Journal of Addictive Diseases最新文献

Background: Individuals who use both cigarettes and e-cigarettes may have multiple nicotine product use self-identities, each of which may be associated with patterns of use, including cessation.

Objectives: This study examined changes in "smoker" and "vaper" identities and product use behaviors over one year among adults who used both cigarettes and e-cigarettes. We hypothesized that stronger baseline vaping identities would be associated with higher odds of smoking cessation, and stronger baseline smoking identities would be associated with continued cigarette use.

Methods: Participants (N = 364), who were recruited for an observational study of cigarette and e-cigarette use, completed measures of "smoker" and "vaper" identity, nicotine dependence, and product use at baseline and 12 months. We examined associations between smoking and vaping identities and tobacco product use. Logistic regression evaluated the effects of age, gender, and baseline smoking and vaping identities on continued smoking or abstinence at 12 months.

Results: Smoking and vaping identities were independent at baseline (p = .51) but associated at 12 months (p = .0001). At 12 months, "ex-smokers" had higher e-cigarette use than "smokers" and "social/occasional smokers" (p <.0001). Those who identified as "vapers" at baseline had lower odds of smoking at 12 months (OR = 2.27, "non-/ex-vaper" vs "vaper"; OR = 2.05, "social/occasional vaper" vs "vaper").

Smoking and vaping identities are associated with changes in tobacco product use over time.

Background: Cannabis use has increased in prevalence over the past several decades, and novel forms of cannabis (e.g., concentrates and edibles) have become readily available.

Objective: The purpose of this narrative review was to compare the prevalence of use, methods of consumption, and risk for cannabis use disorder outcomes across cannabis forms to better understand the diversifying landscape of cannabis products and practices.

Methods: The electronic database PubMed was used to find relevant articles with keyword searches related to the prevalence of use, methods of consumption, and risk for cannabis use disorder for three major forms of cannabis (flower, concentrates, and edibles).

Results: Use of all three major forms is prevalent among many cannabis users, but there are differences in user demographics and methods of consumption. Use of cannabis concentrates may be associated with a greater risk for cannabis use disorder. Given the historical predominance of cannabis flower use, many outcomes have not been compared with concentrates or edibles. Furthermore, form-specific longitudinal data is lacking.

Conclusions: Given the more recent emergence of novel cannabis products, comparisons of the long-term outcomes of use for each form are needed to advance the development of more informed harm reduction practices that are common to and specific to each form of cannabis.

Background: E-cigarette use has risen rapidly, especially among young people. TikTok is one of the most commonly used social media platforms among young people. The representation of vaping cessation messages in TikTok content remains unexplored. We aimed to address this gap by analyzing the vaping cessation content prevalent on TikTok.

Methods: This cross-sectional mixed methods study analyzed the top 100 TikTok videos-determined based on view-counts-related to vaping cessation. Our quantitative analysis examined video characteristics, while our qualitative analysis identified key thematic representations.

Results: The final sample included 87 videos, with a combined total of over 100 billion views. Most videos were created by regular users (general TikTok content creators) rather than those identifying as health experts or professionals such as doctors, acupuncturists or dental hygienists. Very few posts mentioned evidence-based cessation aids or support. Videos scored high on understandability but low on actionability based on standardized criteria. Qualitative analysis identified nine key themes: motivations for quitting, barriers to quitting, use of aids and strategies, relapse experiences, identity and self-image, celebrating cessation success, emotional journey of quitting vaping, seeking social support, and limited mentions of healthcare providers.

Conclusions: TikTok appears to be a useful influential forum for studying quitting behavior through the sharing of personal experiences and perspectives on vaping cessation. Opportunities exist to integrate evidence-based messaging and support into this platform. Findings can inform social media interventions designed to counter pro-vaping content and promote quitting e-cigarette use.

Implications: Partnerships among health professionals, public health experts, and social media influencers may be leveraged to disseminate proven vaping cessation techniques on leading social media platforms such as TikTok.

Background: Persons with opioid use disorder (OUD) urgently need improved access to medications for opioid use disorder (MOUD) and long-term treatment. Promising options include initiating buprenorphine in the emergency department (ED), telemedicine, and proactive treatment referrals before overdose events.

Objective(s): We describe the process and outcomes of a novel referral path utilizing preemptive outreach and telemedicine to facilitate rapid access to MOUD and long-term treatment.

Methods: Participants were referred to telemedicine appointments with ED providers for buprenorphine initiation and to treatment agencies via an electronic referral network. Administrative data tracked participation at each stage of the process. Independent samples t-tests and chi-square tests assessed differences in process completion based on demographics.

