Substance use & addiction journal最新文献

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.

Background: The American opioid use disorder (OUD) and overdose epidemic require physicians and advanced care providers to be prepared to care for patients with this life-threatening condition. Learning to identify, engage, and treat patients with OUD with medications is an essential skill for providers, as is developing requisite confidence and therapeutic attitudes regarding the care of patients with OUD (CP-OUD). To address the need for improved OUD treatment education, our team built and implemented a 12-module asynchronous course entitled, "Care of Patients with Opioid Use Disorder", in 3 Doctor of Medicine (MD) programs and a Graduate School of Nursing (GSN) program.

Methods: Students self-reported their attitudes and confidence regarding the CP-OUD before and after each module. Twelve questions assessed confidence, and 12 questions assessed attitude. Students' change in confidence and attitudes before and after training was calculated.

Results: Responses were collected between January 2021 and November 2024. The number of students completing each module ranged from 552 to 967 MD students and 81 to 149 GSN students. Students reported improved confidence after completing each of the 12 modules (<0.0001). Students reported improved attitudes after completing 10 of the 12 modules (<0.0001). Differences ranging from small to medium size were observed between MD and GSN student's baseline confidence for 4 modules, and baseline attitudes for 6 modules.

Conclusions: Asynchronous learning modules can be effectively implemented in medical and nursing education to improve confidence and attitudes regarding the CP-OUD. The use of asynchronous training modules allows for flexible deployment, as evidenced by their use in 3 MD programs and a GSN program. Future research should investigate whether improved confidence and attitudes during medical and nursing education result in more graduates caring for patients with OUD post-training.

Background: Medication misuse is a major public health concern, with community pharmacies playing a vital role in addressing it. This study assessed Swiss pharmacists' awareness, experiences, risk factors, and knowledge gaps regarding potential drug misuse cases.

Methods: An electronic survey was sent to the Swiss Pharmacists Association (pharmaSuisse) members and to 23 cantonal pharmacists' associations individually. The anonymous SurveyMonkey® survey covered pharmacists' demographics, pharmacy characteristics, suspected frequently misused substances and profiles of potential persons with a substance use disorder. Data were analyzed using the complete case approach. Univariable tests and multivariable regression models investigated potential predictors of suspected misuse rates.

Results: Of 1560 pharmacies, 188 (12%) responded with 207 pharmacists participating (64% <51 years, 78% women). All 198 responders (100%, 198/198) indicated suspicion of misuse cases throughout their career, with 47% (85/181) reporting >6 suspected cases in the past 3 months. Benzodiazepine-like anxiolytics and sedatives (80%, 151/188), as well as nasal decongestants (63% 117/186) and opioids (50%, 92/186), were reported as the most frequently suspected substances. Potential persons with a substance use disorder were described by the majority as independent of sex (90%, 163/181) and age (69%, 126/182). Commonly reported signs of suspected misuse were repeated visits (94%, 176/188), refusal of alternatives (78%, 146/188), and request for larger quantities (76%, 142/188). No significant differences were found between the number of suspected cases in the past 3 months based on pharmacists' characteristics (age, sex, education, position), pharmacy's location (eg, city/countryside), or additional services (eg, night shifts).

Conclusion: Virtually all participants reported suspected medication misuse, albeit in varying frequencies. Anxiolytics/sedatives, nasal decongestants, and opioids were the most common classes reported to be subject to potential drug misuse. Guidelines for handling suspected misuse cases are needed, informed by further research using structured data beyond pharmacist-reported incidents, such as pharmacy dispensing records, and hospital or emergency department data.

Objectives: Smoking cessation efforts may be hindered by certain consumer purchase characteristics, for example, quality/brand and menthol-flavored cigarettes, which are prominently used among U.S. adults, particularly Black adults. Other sociodemographics, such as income, education, and marital status, among others, may also influence smoking cessation. Meanwhile, tobacco control policies play a crucial role in promoting smoking cessation. Given the rapidly changing tobacco market and diverse regulatory environments across states in the United States, we evaluated consumer purchase characteristics, sociodemographics, and state tobacco control policies related to smoking cessation among U.S. households between 2010 and 2021.

