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A Pragmatic, Person-Centered View of Cannabis in the United States: Pursuing Care That Transcends Beliefs. 务实、以人为本的美国大麻观:追求超越信仰的关怀。
IF 3.5 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-10-01 Epub Date: 2023-10-30 DOI: 10.1177/08897077231202836
Hannah G Bosley, Juan M Peña, Andrew D Penn, James L Sorensen, Matthew Tierney, Annesa Flentje

Background: Rates of cannabis use are increasing in the United States, likely as a result of changes in societal attitudes and expanding legalization. Although many patients report wanting to discuss the risks and benefits of cannabis use with their clinical providers, many providers hold conflicting beliefs regarding cannabis use and often do not engage patients in discussion about cannabis. This dilemma is underscored by the limitations imposed on cannabis related research, and lack of empirically based best-practice guidelines for clinicians when addressing cannabis use with patients.

Objectives: We aimed to briefly summarize clinician and patient attitudes toward cannabis use and review current clinical guidelines and provide suggestions to assist health care providers and clinicians in increasing their comfort and skill in discussing cannabis use with patients.

Methods: A narrative review on attitudes toward cannabis use and clinical guidelines was performed to summarize the literature and provide evidence-based recommendations.

Results: Attitudes toward cannabis use have been shaped by personal and political factors and contribute to clinician hesitance in speaking with patients about the topic. Administrative barriers have hindered the development of clearer public health guidelines that might enable the dissemination of evidence-based information on the health effects of cannabis use and might ultimately lead to better health outcomes.

Conclusion: Not discussing cannabis use with patients may be a crucial missed opportunity for harm reduction. In the absence of empirically supported best-practice guidelines, a person-centered approach can facilitate conversations on the harms and benefits of cannabis use.

背景:美国大麻使用率正在上升,这可能是社会态度变化和合法化扩大的结果。尽管许多患者报告说,他们希望与临床提供者讨论使用大麻的风险和益处,但许多提供者对大麻的使用持有相互矛盾的信念,并且往往不让患者参与有关大麻的讨论。大麻相关研究的局限性,以及临床医生在处理患者使用大麻问题时缺乏基于经验的最佳实践指南,突显了这一困境。目的:我们旨在简要总结临床医生和患者对大麻使用的态度,审查当前的临床指南,并提供建议,以帮助医疗保健提供者和临床医生在与患者讨论大麻使用时提高舒适度和技能。方法:对大麻使用态度和临床指南进行叙述性综述,总结文献并提供循证建议。结果:对大麻使用的态度受到个人和政治因素的影响,导致临床医生在与患者谈论这个话题时犹豫不决。行政障碍阻碍了制定更明确的公共卫生准则,这些准则可能有助于传播关于大麻使用对健康影响的循证信息,并可能最终带来更好的健康结果。结论:不与患者讨论大麻使用可能是减少伤害的关键错失机会。在缺乏经验支持的最佳实践指南的情况下,以人为中心的方法可以促进关于大麻使用的危害和好处的对话。
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引用次数: 0
Impact of Mandated Case Review Policy on Opioid Discontinuation and Mortality Among High-Risk Long-Term Opioid Therapy Patients: The STORM Stepped-Wedge Cluster Randomized Controlled Trial. 强制病例审查政策对高危长期阿片治疗患者阿片停用和死亡率的影响:STORM阶梯楔形群随机对照试验。
IF 3.5 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-10-01 Epub Date: 2023-10-13 DOI: 10.1177/08897077231198299
Yufei Li, Kyle D Barr, Jodie A Trafton, Elizabeth M Oliva, Melissa M Garrido, Austin B Frakt, Kiersten L Strombotne

Background: Although long-term opioid therapy (LTOT) has its own risks, opioid discontinuation could pose harm for high-risk Veterans Health Administration (VHA) patients receiving LTOT. There is limited information on the impact of a mandate requiring providers to perform case reviews on high-risk patients with an active opioid prescription (ie, mandated case review policy) on opioid discontinuation and mortality.

Methods: Our study is a secondary data analysis of a 23-month stepped-wedge cluster randomized controlled trial between April 2018 and March 2020. The study included 10 685 LTOT patients with a predicted risk of a serious adverse event between the top 1% to 5% nationally who entered the risk range between 4/18/2018 and 11/9/2019. We examined whether the mandated case review policy had an impact on opioid discontinuation and mortality for the patients.

