Substance use & addiction journal最新文献

Background: Addiction is a devastating chronic disease requiring significant resources and attention. Healthcare professionals have noted struggles in caring for patients with substance use disorder (SUD) due to stigma, perceived difficulties in dealing with patients, and issues with treatment compliance. Challenges in dealing with individuals with SUD may stem from an inadequate understanding of the disease and consequent misconceptions about patient behaviors. The type and extent of addiction education affect the depth of understanding of SUD and shape attitudes toward patients. In this review, we explore aspects of addiction education including examining curricular guidelines and educational strategies, especially regarding the neurobiology of addiction.

Methods: We conducted a narrative review using online databases and search engines to identify studies related to addiction/SUD education with emphasis on the type and extent of neurobiological content.

Results: Studies examining addiction education document deficiencies that may contribute to insufficiencies in SUD treatment and disrespectful treatment of individuals with SUD. There is also a lack of detail regarding the extent of the neurobiology of addiction education in professional core courses and curricular guidelines. Implementing a more detailed approach to addiction education with more comprehensive neurobiology is discussed along with strategies to motivate students to learn and appreciate these complex details.

Conclusions: While there are many aspects of addiction education, a solid foundation in the neurobiological mechanisms of addiction is important to establish an appreciation for the disease nature of addiction and the resulting behaviors of the individual. Teaching beyond the rewarding nature of addiction is essential to enable students to comprehend how the activation of survival stress systems and compromised decision-making affects the behavior of individuals with SUD. A more comprehensive understanding of addiction fosters more respect for individuals with SUD and creates potential for more opportunities for effective treatment.

Background: Substance use disorders (SUD) are a significant public health challenge, necessitating that clinicians are trained in SUD treatment and harm reduction (HR) strategies. Despite this, no studies have assessed the extent of SUD and HR training across all medical schools. This study assesses the current state of SUD and HR curriculum among medical students in the United States and Canada.

Methods: From May to July 2023, we conducted an anonymous online survey via email invitation to student affairs' offices of all 220 accredited US and Canadian medical schools. The survey assessed the curricula students were exposed to related to SUD treatment, HR, and stigmatizing attitudes.

Results: A sample of 568 students from 52 medical schools (23.6% of all US and Canadian medical schools) completed the survey. Participants reported that in their medical school they were taught about: recognition of an opioid overdose (80.0%), identifying and treating opioid withdrawal (68.2%), principles and practices of HR (60.6%), administering naloxone (56.6%), the importance of syringe service programs (51.8%), prescribing methadone and/or buprenorphine (29.5%), and counseling patients on safe injection practices (11.4%). In addition, participants reported that they were taught: how to identify drug-seeking behavior (36.4%), that people who use heroin are "drug abusers" (24.4%), to withhold opioid pain medication from patients who are known or suspected to use drugs (15.9%), and that medication for opioid use disorder is another form of addiction (12.6%).

Discussion: We found large curricular gaps related to the administration of medications for opioid use disorder and treating opioid overdose and withdrawal, as well as a significant prevalence of stigmatizing attitudes. Renewed efforts are needed to implement comprehensive and destigmatizing SUD curricula. The study is limited by response bias and is expected to overestimate the extent of HR related curriculum, indicating the true gap is likely higher than reported.

Objective: A growing body of evidence points to a role for mindfulness in the development or maintenance of co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD). However, the mechanisms of this relationship remain unclear in the veteran population. This study seeks to understand how PTSD and facets of mindfulness are associated with factors of SUD in veterans enrolled in a VA specialty SUD treatment program.

Method: Veterans enrolled in the SUD treatment program were recruited from group classes and waiting rooms, and completed measures assessing SUD-related factors of frequency of alcohol use, hazardous alcohol use, consequences from substance use, and craving, as well as PTSD symptoms, mindfulness facets, and depressive symptoms. Three hierarchical multiple regressions assessed the extent to which significant relationships between mindfulness and SUD-related factors exist beyond associations commonly found with PTSD, depression, and craving.

Results: Participants (n = 159) were predominately male (91.2%) and White (86.2%) (age: Mean = 57.3; SD = 12.9). After controlling for demographic factors, PTSD, and clinical variables, mindfulness facets were associated with SUD-related factors; observe was positively related to frequency of alcohol use, non-judging was positively related to hazardous alcohol use, and non-reactivity was negatively associated with consequences from use. Exploratory analyses suggested that non-reactivity mediated the relationship between PTSD and consequences from use.

Conclusions: Facets of observe, non-judging, and non-reactivity may help explain relationships between PTSD and SUD-related factors. However, associations with non-judging and observe were in the opposite direction hypothesized. More research is needed to understand positive associations between mindfulness and factors of SUD in veteran samples.

