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Patient and clinician experiences with the implementation of telemedicine and related adaptations in office-based buprenorphine treatment during the COVID-19 pandemic: a qualitative study. 在 COVID-19 大流行期间,患者和临床医生在基于诊室的丁丙诺啡治疗中实施远程医疗和相关调整的经验:一项定性研究。
IF 3.7 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2025-03-04 DOI: 10.1186/s13722-025-00536-3
Melissa Davoust, Angela R Bazzi, Samantha Blakemore, Juliana Blodgett, Anna Cheng, Sarah Fielman, Kara M Magane, Jacqueline Theisen, Richard Saitz, Alicia S Ventura, Zoe M Weinstein

Background: Deaths from opioid overdose have increased dramatically in the past decade. For individuals with opioid use disorder (OUD), agonist medications such as methadone and buprenorphine reduce opioid-related morbidity and mortality. Historically, the provision of buprenorphine treatment in office-based settings has relied on frequent in-person contact, likely influencing patients' access to and retention in care. In response to the COVID-19 pandemic, providers of office-based buprenorphine treatment rapidly adapted their care processes, increasingly relying on telemedicine visits. To date, relatively few prior studies have combined patient and clinician perspectives to examine the implementation of telemedicine and related care adaptations, particularly in safety-net settings.

Methods: Qualitative methods were used to explore clinician and patient experiences with telemedicine in an office-based buprenorphine treatment clinic affiliated with an urban safety-net hospital. From this clinic, we conducted semi-structured interviews with 25 patients and 16 clinicians (including prescribers and non-prescribers). We coded all interview data and used a thematic analysis approach to understand how telemedicine impacted treatment quality and engagement in care, as well as preferences for using telemedicine moving forward.

Results: Five themes regarding the implementation of telemedicine and other COVID-19-related care adaptations arose from patient and clinician perspectives: (1) telemedicine integration precipitated openness to more flexibility in care practices, (2) concerns regarding telemedicine-related adaptations centered around safety and accountability, (3) telemedicine encounters required rapport and trust between patients and clinicians to facilitate open communication, (4) safety-net patient populations experienced unique challenges when using telemedicine, particularly in terms of the technology required and the need for privacy, and (5) there is an important role for telemedicine in office-based buprenorphine treatment moving forward, primarily through its use in hybrid models of care which integrate both in-person and virtual visits.

Conclusions: Telemedicine implementation within office-based buprenorphine treatment has the potential to improve patients' engagement in care; however, our findings emphasize the need for tailored approaches to implementing telemedicine in office-based buprenorphine treatment, particularly within safety-net settings. Overall, this study supports the maintenance of changes to policy and practice that facilitate the use of telemedicine in office-based buprenorphine treatment beyond the COVID-19 public health emergency.

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引用次数: 0
Conference abstracts - Liberating Methadone: Building a Roadmap & Community for Change.
IF 3.7 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2025-02-27 DOI: 10.1186/s13722-025-00535-4
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引用次数: 0
Is it about substituting an addiction with another? development and initial psychometric properties of the first heated tobacco products addiction questionnaire (HeaTPAQ).
IF 3.7 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2025-02-26 DOI: 10.1186/s13722-025-00551-4
Feten Fekih-Romdhane, Rabih Hallit, Diana Malaeb, Fouad Sakr, Mariam Dabbous, Sahar Obeid, Souheil Hallit

Background: Public health experts currently agree that heated tobacco products (HTPs) pose a significant health risk for their consumers. The same concentrations and speed of delivery of nicotine found for HTPs and conventional combustion cigarettes make it necessary to consider the addictiveness of HTPs, and provide precise diagnostic instruments to serve as the basis for effective treatment plans. Therefore, the main objectives of this study were to design a questionnaire for HTPs addiction called "Heated Tobacco Products Addiction Questionnaire (HeaTPAQ)" and to examine its psychometric properties.

Methods: Adults from the general population of Lebanon (n = 754) were administered the HeatPAQ, along with the Fagerström test for nicotine dependence (FTND), the Caffeine Use Disorder Questionnaire, the Generalized Anxiety Disorder 7-item, and the Patient Health Questionnaire-9. We split the main sample into two subsamples; subsample 1 consisting of 33% of the participants used for the exploratory factor analysis (EFA) (n = 246; mean age 27.82 ± 9.38 years) and subsample 2 consisting of 67% of the participants used for the confirmatory factor analysis (CFA) (n = 508; mean age 27.81 ± 8.80 years).

Results: EFA then CFA analyses revealed a one-factor model consisting of 13 items with acceptable fit to the data. The HeaTPAQ reached excellent internal consistency coefficients, with both Cronbach's α and McDonald's ω values of 0.96. The one-dimensional structure of the HeaTPAQ was found to be invariant across sex groups. Convergent validity was demonstrated through significant positive correlation with FTND scores. Furthermore, HeaTPAQ scores correlated positively with measures of caffeine addiction, anxiety and depression, which suggests the adequate concurrent validity of the scale.