Results: Among 10 685 LTOT patients (88.2% male; mean [SD] age, 61.1 [11.7] years), 29.1% experienced discontinuation and the mortality rate was 9.5%. Patients under mandated case review had a decreased risk of opioid discontinuation (average marginal effect [AME], -11.16 [95% CI, -15.30 to -7.01] percentage points) and all-cause mortality (AME, -3.31 [95% CI, -5.63 to -1.00] percentage points), relative to patients who were not under the mandate.

Conclusions: The VHA mandated case review policy was associated with lower probability of discontinuation and all-cause mortality for high-risk patients receiving LTOT. Interventions that maintain care engagement while optimizing pain management for high-risk patients may be beneficial for minimizing mortality and other risks associated with discontinuation.

背景:尽管长期阿片类药物治疗(LTOT)有其自身的风险,但阿片类物质的停用可能会对接受LTOT的高危退伍军人健康管理局(VHA)患者造成伤害。关于要求提供者对有活性阿片类药物处方的高危患者进行病例审查的规定(即规定的病例审查政策)对阿片类药品停用和死亡率的影响,信息有限。方法:我们的研究是对2018年4月至2020年3月间一项为期23个月的阶梯式楔形群随机对照试验的二次数据分析。该研究包括10项 685名LTOT患者,其严重不良事件的预测风险在全国前1%至5%之间,在2018年4月18日至2019年11月9日期间进入风险范围。我们研究了强制病例审查政策是否对阿片类药物停用和患者死亡率产生影响。结果:10个 685名LTOT患者(88.2%为男性;平均[SD]年龄,61.1[11.7]岁),29.1%经历了停药,死亡率为9.5%。接受强制病例审查的患者阿片类药物停药风险降低(平均边际效应[AME],-11.16[95%CI,-15.30至-7.01]个百分点),全因死亡率降低(AME,-3.31[95%CI,-56.63至-1.00]个百分点),相对于未受授权的患者。结论:VHA强制的病例审查政策与接受LTOT的高危患者的停药概率和全因死亡率较低有关。在优化高危患者疼痛管理的同时保持护理参与的干预措施可能有利于最大限度地降低死亡率和与停药相关的其他风险。
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引用次数: 0
Advancing Proficiencies for Health Professionals in the Treatment of Tobacco Use Among Marginalized Communities: Development of a Competency-Based Curriculum and Virtual Workshop. 提高卫生专业人员在边缘化社区治疗烟草使用方面的能力:开发基于能力的课程和虚拟讲习班。
IF 3.5 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-10-01 Epub Date: 2023-10-16 DOI: 10.1177/08897077231200987
Christine E Sheffer, Alina Shevorykin, Roberta Freitas-Lemos, Darian Vantucci, Ellen Carl, Lindsey Bensch, Matthew Marion, Deborah O Erwin, Philip H Smith, Jill M Williams, Jamie S Ostroff

Background: Tobacco-related disparities are a leading contributor to health inequities among marginalized communities. Lack of support from health professionals is one of the most cited barriers to tobacco cessation reported by these communities. Improving the proficiencies with which health professionals incorporate social and cultural influences into therapeutic interactions has the potential to address this critical barrier. In general, training to improve these proficiencies has shown promise, but the specific proficiencies required for treating tobacco use among marginalized communities are unknown. This project aimed to develop a competency-based curriculum to improve these proficiencies among health professionals with experience and training in the evidence-based treatment of tobacco use, and then pilot test the content delivered via an expert review of a virtual, self-paced workshop.

Methods: We used the Delphi Technique to systematically identify the specific competencies and corresponding knowledge and skill sets required to achieve these proficiencies. Educational content was developed to teach these competencies in a virtual workshop. The workshop was evaluated by 11 experts in the field by examining pre- and post-training changes in perceived knowledge, skill, and confidence levels and other quantitative and qualitative feedback. Repeated measures analysis of variance and paired sample t-tests were used to examine pre-post training differences.

Results: Six competencies and corresponding skill sets were identified. After exposure to the virtual workshop, the experts reported significant increases in the overall proficiency for each competency as well as increases in nearly all levels of knowledge, skill, and confidence within the competency skill sets. Qualitative and quantitative findings indicate that content was relevant to practice.

Conclusions: These findings provide preliminary support for 6 competencies and skills sets needed to improve therapeutic interpersonal interactions that recognize the importance of social and cultural influences in the treatment of tobacco use.

