Drug and alcohol dependence reports最新文献_第4页

Cannabis use patterns among people with HIV before and after legalization 艾滋病毒感染者在大麻合法化前后的大麻使用模式

Drug and alcohol dependence reports

Pub Date : 2024-10-28 DOI: 10.1016/j.dadr.2024.100291

AW Hahn , SA Ruderman , RM Nance , JAC Delaney , BM Whitney , S. Eltonsy , L. Haidar , LN Drumright , J. Ma , KH Mayer , C. O’Cleirigh , L. Bamford , E. Cachay , NT Fox , G. Burkholder , K. Cropsey , MA Owens , G. Chander , HM Crane , RJ Fredericksen

Background

Cannabis use is highly prevalent and detrimental among people with HIV (PWH). Legislative changes in several states altered the legality and accessibility of cannabis. We examined pre-post legislative changes in current, daily, and severe use in PWH in clinical care.

Methods

PWH engaged in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort from 3 sites/states were asked about past 3-month cannabis use on a routine clinical assessment of health behavior before and after legalization. A fourth site in a state without legalization served as a comparator. We used linear regression to estimate changes in use prevalence from 1 year before to 1 year after legalization.

Results

Among PWH (n=7885), from 1 year before to 1 year after legalization, cannabis use prevalence increased slightly in Boston, MA (32–38 %), Birmingham, AL (26–27 %), and San Diego, CA (25–29 %); and decreased in Seattle, WA (44–41 %). Contemporaneously, daily cannabis use increased modestly (less than 5 %) at all sites. Severe use (cannabis-specific ASSIST score ≥27) decreased or plateaued at all sites. No site showed significant change in prevalence trends of current, daily, or severe use 1 year before and after legalization in linear regression (p >0.05).

Conclusion

Few changes prevailed in cannabis use patterns around dates of legalization among PWH in care in the U.S. Relaxation of cannabis policy does not appear to result in an immediate increase in use among PWH.

背景吸食大麻在艾滋病病毒感染者（PWH）中非常普遍，而且对他们有害。一些州的立法变化改变了大麻的合法性和可获得性。我们研究了临床护理中的艾滋病病毒感染者当前、每日和严重使用大麻情况在立法前后的变化。方法在大麻合法化前后，我们在对健康行为的常规临床评估中询问了三个州的艾滋病研究中心综合临床系统网络（CNICS）队列中的艾滋病病毒感染者过去三个月的大麻使用情况。位于未实行大麻合法化的州的第四个研究机构作为比较对象。我们使用线性回归法估算了从合法化前一年到合法化后一年期间使用率的变化。结果在威尔士人（人数=7885）中，从合法化前一年到合法化后一年期间，马萨诸塞州波士顿（32-38%）、阿拉巴马州伯明翰（26-27%）和加利福尼亚州圣地亚哥（25-29%）的大麻使用率略有上升；而华盛顿州西雅图（44-41%）的大麻使用率则有所下降。与此同时，所有地点的大麻日使用率都略有上升（低于 5%）。所有地点的严重使用率（大麻特异性 ASSIST 评分≥27 分）均有所下降或趋于平稳。在合法化前后 1 年的线性回归中，没有任何地点的当前使用、每日使用或严重使用的流行趋势出现明显变化（p >0.05）。

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引用次数: 0

Characteristics associated with adult non-fatal opioid and stimulant overdose and substance use disorder emergency department visits in Michigan 与密歇根州成人非致命性阿片类药物和兴奋剂过量以及药物使用障碍急诊就诊相关的特征

Drug and alcohol dependence reports

Pub Date : 2024-10-11 DOI: 10.1016/j.dadr.2024.100290

Olivia Martin , Harriet Bird , Sarah Nechuta

Background

Understanding risk factors for emergency department (ED) visits for overdose and substance use disorder (SUD) can inform prevention efforts. Few studies have considered non-fatal opioid overdoses, stimulant overdoses and SUD, and limited data exists by overdose intentionality and by sex.

Methods

We conducted a serial cross-sectional study with Healthcare Cost and Utilization Project Michigan (MI) 2019–2020 ED discharge data (n=5,716,716). Primary outcomes included non-fatal opioid overdoses, non-fatal stimulant overdoses, and SUD primary diagnoses in a single ED visit. We examined demographic and socioeconomic factors associated with study outcomes using binary and multinomial logistic regression (for overdose intentionality) models, which estimated adjusted odds ratios (AOR) and 95 % confidence intervals (CI).

