Substance Use & Misuse最新文献

Background: Opioid Use Disorder (OUD) often provokes dramatic consequences in terms of increased morbi-mortality. Two medications have mainly been worldwide used for OUD (MOUD), buprenorphine and methadone. Recently, however, some reports have highlighted the use of Morphine Sulfate (MS) mainly obtained without a prescription but used as MOUD by opioid users and especially People Who Inject Substances (PWIS). We propose to characterize the prevalence and distribution of MOUD and MS use in PWIS.

Methods: This study examines the use of MOUD and MS amongst French PWIS recruited in harm reduction facilities and drug consumption rooms in the context of the COSINUS (Cohort to assess structural and individual factors in drug use) study.

Results: MOUD are prescribed, respectively, to one-third and one-fifth of PWIS, whereas a half of them declared MS consumption without prescription. MS users live with higher precariousness and are younger than non-users. MS is associated with salt cocaine and heroin use. It is often consumed with methadone and more rarely with buprenorphine and we hypothesized that this is probably linked to buprenorphine's pharmacological antagonism.

Discussion: Our results show the high prevalence of MS consumption and highlight the importance of considering the highly restricted possibility of prescribing MS as MOUD. Its association with methadone raises the question of their synergistic action on craving and mental disorders. The profiles of opioid users who could benefit from MS with or without methadone must be examined to improve their care but with the utmost caution, given the risk of overdose.

Background: Telehealth-only provision of buprenorphine for opioid use disorder was made possible during the COVID-19 pandemic, but policymakers are considering ending this practice. A primary concern is potential diversion of buprenorphine, although it is unknown how many patients enter telehealth-only treatment already using diverted buprenorphine. Methods: We performed a retrospective chart review of 500 consecutive newly enrolled patients in our large telehealth-only program in January 2023. We recorded if the patient was already taking buprenorphine at the time of the intake visit and if the buprenorphine was from a diverted source. Results: Five hundred patients enrolled from January 3-20, 2023. Patients were 61.0% male; mean age was 40.3 (standard deviation 10.3) years. Buprenorphine use at the time of enrollment was reported by 46.4% (n = 232) of patients, and 18.4% (n = 92) reported using diverted buprenorphine. Conclusions/Importance: Over one in six patients initiating care with our telehealth-only practice reported taking diverted buprenorphine. These findings indicate that the telehealth care setting possibly decreases diversion of buprenorphine when patients use this modality to obtain legitimate treatment.

Background: Emergency department (ED) visits are an opportunity to provide prevention services to people at high risk of overdose. Considering patients' resources to initiate and sustain recovery ("recovery capital") may be useful for tailoring ED services, although its relevance in this population is unknown.

Methods: This secondary analysis used data from ED patients at high risk of opioid overdose enrolled in a randomized controlled trial in Rhode Island (2018-2021). We assessed baseline recovery capital using the Brief Assessment of Recovery Capital (BARC-10), dichotomized as a total score <47 versus ≥47. Post-discharge addiction treatment engagement within 30 days and non-fatal opioid overdose and fatal overdose within 18 months were assessed using statewide administrative data. We used modified Poisson regression and Cox proportional hazards models to estimate the association between recovery capital and (1) treatment engagement and (2) overdose risk, respectively, adjusting for potential confounders.

Results: Among 543 participants, 32.2% had a baseline BARC-10 total score of ≥47, 32.6% engaged in treatment within 30 days, and 25.6% had a non-fatal opioid overdose and 4.2% had a fatal overdose within 18 months. BARC-10 total score was not associated with treatment engagement within 30 days (adjusted relative risk = 0.79, 95% confidence interval [CI] = 0.60-1.05) or non-fatal opioid overdose (adjusted hazard ratio [aHR] = 0.83, 95%CI = 0.57-1.20) or fatal overdose (aHR = 0.45, 95%CI = 0.14-1.40) within 18 months.

Conclusion: The majority of ED patients at high risk of opioid overdose had a BARC-10 total score of <47, suggesting low recovery capital. BARC-10 total score was not associated with post-discharge treatment engagement or overdose risk.

Objectives: Tobacco smoking remains a major public health risk, responsible for millions of deaths worldwide. While smoking patterns in Mexico differ from those in countries with higher rates, comorbidities such as diabetes pose a health risk. Although many smokers want to quit, access to cessation services is limited. Internet-based cessation (I-BC) services are a promising modality that offers accessibility and machine learning (ML) has been successfully used to predict tobacco outcomes. This study uses ML to identify characteristics associated with requesting I-BC through an online self-assessment questionnaire in Mexico.