Conclusion: Findings suggest that the HeatPAQ is a specific, short and simple-to-use self-report questionnaire to assess HTPs addiction reliably and validly. Pending future studies confirming our results, we hope that the HeatPAQ will facilitate routine screening for HTPs addiction, which is an essential step towards appropriate prevention and intervention efforts and to inform policy makers.

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引用次数: 0
Initiating buprenorphine to treat opioid use disorder without prerequisite withdrawal: an updated systematic review.
IF 3.7 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2025-02-20 DOI: 10.1186/s13722-025-00548-z
Kathleen K Adams, Kristin Waters, Diana M Sobieraj

Background: Withdrawal prior to buprenorphine initiation may be intolerable or create barriers to therapy. We aim to update our previous systematic review on the efficacy and safety of buprenorphine initiation strategies that aim to omit prerequisite opioid withdrawal (POW).

Methods: We used the same search strategy for this update as in the original review with the modification of an additional term "low dose." We searched Embase and Scopus from April 11, 2020 to August 1, 2024 with searches in Google Scholar and www.

Clinicaltrials: gov . A study was included if it described patients with opioid use disorder or chronic pain that transitioned from a full mu-opioid agonist to buprenorphine without preceding withdrawal and reported withdrawal during initiation as an outcome. Two investigators independently screened citations and articles for inclusion, collected data using a standardized data collection tool, and assessed study risk of bias.

Results: Forty-four articles met our inclusion criteria; 31 were case reports/series reporting 84 cases and 13 were single-arm observational studies reporting a total of 576 cases. These studies were added to the literature from our original systematic review, totaling 59 studies and 682 patients. Sublingual buprenorphine was the most common initial formulation, comprising 55% (376/682) of cases. In case reports/series, use of a validated scale to measure withdrawal was uncommon; validated scales were only used in 36% of patients. All other patients had withdrawal assessed in a manner not utilizing a validated scale. Approximately half of these patients experienced any level of withdrawal (57/106 = 54%). The specific outcome of "any level of withdrawal" was not consistently reported in single-arm observational studies. Eight studies reported on any level of withdrawal, which occurred in 41% (177/428) of initiation attempts; some patients experienced more than one initiation attempt. Thirteen patients in case reports/series and 37 patients in the single-arm observational studies reported clinically significant withdrawal (50/682 = 7%). 81% (451/555) of patients transitioned to buprenorphine.

Conclusion: The prevalence of buprenorphine dosing strategies that aim to omit POW has vastly increased over the past 4 years. While quality of evidence remains low, the increased quantity of publications and integration into health-system guidelines and protocols demonstrates the need for prospective, controlled studies. It is unknown how selection bias impacts current findings, further highlighting the need for prospective, randomized, controlled trials evaluating these dosing strategies.

背景:丁丙诺啡起始治疗前的戒断可能令人难以忍受,或对治疗造成障碍。我们旨在更新之前关于丁丙诺啡起始策略疗效和安全性的系统综述,这些策略旨在省略阿片类药物戒断(POW)的前提条件:我们采用了与原始综述相同的检索策略,但增加了一个新词 "低剂量"。我们在 2020 年 4 月 11 日至 2024 年 8 月 1 日期间检索了 Embase 和 Scopus,并在 Google Scholar 和 www.Clinicaltrials: gov 中进行了检索。如果一项研究描述了阿片类药物使用障碍或慢性疼痛患者从全μ-阿片类激动剂过渡到丁丙诺啡而未出现戒断,并将起始治疗期间的戒断作为一项结果进行了报告,则该研究被纳入其中。两名研究人员独立筛选了引用文献和纳入文章,使用标准化数据收集工具收集数据,并评估了研究的偏倚风险:44篇文章符合我们的纳入标准;其中31篇为病例报告/系列研究,报告了84个病例,13篇为单臂观察研究,报告了共计576个病例。这些研究与我们最初的系统综述文献相加,共有 59 项研究和 682 名患者。舌下丁丙诺啡是最常见的初始制剂,占病例总数的 55%(376/682)。在病例报告/系列研究中,使用有效量表测量戒断情况的情况并不常见;仅有 36% 的患者使用了有效量表。所有其他患者的戒断评估方式均未使用验证量表。这些患者中约有一半出现过任何程度的戒断(57/106 = 54%)。在单臂观察研究中,"任何程度的戒断 "这一具体结果的报告并不一致。八项研究报告了任何程度的戒断,这发生在41%(177/428)的起始尝试中;一些患者经历了不止一次起始尝试。病例报告/系列研究中的 13 名患者和单臂观察研究中的 37 名患者报告了具有临床意义的戒断(50/682 = 7%)。81%(451/555)的患者过渡到使用丁丙诺啡:结论:在过去 4 年中,旨在避免 POW 的丁丙诺啡给药策略的普及率大幅提高。虽然证据的质量仍然较低,但出版物数量的增加以及纳入医疗系统指南和方案的情况表明,有必要开展前瞻性对照研究。目前尚不清楚选择偏倚如何影响目前的研究结果,这进一步凸显了对这些剂量策略进行前瞻性、随机对照试验评估的必要性。
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引用次数: 0
"We need all hands on deck": characterizing addiction medicine training in Canada-a mixed methods study of fellowship program directors.
IF 3.7 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2025-02-19 DOI: 10.1186/s13722-025-00543-4
Clara Lu, Kathryn Chan, Leslie Martin, Nadia Fairbairn

