Substance use & addiction journal最新文献

Background: Primary prevention research rarely include measures for multiple risk and protective factor domains for youth alcohol, tobacco, and other drug (ATOD) use onset simultaneously within the same prospective study. The aim of this study is to test the simultaneous longitudinal relationships between risk and protective factors within these 5 domains and ATOD onset among early adolescents.

Methods: Analyses are based on waves 1 to 6 from the Young Mountaineer Health Study cohort that was conducted every ~6 months over a 3-year period between 2020 and 2023 in 20 diverse schools in West Virginia in the United States. For the present analysis, 2916 sets of student data were included from all 6 waves. Longitudinal analyses were conducted using best linear unbiased predictors for all domain exposure variables across the 6 time points using high-performance linear mixed modeling in conjunction with logistic regression.

Results: Risk and protective factors within the 5 exposure domains of parents/caregivers, peers, school, leisure time, and community were simultaneously related to odds of substance use onset among early adolescents.

Conclusions: Our findings underscore the need for both basic and prevention research guided by systems-based approaches versus a focus on a limited set of etiological factors.

Background: Injection drug use (IDU) is associated with health risks, including infections, vascular damage, and overdose. Among those who inject drugs, having trouble accessing veins may lead to riskier injection practices and result in higher morbidity and mortality. This study explores patient characteristics associated with difficult venous access, with particular attention to disparities facing women who use drugs.

Methods: Survey data were collected from 120 people who inject drugs who accessed medical services at an urban academic medical center.

Results: Most participants were men (68%) in their thirties (56%), of white race (95%), and had experienced housing insecurity in the last 3 months (77%). Heroin and fentanyl were the most commonly injected drugs (79%). Most participants (77%) reported difficulty with venous access. Those with difficult venous access reported a greater number of years of injection experience (median: 15 vs 11, P = .020). Difficult venous access was significantly associated with female gender identity (92% vs 70%, P = .009), injection by someone else (93% vs 64%, P < .001), injection into subcutaneous tissue (95% vs 56%, P < .001), and injection into the neck (96% vs 73%, P = .024).

Conclusions: Given that difficult venous access is associated with injection behaviors that portend higher risks of health complications, clinicians and harm reduction providers should discuss venous access with their patients who use drugs and provide counseling around safer injection practices. Future interventions should be tailored to those groups at the highest risk of difficult venous access, including women who use drugs, those who are injected by others, and people with a long history of IDU.

Background: Opioid-related deaths remain a major cause of preventable mortality, but access to medications for opioid use disorder (MOUD) such as methadone and buprenorphine remains restricted globally. This review compares national MOUD policies across 8 countries (the United States, Canada, the United Kingdom, Russia, France, Iran, Australia, and Portugal) to examine how regulation may affect treatment coverage, mortality, and system responsiveness. Secondary aims include identifying barriers to MOUD access and illustrating potential lives saved and economic gains from expanded U.S. coverage.

Methods: A targeted narrative review of peer-reviewed and policy literature characterized methadone and buprenorphine regulations, prescriber eligibility, dispensing models, and coverage across countries, with opioid-related mortality data drawn from the Global Burden of Disease Study 2021. A U.S. modeling analysis estimated overdose deaths averted and economic savings at increasing levels of MOUD coverage using national prevalence data, meta-analytic mortality reductions from treatment, and Centers for Disease Control and Prevention economic valuations adjusted for treatment costs.

Results: Regulatory bottlenecks including daily supervised dosing, restricted community prescribing, and stigmatizing drug scheduling limit MOUD access. International models demonstrate feasible alternatives: in the U.K. and Australia, community pharmacy dispensing supports reach without compromising safety; in France, liberal buprenorphine prescribing through primary care facilitated rapid national scale-up; in Portugal and Iran, decriminalization and expansion of flexible, low-threshold public health-integrated models coincided with reductions in overdose deaths. In contrast, Russia's prohibition underscores the harms of abstinence-only policies. Increasing U.S. MOUD coverage to 25% could prevent about 3500 overdose deaths annually, and universal coverage could avert over 41 000, yielding $38 to $444 billion in net economic savings.

Conclusions: International evidence suggests that regulatory reform and integration of MOUD into mainstream healthcare can expand access and reduce mortality. Aligning policies with these lessons, by decentralizing methadone delivery, modernizing buprenorphine scheduling, and embedding MOUD within public health systems, represents both a public health and economic imperative.

Background: The REadiness to Discuss Use, Common Effects, and HArm Reduction Measure (REDUCE-HARM) is a new survey instrument with 2 subscales intended to assess attitudes toward substance use and confidence in core addiction topics among health professions students. Previously, we validated its content via a modified Delphi process with interdisciplinary experts across the United States. This study assessed the construct validity and reliability of REDUCE-HARM among students in health professions to be used in developing and evaluating addiction-related curricula.

