Substance use & addiction journal最新文献

Background: Opioid use disorder continues to cause significant morbidity and mortality in the United States. Buprenorphine is a highly effective treatment option, but is not easily accessible due in part to an insufficient prescriber workforce. Primary care professionals (PCPs) have the potential to greatly improve access to buprenorphine, but they report significant barriers such as inadequate addiction training. This study aimed to characterize the value of different peer prescriber support training models for PCPs practicing in urban and rural clinics in Ohio.

Methods: We interviewed 26 purposively sampled PCPs as part of a clinical trial planning grant to develop and pilot a buprenorphine prescribing support program. PCPs provided feedback on the training module and additional training needs during semi-structured interviews. Interviews were coded using an inductive approach, informed by grounded theory.

Results: PCPs expressed a need for support from other buprenorphine prescribers and on-the-job shadowing and consultation opportunities to confidently prescribe buprenorphine. Interactions with colleagues who did not support or prescribe medications for opioid use disorder (MOUD) were similarly influential, reducing PCPs' interest in prescribing buprenorphine. Internal mentorship opportunities, like starting with managing a few stable patients in collaboration with current prescribers, improved PCPs' comfort with MOUD, but were more available in urban than rural clinics. Structured external mentorship, including real-time consultation options, was also beneficial, especially for rural PCPs.

Conclusion: Support from buprenorphine prescribers, both peer PCPs and external experts, may be a useful strategy for overcoming reluctance to prescribe buprenorphine in primary care. On-site peer mentors may be more readily available to urban providers. More research is needed to understand effective strategies for fostering rural peer prescriber mentorship networks, especially in the absence of on-site mentors. Future research should test innovative strategies for bolstering rural and urban addiction mentorship networks.

Background: Persons with both opioid use disorder (OUD) and chronic pain face mental health challenges, poor substance use prognosis, and compromised quality of life. One way to improve outcomes in this vulnerable patient population is to enhance health literacy, particularly literacy regarding opioid medications. A fundamental metric of such literacy is whether persons with OUD can correctly identify medications, including those prescribed for OUD, as opioids. This question has yet to be researched extensively.

Methods: Participants were 163 adults with OUD and chronic pain receiving buprenorphine treatment who provided information about demographics and substance use history and classified 17 select medications and psychoactive substances as opioids or non-opioids.

Results: Nearly all study participants correctly identified most assessed medications and other psychoactive substances as (non-)opioids but were less able to identify medications for OUD. Only two thirds of the sample correctly identified buprenorphine, a medication they were currently taking, as an opioid. In general, greater opioid identification was associated with greater use of substances (including opioids) and a history of drug overdose.

Conclusion: These findings underscore the need to enhance opioid medication literacy, especially in persons with less opioid use experience, in order to prevent some of its more deadly consequences.

Background: Peer recovery specialists (PRSs) are professionals with lived experience in substance use and recovery, playing an important and growing role in the substance use care workforce. However, there is limited guidance on best practices for integrating PRSs into health care settings and supporting their well-being and career development. This study explores the perspectives experienced PRSs across diverse clinical settings regarding training, support, and professional development.

Methods: Between September 2021 and February 2022, we conducted semi-structured interviews with 15 PRSs from the Philadelphia area who participated in a virtual PRS support group. The interviews focused on barriers, facilitators, and unmet needs in their roles. Interviews were recorded, transcribed, and analyzed using thematic content analysis.

Results: Most participants were female (53%) and white (93%) (Table 1), with 80% having 4 or more years of work experience. Participants worked in a variety of settings, including community-based programs (47%), outpatient specialty substance use disorder treatment (27%), and primary care (20%). Key interview themes included : (1) Motivation and satisfaction: Participants found meaning in client successes and peer support, emphasizing relationships and teamwork; (2) Burnout and role challenges: Many experienced high stress due to role ambiguity, excessive caseloads, and secondary trauma; (3) Supportive workplace factors: structured supervision, professional networks, and feeling valued within care teams were crucial supports; and (4) Professional development needs: Participants identified gaps in training, system navigation, and career advancement opportunities.

Conclusion: PRSs are vital in substance use care but face significant challenges related to burnout, ambiguous role expectations, and inadequate job training. Establishing structured models for PRS training, supervision, and professional development may enhance their effectiveness within health systems.

Background: During the COVID-19 pandemic, substance use in the Americas was influenced by various factors, including social isolation, increased stress, and disruption of healthcare services. While the impacts varied across populations, the health crisis exacerbated challenges related to substance use, particularly in more vulnerable groups. This article aims to describe the pandemic's impact on substance use and substance use disorders in the Americas region.

Methods: We conducted a scoping review across 4 databases (Pubmed, Scielo, Lilacs, and Google Scholar) using a search paradigm based on the combination of several keywords related to substance use during the COVID-19 pandemic in the Americas.