背景:与烟草有关的差异是边缘化社区健康不平等的主要原因。缺乏卫生专业人员的支持是这些社区报告的最常见的戒烟障碍之一。提高卫生专业人员将社会和文化影响纳入治疗互动的熟练程度,有可能解决这一关键障碍。总的来说,提高这些熟练程度的培训显示出了希望,但边缘化社区治疗烟草使用所需的具体熟练程度尚不清楚。该项目旨在开发一个基于能力的课程,以提高在烟草使用循证治疗方面有经验和受过培训的卫生专业人员的这些熟练程度,然后通过对虚拟、自定节奏的研讨会进行专家评审,对所提供的内容进行试点测试。方法:我们使用德尔菲技术来系统地确定实现这些熟练程度所需的特定能力以及相应的知识和技能集。开发了教育内容,在虚拟研讨会上教授这些能力。该领域的11位专家对研讨会进行了评估,考察了培训前后感知知识、技能和信心水平的变化以及其他定量和定性反馈。重复测量方差分析和配对样本t检验用于检验训练前后的差异。结果:确定了六种能力和相应的技能。在参加虚拟研讨会后,专家们报告说,每项能力的总体熟练程度都有显著提高,能力技能集中几乎所有级别的知识、技能和信心都有所提高。定性和定量研究结果表明,内容与实践有关。结论:这些发现为改善治疗性人际互动所需的6种能力和技能提供了初步支持,这些能力和技能认识到社会和文化影响在治疗烟草使用中的重要性。
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引用次数: 0
Research Priorities for Expansion of Opioid Use Disorder Treatment in the Community Pharmacy. 扩大社区药房阿片类药物使用障碍治疗的研究重点。
IF 2.8 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-10-01 Epub Date: 2023-10-30 DOI: 10.1177/08897077231203849
Jennie B Jarrett, Jeffrey Bratberg, Anne L Burns, Gerald Cochran, Bethany A DiPaula, Anna Legreid Dopp, Abigail Elmes, Traci C Green, Lucas G Hill, Felicity Homsted, Stephanie L Hsia, Michele L Matthews, Udi E Ghitza, Li-Tzy Wu, Gavin Bart

In the last decade, the U.S. opioid overdose crisis has magnified, particularly since the introduction of synthetic opioids, including fentanyl. Despite the benefits of medications for opioid use disorder (MOUD), only about a fifth of people with opioid use disorder (OUD) in the U.S. receive MOUD. The ubiquity of pharmacists, along with their extensive education and training, represents great potential for expansion of MOUD services, particularly in community pharmacies. The National Institute on Drug Abuse's National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) convened a working group to develop a research agenda to expand OUD treatment in the community pharmacy sector to support improved access to MOUD and patient outcomes. Identified settings for research include independent and chain pharmacies and co-located pharmacies within primary care settings. Specific topics for research included adaptation of pharmacy infrastructure for clinical service provision, strategies for interprofessional collaboration including health service models, drug policy and regulation, pharmacist education about OUD and OUD treatment, including didactic, experiential, and interprofessional curricula, and educational interventions to reduce stigma towards this patient population. Together, expanding these research areas can bring effective MOUD to where it is most needed.

在过去十年中,美国阿片类药物过量危机加剧,特别是自从引入包括芬太尼在内的合成阿片类物质以来。尽管药物治疗阿片类药物使用障碍(MOUD)有好处,但在美国,只有约五分之一的阿片类物质使用障碍(OUD)患者接受了MOUD治疗。药剂师的普遍存在,加上他们广泛的教育和培训,代表着扩大MOUD服务的巨大潜力,特别是在社区药房。国家药物滥用研究所的国家药物滥用治疗临床试验网络(NIDA CTN)召集了一个工作组,制定了一项研究议程,以扩大社区药房部门的OUD治疗,以支持更好地获得MOUD和患者结果。已确定的研究环境包括独立和连锁药店以及初级保健环境中的合用药店。研究的具体主题包括适应临床服务提供的药学基础设施、跨专业合作战略,包括卫生服务模式、药物政策和监管、药剂师关于OUD和OUD治疗的教育,包括教学、体验和跨专业课程,以及教育干预措施,以减少对这一患者群体的污名化。共同扩大这些研究领域可以将有效的MOUD带到最需要的地方。
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引用次数: 0
Care Practices of Mental Health Clinical Pharmacist Practitioners Within an Interdisciplinary Primary Care Model for Patients With Substance Use Disorders. 药物使用障碍患者跨学科初级保健模式下心理健康临床药剂师的护理实践。
IF 2.8 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-10-01 Epub Date: 2023-10-15 DOI: 10.1177/08897077231198679
Annette Percy, A Taylor Kelley, Natalie Valentino, Amy Butz, Jacob D Baylis, Ying Suo, Adam J Gordon, Audrey L Jones

Background: Clinical pharmacist practitioners (CPPs) play an increasingly important role in interdisciplinary care for patients with substance use disorders (SUDs). However, CPPs' scope of practice varies substantially across clinics and settings.