Methods: We analyzed NielsenIQ Consumer Panel data from 5089 households that purchased ≥20 cigarette packs between 2010 and 2021. Analyses assessed factors associated with smoking cessation, as indicated by discontinued cigarette purchases (≥1-year gap in purchases). Independent variables include sociodemographics; consumer purchase characteristics, including primarily (≥80%) menthol cigarette purchases, quality preference (average price/pack), and purchase recency; and strength of state tobacco control (taxation, smoke-free policies). Cox regression models estimated the associations between the exposures and discontinued purchases, accounting for clustering and reporting adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).

Results: Overall, 46% of households discontinued cigarette purchases. About 28% primarily purchased menthol cigarettes. Being non-Hispanic Black (vs all other races/ethnicity groups; aHR = 0.68, 95% CI = 0.53-0.87) and divorced/separated (vs married; aHR = 0.80, 95% CI = 0.65-0.99) were associated with lower hazard rates of discontinued purchases, while infrequent purchases (aHR = 1.35, 95% CI = 1.32-1.38) and higher cigarette taxes (aHR = 1.31, 95% CI = 1.10-1.55) were associated with greater hazard rates of discontinued purchases. Menthol purchasing was not associated with discontinued purchases (aHR = 0.96, 95% CI = 0.82-1.12).

Conclusion: Non-Hispanic Black panelists were less likely to discontinue purchases compared to other race/ethnicity groups, emphasizing the need for equity-focused tobacco control interventions and policy frameworks. Findings also highlight the importance of marital status, purchase recency, and cigarette taxes on smoking cessation-related outcomes.

Background: Harm reduction is a grassroots, practical set of strategies to mitigate the negative consequences of drug use, and it is a movement that acknowledges that people may not stop using drugs. Clinician stigma remains a barrier to implementation of harm reduction practices, which further disempowers and jeopardizes the health of people who use drugs (PWUD). Our study objective was to understand the impact of interprofessional harm reduction trainings on health professions students' and clinicians' knowledge and stigma toward PWUD.

Methods: Harm reduction outreach specialists, faculty physicians, and individuals with lived experience delivered 3 virtual, interactive trainings. We conducted pre-/post-surveys of knowledge and stigma. Stigma was evaluated using a validated instrument, the Medical Condition Regard Scale. Using SPSS Version 29, pre- and post-survey responses were compared using McNemar's test for paired knowledge/attitude categories, paired t-test for stigma scores. Our institutional IRB reviewed this study as exempt research.

Results: Of 313 participants, the majority were medical (n = 116, 37%), dental (n = 66, 22%), pharmacy (n = 17, 5%), or nursing (n = 16, 5%) students. Ninety-four participants submitted pre- and post-training surveys; 87 fully completed both surveys. Although baseline knowledge of harm reduction was high, knowledge/attitudes showed a trend toward improvement. Comfort in applying harm reduction was enhanced from pre- to post-training (68%-95%, P < .001), and respondents increasingly applied harm reduction strategies, from 62% pre-training to 86% post-training (P < .001). Participant stigma scores improved from 50 + 8 pre-training, and 53 + 8 post-training (P < .001).

Conclusion: Harm reduction curricula developed and administered by interprofessional teachers, including those with lived experience, may reduce stigma toward PWUD, increase clinician comfort, and support consistent application of harm reduction practices in those with prior elevated baseline knowledge. Our work highlights the importance of including harm reduction training in interprofessional education.

Background: We evaluated agreement between self-reports of prenatal cannabis use and biologic assays, and identified factors associated with discordance.

Methods: Ancillary analysis of the "Nulliparous Pregnancy Outcomes Study: Monitoring Mothers to Be" (nuMoM2b) study, a United States multicenter prospective cohort of pregnant individuals from October 2010 to September 2013. Past 30-day self-reported prenatal cannabis use was assessed at nuMoM2b study visit 2 (16 weeks and 0 days-21 weeks and 6 days), visit 3 (22 weeks and 0 days-29 weeks and 6 days), and at delivery. Biologic detection of cannabis metabolite (11-nor-9-carboxy-delta-9-tetrahydrocannabinol) was performed with urine samples from visit 2 and visit 3 and the umbilical cord at delivery. The agreement between self-report and biologic assay was evaluated with a Kappa statistic. Factors associated with discordance were evaluated with multivariable logistic regression.

