American Journal of Drug and Alcohol Abuse最新文献

Background: Substance-involved suicide and unintentional overdose deaths share risk factors, yet our understanding of how these deaths overlap and differ remains limited. Direct comparisons of substance-involved suicide and unintentional deaths are lacking.Objective: To guide effective prevention and intervention efforts regarding substance-involved suicide, we examined risk factors, demographic and substance-related, of substance-involved suicide and unintentional deaths.Methods: Using logistic and multinomial regression, we used medical examiner records obtained annually (N = 6,467, 72% male) to examine characteristics associated with suicide and unintentional substance-involved deaths in St. Louis, Missouri between 2011 and 2021.Results: Between 2011 and 2021, age-standardized suicide rates slightly decreased (3.55 to 3.33), while unintentional deaths nearly tripled (23.2 to 68.2). Many deaths involved both alcohol and traumatic injury, and almost a fifth of suicides involved prescription opioids. In the logistic model (combining data across 11 years), the following factors were associated with increased odds of suicide, relative to unintentional deaths: White race (OR = 5.42, 95%CI[3.95,7.56]), greater age (OR = 1.01, 95%CI[1.00,1.02]), traumatic injury (OR = 4.40, 95%CI[3.17,6.13]), and presence of not otherwise classified substances (including prescription medications; OR = 4.36, 95%CI[3.11,6.10]). The following were associated with decreased odds of suicide: presence of medical condition (OR = 0.32, 95%CI[0.23,0.45]), fentanyl (OR = 0.04, 95%CI[0.02,0.06]), ethanol (OR = 0.64, 95%CI[0.46,0.88]), cocaine (OR = 0.40, 95%CI[0.24,0.63]), heroin (OR = 0.05, 95%CI[0.03,0.09]), and other stimulants (OR = 0.32, 95%CI[0.20,0.50]).Conclusions: Results suggest a divergence over time in the rates of classified substance-involved suicide and unintentional deaths. A distinctive set of demographic and substance use characteristics differentiated the two manners of death, highlighting potential risk factors to inform further research and targeted interventions.

Background: Most state policies targeting pregnant people's alcohol use are ineffective, while some broader alcohol availability policies like government monopolies on retail spirits sales are effective. Previous research has not explored interactions of these policies.Objective: Analyze whether there are interactive effects between pregnancy-specific alcohol policies and government monopolies over retail spirits sales on infant and maternal outcomes.Methods: Outcome data were from Merative MarketScan®, a commercial insurance claims database, and included individuals who birthed singletons between 2006 and 2019 (N = 1,432,979 birthing person-infant pairs). We examined interactions between six pregnancy-specific policies and government monopolies. Regression models include (monopolyXpregnancy-specific policy) interaction terms, state and year fixed-effects, state-specific time trends, individual- and state-level controls, and clustering by state.Results: Associations of pregnancy-specific policies were generally stronger, or only present, in monopoly states. However, there was no consistent pattern regarding direction. Conversely, government monopolies consistently related to reduced infant maltreatment, with the largest effect when Priority Treatment for pregnant women policies were also in place [-1.64% (95% CI -1.87, -1.41)]. Protective associations of government monopolies on infant morbidities differed across reporting policies; for example, monopolies were protective without Reporting Requirements for child welfare [-0.28% (95% CI -0.40, -0.17)], but no longer protective with this policy [0.00% (95% CI -0.53, 0.55)].Conclusions: Government monopolies on retail spirits sales generally relate to reduced infant maltreatment and morbidities, although some pregnancy-specific alcohol policies blunt the protective effects of government monopolies. Repealing some ineffective pregnancy-specific policies - e.g. some Reporting Requirements - in monopoly states might improve infant outcomes.

Background: Major depressive disorder (MDD) and substance use disorders (SUDs) frequently co-occur, influenced by sex (biological) and gender (sociocultural) factors. The extent and consistency of these differences across substance types in populations with co-occurring MDD remains unclear.Objectives: This systematic review synthesizes evidence on sex and gender differences in the prevalence, clinical characteristics, and treatment outcomes of individuals with co-occurring MDD and four SUDs: alcohol use disorder (AUD), cannabis use disorder (CUD), opioid use disorder (OUD) and cocaine use disorders (CoUD).Methods: Following PRISMA guidelines, we searched PsycINFO, MEDLINE, and Embase for peer-reviewed studies from inception to present. Eligible studies examined co-occurring MDD and at least one SUD, and disaggregated outcomes by sex or gender.Results: Forty-seven studies were included (N = 648,414), spanning diverse age groups and geographic regions. Women with SUDs were more likely to experience co-occurring MDD, particularly in AUD and OUD; findings were less consistent for CUD and CoUD. Men with MDD were more likely than women to report co-occurring AUD. Co-occurring MDD-SUD conferred increased suicide risk, particularly among women. Treatment-related findings were mixed: some evidence suggested MDD increased relapse risk in men but buffered relapse in women. Common methodological limitations included inconsistent definitions of sex and gender and reliance on cross-sectional designs.Conclusion: Sex and gender shape the risks and treatment trajectories of co-occurring MDD and SUDs, underscoring the need for personalized screening, suicide prevention, and relapse management strategies. Greater conceptual clarity and inclusion of gender-diverse individuals could inform equitable clinical practices and targeted interventions.

