Substance use : research and treatment最新文献

Background: Rural communities face significant implementation challenges addressing the overdose epidemic, including limited treatment capacity, pervasive stigma toward people who use drugs, and social and political opposition to evidence-based interventions.

Objectives: Rather than implementing prescribed harm reduction services that may face community resistance, the Ohio Opioid Project adopted a capacity-building approach to address structural barriers and enhance community readiness for future harm reduction and treatment innovation across 3 rural Appalachian Ohio counties.

Methods: This applied implementation project used the Evidence-Making Intervention framework with process evaluation. Mixed-methods formative research included interviews with stakeholders (n = 34) and people who use drugs (n = 30), respondent-driven sampling surveys with people who use drugs (n = 258), organizational network analysis, and surveillance data review. A 9-member Community Leadership Board - including health commissioners, treatment providers, and harm reduction program representatives - co-developed interventions targeting 3 structural barriers: substance use-related stigma, interagency fragmentation, and inadequate provider capacity. Community members served as leadership board representatives, implementation staff, intervention consultants, and data collectors, democratizing research involvement and building local public health capacity. Implementation followed an adaptive approach, allowing activities to evolve based on emerging needs, policy changes, and the COVID-19 pandemic.

Results: The service delivery plan included 20+ activities across stigma reduction, interagency coordination, and provider capacity building. Key activities included peer recovery supporter training, law enforcement harm reduction seminars, faith-based stigma reduction forums, conflict resolution processes, establishment of drug court buprenorphine protocols, and HCV telehealth partnerships. Multiple activities were sustained by community partners beyond the research period, including resource clearinghouses, new regional partnerships, and organizational protocols integrating harm reduction into existing services.

Conclusions: Capacity-building implementation science can address structural barriers to community-based harm reduction in resistant rural settings. By prioritizing community co-creation and adaptive implementation, this approach created foundational conditions for sustainable harm reduction innovation while respecting local contexts and readiness for change.

Background: The US Food and Drug Administration (FDA) issued a drug safety communication warning of dental-related adverse events (DAE) reported in patients using buprenorphine films or tablets in January 2022. This study utilized more recent data with a broader dental outcome definition beyond what has been previously reported to provide comprehensive evidence of this risk.

Objective: Assess the association between buprenorphine use and the risk of DAE among opioid use disorder (OUD) patients.

Design: A retrospective cohort study.

Methods: Using the Veradigm-MarketScan® linked dataset, adults aged ⩾18 years with an OUD diagnosis between June 30, 2018, and July 1, 2023, and who met our selection criteria were included. Patients were grouped as: (1) BUP users and (2) non-BUP users (control group). We used Prescription Time Distribution Matching (PTDM) and Inverse Probability Treatment Weighting (IPTW) methods to balance potential confounders between the 2 groups. The primary outcome was dental-related adverse events (DAE). Cox proportional hazards models estimated adjusted hazard ratios (HRs).

Results: A total of 14 495 OUD adult patients were included. Of these patients, 4199 (28.97%) initiated oral buprenorphine. Among the overall population, most were males, 8742 (60.3%), with an average age of 44.9 years. The absolute risk of DAE was slightly higher among buprenorphine users (2.17%) compared to controls (1.66%). We found an increased risk of DAE in buprenorphine users compared to the control group (adjusted HR, 1.36; 95%CI, 1.04-1.78).

Conclusions: There is an increased risk of DAE among buprenorphine users compared to non-users after 6 months of follow-up. Although this risk is modest, this finding suggests the need for increased awareness and preventive interventions among these users.

Objectives: Remote biochemical verification of smoking abstinence is limited by low adherence rates and technical problems with test completion. Qualitative data from study participants about their experiences completing these remote tests is lacking. The objectives were to interview participants who provided biochemical verification in a randomized trial of a smoking cessation intervention to (1) learn about participants' actual experiences with cotinine saliva testing; (2) examine willingness to conduct smartphone app-based carbon monoxide (CO) breathalyzer testing; and (3) gather recommendations to minimize barriers and improve adherence.