Results

Among all MI discharges, 13,908, 1,379, and 23,462 were nonfatal opioid, stimulant, or SUD overdose visits, respectively. Lower median household income (vs. higher income), male sex (vs. female), metropolitan county of residence (vs. small urban/rural), and Medicaid (vs. private insurance) were associated with increased odds of all outcomes. For example, ORs(95 % CIs) for Medicaid were 4.41(4.18,4.65), 2.25(1.95,2.60), and 2.80(2.70,2.91) for opioid overdoses, stimulant overdoses, and SUD, respectively. All outcomes had the highest increased odds in ages 28–32 years compared to 18–22 years. Stratification by sex and non-fatal overdose intentionality modified some associations, with the strongest associations observed for non-fatal opioid overdoses.

Conclusions

Male sex, Medicaid, and race/ethnicity were consistently associated with all outcomes similarly, but other characteristics varied in patterns, strengths of association, and statistical significance by outcome groups, sex, and non-fatal opioid or stimulant overdose intentionality.

背景了解因用药过量和药物使用障碍（SUD）而到急诊科（ED）就诊的风险因素可以为预防工作提供参考。很少有研究考虑了非致命性阿片类药物过量、兴奋剂过量和药物使用障碍，按过量意图和性别分列的数据也很有限。方法我们利用密歇根州（MI）2019-2020 年医疗成本和利用项目急诊科出院数据（n=5,716,716）开展了一项连续横断面研究。主要结果包括非致命性阿片类药物过量、非致命性兴奋剂过量和单次 ED 就诊中的 SUD 主要诊断。我们使用二元和多叉逻辑回归（针对用药过量的意向性）模型研究了与研究结果相关的人口和社会经济因素，并估算了调整后的几率比（AOR）和 95% 的置信区间（CI）。结果在所有 MI 出院患者中，分别有 13908 人、1379 人和 23462 人因非致命性阿片类药物、兴奋剂或 SUD 用药过量就诊。家庭收入中位数较低（与收入较高）、男性（与女性）、居住地为大都市（与小城市/农村）以及医疗补助（与私人保险）与所有结果的发生几率增加有关。例如，在阿片类药物过量、兴奋剂过量和 SUD 方面，医疗补助的 ORs（95 % CIs）分别为 4.41（4.18,4.65）、2.25（1.95,2.60）和 2.80（2.70,2.91）。与 18-22 岁的人群相比，28-32 岁的人群出现所有结果的几率增加最高。结论男性性别、医疗补助和种族/民族与所有结果的相关性相似，但其他特征在模式、相关性强度和统计显著性方面因结果组别、性别和非致命性阿片类药物或兴奋剂过量的意向性而异。

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引用次数: 0

Engagement in substance use disorder treatment after an emergency department visit among persons at high risk of opioid overdose: A prediction analysis 阿片类药物过量高危人群在急诊就诊后接受药物使用障碍治疗的情况：预测分析

Drug and alcohol dependence reports

Pub Date : 2024-10-10 DOI: 10.1016/j.dadr.2024.100287

Fiona Bhondoekhan , Yu Li , Benjamin D. Hallowell , Linda Mahoney , Mackenzie M. Daly , Jamieson Goulet , Francesca L. Beaudoin , Laura C. Chambers , Brandon D.L. Marshall

Background

Certified peer recovery specialists (CPRS) and licensed clinical social workers (LCSWs) can facilitate substance use disorder (SUD) treatment engagement for emergency department (ED) patients at risk for overdose. Predictors of treatment engagement after such behavioral services are unknown.

Methods

This secondary analysis included Rhode Island ED patients at high risk for opioid overdose participating in a randomized controlled trial comparing the effectiveness of CPRS and LCSWs services (2018–2021). SUD treatment engagement within 90 days post-discharge was identified using statewide administrative data. Potential predictors were obtained from baseline questionnaires. Classification and regression trees (CART) were used to identify predictors of treatment engagement.

