Substance use & addiction journal最新文献

Background: Cross-national comparisons of driving under the influence (DUI) of cannabis (DUIC) or DUI of alcohol (DUIA; ie, driving after consuming too much to drive safely) may inform policies and preventative measures, although research is currently limited. This cross-national study sought to compare the frequency of DUI, being a passenger with an impaired driver, and associated risk perceptions.

Methods: Secondary analyses of students from 6 countries (Argentina, Canada, England, Spain, South Africa, United States). Participants (n = 5167; 70% women; mean age 20.1 [SD = 3.7]) completed an online survey assessing past-year frequency of alcohol or cannabis-impaired driving and being a passenger with an impaired driver. Risk perceptions included the perceived threat to personal safety of impaired driving, and perceived likelihood of negative consequences (eg, being in an accident, stopped by police). Differences across countries were tested using chi-square tests with Bonferroni-corrected adjusted residuals for pairwise comparisons.

Results: Endorsement of impaired driving was generally low (<12%) across countries. Significant differences were found across countries in perceived threat to the safety of driving after using alcohol or cannabis. Compared to other countries, England and Spain rated DUIA as less of a threat, and Argentina rated DUIC as less of a threat. Perceived likelihood of consequences also differed across countries, potentially due to perceptions of reduced enforcement in some countries (eg, Argentina, South Africa). Finally, participants with a history of impaired driving and men in some countries were more likely to report more favorable risk perceptions (ie, lower threat and lower likelihood of consequences) than drivers who reported never driving impaired.

Conclusions: These results offer preliminary evidence of cross-national differences in alcohol and cannabis impaired driving and associated risk perceptions, providing a foundation for future studies investigating causal factors such as legalization and enforcement of driving-related laws across countries.

Background: As opioid overdose rates remain high, systems-level tools are needed to monitor and improve the quality of care for opioid use disorder treatment. Although retention in care is a commonly used metric, the concept is variably defined in the literature, and clinics may not have real-time access to their own retention data.

Methods: We designed a Structured Query Language (SQL)-based reporting tool to provide real-time and summative metrics related to buprenorphine retention. A retrospective observational design is used to characterize the summative metrics for an urban network of community health centers.

Results: Among 569 patients started on buprenorphine between June 2020 and June 2022, by June 2023, 17% of patients remained actively engaged, 3% recently engaged, and 80% disengaged. Of those who disengaged, 55.4% did so after 3 or less prescriptions. The median duration of care was 5.3 months for all patients and 26.8 months for the 97 actively engaged patients. The median percentage of days covered by a buprenorphine prescription was 77.2% for actively engaged patients.

Conclusion: Implementation of the SQL report has given the clinic network access to real-time, nuanced buprenorphine retention data and has guided targeted patient outreach.

Background: With increasing frequency, providers are encountering patients with opioid overdose who recrudesce after intermittent bolus dosing of naloxone. Some patients require a continuous infusion to maintain ventilation, which necessitates admission to a monitored setting. Buprenorphine could shorten the duration of a continuous naloxone infusion (CNI) or preclude the need altogether because its long-lasting partial agonist effects compete with and blunt the respiratory depressant effects of full agonist opioids. This case series describes the replacement by sublingual (SL) buprenorphine of a CNI in patients experiencing prolonged and recurrent respiratory depression from an opioid overdose.

Case series: We describe 3 patients presenting to the emergency department at a large urban academic hospital after an opioid overdose. All 3 patients received intranasal naloxone by emergency medical services prior to arrival. These patients received multiple intermittent bolus doses of intravenous naloxone for recurrent respiratory depression. Because of continued recurrence, they were started on CNIs. After consultation with medical toxicology, they each received 16 mg of SL buprenorphine, which allowed the successful discontinuation of the CNI without the need for additional naloxone, as well as initiating the transition to medication for opioid use disorder (MOUD) using buprenorphine.

Discussion: SL buprenorphine may be an option to facilitate discontinuation of a CNI. This strategy may be useful in select patients to reverse an acute opioid overdose, reduce hospital resource utilization, and initiate patients on MOUD.

Background: Infective endocarditis (IE) rates have risen sharply, spurred by injection drug use (IDU). Public health interventions to prevent infectious complications of IDU have primarily focused on communicable diseases, such as HIV and viral hepatitis. We assessed patients' knowledge of IE in relation to IDU practice.

Methods: From 2021 to 2022, we conducted in-person semi-structured interviews (SSIs) with 16 adults hospitalized with IDU-related IE at an academic medical center in North Carolina. SSIs explored participants' knowledge and experience of IE and IDU practices. The SSIs were audio-recorded, transcribed verbatim, and thematically coded.

Results: We identified 4 primary themes: limited knowledge of IE; nonspecific IE symptoms; injection behavior and infection prevention; and knowledge of other IDU-related infections, such as hepatitis C virus (HCV) and HIV. Most patients reported little or no knowledge of IE before hospitalization despite previously having soft tissue infections, such as skin abscesses. Presentations were heterogeneous, with many patients not recognizing their symptoms as IE, and often delaying seeking care. In contrast to limited information about IE, all patients reported prior testing for HIV and HCV. While many expressed the importance of not reusing injection equipment, many patients reported reusing injection equipment nonetheless, and several specifically reported that they take no dedicated precautions to prevent infections.