Methods: Participants who completed biochemical verification were invited to participate in semi-structured interviews that included watching an instructional video about the breathalyzer test. Audio recordings were professionally transcribed, and 2 independent coders applied an interactive inductive thematic analysis approach.

Results: Ten participants, ages 38.7 (9.5) years (30% male) completed interviews. Barriers to successful saliva cotinine testing included: technical issues submitting results (56%), issues following written instructions (44%), saliva collection sponge discomfort (33%), confusion about invalid results (33%), and concerns with device safety/data usage (22%). While more participants said they would, in concept, prefer the CO test or had no preference, they reported more problems with completing the CO test, including potential inaccessibility for people with respiratory illness. Key recommendations for improving compliance included: increasing monetary incentives, diversifying reminders, amplifying reciprocity messaging, managing expectations, and embedding clear, concise in-app guidance.

Conclusion: Results suggest that compliance with remote biochemical verification can be improved through a comprehensive approach that includes increasing incentives, managing expectations, streamlining visual instructions, and diversifying reminders.

Introduction: Little is known about whether liking a person to reduce alcohol drinking (social pressure) might be related to mortality.

Objectives: To analyze whether social pressure and an intention to reduce alcohol drinking may be related to time to death in an adult general population sample.

Methods: Among the general population in northern Germany at age 18 to 64, a random sample had been drawn. Included in this study were persons who had consumed alcohol 3 or more times a week or drank 27 g pure alcohol per drinking day or had 1 or more alcohol dependence criteria or problems fulfilled. These persons provided data about social pressure and an intention to reduce alcohol drinking and were known to be alive or deceased 20 years later. Associations between social pressure and time to death were calculated.

Results: Among the sample, 4075 (69.9%) residents participated at baseline, and 2060 fulfilled the inclusion criteria for this study. High social pressure to reduce alcohol drinking was related to a short time to death (hazard ratio 1.78; 95% confidence interval 1.17-2.73) after adjustment for the amount of alcohol drinking, an intention to reduce it, age, and sex.

Conclusion: The finding suggests that social pressure to reduce alcohol drinking in addition to the amount of alcohol drinking is part of a trajectory of alcohol consumption leading to death in this general population sample.

Background: Cannamom culture (CMC), an online movement for acceptance of cannabis use among mothers, has gained traction on social media. The urgency for exploration of CMC in a Canadian context was enhanced through legalization of cannabis in 2018, followed by legalization of cannabis edibles in 2019.

Objectives: We sought to explore cannamoms' social media and blog posts, and their representations of cannabis use and motherhood.

Methods: This qualitative study utilized reflexive thematic analysis of Canadian cannamom blog posts (N = 30) and Instagram posts (N = 34). Analysis of these outlets was considered through the lenses of similar social media phenomena, such as influencer, wine mom, wellness, and mental health cultural movements.

Results: The overarching theme identified was mothers marketing to mothers, with outlets advertising cannabis products and coaching. Three inter-related sub-themes were present within posts that facilitated this marketing: (1) a focus on increased normalization, attempted destigmatization, and legalization of cannabis due to its favorable health effects compared to other normalized substances; (2) responsible and personalized cannabis consumption to promote health and wellness; and (3) cannabis use as a way to achieve motherhood ideals including thinness, productivity, mental wellness, and engaged parenting.

Conclusions: CMC spaces online reproduce intensive motherhood narratives and position cannabis as an acceptable solution to motherhood struggles. The focus on wellness and personalization draws on wellness movements by constructing cannabis consumption as natural, responsible, and health promoting. These findings have implications for policy makers and healthcare providers regarding mothers' understandings of cannabis use and health.

Background: Substance use disorder (SUD) exacts a devastating psychosocial and medicolegal toll in Veterans. Despite the availability of quality SUD care provided by the Veterans Health Administration, many Veterans with SUD who initially seek treatment do not attend their intake appointment that helps determine their assigned level of care. Demographic and administrative factors have been used to predict outpatient no-shows, but whether patient-reported attitudes can be feasibly probed prior to the intake appointment to potentially predict intake no-show is largely unexplored.