Background: Caregiver problematic substance use (SU) is a common adverse childhood experience that is associated with the development of SU disorders in adolescence and poor health outcomes. Most pediatricians do not currently screen for caregiver SU, missing an opportunity to provide targeted prevention counseling to at-risk youth and their families. The objective of this study was to assess whether pediatric residents' screening-related competencies, beliefs, and training were associated with current screening practices and/or preparedness to screen in the future.

Methods: Baseline surveys from a quality improvement initiative to increase screening for household SU in pediatric primary care were e-mailed to all pediatric residents at an academic medical center. Surveys assessed residents' current screening practices, preparedness to screen in the future, screening-related competencies, receipt of SU training, beliefs about screening, perceived caregiver acceptability of screening, and stigma about caregiver SU.

Results: Residents agreed screening for household SU is a pediatrician's responsibility and beneficial for patients and families, yet only 5% universally screened. Preparedness to screen in the future was positively associated with reported screening-related competencies and receipt of training on SU screening during residency.

Conclusions: Most residents did not universally screen for household SU, thereby missing opportunities for targeted secondary prevention of adolescent SU. Trained residents who reported competence in addressing families' concerns were more likely to feel prepared to screen in the future, suggesting education that addresses caring for affected families, reviews available resources, and improves pediatrician confidence may be particularly impactful.

Background: Given the substantial expansion of the US cannabis market and the impact of cannabis advertising exposure on use, cannabis marketing surveillance is needed to inform regulations and protect consumers.

Methods: Using 2020-2021 Vivvix advertising data from 4 US cannabis companies (Cresco, Mindy's, MedMen, and Uncle Ike's), we examined (1) general advertising characteristics (eg, number of unique ads and ad occurrences, ad expenditures, market, and media channel); and (2) ad content (ie, headlines and imagery) and placement (ie, source themes, eg, specific websites and magazines), overall and by company.

Results: There were 399 unique ads and 1171 occurrences, totaling $488,617 in expenditures. Cresco and Uncle Ike's accounted for most unique ads (~45% each); Cresco represented the majority of ad occurrences (52.4%) and expenditures (63.4%). Most ads were disseminated via online displays (occurrences = 69.2%; expenditures = 45.8%). The primary source for ad dissemination was news/weather (occurrences = 36.3%; expenditures = 40.2%). Ad headlines most frequently emphasized product type (occurrences = 40.1%; expenditures = 37.0%). Visual strategies to attract attention included gifs (occurrences = 63.6%; expenditures = 71.1%). Companies differed in their marketing strategies (ie, volume, markets, channels, and content).

Conclusions: Findings underscore the need to restrict cannabis marketing, for example, restricting ad content and marketing channels. This may reduce exposure to cannabis marketing, which is associated with cannabis perceptions and use.

Background: Methamphetamine and other stimulant use are increasing across Mexico while treatment options and public funding remain scarce for substance use treatment. This study examined the attitudes and perspectives of service providers who work with persons who use stimulants in Mexico.

Methods: Semistructured qualitative interviews were conducted with 20 service providers in diverse cities in the northern and central regions of Mexico, from healthcare centers and harm reduction community-based organizations (CBOs). All interviews were audio-recorded, transcribed, and de-identified. We conducted a thematic analysis to identify and compare common themes and patterns among participants, including portrayal of persons who use stimulants, dynamics of use, attitudes toward persons who use stimulants, and treatment availability and effectiveness.

Results: First, service providers considered that persons who use stimulants have more complex backgrounds than others who use other substances. Second, although most providers mentioned trauma, pain, and the risk environment, CBO providers also stressed the importance of accounting for hedonism for understanding stimulant use trajectories. Third, treatment options are based on the type of services the institutions provide, usually constrained to guidelines for any substance use. In a few cases, cocaine treatment guidelines are used regardless of the type of stimulant used. Fourth, although health care services are abstinence-based, providers acknowledge the effectiveness of harm reduction approaches. In contrast, CBOs provide person-centered options.

Conclusions: Overall, although service providers are aware of the increase in stimulant use, stigmatizing attitudes are prominent among some of them. However, providers in CBOs were more sensitized to their communities' specific needs. Public policy recommendations include training to eliminate institutional stigmatization, the importance of first-person language, harm reduction effectiveness, and implementing community-based interventions to improve stimulant use-related services.

Introduction: Young childbearing sexual minority (SM) people are more likely to use cannabis and to have an unintended pregnancy than their heterosexual peers; however, little is known about their perceptions and experiences of peripartum cannabis use. This qualitative study explores the relationships young pregnant and parenting SM people have with cannabis, as well as their feelings and opinions about prenatal cannabis use.

Method: Participants who identified as SM from baseline surveys of the YoungMoms study were recruited for semi-structured qualitative interviews (n = 13). Interviews focused on cannabis use experiences before and during pregnancy. Data were analyzed using thematic analysis.

