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Relationships Between Stigma, Risk Tolerance, and Buprenorphine Dispensing Intentions Among Community-Based Pharmacists: Results From a National Sample 社区药剂师的耻辱感、风险容忍度和丁丙诺啡配药意向之间的关系:全国抽样调查结果
Pub Date : 2024-01-04 DOI: 10.1177/29767342231215178
Alysson E. Light, Traci C. Green, Patricia R. Freeman, Paria Sanaty Zadeh, Anne L. Burns, Lucas G. Hill
Concerns have been raised that pharmacists sometimes act as barriers to patients with opioid use disorder (OUD) accessing buprenorphine treatment. The present research explores how community pharmacists’ endorsement (vs non-endorsement) of stigmatizing beliefs about patients taking buprenorphine relate to intentions, comfort, and decisions regarding dispensing buprenorphine for OUD. In addition, we assessed attitudes toward risk in pharmacy practice as a novel correlate of dispensing intentions and decisions. A sample of 207 active community-based pharmacists practicing in the United States responded to survey items measuring stigma, risk tolerance, and intentions to dispense buprenorphine. The survey included 2 vignettes in which patients presented to the pharmacy with a prescription for buprenorphine, and respondents rated their comfort with dispensing and decisions regarding dispensing in the vignette. Results suggest that both stigma toward patients taking buprenorphine to treat OUD and tolerance for risk in pharmacy settings are related to differences in pharmacists’ intentions to and willingness to dispense buprenorphine for OUD. Findings support the need for interventions to reduce stigma associated with buprenorphine use among pharmacists and suggest that risk tolerance is an important determinant of pharmacists’ behavior that merits further study.
有人担心,药剂师有时会成为阿片类药物使用障碍(OUD)患者获得丁丙诺啡治疗的障碍。本研究探讨了社区药剂师对患者服用丁丙诺啡的污名化信念的认可(与不认可)与配发丁丙诺啡治疗 OUD 的意愿、舒适度和决定之间的关系。此外,我们还对药学实践中的风险态度进行了评估,将其作为配药意向和决策的新相关因素。在美国执业的 207 名活跃的社区药剂师对调查项目进行了回答,这些调查项目涉及耻辱感、风险容忍度和丁丙诺啡配药意向。调查包括 2 个小插曲,在这些小插曲中,患者带着丁丙诺啡处方来到药房,受访者对他们在小插曲中配药的舒适度和配药决定进行评分。结果表明,对服用丁丙诺啡治疗 OUD 的患者的成见和药房环境中的风险容忍度与药剂师配发丁丙诺啡治疗 OUD 的意向和意愿的差异有关。研究结果支持有必要采取干预措施,减少药剂师对丁丙诺啡使用的成见,并表明风险容忍度是药剂师行为的一个重要决定因素,值得进一步研究。
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引用次数: 0
Is Early Onset of Nonmedical Prescription Stimulant Use Associated With Cocaine Use During Adolescence? Results From a National Study 青少年时期过早开始使用非医疗处方兴奋剂与使用可卡因有关吗?一项全国性研究的结果
Pub Date : 2024-01-04 DOI: 10.1177/29767342231219139
S. McCabe, Ty S. Schepis, J. Schulenberg, T. Wilens, P. Veliz
To examine the associations between early onset of nonmedical prescription stimulant use (NPSU) and cocaine use. Nationally representative samples of high school seniors were surveyed annually. Data were collected via self-administered questionnaires in nationally representative public and private schools in the United States (1976-2020) as part of the Monitoring the Future Study. The sample consisted of 45 cohorts of 12th grade students (N = 121 909). The main outcome was lifetime, past-year, and past-month cocaine use. An estimated one in every 10 (10.1%) individuals reported lifetime NPSU while 8.5% reported any cocaine use. The vast majority of youth (87.2%) initiated NPSU before cocaine among those who reported both substances. Cocaine use was most prevalent among youth who reported early onset of NPSU in 8th grade or earlier (51.7%) followed by those who reported later onset of NPSU in 12th grade (24.7%), and those who never initiated NPSU (3.7%). Binary logistic regression analysis indicated that early onset of NPSU had greater adjusted odds of cocaine use compared to those with later onset of NPSU or those who never reported NPSU. Moreover, the adjusted odds of cocaine use were higher for adolescents who initiated NPSU before or after medical use of prescription stimulants compared to those with no history of medical use or NPSU. Similar results were found for lifetime, past-year, and past-month cocaine use as a function of NPSU onset; this association was stronger among more recent cohorts. Early onset of NPSU appears to be a signal of increased risk of cocaine use among US adolescents. NPSU should be included in screening and early prevention strategies among secondary school students. Health professionals, school officials, and families are encouraged to monitor youth for NPSU based on the increased risk of later cocaine use and related consequences.
