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Methadone Take-Home Policies and Associated Mortality: Permitting versus Non-Permitting States. 美沙酮带回家政策与相关死亡率:许可州与非许可州。
Pub Date : 2024-08-16 eCollection Date: 2024-01-01 DOI: 10.1177/29768357241272379
Rebecca Arden Harris

To mitigate COVID-19 exposure risks in methadone clinics, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary modification of regulations in March 2020 to permit, with state concurrence, extended take-home methadone doses. The modification allowed for up to 28 days of take-home methadone for stable patients and 14 days for those less stable. Using both interrupted time series and difference-in-differences methods, this study examined the association between the policy change and fatal methadone overdoses, comparing states that permitted the expansion of take-home doses with states that did not. The findings suggest the pandemic emergency take-home policy did not increase methadone-involved mortality.

为降低美沙酮诊所的 COVID-19 暴露风险,美国药物滥用和精神健康服务管理局 (SAMHSA) 于 2020 年 3 月发布了一项临时法规修订,允许在州政府同意的情况下延长带回家的美沙酮剂量。修改后的规定允许病情稳定的患者将美沙酮带回家服用长达 28 天,病情不太稳定的患者可服用 14 天。本研究采用间断时间序列法和差分法,比较了允许扩大带回家服用剂量的州和不允许扩大带回家服用剂量的州,研究了政策变化与致命美沙酮过量之间的关联。研究结果表明,大流行病紧急带回家政策并未增加美沙酮相关死亡率。
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引用次数: 0
Substance Use Treatment Utilization Among Individuals With Substance Use Disorders in the United States During the COVID-19 Pandemic: Findings on the Role of Polysubstance Use, Criminal Justice Involvement, and Mental Illness From the National Survey on Drug Use and Health. COVID-19 大流行期间美国药物使用失调患者的药物使用治疗利用情况:全国毒品使用与健康调查》对多种物质使用、刑事司法参与和精神疾病的作用的研究结果。
Pub Date : 2024-06-12 eCollection Date: 2024-01-01 DOI: 10.1177/29768357241259947
Hannah B Apsley, Alexis R Santos-Lozada, Joy Gray, Gregory Hard, Abenaa A Jones

This study used the National Survey on Drug Use and Health to assess a nationally representative sample (N = 4596) weighted to represent 35.2 million adults with DSM-5 criteria-determined substance use disorders (SUDs). This study explored substance use treatment utilization in 2020, emphasizing populations with high vulnerability (e.g., criminal justice involvement (CJI) through parole or probation, polysubstance use, severe mental illness, and HIV/STI). Substance use treatment was broadly defined (any inpatient, outpatient/doctor's office, self-help/other for alcohol/drugs). Our results indicated that among adults with SUDs in 2020, 7 million (20%) had multiple SUDs, 1.75 million (5%) had CJI, 5.3 million (15%) had a severe mental illness, and 1.8 million (5%) had a diagnosis of HIV/STI in the last year. Only 7% of individuals with SUD sought any substance use treatment in the past year. CJI (aOR: 13.39, 95% CI: [7.82, 22.94]), serious mental illness (aOR: 3.27, 95% CI: [1.93, 5.55]), and having both 2 (aOR: 2.10, 95% CI: [1.29, 3.42]) or 3 or more SUDs (aOR: 3.46, 95% CI: [1.82, 6.58]) were all associated with a greater likelihood of receiving treatment. Marriage (aOR: 0.43, 95% CI: [0.25, 0.74]) and having an income twice the poverty threshold (aOR: 0.53, 95% CI: [0.29, 0.94]) were associated with reduced odds of receiving any substance use treatment. Compared to those 18 to 25, older individuals had increased odds (2-4 times) of receiving treatment. Interventions are crucially needed to increase access to treatment among those with SUDs.

