Journal of Addictive Diseases最新文献

Background: The current study uses geographic information system (GIS) methods to better understand structural risks significantly associated with substance misuse and how those risks may be driven by urbanicity versus rurality.

Methods: Using Alabama Medicaid administrative claims data from January 1, 2015, to December 31, 2020, we identified Medicaid recipients with claims for methamphetamine use. Our dataset included 100% of claims for the 2015-2020 study period. County-level geocodes were also obtained for each Medicaid recipient aged > 18 years (n = 9,861). We added a rural-urban designation variable for each county by utilizing the rural-urban continuum codes from the United States Department of Agriculture.

Results: Fifty-one counties (76.12%), specifically, had changes in methamphetamine use rates > 0% during the study period, with 10 (14.93%) counties exhibiting >100% increases in methamphetamine use rates. Findings suggest that Alabamians residing in rural portions of the state engaged in greater usage as compared with those in urban locations.

Conclusion: Findings point to the need for intervention in rural Alabama targeting methamphetamine use. The development of prevention and intervention approaches that target risks stemming from geographical differences may bolster current efforts to reduce methamphetamine and other forms of substance misuse.

Oxymetazoline hydrochloride 0.05% is a lipophilic sympathomimetic nasal decongestant spray available over the counter (OTC) and commonly used for allergic and chronic rhinitis. A well-known side effect of these nasal sprays is rebound congestion termed rhinitis medicamentosa (RM), but there is little literature attesting to the relationship between RM and substance use disorder. This is a case report of severe nasal spray oxymetazoline use disorder per DSM-5 criteria discovered incidentally in a 44-year-old patient receiving care at a residential addiction treatment center for long-standing polysubstance use and bipolar disorders. The patient began using oxymetazoline in 2003 for allergic rhinitis and developed rhinitis medicamentosa that progressed to an oxymetazoline use disorder. Despite medical and clinical interventions, cravings and urges prevented her from stopping the nasal spray. We discuss the pharmacological properties of oxymetazoline, the behavioral aspects of its intranasal administration, and the drug-induced rebound congestion that may contribute to its misuse. To our knowledge, this is the first reported case of oxymetazoline use disorder lasting 20 years.

Methadone maintenance therapy is the cornerstone of treatment for heroin addiction. Hyperhidrosis is a common and often-overlooked side effect of methadone. Different medications, such as antihistamines and anticholinergic drugs, have been reported to be effective against opioid-induced sweating, but there is no standardized therapy. A 51-year-old patient under methadone maintenance therapy reported long-standing hyperhidrosis, which worsened each time the methadone dosage was increased. After substituting methadone with levomethadone, while maintaining equivalent dosages, the patient reported a stark reduction in sweating. Therefore, levomethadone could be a promising alternative for patients in methadone maintenance therapy who suffer from methadone-induced hyperhidrosis.

Objectives: There is increasing evidence of ketamine's therapeutic potential in reducing substance use in individuals with substance use disorders. However, its effects on tobacco use disorder are unknown. We investigated the effect of a subanesthetic dose of ketamine on tobacco use.

Methods: This randomized, single-blind, placebo-controlled, pilot study administered intravenous ketamine to individuals with tobacco use disorder recruited from the local community. Participants were randomized to receive either ketamine (0.5 mg/kg) (n = 6) or saline placebo (n = 4) over 20 min. Primary outcomes included measures of drug safety and tolerability during and within an hour after the infusion. Secondary outcomes included measures of tobacco use, craving, and withdrawal before, and 24-hours after, the drug infusion study day. A follow-up visit occurred eight days after the infusion.

Results: Intravenous ketamine was well tolerated with transient side effects. No significant effects were noted on cigarette smoking, craving, or withdrawal symptoms on the post-infusion visit following overnight abstinence or on the follow-up visit (p's > 0.05).

Conclusions: Although limited by the small sample size, this pilot study extends previous research on ketamine for substance use disorders. While ketamine was well tolerated in this sample, additional research testing different ketamine doses and administration routes is necessary to determine whether ketamine has therapeutic potential for tobacco use disorder.

