Journal of Addictive Diseases最新文献

Introduction: Injectable extended-release buprenorphine is an effective treatment for opioid use disorder (OUD), but injection site reactions (ISRs) are common treatment-emergent adverse events that may impact patient comfort, adherence, and outcome. This report examines the clinical presentation, prevalence, and management of Sublocade-related ISRs through two case studies and a review of existing literature.

Case presentation: We present two cases of ISRs in patients receiving extended-release buprenorphine, Sublocade. The first involves a 65-year-old male who experienced localized pain, swelling, and erythema after the injection. The second case features a 58-year-old male with injection site swelling, tenderness, and presumed cellulitis. We also examine ISR prevalence and severity from clinical trials and real-world data.

Management & outcomes: Both patients received timely care and responded well to appropriate interventions. The first case was managed conservatively with cold compresses, topical hydrocortisone, and ibuprofen, resulting in symptom resolution. The second case required oral antibiotics after ultrasound imaging revealed a subcutaneous fluid collection; the cellulitis resolved without systemic complications.

Conclusion: While ISRs associated with Sublocade are common, most are manageable with conservative interventions. Emphasizing patient education, proper injection techniques, and site rotation is essential to prevent ISRs, minimize their severity, and enhance treatment outcomes in patients with OUD.

Background: Comorbidity between opioid use disorder (OUD) and chronic pain is substantial. Pain has been shown to be a motivator for OUD onset, maintenance, relapse, and treatment delay. A cluster of pain conditions known as chronic overlapping pain conditions (COPCs), also now referred to in contemporary ICD classification as primary pain conditions, are particularly refractory to traditional forms of pain treatment, and likely adversely impact comorbid OUD.

Objective: This cross-sectional descriptive study sought to obtain a better understanding of the prevalence of COPCs among individuals with OUD.

Methods: The COPCs screener was originally developed to address the challenges of readily assessing for multiple of these conditions; which is important given that the number of said conditions acts as a marker for the likely presence of nociplastic pain. This screener was used alongside supplementary survey items to describe COPCs and pain distribution in a sample of individuals with active OUD recruited from a syringe exchange program.

Results: Comparisons of COPC prevalence between the study sample and global prevalence estimates found that among those with OUD, there is a significantly higher-than-expected prevalence of chronic low back pain, myalgic encephalomyelitis/chronic fatigue syndrome, chronic migraine headache, and fibromyalgia.

Conclusions: Results support further investigations into COPCs in the context of OUD. Further research may reveal methods of enhancing OUD treatment and identifying additional targets for intervention and prevention.

Introduction: Alcohol withdrawal syndrome (AWS) and serotonin syndrome (SS) share several overlapping symptoms, complicating diagnosis in patients with alcohol use disorder (AUD) on serotonergic treatment.

Case presentation: We describe a 54-year-old male with a history of AUD and anxiety disorder who presented to a residential treatment center after patient report about 11 days of alcohol abstinence. Despite an initially mild withdrawal course, he developed worsening tremors, nausea, diarrhea, diaphoresis, muscle twitching, rigidity, and restlessness beyond the typical AWS timeframe. His medication regimen included multiple serotonergic agents. Neurological examination revealed hyperreflexia, clonus, and persistent hypertension, fulfilling the Hunter Serotonin Toxicity Criteria for SS. All serotonergic medications were discontinued and supportive care was initiated, leading to rapid symptom improvement and resolution.

Conclusions: Thorough evaluation of medication history and symptom timeline during clinical assessment is critical for differentiating AWS and SS. Clinicians are encouraged to remain vigilant for SS in patients with AUD on serotonergic agents to prevent adverse outcomes and potential mortality.

Background: Services for individuals severely physically dependent on alcohol, wishing to undergo detoxification are limited. This is partly due to a lack of evidence surrounding safe alcohol reduction advice.

Objectives: To summarize the practices from an elective alcohol detoxification service provided by Sandwell and West Birmingham NHS Trust (SWB) (Birmingham, United Kingdom) aimed at preparing high-risk individuals for detoxification.