Methods: This was a retrospective, predictive, secondary analysis of 14,182 records of individuals aged 18 years and older who completed an online screening for nicotine dependence and their request for tobacco cessation services. Random forest algorithm with four oversampling methods was compared to select the best predictive model. The relative importance of predictor variables was measured as well.

Results: The algorithm had a sensitivity of 78.6% and a specificity of 68.8%. Specifically, age, sex, dependence severity indicators, locations such as the state of Mexico or Sinaloa, and even occasions such as World No Tobacco Day were identified as key factors influencing cessation service requests.

Conclusions: These results suggest the random forest algorithm's effectiveness in predicting potential cessation service users. Furthermore, the predictor variables provide valuable insights for designing targeted prevention and awareness campaigns, potentially leading to improved campaign effectiveness and more individuals receiving cessation support.

Introduction: To investigate factors associated with suicide attempts among patients presenting after an opioid overdose.

Materials and methods: This analysis consists of patients enrolled in the Toxicology Investigators Consortium Fentalog Study, an ongoing prospective observational study of patients presenting to 1 of 10 emergency departments (EDs) for a suspected opioid overdose. Residual serum samples were analyzed to detect over 1,200 drugs and metabolites. Chart reviews were conducted to determine the patients' intentions for the opioid overdose (suicide attempt vs. unintentional overdose), medical/social history, and clinical variables. Logistic regression analyses were conducted to examine factors associated with suicide attempts.

Results: Among 1,259 patients, 6.4% were classified as suicide attempts. Prescription opioids only (without illicit opioids) were associated with suicide attempts compared to unintentional overdose (OR: 1.27; 95% CI: 1.21, 1.34). Compared to unintentional overdoses, suicide attempts were not associated with an increased odds of medical interventions being provided, such as CPR, intubation, or ICU admission.

Conclusions: Among patients presenting to EDs after opioid overdose, suicide attempts comprised 6% of the study population and were associated with prescription opioids rather than illicit opioids.

Background: Research suggests that individuals who experience four or more adverse childhood experiences (ACEs) have increased rates of cannabis use. However, most prior research does not separate recreational and medical usage. Medical cannabis is used legally in many states to treat a variety of health conditions, many of which are also associated with ACEs. Objectives: Therefore, we explore the extent to which medical cannabis users differ from recreational cannabis users and whether medical use is associated with ACEs, poor health, or disability. Accordingly, we ask the following questions: Are ACEs associated with any cannabis use when controlling for measures of poor health and disability? Are ACEs associated with medical cannabis use? Are associations between ACEs and medical cannabis use explained by poor health and/or disability? Results: Using 2019 BRFSS data, we find that ACEs are significantly associated with cannabis use, but that disability and poor health fully account for the effect of ACEs on medical cannabis use. Conclusions: We conclude that practitioners screen for ACEs and disability status when prescribing medical cannabis.

Background: People who inject drugs (PWID) are especially vulnerable to harms from opioid use disorder (OUD). Medications for OUD (MOUD) effectively reduce overdose and infectious disease transmission risks.

Objective: We investigate whether state Medicaid coverage for methadone and buprenorphine is related to past-year MOUD use among PWID using cross-sectional, multilevel analyses with individual-level data on PWID from the Centers for Disease Control and Prevention's 2018 National HIV Behavioral Surveillance. The sample included 8,142 PWID aged 18-64 who reported daily opioid use from 22 U.S. metropolitan areas. Our outcome was any self-reported MOUD use in the past 12 months. Exposures were state Medicaid coverage and prior authorization requirements for methadone and buprenorphine. We interacted these exposures with PWID race/ethnicity, insurance status, and spatial access to treatment and harm reduction resources.

Results: Compared with PWID in states without Medicaid methadone coverage, odds of past-year MOUD use were 73% (p<0.05) higher among PWID in states with methadone coverage requiring prior authorization and 80% (p<0.05) higher among PWID in states with coverage without prior authorization. Insured PWID were twice as likely to report MOUD use than uninsured PWID, with no statistically significant differences between Medicaid versus other insurance. Medicaid prior authorization requirements for buprenorphine were not significantly associated with MOUD use. Non-Hispanic Black PWID were significantly less likely to use MOUD than non-Hispanic White and Hispanic PWID.

Conclusions: State Medicaid methadone coverage was strongly associated with higher odds that PWID utilized MOUD, suggesting that expanding methadone insurance coverage could improve MOUD treatment in a vulnerable population.

