American Journal of Drug and Alcohol Abuse最新文献

Background: In January 2023, British Columbia (BC) implemented a three-year pilot decriminalizing possession of up to 2.5 grams of certain illegal drugs, including opioids, cocaine, methamphetamine, and MDMA, the first policy of its kind in Canada. This initiative has faced scrutiny, culminating in a May 2024 amendment banning possession and use in public spaces.Objectives: To examine public opinion on BC's decriminalization policy by assessing perceptions of the 2024 policy amendment, potential changes in support between 2024 and 2025, and demographic factors associated with support for repealing the policy.Methods: We analyzed two waves of online, non-probability surveys of BC adults (male 48%, non-male 52%): Wave 1 (March 26-April 1, 2024; N = 1,202) and Wave 2 (February 12-18, 2025; N = 1,200). Changes in values between both waves were tested with Rao-Scott chi-square analyses, and demographic predictors of support for the policy's repeal were assessed using multinomial logistic regression.Results: Support for decriminalization weakened between 2024 and 2025, as opposition rose from 41% to 47% (p = .0427). Fewer respondents believed decriminalization reduced criminalization (50% vs. 39%; p < .0001), reduced policing costs (37% vs. 25%; p < .0001), or improved treatment access (34% vs. 27%; p = .0229). Disagreement that decriminalization reduced stigma increased from 45% to 55% (p < .0001), while perceptions of community safety declined from 28% vs. 22% (p = .0019). Overall, 61% supported the amendment, and 46% supported repeal, with support varying by age, gender, region, education, and household composition.Conclusion: Public opinion in BC reflects growing skepticism toward decriminalization, strong support for public use restrictions, and significant backing for the policy's repeal. Without visible improvements in overdose prevention, service access, and public communication, the policy's long-term viability remains uncertain. Sustained investments in harm reduction and strategic public messaging are essential.

Background: Prescription opioid misuse (i.e. use without a prescription or in ways other than prescribed) is a significant health concern among individuals with chronic pain. Hazardous alcohol use (i.e. drinking that increases risk of negative consequences) is common among individuals with pain, including among those who are prescribed opioids. Everyday discrimination, which is characterized by interpersonal experiences of identity-based harassment, has been independently linked to both depressive symptoms and prescription opioid misuse. Although promising as a potentially modifiable intervention target, the mediating role of depressive symptoms in associations between everyday discrimination and prescription opioid misuse remain largely unexplored. Further, it is important to identify factors associated with prescription opioid misuse among individuals with chronic pain who engage in hazardous alcohol use, as both are positively associated with prescription opioid misuse.Objectives: To examine indirect associations between everyday discrimination and prescription opioid misuse via depressive symptoms among adults with chronic pain who engage in hazardous drinking.Methods: Participants included 150 adults with pain (35.7% Black/African American; 59.7% female; M_age = 44.27) who were prescribed opioids and drank hazardously.Results: A process model revealed that depressive symptoms acted as mediator of associationsbetween everyday discrimination and prescription opioid misuse (b  = 0.26, bootstrapped 95% CI [0.15, 0.39]). Specifically, everyday discrimination was associated with greater depressive symptoms, which in turn was associated with greater prescription opioid misuse.Conclusion: These findings suggest that providers should screen for depressive symptoms in the context of prescription opioid misuse, particularly among individuals who experience discrimination.