Background: Addiction Medicine training in Canada has evolved substantially in the last few years with the establishment of accreditation standards and several new fellowship programs. The novelty of these formal training programs, created in response to complex and ever-expanding clinical needs in Addiction Medicine, creates unique educational circumstances that must be understood to support future growth. This study characterizes the current state of these postgraduate training programs in Canada through the perspectives of Program Directors (PDs).

Methods: This study is a mixed methods study of 12 PDs. In Phase 1, participants completed a quantitative survey analyzed through descriptive statistics. In Phase 2, participants underwent a qualitative semi-structured interview that was coded with a thematic analysis approach. Mixing occurred both during the interim analysis between phases and during the interpretation stage.

Results: 28 trainees enrolled in a fellowship program in 2021-22 across 10 programs, and 27 trainees enrolled in 2022-23 across 11 programs. In each year, there were significantly fewer available spots than applications (31% and 29%, respectively). PDs identified a funding "bottleneck" as the most difficult and important challenge facing programs, with trainees supported by diverse and unstable funding sources. Qualitative analysis highlighted the need for sustainable funding models, flexibility toward alternative training pathways (shorter durations of training and re-entry from practice), and establishment of a national community of practice to support the co-creation of a robust addictions medical education infrastructure.

Conclusion: For Addiction Medicine training to meet workforce demands, PDs stressed that funding was the challenge of prime importance. Future studies should examine the perspectives of Addiction Medicine fellows, the clinical and research impacts of fellowship graduates, and the cost-effectiveness of fellowship funding models.

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引用次数: 0
Patient characteristics associated with their level of twelve-step attendance prior to entry into treatment for substance use disorders.
IF 3.7 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2025-02-14 DOI: 10.1186/s13722-025-00542-5
Marc Galanter, William L White, Michael L Dennis, Brooke Hunter, Lora Passetti, Dan Lustig

Background: The availability of the fellowships of Alcoholics Anonymous and Narcotics Anonymous in community settings is extensive and patients admitted to treatment programs for substance use disorder may therefore have previously attended meetings of these two Twelve Step (TS) programs. Data on such prior attendance and related clinical findings, however, are not typically available. They can, however, be relevant to how ensuing treatment is planned. We therefore undertook this study to ascertain the feasibility of evaluating how the level of TS attendance prior to treatment entry can be evaluated, and to determine clinically relevant findings that are associated with such attendance.

Methods: Over the course of 2022, 3,125 patients were admitted to a large urban multimodal United States-based treatment center. All patients were administered the structured interview-based Global Appraisal of Individual Needs upon admission. This instrument is employed to evaluate substance use, demographics, and related psychosocial variables. Clinically related variables were analyzed relative to whether given respondents have a history of any TS group attendance prior to admission.

Results: Distinctions were found between the 57.3% of respondents who had previously attended any TS meetings and the 42.6% who had not attended any meetings. Compared to respondents who had never attended TS meetings, those who had ever attended scored higher on emotional problems (p <.001, d = -0.58), and had more likely undergone previous SUD treatment (p <.001, d = 0.80). They were less likely to use substances in unsafe situations (p <.001, d = -0.55) and were less likely to express reluctance to remain abstinent (p <.001, d = -0.50). The 11% of respondents who considered themselves regular TS members reported a lower frequency of recent substance use (p <.001, d = -0.80) and were more likely to have attended intensive outpatient (p <.001, 0.46) and residential (p <.001, 0.44) treatment than patients who did not consider themselves regular attenders.

Conclusions: Examination of TS attendance prior to treatment admission is feasible. Findings can be clinically relevant for differential treatment planning and can also serve as a basis for further research into the role of TS participation in community settings.