研究早期开始使用非医用处方兴奋剂(NPSU)与使用可卡因之间的关联。每年对具有全国代表性的高三学生样本进行调查。作为 "监测未来研究"(Monitoring the Future Study)的一部分,数据是通过在美国具有全国代表性的公立和私立学校进行自填式问卷调查收集的(1976-2020 年)。样本包括 45 批 12 年级学生(N = 121 909)。主要结果是可卡因的终生、过去一年和过去一个月的使用情况。据估计,每 10 人中就有 1 人(10.1%)报告终生吸食非苯丙醇,8.5% 的人报告吸食过可卡因。在报告同时吸食两种毒品的青少年中,绝大多数(87.2%)在吸食可卡因之前开始吸食非苯丙醇。可卡因的使用在那些报告在 8 年级或更早开始 NPSU 的青少年中最为普遍(51.7%),其次是那些报告在 12 年级晚些时候开始 NPSU 的青少年(24.7%),以及那些从未开始 NPSU 的青少年(3.7%)。二元逻辑回归分析表明,与那些较晚开始 NPSU 或从未报告过 NPSU 的人相比,较早开始 NPSU 的人使用可卡因的调整几率更大。此外,与无处方兴奋剂使用史或非处方兴奋剂使用史的青少年相比,在使用处方兴奋剂之前或之后开始使用非处方兴奋剂的青少年使用可卡因的调整后几率更高。在终生、过去一年和过去一个月使用可卡因的情况中,也发现了类似的结果,这与开始使用非苯丙胺类兴奋剂的时间有关;这种关联在较近的队列中更为强烈。在美国青少年中,较早出现非典型肺炎似乎是吸食可卡因风险增加的信号。应将 NPSU 纳入中学生的筛查和早期预防策略中。鉴于青少年日后吸食可卡因的风险和相关后果会增加,我们鼓励卫生专业人员、学校官员和家庭对青少年进行NPSU监测。
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引用次数: 0
The Cost of Safe Injection: Insights on Nonprescription Syringe Price Variability From Systematic Secret Shopping 安全注射的成本:从系统性秘密购物看非处方药注射器的价格差异
Pub Date : 2024-01-04 DOI: 10.1177/29767342231217831
Malcolm J. Blough, Amanda Rocha, Jeffrey P. Bratberg, J. Silcox, Derek Bolivar, Anthony S. Floyd, Mary Gray, Traci C. Green
Although the sale of nonprescription syringes in pharmacies is legal in most states, people who inject drugs (PWID) continue to face obstacles to syringe purchase like stigma, prohibitive costs, restrictive policies, and stocking issues. We examined the consistency of syringe pricing as another possible barrier. We analyzed data on syringe prices and other relevant variables from 153 unique secret shopper visits to 2 retail chain pharmacies in Massachusetts (MA), New Hampshire (NH), Oregon (OR), and Washington (WA) as part of the fidelity component of a large pharmacy-focused intervention study. Pretax prices from purchases made between August 2019 and May 2021 were adjusted for inflation to 2022 dollars, and a linear regression of the price of a 10-pack of syringes was constructed to examine the determinants of syringe pricing. The average real price of a 10-pack of syringes across all states was $4.53 (SD = 0.99), with wide variability between pharmacies (max = $11.44, min = $1.70) and between states (mean OR = $5.76, WA = $4.74, MA = $4.33, NH = $4.30). Forty-seven percent (n = 72) of the purchases were taxed despite syringes being tax exempt in MA and WA, and not having a sales tax in NH or OR. The results of the regression suggest that certain needle gauges were associated with lower overall prices, while 1 pharmacy chain and 2 syringe brands were associated with higher overall prices. The high variability in syringe pricing presents another barrier to pharmacy-based syringe access since high prices may leave PWID no choice but to reuse or share needles, especially in areas with limited alternatives or without a syringe service program. Leadership from healthcare systems, pharmacy chains, and state and local policymakers is essential to reduce stigma and to implement policies that streamline syringe purchases, eliminate the taxation of exempt syringes in accordance with state laws, and reduce the variation in syringe prices.