Results: 163 persons with OUD or recent opioid overdose were referred, with high rates of participant follow-through, resulting in 126 new buprenorphine prescriptions and 114 linkages to long-term treatment. Of the 163 patients referred, 114 (69.9%) completed all steps. Participant demographics were not associated with significantly different completion rates.

Conclusions: This model serves as a viable pathway to link people to treatment resources and MOUD, and novelly combines prospective client outreach with telemedicine to reach persons before they arrive in the ED following an overdose. Future studies should examine the impact of similar programs on subsequent opioid use rates and treatment retention.

Opioid-related overdose deaths have significantly increased in the USA and in Alabama. Despite this, medications for opioid use disorder (MOUD) remains significantly underutilized. Thus, this study aims to gain a better understanding of clinicians' viewpoints on potential barriers and opportunities that are likely to impact and improve the access to MOUD, especially buprenorphine prescribing. A cross-sectional survey study was conducted with Alabama's clinicians (n = 492). The survey containing a QR code was mailed to clinicians throughout the state and was asked about their viewpoints and thoughts on prescribing buprenorphine. Multivariable linear regression was used to examine associations between OUD self-efficacy, beliefs about the effectiveness of MOUD, attitudes regarding whether or not MOUD is addictive, and positive affect surrounding the treatment of OUD patients. A minority of respondents (39.8%) reported that they have an active X-waiver for MOUD. Results showed that beliefs that MOUD is addictive were significantly inversely correlated with beliefs about MOUD being effective. Furthermore, both self-efficacy and positive affect were significantly and positively associated with beliefs that MOUD is effective. Furthermore, nurse practitioners were more likely than physicians to have higher scores on the "MAT is Addictive" construct. Self-efficacy with OUD patients was positively associated with the "MOUD is Effective" construct. Finally, results showed that X-waivered providers expressed greater positive affect toward OUD patients than providers who were not X-waivered (b = 2.9, p < 0.001). Belief that MOUD is effective was also positively associated with higher scores on the positive affect construct (b = 0.5, p < 0.001). Several barriers and opportunities were identified in our survey data which could be used to explore MOUD expansion, especially buprenorphine prescribing. Strategic plans in expanding MOUD access may include educational trainings on MOUD, motivating clinicians to utilize their capacity by implementing incentive plans, increasing provider self-efficacy, reducing stigma around MOUD, and providing more financial support to uninsured patients.

Background: Psychoactive substance use among pregnant women has reached alarmingly high rates. Our aim was to characterize the psychiatric and clinical profiles of pregnant crack users in Brazil.

Methods: This was a cross-sectional study of 24 pregnant crack users admitted to a referral hospital for psychiatric disorders in pregnant women, in Porto Alegre, Brazil, over three years. The following instruments were applied: a clinical-obstetric questionnaire; the condensed version of the Addiction Severity Index; a diagnostic interview for psychoactive substance use based on DSM-5; the Mini International Neuropsychiatric Interview for DSM-IV; and the Semi-Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II).

Results: Most patients had severe crack dependence and used other substances, such as tobacco, cannabis, and alcohol. The median duration of crack use was three years, ranging between three and 12 years. Most women subsisted from illegal or informal activities; a fifth had previously been arrested and often had relationship problems. Twenty percent had HIV (n = 5), and 37.5% (n = 9) had syphilis. Borderline personality disorder was the most prevalent mental condition (62.5%), followed by suicidal tendencies (45.8%), hypomanic episodes due to substance use (37.5%), and past major depressive episodes (33.3%).

Conclusions: An alarmingly high prevalence of consumption of other drugs, psychiatric disorders, and difficult-to-treat personality disorders was observed in our study. Investigating the psychiatric profile of women who use substances is essential to minimize the impacts on the mother and child, optimize therapeutic approaches to comorbidities, and enable more effective relapse prevention.

Objectives: Chronic pain is both an important antecedent and consequence of substance use. Although evidence suggests healthcare professionals may be uniquely vulnerable to chronic pain, this vulnerability remains largely unexamined in the context of recovery from substance use disorders (SUDs). We characterized pain in a sample of treatment-seeking individuals, examined potential differences in pain trajectories between healthcare professionals and non-healthcare patients, and interrogated potential pain-related vulnerabilities in treatment outcomes between these groups. Methods: Patients with SUDs (n = 663; 251 women) completed questionnaires indexing pain intensity, craving, and abstinence self-efficacy (including self-efficacy in pain-related contexts). Assessments were conducted at treatment entry, 30 days, and discharge. Analyses included chi-square and longitudinal mixed models. Results: The proportion of healthcare and non-healthcare patients endorsing recent pain was equivalent (χ²=1.78, p=.18). Healthcare professionals reported lower pain intensity (p = 0.02) and higher abstinence self-efficacy (p < 0.001). Profession by pain interactions (ps <.040) revealed that among medical professionals, associations between pain and all three treatment outcomes of interest were more robust relative to the non-healthcare group. Conclusions: Results suggest that although healthcare professionals endorse similar rates of pain and lower average pain intensity, they may be uniquely vulnerable to pain-related disruptions in craving and abstinence self-efficacy.