本研究利用《全国药物使用和健康调查》对具有全国代表性的样本(N = 4596)进行了评估,该样本经过加权,代表了 3520 万患有 DSM-5 标准确定的药物使用障碍(SUD)的成年人。本研究探讨了 2020 年的药物使用治疗利用情况,重点关注易受影响的人群(例如,通过假释或缓刑参与刑事司法(CJI)、多种药物使用、严重精神疾病和 HIV/STI)。对药物使用治疗的定义较为宽泛(任何住院、门诊/医生办公室、自助/其他酒精/毒品治疗)。我们的研究结果表明,在 2020 年患有药物滥用症的成年人中,有 700 万人(20%)患有多种药物滥用症,175 万人(5%)患有 CJI,530 万人(15%)患有严重精神疾病,180 万人(5%)在过去一年中被诊断患有 HIV/STI。只有 7% 的 SUD 患者在过去一年中寻求过任何药物使用治疗。CJI(aOR:13.39,95% CI:[7.82, 22.94])、严重精神疾病(aOR:3.27,95% CI:[1.93, 5.55])以及同时患有 2 种(aOR:2.10,95% CI:[1.29, 3.42])或 3 种以上 SUD(aOR:3.46,95% CI:[1.82, 6.58])均与接受治疗的可能性增加有关。婚姻(aOR:0.43,95% CI:[0.25,0.74])和收入是贫困线两倍(aOR:0.53,95% CI:[0.29,0.94])与接受任何药物使用治疗的几率降低有关。与 18-25 岁的人相比,年龄较大的人接受治疗的几率更高(2-4 倍)。我们亟需采取干预措施,以增加吸毒成瘾者接受治疗的机会。
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引用次数: 0
Virtual Hybrid Versus In-Person Administration of Transcending Self Therapy for Veterans with Substance Use Disorders. 为有药物使用障碍的退伍军人提供超越自我疗法的虚拟混合疗法与面对面疗法。
Pub Date : 2024-05-26 eCollection Date: 2024-01-01 DOI: 10.1177/29768357241255437
James M Bjork, Jaclyn S Sadicario, Nabila F Jahan, Espn Curiel, Lillia Thumma, Jarrod Reisweber

Objectives: Veterans with substance use disorder (SUD) can show high severity and are at high risk of relapse due to trauma histories and other comorbid conditions. However, evidence-based SUD therapies may not be available to many veterans due to geographic or transportation constraints. Telehealth approaches have shown promise to improve access to different SUD therapy formats but have not been well-studied in open (rolling-admission) group therapy of in-person patients as administered by a single on-screen therapist.

Methods: Social distancing required by the COVID-19 pandemic forced the transition of delivery of Transcending Self Therapy (TST) from an in-person therapist to a single remote (on-screen) therapist. In this virtual model, veterans continued to receive TST but the therapist was off site and provided therapy to veterans who were together in the same room during a 28 day residential Veterans Affairs treatment program. In a program evaluation, we compared their changes in quality of life (QoL), treatment satisfaction ratings and group therapy treatment outcomes with those of Veterans who received TST from an in-person therapist.

Results: In both groups, there was a significant increase in QoL Inventory scores from baseline to post-treatment, with no difference in improvement between treatment modalities (i.e., in-person group vs telehealth-delivered group). Veterans professed knowledge of therapy-driven skills at the end of treatment in both groups and overwhelmingly rated TST as helpful and understandable.

Conclusions: These data extend previous findings of patient acceptability of remotely-delivered SUD treatment, here with a remote therapist administering open group therapy, as evidenced by improvement in QoL and positive patient feedback about the remote intervention.

