Substance use & addiction journal最新文献

Background: Hospitalizations are important opportunities to deliver evidence-based opioid use disorder (OUD) care, yet most hospital-based generalist physicians receive minimal OUD training. We describe a novel OUD training for generalists and mixed-methods evaluation in a large urban hospital.

Methods: Training Description: Hospital-based generalist physicians received a single, 1-hour, small-group, in-person OUD training (OUD diagnosis, initiating medications for OUD [MOUD], and discharge planning) and post-training support. Evaluation: We examined self-reported changes in knowledge, confidence, skill, and frequency of providing OUD care; barriers and facilitators to applying training skills; and suggestions for training modification. Data collection included the following: (1) end-of-training questionnaires; (2) 12-month follow-up questionnaires (retrospective pre-post-design); and (3) qualitative interviews and a focus group. Stuart Maxwell tests were used to examine pre-/post-differences in knowledge, confidence, and skill. Rapid qualitative analysis identified barriers and facilitators to applying training skills.

Results: Nineteen generalist physicians participated, with 11 (58%) providing 12-month follow-up data. At 12 months, compared to pre-training, more participants agreed or highly agreed that after the training, they had adequate knowledge (100% vs 44%), confidence (100% vs 44%), and skill (89% vs 44%) in OUD care, but differences were not statistically significant. Self-reported frequency of providing OUD care was unchanged. During qualitative interviews (2 participants) and the focus group (3 participants), participants appreciated the training format but described confidence declining over time. Ongoing barriers to MOUD initiation included challenges with counseling patients about MOUD, discharge planning, accessing OUD care protocols and decision aides, lack of interprofessional collaboration, and time pressures.

Conclusion: Generalist physicians reported increases in knowledge, confidence, and skill with OUD training, but a single session was insufficient to maintain confidence and change practice. Additional training sessions emphasizing patient counseling and discharge planning should be developed and evaluated in a larger sample. Simultaneous efforts to address systemic barriers are also needed.

Background: Unplanned discharge is common in substance use disorder (SUD) residential programs and associated with worse outcomes such as relapse and suicide. There is high variation in unplanned discharge rates across Department of Veterans Affairs (VA) SUD residential programs. Little is known about program factors related to unplanned discharge in these settings. We aimed to discover staff beliefs about avoiding unplanned discharge and related harms in VA SUD residential programs.

Methods: We identified VA sites with low (<10%) and high rates (≥30%) of unplanned discharge. Informed by the Theory of Planned Behavior, we conducted semi-structured interviews with staff members at sites to learn about staff beliefs about unplanned discharge and its related harms in SUD residential settings. Two analysts reviewed the data and employed a combination of directed-content analysis and inductive methods to identify themes stratified by high- versus low-rate sites.

Results: We enrolled 10 sites (20 participants). There was high variability in how participants and sites operationalized unplanned discharge. Participants at low-rate sites generally emphasized harm-reduction approaches as useful ways to treat problematic behaviors that could result in an unplanned discharge. Participants at high-rate sites, on the other hand, favored the use of boards or councils to manage these concerns.

Conclusions: SUD residential programs should standardize the way that they define and document unplanned discharge. Future research should study the role of harm-reduction strategies and councils in mitigating unplanned discharge and related harms.

For over 20 years, the Addiction Health Services Research (AHSR) Conference has brought together researchers, policymakers, and treatment providers to solve the problems of inequity, access, effectiveness, and implementation of addiction services. This conference has been hosted across the United States at leading institutions. The AHSR 2024 Conference took place in San Francisco, October 16 to 18, and was hosted by the Stanford Center for Dissemination and Implementation, Stanford University School of Medicine. With over 400 attendees, the Conference sought to further the positive impact of prevention and treatment services for substance misuse and use disorders. The agenda included 8 pre-conference workshops, 4 plenary sessions, 144 oral sessions, including 12 organized symposia, and 160 posters across 2 sessions. The conference supported 7 early-career investigator award recipients and registration support for over 30 early-career applicants. Over 80 students and junior faculty participated in a mentoring program. AHSR 2024 fostered important discussions of cutting-edge health services research findings and accelerated the development of collaborative relationships among attendees.

Background: Despite increased demand, few people receive the addiction services they need, and substance use disorders (SUD) workforce shortages persist. Addiction counselors are a workforce that can help address SUD needs. However, recent projections highlight national shortages of nearly 88 000 addiction counselors through 2036. Given state variations, it is difficult to discern how high school- and bachelor's-level (HS/BA) addiction counselors are defined based on education and training, state credentialing requirements, and Medicaid reimbursement allowances.