背景:匿名酗酒者协会和匿名戒毒者协会在社区环境中广泛开展活动,因此被药物使用障碍治疗项目收治的患者可能曾经参加过这两个十二步骤(TS)项目的会议。不过,有关这些患者以前参加过的聚会和相关临床结果的数据通常并不存在。不过,这些数据可能与如何规划后续治疗有关。因此,我们开展了这项研究,以确定评估进入治疗前参加 TS 项目程度的可行性,并确定与此类参加程度相关的临床相关结果:在 2022 年期间,美国一家大型城市多模式治疗中心共收治了 3125 名患者。所有患者在入院时都接受了基于结构化访谈的 "个人需求全面评估"。该工具用于评估药物使用、人口统计学和相关社会心理变量。根据受访者在入院前是否参加过任何 TS 小组,对临床相关变量进行了分析:结果:57.3%的受访者曾参加过任何 TS 小组会议,42.6%的受访者从未参加过任何会议。与从未参加过 TS 小组会议的受访者相比,参加过 TS 小组会议的受访者在情绪问题上的得分更高(P. 结论):在入院治疗前检查 TS 出席情况是可行的。研究结果可用于临床上的差别治疗规划,也可作为进一步研究 TS 在社区环境中的作用的基础。
{"title":"Patient characteristics associated with their level of twelve-step attendance prior to entry into treatment for substance use disorders.","authors":"Marc Galanter, William L White, Michael L Dennis, Brooke Hunter, Lora Passetti, Dan Lustig","doi":"10.1186/s13722-025-00542-5","DOIUrl":"10.1186/s13722-025-00542-5","url":null,"abstract":"<p><strong>Background: </strong>The availability of the fellowships of Alcoholics Anonymous and Narcotics Anonymous in community settings is extensive and patients admitted to treatment programs for substance use disorder may therefore have previously attended meetings of these two Twelve Step (TS) programs. Data on such prior attendance and related clinical findings, however, are not typically available. They can, however, be relevant to how ensuing treatment is planned. We therefore undertook this study to ascertain the feasibility of evaluating how the level of TS attendance prior to treatment entry can be evaluated, and to determine clinically relevant findings that are associated with such attendance.</p><p><strong>Methods: </strong>Over the course of 2022, 3,125 patients were admitted to a large urban multimodal United States-based treatment center. All patients were administered the structured interview-based Global Appraisal of Individual Needs upon admission. This instrument is employed to evaluate substance use, demographics, and related psychosocial variables. Clinically related variables were analyzed relative to whether given respondents have a history of any TS group attendance prior to admission.</p><p><strong>Results: </strong>Distinctions were found between the 57.3% of respondents who had previously attended any TS meetings and the 42.6% who had not attended any meetings. Compared to respondents who had never attended TS meetings, those who had ever attended scored higher on emotional problems (p <.001, d = -0.58), and had more likely undergone previous SUD treatment (p <.001, d = 0.80). They were less likely to use substances in unsafe situations (p <.001, d = -0.55) and were less likely to express reluctance to remain abstinent (p <.001, d = -0.50). The 11% of respondents who considered themselves regular TS members reported a lower frequency of recent substance use (p <.001, d = -0.80) and were more likely to have attended intensive outpatient (p <.001, 0.46) and residential (p <.001, 0.44) treatment than patients who did not consider themselves regular attenders.</p><p><strong>Conclusions: </strong>Examination of TS attendance prior to treatment admission is feasible. Findings can be clinically relevant for differential treatment planning and can also serve as a basis for further research into the role of TS participation in community settings.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"16"},"PeriodicalIF":3.7,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Individual differences in treatment effects of internet-based cognitive behavioral therapy in primary care: a moderation analysis of a randomized clinical trial.
IF 3.7 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2025-02-14 DOI: 10.1186/s13722-025-00546-1
Karin Hyland, Danilo Romero, Sven Andreasson, Anders Hammarberg, Erik Hedman-Lagerlöf, Magnus Johansson

Background and aims: Little is known regarding predictors of outcome in treatment of alcohol dependence via the internet and in primary care. The aim of the present study was to investigate the role of socio-demographic and clinical factors for outcomes in internet-based cognitive behavioral treatment (ICBT) added to treatment as usual (TAU) for alcohol dependence in primary care.

Design: Secondary analyses based on data from a randomized controlled trial in which participants were randomized to ICBT + TAU or to TAU only.

Setting: The study was conducted in collaboration with 14 primary care centers in Stockholm, Sweden.

Participants: The randomized trial included 264 adult primary care patients with alcohol dependence enrolled between September 2017 and November 2019.

Interventions: Patients in the parent trial were randomized to ICBT that was added to TAU (n = 132) or to TAU only (n = 132). ICBT was a 12-week intervention based on motivational interviewing, relapse prevention and behavioral self-control training.

Measures: Primary outcome was number of standard drinks last 30 days. Sociodemographic and clinical predictors were tested in separate models using linear mixed effects models.