Results

In the ED, 323 and 325 participants received CPRS and LCSWs services, respectively, among whom 141 (43.7 %) and 137 (42.2 %) engaged in SUD treatment within 90 days post-discharge. For the CPRS group, predictors of treatment engagement included unhealthy alcohol use, prescription opioid or benzodiazepine use in past 6 months, and lifetime history of: unstable housing, barriers to treatment, bipolar disorder diagnosis, addiction treatment, and recovery services. In the LCSW group, predictors included health insurance, current pain, opioid overdose in past year, and lifetime history of anxiety disorder diagnosis and mental illness treatment. However, CART had low predictive accuracy (CPRS: 60.9 %, LCSW: 54.8 %).

Conclusions

Among ED patients at high risk of opioid overdose receiving behavioral services, 90-day SUD treatment engagement was high. Sociobehavioral and clinical patient characteristics did not accurately predict treatment engagement. Behavioral services should be offered to all ED patients at high risk of opioid overdose.

背景经认证的同伴康复专家（CPRS）和持证临床社工（LCSW）可以促进有用药过量风险的急诊科（ED）患者参与药物使用障碍（SUD）治疗。方法这项二次分析包括罗德岛州急诊科阿片类药物过量高危患者，他们参与了一项随机对照试验，比较 CPRS 和 LCSWs 服务的有效性（2018-2021 年）。出院后 90 天内的 SUD 治疗参与情况通过全州范围内的行政数据进行确认。潜在的预测因素来自基线问卷。结果在 ED 中，分别有 323 名和 325 名参与者接受了 CPRS 和 LCSWs 服务，其中分别有 141 人（43.7%）和 137 人（42.2%）在出院后 90 天内接受了 SUD 治疗。对于 CPRS 组，参与治疗的预测因素包括不健康饮酒、过去 6 个月内使用处方类阿片或苯二氮卓类药物，以及终生经历：不稳定住房、治疗障碍、双相情感障碍诊断、成瘾治疗和康复服务。在 LCSW 组中，预测因素包括医疗保险、当前疼痛、过去一年阿片类药物过量，以及焦虑症诊断和精神疾病治疗的终生病史。结论在接受行为服务的阿片类药物过量高危急诊患者中，90 天 SUD 治疗参与率较高。患者的社会行为特征和临床特征并不能准确预测治疗参与度。应为所有阿片类药物过量高危急诊患者提供行为服务。

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引用次数: 0

Prevalence of cannabidiol use and correlates in U.S. adults 美国成年人使用大麻二酚的普遍程度及其相关因素

Drug and alcohol dependence reports

Pub Date : 2024-10-09 DOI: 10.1016/j.dadr.2024.100289

Namkee G. Choi , C. Nathan Marti , Bryan Y. Choi

Background

Cannabidiol (CBD) use has been increasing for its putative therapeutic potential for various health conditions. Research using a nationally representative sample is needed to examine characteristics of CBD users.

Methods

Data came from the adult sample (N=47,100) of the 2022 U.S. National Survey on Drug Use and Health. We fitted generalized linear models to examine the sociodemographic, health, other substance use, and cannabis risk perception as correlates of CBD-only use and CBD-cannabis co-use, compared to cannabis-only use.

Results

In 2022, 20.6 % and 23.0 % of U.S. adults reported using CBD and cannabis, respectively, in the preceding 12 months, and 63 % of CBD users also used cannabis. CBD use was significantly higher among women (CBD-only vs. cannabis-only use: IRR=1.43, 95 % CI=1.31–1.57), but significantly lower among Black and Hispanic individuals compared to non-Hispanic White individuals (CBD-only vs. cannabis-only use: IRR=0.71, 95 % CI=0.60–0.85 for Black individuals; IRR=0.79, 95 % CI=0.65–0.96 for Hispanic individuals). Older ages, higher SES, chronic medical conditions, mental illness, and high cannabis risk perception were also associated with higher likelihood of CBD-only use versus cannabis-only use. CBD-cannabis co-users were at most risk in terms of chronic illness, mental illness, cannabis use disorder, and other substance use problems.

Conclusions

The high prevalence of self-reported CBD use among those with physical and mental health problems warrants public health warnings about potential side effects and drug interactions. The high CBD-cannabis co-use rate also calls for more research on potential benefits and negative effects of the co-use.