Methods: A state policy analysis across all 50 states and Washington, DC was conducted from November 2023 to June 2024. A systematic review of state Practice Acts, credentialing rules, and guidance documents from licensing bodies and state organizations was conducted to extract: (1) titles and degree classifications, (2) credentialing and examination requirements, (3) supervision, and (4) Medicaid state plans.

Results: There are 160 credentials offered across all 50 states and DC across high-school (n = 56; 35%), associate's (n = 25; 16%), and bachelor's (n = 59; 37%) degrees. Only 3 states (AZ, NY, TX), offer addiction counselor credentials across all degree types. Thirteen states do not specify a degree but instead require training hours. However, the number of credentials offered per state ranges (1-16), and there is wide variability in how HS/BA addiction counselors are credentialed. Forty states allow some type of Medicaid reimbursement for HS/BS addiction counselors, while 11 states do not.

Conclusion: Addiction counselors are a critical workforce tasked with addressing SUD. To do so, they require clear training pathways, regulations, and payment mechanisms. Findings highlight wide variability within the addiction counselor workforce at the HS/BA level, including inconsistencies in minimum educational requirements and training hours, as well as an overall lack of uniformity across states. Clearly articulating addiction counselor career pathways is necessary to simplify and enhance states' SUD workforce. Identifying Medicaid and other reimbursement mechanisms is an important way to further expand how the SUD workforce is deployed to meet increased addiction-related needs.

Different barriers inhibit access to medications for opioid use disorder (MOUD), such as transportation limitations or reduced geographic proximity to providers. Mobile clinics for opioid use disorder (OUD) treatment provide opportunities to expand access to MOUD. There is limited literature describing the lessons learned and barriers faced when implementing a mobile clinic for OUD treatment in an urban and rural context. This paper focuses on 2 mobile clinics: Prevention Point Medical Mobile Unit, which was implemented in an urban location in Pittsburgh, Pennsylvania, and Addiction Treatment: Linking Access & Services, which was implemented in a rural location in Robeson County, North Carolina. The focal points of this paper include (1) community engagement, (2) community environment, (3) cost, (4) low-barrier MOUD, (5) mobile unit, (6) partnerships with local pharmacies, and (7) weather. With direct insight from providers who led programs in 2 different geographic contexts, this paper offers valuable guidance and lessons learned for those considering initiating mobile clinics to increase access to OUD treatment.

Harm reduction services save lives and facilitate treatment uptake for people who are unhoused and use drugs. It is unknown whether provision of harm reduction services within a transitional housing environment affects treatment uptake, drug supply, or drug using behaviors. This study focused on mitigation of the impacts of mass relocation and uptake of services by residents of harm reduction housing (HRH) to generate novel insights on individual drug use, social cohesion, collective efficacy, and health outcomes resulting from HRH. We used a mixed-methods study leveraging our prior Rapid Assessment of Consumer Knowledge findings and ongoing drug checking capacity to gather data on response to rapid rehousing in Boston's "Mass and Cass" neighborhood. First, we developed an inventory of harm reduction services offered and accessible to HRH residents to sufficiently measure exposure. Second, we launched an observational cohort following 106 HRH residents at 2 time periods over 12 months. Finally, we invited a subset of 28 cohort members to take part in repeated, longitudinal one-on-one interviews to gain greater insight into HRH, development of social cohesion and collective efficacy, and drug-related outcomes. Protocol adaptations due to housing shifts, over policing, and serendipity were applied.

Background: Minority stress is related to tobacco use inequities among sexual and gender minoritized young adults (SGM YAs). Neurodivergent SGM YAs may experience greater minority stress (from dual-minoritized identities) and tobacco use.

Methods: A 2023 survey assessed neurodivergence (defined as attention-deficit hyperactivity disorder [ADHD] or a learning-related condition), minority stressors (mental health symptoms, internalized SGM stigma, SGM community connectedness), and tobacco use (past-month cigarette, e-cigarette, any tobacco product use; number of products used) among SGM YAs (aged 18-34) in the United States. Multivariable regression examined associations of neurodivergence with minority stressors and tobacco use.