Findings: Severity of dependence, assessed by ICD-10 criteria for alcohol dependence, was the only predictor for changes in alcohol consumption and the only moderator of the effect of treatment. Participants with severe dependence showed a larger reduction in alcohol consumption between baseline and 3-months follow-up compared to participants with moderate dependence. The patients with moderate dependence continued to reduce their alcohol consumption between 3- and 12-months follow-up, while patients with severe dependence did not.

Conclusions: Dependence severity predicted changes in alcohol consumption following treatment of alcohol dependence in primary care, with or without added ICBT. Dependence severity was also found to moderate the effect of treatment. The results suggest that treatment for both moderate and severe alcohol dependence is viable in primary care.

Clinical trial registration: The study was approved by the Regional Ethics Board in Stockholm, no. 2016/1367-31/2. The study protocol was published in Trials 30 December 2019. The trial identifier is ISRCTN69957414, available at http://www.isrctn.com , assigned 7 June 2018, retrospectively registered.

背景和目的:关于通过互联网和初级保健治疗酒精依赖的结果预测因素,人们知之甚少。本研究旨在调查社会人口学和临床因素对初级保健中酒精依赖症的互联网认知行为治疗(ICBT)和常规治疗(TAU)的疗效的影响:设计:根据随机对照试验的数据进行二次分析,在该试验中,参与者被随机分配接受 ICBT + TAU 或仅接受 TAU:研究与瑞典斯德哥尔摩的14个初级保健中心合作进行:随机试验包括2017年9月至2019年11月期间入组的264名成年酒精依赖初级保健患者:母体试验中的患者被随机分配到在TAU基础上添加ICBT(n = 132)或仅TAU(n = 132)。ICBT是一项为期12周的干预措施,以动机访谈、复发预防和行为自控训练为基础:主要结果为过去 30 天内标准饮酒次数。采用线性混合效应模型对社会人口学和临床预测因素进行了单独测试:根据ICD-10酒精依赖标准评估的酒精依赖严重程度是酒精消耗量变化的唯一预测因素,也是治疗效果的唯一调节因素。与中度依赖患者相比,重度依赖患者从基线到3个月随访期间的饮酒量下降幅度更大。中度依赖患者在3个月至12个月的随访期间继续减少饮酒量,而重度依赖患者则没有:结论:无论是否添加 ICBT,依赖严重程度都能预测初级保健中酒精依赖治疗后酒精消耗量的变化。研究还发现,依赖严重程度也会影响治疗效果。研究结果表明,在初级保健中治疗中度和重度酒精依赖都是可行的:该研究获得了斯德哥尔摩地区伦理委员会的批准,批准号为2016/1367-31/2。研究方案于2019年12月30日发表在《试验》上。试验标识符为ISRCTN69957414,可在http://www.isrctn.com ,分配日期为2018年6月7日,回顾性注册。
{"title":"Individual differences in treatment effects of internet-based cognitive behavioral therapy in primary care: a moderation analysis of a randomized clinical trial.","authors":"Karin Hyland, Danilo Romero, Sven Andreasson, Anders Hammarberg, Erik Hedman-Lagerlöf, Magnus Johansson","doi":"10.1186/s13722-025-00546-1","DOIUrl":"10.1186/s13722-025-00546-1","url":null,"abstract":"<p><strong>Background and aims: </strong>Little is known regarding predictors of outcome in treatment of alcohol dependence via the internet and in primary care. The aim of the present study was to investigate the role of socio-demographic and clinical factors for outcomes in internet-based cognitive behavioral treatment (ICBT) added to treatment as usual (TAU) for alcohol dependence in primary care.</p><p><strong>Design: </strong>Secondary analyses based on data from a randomized controlled trial in which participants were randomized to ICBT + TAU or to TAU only.</p><p><strong>Setting: </strong>The study was conducted in collaboration with 14 primary care centers in Stockholm, Sweden.</p><p><strong>Participants: </strong>The randomized trial included 264 adult primary care patients with alcohol dependence enrolled between September 2017 and November 2019.</p><p><strong>Interventions: </strong>Patients in the parent trial were randomized to ICBT that was added to TAU (n = 132) or to TAU only (n = 132). ICBT was a 12-week intervention based on motivational interviewing, relapse prevention and behavioral self-control training.</p><p><strong>Measures: </strong>Primary outcome was number of standard drinks last 30 days. Sociodemographic and clinical predictors were tested in separate models using linear mixed effects models.</p><p><strong>Findings: </strong>Severity of dependence, assessed by ICD-10 criteria for alcohol dependence, was the only predictor for changes in alcohol consumption and the only moderator of the effect of treatment. Participants with severe dependence showed a larger reduction in alcohol consumption between baseline and 3-months follow-up compared to participants with moderate dependence. The patients with moderate dependence continued to reduce their alcohol consumption between 3- and 12-months follow-up, while patients with severe dependence did not.</p><p><strong>Conclusions: </strong>Dependence severity predicted changes in alcohol consumption following treatment of alcohol dependence in primary care, with or without added ICBT. Dependence severity was also found to moderate the effect of treatment. The results suggest that treatment for both moderate and severe alcohol dependence is viable in primary care.</p><p><strong>Clinical trial registration: </strong>The study was approved by the Regional Ethics Board in Stockholm, no. 2016/1367-31/2. The study protocol was published in Trials 30 December 2019. The trial identifier is ISRCTN69957414, available at http://www.isrctn.com , assigned 7 June 2018, retrospectively registered.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"17"},"PeriodicalIF":3.7,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A stakeholder-driven approach to designing a peer recovery coach role for implementation in community-oriented primary care teams in South Africa. 以利益相关者为导向,设计同伴康复指导员角色,在南非以社区为导向的初级保健团队中实施。
IF 3.7 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2025-02-13 DOI: 10.1186/s13722-025-00544-3
Bronwyn Myers, Kristen S Regenauer, Kim Johnson, Imani Brown, Alexandra L Rose, Nonceba Ciya, Sibabalwe Ndamase, Yuche Jacobs, Morgan S Anvari, Abigail Hines, Dwayne Dean, Rithika Baskar, Jessica F Magidson

