的社会耻辱和自我耻辱在人们寻求治疗意愿中的作用。虽然在某些样本中,耻辱感可能经常被认为是治疗的障碍,但其对治疗决策的影响程度差异很大。需要做更多的研究来标准化自我和感知的社会耻辱的定义和测量,以充分确定它们对寻求治疗决定的影响程度。
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引用次数: 108
Mindfulness meditation in the treatment of substance use disorders and preventing future relapse: neurocognitive mechanisms and clinical implications. 正念冥想治疗物质使用障碍和预防未来复发:神经认知机制和临床意义。
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2018-11-16 DOI: 10.2147/SAR.S145201
Sarah E Priddy, Matthew O Howard, Adam W Hanley, Michael R Riquino, Katarina Friberg-Felsted, Eric L Garland

Substance use disorders (SUDs) are a pervasive public health problem with deleterious consequences for individuals, families, and society. Furthermore, SUD intervention is complicated by the continuous possibility of relapse. Despite decades of research, SUD relapse rates remain high, underscoring the need for more effective treatments. Scientific findings indicate that SUDs are driven by dysregulation of neural processes underlying reward learning and executive functioning. Emerging evidence suggests that mindfulness training can target these neurocognitive mechanisms to produce significant therapeutic effects on SUDs and prevent relapse. The purpose of this manuscript is to review the cognitive, affective, and neural mechanisms underlying the effects of mindfulness-based interventions (MBIs) on SUDs. We discuss the etiology of addiction and neurocognitive processes related to the development and maintenance of SUDs. We then explore evidence supporting use of MBIs for intervening in SUDs and preventing relapse. Finally, we provide clinical recommendations about how these therapeutic mechanisms might be applied to intervening in SUDs and preventing relapse.

物质使用障碍是一个普遍存在的公共卫生问题,对个人、家庭和社会造成有害后果。此外,SUD干预因持续复发的可能性而变得复杂。尽管进行了几十年的研究,SUD复发率仍然很高,这突出了需要更有效的治疗。科学发现表明,SUD是由奖励学习和执行功能背后的神经过程失调驱动的。新出现的证据表明,正念训练可以针对这些神经认知机制,对SUD产生显著的治疗效果,并防止复发。本文的目的是回顾基于正念的干预措施(MBI)对SUD影响的认知、情感和神经机制。我们讨论成瘾的病因以及与SUD的发展和维持相关的神经认知过程。然后,我们探索支持MBI用于干预SUD和预防复发的证据。最后,我们提供了关于如何将这些治疗机制应用于SUD干预和预防复发的临床建议。
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引用次数: 48
Butane hash oil and dabbing: insights into use, amateur production techniques, and potential harm mitigation. 丁烷哈希油和涂抹:洞察使用,业余生产技术,和潜在的危害缓解。
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2018-11-02 eCollection Date: 2018-01-01 DOI: 10.2147/SAR.S135252
Ihsan Al-Zouabi, John M Stogner, Bryan Lee Miller, Elizabeth S Lane

The use of marijuana concentrates has escalated in recent years with butane extracts appearing particularly popular. The administration of butane hash oil, colloquially referred to as "dabbing," is distinct from traditional flower cannabis usage due to the THC content of samples and the presence of impurities such as unpurged butane. While this may confer heightened risk to the user, additional significant concerns are tied to fires and explosions. Using butane as a solvent in amateur "blasting" methods may result in a flammable vapor pooling in enclosed spaces and igniting when exposed to a spark. As research on butane extract users, amateur production techniques, health risks, and legality is in its infancy, we explored existing studies on the topic to create a review of substantiated knowledge related to THC extracted using butane. The resulting assessment centers on three areas: 1) dab users including both recreational users and medical marijuana patients; 2) butane extraction techniques including illicit amateur open methods and the safer closed-loop system employed in medicinal/recreational states; and 3) risks, both related to fires and legality. We follow the presentation of this material with a summary of the (mis)information reaching the public in print and online sources so that public educational campaigns can focus on dispelling the inaccuracies and false notions of safety that may be tied to amateur production.

