Substance use & addiction journal最新文献

The evolving unregulated drug supply in the United States has led to an unprecedented rise in xylazine-adulterated synthetic opioid use-related morbidity and mortality, of which Pennsylvania shoulders a disproportionate burden. People experiencing these xylazine harms who seek acute medical care require complex clinical management, multidisciplinary coordination, and appropriate linkage to outpatient care. We describe our experience leading a hospital-wide multidisciplinary xylazine workgroup from February to June 2024 to collaboratively develop time-sensitive clinical protocols on inpatient management of patients exposed to xylazine. Workgroup participants were organized into three subgroups: (1) toxicology screening and harm reduction; (2) withdrawal management; and (3) inpatient wound care management and linkage to outpatient wound care. We summarize our implementation process and clinical protocol recommendations of each subgroup and highlight important cross-cutting issues related to the changing drug supply, standardized patient and provider educational tools, care coordination, and next steps.

Background: To address the urgent housing needs of individuals experiencing unsheltered homelessness and substance use disorder (SUD) living in an encampment, Boston established six harm reduction low-threshold shelter (LTS) sites in January 2022.

Methods: To understand the LTS guest experience of persons who had been living in the tent encampment, assess early outcomes of the LTS service model, and inform concurrent implementation of this new shelter model, the Boston Public Health Commission implemented a point-in-time survey of 50 individuals who moved from the encampment into LTS three to six months after the encampment closure. The in-person survey assessed participant experience, quality of life, and service access.

Results: Seventy-two percent to 90.0% of survey participants reported improvements in sleep quality, food security, and connection with others since moving into LTS. Sixty-eight percent to 92.0% of participants indicated increased access to mental health and healthcare providers and housing navigation services. Over 80.0% of respondents reported increased confidence in overdose response since moving into LTS, and almost half reported being in some form of treatment for SUD. Importantly, 90.0% of participants agreed that they had hope for the future.

Conclusion: Harm reduction transitional shelter spaces remove access barriers to people experiencing unsheltered homelessness and SUD and promote safety, well-being, and access to critical support services and housing navigation.

Background: Postpartum women with substance use disorder (SUD) are at heightened risk of adverse health outcomes problems. The current understanding of early motherhood while managing SUD is poorly understood, as the transitional period following delivery has been a neglected area within research. This qualitative study examined how postpartum women balance new motherhood while navigating early recovery from SUDs.

Methods: The primary aim was to elicit individual experiences in the context of maternal functioning (social support, psychological well-being, infant care, self-care, mother-child interaction, management, and adjustment). In 2023, we purposefully recruited a sample of postpartum women receiving residential services for SUD (N = 22) and conducted semi-structured individual interviews. Interviews were audio-recorded and transcribed verbatim, and codes were analyzed using deductive and subsequent inductive analysis to identify themes unique to each functioning domain among postpartum women with SUDs.

Results: Participants were predominately white (81%), single (86%), and between 20 and 40 years of age and were the primary caregivers for their children, and half were less than 3 months postpartum. Balancing infant care and self-care was cited as a significant challenge. Several participants expressed a need for more early parenting support and assistance in navigating social services and life after leaving residential treatment. Pregnancy catalyzed entering and remaining in treatment while remaining engaged in recovery and sustaining sobriety was a form of self-care. The social network gained as part of the treatment was frequently described as crucial for new moms to care for their children while navigating early recovery.

Conclusions: This study highlights the importance of exploring the postpartum experience and needs among postpartum people in SUD recovery. Maintaining recovery through sustainable sobriety was considered a form of self-care, indicating that the postpartum period is a critical point in both a mother's life and a unique intervention point for postpartum women with SUD.

Objective: To use the opioid use disorder (OUD) cascade of care to explore the OUD treatment experiences and preferences of pregnant and postpartum people with OUD who experienced incarceration during pregnancy.

Method: We conducted 12 semi-structured interviews with pregnant and postpartum people with OUD who were either currently incarcerated or in a residential treatment program with experience of perinatal incarceration. The interview guide was developed using a trauma-informed approach and Reproductive Justice framework. Interview transcripts were analyzed using the rigorous and accelerated data reduction technique and a generalized inductive approach with the codebook developed a priori with topical codes from the interview guide and then expanded with interpretive codes.

Results: We identified themes along the OUD cascade of care. Treatment engagement was shaped by individual readiness and the availability of treatment, both in the community and during incarceration. Medications for opioid use disorder (MOUD) initiation was limited in some instances by the availability of the medication and, in many instances, stigma limited the desire for and ease of MOUD initiation. Participants described potential facilitators (navigation, gender-responsive services) and barriers (lack of mental health care, unmet preferences in terms of treatment format/structure) to retention in care in the community after incarceration. Participants had limited experience with sustained remission and did not identify incarceration as an effective strategy for sustained remission.

