Substance Use & Misuse最新文献

Background: We analyzed trends in drugs most often injected and their associations with HIV risk among people who inject drugs (PWID) in San Francisco, United States from 2018 to 2024.

Methods: Data are from National HIV Behavioral Surveillance serial cross-sectional surveys in 2018, 2022, and 2024. Participants were recruited through respondent-driven sampling. Trends in drugs most often injected were assessed using multinomial logistic regression analysis, adjusting for demographic differences across survey samples. Secondary analyses examined trends by age and race/ethnicity, and associations between risk behaviors and drugs most often injected.

Results: A total of 1,500 PWID were surveyed. PWID who injected methamphetamine most often rose from 23.9% in 2018 to 55.7% in 2024, while those injecting heroin most often dropped from 52.5% to 15.8%, and those injecting fentanyl most often rose from 0.9% to 11.3%. These shifts occurred earlier among younger and Hispanic PWID, while later for Black/African American PWID. PWID who most often injected methamphetamine had the highest prevalence of HIV (12.7%), sexually transmitted infections (16.3%), male-male sex (28.2%), and multiple sexual partners (55.3%). PWID who injected fentanyl most often had the highest prevalence of condomless sex (64.4%) and sharing of injection equipment (54.0%). HIV pre-exposure prophylaxis use was low (1.5%-3.0%) regardless of the drug most often injected.

Conclusions: Methamphetamine supplanted heroin as the drug most often injected in San Francisco, with fentanyl increasing. These drugs' associations with HIV risk may increase transmission unless effective prevention methods such as PrEP can be rapidly scaled up.

Background: Unregulated fentanyl use is driving overdose deaths, and fentanyl test strips (FTS) are a tool to support overdose risk reduction. This quality improvement project assessed a novel pharmacist-led model of FTS education and distribution Veterans Affairs (VA) substance use disorder (SUD) care and its association with fentanyl-related knowledge and overdose risk reduction behaviors (ORRBs).

Methods: This prospective single-arm cohort project was completed in outpatient SUD clinics at a VA Medical Center. A pharmacist delivered education (fentanyl, opioid overdose risk, FTS use) and offered Veterans FTS and intranasal naloxone. Veterans completed surveys pre-/post-education and at one-month. Pre-/post-changes in fentanyl knowledge, concerns, and planned ORRBs were analyzed using paired t-tests with Cohen's d for effect size.

Results: Fifty-seven Veterans (mean age 59.3 years, 100% male) participated (January-October 2020). Most (n = 56, 98.2%) accepted at least one FTS kit, and 25 (43.9%) accepted naloxone. Significant pre-post improvements were observed in knowledge of carfentanil potency (p < 0.001, d = 1.21), fentanyl potency (p < 0.001, d = 0.74), and concern about fentanyl contamination (p < 0.001, d = 0.59). Planned ORRBs improved: keeping naloxone nearby (p < 0.001, d = 0.67); testing non-prescribed opioids for fentanyl (p < 0.001, d = 0.61). Eleven (22.2%) reported using at least one FTS; most positive results were followed by ORRBs.

Conclusions: A brief, pharmacist-led FTS education and distribution model was feasible in outpatient VA SUD care and associated with improved knowledge and ORRBs among Veterans. This model may reach Veterans who do not access conventional community-based harm reduction services and supports broader integration of FTS education and distribution in Veteran-focused SUD care to reduce overdose risk.

Background: Insufficient sleep is a known risk factor for various adolescent health issues, yet its pathways to substance use remain unclear. This study tested whether depressive symptoms and low self-control mediate the association between sleep duration and adolescent substance use.

Methods: Data were drawn from 47,572 Florida middle and high school students participating in the 2022 Florida Youth Substance Abuse Survey. Multilevel generalized structural equation modeling assessed direct and indirect associations between sleep duration, depressive symptoms, self-control, and substance use.

Results: Shorter sleep duration was significantly associated with greater depressive symptoms (b = -0.11), lower self-control (b = -0.06), and higher expected substance use. Each additional hour of sleep corresponded to a 3% decrease in past 30-day substance use (IRR = 0.97). Both depressive symptoms and self-control independently predicted substance use and significantly mediated the relationship between sleep and substance use.

Conclusions: Adequate sleep appears to protect against adolescent substance-use risk by reducing depressive symptoms and enhancing self-control. Findings support both general strain and self-control theories, which point to the critical role of sleep in youth prevention efforts.

Background: Nicotine and alcohol are among the most commonly co-used substances. The rise in e-cigarette use, particularly among younger populations, has introduced new dynamics in substance use behaviors, potentially altering traditional consumption patterns and raising concerns about the relationship between e-cigarette use and alcohol consumption. This systematic review and meta-analysis aimed to synthesize existing data to elucidate the relationship between e-cigarette use and alcohol consumption behaviors.

