Journal of Addictive Diseases最新文献

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.

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.

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.

Concurrent use of benzodiazepines (BZDs) and opioids in patients with opioid use disorder (OUD) is prevalent and poses significant clinical challenges, including increased risks of overdose, ER visits, and treatment discontinuation. This article synthesizes current evidence on the prevalence, risks, and management of BZD co-use in OUD, focusing on patients receiving medications for OUD (MOUD) such as buprenorphine and methadone. Data indicate that approximately 16-21% of patients on buprenorphine and up to 40-47% of those on methadone use BZDs, with nonmedical use linked to a significant increase in overdose-related emergency visits and overdose mortality (95% CI: 7.8-13.2). We propose an evidence-informed framework for managing co-use, prioritizing OUD stabilization, close monitoring and harm reduction, gradual BZD tapering, and integrated psychosocial interventions. This approach balances safety and efficacy, ensuring patient-centered care while mitigating risks.

Background: Despite the rising prevalence of methamphetamine use disorder (MUD) among adolescents and its severe consequences, data on hematological inflammatory indices in this population remain limited.

Objectives: This study aimed to evaluate systemic inflammatory markers in adolescents with MUD and their associations with addiction severity.

Methods: The retrospective case-control study included 44 adolescents with MUD and 44 age- and gender-matched healthy controls. Hematological indices were calculated from complete blood count data, including neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), Basophil-to-lymphocyte ratio (BLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI). Group comparisons, receiver operating characteristic (ROC) analyses, and partial correlations were performed.

Results: The MUD group included 30 females (68.2%) and 14 males (31.8%); the control group included 25 females (56.8%) and 19 males (43.2%). Adolescents with MUD showed significantly higher neutrophil and platelet counts, NLR, dNLR, PLR, MLR, SII, SIRI, and AISI, alongside reduced lymphocyte counts, compared with controls (all p < .05). ROC analyses revealed good discriminative ability for SII (AUC = 0.79), AISI (AUC = 0.73), and SIRI (AUC = 0.69). Several indices, including NLR, PLR, and SII, correlated negatively with treatment motivation, while PLR and MLR correlated positively with diagnostic severity.

Conclusions: Adolescents with MUD demonstrate marked systemic inflammatory alterations detectable through routine hematological indices. These markers may serve as low-cost, clinically accessible biomarkers for identifying high-risk individuals and monitoring disease severity, with implications for early intervention and personalized treatment.

Background and objectives: Reaching the maintenance phase and reducing illicit substance use in those with severe opioid use disorder (OUD) remains a large clinical challenge. The use of intravenous opioid agonist treatment has become a last-line treatment for severe OUD. In this case series, we describe a novel form of this treatment using both long-acting buprenorphine and injectable hydromorphone.

Methods: Retrospective chart review of cases in specialized enhanced addiction treatment centers in Alberta, Canada of patients prescribed long-acting injectable buprenorphine and intravenous hydromorphone.

Results: We describe four cases of males ranging from 39 to 64 years of age with treatment-refractory opioid use disorder and multiple concurrent mental health and social issues who have experienced various periods of stability on long-acting injectable buprenorphine and along with intravenous hydromorphone or slow release oral morphine).

Discussion and conclusions: This case series presents a novel treatment combining buprenorphine extended-release injection with hydromorphone or slow release oral morphine for individuals with OUD who have not responded to standard opioid agonist treatment. The approach showed promise in managing withdrawal and cravings, potentially improving treatment retention. Further research is needed to evaluate long-term outcomes and optimize retention strategies to reduce opioid-related mortality.

Cocaine use disorder (CUD) is a significant public health issue, and cocaine's common pairing with alcohol has been linked to adverse cardiovascular outcomes. Among adults with unhealthy alcohol use, we investigated whether co-occurring CUD was associated with excess risk of acute coronary syndrome (ACS). We retrospectively studied 413,511 adults in Northern California from June 1, 2013 to December 31, 2022, with documented unhealthy alcohol use, defined as exceeding either the daily limit and/or weekly drinking limits recommended by the U.S. National Institute of Alcohol Abuse and Alcoholism (NIAAA) guidelines. Using health system electronic health record (EHR) data, concomitant CUD was ascertained from ICD-9/10 diagnosis codes, and alcohol consumption from patient self-report on screening questionnaires. During a follow-up period of up to 9.5 years, ACS was defined as a primary hospital discharge ICD-9/10 diagnosis code for unstable angina or myocardial infarction with elevated cardiac troponin I. Logistic regression evaluated the association of concomitant CUD and alcohol consumption levels with ACS. Models were adjusted for demographic, socioeconomic, and clinical covariates, including cardiovascular risk factors. The prevalence of CUD diagnoses was 0.6%, and 12.4% of the cohort exceeded both daily and weekly drinking limits. CUD was not significantly associated with ACS (adjusted odds ratio [aOR] = 1.27 [95% CI: 0.94-1.73]). Patients who exceeded daily and weekly drinking limits had higher odds of ACS, compared to those who exceeded only daily limits (aOR = 1.20 [95% CI: 1.12-1.28, p < .001). Among adults with unhealthy alcohol use, diagnosed CUD was not significantly linked to ACS. The heaviest drinking pattern was associated with a modestly higher adjusted risk of ACS.