Conclusion: Our findings suggest prior to hospitalizations, knowledge of IE, its symptoms, and prevention is limited among persons who inject drugs who acquire IE. Our study indicates an urgent need to disseminate public health messages regarding preventing IDU-related invasive bacterial infections and providing access to sterile equipment to prevent bacterial infections.

Background: Mobile health (mHealth) applications are positioned to provide information and support anywhere and anytime, though few focus on overdose-related harm reduction. We aimed to describe the use of an e-harm reduction smartphone application theoretically based on self-determination theory among people who inject drugs.

Methods: We enrolled 60 clients from 3 syringe services programs in Wisconsin in a single-arm, pre-post pilot study between December 2022 and June 2023. Eligible participants used opioids and injected drugs within the past week. Participants received a smartphone, unlimited data plan, and e-harm reduction focused mHealth application based on the self-determination theory principles of autonomy, competence, and relatedness. The app was used to deliver a 12-week overdose risk reduction intervention. Every week, participants self-selected 1 of 11 available overdose-focused harm reduction goals and received tailored education, resources, and support from study staff through the smartphone application. We evaluated the use of app features, intervention adherence, and described the most commonly selected overdose risk reduction goals.

Results: Of available app features, participants most often used private messaging (median, interquartile range [IQR] days used: 28 [18-53]), viewed a motivational "thought of the day" (median [IQR] days used: 24 [15-47]), and interacted with discussion boards (median [IQR] days used: 12 [5-24]). Of 12 available weekly goal-setting intervention activities, participants completed a median of 9 (IQR: 4-11). Of 448 completed goal-setting activities, reducing drug injection and reducing drug use were the most commonly selected goals (chosen N = 86 [19.2%] and N = 81 [18.1%] times, respectively) followed by quitting use (N = 69 times, 15.4%), and reducing solitary drug use (N = 54 times, 12.1%).

Conclusion: An e-harm reduction mHealth application was used by participants for overdose risk reduction goal setting, messaging, and viewing motivational content. Future studies will evaluate benefits of engaging with e-harm reduction mHealth applications for overdose prevention intervention relative to a control group.

Background: Stigma continues to be a barrier to accessing quality care for many patients with mental health conditions and/or substance use disorder (SUD), commonly referred to as addiction. This paper aims to evaluate the impact that undergraduate medical education (UME) has in reducing stigmatizing language use and potentially mitigating this barrier to care.

Methods: A systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines identified 2017 articles across 7 databases. Search terms related to stigma surrounding mental health, addiction, and suicide were incorporated into medical education. Blinded, double-reviewed papers meeting the inclusion criteria were further evaluated at full length to obtain information including sample size, variables, and outcomes.

Results: Three studies met the review's selection criteria: 1 pretest/posttest case series, 1 survey evaluating language stigma, and 1 qualitative essay review to discover common themes in medical students' experience with patients with SUD. Statistically significant results included changes in characteristic association, attitudes based on language, and the effects of an educational intervention.

Conclusions: These results reinforce the importance of language and educational exposure in addressing stigma toward patients with mental health diagnoses. Although the results of all studies indicated some level of stigma associated with patients with a mental health diagnosis, there was limited consensus surrounding methods to reduce it in UME. Additional research on the implementation of medical school-focused mental health awareness programs is needed, preferably using rigorous randomized controlled trial study designs, longitudinal follow-up, and critical appraisal of texts to better understand effective interventions on persistent mental health stigma among medical students.

Background: Controlled studies show cannabis impairs driving performance and may increase crash risk. Recent approaches in behavioral economics have used marijuana purchase tasks (MPTs) to understand driving after cannabis use (DACU). One factor that may influence DACU is the latency between smoking and having to drive.

Method: A crowdsourced sample of adults who smoke cannabis at least monthly (n = 167; 77% White; 45% women; mean age = 38.55) completed 4 MPTs in the context of different instructional vignettes with different smoked cannabis use and driving latencies (non-driving; 20 minutes, 1 hour, and 6 hours). Participants reported frequency and perceived dangerousness of DACU. Demand indices included intensity (consumption when free), breakpoint (last price with any consumption), O_max (maximum expenditure), and P_max (price at O_max).

Results: Repeated measures analysis of variance revealed main effects of latency on all demand indices (ps <0.001), attributed to lower demand in each of the DACU conditions relative to the non-driving condition (ps <0.015; ds = 0.09-1.52). Demand increased in a linear fashion as latency increased. Participants with a history of DACU showed a blunted reduction in demand (except breakpoint) at each latency compared to participants with no DACU history (ps <0.043; η_p² = 0.008-0.043). Perceived dangerousness was inversely correlated with demand (except breakpoint; rs -0.29 to -0.62, ps <0.05).