Results: Among SGM YAs (N = 1115; M_age = 25.34 [SD = 4.84]; 65.2% bisexual+, 29.5% monosexual, 4.8% another identity; 52.2% cisgender women, 29.8% cisgender men, 17.2% gender minority), 36.1% reported neurodivergence, 23.4% reported current cigarette use, 30.0% e-cigarette use, and 40.4% any tobacco use. On average, participants reporting current tobacco use used 2 to 3 products (M = 2.06 [SD = 1.25]). Neurodivergence was associated with higher odds of experiencing mental health symptoms (aOR = 1.53, 95% CI [1.19-1.95]), cigarette use (aOR = 1.48, 95% CI [1.07-2.05]), e-cigarette use (aOR = 1.80, 95% CI [1.35-2.42]), and any tobacco product use (aOR = 1.63, 95% CI [1.23-2.17]). Mental health symptoms were associated with cigarette (aOR = 1.63, 95% CI [1.19-2.25]), e-cigarette (aOR = 1.58, 95% CI [1.19-2.11]), and any tobacco product use (aOR = 1.48, 95% CI [1.13-1.96]).

Conclusions: Neurodivergent SGM YAs (vs those without ADHD or learning-related conditions) may have greater risk for mental health symptoms and related tobacco use, underscoring the need for appropriate and culturally competent mental healthcare to reduce tobacco use.

Background and aims: Patients under medication-assisted treatment (MAT) with methadone and buprenorphine experience sleep disturbances related to drug addiction, which are risk factors for craving and relapse to opioids. Plants such as pomegranate, due to their ingredients, appear to act therapeutically ameliorating symptoms of sleep disorders. Thus, the aim of the present study was to investigate the impact of pomegranate juice on sleep quality and melatonin concentration of patients under MAT.

Methods: In total, 58 volunteers were included in the present investigation. They were divided into the experimental group (n = 40), comprising patients under MAT who were administered with pomegranate juice (dosage: 250 ml/day, 7 days/week, 120 days) and the control group (n = 18) with MAT patients without juice consumption. These groups were further stratified based on MAT, namely, methadone maintenance treatment (MMT) and buprenorphine maintenance treatment (BMT). Melatonin concentration was measured in saliva and sleep quality was assessed through the Pittsburgh Sleep Quality Index at the 1st, 60th, and 120th day.

Results: Melatonin concentration was increased in both MMT and BMT patients at the 120th day due to pomegranate juice consumption compared with that in the control. Furthermore, the applied nutritional intervention improved sleep quality only in the MMT patients at the 120th day, whereas sleep quality of MMT patients was compromised compared with those under BMT in the control group.

Conclusions: The obtained findings indicate that pomegranate could be considered as an auxiliary intervention, in parallel with medication, toward rehabilitation of patients under MAT.

The evolving unregulated drug supply in the United States has led to an unprecedented rise in xylazine-adulterated synthetic opioid use-related morbidity and mortality, of which Pennsylvania shoulders a disproportionate burden. People experiencing these xylazine harms who seek acute medical care require complex clinical management, multidisciplinary coordination, and appropriate linkage to outpatient care. We describe our experience leading a hospital-wide multidisciplinary xylazine workgroup from February to June 2024 to collaboratively develop time-sensitive clinical protocols on inpatient management of patients exposed to xylazine. Workgroup participants were organized into three subgroups: (1) toxicology screening and harm reduction; (2) withdrawal management; and (3) inpatient wound care management and linkage to outpatient wound care. We summarize our implementation process and clinical protocol recommendations of each subgroup and highlight important cross-cutting issues related to the changing drug supply, standardized patient and provider educational tools, care coordination, and next steps.

Background: To address the urgent housing needs of individuals experiencing unsheltered homelessness and substance use disorder (SUD) living in an encampment, Boston established six harm reduction low-threshold shelter (LTS) sites in January 2022.

Methods: To understand the LTS guest experience of persons who had been living in the tent encampment, assess early outcomes of the LTS service model, and inform concurrent implementation of this new shelter model, the Boston Public Health Commission implemented a point-in-time survey of 50 individuals who moved from the encampment into LTS three to six months after the encampment closure. The in-person survey assessed participant experience, quality of life, and service access.

Results: Seventy-two percent to 90.0% of survey participants reported improvements in sleep quality, food security, and connection with others since moving into LTS. Sixty-eight percent to 92.0% of participants indicated increased access to mental health and healthcare providers and housing navigation services. Over 80.0% of respondents reported increased confidence in overdose response since moving into LTS, and almost half reported being in some form of treatment for SUD. Importantly, 90.0% of participants agreed that they had hope for the future.

Conclusion: Harm reduction transitional shelter spaces remove access barriers to people experiencing unsheltered homelessness and SUD and promote safety, well-being, and access to critical support services and housing navigation.