American Journal of Drug and Alcohol Abuse最新文献

Background: Tobacco 21 (T21) laws (prohibiting tobacco sales under age 21) and flavor restrictions have recently been enacted, yet little is known about the extent to which these policies shifted adolescent tobacco use.Objectives: To examine the associations between state-level T21 laws and flavor restrictions with adolescent tobacco use overall and by age.Methods: We linked state-level T21 laws and flavor restrictions with individual-level data on self-reported levels of cigarette, cigar, and electronic nicotine delivery systems (ENDS) use among 979,477 (500,205 female/479,272 male) 14-18+-year-olds from the 2011-2021 Youth Risk Behavior Surveys. We estimated adjusted zero-inflated negative binomial regression models to predict the likelihood of zero use and frequency of use among users and calculated total predicted use, with year and state fixed effects.Results: There were no associations between flavor restrictions and cigarette, cigar, or ENDS use. There also were no associations between T21 laws and cigarette use; however, when categorized based on the laws' policy components, strong T21 laws were associated with lower cigarette use (total marginal effect estimate: -0.34; -0.59, -0.09; p = .009, showing a 0.34 day/month decline). T21 laws were associated with higher ENDS use (total marginal effect estimate: 0.36; 0.11, 0.60; p = .004, showing a 0.36 day/month increase). Policy effects did not vary by age.Conclusion: Current state policies aimed at reducing access to tobacco products have not curbed adolescent tobacco use. Our findings suggest that more comprehensive state laws, including T21 laws with strong policy components, are needed to fill gaps in federal age and flavor restrictions.

The Modernizing Opioid Treatment Access (MOTA) Act proposes reforms to methadone regulation by allowing addiction physician specialists to prescribe up to 30-day doses through community pharmacies. This perspective examines the bill's implications, implementation challenges, and future policy directions to improve equitable access to methadone. While opioid treatment programs have played a critical role in methadone delivery, their restrictive model can increase stigma and limit access, particularly in underserved areas. The COVID-19 pandemic demonstrated that 30-day take-home methadone-dispensed through opioid treatment programs-could be implemented safely in the U.S. and international pharmacy-dispensing models further support a less restrictive approach. However, successful implementation requires addressing inadequate prescriber training, pharmacy participation barriers, and insurance coverage limitations. Expanding methadone access through pharmacies is a step toward integrating addiction treatment into mainstream healthcare. If able to effectively increase accessibility, the MOTA Act may also help reduce stigma and improve outcomes for individuals with opioids use disorder.

Background: Opioid overdose death is a public health crisis. Buprenorphine is a partial μ-opioid receptor agonist used for maintenance treatment of opioid dependence and significantly reduces mortality. Hospitalized patients with opioid use disorder requiring narcotics for pain control present clinical challenges such as adequately controlling pain, preventing withdrawal and early discontinuation of treatments (i.e., leaving against medical advice). Therefore, inducing these patients onto buprenorphine while hospitalized is difficult. A three-day rapid cross-titration of low dose buprenorphine from a full-opioid agonist is a hypothesized novel method that induces patients onto buprenorphine in the hospital setting.Objectives: To examine the utility of a three-day buprenorphine microinduction protocol in a large safety-net hospital.Methods: A retrospective chart review was conducted for 48 adult patients (27 female) with opioid use disorder (OUD) requiring pain management who underwent buprenorphine microinduction in the inpatient setting. The primary outcome for this study was the rate of successful inductions defined as: 1) completion of a full rapid three-day microinduction protocol without precipitated withdrawal and 2) reaching an adequate maintenance dose of buprenorphine for treatment of OUD, defined as a total dose of ≥ 8 mg of buprenorphine daily. Other outcomes of interest included pain and withdrawal symptoms during induction, rehospitalization and buprenorphine pickup from pharmacy.Results: Forty-one patients (27 female) underwent a rapid three-day microinduction. Thirty-six patients (87.8%) tolerated the cross-titration and successfully titrated to at least 8 mg/day buprenorphine. There were zero cases of precipitated withdrawal.Conclusions: These findings support the safety and feasibility of buprenorphine microinductions in hospitalized patients with OUD, pain, and complicated medical presentations. This strategy allows adequate pain control while simultaneously transitioning to buprenorphine within three days, leading to improved retention, safety, and comfort.