Objectives: We sought to describe CPP practices and activities within an interdisciplinary, team-based primary care clinic dedicated to treat Veterans with histories of substance use disorders, experience of homelessness, high medical complexity, and other vulnerabilities.

Methods: We conducted a retrospective cohort study of CPP activities using Department of Veterans Affairs (VA) administrative data in 2019.

Results: CPPs provided care for 228 patients, including 766 in-clinic visits, 341 telephone visits, and 626 chart reviews, with an average of 2.5 hours spent per patient per year. Patients seen by CPPs frequently experience mental health conditions and SUDs, including depression (66%), post-traumatic stress disorder (52%), opioid use disorder (OUD) (45%), and alcohol use disorder (44%). CPPs managed buprenorphine medications for OUD or chronic pain in 76 patients (33%). Most CPP interventions (3330 total) were for SUDs (33%), mental health conditions (24%), and pain management (24%), with SUD interventions including medication initiation, dose changes, discontinuations and monitoring. As part of opioid risk mitigation efforts, CPPs queried the state's prescription drug monitoring program 769 times and ordered 59 naloxone kits and 661 lab panels for empaneled patients.

Conclusion: CPPs managed a high volume of vulnerable patients and provided complex care within an interdisciplinary primary care team. Similar CPP roles could be implemented in other primary care settings to increase access to SUD treatment.

背景:临床药剂师在药物使用障碍患者的跨学科护理中发挥着越来越重要的作用。然而,CP的执业范围因诊所和环境而异。目的:我们试图描述CPP在一个跨学科、团队基础的初级保健诊所内的实践和活动,该诊所致力于治疗有药物使用障碍史、无家可归经历、高度医疗复杂性和其他脆弱性的退伍军人。方法:我们使用退伍军人事务部(VA)2019年的行政数据对CPP活动进行了回顾性队列研究。结果:CPP为228名患者提供了护理,包括766次门诊就诊、341次电话就诊和626次图表审查,平均2.5 每位患者每年花费的小时数。CPP患者经常出现心理健康状况和SUD,包括抑郁症(66%)、创伤后应激障碍(52%)、阿片类药物使用障碍(OUD)(45%)和酒精使用障碍(44%)。在76名患者(33%)中,CPPs管理丁丙诺啡药物治疗OUD或慢性疼痛。大多数CPP干预措施(共3330项)针对SUD(33%)、心理健康状况(24%)和疼痛管理(24%),SUD干预措施包括药物开始、剂量变化、停药和监测。作为阿片类药物风险缓解工作的一部分,CP对该州的处方药监测计划进行了769次询问,并为指定患者订购了59个纳洛酮试剂盒和661个实验室小组。结论:CPPs管理了大量易受伤害的患者,并在跨学科的初级保健团队中提供了复杂的护理。类似的CPP角色可以在其他初级保健环境中实施,以增加获得SUD治疗的机会。
{"title":"Care Practices of Mental Health Clinical Pharmacist Practitioners Within an Interdisciplinary Primary Care Model for Patients With Substance Use Disorders.","authors":"Annette Percy, A Taylor Kelley, Natalie Valentino, Amy Butz, Jacob D Baylis, Ying Suo, Adam J Gordon, Audrey L Jones","doi":"10.1177/08897077231198679","DOIUrl":"10.1177/08897077231198679","url":null,"abstract":"<p><strong>Background: </strong>Clinical pharmacist practitioners (CPPs) play an increasingly important role in interdisciplinary care for patients with substance use disorders (SUDs). However, CPPs' scope of practice varies substantially across clinics and settings.</p><p><strong>Objectives: </strong>We sought to describe CPP practices and activities within an interdisciplinary, team-based primary care clinic dedicated to treat Veterans with histories of substance use disorders, experience of homelessness, high medical complexity, and other vulnerabilities.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of CPP activities using Department of Veterans Affairs (VA) administrative data in 2019.</p><p><strong>Results: </strong>CPPs provided care for 228 patients, including 766 in-clinic visits, 341 telephone visits, and 626 chart reviews, with an average of 2.5 hours spent per patient per year. Patients seen by CPPs frequently experience mental health conditions and SUDs, including depression (66%), post-traumatic stress disorder (52%), opioid use disorder (OUD) (45%), and alcohol use disorder (44%). CPPs managed buprenorphine medications for OUD or chronic pain in 76 patients (33%). Most CPP interventions (3330 total) were for SUDs (33%), mental health conditions (24%), and pain management (24%), with SUD interventions including medication initiation, dose changes, discontinuations and monitoring. As part of opioid risk mitigation efforts, CPPs queried the state's prescription drug monitoring program 769 times and ordered 59 naloxone kits and 661 lab panels for empaneled patients.</p><p><strong>Conclusion: </strong>CPPs managed a high volume of vulnerable patients and provided complex care within an interdisciplinary primary care team. Similar CPP roles could be implemented in other primary care settings to increase access to SUD treatment.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":" ","pages":"330-336"},"PeriodicalIF":2.8,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41238680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Improving DEIB in Addiction Medicine Training Through Interdisciplinary Collaboration and Program Evaluation. 通过跨学科合作和项目评估提高成瘾医学培训的DEIB。
IF 3.5 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-10-01 Epub Date: 2023-10-13 DOI: 10.1177/08897077231199552
Sophia M Ly, Amanda M Fitzpatrick, Jules Canfield, Amaya Powis, Kaku So-Armah, Emily E Hurstak