Results: Most studies were conducted at the beginning of the pandemic and carried out in the United States and Canada. A higher proportion of the general population decreased or showed no changes in cannabis consumption. On the other hand, for those who reported pre-pandemic substance use, consumption has increased as a strategy to cope with COVID-related stress, exacerbating preexisting problems. Patients with substance use disorders reduced their visits to treatment services and in-person medication visits declined significantly. In an attempt to reverse the distancing of patients from the services, there was an increase in take-home medication and telehealth services. Rates for opioid-related deaths and other substance overdose-related deaths increased during the pandemic, especially among racial/ethnic minorities.

Conclusion: The study concludes that the pandemic-intensified substance use among vulnerable populations, particularly individuals with pre-existing mental health conditions or a history of substance use disorders, while having a low impact on the general population. This divergence has contributed to widening health disparities.

Background: Alkyl nitrites, commonly known as "poppers," have been widely used as recreational inhalants since the 1970s, particularly among men who have sex with men (MSM). Despite regulatory restrictions in the United States, poppers remain available under misleading product labels (eg, nail polish removers). Limited epidemiologic research has focused on trends in prevalence and correlates of poppers use, particularly among populations that include non-MSM individuals.

Methods: We analyzed data from a repeated cross-sectional survey of adults entering electronic dance music events at nightclubs in New York City (NYC) between 2017 and 2024 (N = 3332). We estimated trends in past-year poppers use overall and stratified by demographic and drug use-related factors in the NYC nightclub-attending population, and we also delineated correlates of use.

Results: We estimated that past-year poppers use increased from 7.2% in 2017 to 18.1% in 2024 (a 151.4% increase; P < .001). Increases were estimated among both males and females (by 115.7% [P = .0013] and 199.4% [P = .003], respectively). While prevalence remained highest among gay males (46.3% in 2024), notable increases were estimated for heterosexual males (with an increase to 6.3% in 2024) and sexual minority females (increasing to 27.5% in 2024). Compared to heterosexual males, sexual minority males and females had higher prevalence of use, and those who used cocaine, ecstasy/MDMA, and/or ketamine also had higher prevalence of use (Ps < .05).

Conclusion: While sexual minority males remain at highest risk for poppers use, prevalence is also increasing among traditional lower-risk groups, underscoring the need for expanded public health messaging and harm reduction strategies.

Objective: The aim of the study was to investigate the views and perspectives of alcohol and drug (AOD) clinicians regarding the introduction of a peer worker (PW) role within an Australian AOD treatment service, to identify strengths and barriers to guide the integration.

Methods: A cross-sectional survey was conducted with AOD clinicians, using a brief, anonymous survey, to gather quantitative and qualitative insights into their perceptions of the strengths and barriers of introduction of a PW role within the service.

Results: A total of 53 clinicians participated. Results indicated that 62% of clinicians believe that a PW would improve services delivered. Thematic analysis identified 3 main perceived strengths: (i) enhancing engagement and role modeling recovery; (ii) advocacy; and (iii) supporting teams and service culture. Four themes emerged as barriers/concerns: (i) role clarity and scope; (ii) organizational culture; (iii) boundaries; and (iv) PW well-being. Some differences were noted according to clinician's having prior experience working with PW.

Conclusion: Few studies have explored the perspectives of AOD clinicians regarding introducing PW roles in an AOD treatment setting. This study highlights that although a majority of AOD clinicians have positive attitudes, many have concerns regarding PW roles, role boundaries, and the legitimacy of peer expertise. Furthermore, organizational readiness, PW well-being, and the integration of PW and lived experience in recovery orientated care within the workplace were areas of concern. Addressing these within staff education and service planning, with organizational leadership, may help to support implementation.

Background: Previous research indicated that having made previous quit attempts increased the likelihood of achieving smoking cessation, and that people with depressive symptoms have more difficulties in quitting smoking. However, how previous quit attempts may affect the relationship between depressive symptoms and long-term smoking cessation has not been studied. This study aims to investigate the interactive effect of previous quit attempts in the relationship between depressive symptoms and cessation at the 12-month follow-up after a psychological intervention for smoking cessation.

Methods: The sample comprised 509 participants who smoked (M_age = 45.35, 61.7% female) requesting treatment to quit smoking. Depressive symptoms were assessed at baseline using the Beck Depression Inventory-II. Participants who did not smoke in the previous 30 days were considered to have quit smoking at the 12-month follow-up.

Results: Regression analyses showed a significant interaction between depressive symptoms and previous quit attempts. Concretely, those participants with higher depressive symptoms and no previous quit experiences were less likely to report quitting at 12-month follow-up compared to those who reported two or more previous quit attempts (OR = 0.45, P = .016). These findings were confirmed by stratified regression models, which showed that depressive symptoms were significantly negatively associated with cessation only among those participants without previous quit attempts (OR = 0.43, P = .004).

Conclusion: Findings of the present study suggest that not having previous experience in quitting smoking may impact the relationship between depressive symptoms and long-term cessation in seeking-treatment people who smoke. These findings could be used in clinical practice to improve long-term smoking cessation success.