近年来,大麻浓缩液的使用不断升级,丁烷提取物似乎特别受欢迎。丁烷哈希油的管理,通俗地称为“涂抹”,与传统的大麻花使用不同,因为样品中的四氢大麻酚含量和未净化的丁烷等杂质的存在。虽然这可能会给用户带来更高的风险,但额外的重大担忧与火灾和爆炸有关。在业余“爆破”方法中使用丁烷作为溶剂可能导致易燃蒸气在封闭空间内聚集,并在暴露于火花时点燃。由于对丁烷提取物的使用者、业余生产技术、健康风险和合法性的研究尚处于起步阶段,我们探索了有关该主题的现有研究,以回顾与使用丁烷提取四氢大麻酚有关的经证实的知识。结果主要集中在三个方面:1)dab使用者包括娱乐性大麻使用者和医用大麻患者;2)丁烷提取技术,包括非法的业余开放方法和用于医疗/娱乐状态的更安全的闭环系统;3)风险,既涉及火灾,也涉及法律。我们在此材料的介绍之后,总结了通过印刷和在线来源到达公众的(错误)信息,以便公共教育活动可以集中精力消除可能与业余生产有关的不准确和错误的安全概念。
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引用次数: 29
Analysis of psychotropic drug-related deaths in south Osaka. 大阪南部精神药物相关死亡分析。
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2018-09-24 eCollection Date: 2018-01-01 DOI: 10.2147/SAR.S163491
Naoto Tani, Tomoya Ikeda, Tomomi Michiue, Shigeki Oritani, Fumiya Morioka, Takaki Ishikawa

Objective: The aim of this study was to investigate the occurrence of deaths due to psychotropic drugs in south Osaka during a 10-year period and discuss societal factors from a medical viewpoint.

Methods: Psychotropic drug-related deaths were retrospectively investigated based on the forensic postmortem data of 1,746 decedents in 2005-2014, and we excluded cases in which stimulant drugs were detected. Of these, 133 cases (7.6%) were found to be psychotropic drug-related deaths and were analyzed.

Results: Psychotropic drug-related deaths occurred in 78 males (59%; age range, 14-95 years) and 55 females (41%; 20-84 years). The direct cause of death was acute drug intoxication in many cases, and of these, acute combined drug intoxication due to the use of multiple drugs accounted for 76% of the deaths. Most of these victims were found to have gastrointestinal and cardiovascular diseases. Cases of psychotropic drug-related deaths had especially poor medical conditions. In addition, tests were positive for blood alcohol in 23% of the cases.

Conclusion: The descriptive results revealed several factors that may be related to psychotropic drug-related deaths. To prevent drug abuse, several factors were deemed to be important, including improvements in the medical state of an individual, the avoidance of social isolation, and from a medical standpoint, the management of prescription drugs by medical personnel.

目的:本研究的目的是调查近10年来大阪南部精神药物死亡的发生情况,并从医学角度探讨社会因素。方法:回顾性分析2005-2014年1746例精神药物相关死亡病例的法医尸检资料,排除检出兴奋剂的病例。其中133例(7.6%)为精神药物相关死亡,并进行了分析。结果:精神药物相关死亡男性78例(59%;年龄范围:14-95岁)和55名女性(41%;20 - 84年)。许多病例的直接死亡原因是急性药物中毒,其中,多种药物使用引起的急性联合药物中毒占死亡人数的76%。这些受害者中的大多数被发现患有胃肠道和心血管疾病。与精神药物有关的死亡病例的医疗条件特别差。此外,23%的病例血液酒精检测呈阳性。结论:描述性结果揭示了可能与精神药物相关死亡有关的几个因素。为了防止药物滥用,有几个因素被认为是重要的,包括改善个人的健康状况,避免社会孤立,以及从医学的角度来看,由医务人员管理处方药。
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引用次数: 2
Relationship between buprenorphine adherence and relapse, health care utilization and costs in privately and publicly insured patients with opioid use disorder. 私人和公共保险阿片类药物使用障碍患者丁丙诺啡依从性与复发、医疗保健利用和费用的关系
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2018-09-21 eCollection Date: 2018-01-01 DOI: 10.2147/SAR.S150253
Naoko A Ronquest, Tina M Willson, Leslie B Montejano, Vijay R Nadipelli, Bernd A Wollschlaeger

Background: Treatment for opioid use disorder is important because of the negative health, societal and economic consequences of illicit opioid use, but treatment adherence can be a challenge. This study assessed the association between buprenorphine medication-assisted treatment (MAT) adherence and relapse, health care utilization and costs.