Introduction: In South Africa, community-oriented primary care teams work to re-engage out-of-care people with HIV (PWH) in treatment, many of whom have substance use (SU) concerns. SU stigma is high among these teams, limiting care engagement efforts. Integrating peer recovery coaches into community-oriented primary care teams could shift SU stigma and improve patients' engagement in care. The peer role does not exist in SA and represents a workforce innovation. To enhance acceptability, feasibility, and appropriateness for the local context, we engaged multiple stakeholder groups to co-design a peer role for community-oriented primary care team integration.

Methods: We used a five-step human-centered design process: (i) semi-structured interviews with healthcare worker (n = 25) and patient (n = 15) stakeholders to identify priorities for the role; (ii) development of an initial role overview; (iii) six ideation workshops with healthcare worker (n = 12) and patient (n = 12) stakeholders to adapt this overview; (iv) refinement of the role prototype via four co-design workshops with healthcare worker (n = 7) and patient (n = 9) stakeholders; and (v) consultation with HIV and SU service leaders to assess the acceptability and feasibility of integrating this prototype into community-oriented primary care teams.

Results: Although all stakeholders viewed the peer role as acceptable, patients and healthcare worker identified different priorities. Patients prioritized the care experience through sharing of lived experience and confidential SU support. Healthcare worker prioritized clarification of the peer role, working conditions, and processes to limit any impact on the community-oriented primary care team. A personal history of SU, minimum 1 year in SU recovery, and strong community knowledge were considered role prerequisites by all stakeholders. Through the iterative process, stakeholders clarified their preferences for peer session structure, location, and content and expanded proposed components of peer training to include therapeutic and professional work practice competencies. Service leaders endorsed the prototype after the addition of peer integration training for community-oriented primary care teams and peer mentoring to address community and team dynamics.

Conclusion: Stakeholder engagement in an iterative design process has been integral to co-designing a peer role that multiple stakeholder groups consider acceptable and that community-oriented primary care teams are willing to implement. This offers a methodological framework for other teams designing SU workforce innovations.

