Journal of Addictive Diseases最新文献

Objectives: Long-acting injectable buprenorphine (LAIB) has demonstrated a good profile for opioid use disorder (OUD) management. However, there is scarce information on LAIB in OUD patients with comorbid mental disorders (dual disorder patients).

Methods: We present a case report on OUD patients with a comorbid mental disorder who have received LAIB for at least 3 months.

Results: Two women and one man with OUD and another comorbid mental disorder were prescribed with LAIB ranging from three to twelve months. Good adherence and opioid abstinence were observed during the follow-up. Psychopathological issues related to comorbid mental disorders were stabilized. A deep discussion on LAIB in this profile of patients is conducted.

Conclusions: LAIB in OUD patients with comorbid mental disorders may be a safe and well tolerated option, similar to OUD patients without comorbid mental disorders. LAIB's impact on psychopathological issues requires further high-quality research to understand the real impact of LAIB on OUD and comorbid mental disorders.

Wernicke's encephalopathy (WE) is a dangerous and potentially fatal neurological condition associated with thiamin deficiency. The standard treatment for WE is intravenous (IV) thiamin, but limited research describes optimal dosing. We present a case of a 40-year-old male with severe alcohol use disorder (AUD) and chronic malnourishment who developed WE. Upon administration of 100 mg IV thiamin, symptoms of WE persisted, but when the dose was increased to 500 mg, altered mental status and ophthalmoplegia resolved rapidly. IV thiamin is a reliable and low-risk treatment for WE, even when administered at high doses. High-dose IV thiamin (i.e., >/100 mg) can treat neurological symptoms and cognitive dysfunction in WE and should be considered for first-line treatment. Further study of WE diagnostic and treatment guidelines is warranted to maximize recovery potential.

Background: Synthetic cannabinoids (SCs) dependence is increasingly prevalent among young individuals globally, with limited understanding of their potential detrimental effects. Therefore, we conducted this comparative study to assess impulsivity and non-suicidal self-harm behavior in patients with SCs dependence.

Subjects and method: We conducted this comparative, case-control study in the outpatient clinics of (Beni-suef University Hospital). We recruited 30 patients with SCs dependence and the 30 healthy subjects as a control group. Psychometric scales, including Addiction Severity Index (ASI), Barratt Impulsivity Scale-11 (BIS-11), Deliberate Self-harm Inventory-Short Version (DSHI), SCID I, SCID II, and drug urine screen, were applied to compare the two study arms.

Results: DSHI-s scores were significantly higher between the two study arms (3.23 ± 4.97 vs. 0.0 ± 0.0, p < 0.001, for cases and controls, respectively). Similarly, the mean ± SD score of the BIS scale was significantly higher in cases 68.13 ± 9.75 compared to the control group (45.67 ± 5.12) with a statistically significant difference (p < 0.001). Using the regression analysis, we observed a significant positive linkage between age, duration of substance use, DSHI-s, and the Barratt scale.

Conclusion: Patients with synthetic cannabis addiction exhibited more impulsivity and self-harm behaviors compared to healthy controls. The adverse effects of substance use disorder escalated, notably in individuals classified as having severe addiction based on the Addiction Severity Index. Age and length of substance use were found to be potential factors influencing the level of impulsivity and self-harm actions.

Background: Alternative tobacco products like midwakh are gaining popularity as potential substitutes for traditional cigarettes despite a misconception among smokers that they may be less harmful.

Objectives: To determine the prevalence, knowledge, beliefs, and predictors of midwakh smoking among adult smokers in Qatar during 2022.

Method: An analytic cross-sectional study was conducted from January 2022 to July 2022. A simple random sample (N = 1036) was employed to include participants from the list of adults 18 years and above obtained from Qatar's National Health Information System who were invited to participate in a telephone survey.