Results: Data analysis revealed 3 key themes. Participants described the contextual adaptivity of their cannabis use, discussing how their use changed based on social context, mental health, and stress but was not directly related to their sexuality. Pregnancy was identified as a potential turning point for cannabis use as participants described trying to reduce or abstain during pregnancy, although some struggled to do so or continued use to address pregnancy symptoms. Facilitating factors of prenatal cannabis reduction were described, including focusing on the financial toll, social environment changes, access to health-related guidance, and replacement hobbies.

Conclusions: This study provides novel information about a public health concern among a pregnant population that is often overlooked in prenatal substance use research. Similar to their heterosexual peers, pregnancy may serve as an opportune time for intervention among young SM people who use cannabis, but consideration of unique factors that contribute to their cannabis use is needed.

Background: In 2020, loosened federal regulations allowed for buprenorphine for opioid use disorder to be initiated via telemedicine. In response to these regulatory changes and growing racial inequities in overdose in St. Louis, MO, a local, peer-led outreach program incorporated a new rapid access (RA) to buprenorphine program. RA facilitated same-day buprenorphine access by conducting peer-facilitated telemedicine visits in community settings.

Methods: This study used logistic regression to compare 1- and 3-month treatment and buprenorphine retention between clients in the RA and Traditional (ie, linkage to brick-and-mortar prescribers within 1-3 days) programmatic arms of a peer-led outreach program between December 2020 and June 2022. Propensity score matching allowed participants across groups to be matched on key factors (eg, sex, race, homelessness). Racial differences in program receipt/enrollment were also assessed through Chi-squared tests.

Results: Total program participation (N = 4139) included 1% (n = 52) in the RA program. Those in RA were more likely to be in treatment at 1 and 3 months and more likely to be on buprenorphine at 3 months compared to those in the Traditional group. The RA program included more White and fewer Black clients than expected. Four of the 8 reasons for non-enrollment differed by race, with Black individuals more likely to already have treatment secured but also more likely to decline the program or be unable to be contacted.

Conclusions: This study is the first to demonstrate sustained benefits in treatment and medication engagement following same-day access to buprenorphine via community-based, peer-facilitated telemedicine. Lower-than-expected enrollment of Black individuals indicates a need for more culturally responsive implementation strategies for peer- and telemedicine-facilitated programs.

Background: Hospital policies play a role in healthcare providers' decision-making about reporting birthing people who use drugs to child welfare. This study sought to understand how these specific hospital policies are made.

Methods: We conducted semi-structured interviews with healthcare professionals involved in developing or revising hospital policies related to child welfare reporting for birthing people who use drugs. The interview guide was informed by an implementation science framework and focused on participants' experiences developing or revising these policies. We coded transcripts inductively, focusing on themes that emerged in the interviews themselves, and deductively, focusing on pre-determined aspects of the policy development process.

Results: Participants (N = 16) were physicians (69%), registered nurses (19%), and social workers (12%). The sample was drawn from all regions of the United States. Two themes emerged in data analysis. The first theme was that urine drug testing policies for pregnant and birthing individuals are seen as part of hospital child welfare reporting policies. Specifically, participants often described child welfare reporting policies as including criteria for urine drug testing and explained that the connection between urine drug testing and child welfare reporting policies was by design. The second theme was that the content of hospital child welfare reporting policies is a result of hospital politics and a focus on legal compliance. They described the legal compliance aspects of the hospital policies as serving to protect the institution and, occasionally, individual employees from legal consequences.

Conclusion: The content of hospital policies regarding birthing people who use drugs appears influenced by political and legal considerations more than considerations of patient or public health.

Objectives: This study compared whether different addiction treatment educational experiences were associated with physicians' attitudes toward patients with opioid use disorder (OUD) and perceived efficacy of medications for opioid use disorder (MOUD).

Methods: Ohio physicians (n = 2757) with and without a waiver to prescribe buprenorphine (Drug Addiction Treatment Act 2000 [DATA 2000] waiver) were surveyed regarding their attitudes toward treating patients with OUD and on the effectiveness of MOUD. We divided physicians into 3 groups: physicians with DATA 2000 waivers, non-waivered physicians with experiential training, and non-waivered physicians without experiential training. We defined experiential training as educational experience directly working with individuals with OUD including those in recovery. Analysis of variance was used to detect statistically significant group differences.

Results: We found significant main effect differences in attitudes toward patients with OUD and perceived efficacy of MOUD between groups (P ≤ .01) for all but one attitude. Post hoc comparisons revealed waivered physicians had the most favorable attitudes. Among physicians without a waiver, those with experiential training had significantly more favorable attitudes toward treating OUD and perceived MOUD to be more effective, including items such as "OUD are treatable illnesses" and "medication assisted treatment is a crucial part of treatment for OUD."

Conclusion: The results suggest that physicians with DATA 2000 waiver and experiential training, as compared to physicians without either a waiver or experiential training in OUD, are associated with less stigmatizing views of treating patients with OUD and prescribing MOUD. While legislation in December 2022 eliminated DATA 2000 waiver training requirement, these findings suggest an ongoing need for training opportunities.