Developing a diverse Addiction Medicine (AM) workforce will improve medical and public health responses to the increasing health risks created by substance use disorders (SUDs). A workforce that embraces diversity, equity, inclusion, and belonging (DEIB) principles may foster novel responses to address the disparities in treatment and outcomes experienced by Black, Indigenous, and People of Color (BIPOC) who are impacted by SUDs. However, experiences of bias and discrimination in the workplace and a lack of exposure to addiction-related content in educational settings limit opportunities to develop and retain a diverse workforce. In this commentary, we describe the creation of the Inclusion, Diversity, and Equity in Addiction medicine, Addiction research, and Addiction health professions (IDEAAA) initiative, a strategy to foster diversity in the field of addiction through efforts targeting learners at different stages of the biomedical education pipeline. Now in its second year, the IDEAAA Program is focused on programmatic evaluation through a qualitative interview study of AM training programs to improve the understanding of experiences of participants who are self-identified members of underrepresented groups (URGs). Interdisciplinary programs with multi-faceted approaches are a strategy to improve DEIB in the AM workforce; IDEAAA's design and methods can inform other AM programs who have the desire to improve DEIB through novel approaches.

培养一支多样化的成瘾医学(AM)队伍将改善医疗和公共卫生应对药物使用障碍(SUD)造成的日益严重的健康风险。一支信奉多样性、公平性、包容性和归属感(DEIB)原则的劳动力队伍可能会促进新的应对措施,以解决受SUD影响的黑人、原住民和有色人种(BIPOC)在待遇和结果方面的差异。然而,工作场所的偏见和歧视经历,以及在教育环境中缺乏与成瘾相关的内容,限制了发展和留住多样化劳动力的机会。在这篇评论中,我们描述了成瘾医学、成瘾研究和成瘾健康专业的包容性、多样性和公平性(IDEAAA)倡议的创建,这是一项通过针对生物医学教育管道不同阶段的学习者的努力来促进成瘾领域多样性的战略。IDEAAA计划已进入第二年,通过对AM培训计划的定性访谈研究,重点关注计划评估,以提高对参与者经验的理解,这些参与者是代表性不足群体(URG)的自我认同成员。采用多方面方法的跨学科项目是提高AM员工DEIB的战略;IDEAAA的设计和方法可以为其他希望通过新方法改进DEIB的AM程序提供信息。
{"title":"Improving DEIB in Addiction Medicine Training Through Interdisciplinary Collaboration and Program Evaluation.","authors":"Sophia M Ly, Amanda M Fitzpatrick, Jules Canfield, Amaya Powis, Kaku So-Armah, Emily E Hurstak","doi":"10.1177/08897077231199552","DOIUrl":"10.1177/08897077231199552","url":null,"abstract":"<p><p>Developing a diverse Addiction Medicine (AM) workforce will improve medical and public health responses to the increasing health risks created by substance use disorders (SUDs). A workforce that embraces diversity, equity, inclusion, and belonging (DEIB) principles may foster novel responses to address the disparities in treatment and outcomes experienced by Black, Indigenous, and People of Color (BIPOC) who are impacted by SUDs. However, experiences of bias and discrimination in the workplace and a lack of exposure to addiction-related content in educational settings limit opportunities to develop and retain a diverse workforce. In this commentary, we describe the creation of the Inclusion, Diversity, and Equity in Addiction medicine, Addiction research, and Addiction health professions (IDEAAA) initiative, a strategy to foster diversity in the field of addiction through efforts targeting learners at different stages of the biomedical education pipeline. Now in its second year, the IDEAAA Program is focused on programmatic evaluation through a qualitative interview study of AM training programs to improve the understanding of experiences of participants who are self-identified members of underrepresented groups (URGs). Interdisciplinary programs with multi-faceted approaches are a strategy to improve DEIB in the AM workforce; IDEAAA's design and methods can inform other AM programs who have the desire to improve DEIB through novel approaches.