目标:患有药物滥用障碍(SUD)的退伍军人可能会表现出很高的严重性,并且由于创伤史和其他合并症,他们复发的风险也很高。然而,由于地理或交通限制,许多退伍军人可能无法获得循证 SUD 治疗。远程医疗方法已显示出改善不同 SUD 治疗形式的前景,但在由单一屏幕治疗师管理的面对面患者的开放式(滚动入院)团体治疗中,远程医疗方法尚未得到充分研究:方法:COVID-19 大流行所要求的社会距离迫使 "超越自我疗法"(TST)的实施从面对面治疗师过渡到单一远程(屏幕)治疗师。在这种虚拟模式中,退伍军人继续接受 TST 治疗,但治疗师不在现场,而是在为期 28 天的退伍军人事务住院治疗项目中为同处一室的退伍军人提供治疗。在项目评估中,我们将退伍军人的生活质量(QoL)变化、治疗满意度评分和小组治疗结果与接受治疗师上门提供的 TST 治疗的退伍军人进行了比较:结果:两组退伍军人的 QoL 量表得分从基线到治疗后都有显著提高,不同治疗方式(即面对面治疗组和远程医疗提供组)之间的提高幅度没有差异。两组退伍军人在治疗结束后都表示掌握了治疗所需的技能,并且绝大多数人都认为 TST 有帮助且易于理解:这些数据扩展了之前的研究结果,即患者可接受远程提供的 SUD 治疗,这里的远程治疗由远程治疗师实施开放式小组治疗,QoL 的改善和患者对远程干预的积极反馈都证明了这一点。
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引用次数: 0
Synthetic Marijuana: Assessment of Usage, Motivation and Associated Risks in Adolescent Substance Users. 合成大麻:评估青少年毒品使用者的使用情况、动机和相关风险。
Pub Date : 2024-05-17 eCollection Date: 2024-01-01 DOI: 10.1177/29768357241254258
Raman Baweja, Sara Mills-Huffnagle, Amanda Jernigan, Nungshitombi Chongtham, Daniel Waschbusch, James G Waxmonsky

Objectives: Use of Synthetic and designer products, including synthetic marijuana (SM), among adolescents poses a major risk to public health. Little is known about the motivating factors of synthetic substance use in adolescents. This study examined the motivations, predictors, perceived risks and benefits, and differences with SM versus natural marijuana among adolescents.

Methods: Between April 2016 and May 2018, a convenience sample of adolescents receiving substance use treatment from a local counseling center completed an anonymous survey to assess the use of natural and synthetic marijuana use, the Strengths and Difficulties Questionnaire to assess levels of current psychiatric symptoms and the Community Assessment of Psychic Experiences-Positive Scale to assess symptoms of psychosis.

Results: A total of 80 adolescents (age range of 14-18 years; 71% male; 53% Caucasian) completed the study. Of these, 39 (49%) reported natural marijuana use (natural marijuana users) and 41 (51%) reported both synthetic and natural marijuana use (dual users). The most commonly reported reasons for using SM were its low cost and reduced risk of detection. Participants who were familiar with SM and reported a desire to avoid detection on drug tests were likelier to use SM (all P < .05). Dual users reported more benefits and risks associated with SM use when compared to natural marijuana users (P ⩽ .05). The use of SM also heightened the perceived medical risks of natural marijuana, including seizures and respiratory issues (P < .05), compared with natural marijuana users. While dual users self-reported more conduct (P = .009) and externalizing problems (P = .024) when compared to natural marijuana users, there were no group differences in psychotic symptoms, nor correlations with the frequency of synthetic or natural marijuana use and psychotic symptoms except that persecutory ideation correlated with the frequency of natural marijuana use during the past 12 months (rp = 0.28, P = .04).

Conclusions: These results suggest that reports of cost savings, and lack of detection on urine drug screens are common reasons for SM use in adolescents despite being aware of the risks of using SM. Perceived benefits of using synthetics and other novel substances appear diverse, and merit further exploration as a better understanding of what motivates adolescents to use specific novel substances may guide prevention and treatment efforts.