尽管在大多数州,药房销售非处方注射器是合法的,但注射吸毒者(PWID)在购买注射器时仍然面临着各种障碍,如耻辱感、高昂的费用、限制性政策和库存问题。我们将注射器定价的一致性作为另一个可能的障碍进行了研究。我们分析了马萨诸塞州(MA)、新罕布什尔州(NH)、俄勒冈州(OR)和华盛顿州(WA)两家零售连锁药店的 153 次秘密顾客访问中有关注射器价格和其他相关变量的数据,这些访问是大型药店干预研究中保真度部分的一部分。2019 年 8 月至 2021 年 5 月期间的购买税前价格根据通货膨胀率调整为 2022 年的美元,并对 10 支装注射器的价格进行线性回归,以研究注射器定价的决定因素。各州 10 支装注射器的平均实际价格为 4.53 美元(SD = 0.99),药店之间(最高 = 11.44 美元,最低 = 1.70 美元)和各州之间(平均 OR = 5.76 美元,华盛顿州 = 4.74 美元,马萨诸塞州 = 4.33 美元,新罕布什尔州 = 4.30 美元)的差异很大。尽管马萨诸塞州和华盛顿州对注射器免税,而新罕布什尔州和俄勒冈州不征收销售税,但仍有 47% 的购买行为(n = 72)被征税。回归结果表明,某些针号与较低的总体价格相关,而 1 家连锁药店和 2 个注射器品牌与较高的总体价格相关。注射器价格的巨大差异是药店提供注射器的另一个障碍,因为高昂的价格可能会让吸毒者别无选择,只能重复使用或共用针头,尤其是在替代品有限或没有注射器服务计划的地区。医疗保健系统、连锁药店以及州和地方政策制定者必须发挥领导作用,以减少污名化,并实施简化注射器购买的政策,根据州法律取消对免税注射器的征税,并减少注射器价格的变化。
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引用次数: 0
Demographic and Behavioral Differences Between Adolescents and Young Adults Who Use E-Cigarettes at Low and High Frequency 使用电子烟频率较低和较高的青少年之间的人口统计学和行为学差异
Pub Date : 2024-01-02 DOI: 10.1177/29767342231214115
Jill M Singer, A. Tackett, Elizabeth G Klein, Bo Lu, Dylan D Wagner, Loren E. Wold, Megan E Roberts
Among adolescents and young adults (AYAs), “current use” of electronic cigarettes (e-cigarettes) is commonly defined as any use in the past 30 days. However, few studies have examined differences among those within this broad category. This study examined characteristics of AYAs who used e-cigarettes at a low frequency (within the last 3 months but <6 days out of the past 30 days) and those who used e-cigarettes at a high frequency (6+ days out of the past 30 days). We conducted cross-sectional analyses among 551 Ohio AYAs (15- to 24-year-olds) who reported using an e-cigarette to vape nicotine in the past 3 months. We used descriptive statistics and logistic regression to characterize those using e-cigarettes at a low frequency and a high frequency. Among our sample of AYAs who reported past 3-month e-cigarette use, about half (50.8%) reported using an e-cigarette 6 or more days out of the past 30 days (ie, high frequency). In the multivariable analysis, reported nicotine dependence (Odds Ratio [OR]: 7.0, 95% CI: 4.8, 10.3) and current other tobacco product use (OR: 1.8, 95% CI: 1.1, 2.9) were associated with high-frequency e-cigarette use. Our results suggest that frequency of use is an important characteristic in understanding AYA e-cigarette use. Any use in the past 30 days may not be sensitive enough to understand dependence and tobacco-use behaviors. Further characterizing “current” e-cigarette use by frequency of use may provide meaningful information for public health professionals to better target intervention and cessation efforts to AYAs.