{"title":"A stakeholder-driven approach to designing a peer recovery coach role for implementation in community-oriented primary care teams in South Africa.","authors":"Bronwyn Myers, Kristen S Regenauer, Kim Johnson, Imani Brown, Alexandra L Rose, Nonceba Ciya, Sibabalwe Ndamase, Yuche Jacobs, Morgan S Anvari, Abigail Hines, Dwayne Dean, Rithika Baskar, Jessica F Magidson","doi":"10.1186/s13722-025-00544-3","DOIUrl":"10.1186/s13722-025-00544-3","url":null,"abstract":"<p><strong>Introduction: </strong>In South Africa, community-oriented primary care teams work to re-engage out-of-care people with HIV (PWH) in treatment, many of whom have substance use (SU) concerns. SU stigma is high among these teams, limiting care engagement efforts. Integrating peer recovery coaches into community-oriented primary care teams could shift SU stigma and improve patients' engagement in care. The peer role does not exist in SA and represents a workforce innovation. To enhance acceptability, feasibility, and appropriateness for the local context, we engaged multiple stakeholder groups to co-design a peer role for community-oriented primary care team integration.</p><p><strong>Methods: </strong>We used a five-step human-centered design process: (i) semi-structured interviews with healthcare worker (n = 25) and patient (n = 15) stakeholders to identify priorities for the role; (ii) development of an initial role overview; (iii) six ideation workshops with healthcare worker (n = 12) and patient (n = 12) stakeholders to adapt this overview; (iv) refinement of the role prototype via four co-design workshops with healthcare worker (n = 7) and patient (n = 9) stakeholders; and (v) consultation with HIV and SU service leaders to assess the acceptability and feasibility of integrating this prototype into community-oriented primary care teams.</p><p><strong>Results: </strong>Although all stakeholders viewed the peer role as acceptable, patients and healthcare worker identified different priorities. Patients prioritized the care experience through sharing of lived experience and confidential SU support. Healthcare worker prioritized clarification of the peer role, working conditions, and processes to limit any impact on the community-oriented primary care team. A personal history of SU, minimum 1 year in SU recovery, and strong community knowledge were considered role prerequisites by all stakeholders. Through the iterative process, stakeholders clarified their preferences for peer session structure, location, and content and expanded proposed components of peer training to include therapeutic and professional work practice competencies. Service leaders endorsed the prototype after the addition of peer integration training for community-oriented primary care teams and peer mentoring to address community and team dynamics.</p><p><strong>Conclusion: </strong>Stakeholder engagement in an iterative design process has been integral to co-designing a peer role that multiple stakeholder groups consider acceptable and that community-oriented primary care teams are willing to implement. This offers a methodological framework for other teams designing SU workforce innovations.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"15"},"PeriodicalIF":3.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Early findings on home delivery of buprenorphine and retention in treatment for opioid use disorder.
IF 3.7 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2025-02-12 DOI: 10.1186/s13722-025-00545-2
Marlene C Lira, Lauren E Hendy, Alisha Liakas, Laura Turanchik, Clare Pritchard, Cynthia Jimes, M Justin Coffey

Individuals with opioid use disorder face barriers accessing first-line pharmacotherapy. Home delivery interventions have been shown to improve medication adherence for other chronic diseases, but the relationship between buprenorphine home delivery and opioid use disorder treatment outcomes has not been assessed. We evaluated the association between medication home delivery and retention in treatment in a feasibility study of adults who initiated telemedicine treatment for opioid use disorder and received one or more prescriptions. We described the characteristics of patients and estimated the odds of attending a telemedicine visit three and six months after enrollment as a function of home delivery use using logistic regression. The sample consisted of 337 adults with the following characteristics: mean age 40.8 years (SD 10.1), 51.0% male, and 70.9% commercially insured. In the first 30 days of treatment 6.8% (n = 23) of patients used home delivery. At three months, the percentages of individuals retained among those with and without home delivery were 82.6% and 58.9%, respectively (odds ratio [OR]: 3.31, 95% confidence interval [CI]: 1.10-9.96). At six months, the percentages of individuals retained among those with and without home delivery were 78.6% and 45.5%, respectively (OR: 4.39, 95% CI: 1.19-16.25, n = 203). Although uptake of medication delivery through the pharmacy partner was low within this sample of patients receiving treatment for opioid use disorder, its use was associated with increased retention in care at three and six months. Given the small sample size, low uptake, and limited statistical power, additional research is warranted.

{"title":"Early findings on home delivery of buprenorphine and retention in treatment for opioid use disorder.","authors":"Marlene C Lira, Lauren E Hendy, Alisha Liakas, Laura Turanchik, Clare Pritchard, Cynthia Jimes, M Justin Coffey","doi":"10.1186/s13722-025-00545-2","DOIUrl":"10.1186/s13722-025-00545-2","url":null,"abstract":"<p><p>Individuals with opioid use disorder face barriers accessing first-line pharmacotherapy. Home delivery interventions have been shown to improve medication adherence for other chronic diseases, but the relationship between buprenorphine home delivery and opioid use disorder treatment outcomes has not been assessed. We evaluated the association between medication home delivery and retention in treatment in a feasibility study of adults who initiated telemedicine treatment for opioid use disorder and received one or more prescriptions. We described the characteristics of patients and estimated the odds of attending a telemedicine visit three and six months after enrollment as a function of home delivery use using logistic regression. The sample consisted of 337 adults with the following characteristics: mean age 40.8 years (SD 10.1), 51.0% male, and 70.9% commercially insured. In the first 30 days of treatment 6.8% (n = 23) of patients used home delivery. At three months, the percentages of individuals retained among those with and without home delivery were 82.6% and 58.9%, respectively (odds ratio [OR]: 3.31, 95% confidence interval [CI]: 1.10-9.96). At six months, the percentages of individuals retained among those with and without home delivery were 78.6% and 45.5%, respectively (OR: 4.39, 95% CI: 1.19-16.25, n = 203). Although uptake of medication delivery through the pharmacy partner was low within this sample of patients receiving treatment for opioid use disorder, its use was associated with increased retention in care at three and six months. Given the small sample size, low uptake, and limited statistical power, additional research is warranted.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"14"},"PeriodicalIF":3.7,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11816807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparison of heroin and fentanyl use in US nationally representative surveys.
IF 3.7 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2025-02-11 DOI: 10.1186/s13722-025-00539-0
Jarratt D Pytell, Paul J Christine, Katherine LeMasters, Karilynn M Rockhill, Joshua C Black, Richard C Dart, Ingrid A Binswanger