Background: Polysubstance use is common among people who use methamphetamine. This prospective study examined the three-month polysubstance use profiles among people enrolled in outpatient treatment for methamphetamine use and associated substance use, mental health, and treatment correlates.

Method: The present study used routinely collected client-reported outcome measures data from N = 1,507 clients enrolled in outpatient treatment who reported methamphetamine as their primary drug of concern (Mean age = 34.48; SD = 8.68; 56% male). Past-month substance use was assessed at baseline, one-, and three-months.

Findings: Repeated measures latent class analyses revealed four classes: (1) high and decreasing methamphetamine + stable moderate alcohol + stable high cannabis and daily tobacco (n = 474, 31.45%); (2) stable high methamphetamine + stable high alcohol and daily tobacco (n = 346, 22.96%); (3) low and decreasing methamphetamine + stable moderate daily tobacco (n = 322, 21.37%); (4) stable high methamphetamine + stable moderate daily tobacco (n = 365, 24.22%). Probability of using substances other than methamphetamine remained relatively stable for each class across time. Classes 1 and 4 had greatest severity of methamphetamine involvement at baseline and three-months. Class 1 had greater odds of experiencing moderate-to-severe depression and anxiety, and PTSD and psychosis, compared to class 3.

Conclusion: Individuals enrolled in outpatient treatment who report methamphetamine as their primary drug of concern report distinct substance use patterns, although daily tobacco use was mostly ubiquitous. Polysubstance use was widespread, with 79% of participants having moderate-to-high probability of polysubstance use at all timepoints. Clients with the most severe polysubstance use had the highest rates of co-occurring psychopathology.

Objective: The current study tested the feasibility and acceptability of a novel, Instagram-based intervention designed to reduce alcohol use and promote mindfulness and protective behavioral strategies among young adults who binge drink.

Methods: Participants were 50 college students with active Instagram accounts who reported regular binge drinking over the past 3 months. Participants followed the Instagram intervention page for forty-two consecutive days. Intervention content contained at least one of the following motivational interviewing or cognitive behavioral therapy techniques: affirmations, norm referencing, protective behavioral strategies, and mindfulness exercises. Participants were instructed to 'like' the study posts as they appeared on their newsfeed. Some participants were exposed to additional story posts ('Stories') during the intervention. Feasibility was measured using retention rates. Acceptability of intervention content was measured using 5-point Likert scales across six dimensions. Alcohol consumption, alcohol-related consequences, protective behavioral strategies, and mindfulness practices were assessed before and after the intervention.

Results: Over half of eligible participants (61.4%) completed the baseline survey. The vast majority of participants (98%) followed the study Instagram page at baseline. Of those who followed the study page, all stayed followed for the intervention duration. Most participants completed the mid-intervention (90%) and post-intervention (84%) surveys. Participants rated the intervention as moderately-to-very acceptable. Preliminary analyses indicate post-intervention decreases in past-month total drinks, drinking days, binge drinking episodes, and mindfulness practices.

Conclusions: Data support the feasibility and acceptability of delivering this intervention to college students. Future directions include testing intervention efficacy, increasing engagement, and optimizing dose.

Substance use and mental health are highly correlated, though few studies assess the risk for depression and anxiety associated with dual and polysubstance use among college students. The purpose of this study was to characterize the relationship between alcohol, cannabis, and e-cigarette exclusive, dual, and polysubstance use and depression and anxiety among U.S. college students by racial and ethnic subgroup and stratified by sex.

Data from 83,467 undergraduate students participating in the 2020-2021 Health Minds Survey, a multi-campus, web-based survey, were used. Sex-stratified logistic regression models examined the effects of exclusive (past 30-day cannabis use, past 30-day e-cigarette use, past 2-week heavy alcohol use), dual (two among cannabis, e-cigarette, or alcohol use), and polysubstance (all three substances) use on anxiety (≥10 GAD-7 score) and depression (≥15 PHQ-9 score).

The study included 60,746 females and 22,721 males. Among females, compared to those who exclusively used alcohol, dual users of cannabis and e-cigarette had the largest odds for depression (adjusted odds ratio (aOR) = 1.92) and anxiety (aOR = 1.69) followed by polysubstance users (aORs = 1.85 and 1.53, respectively). Among males, compared to those who exclusively used alcohol, dual users of cannabis and e-cigarette had the largest odds for depression (aOR = 2.72) and anxiety (aOR = 2.23) followed by polysubstance users (aOR = 1.71 and 1.85, respectively). African American female and male students had lower odds of anxiety and depression compared to White students.

The results suggest that single, dual, and polysubstance use are associated with anxiety and depression among U.S. college students, though not necessarily in additive ways.