目标:青少年使用合成和特制产品,包括合成大麻(SM),对公众健康构成了重大威胁。人们对青少年使用合成药物的动机知之甚少。本研究考察了青少年使用合成大麻的动机、预测因素、感知风险和益处,以及合成大麻与天然大麻的差异:2016年4月至2018年5月期间,接受当地咨询中心药物使用治疗的青少年方便抽样完成了一项匿名调查,以评估天然大麻和合成大麻的使用情况;完成了 "优势与困难问卷 "以评估当前精神症状的程度;完成了 "精神体验社区评估-阳性量表 "以评估精神病症状:共有 80 名青少年(年龄在 14-18 岁之间;71% 为男性;53% 为白种人)完成了研究。其中 39 人(49%)报告使用天然大麻(天然大麻使用者),41 人(51%)报告同时使用合成大麻和天然大麻(双重使用者)。据报告,使用 SM 的最常见原因是其成本低和降低了被发现的风险。熟悉 SM 并表示希望避免在毒品检测中被发现的参与者更有可能使用 SM(所有 P P ⩽.05)。与天然大麻使用者相比,使用合成大麻也增加了天然大麻的医疗风险感知,包括癫痫发作和呼吸系统问题(P P = .009)以及外化问题(P = .024),但精神病症状没有群体差异,合成大麻或天然大麻的使用频率与精神病症状也没有相关性,只有迫害意念与过去 12 个月天然大麻的使用频率相关(rp = 0.28,P = .04):这些结果表明,尽管青少年知道使用天然大麻的风险,但他们使用天然大麻的常见原因是关于节省成本的报告以及在尿液药物筛查中未被发现。使用合成药物和其他新型物质的好处似乎多种多样,值得进一步探讨,因为更好地了解促使青少年使用特定新型物质的原因可以指导预防和治疗工作。
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引用次数: 0
Family-based Interventions of Preventing Substance Use Among Immigrant Youth: A Scoping Review. 基于家庭的移民青少年药物使用预防干预:范围审查》。
Pub Date : 2024-05-04 eCollection Date: 2024-01-01 DOI: 10.1177/29768357241244680
Yiyan Li, Geoffrey Maina, Ghazal Mousavian, Yiting Fang, Barbara Twum-Antwi, Jordan Sherstobitoff, Jonathan Amoyaw, Mamata Pandey

Introduction: Immigrant youth face heightened risks of substance use due to the stress associated with immigration and acculturation. While parental intervention can have a preventative impact on substance use, parents need to be well-informed about substance use and effective interventions that can prevent substance use among immigrant youth. Such interventions ought to be culturally sensitive, family-based, and targeted at the specific substances that are prevalent in a given context. Identifying and curating interventions that can empower parents in addressing substance use can help mitigate the risks that immigrant youth may face.

Methods: This scoping review aimed to identify the types, characteristics, and effectiveness of family-based substance use intervention programs. Based on Arksay and O'Malley's guidelines, interventions included in the review must have met the following criteria: (a) was a family-based intervention aiming to prevent substance use; (b) targeted immigrant teens aged 12 to 17 years old; (c) was published in English; (d) originated from Australia, Canada, New Zealand, or the United States. The pinch table was used to synthesize included articles, after which studies were compared and categorized, and cross-cutting categories were identified.

Results: After screening 4551 searched literature, 13 studies that utilized family-based interventions were included in the review. All interventions were face-to-face programs, and most interventions involved parents and youth as participants. Eco-developmental theory and active learning strategies were used by multiple interventions. Given immigrant families were target stakeholders, both deep structure and surface structure cultural adaptations were utilized. Interventions increased parents' knowledge and skills regarding substance use prevention and delayed substance use initiation among youth.

Conclusion: From the review, it was evident that parents are an essential element in any program aiming to prevent or reduce children's substance use. Besides information about substance use prevention, the curriculum also involves parenting and communication skills for parents to understand the protective effects of family. Effective family-based interventions for immigrant youth require attention to parenting and immigration stress, while also considering cultural adaptation. Future directions and limitations are also discussed.