Opioid use disorder (OUD) is associated with a reduction in brain white matter, affecting critical areas involved in decision-making, impulse control, and reward processing. The FDA has approved several drugs and natural compounds that enhance myelination, targeting oligodendrocyte progenitor cells (OPCs), directly enhancing oligodendrocyte (OL) function, or acting as cofactors for myelin production. This retrospective case study aimed to assess whether current clinical evidence supports the use of myelin-enhancing agents to promote remission in OUD. We evaluated a range of compounds with demonstrated effects on myelination, including muscarinic antagonists, cholesterol and lipid homeostatic agents, anti-aging drugs, immunomodulatory agents, anti-inflammatory medications, and others (25 medications in total), as well as 17 vitamins and supplements. Buprenorphine and methadone were used as positive controls. Sequential analyses were performed to identify individual drugs driving significant changes in remission rates (p ≤ 0.01; N ≥ 3,000) and their effects across age, sex, and Body Mass Index (BMI) categories. Three key findings emerged: (1) melatonin improved remission rates in males but showed no effect in females; (2) ibuprofen significantly increased remission rates, particularly in individuals aged 20-39 and 40-59 years; and (3) thiamin was associated with decreased remission rates in males and individuals with a BMI ranging from normal weight to obese. Additionally, buprenorphine and methadone were confirmed as effective in promoting remission. These findings highlight the importance of personalized medicine in treating OUD and suggest that further research is needed to explore individualized treatment strategies based on sex, age, and BMI.

Methods: This descriptive-analytical study included a self-report questionnaire based on the TPB model, and was distributed to a sample of 115 people recovering from SUD, aged 18-69, 62% of whom were men.

Results: Attitude, Subjective Norms (SN), and Perceived Behavioral Control (PBC) toward online addiction treatment was significantly positive in relation to intention and past behavior of participants in online addiction treatment. Attitude and PBC were found to be significant predictors, and the TPB model was found to be significant {F (3,111) = 47.29, p < 0.01}, explaining 56% of the variance of intention for participants in online addiction treatment.

Conclusion: As online treatment is a relatively new tool in addiction treatment, professionals and treatment providers should encourage beliefs, attitudes, moral norms, and perceived behavior control to increase intentions among future participants in online addiction treatment.

Background: Consuming opioid agonists is a risk factor for cardiovascular disease particularly in intravenous heroin users. The monthly injectable extended-release opioid antagonist, naltrexone (XR-NTX) is an effective treatment for opioid use disorder. The impact of opioid receptor blockade through XR-NTX on blood pressure, a critical risk factor for cardiovascular morbidity, has not yet been characterized.

Methods: The study evaluated the change in blood pressure during XR-NTX treatment among 14 patients who predominately used intravenous heroin and 24 patients who used prescription oral opioids, all with opioid use disorder. Blood pressure was measured in each patient immediately before the first XR-NTX injection and ∼two weeks after the first injection. The change in diastolic and systolic pressure was compared between the heroin users and the prescription opioids users using analysis of variance.

Results: XR-NTX treatment was associated with significant decreases in diastolic blood pressure in the heroin group, but not in the prescription opioids group. Systolic blood pressure values in the heroin users showed a decline at trend level only.

Conclusions: Further research is warranted to replicate our findings and to determine whether XR-NTX effect is relatively specific to blood pressure or generalizes to other components of metabolic syndrome. Distinguishing between heroin and prescription opioid users could shed light on the unique clinical and pharmacological profiles of opioid drugs, particularly regarding their cardiovascular safety. This information can be useful in developing personalized therapeutic strategies based on the route of opioid administration.

Background: Most studies on Food Addiction (FA) used the strict classical diagnosis approach without quantifying sub-threshold symptoms (i.e. uncontrolled/excessive food intake, negative affect, craving, tolerance, withdrawal, and continued use despite harm) nor indicating where they stand on the "three-stage addiction cycle" modeling the transition from substance use to addiction.