在青少年和年轻成年人(AYAs)中,"当前使用 "电子香烟(e-cigarettes)通常被定义为过去 30 天内的任何使用行为。然而,很少有研究对这一大类人群之间的差异进行研究。本研究调查了低频率使用电子烟(过去 3 个月内但过去 30 天中使用电子烟的天数少于 6 天)和高频率使用电子烟(过去 30 天中使用电子烟的天数超过 6 天)的青少年的特征。我们对 551 名俄亥俄州的青少年(15 至 24 岁)进行了横截面分析,他们报告在过去 3 个月内使用过电子烟吸食尼古丁。我们使用描述性统计和逻辑回归对使用电子烟频率较低和较高的人群进行了特征描述。在我们报告过去 3 个月使用电子烟的亚裔样本中,约有一半(50.8%)报告在过去 30 天中有 6 天或更多天使用电子烟(即高频率)。在多变量分析中,报告的尼古丁依赖(OR 比 [OR]:7.0,95% CI:4.8, 10.3)和当前使用其他烟草制品(OR 比:1.8,95% CI:1.1, 2.9)与高频率使用电子烟有关。我们的研究结果表明,使用频率是了解青少年使用电子烟的一个重要特征。过去 30 天内的任何使用情况对于了解依赖性和烟草使用行为可能不够敏感。通过使用频率来进一步描述 "当前 "电子烟的使用情况可能会为公共卫生专业人员提供有意义的信息,从而更好地对青少年进行有针对性的干预和戒烟工作。
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引用次数: 0
Xylazine-Associated Wounds and Related Health Concerns Among People Who Use Drugs: Reports From Front-Line Health Workers in 7 US States 毒品使用者中与 Xylazine 相关的伤口及相关健康问题:美国 7 个州一线卫生工作者的报告
Pub Date : 2024-01-02 DOI: 10.1177/29767342231214472
Jennifer J. Carroll
Xylazine, an adrenergic alpha-2 agonist increasingly present in the US drug supply, is associated with severe skin ulcers and other harms. Expert knowledge from front-line harm reduction and healthcare professionals is an essential component of evidence-based practice. The purpose of this study is to describe the progression and treatment of xylazine-associated wounds, other xylazine-related health concerns, and the most urgent research priorities as reported by front-line harm reduction and healthcare professionals serving people who use drugs. A convenience sample of 17 healthcare and harm reduction professionals who serve people who use drugs in the US states of Maryland, Massachusetts, Michigan, Minnesota, North Carolina, Pennsylvania, and Texas participated in semi-structured interviews. Participants were asked about the appearance and progression of xylazine-associated wounds; preferred treatment strategies; other xylazine-related harms experienced by people who use drugs; and the most urgent priorities for xylazine-related research. Xylazine-associated wounds were broadly described as small lesions appearing mostly on extremities both at and away from injection sites, often within hours or days of exposure, that quickly developed into large, complex, chronic wounds. Reported risk of secondary infection was generally low but appeared more common among unhoused populations. Most participants preferred conservative treatment strategies that included regular wound care, enzymatic debridement, and hygiene. Xylazine-associated wounds and xylazine withdrawal reportedly act as significant barriers to care, including addiction treatment. Participants reported urgent need for scientific research and evidence-based guidance on the management of xylazine-associated wounds and withdrawal. High-quality scientific evidence on risk factors for xylazine-associated wounds and on their biologic mechanisms is needed. Such studies could inform new strategies for the prevention and treatment of these wounds. Efforts to improve the management of xylazine withdrawal and to reduce stigma by incorporating harm reduction professionals into healthcare settings may improve access to and retention in care.