导言:由于移民和文化适应带来的压力,移民青少年面临着更大的药物使用风险。虽然父母的干预可以对药物使用产生预防性影响,但父母需要充分了解药物使用情况以及可以预防移民青少年使用药物的有效干预措施。这些干预措施应具有文化敏感性,以家庭为基础,并针对特定环境中普遍存在的特定物质。确定并制定能够增强父母处理药物使用问题能力的干预措施,有助于降低移民青少年可能面临的风险:此次范围界定审查旨在确定基于家庭的药物使用干预计划的类型、特点和有效性。根据 Arksay 和 O'Malley 的指导方针,纳入综述的干预措施必须符合以下标准:(a) 以家庭为基础,旨在预防药物使用的干预措施;(b) 针对 12 至 17 岁的移民青少年;(c) 以英语发表;(d) 源自澳大利亚、加拿大、新西兰或美国。研究人员使用撮合表对收录的文章进行了综合,然后对研究进行了比较和分类,并确定了交叉类别:结果:在对 4551 篇检索文献进行筛选后,有 13 项利用家庭为基础的干预措施的研究被纳入综述。所有干预都是面对面的项目,大多数干预都有家长和青少年参与。生态发展理论和主动学习策略被多种干预措施所采用。鉴于移民家庭是目标利益相关者,因此采用了深层结构和表层结构的文化适应措施。干预措施提高了家长在预防药物使用方面的知识和技能,推迟了青少年开始使用药物的时间:综述表明,在任何旨在预防或减少儿童药物使用的计划中,父母都是不可或缺的要素。除了有关预防药物使用的信息外,课程还涉及为人父母和沟通技巧,让父母了解家庭的保护作用。针对移民青少年的有效家庭干预措施需要关注养育子女和移民压力,同时还要考虑文化适应问题。此外,还讨论了未来的方向和局限性。
{"title":"Family-based Interventions of Preventing Substance Use Among Immigrant Youth: A Scoping Review.","authors":"Yiyan Li, Geoffrey Maina, Ghazal Mousavian, Yiting Fang, Barbara Twum-Antwi, Jordan Sherstobitoff, Jonathan Amoyaw, Mamata Pandey","doi":"10.1177/29768357241244680","DOIUrl":"https://doi.org/10.1177/29768357241244680","url":null,"abstract":"<p><strong>Introduction: </strong>Immigrant youth face heightened risks of substance use due to the stress associated with immigration and acculturation. While parental intervention can have a preventative impact on substance use, parents need to be well-informed about substance use and effective interventions that can prevent substance use among immigrant youth. Such interventions ought to be culturally sensitive, family-based, and targeted at the specific substances that are prevalent in a given context. Identifying and curating interventions that can empower parents in addressing substance use can help mitigate the risks that immigrant youth may face.</p><p><strong>Methods: </strong>This scoping review aimed to identify the types, characteristics, and effectiveness of family-based substance use intervention programs. Based on Arksay and O'Malley's guidelines, interventions included in the review must have met the following criteria: (a) was a family-based intervention aiming to prevent substance use; (b) targeted immigrant teens aged 12 to 17 years old; (c) was published in English; (d) originated from Australia, Canada, New Zealand, or the United States. The pinch table was used to synthesize included articles, after which studies were compared and categorized, and cross-cutting categories were identified.</p><p><strong>Results: </strong>After screening 4551 searched literature, 13 studies that utilized family-based interventions were included in the review. All interventions were face-to-face programs, and most interventions involved parents and youth as participants. Eco-developmental theory and active learning strategies were used by multiple interventions. Given immigrant families were target stakeholders, both deep structure and surface structure cultural adaptations were utilized. Interventions increased parents' knowledge and skills regarding substance use prevention and delayed substance use initiation among youth.</p><p><strong>Conclusion: </strong>From the review, it was evident that parents are an essential element in any program aiming to prevent or reduce children's substance use. Besides information about substance use prevention, the curriculum also involves parenting and communication skills for parents to understand the protective effects of family. Effective family-based interventions for immigrant youth require attention to parenting and immigration stress, while also considering cultural adaptation. Future directions and limitations are also discussed.</p>","PeriodicalId":517405,"journal":{"name":"Substance use : research and treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11069246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impulsivity Dimensions Predict Treatment Dropout Among Women in Residential Treatment for Substance Use Disorders. 在接受药物使用障碍住院治疗的女性中,冲动性维度可预测治疗辍学情况。
Pub Date : 2024-04-14 eCollection Date: 2024-01-01 DOI: 10.1177/29768357241245827
Evan J Basting, Alyssa M Medenblik, Kaja Switalska, Alisa R Garner, Ryan C Shorey, Gregory L Stuart

