Substance use & addiction journal最新文献

Background: Gender-related disparities in access to alcohol-related care exist in the Department of Veterans Affairs' (VA) health care system. Understanding differences in the use of alcohol-related care in the context of potentially important covariates (e.g., race, ethnicity, younger age, and military sexual trauma [MST]) is critical to support the health and well-being of women Veterans. This study examined differences in the use of alcohol preventive care among women Veterans.

Methods: From VA administrative data (2010-2016), we drew a sample of women Veterans (n = 280) who screened positive for at-risk drinking in inpatient/outpatient settings. We conducted a chart review to abstract variables from the medical record. Then, we employed logistic regression to predict receipt of any follow-up (brief intervention and/or referral to treatment) and initiation of treatment, as with covariates of race, ethnicity, age, and clinical characteristics such as MST.

Results: Seventy-four percent (n = 207) of the sample received any follow-up. Of those referred to treatment (n = 115), 73% (n = 84) initiated treatment. Hispanic women were 71% less likely to receive follow-up care than non-Hispanic women. Women Veterans 21 to 24 years were less likely to initiate treatment than those 25 to 29 years. While women Veterans who endorsed MST were more likely to receive follow-up care than others, they were no more likely to initiate treatment.

Conclusions: Given the rapid growth of the women Veteran population, their access to alcohol-related care is vital. Without culturally competent, clinically and developmentally appropriate alcohol prevention messaging for Hispanic and younger women Veterans with trauma, differences in access to care and disparities in outcomes will persist.

Background: Among patients with chronic pain (CP; pain persisting for 3+ months) and opioid use disorder (OUD), ~3 in 4 report co-occurring mental health conditions, which may exacerbate difficulties accessing and engaging in behavioral health treatment. Beyond rates of co-occurring diagnoses, little is known about the differences in specific behavioral health needs of individuals with CP versus those without CP when they seek behavioral health treatment for OUD and co-occurring mental health disorders.

Methods: These secondary analyses utilized data from a randomized controlled trial. Patients (n = 396) were individuals with (n = 281) and without CP (n = 115) seeking behavioral health treatment for OUD and co-occurring mental health disorders. Analyses focused on intake assessment data from validated patient-reported outcome measures for CP, OUD, and mental health: (1) pain intensity and interference (ie, impact on daily activities), (2) mental health symptoms and functioning, (3) current substance use, (4) quality of life, (5) sleep disturbance, (6) physical function, and (7) cognitive function.

Results: Seventy-one percent of patients reported current CP at intake, and these patients reported high pain intensity and interference. Compared to those without CP, patients with CP reported significantly more depression, anxiety, and trauma symptoms; more difficulty with mental health functioning; lower quality of life; more sleep disturbance; and worse physical function. There were no significant differences in self-reported substance use or cognitive function.

Conclusions: This study suggests that individuals with CP as well as OUD and co-occurring mental health disorders may have worse mental health, quality of life, sleep, and physical functioning upon entering treatment compared to those without CP. Thus, behavioral health treatment providers should assess broad mental and physical health needs in addition to screening for CP to address any issues, which may interfere with successful behavioral health treatment.

Introduction: Relevant characteristics of women with opioid use disorder (OUD) can guide new treatment plans or improve old ones. Despite known challenges, understanding why some women remain engaged in treatment while others do not is unclear. Continued treatment improves recovery and reduces relapse risks. Integrating characteristic parameters such as attributes, behaviors, and patterns into treatment can potentially prevent relapse and overdose risks. Therefore, the purpose of this study is to assess characteristic parameters such as demographics, health behavior, health status, utilization, and drug use patterns to inform the continued recovery of parenting women.

Method: This is a descriptive cross-sectional study to assess the characteristics of parenting women with OUD (n = 39) recruited from residential facilities in an original study to explore capital factors for sustained recovery. Data were collected through interviews from 2021 to 2022.

Results: Women in the sample had a mean age of 35 years, were single, white, and had completed high school. Most women were unemployed, received public assistance, including Medicaid, smoked, and were not ready to quit. Approximately 50% reported good to excellent physical/mental health; 67% utilized primary care services compared to emergency departments/hospitals. Women reported drug use for 13.7 years; prescription opioid misuse at about 19 years, and marijuana as the first drug used, before opioids. On average, more women were on methadone than on buprenorphine medication.

Conclusion: This study highlights the influence of key characteristic parameters, including age, smoking, health status, utilization, and drug use patterns, to inform gender-based treatment planning for continued recovery.

Background: Misuse of anabolic-androgenic steroids (AAS), especially through "stacking" multiple substances, poses significant health risks. This study leverages data from the FDA's Adverse Event Reporting System (FAERS) to assess these risks and identify factors predicting severe outcomes.

