Journal of Addictive Diseases最新文献

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.

Introduction: Emergency departments (EDs) are critical points of contact for individuals at high risk, as opioid use disorder (OUD) remains a major public health crisis. While Screening, Brief Intervention, and Referral to Treatment (SBIRT) andother brief intervention (BI) models have been promoted as pragmatic approaches in acute care, their efficacy for OUD is uncertain. In contrast, ED-initiated buprenorphine (BUP) has shown promise for improving outcomes, but comparative trial data require synthesis.

Methods: Following PRISMA 2020 guidelines, we reviewed randomized and nonrandomized clinical trials comparing ED-initiated BUP with BI, referral, or usual care. Primary outcomes were treatment engagement and retention; secondary outcomes included opioid use, overdose risk behaviors, and healthcare utilization. Searches were conducted in PubMed, Scopus, Google Scholar, Web of Science, and trial registries through January 29, 2025. Risk of bias was assessed using ROB-2, and data were pooled via random-effects models.

Findings: Nine trials (n = 1,172), primarily from North America, met inclusion criteria. Compared with BI (52%), BUP initiation yielded higher adherence (61%) and lower opioid use prevalence (17% vs. 28%). Multiple RCTs consistently favored BUP for short-term engagement, whereas BI showed minimal effects on treatment utilization, overdose risk, or substance use outcomes. Considerable heterogeneity (I² ≈ 99%) and potential publication bias were observed.

Conclusion: ED-initiated BUP is superior to BI for short-term treatment engagement and reducing opioid use, reinforcing its role as a frontline intervention in acute care. Nevertheless, high heterogeneity, short follow-up, and limited geographic scope constrain the evidence base, highlighting the need for broader and longer-term studies.

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: No FDA-approved medications for methamphetamine (MA) use disorder (MUD) are available. Suvorexant (SUVO), a dual orexin receptor antagonist that is FDA approved for insomnia treatment, reduces MA self-administration and MA-induced reinstatement responding in preclinical studies. SUVO may also reduce MA use by targeting substance use risk factors, including insomnia, stress, cue reactivity, and craving. This case series study assessed the (1) feasibility and safety of administering suvorexant in a sample of individuals with MUD; and (2) preliminary effects of suvorexant on objective and subjective measures of sleep, stress, and cue reactivity/craving. Method: Participants (n = 3) were randomized to receive 1 week of SUVO or placebo using a within-subject, crossover design with a 1-week washout period between doses. Participants completed self-report (sleep quality, stress), behavioral (cold pressor task), and physiological measures (heart rate, electroencephalogram) during all three weeks. Participants wore a Fitbit to monitor sleep throughout the study. Results: Participants completed all study visits and tasks. One report of severe drowsiness and of severe headache were made; no other severe side effects were associated with SUVO. SUVO improved total sleep time and resulted in lower resting-state alpha power, but was mixed for subjective sleep quality. SUVO administration was associated with increased overall brain reactivity to cues that was not specific to MA cues and also reduced stress, though self-reported stress demonstrated mixed results. Conclusion: Suvorexant was safe and tolerable in a MUD sample. Future research may benefit from investigating SUVO in a well-controlled study with a larger sample.

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: To examine whether various quit strategies and relapse triggers are associated with maintenance period in a sample of people who quit vaping.

Method: Young Canadians who used to vape (N = 772) completed an online survey on maintenance period, quit strategies, and relapse triggers. Logistic regression was employed to variables associated with maintenance period.

Results: People with past vaping history who quit unassisted or through eliminating social influences were more likely to achieve long-term maintenance. Those who quit through thinking about health improvements, distraction techniques, or self-restriction were less likely to achieve long-term maintenance. Other substance use or sensory vaping cues as relapse triggers were less likely to be experienced for those in long-term maintenance. Using very high concentrations of nicotine prior to quitting, and being unemployed were associated with lower likelihood for long-term maintenance.

Conclusions: It is important to consider quit strategies, relapse triggers, and nicotine use prior to quitting in vaping cessation programing as they are related to maintenance period.

Introduction: Stigma within communities is pervasive and a barrier to substance use disorder (SUD) treatment. The current proof-of-concept study evaluated enCompass, a community-based SUD knowledge and stigma intervention.

Methods: In 2021, 22 enCompass trainings were offered to community members in partnership with the Ohio Governor's RecoveryOhio initiative to 22 Ohio counties with high numbers of overdose deaths. Participants of the current study included 492 individuals who completed surveys measuring knowledge of SUD treatment and medication, and SUD stigma (i.e., stereotypes, prejudice, discrimination), before and after the intervention. Implementation-related outcomes (i.e., acceptability, appropriateness, feasibility) were also measured after the intervention.

Results: Participants' knowledge increased, and their SUD stigma decreased, from before to after the intervention. Participants strongly agreed that the intervention was acceptable, appropriate, and feasible.

Discussion: Although more testing with longitudinal, randomized designs is needed, preliminary results suggest that enCompass is a promising community-based SUD knowledge and stigma intervention.

The illicit production, trafficking, and consumption of Captagon an amphetamine-type stimulant (ATS) has surged dramatically in West Asia, posing complex public health, security, and socio-political challenges. Originally synthesized as a therapeutic agent, Captagon's potent stimulant effects have made it a favored substance among combatants and youth in conflict zones, notably in Syria and neighboring countries. This comprehensive review synthesizes current knowledge on Captagon's chemical properties, pharmacology, and associated health consequences, alongside the socio-cultural, religious, regulatory, and geopolitical factors underpinning its endemic presence in West Asia. We critically examine the roles of conflict economies, fragile governance, and regional rivalries in sustaining illicit markets and assess the fragmented regulatory frameworks and enforcement challenges. Drawing on successful drug control models from low-prevalence countries, we propose integrated, context-sensitive strategies emphasizing governance reform, regional cooperation, public health expansion, and socio-economic interventions. Significant knowledge gaps remain, particularly regarding epidemiology, trafficking networks, and demand drivers, underscoring the urgent need for interdisciplinary research and enhanced real-time surveillance. Our findings highlight that multidimensional, regionally coordinated efforts, informed by robust evidence, are essential for mitigating the Captagon crisis and its far-reaching impacts in West Asia.