Methods: We sent the REDUCE-HARM to early-training nursing, nurse practitioner, pharmacy, and medical students using class-wide email distribution lists at 7 academic medical centers in the United States from December 2021 to October 2022. We evaluated construct validity and reliability for the complete REDUCE-HARM instrument and the attitudes and confidence subscales using psychometric testing. We used t-tests to compare scores between those with and without prior addiction-related experience.

Results: Of the 288 participants, 26% were nurses, 9.7% were nurse practitioners, 30.2% were pharmacists, and 34.0% were medical; 52.8% had prior addiction-related experiences. Principal component analysis and confirmatory factor analysis demonstrated a 2-factor structure of the REDUCE-HARM that corresponded with the subscale constructs of attitudes and confidence. Cronbach's alphas were .912 (95% confidence interval [CI] .896-.925), .798 (95% CI .765-.827), and .938 (95% CI .925-.947) for the complete REDUCE-HARM, attitudes subscale, and confidence subscale, respectively. There were significantly higher mean attitude scores (59.8 vs 57.8; scale: 12-72; P = .021) and mean confidence scores (46.8 vs 37.3; scale: 12-72; P < .001) for students with prior addiction-related experiences compared to students without.

Conclusions: Our analysis supports the construct validity and reliability of the REDUCE-HARM among early trainee U.S.-based health professions students and the benefit of direct addiction-related experiences. Future research should evaluate responsiveness to addiction-related educational programs and with additional trainee populations.

Background: Drug checking is an evidence-based harm reduction strategy that can contribute to safer use by providing people who use drugs (PWUD) with actionable information about the contents of the drugs they are using and ways to reduce harm. In response to persistently high overdose rates largely driven by adulteration and volatility of the unregulated drug supply, the New York City Department of Health & Mental Hygiene (NYC DOHMH) initiated a point-of-care drug-checking pilot study in partnership with syringe service programs.

Methods: Drug-checking services were piloted at 6 sites over the study period. DOHMH staff were trained to use immunoassay test strips and Fourier-transform Infrared Spectrometers, analyze and interpret drug-checking results, and provide tailored harm reduction education to participants. Samples were sent for secondary testing to support technician training and quality assurance. Participant demographics, information about the drug sample, and how individuals planned to use the results were collected and entered into a REDCap database.

Results: From November 2021 through December 2023, more than 1600 samples were submitted for analysis. Over half of the samples were sold as opioids (55%; n = 903). The presence of fentanyl in samples sold as opioids was very high (95%; n = 859). Xylazine was detected in 35.0% (n = 201) of opioid samples for which secondary laboratory results were available. 51.5% of participants indicated that they planned to employ a harm reduction strategy or take some other action following receipt of their drug-checking results.

Conclusion: Findings from the pilot study demonstrate that it is feasible and acceptable for local health departments to implement point-of-care drug-checking services in partnership with programs that serve PWUD. For some participants, drug-checking interactions may support behavioral intention changes about the drugs they use. Key implementation considerations include the importance of a robust technician training model, selection of appropriate and complementary drug-checking technologies, and availability of secondary lab testing.

Background: Peer support programs are recognized as an evidence-based practice to effectively support individuals in recovery from substance use and reduce recidivism. Peer support is provided by trained individuals with lived experience who guide individuals navigating similar life challenges. Organizations design and structure peer support programs differently; some have developed unique approaches to meet the needs of the individuals they serve. This study provides guidance for implementing peer support programs within community based organizations with a focus on recovery or reentry after incarceration.

Methods: The Consolidated Framework for Implementation Research (CFIR) is part of implementation science which aims to facilitate the uptake of evidence-based strategies into practice. The CFIR was used to guide data collection and analysis. Interviews with 20 individuals were conducted with leaders from 7 community-based organizations that employ peer support specialists. One participant from each organization completed a survey about their organization and provided program-related documents for review. Qualitative data were analyzed via MAXQDA and the CFIR rating system was applied to each construct to determine those that strongly influence implementation.

Results: Key elements to program success include sustainable funding, strong leadership, clear reporting structure, impactful interactions between peer mentor and client, and program flexibility. Challenges identified by organizations included a need to hire additional qualified peer mentors, limited availability of training to certify peer mentors, limited career growth for peer mentors, staff burnout, and establishing clear boundaries with clients.

Conclusions: Peer support is an effective way to bridge the gap between clients and providers of healthcare, mental health, or behavioral health services. Organizations must be intentional in developing and structuring their peer support programs. The results of this study offer actionable insights for organizations to implement and sustain peer support programs effectively.

Background: Utilizing the 72-hour rule to initiate methadone in low-threshold Bridge Clinics offers a novel way to rapidly start treatment. Recent updates to federal methadone regulations allow for higher starting doses. This study evaluates the implementation of methadone initiation in a Bridge Clinic utilizing higher doses of methadone based on updates to 42CFR part 8.