Residential treatment for substance use disorders (SUDs) is effective at reducing substance use, dependence, and other related problems. However, dropout from treatment against medical advice (AMA) is common in residential treatment settings. Studies have shown that impulsivity is associated with substance misuse and treatment dropout in predominately male samples, but less is known regarding whether impulsivity dimensions predict treatment dropout among women. This study examined impulsivity dimensions (ie, negative urgency, positive urgency, lack of perseverance, lack of premeditation, and sensation seeking) as predictors of dropout AMA among women in a residential substance use treatment facility (N = 229). Logistic regression results demonstrated that elevations in lack of perseverance and sensation seeking were associated with an increased odds of treatment dropout AMA and that lack of premeditation was associated with a decreased odds of treatment dropout AMA. Study findings suggest that early evidence-based interventions for sensation seeking and lack of perseverance may improve retention of women in residential treatment.

药物使用失调(SUD)的住院治疗能有效减少药物使用、依赖和其他相关问题。然而,在住院治疗环境中,违背医嘱(AMA)而放弃治疗的情况很常见。研究表明,在以男性为主的样本中,冲动性与药物滥用和治疗辍学有关,但对于冲动性是否能预测女性的治疗辍学,目前还知之甚少。本研究将冲动性维度(即消极紧迫感、积极紧迫感、缺乏毅力、缺乏预谋和寻求感觉)作为药物使用住院治疗机构中女性(N = 229)的辍学预测因素。逻辑回归结果表明,缺乏毅力和寻求感觉与AMA治疗辍学几率增加有关,而缺乏预谋与AMA治疗辍学几率降低有关。研究结果表明,针对寻求感觉和缺乏毅力的早期循证干预措施可能会提高住院治疗妇女的保留率。
{"title":"Impulsivity Dimensions Predict Treatment Dropout Among Women in Residential Treatment for Substance Use Disorders.","authors":"Evan J Basting, Alyssa M Medenblik, Kaja Switalska, Alisa R Garner, Ryan C Shorey, Gregory L Stuart","doi":"10.1177/29768357241245827","DOIUrl":"https://doi.org/10.1177/29768357241245827","url":null,"abstract":"<p><p>Residential treatment for substance use disorders (SUDs) is effective at reducing substance use, dependence, and other related problems. However, dropout from treatment against medical advice (AMA) is common in residential treatment settings. Studies have shown that impulsivity is associated with substance misuse and treatment dropout in predominately male samples, but less is known regarding whether impulsivity dimensions predict treatment dropout among women. This study examined impulsivity dimensions (ie, negative urgency, positive urgency, lack of perseverance, lack of premeditation, and sensation seeking) as predictors of dropout AMA among women in a residential substance use treatment facility (N = 229). Logistic regression results demonstrated that elevations in lack of perseverance and sensation seeking were associated with an increased odds of treatment dropout AMA and that lack of premeditation was associated with a <i>decreased</i> odds of treatment dropout AMA. Study findings suggest that early evidence-based interventions for sensation seeking and lack of perseverance may improve retention of women in residential treatment.</p>","PeriodicalId":517405,"journal":{"name":"Substance use : research and treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11020744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Improving Medical Student Knowledge and Reducing Stigmatizing Attitudes Toward Treating Patients With Opioid Use Disorder. 提高医学生对治疗阿片类药物使用障碍患者的认识,减少对患者的轻蔑态度。
Pub Date : 2024-02-29 eCollection Date: 2024-01-01 DOI: 10.1177/11782218241234808
Dana H Chung, Stephanie Slat, Aditi Rao, Jennifer Thomas, Adrianne Kehne, Colin Macleod, Erin F Madden, Pooja Lagisetty