甲氧苄啶是一种肾上腺素能α-2受体激动剂,在美国的药品供应中越来越多,它与严重的皮肤溃疡和其他危害有关。来自一线减低危害和医疗保健专业人员的专业知识是循证实践的重要组成部分。本研究的目的是根据为吸毒者提供服务的一线减低危害和医疗保健专业人员的报告,描述与异丙嗪相关的伤口的发展和治疗情况、与异丙嗪相关的其他健康问题以及最紧迫的研究重点。美国马里兰州、马萨诸塞州、密歇根州、明尼苏达州、北卡罗来纳州、宾夕法尼亚州和得克萨斯州的 17 名为吸毒者服务的医疗保健和减低危害专业人员参加了半结构式访谈。访谈中,他们被问及了以下问题:与异丙嗪相关的伤口的出现和发展;首选的治疗策略;吸毒者所经历的与异丙嗪相关的其他危害;以及与异丙嗪相关的研究的当务之急。据广泛描述,与异丙嗪相关的伤口主要出现在注射部位和远离注射部位的四肢上,通常在接触后数小时或数天内出现,并迅速发展为大面积、复杂的慢性伤口。据报告,继发感染的风险普遍较低,但在无住房的人群中似乎更为常见。大多数参与者倾向于保守治疗策略,包括定期伤口护理、酶清创和卫生处理。据报道,甲氧苄啶相关伤口和甲氧苄啶戒断是治疗(包括戒毒治疗)的重大障碍。与会人员报告称,在管理与异丙嗪相关的伤口和戒断方面,迫切需要科学研究和循证指导。我们需要高质量的科学证据来说明与异丙嗪相关的伤口的风险因素及其生物机制。此类研究可为预防和治疗这些伤口的新策略提供依据。通过将减低伤害专业人员纳入医疗机构,努力改善对停用甲苯噻嗪的管理并减少耻辱感,这可能会改善获得和保留护理的机会。
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引用次数: 0
Training Master of Social Work Students in Brief Intervention for Unhealthy Alcohol Use: Results of a Validated Adherence Assessment 培训社会工作硕士生对不健康饮酒进行简短干预:经过验证的依从性评估结果
Pub Date : 2024-01-02 DOI: 10.1177/29767342231214407
Lisa Berger, James Topitzes, Michelle R. Di Paolo
Many social workers receive limited training in working with clients engaged in unhealthy substance use. As a result, national organizations and agencies such as the Council on Social Work Education and individual social work programs are beginning to address this need by incorporating training into higher education social work programs. The purpose of this study was to examine Master of Social Work (MSW) students’ adherence to a brief intervention protocol for unhealthy alcohol use. A total of 91 MSW students consented to the assessment of their digital, audio-recorded class assignment by independent raters. Although 90% of MSW student participants were found to be overall adherent to the protocol, gaps in training quality were also identified. Lessons learned for addressing the gaps are discussed, along with future directions for teaching and learning in social work related to substance use.