Objectives: We wished to determine whether patient attitudes about SUD and SUD treatment can be feasibly probed in veterans and whether such attitudes could potentially predict intake no-show.

Methods: In a preliminary feasibility study, we administered by mail, smartphone app, or by in-person or telephone verbal interview a list of potential standard-of-care intake interview questions regarding attitudes about self and SUD treatment in n = 79 veterans scheduled for SUD treatment intake, of whom 29% did not attend the intake. To examine the power of attitudinal factors to predict intake no-show, we utilized decision tree-based machine learning (ML) analysis of veteran responses about addiction beliefs and other patient factors.

Results: ML analyses indicated that older age, longer time before intake date as well as self-reported low levels of medical adherence were independently predictive of intake no-show. Regarding attitudinal factors, no-show was also predicted by high endorsements of craving, having "an addiction," trust in previous SUD treatment providers, and existing engagement in the recovery community.

Conclusion: These preliminary data suggest the feasibility and potential predictive utility of querying Veterans slated for treatment intake about their attitudes regarding SUD and SUD treatment. Future replication studies with a larger sample size could yield briefer, lower-burden assessments of attitudinal no-show risk factors that could be targeted by pre-intake motivational interventions.

Background: Opioid use disorder (OUD) can be associated with cognitive impairment. However, little is known about how patients with OUD self-perceive any cognitive impairments, particularly in attention, executive function, and memory. No studies have addressed this issue in patients with OUD and self-reported adherence to office-based medication-assisted treatment (MAT).

Methods: This was an observational, multisite, cross-sectional survey study to evaluate self-reported cognitive function in adults with OUD, enrolled at 7 sites in the U.S., who had received ⩾3 months of office-based MAT. A cognitive self-report survey was administered to a clinical sample of adults with OUD (N = 255) adherent to buprenorphine (BUP; N = 139) or extended-release naltrexone (XR-NTX; N = 116). Impairments in attention, executive function, and memory were assessed with relevant items of the Executive Function Index (EFI) and Prospective Retrospective Memory Questionnaire (PRMQ). Factor analysis explored item factor structure; item scores were summed to generate scales, and association was estimated by linear regression.

Results: Approximately one-third of participants reported head injury and nearly one-half reported psychiatric comorbidities, particularly anxiety and depression. Most participants reported difficulties in ⩾1 cognitive item: 80.8% (206/255) for EFI and 49.0% (125/255) for PMRQ. Factor analysis suggested 3 cognitive scales (attention, executive, memory). Differences between the XR-NTX and the BUP groups on memory, executive function, and attention either were not found or lost significance after adjustment for neurological history. seizure). All scales were associated with a range of demographic and clinical variables.

Conclusions: Most adults receiving office-based MAT for OUD reported self-perceived cognitive impairment, but neurological comorbidities may also play a role in these perceptions.

Background: An estimated 2.7 million people in the United States ages 12 years and older suffered from opioid use disorder (OUD) in 2020; during the same period, approximately 68,000 people died due to an opioid overdose. In recent years, with support from federal funding, medication for opioid use disorder (MOUD) has emerged as a viable treatment option. The partial-opioid-agonist buprenorphine/naloxone (brand name, Suboxone) is the most used MOUD and is commonly administered as a daily oral dose. Naltrexone is an opioid antagonist primarily administered as a slow-release monthly injection formulation (brand name, Vivitrol).

Objective: This study aimed to explore clients' perceptions and experiences of using oral Suboxone and injectable Vivitrol for OUD treatment.

Design: This was a cross-sectional qualitative study.

Methods: We conducted semi-structured interviews with 65 clients from 2 residential treatment facilities in Tennessee between August 2019 and October 2020. Data were analyzed in Dedoose qualitative software using thematic analysis.