Background: Despite increases in cannabis-related healthcare encounters, research comparing trends in healthcare encounters involving cannabis poisoning with other substances is limited.Objective: To describe healthcare encounters (emergency department [ED] visits and hospitalizations) for poisonings involving cannabis versus other substances (heroin, cocaine, benzodiazepines, alcohol).Methods: We used cross-sectional data from the Nationwide Emergency Department Sample, the National Inpatient Sample (2016-2020), and the National Survey on Drug Use and Health to estimate annual national encounters involving poisoning and utilization-adjusted prevalence per 100,000 individuals reporting past-year use of that substance.Results: From 2016 to 2020, encounters involving cannabis poisoning were lower than heroin and benzodiazepines, and utilization-adjusted prevalence was lower than heroin, cocaine, and benzodiazepines. U.S. cannabis poisoning ED visits (2016: 29,050; 2019: 49,357; 2020: 47,655) and hospitalizations (2016: 12,940; 2019: 18,470; 2020: 13,680) increased between 2016 and 2019, and decreased in 2020, whereas most other substances decreased. Utilization-adjusted prevalence of cannabis poisoning ED visits (2016: 77.3 [95%CI, 70.3-84.3]; 2019: 102.0 [95%CI, 94.7-109.2]; 2020: 98.5 [95%CI, 91.0-106.0]) and hospitalizations (2016: 34.4 [95%CI, 32.6-36.3]; 2019: 38.2 [95%CI, 36.4-39.9]; 2020: 28.3 [95%CI, 26.9-29.7]) followed the same pattern, whereas most other substances declined. In 2020, utilization-adjusted prevalence of transfer/hospital admission was lower for single-substance ED visits involving cannabis poisoning than most other substances. Deaths were higher in single-substance hospitalizations for other substances than cannabis in 2020.Conclusions: Healthcare encounters involving cannabis poisoning increased while remaining lower, and having fewer admissions/deaths, than selected, other substances. These findings can inform healthcare policy and prevention strategies for cannabis-related healthcare encounters.

Background: Heavy episodic drinking (HED) poses significant risks during adolescence. Despite declining prevalence over years, it remains unclear whether these trends are influenced by historical changes or are independent of age and birth cohort effects.Objectives: To investigate the age-period-cohort (APC) effects on HED among adolescents in Ontario, Canada.Methods: Data drawn from the Ontario Student Drug Use and Health Survey (OSDUHS) from 1999 to 2023. OSDUHS is a repeated cross-sectional survey of students in grades 7 through 12 attending publicly funded schools in Ontario, Canada. The survey used a stratified two-stage cluster sampling method, including 103,977 adolescents (50.9% females) aged 12-18 years.Results: The observed prevalence of HED in the past 30 days declined from 27% in 1999 to 9.6% in 2023. In the pooled sample, HED increased from 2.2% at age 12-41.6% at age 18, with a notable divergence in HED rates between males and females at ages 17 and 18. APC analysis revealed that adolescents born in the early 1990s (cohort effect) were nearly twice as likely to engage in HED as those born in 2000 (RR = 1.78, 95%CI: 1.63-1.95). The strongest period effect was evident in 2000, with odds of HED higher than 2015 (RR = 1.55, 95%CI: 1.39-1.72), followed by a peak in 2018 and a decline in recent periods.Conclusions: Teen binge drinking has declined over time, with newer generations drinking less. These shifts may reflect changing social norms and lifestyle preferences. Identifying the most affected age and cohort groups can guide targeted prevention.

Background: Previous work demonstrated that administration of saikosaponin A (SSA), one of the major components of the roots of Bupleurum falcatum, reduced oral alcohol self-administration, a validated measure of the reinforcing and motivational properties of alcohol, in Sardinian alcohol-preferring (sP) rats.Objectives: To evaluate whether SSA ability to reduce the reinforcing and motivational properties of alcohol extends to well-established binge-like drinking paradigms, characterized by intoxicating drinking patterns, in sP rats and C57BL/6J mice.Methods: Male sP rats (n = 48) were exposed to the 4-bottle [10%, 20%, and 30% (v/v)] alcohol vs water choice regimen, with limited and unpredictable time to access to alcohol. Male C57BL/6J mice (n = 56) were subjected to a single-bottle, 20% alcohol "drinking in the dark" protocol, initiated 3 hours into the dark phase. In both experiments, SSA (0, 1, 2, or 4 mg/kg) was administered acutely and intraperitoneally 15 min before the start of the drinking session. SSA was also tested on spontaneous locomotor activity in alcohol-naive sP rats (n = 48) and C57BL/6J mice (n = 39).Results: Alcohol binge-like drinking was prevented by administration of 2 and 4 mg/kg SSA in sP rats (p < .05; p < .005) and C57BL/6J mice (p < .005; p < .0001). However, the results of the locomotor activity experiments indicated that specificity of the reducing effect of SSA on alcohol intake was limited to sP rats and observed only at the dose of 2 mg/kg (p > .05).Conclusion: Overall, our findings support the potential of SSA as a treatment for binge alcohol drinking.