许多社会工作者在与使用不健康药物的客户打交道方面接受的培训有限。因此,社会工作教育委员会(Council on Social Work Education)等全国性组织和机构以及个别社会工作项目开始通过将培训纳入高等教育社会工作项目来满足这一需求。本研究旨在考察社会工作硕士(MSW)学生对不健康饮酒简短干预方案的遵守情况。共有 91 名社会工作硕士(MSW)学生同意由独立评分员对他们的数字录音课堂作业进行评估。虽然发现 90% 的 MSW 学生总体上遵守了协议,但也发现了培训质量方面的差距。本文讨论了弥补差距的经验教训,以及与药物使用相关的社会工作教学的未来方向。
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引用次数: 0
Motivations for Misusing Opioids Among African Americans 非裔美国人滥用阿片类药物的动机
Pub Date : 2024-01-02 DOI: 10.1177/29767342231214118
Khary K. Rigg, Ethan Kusiak, Lindi K. Rigg
A wide range of opioid misuse motives have been documented in the literature, including to relieve physical pain, feel good/get high, relax, manage feelings/emotions, sleep, and moderate the effects of other substances. Despite a rise in opioid misuse among African Americans over the last 2 decades, their motivations for misuse remain unclear. Much of the research on opioid misuse motivations either rely on samples with little racial diversity or do not stratify their findings by race. As a result, less is known about the specific reasons why African Americans engage in opioid misuse. The objective of this study, therefore, was to identify and explain the most common motives for misusing opioids among African Americans. Qualitative interview data are also presented to explain/contextualize the most prevalent motivations. This study used data from the Florida Minority Health Survey, a mixed-methods project that included online surveys (n = 303) and qualitative in-depth interviews (n = 30) of African Americans. Data collection was conducted from August 2021 to February 2022 throughout Southwest Florida. Analyses revealed that while some (33.9%) misused opioids for purposes of recreation/sensation seeking (eg, feel good/get high), the majority (66.1%) were attempting to self-treat perceived medical symptoms (eg, physical pain, anxiety/trauma, withdrawals, insomnia). This study contributes to a better understanding of why some African Americans engage in opioid misuse and findings highlight the need for interventions to be trauma informed and address unmanaged physical pain among African Americans. Given that most studies on motivations are quantitative in nature, the study contributes to the literature by capturing the voices of African Americans who use drugs.
文献中记载了多种滥用阿片类药物的动机,包括缓解身体疼痛、感觉良好/兴奋、放松、控制感情/情绪、睡眠以及缓和其他药物的作用。尽管非裔美国人滥用阿片类药物的情况在过去 20 年中有所上升,但他们滥用阿片类药物的动机仍不明确。大部分关于阿片类药物滥用动机的研究要么依赖于种族多样性很少的样本,要么没有按种族对研究结果进行分层。因此,人们对非裔美国人滥用阿片类药物的具体原因知之甚少。因此,本研究的目的是找出并解释非裔美国人滥用阿片类药物的最常见动机。本研究还提供了定性访谈数据,以解释/说明最普遍的动机。本研究使用了佛罗里达少数民族健康调查的数据,这是一个混合方法项目,包括在线调查(n = 303)和对非裔美国人的定性深入访谈(n = 30)。数据收集工作于 2021 年 8 月至 2022 年 2 月在佛罗里达州西南部进行。分析表明,虽然有些人(33.9%)滥用阿片类药物是为了娱乐/寻求感觉(如感觉良好/获得快感),但大多数人(66.1%)是为了自我治疗感知到的医学症状(如身体疼痛、焦虑/创伤、戒断、失眠)。这项研究有助于人们更好地了解一些非裔美国人滥用阿片类药物的原因,研究结果突出表明,干预措施需要考虑到非裔美国人的心理创伤,并解决他们未得到管理的身体疼痛问题。鉴于大多数关于吸毒动机的研究都是定量研究,本研究通过捕捉吸毒的非裔美国人的声音,为相关文献做出了贡献。
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引用次数: 0
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Substance Use &amp;amp; Addiction Journal
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