Background: Alcohol use disorder (AUD) remains a major global health challenge with limited effective treatments. Ketamine, an NMDA receptor antagonist with rapid anti-craving and neuroplastic effects, has emerged as a promising novel therapy for AUD.Objective: To review the literature examining the safety and efficacy of ketamine for treating AUD.Methods: PubMed and Embase were searched to identify eligible studies published until December 2024. Studies were screened as per the eligibility criteria. Appropriate Joanna Briggs Institute tool was used for risk of bias assessment. A narrative synthesis of findings from the included studies was done. The review protocol was pre-registered in PROSPERO (CRD42022318120).Results: Six studies comprising a total of 605 patients (528 male) from three different countries (USA, UK, Russia) were reviewed. Five of them reported favorable effects of adjunctive ketamine treatment on a range of different alcohol-related outcomes such as abstinence rates or period, alcohol-related craving, and number of heavy drinking days. However, methodological differences including variations in ketamine dosing strategies (route: oral, IV, IM; dose/session: 0.5 mg/kg IV to 2.5 mg/kg IM; number of sessions: 1-3), treatment duration, sample characteristics, and method used for measuring study outcomes led to significant heterogeneity and limited comparability of results. No study reported any serious adverse event or ketamine misuse following ketamine treatment.Conclusion: This review underscored ketamine's potential as an adjunctive treatment for AUD. While promising, considerable variability in dosing, therapeutic approaches, and study designs limits the certainty of evidence. Future research examining the long-term safety and efficacy of ketamine is needed.

Background: Depression and suicidal ideation are prevalent in patients with opioid use disorder (OUD).Objectives: This study examined changes in suicidal ideation during OUD treatment with buprenorphine-naloxone or extended-release naltrexone.Methods: 570 adults with OUD (29.6% female) were recruited into a National Drug Abuse Clinical Trials Network randomized trial (NCT02032433) comparing extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT). Suicidal ideation was assessed at baseline and regular intervals over 24 weeks using continuous self-reported and binary clinician-rated measures from the Concise Health Risk Tracking-Self Report and the Hamilton Depression Rating Scale, respectively. A mixed-effects model was used to assess the association between continuous outcome self-reported suicidal ideation and treatment over time while adjusted for baseline suicidal ideation.Results: Continuous self-report suicidal ideation scores decreased in both groups with a significant time-by-treatment interaction indicating that the treatment effect differed over time (F_{(11, 3497)} = 1.81, p = .0464). Scores were significantly lower in the buprenorphine group only in weeks 1 and 3 and when averaged across weeks 1-4. Binary clinician-rated suicidal ideation dropped from 15 (5.25%) and 12 (4.24%) at baseline, to 5 (1.89%) and 3 (1.49%) at week 1, for buprenorphine and naltrexone groups, respectively.Conclusion: OUD treatment with extended-release naltrexone or buprenorphine-naloxone was associated with suicidal ideation reductions from the first week. Suicidal ideation was lower with buprenorphine-naloxone in the first 4 weeks, with no significant differences thereafter. Despite overall low suicidal ideation scores and modest differences, these findings suggest beneficial effects of both treatments in individuals with OUD and mild baseline suicidality.

Background: Dopaminergic neurochemical markers are associated with working memory performance in healthy participants and patients with schizophrenia. Individuals with stimulant use disorder have below-control levels of dopaminergic markers, such as striatal D2-type receptor (D2/3 R) availability (i.e. D2 + D3 subtypes), and they underperform healthy controls on tests of working memory.Objectives: For consideration in the design of treatments for stimulant use disorder, we tested whether working memory and D2/3 R availability are related in this population.Methods: Eighty-four adults with stimulant use disorder at varying lengths of abstinence (74 with methamphetamine use disorder, 10 with cocaine use disorder; 61/23 male/female) and 47 control subjects (26/21 male/female) completed the Spatial Capacity Delayed Response Task (SCAP), a test of working memory. In the stimulant group only, a subset (n = 52) underwent positron emission tomography (PET) using the D2/3 R ligand [¹⁸F] fallypride. Correlation between SCAP performance and D2/3 R availability was tested in bilateral cortical regions of interest previously associated with working memory (frontal, parietal, insular, and cingulate).Results: Controlling for demographics and estimated intelligence, participants in the stimulant group underperformed the control group on the SCAP (F(1, 125) = 5.58, p < .05). In the subset of the stimulant group who received PET, SCAP performance was positively related to D2/3 R availability in the cingulate cortex (β = 0.43, p < .013, Bonferroni corrected).Conclusion: The findings suggest that the weakness in working memory in participants who use stimulants reflects a deficit in cortical D2/3 R signaling. Strategies to augment cortical D2/3 R signaling may enhance cognitive function to improve treatment response.