Results: Among the 806 participants (response rate 77.8%), 9.3% were current midwakh smokers, and 5.2% had ever smoked midwakh. The majority were male (97.2%), non-Qatari (70.9%), and aged over 24 years. Additionally, 66.7% of midwakh smokers reported having at least one family member or friend who smoked any tobacco product. Reasons for midwakh use included enjoyment, experimentation, cessation of other tobacco products, affordability, and lack of odor. Moreover, 70.9% believed midwakh smoking could lead to addiction, while 66.7% perceived it as more dangerous than other tobacco products, potentially causing severe health conditions like lung cancer. Multivariable logistic regression indicated a significant association between midwakh use and nationality, with Qataris being 0.21 times less likely to smoke midwakh than non-Qataris (adjusted odds ratio of 0.214, 95% confidence interval: 1.58-4.225, p value of 0.0001).

Conclusion: Midwakh smoking poses health risks comparable to other tobacco products, with peer influence being significant. Urgent action is needed to heighten awareness and allocate resources for effective intervention.

Background: Buprenorphine for opioid use disorder (B-MOUD) is essential to improving patient outcomes; however, retention is essential.

Objective: To develop and validate machine-learning algorithms predicting retention, overdoses, and all-cause mortality among US military veterans initiating B-MOUD.

Methods: Veterans initiating B-MOUD from fiscal years 2006-2020 were identified. Veterans' B-MOUD episodes were randomly divided into training (80%;n = 45,238) and testing samples (20%;n = 11,309). Candidate algorithms [multiple logistic regression, least absolute shrinkage and selection operator regression, random forest (RF), gradient boosting machine (GBM), and deep neural network (DNN)] were used to build and validate classification models to predict six binary outcomes: 1) B-MOUD retention, 2) any overdose, 3) opioid-related overdose, 4) overdose death, 5) opioid overdose death, and 6) all-cause mortality. Model performance was assessed using standard classification statistics [e.g., area under the receiver operating characteristic curve (AUC-ROC)].

Results: Episodes in the training sample were 93.0% male, 78.0% White, 72.3% unemployed, and 48.3% had a concurrent drug use disorder. The GBM model slightly outperformed others in predicting B-MOUD retention (AUC-ROC = 0.72). RF models outperformed others in predicting any overdose (AUC-ROC = 0.77) and opioid overdose (AUC-ROC = 0.77). RF and GBM outperformed other models for overdose death (AUC-ROC = 0.74 for both), and RF and DNN outperformed other models for opioid overdose death (RF AUC-ROC = 0.79; DNN AUC-ROC = 0.78). RF and GBM also outperformed other models for all-cause mortality (AUC-ROC = 0.76 for both). No single predictor accounted for >3% of the model's variance.

Conclusions: Machine-learning algorithms can accurately predict OUD-related outcomes with moderate predictive performance; however, prediction of these outcomes is driven by many characteristics.

Nitrous oxide is used medically as an anesthetic agent; in the food industry as a propellant for condiments; and recreationally for its euphoric and dissociative effects. We report three cases of nitrous oxide misuse causing severe, symptomatic cobalamin (vitamin B12) deficiency in which signs of nitrous oxide use per se, as well as signs of toxicity, were observed, including characteristic palmar calluses over the metacarpal heads, and frostbite. These signs may assist clinicians in the recognition of nitrous oxide use and the timely diagnosis of nitrous oxide toxicity.

Background: Uric acid, the final product of purine metabolism, may indicate various mental disorders and may be associated with behavioral and clinical features due to its role in adenosine transmission and the antioxidant system.

Objective: In this study, it was aimed to investigate the relationship between serum uric acid, impulsivity, and suicidality in patients with opioid use disorder.

Methods: An analytical, cross-sectional study was conducted with a total of 115 participants: 62 patients diagnosed with opioid use disorder and 53 healthy controls. We performed blood tests at admission and administered the Barratt Impulsivity Scale-11, Columbia-Suicide Severity Rating Scale, Suicide Probability Scale, Structured Clinical Interview Form for DSM-5, and the Sociodemographic and Clinical Data Collection Form to the participants.

Results: Serum uric acid levels were significantly lower in the opioid use disorder group than in the healthy control group. No significant correlation was found between serum uric acid levels, suicidality, and impulsivity in the opioid use disorder group.