Background: Given the opioid overdose crisis, surveillance of evolving opioid use patterns is critical to the effective deployment of mitigation strategies. The National Survey on Drug Use and Health (NSDUH) provided the first annual US estimate of illicitly manufactured fentanyl (IMF) use in 2022. However, as a household survey, NSDUH may not capture the full extent of population heroin and IMF use. We compare estimates of past-year heroin and IMF use and correlates of use in NSDUH and the Survey of Non-Medical Use of Prescription Drugs (NMURx) survey which employ an alternate sampling strategy.

Methods: We conducted a cross-sectional analysis of the 2022 NSDUH and NMURx. NSDUH samples respondents using a probability-based approach targeting community-dwelling individuals, while NMURx samples respondents using an opt-in, online survey panel. US adults ages 18 years and older were included. The main outcomes were differences in the weighted percentage of population reporting past-year use of heroin, IMF, and either heroin or IMF between the surveys. Secondary outcomes were the patterns of association of past-year heroin or IMF use with comorbid substance use, treatment utilization, and demographic characteristics between the surveys. Data were analyzed March to June 2024.

Results: NSDUH (n = 47,100 respondents) had a lower proportion of respondents who identified as non-Hispanic White and graduated college, and a higher proportion with past week employment than NMURx (N = 59,041 respondents). Past-year use of heroin, IMF, and either heroin or IMF were lower in the NSDUH than the NMURx. NSDUH estimated 0.52% (95% CI: 0.40%, 0.69%) %) of the US population used either heroin or IMF in the past year compared to 1.05% (95% CI: 0.97%, 1.14 0) in NMURx. In regression models, stimulant and benzodiazepine use were consistently associated with increased heroin or IMF use across both surveys.

Conclusions and relevance: The estimated prevalence of heroin or IMF use was nearly 50% higher in the NMURx compared to NSDUH. These results highlight the importance of using complementary surveillance approaches to obtain accurate estimates of the prevalence and patterns of heroin or IMF use.

{"title":"Comparison of heroin and fentanyl use in US nationally representative surveys.","authors":"Jarratt D Pytell, Paul J Christine, Katherine LeMasters, Karilynn M Rockhill, Joshua C Black, Richard C Dart, Ingrid A Binswanger","doi":"10.1186/s13722-025-00539-0","DOIUrl":"10.1186/s13722-025-00539-0","url":null,"abstract":"<p><strong>Background: </strong>Given the opioid overdose crisis, surveillance of evolving opioid use patterns is critical to the effective deployment of mitigation strategies. The National Survey on Drug Use and Health (NSDUH) provided the first annual US estimate of illicitly manufactured fentanyl (IMF) use in 2022. However, as a household survey, NSDUH may not capture the full extent of population heroin and IMF use. We compare estimates of past-year heroin and IMF use and correlates of use in NSDUH and the Survey of Non-Medical Use of Prescription Drugs (NMURx) survey which employ an alternate sampling strategy.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of the 2022 NSDUH and NMURx. NSDUH samples respondents using a probability-based approach targeting community-dwelling individuals, while NMURx samples respondents using an opt-in, online survey panel. US adults ages 18 years and older were included. The main outcomes were differences in the weighted percentage of population reporting past-year use of heroin, IMF, and either heroin or IMF between the surveys. Secondary outcomes were the patterns of association of past-year heroin or IMF use with comorbid substance use, treatment utilization, and demographic characteristics between the surveys. Data were analyzed March to June 2024.</p><p><strong>Results: </strong>NSDUH (n = 47,100 respondents) had a lower proportion of respondents who identified as non-Hispanic White and graduated college, and a higher proportion with past week employment than NMURx (N = 59,041 respondents). Past-year use of heroin, IMF, and either heroin or IMF were lower in the NSDUH than the NMURx. NSDUH estimated 0.52% (95% CI: 0.40%, 0.69%) %) of the US population used either heroin or IMF in the past year compared to 1.05% (95% CI: 0.97%, 1.14 0) in NMURx. In regression models, stimulant and benzodiazepine use were consistently associated with increased heroin or IMF use across both surveys.</p><p><strong>Conclusions and relevance: </strong>The estimated prevalence of heroin or IMF use was nearly 50% higher in the NMURx compared to NSDUH. These results highlight the importance of using complementary surveillance approaches to obtain accurate estimates of the prevalence and patterns of heroin or IMF use.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"13"},"PeriodicalIF":3.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Addiction Science & Clinical Practice
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