Background: In utero cannabis exposure is associated with deleterious offspring neural development and behaviors that emerge across the lifespan. We explored if brain morphology differed in neonates exposed and unexposed to cannabis in utero in the first month of life.Objective: To evaluate differences in global and subcortical regional brain volume (in the amygdala and hippocampus) in neonates in the first month of life according to in utero cannabis exposure.Methods: Prospective pre-birth prospective cohort study of mother-infant pairs selected on the basis of prenatal cannabis use in the absence of alcohol, tobacco, or illegal drug use. The presence of cannabinoids using ultra-high performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) was quantified in maternal and neonatal biological samples. Neonatal MRI was conducted to evaluate differences in global and subcortical brain morphology between the exposed and unexposed infants (18 exposed, 21 unexposed). Inverse probability of treatment weighting was utilized in a generalized linear model framework to remove structural confounding bias between exposure groups. Clinical Trial Registration: NCT03718520.Results: The sex distribution of neonates was 43% female. Neonates exposed to cannabis in utero had significantly lower total brain volume (estimated effect size = 26,496.90 mm³, p = .02), independent of confounders including maternal stress, compared to unexposed infants. The unadjusted difference in brain volume was 29,159.82 mm³, p = .05). Regional volumetric differences were not detected in the amygdala or hippocampus.Conclusion: Given the evidence of the adverse effects of exogenous cannabinoids on fetal brain development, it is vital to prioritize prevention and cessation efforts targeting pregnant women.

Background: Illegal opioids can create substantial harms, but the extent depends on multiple factors, including the amount consumed.Objectives: To examine how consumption varies across time and context, with implications for treatment and drug policy.Methods: We searched EBSCOhost and PubMed for literature on individuals: (1) not-in-treatment and purchasing from illegal markets, (2) reporting pre-treatment use at treatment intake, and (3) with opioid use disorder (OUD) receiving medically supplied opioids. A total of 135 articles were deemed relevant.Results: Average consumption intensities vary enormously, from below 100 morphine milligram equivalents (MME) per day for use outside of treatment where prices are high, to ~600 MME in typical illegal markets, and 1,100-1,800 MME per day when supply is free, as in heroin assisted treatment and injectable hydromorphone treatment. MME in methadone programs (190-460) is less than in the traditional British heroin prescribing system (600-1,300). Intensities tended to be higher in recent times, whereas the prices have been lower. Studies during the fentanyl era suggest MMEs per day may be much higher than in the past.Conclusion: The adaptability of consumption has several potential implications. Expansions in supply could have greater effects on quantity consumed than on prevalence. Treatment protocols and overdose prevention strategies may need to adjust for higher baseline consumption. Furthermore, assumptions about health harms from long-term use may need revisiting if they are predicated on lower, historical consumption intensities. These findings are caveated by limitations in reporting of data and variations in methodologies. Hence, greater investments in monitoring consumption intensities are warranted.

Background: North America is experiencing an unrelenting overdose crisis driven by a volatile and toxic unregulated drug supply. Safer supply programs, which provide individuals with pharmaceutical-grade alternatives to the unregulated drug supply, have been implemented in various Canadian jurisdictions. While most programs provide tablet hydromorphone, the Safer Alternatives for Emergency Response (SAFER) program in Vancouver, Canada, offers pharmaceutical-grade fentanyl, including a powder formulation for witnessed consumption.Objectives: To explore early experiences among SAFER program participants receiving powder fentanyl.Methods: Qualitative one-on-one interviews were conducted with 18 (12 men, 6 women) people prescribed fentanyl powder from the SAFER program. Interview coding and analysis involved a team-based approach to identify common themes related to program experiences, focusing on impacts on unregulated drug use.Results: Most (13/18; 72%) participants reported reducing unregulated drug use since program enrollment. This was largely attributed to the SAFER fentanyl powder being effective for managing withdrawal, thereby limiting their need to access street-purchased drugs. Additionally, some participants, particularly those prescribed higher doses, suggested that SAFER fentanyl powder, unlike other safe supply medications, was a suitable alternative to street-purchased fentanyl. Participants also reported reduced overdose risk. Operating hours and dosing challenges were barriers to program engagement contributing to continued unregulated drug use for some.Conclusion: Our findings demonstrate a number of positive outcomes of the SAFER program and suggest that fentanyl safer supply has the potential to play a useful role in addressing the ongoing overdose crisis.