Conclusion: Although there is previous research that suggested a potential link between uric acid levels, impulsivity, and suicidality, we could not find a significant correlation between uric acid levels, impulsivity, and suicidality in the opioid use disorder group. However, the possible relationship between uric acid, impulsivity, and suicidality may be masked by decreasing the effect of opioid use on uric acid levels.

Background: The increasing rate of Hepatitis C virus (HCV) infection has been attributed to the substance use epidemic. There is limited data on the current rates of the paralleling HCV epidemic.

Objectives: To estimate the prevalence of maternal HCV infection in West Virginia (WV) and identify contributing factors.

Methods: Population-based retrospective cohort study of all pregnant individual(s) who gave birth in WV between 01/01/2020 to 01/30/2024 (N = 69,925). Multiple log-binomial regression models were used to estimate the adjusted risk ratio (ARR) and the 95% confidence intervals (CI).

Results: The rate of maternal HCV infection was 38 per 1,000 deliveries. The mean age of pregnant individual(s) with HCV was 29.99 (SD 4.95). The risk of HCV was significantly higher in White vs. minority racial groups [ARR 1.93 (1.50, 2.49)], those with less than [ARR 1.57 (1.37, 1.79)] or at least high school [ARR 1.31 (1.17, 1.47)] vs. more than high school education, those on Medicaid [ARR 2.32 (1.99, 2.71)] vs. private health insurance, those residing in small-metro [ARR 1.32 (1.17, 1.48)] and medium-metro [ARR 1.41 (1.24, 1.61)], vs. rural areas, and those who smoked [ARR 3.51 (3.10, 3.97)]. HCV risk was highest for those using opioids [ARR 4.43 (3.95, 4.96)]; followed by stimulant use [ARR = 1.79 (1.57, 2.04)].

Conclusions: Our findings highlight that maternal age, race, education, and type of health insurance are associated with maternal HCV infection. The magnitude of association was highest for pregnant individual(s) who smoked and used opioids and stimulants during pregnancy in WV.

Background: Demand is growing for support services for affected family members (AFM) of relatives with a substance use disorder or problematic substance use. This study examined referral patterns and factors influencing referral types of AFM who sought support through the program 'Recomeço Família' in São Paulo, Brazil. Methods: A cross-sectional retrospective analysis of 5,192 records of family members registered in the program between 2014 and 2018. Referrals made by health professionals to external services were assessed and factors associated with referral types were assessed through univariate binary logistic regressions. Results: Most of the referrals were to individual therapies (counseling/psychotherapy)(64.30%), followed by family support groups (21.15%) and psychoeducational programs (14.55%). Referral destinations varied by AFM and their relative characteristics, including gender, age, kinship, levels of emotional distress, help-seeking history and substance type. Conclusion: The findings highlight factors that may influence referral decisions and underscore the need for further investigation into whether these referrals effectively address the specific needs of AFM.

Mephentermine is a sympathomimetic amine with structural and pharmacological similarities to amphetamines. Despite its increasing misuse, particularly among athletes and bodybuilders, there is limited literature on its management. No pharmacological treatments have been approved for mephentermine misuse. We describe two cases of young adult males presenting with symptoms of mephentermine withdrawal, including insomnia, anxiety, and craving. Both had histories of prolonged intravenous mephentermine use, with one managed on an outpatient basis and the other as an inpatient. Mirtazapine was initiated in both cases and was associated with improvements in sleep, anxiety, craving and hyperarousal. Psychotic symptoms in one patient resolved with short-term risperidone. Both patients received brief motivational enhancement therapy and remained abstinent from all substances except tobacco during two months of follow-up. These cases highlight the potential utility of mirtazapine in managing mephentermine misuse, particularly for addressing withdrawal symptoms and craving. Given its noradrenergic and serotonergic profile and its demonstrated efficacy in methamphetamine use, mirtazapine may be a promising candidate for treatment. However, the findings are limited by the case series design and larger, controlled studies are needed to confirm its role in clinical management.