Methods: Semi-structured interviews were conducted with healthcare professionals working at the SWB elective detoxification service, representing a collective experience of 50+ years in the management of alcohol related presentations. A descriptive qualitative analysis approach was adopted.

Results: Four categories of discourse were observed: 1) establishing a motivation to change, 2) the importance of an in-depth alcohol history, and 3) an individualized approach to patients, and 4) the role that readiness to change attitudes play in preparedness for detoxification. Practical advice relating to alcohol reduction included: consolidation of multiple beverages to fewer, 'measure and discard' techniques, and spacing out consumption/diluting beverages.

Conclusions: Core components to elective detoxification preparation were: 1) safety, 2) the requirement of an individualized approach and 3) a willingness to take ownership of recovery. The approaches discussed may help improve translation of alcohol detoxification services to those considered high-risk. The Standards for Reporting Qualitative Research framework was applied throughout.

Methamphetamine use disorder (MUD) currently lacks FDA-approved treatments. Previous studies involving transcranial magnetic stimulation (TMS) over the left dorsolateral prefrontal cortex (L.dlPFC) have shown promise in TMS's effectiveness at decreasing craving for methamphetamine. Theta burst stimulation (TBS), which includes intermittent (iTBS) and continuous (cTBS) protocols, is increasingly being used for substance use disorders, including MUD. Previous reviews of TMS in MUD performed subgroup meta-analyses of studies that delivered TBS in MUD. However, these meta-analyses included studies with overlapping participant cohorts, limiting their validity. To address this limitation, we reviewed randomized controlled trials (RCTs) using unique patient cohorts from PubMed/Medline, EMBASE, and Google Scholar until September 1, 2024, comparing the impact of TBS versus sham on cue-induced methamphetamine craving in patients with MUD. We performed a meta-analysis with four eligible RCTs that delivered iTBS. Results suggest iTBS was more effective in reducing cue-induced methamphetamine craving than sham iTBS (standardized mean difference [SMD] in change = 1.04; 95% CI [0.16, 1.92]). Two additional RCTs without sham control arms were reviewed, and one demonstrated a significant reduction in craving following accelerated iTBS. Future studies should examine whether neuroimaging-targeted iTBS can impact outcome measures other than craving, such as methamphetamine use, by measuring return to use. Exploring accelerated iTBS and cTBS for MUD, targeting alternative cortical sites such as the frontal pole, and studying their effects on relevant MUD biomarkers is also pertinent. This review demonstrates the effectiveness of TBS for MUD, emphasizing its potential to advance treatment options for MUD.

Background: Literature highlighted a higher sweet preference among patients with alcohol use disorder (AUD) that may act as an endophenotypical vulnerability. However, results remain heterogenous and seldom information is available regarding possible origins, such as hedonic abilities, reward sensitivity or impulsivity.

Objective: This cross-sectional study aims to explore the relationship between AUD and sweet preference as well as its endophenotypical properties.

Methods: Ninety-two participants were divided into three groups (36 patients with AUD, 29 healthy controls and 27 healthy first-degree relatives), and were asked to take a sweet preference test, a hedonic test, the Iowa Gambling Task (IGT) and self-reported inventories measuring impulsivity (Barratt Impulsiveness Scale [BIS-11]), anxiety and depression (Hospital Anxiety and Depression scale [HADS]). A stepwise linear regression with all available variables was performed to compare patients and controls. Factors included in the retained model were then added as mediators in a path analysis.

Results: Compared to healthy controls, patients with AUD had a lower sweet score. The difference lost its significance in the linear regression: the retained model only included antidepressant use (p = .016) and tobacco use status (p = 0.074). The path analysis showed that antidepressant use, but not tobacco use status, significantly mediated the effect of AUD on sweet preference. Sweet score did not significantly differ between first-degree relatives and the two other groups.