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":" ","pages":"277-281"},"PeriodicalIF":3.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41213571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treatment Initiation, Substance Use Trajectories, and the Social Determinants of Health in Persons Living With HIV Seeking Medication for Opioid Use Disorder. 寻求阿片类药物使用障碍药物治疗的艾滋病毒感染者的治疗开始、药物使用轨迹和健康的社会决定因素。
IF 2.8 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-10-01 Epub Date: 2023-10-16 DOI: 10.1177/08897077231200745
Ryan R Cook, Erin N Jaworski, Kim A Hoffman, Elizabeth N Waddell, Renae Myers, P Todd Korthuis, Pamela Vergara-Rodriguez

Background: People living with HIV and opioid use disorder (OUD) are disproportionally affected by adverse socio-structural exposures negatively affecting health, which have shown inconsistent associations with uptake of medications for OUD (MOUD). This study aimed to determine whether social determinants of health (SDOH) were associated with MOUD uptake and trajectories of substance use in a clinical trial of people seeking treatment.

Methods: Data are from a 2018 to 2019 randomized trial comparing the effectiveness of different MOUD to achieve viral suppression among people living with HIV and OUD. SDOH were defined by variables mapping to Healthy People 2030 domains: education (Education Access and Quality), income (Economic Stability), homelessness (Neighborhood and Built Environment), criminal justice involvement (Social and Community Context), and recent SUD care (Health Care Access and Quality). Associations between SDOH and MOUD initiation were assessed with Cox proportional hazards models, and SDOH and substance use over time with generalized estimating equation models.

Results: Participants (N = 114) averaged 47 years old, 63% were male, 56% were Black, and 12% Hispanic. Participants reported an average of 2.3 out of 5 positive SDOH indicators (SD = 1.2). Stable housing was the most commonly reported SDOH (61%), followed by no recent criminal justice involvement (59%), having a high-school level education or greater (56%), income stability (45%), and recent SUD care (13%). Each additional favorable SDOH was associated with a 25% increase in the likelihood of MOUD initiation during the study period [adjusted HR = 1.25, 95% CI = (1.01, 1.55), P = .044]. Positive SDOH were also associated with a decrease in the odds of baseline opioid use and a greater reduction in opioid use during subsequent weeks of the study (P < .001 for a joint test of baseline and slope differences).

Conclusions: Positive social determinants of health, in aggregate, may increase the likelihood of MOUD treatment initiation among people living with HIV and OUD.