Methods: We analyzed 286 FAERS reports of intentional AAS misuse. After removing duplicates, the final dataset included 218 unique cases involving men, 7 involving women, and 14 cases with unspecified sex. Drugs, adverse drug reactions (ADRs), and demographic data were categorized. Statistical analyses, including logistic regression, evaluated associations between substance combinations and serious outcomes.

Results: Serious cases constituted 46.8% of the total among men, with cardiovascular, endocrine, and psychological ADRs being most frequent. Stacking other drugs on top of AAS was highly associated with serious outcomes (P < .001). Stacking central nervous system (CNS) depressants (P = 3.50 × 10^-8), fat-burning agents (P = 1.51 × 10^-10), endocrine modulators (P = 6.26 × 10^-6), and other CNS-active substances (P = 3.34 × 10^-5) were strongly associated with serious outcomes. Logistic regression revealed younger age (P = .0188, negative coefficient -0.117) and higher drug count (P = .0458, positive coefficient 0.991) and recent report year (P = .0006, negative coefficient -0.467) as significant predictors of life-threatening events.

Conclusions: AAS misuse, especially through high-risk stacking, significantly elevates the risk of serious health outcomes, particularly in younger individuals. Public health interventions-including targeted outreach, harm reduction, and enhanced healthcare provider awareness training-are necessary to educate on and mitigate these risks.

Individuals with substance use disorders (SUD) often encounter challenges in healthcare, including provider attitudes, stigma, and gaps in clinical education. For pregnant and birthing individuals with SUD, these challenges are further compounded by moral blame, judgment, clinician burnout, and limited institutional support. Each of the aforementioned factors are barrier to evidence-based, person-centered care, and contributes to adverse outcomes for both birthing individuals and newborns. This study aims to address those barriers by designing and implementing a stigma-reduction and clinical empathy training package tailored for the intrapartum healthcare workforce. Focusing on the in-patient labor and delivery period, the intervention aims to foster institutional change, grow clinician confidence, and promote a culture of empathy and understanding. The proposed intervention, Interprofessional Simulation Program for Clinical Resilience and Empathy (INPSIRE), will include multi-component training modules and an adaptive intervention designed to address provider clinical knowledge, stigma, and burnout among clinicians and will promote the use of practical tools for demonstrating clinical empathy and support. In developing the intervention, the study will examine quality and stigma in intrapartum care from clinician and patient perspectives through focus group discussions, key informant interviews, restorative justice story circles, and postpartum patient interviews. Drawing insights from these qualitative methods, the INSPIRE intervention will then be co-designed with stakeholders to ensure relevance and effectiveness. The impact of the INSPIRE intervention will be evaluated using a quasi-experimental design, assessing its effects on healthcare team outcomes, patient outcomes, and scalability. Through self-directed online learning and in-person team simulation, the INSPIRE intervention aims to enhance provider skills, promote respectful care, and ultimately improve maternal health outcomes for individuals with SUD.

Objectives: This study evaluated the psychological impact of moderate-to-vigorous aerobic exercise (MVE) on male methamphetamine (MA) use disorders (MUD) rehabilitation inpatients.

Methods: Hundred male MUD rehabilitation inpatients were randomized into 2 groups; the experimental group received the MVE intervention, and the control group received a low-to-moderate-intensity exercise intervention for 1 hour, 5 times a week for 3 months. Psychological assessment was performed using Symptom Checklist 90, and MA craving was assessed using the Virtual Reality Addiction Assessment System developed by Tsing Research Technology (http://www.qingtech.com.cn/AntiDrug/VrDrug). Two-factor repeated measures ANOVA was utilized to compare treatment differences between the 2 groups.

Results: There were better outcomes in the MVE group than in controls, mainly in terms of lower scores for compulsive symptoms (P < .05, η² = .046), depression (P < .01, η² = .061), and MA cravings (P < .05, η² = .054). However, group × time interaction effects had no significant impact on somatization, interpersonal relationships, anxiety, hostility, paranoia, phobia, and psychoticism.

Conclusions: MVE helps reduce depression, compulsive symptoms, and MA cravings scores in adult men MUD rehabilitation inpatients. However, randomized double-blind trials are needed to validate this result further.

Trial registration: ChiCTR2400080819.

Background: Within office-based addiction treatment (OBAT) for opioid use disorder, routine urine drug testing (UDT) has been a near-universal practice, despite concerns about increased stigma and limited evidence on improved patient outcomes. During the COVID-19 pandemic, routine UDT was suspended in many settings as care transformed to telehealth, providing an opportunity to explore viewpoints about routine UDT and the implications of its absence.