Background: Exposure to racial and ethnic discrimination (RED) is positively associated with alcohol-related outcomes among Hispanics; however, links between RED and alcohol use are poorly understood, particularly when considering RED in social media.Objectives: Study aimed to (1) examine the direct and indirect associations between RED on social media and alcohol use severity (i.e., AUDIT total score) via coping drinking motives (a form of negative reinforcement in which an individual uses alcohol to alleviate/regulate negative emotions) among Hispanic emerging adult college students, and (2) examine if psychological resilience moderates the direct and indirect associations of social media discrimination on alcohol use severity.Methods: A convenience sample of 423 (women = 300, men = 123) Hispanic college students from Texas and Florida completed a cross-sectional online survey. Data were analyzed by conducting a conditional process analysis.Results: Social media discrimination did not have a direct association with alcohol use severity (β = .05, 95% CI=[-.03, .13], p > .05), but it did have a statistically significant indirect association with alcohol use severity via coping drinking motives (β = .08, 95% CI = [.03, .13], p < .05). Further, psychological resilience functioned as a moderator that weakened the indirect association between social media discrimination and alcohol use severity (β = -.14, 95% CI=[-.23, -.05], p < .001).Conclusions: Our conditional process analysis may help guide etiological studies on RED and alcohol use. The data suggest that psychological resilience and coping drinking motives may be relevant constructs for interventions that aim to mitigate the association between RED and alcohol use.

Background: Postnatal alcohol exposure impairs the development of the central nervous system, including the visual system. The behavioral consequences of such exposure on visual function remain poorly understood.Objectives: In this study, we investigated the effects of postnatal ethanol exposure on visuospatial learning and memory in C57BL/6 mice.Methods: Ethanol (3.0 g/kg) was administered via intubation on postnatal days 3-20. Controls received intubation only or no intervention. Pups were assigned to alcohol-treated (A, n = 11), intubation control (IC, n = 11), or non-intubated control (C, n = 9) groups. At three months, mice underwent the Novel Object Recognition (NOR) test and a visual water task. The NOR test measured recognition memory and exploratory behavior. The visual water task assessed visual acuity using sinusoidal gratings presented on monitors. Mice were trained over 17 days to associate a grating with a hidden platform, and visual acuity thresholds were determined based on performance at varying spatial frequencies.Results: Alcohol-exposed mice showed significant deficits in recognition memory and visual acuity. No group differences in body weight were observed. However, alcohol-treated mice displayed reduced exploration of novel objects (p = .0085, R² = 0.29) and lower visual acuity thresholds at higher spatial frequencies (p = .048, R² = 0.24).Conclusion: These findings demonstrate that early postnatal alcohol exposure can lead to lasting impairments in visual-cognitive functions. Given their similarity to deficits seen in children with Fetal Alcohol Spectrum Disorders (FASD), our results suggest the importance of early behavioral and visual assessments in children with suspected prenatal or early postnatal alcohol exposure.

Background: Although religious and cultural factors have been related to substance use in various populations, research is needed regarding associations for Arab Americans.Objectives: We examined how ethnic identity and religiosity relate to the odds and frequency of alcohol and cannabis use in Arab American college students during the COVID-19 pandemic, as well as differences by biological sex and Muslim upbringingMethods:Arab American college students (N = 173; M_age = 20.1, range 17-23; 60.7% female; 44.5% Christian upbringing, 43.9% Muslim upbringing) were recruited through electronic flyers and a psychology subject pool in California. Participants reported their ethnic identity affirmation (i.e. feeling positively about being Arab American) and search (i.e. learning about Arab culture), religiosity, and past-year alcohol and cannabis useResults: Greater ethnic identity affirmation was related to less frequent alcohol (OR = .68, p = .046) and cannabis use over the past year (OR = .58, p = .030), whereas greater ethnic identity search was related to lower odds of alcohol (OR = 0.66, p = .025) and cannabis use (OR = 0.68, p = .025). Greater ethnic identity search was also related to less frequent alcohol use among individuals from Muslim upbringings (OR = .37, p = .004). Greater religiosity was related to less frequent alcohol (OR = .61, p = .015) and cannabis use (OR = .44, p = .005). It was also related to lower odds of using alcohol and cannabis, with significantly stronger associations among individuals from Muslim upbringings (OR = .39, p = .040; OR = .40, p = .048)Conclusion: Ethnic identity and religiosity buffered substance use risk. Culturally tailored interventions and supporting cultural experiences may reduce Arab American students' substance use.