背景:艾滋病毒和阿片类药物使用障碍(OUD)患者受到不良社会结构暴露的不成比例的影响,对健康产生负面影响,这与OUD药物摄入的相关性不一致。本研究旨在确定在一项针对寻求治疗者的临床试验中,健康的社会决定因素(SDOH)是否与MOUD摄入和药物使用轨迹有关。方法:数据来自2018年至2019年的一项随机试验,该试验比较了不同MOOD在HIV和OUD患者中实现病毒抑制的有效性。SDOH是通过映射到2030年健康人群领域的变量来定义的:教育(教育机会和质量)、收入(经济稳定)、无家可归(邻里和建筑环境)、刑事司法参与(社会和社区背景)和最近的SUD护理(医疗保健机会和质量)。用Cox比例危险模型评估SDOH和MOOD引发之间的关联,用广义估计方程模型评估SDOH-物质使用随时间的变化。结果:参与者(N = 114)平均47 岁,63%为男性,56%为黑人,12%为西班牙裔。参与者报告了5项SDOH阳性指标中的平均2.3项(SD = 1.2)。稳定的住房是最常见的SDOH(61%),其次是最近没有刑事司法参与(59%)、受过高中或以上教育(56%)、收入稳定(45%)和最近的SUD护理(13%)。在研究期间,每增加一个有利的SDOH都会使MOOD发生的可能性增加25%[调整后的HR = 1.25,95%CI = (1.01,1.55),P = .044]。SDOH阳性也与基线阿片类药物使用几率的降低和随后几周阿片类物质使用的更大减少有关(P 结论:总体而言,健康的积极社会决定因素可能会增加HIV和OUD感染者开始MOUD治疗的可能性。
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引用次数: 0
Cocaine Use is Associated With Increased LVMI in Unstably Housed Women With Polysubstance Use. 在使用多种物质的不稳定家庭妇女中,可卡因的使用与LVMI的增加有关。
IF 2.8 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-10-01 Epub Date: 2023-10-13 DOI: 10.1177/08897077231199572
Akshay Ravi, Eric Vittinghoff, Alan H B Wu, Leslie W Suen, Phillip O Coffin, Priscilla Hsue, Kara L Lynch, Sithu Win, Dhruv S Kazi, Elise D Riley

Background: While substance use is known to influence cardiovascular health, most prior studies only consider one substance at a time. We examined associations between the concurrent use of multiple substances and left ventricular mass index (LVMI) in unhoused and unstably housed women.

Methods: Between 2016 and 2019, we conducted a cohort study of unstably housed women in which measurements included an interview, serum/urine collection, vital sign assessment, and a single transthoracic echocardiogram at baseline. We evaluated independent associations between 39 separate substances confirmed through toxicology and echocardiography-confirmed LVMI.

Results: The study included 194 participants with a median age of 53.5 years and a high proportion of women of color (72.6%). Toxicology-confirmed substance use included: 69.1% nicotine, 56.2% cocaine, 28.9% methamphetamines, 28.9% alcohol, 23.2% opioid analgesics, and 9.8% opioids with catecholaminergic effects. In adjusted analysis, cocaine was independently associated with higher LVMI (Adjusted linear effect: 18%; 95% CI 9.9, 26.6). Associations with other substances did not reach levels of significance and did not significantly interact with cocaine.

Conclusion: In a population of vulnerable women where the use of multiple substances is common, cocaine stands out as having particularly detrimental influences on cardiac structure. Blood pressure did not attenuate the association appreciably, suggesting direct effects of cocaine on LVMI. Routinely evaluating stimulant use as a chronic risk factor during risk assessment and preventive clinical care planning may reduce end organ damage, particularly in highly vulnerable women.

背景:虽然已知物质使用会影响心血管健康,但大多数先前的研究一次只考虑一种物质。我们研究了未使用和居住不稳定的女性同时使用多种物质与左心室质量指数(LVMI)之间的关系。方法:在2016年至2019年间,我们对居住不稳定的女性进行了一项队列研究,其中的测量包括访谈、血清/尿液采集、生命体征评估和基线时的单次经胸超声心动图。我们评估了经毒理学和超声心动图证实的LVMI中39种不同物质之间的独立相关性。结果:该研究包括194名参与者,中位年龄为53.5 毒理学证实的物质使用包括:69.1%的尼古丁、56.2%的可卡因、28.9%的甲基苯丙胺、28.9%酒精、23.2%的阿片类止痛药和9.8%具有儿茶酚胺能作用的阿片。在调整后的分析中,可卡因与较高的LVMI独立相关(调整后的线性效应:18%;95%CI 9.9,26.6)。与其他物质的关联没有达到显著水平,也没有与可卡因发生显著相互作用。结论:在易受伤害的女性群体中,多种物质的使用很常见,可卡因对心脏结构的影响尤其有害。血压并没有明显减弱这种联系,这表明可卡因对LVMI有直接影响。在风险评估和预防性临床护理规划期间,将兴奋剂的使用作为一种慢性风险因素进行常规评估,可以减少末端器官损伤,尤其是在高度脆弱的女性中。
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引用次数: 0
Association of MOUD ECHO Participation on Expansion of Buprenorphine Prescribing in Rural Primary Care. MOUD ECHO协会参与扩大农村初级保健中的丁丙诺啡处方。
IF 3.5 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-10-01 Epub Date: 2023-10-30 DOI: 10.1177/08897077231198971
Julie G Salvador, Orrin B Myers, Snehal R Bhatt, Vanessa Jacobsohn, Larissa Lindsey, Rana S Alkhafaji, Heidi Rishel Brakey, Andrew L Sussman