Objectives: To estimate the effect of the passage of state laws targeting patient brokering on opioid-related outcomes.

Background: In response to growing awareness of unethical substance use disorder (SUD) treatment practices, several states in the United States have passed laws targeting patient brokering and deceptive marketing. Patient brokering and deceptive marketing laws are intended to reduce the chances individuals with SUD interact with bad actors or suffer from adverse outcomes related to inappropriate SUD treatment, but the effectiveness of these laws is unknown.

Methods: Matched event study analysis comparing early population-level outcomes in 6 states that passed laws targeting patient brokering between 2018 and 2019 and 24 comparison states with similar census region and presence of recovery residence regulations, anti-kickback laws, state SUD task forces. Outcomes, analyzed through 2019, included monthly rates of opioid-related mortality and quarterly rates of opioid-related emergency department visits and hospitalizations per 100,000 residents, and state-year prevalence of unusual patterns of claims for SUD-related services.

Results: In 2018, there was a mean of 326.9 (SD = 72.0) opioid-related hospitalizations/100k state residents, 234.6 (SD = 37.7) opioid-related ED visits/100k state residents, and 122.9 (SD = 73.6) opioid-related deaths/100k state residents in the states in our treatment group. We did not observe evidence that passage of state laws targeting patient brokering or deceptive marketing was associated with changes in any of our outcomes.

Conclusions: The passage of state laws targeting patient brokering is not associated with significant changes in opioid-related outcomes. Additional resources may be needed to accompany implementation and enforcement efforts before desired policy effects are realized.

Background: The rise of suicidal thoughts and behaviors (STBs) in the United States and their association with substance use disorders, including the emerging concern over Kratom-a psychoactive substance-necessitates an investigation into its role in STBs. This study provides the first epidemiologic assessment of the association between Kratom use and STBs in the United States.

Methods: This study leveraged data from the 2021 National Survey on Drug Use and Health (NSDUH) to examine the association between Kratom use and STBs. The NSDUH was carried out among a representative sample of American individuals. Our study sample comprised 47 291 individuals aged 18 and older across the United States. Lifetime Kratom use was the exposure, while outcomes included past-year suicidal thoughts, plans, and attempts.

Results: Persons who use Kratom (PWUK) exhibited higher odds of reporting past-year suicidal thoughts (odds ratio [OR]: 2.14), plans (OR: 1.95), and attempts (OR: 2.50) compared to persons who never used Kratom. The associations also varied by sex and race, with pronounced effects among male and Black individuals. Specifically, subgroup analyses revealed higher odds of suicidal thoughts among Black PWUK (OR: 11.00) and among male PWUK (OR: 2.74).

Conclusions: The findings suggest a significant association between Kratom use and STBs in the U.S. adult population, with variations by sex and race. These results highlight the need for further research examining the causal relationships between Kratom use and STBs, including whether episodic use differs from addiction, as well as assessing the associations of Kratom use with other mental health conditions. This understanding is crucial for informing the development and implementation of targeted interventions, policies, and programs aimed at addressing Kratom use and its mental health consequences.

Background: Benzodiazepines and opioids are among the most frequently misused psychoactive substances, but their patterns of co-use (polysubstance use) in rural areas are unclear. As resources to address substance use are disproportionally scarce in rural areas, a better understanding of this polysubstance use is critical to allocate and direct interventions.

Methods: The Rural Opioid Initiative comprises 8 research cohorts spanning 10 states and 65 rural counties. Participants were recruited from January 2018 to March 2020 and eligibility included past 30-day opioid use by any route or past 30-day injection of any substance. Analyses were restricted to participants reporting past 30-day opioid use and either benzodiazepine or stimulant use. We described bivariate cross-sectional associations between benzodiazepine+opioid use, compared with stimulant+opioid use, and substance use behaviors, health outcomes, injection drug use, addiction treatment, and criminal legal system involvement.

Results: Of the 1107 ROI participants that met inclusion criteria, 10% (n = 107) reported benzodiazepine+opioid use, and 90% (n = 1000) reported stimulant+opioid use. The benzodiazepine+opioid group, compared with the stimulant+opioid group, had a higher use of opioid pain medication (73% vs 55%), gabapentin (43% vs 23%), and clonidine (12% vs 4%) to get high and used these substances more frequently; they also reported more frequent heavy episodic drinking (6.1 days per 30 days, SD = 9.4 vs 4.1 days, SD 7.5). The benzodiazepine+opioid group reported a lower prevalence in the past 6 months of law enforcement stop-and-search incidents (29% vs 48%), arrests (11% vs 28%), probation (22% vs 34%), jail/prison (18% vs 41%), and fewer days in jail/prison (4.7, SD = 19.1 days vs 15.9, SD = 35.7 days).

Conclusion: We found that benzodiazepines+opioids use was associated with more heavy episodic drinking and gabapentin use, and lower prevalence of criminal legal system involvement. These data suggest that individuals reporting benzodiazepines+opioids use have distinct behavioral patterns and outcomes that require targeted interventions for rural populations.