Objectives: Stigma and lack of knowledge are barriers to clinicians when caring for individuals with opioid use disorder (OUD). In 2018, only about 15 out of 180 American medical schools had comprehensive addiction programs. The AAMC reports that institutions are increasingly incorporating competencies to address the OUD and opioid epidemic. There have been few evaluated curriculums focused on reducing stigmatizing attitudes. This study evaluated whether a 4-hour case-based curriculum focused on improving stigmatizing attitudes toward patients with OUD could reduce medical student perceptions around viewing addiction as a punitive condition and other substitution-based misconceptions around opioid agonist-based medication.

Methods: Medical students completed a 4-hour curricular workshop which included learning objectives focusing on barriers to healthcare/stigmatizing attitudes, effective behavioral therapy options, and appropriate use of opioid medications. We measured changes in knowledge and attitudes using validated scales on stigma. Non-parametric repeated measure tests determined statistically significant differences between pre and post assessments between OUD related perceptions and a control condition (diabetes).

Results: Of 135 eligible participants, 99 (76%) students completed both pre- and post-surveys. Mean scores across knowledge questions improved (60%-81%, P < .001) and stigmatizing attitudes regarding perceived violence of people with OUD decreased (2.04-1.82, P = .016). There was significant improvement in mean scores for OUD-related opinions including desire to work with and effectively treat patients with OUD (3.58-3.88, P < .001) while no significant concurrent change was observed in mean opinion scores of a non-OUD comparator, diabetes (3.88-3.97, P = .201).

Conclusions: Results indicate that the workshop was associated with measurable changes in knowledge and attitudinal forms of OUD stigma. With recent policy changes eliminating the X-waiver, healthcare institutions are eager to design curriculum around OUD management and treatment. This study provides a blueprint for an effective curriculum that improves clinician knowledge and reduces stigmatizing attitudes.

目标:污名化和知识匮乏是临床医生治疗阿片类药物使用障碍(OUD)患者的障碍。2018 年,在 180 所美国医学院校中,只有约 15 所开设了综合成瘾课程。美国医学会报告称,越来越多的机构正在纳入应对 OUD 和阿片类药物流行的能力。很少有经过评估的课程侧重于减少轻蔑态度。本研究评估了以改善对 OUD 患者的鄙视态度为重点的 4 小时案例课程是否能减少医学生将成瘾视为一种惩罚性疾病的看法,以及对阿片类激动剂药物治疗的其他替代性误解:医科学生完成了一个 4 小时的课程研讨会,其中包括以医疗保健障碍/轻蔑态度、有效的行为疗法选择和阿片类药物的适当使用为重点的学习目标。我们使用经过验证的成见量表测量了知识和态度的变化。非参数重复测量检验确定了与 OUD 相关的认知和对照条件(糖尿病)在前后评估之间的统计学显著差异:在 135 名符合条件的参与者中,99 名(76%)学生完成了前后两次调查。知识问题的平均得分有所提高(60%-81%,P P = .016)。与 OUD 相关的观点,包括希望与 OUD 患者合作并有效治疗 OUD 患者的观点的平均得分有了明显提高(3.58-3.88,P P = .201):研究结果表明,该讲习班与 OUD 耻辱化的知识和态度形式的可测量变化有关。随着最近取消 X-waiver 的政策变化,医疗机构迫切希望围绕 OUD 管理和治疗设计课程。本研究提供了一个有效的课程蓝图,可提高临床医生的知识水平并减少污名化态度。
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引用次数: 0
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Substance use : research and treatment
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