Conclusions: Incarceration is not an effective strategy for sustained remission. Individual, organizational, and structural supports are required to support attempts at recovery that are initiated during incarceration.

Background: Two factors that may influence young adults' cannabis use include having cannabis-using parents (CUP) and becoming parents themselves. These factors may differentially impact certain subgroups that are more likely to use cannabis (e.g., males, those with mental health conditions or living in states with legal nonmedical cannabis). This study examined intergenerational transmission of cannabis use across US young adult subgroups.

Methods: We analyzed 2023 survey data among 4031 young adults (M_age = 26.29; 48.8% past-month cannabis use by design). Multivariable logistic regression examined whether participants had CUP and children in relation to past-month cannabis use, and the moderating effects of having CUP and children on other use-related factors, including sociodemographics (age, sex, race/ethnicity, education, relationship status), psychosocial factors (depression, anxiety disorder, and attention deficit hyperactivity disorder [ADHD] diagnoses; adverse childhood events [ACEs]), and state nonmedical cannabis legalization.

Results: Having CUP (aOR = 2.90, 95% CI = 2.42, 3.47) and children (aOR = 1.37, 95% CI = 1.12, 1.67) were associated with cannabis use; however, a significant interaction indicated that having children was associated with use only among those without CUP. Living in legalized states and more ACEs were also related to cannabis use only in those without CUP. For participants with children (but not those without), having association between being male and use was stronger in those with (vs without) children. Other correlates included being older, sexual minority, Hispanic, Black, unmarried, and diagnosed with depression or ADHD.

Conclusion: Given intergenerational influences on cannabis use and related disparities, interventions targeting parental use and related communication with children are needed.

Background: People who inject drugs (PWID) may develop skin and soft tissue infections because of limited access to sterile injection supplies and education regarding safer injection techniques. The purpose of this study was to assess wound care experiences, knowledge, and practices among individuals accessing community-based services and inform service provision for PWID.

Methods: Using convenience sampling, participants of an organization that engages with PWID in Austin, Texas, were engaged in a multiphase mixed-methods study. Phase 1 (N = 39) included completion of a 23-item quantitative survey; eligibility required injection drug use in the past 30 days. Phase 2 (N = 20) included brief semi-structured interviews to explore wound care practices. Participants received $20 grocery store gift cards for participating in each phase. Qualitative data were analyzed using an analytic matrix to identify themes.

Results: PWID reported injecting methamphetamine, heroin, and fentanyl; 53.8% (21/39) injected more than 1 substance. The same proportion (21/39) had experienced at least 1 injection-related wound in the past 6 months and reported often or always self-treating injection-related wounds. Their reasons included confidence in self-treating, lack of perceived wound severity, and experience of stigma. Interview participants described their experiences with infections, how they cleaned wounds and obtained antibiotics, how they decided when to seek medical care (eg, wound severity, confidence in self-treatment), and barriers to seeking care (eg, stigma, financial concerns).

Conclusions: Needs for wound care treatment and education among PWID are currently unmet, and stigma from health care providers remains a challenge to seeking early intervention for infections. Delivering wound care services and education through community-based organizations that have established credibility and connection may enhance access to care.

Introduction: During the postpartum period, new parental responsibilities may compound changing social, community, and health care environments to increase risk of health and drug-related problems. This study examines both county-level and individual-level factors associated with hospitalization among individuals with opioid use disorder (OUD) throughout the first-year postpartum.

Methods: A cohort of individuals with OUD at delivery were identified in Pennsylvania hospital discharge data (n = 1966). Multilevel logistic regression models examined county-level (median household income, rurality, jail rate, OUD treatment facilities, hospital beds) and individual-level (demographics, insurance, tobacco use, other substance use disorders, mental health conditions) factors associated with inpatient hospitalizations (all-cause, OUD-related, mental health-related) in the early (0-42 days) and late (43-365 days) postpartum periods.

Results: In total, 280 individuals (14%) with OUD had at least 1 hospitalization in the first-year postpartum. After adjustment, higher county densities of OUD treatment facilities were associated with lower odds of all 3 types of hospitalizations in early postpartum, including 80% to 86% reduced odds of OUD-related hospitalizations for those in counties with the 3 highest quartiles of treatment facility densities compared with the lowest quartile. These associations did not remain significant in late postpartum. All maternal age groups, compared with those aged 25 to 29, had increased odds of a mental health-related hospitalization in early postpartum, and the youngest age group (17-24 years) had increased odds in late postpartum. Experiencing any hospitalization from 0 to 42 days postpartum was positively associated with all 3 types of hospitalizations in late postpartum.

