Substance use & addiction journal最新文献

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: 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: 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.

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: 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: 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.