背景由于大麻二酚（CBD）对各种健康状况具有治疗潜力，其使用量不断增加。方法数据来自 2022 年美国全国药物使用和健康调查的成人样本（N=47,100）。我们建立了广义线性模型来研究社会人口学、健康、其他物质使用和大麻风险认知与只使用 CBD 和同时使用 CBD 和大麻的相关性。结果在 2022 年，20.6% 和 23.0% 的美国成年人报告在过去 12 个月中分别使用过 CBD 和大麻，63% 的 CBD 使用者也使用过大麻。女性使用 CBD 的比例明显更高（只使用 CBD 与只使用大麻的对比：IRR=1.43，95 % CI=1.31-1.57），但黑人和西班牙裔个人使用 CBD 的比例明显低于非西班牙裔白人（只使用 CBD 与只使用大麻的对比：IRR=0.71，95 % CI=1.31）：黑人的 IRR=0.71，95 % CI=0.60-0.85；西班牙裔的 IRR=0.79，95 % CI=0.65-0.96）。年龄越大、社会经济地位越高、慢性病、精神疾病和大麻风险意识越强，也越有可能只使用 CBD 而不是只使用大麻。在慢性疾病、精神疾病、大麻使用障碍和其他药物使用问题方面，CBD-大麻共同使用者的风险最高。同时使用 CBD 和大麻的比例较高，这也要求对同时使用 CBD 和大麻的潜在益处和负面影响进行更多研究。

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引用次数: 0

Associations of HIV pre-exposure prophylaxis (PrEP) indication, HIV risk perception and unwillingness to use PrEP among people who inject drugs in Baltimore, MD 马里兰州巴尔的摩市注射毒品者中艾滋病毒暴露前预防疗法（PrEP）适应症、艾滋病毒风险认知和不愿使用 PrEP 的相关性

Drug and alcohol dependence reports

Pub Date : 2024-10-08 DOI: 10.1016/j.dadr.2024.100288

Tarfa Verinumbe , Gregory M. Lucas , Katie Zook , Brian Weir , Miles Landry , Kathleen R. Page , Susan G. Sherman , Oluwaseun Falade-Nwulia

Background

Perceived HIV risk may impact willingness to initiate PrEP among people who inject drugs (PWID).

Methods

We analyzed baseline data from PrEP eligible PWID in Baltimore, MD. Risk perception was assessed by PWID relative to the average risk of their age group categorized as: higher-than, lower-than, or about average. Participants were informed of PrEP for HIV prevention and asked about their willingness to use daily PrEP. Associations of PrEP indication (categorized as injection risk only vs any sexual risk), perceived HIV risk and non-willingness to use PrEP was assessed using generalized linear models.

Results

Among 489 participants, 61 % were male, 66 % were Black and mean age was 46 years. One-third (35 %) of the participants were aware of PrEP and <1 % had used PrEP in the prior 30 days. Overall, 30 % of PWID reported lower-than-average perceived HIV risk and 18 % reported non-willingness to use PrEP. Participants with injection risk only were more likely (aOR: 2.75; 95 %CI: 1.60 – 4.73) to report having lower-than-average perceived HIV risk compared to those with any sexual risk. Participants with lower-than-average perceived risk were more likely to report non-willingness to use PrEP compared to those with higher perceived risk (adjusted PR: 1.91; 95 %CI: 1.18 – 3.10).

Conclusion

A considerable proportion of PWID eligible for PrEP reported having low risk of HIV acquisition despite being eligible for PrEP. Consistent and tailored PrEP messaging that addresses drug use HIV risk perception may be critical to increasing PrEP uptake among PWID.

方法我们分析了马里兰州巴尔的摩市符合 PrEP 条件的注射吸毒者的基线数据。我们对巴尔的摩市符合 PrEP 条件的注射吸毒者的基线数据进行了分析。注射吸毒者的风险认知是相对于其年龄组的平均风险而言的，分为：高于平均风险、低于平均风险或接近平均风险。研究人员向参与者介绍了 PrEP 预防艾滋病的知识，并询问他们是否愿意每天使用 PrEP。使用广义线性模型评估了 PrEP 适应症（分为仅注射风险和任何性风险）、感知到的 HIV 风险和不愿意使用 PrEP 的相关性。结果在 489 名参与者中，61% 为男性，66% 为黑人，平均年龄为 46 岁。三分之一（35%）的参与者了解 PrEP，1% 的参与者在过去 30 天内使用过 PrEP。总体而言，30% 的注射吸毒者表示其感知到的艾滋病毒风险低于平均水平，18% 表示不愿意使用 PrEP。与有任何性行为风险的参与者相比，仅有注射风险的参与者更有可能（aOR：2.75；95 %CI：1.60 - 4.73）报告其感知到的 HIV 风险低于平均水平。与感知风险较高的参与者相比，感知风险低于平均水平的参与者更有可能表示不愿意使用 PrEP（调整后 PR：1.91；95 %CI：1.18 - 3.10）。针对吸毒者的艾滋病病毒感染风险认知开展一致的、有针对性的 PrEP 信息宣传，对于提高吸毒者中的 PrEP 使用率至关重要。