Methods: A literature search was conducted across PubMed, Embase, and Web of Science up to July 15, 2024. Studies reporting measures of association between alcohol behaviors and e-cigarette use were included. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models, with heterogeneity assessed via the I² statistic and prediction intervals. The Newcastle-Ottawa Scale was used for quality assessment. All statistical analyses were performed in R software version 4.4.

Results: Among the 4,771 records screened, 34 studies were included. The meta-analysis revealed a significant association between alcohol use and e-cigarette use (pooled OR = 1.796, 95% CI: 1.412 to 2.285). Additionally, binge drinking was strongly associated with e-cigarette use (pooled OR = 3.078, 95% CI: 2.364 to 4.007). E-cigarette users were also more likely to engage in alcohol consumption (pooled OR = 3.731, 95% CI: 2.137 to 6.514) and binge drinking (pooled OR = 4.071, 95% CI: 3.209 to 5.166).

Conclusion: The findings indicate a possible relationship between e-cigarette use and alcohol consumption and binge drinking. Integrated prevention strategies addressing the co-use of these substances, particularly among youth and young adults, are needed.

Background: With increasing polydrug overdose deaths, public health messaging has centered around overdose prevention. However, it is important to contextualize overdose risk through the lived experience of people who use drugs (PWUD) and challenge the assumption that overdose is their primary salient risk. PWUD navigate multiple competing risk priorities daily and will adjust their behaviors in response to risks they prioritize.

Objectives: Conduct in-depth interviews to explore the lived experience of PWUD in North Carolina, how they conceptualize the risks related to polydrug use, and what protective strategies they use to mitigate those risks.

Results: Four major themes emerged from the qualitative interviews. First, overdose is ubiquitous, but not salient. Participants did not express distress regarding overdose because they thought they were careful or because they were not afraid of dying. Second, participants' primary concern was avoiding withdrawal. The immediate suffering of withdrawal outweighed the probabilistic risk of overdose. Third, participants strategically engaged in polydrug use to mitigate risks they prioritized. Fourth, despite not being significantly concerned about overdose, participants were knowledgeable and open to harm reduction strategies. PWUD employed a range of risk reduction practices aligned with their risk hierarchies.

Conclusions: Implications for these findings include the need for harm reduction providers and other public health stakeholders to target education, treatment, and interventions to align with the risks and considerations most salient and potentially persuasive to PWUD.

Objective: This study investigated the association between intersectional oppression-based stressors and substance use among sexual and gender minority (SGM; queer and transgender [QT]) adolescents who are Black, Indigenous, and People of Color (QTBIPOC) and examined the potential moderating role of school safety.

Method: Data were a subset of QTBIPOC adolescents (N = 3,563) from a dataset of SGM adolescents in the United States ages 13-18 years old.

Results: Intersectional oppression-based stressors (OBS) were associated with greater likelihood of recent use of alcohol, cigarettes, cannabis, vaping, and other drugs; nonmedical use of prescription pain medicine; and heavy alcohol use. School safety was associated with lower likelihood of recent use of cigarettes, cannabis, vaping, and other drugs; nonmedical use of prescription pain medicine; and heavy alcohol use. School safety buffered the association between intersectional OBS and heavy alcohol use, but not other substances.

Conclusions: Intersectional OBS are prevalent in the lives of QTBIPOC adolescents and these experiences are associated with greater likelihood of recent substance use. Although higher levels of school safety were generally associated with lower likelihood of substance use, school safety does not appear to be a robust protective factor against substance use for QTBIPOC adolescents experiencing OBS. This study highlights the need for interventions reducing intersectional OBS and research identifying factors that protect against substance use in this population.

Background: This study examined illicit substance use among youth in Taiwanese temple parade troupes, a culturally distinct but high-risk population.

Methods: In 2019, we surveyed 696 participants recruited on-site through convenience sampling across Taiwan using a structured questionnaire that assessed demographics, alcohol and tobacco use, substance-involved social ties, and acquisition settings. Three domains of substance-involved ties (family, peers, intimate partners; range 0-3) and three types of acquisition settings (private, social, public; range 0-3) were analyzed using descriptive statistics, one-way ANOVAs, and logistic regression models. The lifetime prevalence of illicit substance use was 9.8%. Because only three female participants reported illicit substance use, multivariable logistic regression analyses were restricted to male participants (n = 593) and adjusted for age and education.