Discussion: County health care and drug treatment systems are associated with hospitalizations among individuals with OUD throughout the first-year postpartum. Addressing policy, sociocultural, and structural barriers to accessing these services should be a priority for improving postpartum health and reducing drug-related harms in this period.

The opioid-related overdose crisis remains a public health priority in the United States. A key component of initiatives to mitigate this crisis are policies that aim to improve equitable access to effective treatments for opioid use disorder (OUD). To facilitate this goal, it is crucial to effectively use and build upon evidence from existing studies evaluating the effectiveness of OUD treatment policies, though assessing the effectiveness of policies is challenging in part due to bespoke differences in how researchers define and categorize policies. This project aimed to improve addiction research through the development of an evidence- and consensus-based classification system for OUD treatment policies. The development of this classification system will take place in 5 steps. The first step will involve a review of existing policy classification systems to create a synthesized list of labels, definitions, and relational structure for OUD treatment policies. The second step will involve a refinement of this list through examining policy labels and definitions in existing empirical studies of OUD treatment policies, with discussion and revision of the list throughout this process. The third step will involve an online expert feedback exercise on the clarity, uniqueness, and completeness of the refined classification system. The fourth step will involve reliability testing of the classification system on existing policies to examine the interrater reliability across different areas of OUD treatment policy. The fifth step will involve a sorting task to place the OUD treatment policies into final categories. A unified classification system of OUD treatment policies can facilitate comprehensive and systematic assessments of what we know from existing empirical research, identify gaps in policy approaches, inform data collection efforts, improve future scientific evaluations, and help policymakers make more informed decisions about which policies are high-value for specific outcomes in specific populations and contexts.

Background: Drug overdose deaths have increased fivefold over the last 20 years, primarily fueled by synthetic opioids, which led the Centers for Disease Control and Prevention to declare an opioid overdose epidemic. Responding to this epidemic, we designed and implemented opioid overdose prevention (OOP) training for medical students to help promote effective naloxone usage. Previously, we compared online and in-person versions of OOP training over 2 years of training. To better establish the evidence for online training, we performed a randomized controlled non-inferiority trial comparing in-person with online opioid prevention training.

Methods: Third-year medical students were randomized into groups to receive either in-person or online training in preparation for clinical rotations. Students randomized to receive online training were provided a link to the training modules. Students randomized to receive in-person training were trained in an in-person setting. We performed a non-inferiority per-protocol analysis with the primary outcome of knowledge using a non-inferiority margin of a -9.1% difference between groups.

Results: A total of 205 students were randomized, 103 students to in-person training and 102 to online training. Eighty-three in-person students and 104 online students were included. The online group had a higher post-training knowledge score compared to the in-person group by 0.44 points (0-11 point scale) with a 95% CI of (-0.04, 0.93) that did not cross the margin of non-inferiority.

Conclusions: Online training for OOP was effective and non-inferior to in-person training. Online OOP training may be considered an alternative to in-person training.

With the ongoing drug crisis, serious injection-related infections (SIRIs), such as endocarditis, have increased significantly. Hospitalizations are a missed opportunity for persons who inject drugs (PWID) to engage in care. We developed a 5-item SIRI Checklist for providers as a standardized reminder to offer medication for opioid use disorder (MOUD), human immunodeficiency virus (HIV), and hepatitis C virus (HCV) screening, harm reduction, and referral to community-based care. We formalized an Intensive Peer Recovery Coach protocol to support PWID on discharge. We hypothesized that the SIRI Checklist and Intensive Peer Intervention would increase HIV and HCV screening, MOUD, and linkage to care: pre-exposure prophylaxis (PrEP) prescription, MOUD prescription, and related outpatient visit(s). This is a feasibility study and randomized control trial of a Checklist and Intensive Peer intervention for hospitalized PWID with SIRI. We will randomize 60 PWID into 4 groups (SIRI Checklist, SIRI Checklist + Intensive Peer, Intensive Peer, and Standard of Care). Results will be analyzed using a 2 × 2 factorial design. Outcomes include the ability to recruit and retain hospitalized PWID and clinical data (HIV, HCV testing, MOUD, and PrEP prescriptions). By testing low-barrier interventions that are accessible and reproducible in a rural, poor state, we aim to identify models of care that promote linkage and engagement in community care.