Patients and methods: Patients with opioid use disorder who were newly initiating a buprenorphine MAT regimen were identified in the 2008-2014 MarketScan® Commercial and Medicaid Databases and followed for 12 months after their earliest outpatient pharmacy claim for buprenorphine. Adherence was categorized using proportion of days covered (PDC) with buprenorphine, and patients with PDC≥0.80 were classified as adherent. Descriptive and adjusted analyses compared relapse prevalence, utilization and costs, all measured in the 12 months following buprenorphine MAT initiation, of adherent patients to patients in non-adherent PDC categories (PDC<0.20, 0.20≤PDC<0.40, 0.40≤PDC<0.60, 0.60≤PDC<0.80).

Results: Adherent patients were 37.1% of the Commercial sample (N=16,085) and 41.3% of the Medicaid sample (N=5,688). In both samples, non-adherent patients were significantly more likely than adherent patients to relapse and to have hospitalizations and emergency department visits. As a result, as buprenorphine MAT adherence increased, pharmacy costs increased, but medical costs decreased. Total costs (pharmacy plus medical costs) in the 12 months following buprenorphine MAT initiation decreased with adherence in Commercial patients ($28,525 for PDC<0.20 to $17,844 for PDC≥0.80). A slight decrease in total costs in the 12 months following buprenorphine MAT initiation was also observed in Medicaid patients ($21,292 for PDC<0.20 to $18,621 for PDC≥0.80). After adjustment, total costs of adherent patients in the Commercial sample ($17,519) were significantly lower compared with those of non-adherent patients (range $20,294-$24,431). In the Medicaid sample, adjusted total costs were not significantly different between adherence groups.

Conclusion: Buprenorphine MAT adherence in the 12 months following treatment was associated with reduced odds of relapse and reduced unadjusted medical costs. For Commercial patients who were adherent to treatment, the adjusted total costs were predicted to be 30% lower than those for patients with PDC<0.20.

背景:阿片类药物使用障碍的治疗很重要,因为阿片类药物非法使用会对健康、社会和经济产生负面影响,但治疗依从性可能是一项挑战。本研究评估了丁丙诺啡药物辅助治疗(MAT)依从性与复发、医疗保健利用和费用之间的关系。患者和方法:在2008-2014年MarketScan®商业和医疗补助数据库中确定了新开始丁丙诺啡MAT方案的阿片类药物使用障碍患者,并在他们最早的门诊药房申请丁丙诺啡后随访12个月。使用丁丙诺啡覆盖天数比例(PDC)对依从性进行分类,PDC≥0.80的患者为依从性。描述性和调整性分析比较了在丁丙诺啡MAT启动后12个月内,依从性PDC患者与非依从性PDC患者的复发率、利用率和成本(PDCResults结果:依从性患者占商业样本(N=16,085)的37.1%,占医疗补助样本(N=5,688)的41.3%)。在这两个样本中,非依从性患者明显比依从性患者更容易复发、住院和急诊。结果,随着丁丙诺啡MAT依从性的增加,药房费用增加,但医疗费用下降。商业患者在丁丙诺啡MAT开始治疗后12个月内的总费用(药费加医疗费用)随着依从性的降低而降低(pdp为28,525美元)。结论:丁丙诺啡MAT治疗后12个月的依从性与复发几率降低和未调整医疗费用降低相关。对于坚持治疗的商业患者,调整后的总成本预计比PDC患者低30%
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引用次数: 65
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Substance Abuse and Rehabilitation
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