Results: Clients shared perspectives on facilities' tapering protocols for Suboxone and generally considered the lack of tapering a favorable attribute for Vivitrol. Both prescriptions were praised for reducing opioid cravings. Pharmacological side effects sometimes hindered clients' ability to continue MOUD treatment and were more common with Suboxone. Clients reported that MOUD gave them confidence and helped them focus on treatment, though concerns were raised about Suboxone's capacity for diversion, the cost of continuing Vivitrol, and the possibility of backsliding when the MOUD prescription was complete. Participants' views on MOUD ranged from enthusiastic to stigmatizing.

Conclusion: Our study provides valuable insights drawn from clients' experiences using oral and injectable MOUD in substance use treatment facilities. The findings will be useful for healthcare providers and policymakers to consider the pros and cons of these medications in substance use treatment settings.

Background: Although medication for opioid use disorder (MOUD) is the most effective form of treatment for reducing opioid misuse and related fatalities, programs continue to struggle to reach and engage those with relatively severe disorders and most in need of treatment.

Objectives: This study assessed whether providing a rapid medical appointment conducted via telehealth could improve MOUD linkage versus the standard model of an in-person referral.

Methods and design: We recruited participants from a syringe service prevention program (SSP) and the surrounding communities, randomly assigning them to have an initial medical examination via telemedicine (n = 136) or an in-person (n = 135) referral. We administered structured interviews and collected urine samples for drug testing at baseline and 90 days. The primary outcome was treatment linkage within 14 days of study enrollment, measured by attendance at their first in-person appointment. Secondary outcomes included MOUD engagement (34 days), 3-month retention, and self-reported and urine-detected non-MOUD opioid use at 3-month follow-up.

Findings: Contrary to expectations, telemedicine participants had lower odds of a successful linkage (aOR=0.42, CI=0.36, 0.49) than control condition participants. A significant interaction between the treatment condition and the timing of the initial treatment appointment indicated that having a treatment appointment scheduled within 48 hours of the medical evaluation had a more pronounced and positive impact than having a telehealth evaluation (aOR=2.9, CI=2.04, 4.12). There were no other significant differences for any secondary outcomes.

Conclusions: Telemedicine participants were less successfully linked to MOUD than standard referrals, likely owing to experiencing longer delays between their medical evaluation and first in-person treatment appointment compared with those having an in-person medical evaluation. More effective alternatives for coordinating MOUD and SSP services include co-locating MOUD within an SSP or full delivery of MOUD via telemedicine at an SSP, both of which would further obviate delays in treatment initiation.

Trial registration: ClinicalTrials.gov (NCT04575324).

Background: Detoxification is often identified as treating drug withdrawal. All drug classes except hallucinogens and inhalants include withdrawal as diagnostic criteria for a substance use disorder diagnosis. This descriptive study provides an analysis of detoxification admissions for individuals with hallucinogens or inhalants as their primary substance.

Objectives: This research aimed to explore the characteristics of these detoxification admissions, focusing on demographics, substance use patterns, and treatment characteristics.

Design: This retrospective study used annual cross-sectional data.

Methods: Using the Treatment Episode Dataset Admissions 2006 to 2022 file, data from 8919 detoxification admissions over a 17-year period from publicly funded treatment facilities in the United States were examined.

Results: During the 17-year period, n = 6761 and n = 2158 detoxification treatment episode admissions had the primary substance hallucinogens and inhalants, respectively. Polysubstance use was prevalent among both samples, with 66% among the hallucinogen sample and 48% among the inhalant sample, with alcohol, cannabis, and cocaine/crack being the most commonly co-used substances. A total of 2872 cases were identified as only having hallucinogens and/or inhalants without other drug classes as reported substances during admission.

Conclusion: These preliminary findings highlight detoxification admissions among individuals with primary substances that do not meet diagnostic criteria for withdrawal. More research is needed to better understand the context of detoxification among individuals with hallucinogens or inhalants as their primary substance.