Results: Odds of illicit substance use increased with the accumulation of substance-involved social relationships, with adjusted odds ratios (aORs, 95% CI) of 2.96 (1.48-5.91) for one type and 11.32 (3.72-34.44) for two types, compared with none; estimates for three types could not be obtained due to complete separation. In contrast, awareness of any acquisition setting was associated with markedly higher odds of illicit substance use (aORs, 95% CI: 1 = 22.48, 5.25-96.34; 2 = 59, 3.78-81.79; 3 = 37.27, 4.75-292.23).

Conclusions: Findings highlight that accumulated substance-involved relationships and access through any acquisition setting are key structural conditions shaping substance use in this cultural context. While limited by its cross-sectional design and convenience sampling, the study provides novel evidence on culture-embedded risk structures and underscores the need for longitudinal and context-sensitive prevention strategies.

Background: Colleges and universities use various prevention and intervention programs to address high-risk drinking among their students. Alcohol eCHECKUP TO GO is one of the most popular programs to address this risk, with strong empirical support. However, it is unclear how the context of the efficacy studies aligns with the context of typical use.

Objectives: The current study examined how institutions are implementing Alcohol eCHECKUP TO GO on their campuses, including: who receives the program (e.g., first-year students), how it is disseminated (remotely versus in person), if the program is delivered on its own or with another program, and if administration systematically varies across institution characteristics (e.g., public or private school). An online survey was sent to all Alcohol eCHECKUP TO GO subscribers. The sample (83 institutions, 51.3% medium-sized schools, 20.5% minority serving) provided information about their implementation of Alcohol eCHECKUP TO GO and institution characteristics.

Results: Most institutions implemented Alcohol eCHECKUP TO GO remotely, to students who receive alcohol violations/sanctions and those who voluntarily seek out the program, and it is combined with another alcohol or health program for many student groups. These factors generally did not vary by institution characteristics; however, implementation to select student groups did vary by school size and if the institution was a minority serving institution.

Conclusions: Institutions implement Alcohol eCHECKUP TO GO with a variety of student groups and mostly remotely. This study provides intervention and prevention researchers interested in the effectiveness of the program with a better understanding of real-world conditions.

Background: Since 2000, rates of suicide and opioid overdose have sharply increased. Approximately one-third of individuals with major depressive disorder (MDD) experience treatment-resistant depression (TRD), highlighting the urgent need for novel therapeutic approaches.

Objective: This review synthesizes pivotal preclinical and clinical findings on low-dose ketamine's rapid antidepressant effects and examines proposed mechanisms underlying its therapeutic action.

Methods: This is a narrative review of key contributions in the literature addressing ketamine's fast-acting antidepressant properties.

Results: Low-dose ketamine rapidly alleviates depressive symptoms, including in refractory depression. Despite multiple hypotheses supported by preliminary data, there is no consensus regarding its definitive mechanism of action. Proposed mechanisms include modulation of dopamine signaling via epigenetic neuroadaptation, interactions with D1/D2 receptor systems, optogenetic activation of D1 pathways, and alterations in D2/D3 receptor availability.

Conclusions: Elucidating ketamine's mechanism of action may inform the development of next-generation psychoplastogens that promote neural plasticity in TRD and unipolar MDD. However, ketamine's psychoactive properties and abuse potential, along with concerns regarding misuse and diversion, underscore the need for enhanced clinical oversight and regulatory frameworks.

Background and aims: Harm reduction represents an approach that aims to reduce risk, promote safety, and prevent disease or disability, and has proven to be effective in preventing overdose death. However, public perceptions are mixed. Past studies have not examined public perceptions across a range of different types of harm reduction strategies. We examine public support for five different types of common harm reduction strategies, including the legalization of safe consumption sites, FDA approval of over-the-counter/nonprescription naloxone, increased number of methadone clinic locations, decriminalizing Fentanyl testing strips, and implementation of syringe service programs, in a national representative sample.

Methods: Latent class analysis was applied to JCOIN Survey 10 data (N∼6500) to investigate whether there are distinct profiles of perceptions supporting these different types of harm reduction strategies. We also explore how demographics and past direct and indirect experiences with opioid use, overdose, and criminal legal involvement relate to these profiles.

Results: We found four distinct profiles: a group of 22.9% expressing strong support for harm reduction policies, a group with mixed support (35.4%), that is, they support some but not other harm reduction policies, a profile of individuals holding neutral opinions (22.4%), and a group holding strong opposition for harm reduction policies (19.3%). Demographics and past experiences with opioids and criminal legal involvement are differentially associated with these profiles.

Conclusions: Information and educational programs should be designed to target different groups of individuals to increase understanding and support for harm reduction policies and programs.