Background: Kratom (Mitragyna speciosa), a Southeast Asian plant, has gained global prominence for its pharmacological properties and widespread use, particularly among vulnerable adolescents and youth, raising concerns about its impact.Objective: We reviewed existing studies to provide a comprehensive understanding of kratom use among adolescents and college students.Methods: We conducted a systematic review of studies published up to October 2024, using PubMed, Scopus, Web of Science, and Google Scholar databases. Search terms included "Kratom" or "Mitragyna speciosa" combined with terms related to adolescents and college students.Results: Six eligible studies conducted in Malaysia, Thailand, and the United States were identified. Distinct regional differences in patterns of kratom use were observed, shaped by cultural traditions in Southeast Asia and commercialization in the United States. Kratom use was more prevalent among males across regions, with variations shaped by socioeconomic status, psychosocial influences and recreational use. Available studies were limited to college students and those enrolled in a drug treatment program (one study). Generally, kratom was commonly used to self-manage withdrawal symptoms from opioids (heroin) and methamphetamines. Polydrug use emerged as a consistent theme across all studies, underscoring the complexity of kratom consumption in this population.Conclusion: The rising prevalence of kratom use among adolescents and college students demands attention. While kratom may hold potential as a harm reduction tool, evidence on its safety, efficacy, and long-term outcomes remain limited, highlighting the importance of distinguishing traditional practices from emerging recreational trends. This review points the need for targeted interventions, education, and regulatory frameworks.

Background: Adolescent binge drinking increases the risk of alcohol use disorder, and individual differences in initial ethanol sensitivity may predict susceptibility to anxiety-like behaviors following ethanol withdrawal in adolescent males. It is still unclear whether these anxiety-like alterations are driven by specific subpopulations.Objectives: This study examined the impact of initial responsiveness to the socially facilitating/inhibiting effects of ethanol in adolescent males on anxiety-like behavior during ethanol withdrawal.Methods: Male rats (n = 72) were divided into socially facilitated, non-responding, and socially inhibited phenotypes using a tertile split based on changes in social behavior after an acute ethanol challenge. Ethanol or water exposure occurred from P28-53. Social anxiety-like behavior was assessed during acute withdrawal from single and repeated binge episodes and during protracted abstinence. Nonsocial anxiety-like changes were also evaluated during protracted abstinence.Results: Males initially facilitated by ethanol displayed transient social anxiety-like behavior during acute withdrawal from chronic exposure (F_2,41 = 4.418, p < .05), but not during protracted abstinence. Males inhibited by ethanol showed anxiety-like behavior during acute withdrawal from chronic exposure (F_2,42 = 4.345, p < .05), but unlike facilitated males, these effects persisted into protracted abstinence (p < .01). Only non-responsive males displayed social anxiety-like behavior during all withdrawal timepoints (F_1,22 = 30.87, p < .0001). Additionally, ethanol-exposed males displayed increased nonsocial anxiety-like behavior regardless of phenotype (F_1,66 = 12.04, p < .001).Conclusions: These results suggest that, in this rodent model, adolescent individual differences in initial ethanol sensitivity may predict ethanol withdrawal vulnerability. These findings inform research aimed at identifying adolescent boys in clinical settings who are vulnerable to developing alcohol use disorder.