Background: Lack of access to buprenorphine to treat Opioid Use Disorder is profound in rural areas where over half of small and remote rural counties have no buprenorphine prescriber. To increase prescribing, an online, Medication of Opioid Use Disorder (MOUD) Extensions for Community Healthcare Outcomes (ECHO) was developed that addressed known barriers to the startup and expansion of treatment. The objective of the present study was to determine the relationship between participating in MOUD ECHO sessions and prescribing of buprenorphine for OUD in rural primary care.

Methods: Using non-random, rolling-recruitment from Feb 2018 to October of 2021, all rural primary care clinics in New Mexico were contacted via phone call and fax to recruit providers (Physicians, Nurse Practitioners, and Physician Assistants) who had no or limited buprenorphine experience to enroll in this study. Participation in the MOUD ECHO was tracked across the 12 week series. Start-up and expansion of buprenorphine treatment was measured every 3 months for up to 2 years using 5 implementation benchmarks spanning training completion, obtaining licensure, prescribing and adding patients. Using a dose-response intention to treat type analysis, associations between number of sessions and benchmark achievement were analyzed using logistic regression.

Results: Eighty providers were enrolled, mostly female (66%) white (82%), non-Hispanic (82%), and mostly nurse practitioners (51%) or MDs (38%). Achievement of prescribing benchmarks at 6 months was significantly increased by attendance at MOUD ECHO sessions including obtaining training and licensure Odds Ratio (OR = 1.24; P = .001); starting to prescribe (OR = 1.31; P = .004), and adding patients (OR = 1.14; P = .025).

Conclusions: This study provides compelling evidence that MOUD ECHO participation may significantly increase the number of providers implementing this treatment and adding patients onto their panels. The dose-response approach helps address current gaps in ECHO research that call for more rigorous examination of the ECHO model's impact on provider practice improvements.

背景:在农村地区,缺乏丁丙诺啡治疗阿片类药物使用障碍的机会是严重的,因为超过一半的偏远农村小县没有丁丙诺菲处方医生。为了增加处方,开发了一个在线的阿片类药物使用障碍(MOUD)社区医疗保健结果扩展(ECHO),解决了启动和扩大治疗的已知障碍。本研究的目的是确定参加MOUD ECHO会议与在农村初级保健中为OUD开具丁丙诺啡处方之间的关系。方法:从2018年2月到2021年10月,通过非随机滚动招募,通过电话和传真联系新墨西哥州所有农村初级保健诊所,招募没有或有限丁丙诺啡经验的提供者(医生、执业护士和医生助理)参加本研究。对12个缔约方参与谅解备忘录ECHO的情况进行了跟踪 周系列。丁丙诺啡治疗的启动和扩展每3次测量一次 最多2个月 使用5个实施基准,涵盖培训完成、获得许可、开处方和增加患者。使用剂量反应意向治疗类型分析,使用逻辑回归分析疗程次数和基准成绩之间的关联。结果:80名提供者被纳入,其中大多数是女性(66%)、白人(82%)、非西班牙裔(82%),大多数是执业护士(51%)或MD(38%)。在6时达到规定基准 通过参加MOUD ECHO会议,包括获得培训和执照的比值比(OR = 1.24;P = .001);开始开处方(或 = 1.31;P = .004),并添加患者(OR = 1.14;P = .025)。结论:这项研究提供了令人信服的证据,表明MOUD ECHO的参与可能会显著增加实施这种治疗并将患者加入其小组的提供者数量。剂量反应方法有助于解决目前ECHO研究中的空白,这些空白要求更严格地检查ECHO模型对提供者实践改进的影响。
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引用次数: 0
Erratum to Volume 44 Issue 1-2, January-April 2023. 第44卷1-2期的勘误,2023年1月至4月。
IF 3.5 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-07-18 DOI: 10.1177/08897077231185670
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引用次数: 0
期刊
Substance abuse
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