Conclusions: Cannabis demand is sensitive to specific parameters surrounding driving contingencies, and risk perceptions may contribute to these associations. Future research is needed to extend these findings and identify other factors impacting DACU, such as different routes of administration or road conditions.

Background: Since the 2018 Agricultural Improvement Act, derived intoxicating cannabis products (DICPs) emerged as largely unregulated products; meanwhile, traditional cannabis use has increased. To inform effective prevention, research is needed to assess differences in motives for using cannabis only versus both cannabis and DICPs, as well as use-related consequences.

Methods: We analyzed survey data (June-November 2023) from 4031 US young adults aged 18 to 34 (average age = 26.9; 63.9% white; 59.0% female; aiming for ~50% past-month cannabis use). The analytic sample included participants reporting past-month cannabis use (n = 1968). Two cross-sectional mediation models were conducted to examine: (1) cannabis use motives (social/cognitive enhancement and coping) in relation to use-related consequences (psychophysiological and sociobehavioral) via use category (cannabis-only vs cannabis-DICP co-use) and (2) consequences in relation to use category via use motives.

Results: Overall, 54.4% reported cannabis-only use and 45.6% reported cannabis-DICP co-use. Greater enhancement and coping motives were associated with cannabis-DICP co-use (vs cannabis-only use). Regarding Model No. 1, lower cannabis coping motives and cannabis-DICP use (vs cannabis-only use) were associated with greater psychophysiological and sociobehavioral consequences, and the associations between coping and enhancement motives and psychophysiological and sociobehavioral consequences were indirectly mediated via cannabis-DICP co-use. For Model No. 2, lower psychophysiological and greater sociobehavioral consequences were associated with greater coping and enhancement motives, greater sociobehavioral consequences was associated with higher odds of cannabis-DICP co-use (vs cannabis-only use), and psychophysiological and sociobehavioral consequences were indirectly associated with cannabis-DICP co-use through enhancement and coping motives.

Conclusions: Considering the risks associated with cannabis and DICP use, future intervention and prevention efforts should focus on the observed associations to reduce risk.

Background: Engaging affected family members (AFMs) of individuals with substance use disorder (SUD) has the potential to improve treatment outcomes across the continuum from identification of substance misuse to treatment initiation, harm reduction, and recovery. Although family and social support improves outcomes for people with SUD, current care models often do not include AFMs in care. This study aimed to understand SUD care team members' behaviors, attitudes, training, and knowledge regarding engaging AFMs, and evaluate whether attitudes and receipt of related training are associated with clinical practices.

Methods: This is a cross-sectional study of interdisciplinary SUD care team members at a large, urban, safety-net hospital. Surveys assessed providers' current clinical practices around including AFMs, related attitudes, prior training and desired support about family engagement, and a knowledge assessment.

Results: Few providers (30%) reported regularly including AFMs in SUD despite most feeling it is helpful for families to be frequently or very frequently involved (68%). Providers more frequently provided education to AFMs about SUD (72%) and treatment (70%) than overdose prevention and naloxone (38%). Only 26% of providers had received any training on strategies to include AFMs and other social supports in SUD care, and the knowledge assessment revealed prevalent inaccurate and potentially stigmatizing beliefs about the involvement of AFMs in care.

Conclusions: Although most SUD care team members recognize the benefit of social support in recovery, a minority regularly involve AFMs in their clinical work with individuals with SUD. Addressing these barriers and improving provider access to training may create opportunities to improve engagement of AFMs and outcomes for individuals with SUD.

Background: Medication for opioid use disorder (MOUD) is the standard evidence-based treatment option for patients with opioid use disorder (OUD). Initiating MOUD in the emergency department (ED) may help patients start the treatment and lead to greater success in sustaining recovery from OUD. Programs have been introduced in EDs to support the initiation of MOUD, but little is known about the implementation facilitators and challenges that impact these programs. The objective of this study was to explore key partners' perspectives about the facilitators and challenges of implementing and operating an ED-based MOUD program in a large, Midwestern academic medical center.

Methods: Interviews were conducted in April and May 2019 with physicians, nurses, social workers, pharmacists, and administrators who were involved in implementing the ED MOUD initiation program. Verbatim transcripts were analyzed both deductively and inductively to identify themes related to the facilitators and challenges of program implementation, and suggestions about factors that contributed to program success.

Results: We found subthemes related to each of these 3 major themes. First, facilitators of program implementation included institutional buy-in, community support, involvement of an interdisciplinary team, availability of ongoing training, and public awareness of the opioid epidemic. Second, program implementation challenges included inadequate staffing and training, complications in treatment linkage, uncertainty in prescribing, unclear workflow, and culture change. Identified success factors for program implementation included provider, community, and patient education, data availability, and provider buy-in.

Conclusion: Our study results suggest that attention to factors such as buy-in, the need for the right training and education, and establishing key relationships with community organizations can help ED-based MOUD programs fill a critical gap in care for patients with OUD.