Background: Timely initiation and continuation of medications for opioid use disorder (MOUD) following a new opioid use disorder (OUD) diagnosis reduces overdose risk.Objectives: To examine patient- and community-level factors associated with timely MOUD receipt and the association of these factors and MOUD modality (buprenorphine, methadone, naltrexone) with subsequent overdose.Methods: This cohort study included Medicaid enrollees in 44 states aged 18-64 with a new OUD diagnosis between April 2016 and December 2019. Multivariable Cox Proportional Hazards models assessed time (in days) to MOUD receipt and medically-treated nonfatal overdose stratified by involvement of heroin/synthetic vs. other (primarily prescription) opioids only. Models adjusted for patient, county, and state-level covariates, and models examining overdose additionally adjusted for time-varying (daily) MOUD receipt.Results: Of 1,172,200 Medicaid enrollees with a new OUD diagnosis, 51.8% were female, 55.8% White, and 42.2% aged 30-44. Most (69.2%) did not receive MOUD within 180 days. MOUD receipt was lower among Black (Hazard Ratio [HR] = 0.68, 95% Confidence Interval [CI] 0.67-0.69) and Hispanic (HR = 0.91, 95%CI = 0.90-0.92) compared to White enrollees. During follow-up, 3.2% of enrollees experienced heroin/synthetic opioid overdose, with reduced risk more strongly associated with methadone (HR = 0.14, 95%CI = 0.12-0.15) and buprenorphine (HR = 0.23, 95%CI = 0.22-0.25) than naltrexone (HR = 0.70, 95%CI 0.64-0.77).Conclusion: Use of methadone and buprenorphine, and to a lesser extent naltrexone, are associated with lower overdose risk among Medicaid beneficiaries newly diagnosed with OUD. State and local policies aimed at increasing timely, equitable, and sustained treatment receipt are needed to address the opioid epidemic and reduce disparities.

Background: Despite the availability of efficacious opioid use disorder (OUD) medications (MOUD), there are racial and ethnic disparities in their use in the general population. Here, we examine the use of MOUD in a racially and ethnically diverse veteran sample.Objectives: To examine racial and ethnic differences in veterans' 1) likelihood of receiving MOUD and 2) treatment retention, dosage, and abstinence outcomes among veterans receiving buprenorphine treatment.Methods: Among 29,502 veterans with OUD, we examined the effects of race and ethnicity on 1) whether methadone or buprenorphine was prescribed as MOUD, and 2) among those prescribed buprenorphine, using multivariable logistic regression to adjust for potential confounders, the likelihood of receiving ≥180 days of treatment and achieving opioid abstinence.Results: Thirty percent of veterans with OUD received MOUD, with race being a significant predictor (p < .01): White veterans were most likely to receive buprenorphine (12%) or both medications (11%), while Black veterans were most likely to receive only methadone (16%). Among 5,768 veterans prescribed buprenorphine, retention was highest among American Indian/Alaska Native (59%), White (59%), and Other race (62%) veterans and lowest among multiracial (47%) and Black veterans (49%). In an adjusted analysis (n = 3,273, 92% male, 8% female), Black veterans had significantly lower odds of opioid abstinence than White veterans (aOR = 0.53, 95% CI = 0.43, 0.67).Conclusion: There are racial disparities in MOUD prescribing and rates of retention, particularly in the rate of abstinence among buprenorphine-treated veterans. Standardized criteria for MOUD selection may help guide clinical decisions and reduce racial disparities in treatment outcomes.

Background: Females remain underrepresented in opioid use disorder (OUD) research, particularly regarding dorsal striatal neuroadaptations. Chaperonins seem to play a role in opioid-induced neural plasticity, yet their contribution to OUD-related changes in the dorsal striatum (DS) remains poorly understood. Given known sex differences in opioid sensitivity, it is important to determine how chaperonin expression contributes to OUD-related adaptations in females.Objective: To investigate how stressor controllability during adolescence influences heroin self-administration (SA) and responses to drug-paired cues in adult female rats, focusing on differential gene expression of chaperonins in the DS.Methods: Female rats were exposed to stress avoidance training during adolescence. These rats underwent, in adulthood, heroin SA followed by cue-induced seeking tests after early and prolonged abstinence.Results: Heroin intake during SA was similar between stress-avoiding and stress-naïve females (n = 8/group, p = .89). However, stress-avoiding females exhibited reduced drug-seeking behavior in response to drug cues at 14 days of abstinence compared to controls (p < .05; d = 0.99), suggesting a protective effect of stressor controllability. qPCR showed that the gene expression of Hspa5, a heat shock protein, was elevated in the dorsolateral striatum (DLS) of stress-avoiding females (p < .05; Cohen d > 1.0). Hspb1 gene expression was upregulated in the dorsomedial striatum (DMS) of stress-avoiding females (p < .05; d > 1.0).Conclusion: These findings suggest that chaperonin dysregulation links opioid exposure and stress avoidance conditions. Increased Hspa5 in the DLS and Hspb1 in the DMS may contribute to the observed behavioral differences supporting further preclinical investigation with clinical implications for stress and OUD.