Methods: We identified patients newly initiating methadone in an urban Bridge Clinic in Boston, MA, USA with an intention of connecting to an Opioid Treatment Program (OTP) and extracted key clinical outcomes from the electronic health record, including average initial and final dose and rates of successful referral to an OTP.

Results: Between April 1, 2024 and March 1, 2025, there were 97 patients who received 1 or more doses of methadone at the Bridge Clinic and were confirmed on chart review to have been newly initiated on methadone with the intent of linking to an OTP. Twenty-three point seven percent of patients initiated methadone twice during the study period. The mean starting dose was 51.6 mg, increasing to 60.9 and 67.1 mg at the second and third doses, respectively. Of the 97 patients, 94 (96.9%) were referred and accepted at an OTP.

Conclusions: Initiating methadone under the 72-hour rule in a low-threshold Bridge Clinic setting utilizing higher doses was feasible and resulted in a majority of patients being accepted to an OTP for ongoing treatment.

The United States faces a profound overdose crisis and a volatile, unregulated drug supply. Despite the availability of effective treatments and harm reduction strategies, many individuals who use drugs have limited access to evidence-based interventions. Punitive approaches to people who use drugs have worsened the situation. In this position statement, we assert that there is a critical need for drug policies to be grounded in public health evidence rather than punitive measures. We focus on 2 case studies to exemplify this idea: (1) xylazine scheduling laws and (2) drug-induced homicide laws. Ultimately, the Association for Multidisciplinary Education and Research in Substance Use and Addiction advocates for a public health approach to drug policy, which is based on the tenets of harm reduction. The organization opposes punitive measures and promotes policies that improve access to healthcare and harm reduction services.

Background: To develop a valid algorithm for temporary bans on new psychoactive substances (NPSs) to minimize the intervention of the subjective opinions of experts in the temporary scheduling process.

Methods: This study consisted of a preliminary survey, a 2-phase Delphi survey, and a final consensus survey. In Phase 1 of the Delphi survey, the importance of 7 criteria for designating subjects of temporary bans, as confirmed through a preliminary survey, was evaluated. Phase 2 survey was conducted to investigate the suitability of detailed questions representing the key criteria to be included in the algorithm. In the final phase, the final algorithm was selected, and several questions regarding the expert evaluation of the algorithm were asked. The mean scores of importance and the content validity ratio were calculated for consistency.

Results: Nineteen panelists participated in a Delphi survey. The experts agreed on 5 criteria and 22 detailed questions for designating subjects of temporary bans. The finally selected algorithm involves primary evaluation of 'Abuse potential and dependence', 'Social risks', and 'Regulatory cases in reference countries' and secondary considerations about 'Pharmacological effects on the central nervous system' and 'Toxicity and harmfulness'. For expert evaluation, the preferred number of participating experts was 7. Many participants (77.8%) responded that the average expert evaluation score for temporary bans was 2 or higher.

Conclusions: We developed a valid algorithm for temporary bans on NPS that can effectively regulate NPS and prevent the spread of addictive substances.

Background: Transportation can be a significant access barrier to effective substance use disorder (SUD) treatment and potentially influence treatment decisions. We aimed to estimate and compare the travel time and cost for outpatient (3 visits/week), opioid treatment program (OTP, 3 visits/week), and residential treatment (1 visit).

Methods: For a 28-day period, we compared travel time and costs for SUD treatment programs using a cross-sectional geospatial analysis of New York State data (March 2024). We estimated travel times using public transit in New York City (NYC) and driving outside of NYC. We estimated travel costs using public transit fares and the standard mileage rate. For comparisons, we used population-weighted paired t-tests both statewide and within urbanicity categories (NYC, urban non-NYC, and rural).

Results: Statewide, OTPs required the longest mean travel times (7.8 hours) and highest mean costs ($139.92), followed by outpatient treatment (4.4 hours, $80.15) and residential treatment (35.9 minutes, $9.28), with a similar pattern in each urbanicity category. In rural areas, compared with residential treatment, the mean travel time for outpatient treatment was longer by 7.44 hours (95% CI: 7.27, 7.61) and more costly by $206.47 (95% CI: 201.03, 211.90) and the mean travel time for OTPs was longer by 13.06 hours (95% CI: 12.75, 13.37) and more costly by $399.67 (95% CI: 388.36, 410.98). Further, in rural areas, compared with outpatient treatment, the mean travel time to OTPs was longer by 5.61 hours (95% CI: 5.32, 5.92) and more costly by $193.21 (95% CI: 181.98, 204.43).

Conclusions: Transportation burdens are significantly higher for outpatient treatment and OTPs compared with residential treatment, and for OTPs compared with outpatient treatment, especially in rural areas. Reducing travel time and cost through strategies including telehealth, flexible methadone take-home dosing, mobile medication units, and integration of methadone treatment into other outpatient programs are needed to improve accessibility.