Methods: We explored patient and provider perspectives through qualitative interviews conducted from May 2021 to May 2022 within an urban, low-threshold OBAT program. Semi-structured interview guides and thematic analysis explored opinions on traditional routine UDT and experiences with its discontinuation during the COVID-19 pandemic.

Results: Based on perspectives of 25 patients and 16 providers, we identified three themes regarding routine UDT and its decreased use during the COVID-19 pandemic: (1) the general utility of UDT within traditional models of care, (2) burdens that routine UDT could present to care engagement, and (3) impacts of UDT on trust within patient-provider relationships.

Conclusions: Our findings support the need for reconsideration of routine UDT in OBAT, as well as the needs for improved care standards. Selective use of UDT can be implemented in a patient-centered manner, including offering it upon patient request (eg, for personal "accountability") and discontinuing it when appropriate and to reduce barriers to care. In place of routine UDT, our findings also highlight the need for alternative, non-stigmatizing clinical tools that can support patients and providers within OBAT care settings.

Background: Recent changes to the US opioid overdose epidemic have been driven by the spread of illicitly manufactured opioids and complex patterns of multisubstance use. Updated analyses of opioid use epidemiology among US adults are needed to guide new research and interventions.

Methods: Cross-sectional study of 2021 to 2022 National Survey on Drug Use and Health. Using nationally representative estimates weighted to 255 053 169 adults, multivariable logistic regression models determined odds of mutually exclusive past-year opioid use categories (nonmedical use of pharmaceutical opioids [NMUPO], heroin use, or both) across demographic, socioeconomic, and clinical variables.

Results: Prevalence of NMUPO among US adults was 3.0%, heroin use 0.2%, and both 0.2%. Demographic characteristics associated with nonmedical opioid use included middle age groups (e.g., 35-49 years old relative to 18-25 years old, NMUPO: adjusted odds ratio [aOR] 1.61, 95% CI 1.26-2.07) and LGB sexual orientation relative to heterosexual orientation (e.g., NMUPO: aOR 1.33, 95% CI 1.09-1.64). Among socioeconomic variables, the strongest associations were with lower educational attainment (e.g., completing high school relative to completing college, both: aOR 3.84, 95% CI 1.53-9.68). Clinical variables strongly associated with opioid use included nonmedical sedative/tranquilizer use (e.g., NMUPO: aOR 7.48, 95% CI 5.86-9.56), nonmedical stimulant use (e.g., both: aOR 32.42, 95% CI 17.11-61.42), lower self-rated health (e.g., "poor" health relative to "excellent" health, NMUPO: aOR 1.98, 95% CI 1.34-2.91), and severe mental illness (e.g., both: aOR 3.78, 95% CI 2.05-6.96).

Conclusions: Future research and public health efforts should account for heterogeneity in opioid use patterns across US adults, including strong associations with nonopioid substance use.

Background: Patients with opioid use disorder (OUD) often face challenges when being treated for acute pain due to opioid tolerance, co-occurring withdrawal, and clinician stigma and knowledge deficits. Guidelines for pain management in this population remain unclear. This study aimed to explore clinician practice patterns and attitudes regarding emergency department and inpatient acute pain management in patients with OUD.

Methods: A survey with 2 clinical vignettes (a patient without OUD, a patient with OUD), 1 knowledge question, and 5 attitude questions was disseminated to clinicians in emergency medicine, internal medicine, and trauma surgery (n = 423, response rate 24.3%) at a single academic medical center. Descriptive statistics were performed on completed surveys (n = 103). An ordinal logistic regression model (α = .05) was generated to evaluate attitude responses by demographic.

Results: In the vignettes, 18 (17.5%) indicated that an OUD diagnosis would not change acute pain management. Four (3.9%) and 2 (1.9%) would avoid IV opioids and oral opioids. Fifty-four (52.4%) and 34 (33.0%) would use higher dose IV and oral opioids, while 18 (17.5%) would use long-acting oral opioids. About half (53, 51.5%) "agreed" or "strongly agreed" that they felt comfortable treating acute pain in patients with OUD. Ninety-eight respondents (95.2%) "disagreed" or "strongly disagreed" that patients with OUD should not receive opioid analgesia. Sixty-six respondents (64.1%) "disagreed" or "strongly disagreed" that the physical symptoms of patients with substance use disorders are treated as seriously as those without.

Conclusions: While most respondents aligned changes in management with pharmacologic principles (ie, higher tolerance requiring more opioids), a sizable proportion reported that they would not make changes or would withhold opioids. Additionally, only half of respondents indicated comfort with treating acute pain in patients with OUD. Additional research and guidelines, development of clinical decision supports, and targeted educational initiatives are needed to improve comfort and clinical care.