Background: A high number of adolescents and young adults engage in opioid misuse and/or meet criteria for opioid use disorder (OUD). Youth also experience worse treatment outcomes when compared to adult counterparts.Objectives: This scoping review aimed to identify and summarize existing interventions designed to increase engagement of youth across the OUD care cascade, as well as describe clinical and research implications.Methods: Peer-reviewed literature was searched using PubMed, PsycInfo, and Web of Science. Studies were eligible if they presented outcomes of an intervention focused on engaging adolescents and young adults (ages 12-25 years) in the OUD care cascade and were published in English.Results: Nine articles met inclusion criteria that described interventions for adolescents and young adults across engagement, initiation, and retention in the OUD care cascade. Several strategies were used in interventions, including behavioral health and integrated health services, contingency management, meaningful family involvement, assertive outreach, and provider trainings/consultation. Only one intervention has been tested with a randomized control trial.Conclusions: Due to small sample sizes and lack of control groups, findings from existing intervention studies do not indicate which strategies are most effective. Further research is urgently needed to develop and evaluate effective interventions for youth with OUD. Providers working with youth should implement services to meet youth's individual needs. Providers should consider utilizing integrated services and referrals to behavioral health, involving family in treatment, and use of contingency management and assertive outreach. Continuing education for providers on OUD treatment and developmental concerns is also crucially needed.

Background: Alcohol administration paradigms are widely used to test the effects of alcohol on human aggression. However, methods used to implement alcohol administration designs can vary considerably, with implications for impact and generalizability.Objectives: This review summarizes and critically evaluates design features of alcohol administration studies on aggression to inform protocol development and provide recommendations for reporting practices.Methods: Ninety-seven studies that employed alcohol administration to study the effects of alcohol on interpersonal aggression were coded for methodological features, including the scope of aggressive behavior and sample characteristics, alcohol administration protocols, and elicitation of alcohol-related expectancies.Results: Alcohol administration studies of aggression have used relatively homogenous samples and aggression paradigms, especially laboratory analogues of alcohol-involved physical aggression. In the alcohol condition, researchers tended to induce relatively high intoxication (mean BrAC = 0.08) using a mixed liquor drink, though drinking and absorption periods relevant for breath alcohol concentration when aggression was assessed were less consistent. Almost all studies with a placebo condition (n = 65 out of 69) included beverage features to enhance alcohol-related expectancies and bolster believability, but only a third told placebo participants they received alcohol. Recommendations for reporting are presented in a checklist.Conclusion: This review identifies several future methodological directions, including greater inclusion of underrepresented individuals and types of aggression (e.g. sexual, intimate partner), consistent reporting of alcohol administration procedures, and evaluation of placebo enhancement strategies. Maximizing the rigor and replicability of these designs is essential for efforts to understand and reduce alcohol-related aggression.

Background: Measurement-based care (MBC) is a clinical practice where patients complete standardized outcome measures throughout treatment to monitor clinical progress and inform clinical decision-making. However, MBC is rarely adopted in routine substance use disorder (SUD) treatment. We developed a digital MBC system and pilot tested it in an outpatient adult community SUD treatment setting.Objectives: The current study aims to characterize qualitative feedback from the pilot participants about their experiences using the MBC system in SUD treatment, focusing on perceived benefits, drawbacks, and suggestions for improvement.Methods: Participants (N = 30; n = 11 female 37%) completed weekly MBC questionnaires via smartphone for 6 months and completed structured interviews at 6-, 12-, and 24-weeks. Themes were identified using a combination of inductive/deductive thematic analysis.Results: Participants highlighted several benefits of using the digital MBC system, including improved self-reflection (e.g. goal clarification, noticing changes over time), treatment enhancement (e.g. improving patient-clinician communication, extending the reach of treatment beyond scheduled sessions), and ease-of-use (e.g. brief, understandable questions). Drawbacks were less frequently expressed and included limited integration with clinical care, repetitiveness of questionnaires, and some questions being difficult to answer. Suggestions included making elements more personalized and improving interactivity with the digital interface.Conclusion: Patients report several benefits of integrating digitally delivered MBC into SUD treatment, along with recommendations that may improve its usability and usefulness. Integrating MBC technology into SUD treatment may potentially aid patients by enhancing self-reflection, facilitating more efficient communication with clinicians, and extending the reach of treatment beyond scheduled treatment sessions.