Objectives: To describe the use of buprenorphine/naloxone micro-inductions in hospitalized patients and characterize the success rate of these inductions.

Methods: We conducted a retrospective chart review of hospitalized patients receiving a buprenorphine/naloxone micro-induction for opioid use disorder in a tertiary care hospital from Jan 2020-Dec 2020. The primary outcome was a description of the micro-induction prescribing patterns used. The secondary outcomes were a description of the demographic characteristics of patients, the estimated frequency of withdrawal symptoms experienced by patients undergoing a micro-induction, and the overall success rate of the micro-inductions defined as retention on buprenorphine/naloxone therapy with no precipitated withdrawal experienced.

Results: Thirty-three patients were included in the analysis. Three main micro-induction regimens were identified, including rapid micro-inductions (8 patients), 0.5 mg SL BID initiations (6 patients), and 0.5 mg SL daily initiations (19 patients). Twenty-four patients (73%) met the criteria for a successful micro-induction, defined as being retained in buprenorphine/naloxone therapy with no precipitated withdrawal experienced. The most common reason for micro-induction failure was patient request to discontinue buprenorphine/naloxone therapy due to perceived adverse effects or personal preference.

Conclusion: Buprenorphine/naloxone micro-induction in hospitalized patients resulted in a majority of patients being successfully initiated on buprenorphine/naloxone therapy without requiring opioid abstinence prior to induction. Dosing regimens were variable, and the ideal regimen remains unclear.

Background: Maternal opioid use (MOU) remains a public health concern. Studies have demonstrated significant increases in MOU, but estimates using ICD-10-CM or stratified by sociodemographic variables are limited.

Objectives: Using a statewide, population-based dataset of Florida resident deliveries from 2000 to 2019, we examined the trend of MOU by age, race/ethnicity, education level, and insurance.

Methods: Florida administrative data was used to conduct a retrospective cohort study. MOU was identified using opioid-related hospital discharge diagnoses documented prenatally or at delivery. Maternal sociodemographic variables were obtained from Florida vital statistics. Joinpoint regression was used to identify statistically significant changes in the trends overall and stratified by sociodemographic variables. Results are presented as annual percentage changes (APC) and 95% confidence intervals.

Results: Our sample included over 3.6 million Florida resident mothers; of which, MOU was identified in 1% (n = 22,828) of the sample. From 2000 to 2019, MOU increased over ten-fold from 8.7 to 94.7 per 10,000 live birth deliveries. MOU increased significantly from 2000 to 2011 (APC: 32.8; 95% CI: 29.4, 36.2), remained stable from 2011 to 2016, and decreased significantly from 2016 to 2019 (APC: 3.9; 95% CI: -6.6, -1.0). However, from 2016 to 2019, MOU increased among non-Hispanic Black mothers (APC: 9.2; 95% CI: 7.5, 11.0), and those ages 30-34 (APC: 2.9; 95% CI: 1.2, 4.6) and 35-39 (APC: 6.4; 95% CI: 4.3, 8.4).

Conclusions: Accurate prevalence estimates of MOU by sociodemographic factors are necessary to fully understand prevalence trends, describe the burden among sub-populations, and develop targeted interventions.

Causal inference represents a rapidly expanding interdisciplinary subfield that involves various assumptions, study designs, and estimation strategies, allowing researchers to establish causal relationships from both clinical trials and observational data. In tobacco research, numerous studies address causal questions, including the contentious issue of whether vaping in nonsmoking youth leads to smoking initiation, known as the "gateway effect." Determining the effectiveness and safety of many health interventions will continue to rely on observational [mainly longitudinal] data because randomized trials are not always feasible, ethical, or timely. Therefore, review articles that are synthesizing evidence on the gateway effects of electronic nicotine delivery systems [ENDS] on subsequent cigarette smoking must also consider observational studies as first-rate evidence that can help bring together the polarized tobacco research community and help better understand the "gateway effect." In addition, this will help ongoing efforts to rigorously prevent ENDS use by youth while expanding the cessation potential of ENDS among adult established smokers who are unwilling to quit otherwise. In this commentary, we discuss causal inference tobacco research as one of the public health challenges and provide some recommendations/implications.