Objectives: (1) to estimate the proportion of clinically significant episodes of distress/impairment in severely obese patients without FA, and (2) to assess their associations with FA symptoms at the subthreshold level.

Methods: The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) assesses 11 symptoms (diagnostic criteria) plus clinically significant impairment and distress (clinical significance criterion). We used this tool to diagnose FA (≥ 2 criteria plus clinical significance) in adult patients with severe obesity, but included only those below the threshold in the analyses. Demographics, clinical features, and obesity complications were collected.

Results: Only 18% of the 192 participants (women n = 148, 77.1%; mean age: 43.0 ± 13.2) reported a total absence of FA symptoms, while one in four reported recurrent episodes of clinically significant distress (24%) or impairment (25%) in social, occupational, or other important areas of functioning. The most common recurrent symptoms were first-stage symptoms (binge/intoxication), while second- (withdrawal/negative affect) and third-stage (preoccupation/anticipation) symptoms affected nearly one patient in five for tolerance and craving, and one in ten for withdrawal. In multivariate analysis, impairment was positively related to withdrawal and tolerance, while distress was positively related to failure in role obligations.

Conclusion: Many patients with severe obesity experience recurrent episodes of FA symptoms at the subthreshold level. Prospective studies will examine whether these symptoms may play a causal role in symptoms progression toward a full-blown FA and obesity outcomes.

Neuroimaging has continually advanced, playing a crucial role in the accurate diagnosis of various brain pathologies and disorders. This integrative review aimed to identify the main changes in brain connections found in fMRI scans of individuals with Internet Gaming Disorder (IGD). The data collection method involved searching for the terms "Magnetic Resonance Imaging", "Psychological Dependence" and "Internet Addiction Disorder" in the PubMed and Embase databases. Studies published between 2020 and January 2023 were included and manually analyzed through the virtual environment created in the "Rayyan" software, compiling a total of 18 scientific studies. The main findings reveal changes such as significant increases or decreases in functional connectivity in certain regions of the brain. Some potential negative impacts on the uncontrolled use of technologies among the young population were evaluated, such as the loss of inhibitory control in decision-making, transforming leisure into dependence, and although the IGD understands the associated risks and harms, it faces difficulties in resisting the desire to stop playing. This situation emphasizes the need for more long-term studies that can be comparative between different age groups. Conclusion, the brain regions with the most significant changes in functional connectivity in individuals with IGD symptoms are the prefrontal cortex, fronto-parietal regions, frontal gyrus, insula lobe, cingulate cortex and striatum. The lack of comprehensive knowledge about the effects of video game addiction across different age groups is a significant concern. Therefore, it is essential to carry out research that evaluates the impact of these technologies on different stages of human development.

Background: There has been extensive research demonstrating the effectiveness of medications for opioid use disorder (MOUD) but limited investigation into its long-term retention rate.

Objective: Assess the long-term treatment retention of a buprenorphine-based MOUD clinic with additional stratifications by age and gender.

Methods: This retrospective study analyzed 10-years of data from a MOUD clinic in West Virginia that served 3,255 unique patients during the study period (2009-2019). Retention was measured by summation of total treatment days with a new episode of care defined as re-initiating buprenorphine treatment after 60+ consecutive days of nonattendance. Kaplan-Meier survival analysis, with the log-rank test, was used to compare retention by gender and age.

Results: The mean age was 38 (SD = 10.6) and 95% were non-Hispanic white. Irrespective of treatment episode, 56.8% of patients were retained ≥ 90 days, and the overall median time in treatment was 112 days. Considering only the first treatment episode, 48.4% of 3,255 patients were retained at least 90 days and the overall median was 77 days. Female patients had a ≥ 90 day retention rate of 52.2% for the first admission and 60.1% for multiple admissions, both significantly higher than those of male subjects (44.1% and 53.0%). Additionally, patients ≤ 24 years old had the lowest rate of treatment retention, while patients aged ≥ 35 had the highest.

Conclusions: This study adds to the limited data regarding long-term retention in MOUD. Our findings indicate gender and age were highly correlated with retention in MOUD treatment.