Conclusions: Our results do not support the hypothesis that sweet preference is an endophenotype of AUD. Instead, they suggest that the association between sweet preference and AUD may be mediated by confounding factors such as antidepressant use.

Substance use disorders (SUDs) are chronic, relapsing conditions characterized by significant neurobiological and behavioral disruptions. Emerging evidence highlights the critical roles of oxidative stress, mitochondrial dysfunction, and neuroinflammation in the pathophysiology of drug misuse. Coenzyme Q10 (CoQ10), a mitochondrial cofactor with potent antioxidant and anti-inflammatory properties, has gained attention as a potential adjunctive therapy for managing substance-related neurotoxicity. This review explores the mechanistic role of CoQ10 in mitigating the oxidative damage and neuroinflammation induced by substances misuse, emphasizing its ability to restore mitochondrial function and support neuronal health. Preclinical studies demonstrate that CoQ10 supplementation reduces apoptosis, preserves neurotransmitter systems, and improves behavioral outcomes in models of cocaine, alcohol, nicotine, and opioid addiction. Clinical evidence, though limited, suggests CoQ10's safety and therapeutic potential in oxidative stress-related conditions, reinforcing its relevance to addiction. Despite these promising findings, challenges such as low bioavailability and the lack of SUD-specific clinical trials remain significant barriers. This review underscores the need for further research to optimize CoQ10's formulation, dosing strategies, and clinical applications in the treatment of SUDs. Integrating CoQ10 into multidisciplinary approaches could advance our ability to address the complex neurobiological challenges of SUDs and improve long-term recovery outcomes.

Introduction: The evolving landscape of laws and policies related to cannabis can inform patterns and trends in adolescent cannabis use. Today, a wide variety of cannabis products and alternatives are available in the legal and illicit markets. Harms associated with their use may vary depending on the amount and type of tetrahydrocannabinol (THC) they contain. Few studies have examined the awareness of and use of these different cannabis products among adolescents.

Methods: Our study examined patterns of cannabis use in adolescent patients of an urban pediatric addiction clinic.

Results: Most adolescents seen at the clinic use multiple cannabis products, and many adolescents use cannabinoid derivatives such as delta-8 and delta-10 THC.

Discussion: These results highlight the need for providers to explore in depth the various cannabis products used by adolescents, educate adolescents on the products, especially due to unknown risks associated with cannabinoid derivatives, and advocate for further regulation of alternative cannabis products.

Background: Cannabis Use Disorder (CUD) involves compulsive cannabis use, leading to significant impairment and distress. Previous research indicates lower physical activity and higher sedentary behavior among cannabis users, but the causal relationship remains unclear. This study aims to use Mendelian randomization (MR) to investigate the causal link between exercise, sedentariness, and CUD.

Methods: We analyzed genetic associations for (1) moderate-to-vigorous physical activity (MVPA), (2) leisure screen time (LST), (3) sedentary commuting behavior (SCB), and (4) sedentary behavior at work (SBW). Genetic instruments for smoking initiation were identified from the GSCAN study. Genetic associations for CUD were derived from the largest Genome-wide association studies (GWAS) of CUD. We selected significant genetic variants, harmonized data. We conducted MR analyses using IVW, assessing heterogeneity and pleiotropy with Cochran's Q test and MR-Egger regression, and performed leave-one-out analyses.

Results: SBW showed a protective causal relationship with CUD (OR = 0.61, 95% CI = 0.42-0.90, p = 0.012). LST increased the risk of CUD (OR = 1.43, 95% CI = 1.20-1.70, p < 0.001). LST also showed a significant causal relationship with smoking initiation (OR = 1.28, 95% CI = 1.21-1.36, p < 0.001), which was associated with increased CUD risk. Smoking initiation mediated 54.08% of the increased CUD risk associated with LST (95% CI = 53.72-54.44%).

Conclusions: A sedentary lifestyle may lead to CUD through smoking. Addressing sedentariness and promoting physical activity may reduce the risk of smoking initiation and subsequent cannabis-related problems.