Findings: Nine thousand one hundred sixteen participants were included, and 434 (4.76%) used cannabis by either self-report or biologic assay. Among participants who used cannabis, 74.5% of prenatal cannabis use at visit 2 and 79.6% of prenatal cannabis use at visit 3 was detected via urine assay and not self-report. Eighty-nine point seven percent of prenatal cannabis at delivery use was detected via cord assay and not self-report. The agreement between self-report and biospecimen assay was fair at visit 2 (Kappa 0.30, 95% confidence interval [CI] 0.24-0.36), fair at visit 3 (Kappa 0.23, 95% CI 0.17-0.29), and slight at delivery (Kappa 0.11, 95% CI 0.01-0.21). Age <30 years, being unmarried, government insurance, and moderate or high perceived stress were associated with discordance between self-reported use and biologic assay.

Conclusions: Nearly threefold more prenatal cannabis use was detected by biologic assay compared with self-report. The agreement was fair between self-report and urine assay during pregnancy and slight between self-report and umbilical cord assay at delivery. Several sociodemographic factors were associated with discordance between self-reported use and biologic assay results.

Background: Designing effective health campaigns requires a thorough understanding of the intended audience. For stigmatized health issues like substance use disorder and mental health disorders, campaigns must be strategic, culturally competent, and evidence based. This manuscript details the process of creating a comprehensive statewide health campaign focused on mental health awareness and substance use prevention in Texas.

Methods: This study employs a multifaceted data collection approach. It includes a review of relevant health communication literature and an environmental scan to evaluate existing substance use and mental health campaigns. Two statewide online surveys were conducted with representative samples of Texans (N = 1028; N = 2033) to gauge views on substance use, mental health, risk perceptions, stigma, social connectedness, and prevention and treatment strategies. Additionally, 35 in-depth interviews were conducted with community leaders across Texas (eg, coalition managers, non-profit leaders, healthcare professionals), who then participated in 2 rounds of focus groups to provide feedback on research results.

Results: This paper demonstrates how a focus on evidence-based health communication can support a statewide public health campaign. Key insights from multiple rounds of formative research include, but are not limited to, the rise of substance use and mental health issues across Texas following COVID-19, the positive impact of social connection, and the need for substance use and mental health education. The interviews and focus groups with community leaders revealed valuable feedback on proposed campaign messages and their potential impact, leading to refinements based on their input.

Conclusion: The findings outline a multi-step, multi-method approach centered on the key elements of health campaign design-an environmental scan, extensive literature reviews, 2 statewide surveys, and interviews and focus groups with community leaders. This process culminates in a creative brief and comprehensive campaign, providing a framework for future researchers to design evidence-based health campaigns.

Background: Lifesaving medications for opioid use disorder (MOUD) exist; however, most people with opioid use disorder (OUD) do not receive treatment. Hospitalization is one important opportunity to engage people with OUD and offer treatment, including MOUD. Between 2018 and 2020, 6 public hospitals in New York City launched the "Consult for Addiction Treatment and Care in Hospitals" (CATCH) program to provide interprofessional addiction consult services to hospitalized patients.

Methods: This qualitative study aims to add perspectives from 30 racially and ethnically diverse people with opioid-related diagnoses who were hospitalized at a CATCH hospital between October 2019 and April 2021. We used purposive sampling to recruit demographically diverse individuals who accepted or declined aspects of CATCH services. Interviews were audio-recorded, transcribed, and coded for emergent themes using grounded theory techniques. The framework of structural vulnerability was utilized to highlight how social context impacts patients' experiences of healthcare, and in turn affects their addiction trajectories.

Results: Participants overwhelmingly accepted MOUD to manage withdrawal symptoms during hospitalization, and many planned to continue MOUD after discharge. Participants appreciated the interprofessional support of CATCH teams which included medical providers, social workers, addiction counselors, and peers. While participants felt that CATCH made holistic addiction treatment including MOUD more accessible, structural issues created barriers to continuing treatment long term. Some participants still felt stigmatized or "punished" for their drug use by non-CATCH providers.

Conclusion: CATCH met an urgent need for nonjudgmental care and medical management of opioid withdrawal. Additional interventions that address broader needs, including housing and social supports, as well as trust-building healthcare encounters for patients who have been historically marginalized, are needed to meet the public health goal of preventing overdose and reducing drug-related morbidity for this population.