American Journal of Drug and Alcohol Abuse最新文献

Background: Gabapentin may help manage opioid withdrawal symptoms, but its effectiveness during buprenorphine taper and transition to naltrexone is uncertain.Objectives: To assess gabapentin's efficacy in improving outcomes for lifetime prescription opioid use disorder (POUD) during outpatient buprenorphine taper and transition to extended-release naltrexone.Methods: This 12-week randomized, double-blind, placebo-controlled trial enrolled 117 (55% male) POUD participants. Weeks 1-3, participants attended clinic 5 days/week for medication, therapy, and assessments, including weekly craving and thrice-weekly opioid withdrawal and supervised urine screens. Participants were inducted onto buprenorphine (12 mg), randomized to receive either placebo or gabapentin (800 mg BID), and underwent a 10-day buprenorphine taper. In week 4, participants transitioned from oral to extended-release naltrexone. Chi-square and generalized estimating equation models assessed outcomes. A subset with baseline fentanyl tests was also examined for fentanyl's impact on outcomes.Results: Of 117 participants, 75 (64.1%) completed the buprenorphine taper (41 gabapentin, 34 placebo), and 24 (20.5%) transitioned to naltrexone (12 gabapentin, 12 placebo). No significant group differences were observed in taper completion, naltrexone transition, craving, withdrawal, or opioid use. Fentanyl-positive participants had lower taper completion (47.8% vs. 75.8%, OR = 0.286, p = .033) and more opioid-positive urines (z = -4.24, p < .0001). Fentanyl-positive participants on gabapentin had higher COWS (z = 3.70, p = .001) and SOWS (z = 3.73, p = .001) scores, while fentanyl-negative participants on gabapentin had lower SOWS scores than those on placebo (z = -3.52, p = .002).Conclusions: Fentanyl exposure impairs buprenorphine taper success and worsens withdrawal in the presence of gabapentin, underscoring the need to tailor OUD treatment in fentanyl-exposed patients. (Clinicialtrials.gov ID NCT02543944).

Background: Healthcare readmissions are often perceived as negative outcomes. However, in the context of substance use disorder (SUD) treatment, they may reflect both systemic gaps and sustained engagement. Despite their frequency, the determinants of SUD readmission remain underexplored, particularly in Latin America, where non-injected drug use is highly prevalent.Objective: To identify factors associated with SUD treatment readmission and examine contextual influences shaping readmission risk in Chile.Method: We employed a mixed-methods parallel convergent design. Quantitative analyses included 107,559 treatment episodes (84,978 males; 22581 females) recorded from 2010 to 2019. We estimated Average Hazard Ratios (AHR) using a PWP-GT model. Qualitative data from 14 in-depth interviews explored social, familial, and environmental contributors to readmission.Results: Compared to those who did not complete, completing ambulatory treatment was associated with a lower risk of readmission (AHR = 0.83, 95% CI: 0.78-0.88), while no significant effect was found in residential programs. Women had a higher risk of readmission than men in both ambulatory (AHR = 1.36, 95% CI: 1.31-1.42) and residential settings (AHR = 1.42, 95% CI: 1.33-1.51). Qualitative findings revealed reintegration difficulties post-discharge, especially in high-risk environments. Gender roles pressured women to seek treatment, particularly when they were primary caregivers.Conclusion: Support for caregiving responsibilities may enhance treatment retention and reduce readmissions among women. Clinicians and policymakers should consider implementing structured post-discharge follow-up and community-based support systems, especially after residential treatment, to mitigate environmental risks and sustain recovery.

Background: Substance use disorders are more prevalent in areas of extreme poverty. Few studies have evaluated the differences in quality of addiction treatment associated with persistent poverty status (counties where at least 20% of residents have been in poverty for 20 years or more) and Medicaid access.Objective: This study aims to (1) investigate whether there is a difference in the quality of addiction treatment between counties identified as persistent poverty counties and those not and (2) determine the effect of Medicaid expansion on quality.Methods: We analyzed data from the National Substance Use and Mental Health Services Survey and the US Census American Community Survey. We performed fixed and random effects regression analysis to determine the likelihood of access to high-quality care, including evidence-based behavioral health services, medications for addiction, staff accreditation, medical treatment, recovery services, increased access to treatment, personalized-treatment plans, and long-term services.Results: Adjusted regression results revealed that persistent poverty county status was associated with a higher likelihood of access to high-quality care in states that expanded Medicaid (OR = 1.37, 95% CI 1.10, 1.70). Persistent poverty counties were also more likely to provide medical services, rapid access to treatment, and personalized treatment plans. However, only access to medical services remained significant in the unadjusted model in states that did not expand Medicaid (OR = 2.10, 95% CI 1.03, 4.30).Conclusions: Substance treatment providers in persistent poverty counties were more likely to provide higher quality care, but Medicaid expansion played an important role. Implications for substance treatment policy and practitioners are discussed.

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: 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: 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: 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.