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引用次数: 0

Examining naloxone access and interest in secondary naloxone distribution on an American Indian Reservation in the Northern Midwest of the United States 在美国中西部北部的一个美国印第安人保留地考察纳洛酮的使用情况和对二次分发纳洛酮的兴趣

Drug and alcohol dependence reports

Pub Date : 2024-10-05 DOI: 10.1016/j.dadr.2024.100285

Kristin E. Schneider , Sean T. Allen , Allison O’Rourke , Molly C. Reid , Maisie Conrad , Pam Hughes , Laura Palombi , Toni Wakemup, Andrea Medley , Melissa Walls

Background

Indigenous communities in the United States experience disproportionate rates of overdose morbidity and mortality due to a range of historical traumas and ongoing oppression. Limited health and harm reduction service access on some Tribal lands exacerbate these challenges. To date, little is known about naloxone access on tribal reservation lands.

Methods

We used cross-sectional survey data from community members on the reservation lands of a northern Midwest Tribe in the United States. We explored the prevalence and correlates of recent (past 6-month) naloxone receipt and interest in secondary naloxone distribution among all participants and people who used drugs (PWUD) recently. Correlates included sociodemographics, cultural identity and spirituality, witnessing overdoses, stigma, and drug use characteristics.

Results

Among 227 Indigenous participants, the average age was 45, 62 % were women, 53 % were single, 29 % were not working, 29 % had experienced recent hunger, and 8 % considered themselves homeless. 91 % said that Indigenous spiritual values were important to them. Sixteen percent had witnessed a recent non-fatal overdose, and 6 % had witnessed a fatal one. Twenty-four percent of the overall sample had recently received naloxone, and 40 % of PWUD had received it. Witnessing both fatal (p<0.001) and nonfatal overdoses (p=0.001) were associated with receiving naloxone. Further, 63 % of participants were willing to distribute naloxone.

Conclusions

Innovative strategies to expand naloxone access that are culturally relevant and responsive are needed in Indigenous communities. Cultural connectedness and shared identity are key strengths of Indigenous communities that can potentially be leveraged to implement secondary naloxone distribution programs.

背景由于一系列历史创伤和持续的压迫，美国土著社区的用药过量发病率和死亡率过高。一些部落土地上有限的健康和减低伤害服务加剧了这些挑战。迄今为止，人们对部落保留地上使用纳洛酮的情况知之甚少。方法我们使用了来自美国中西部北部一个部落保留地上社区成员的横断面调查数据。我们探讨了最近（过去 6 个月）在所有参与者和最近使用过毒品的人（PWUD）中接受纳洛酮以及对二次分发纳洛酮感兴趣的普遍性和相关性。相关因素包括社会人口统计学、文化认同和精神信仰、目睹吸毒过量、耻辱感和吸毒特征。结果在 227 名土著参与者中，平均年龄为 45 岁，62% 为女性，53% 为单身，29% 没有工作，29% 最近经历过饥饿，8% 认为自己无家可归。91%的人表示土著精神价值观对他们很重要。16%的人曾目睹过最近一次非致命的吸毒过量，6%的人曾目睹过一次致命的吸毒过量。总体样本中有 24% 的人最近接受过纳洛酮治疗，40% 的残疾人接受过纳洛酮治疗。目睹致命性用药过量（p<0.001）和非致命性用药过量（p=0.001）与接受纳洛酮有关。此外，63% 的参与者愿意分发纳洛酮。结论土著社区需要具有文化相关性和响应性的创新策略来扩大纳洛酮的使用范围。文化联系和共同身份是原住民社区的主要优势，可以利用这些优势实施二次纳洛酮分发计划。

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引用次数: 0

Predictors of future overdose among people who inject drugs in Baltimore, Maryland 马里兰州巴尔的摩市注射吸毒者未来用药过量的预测因素

Drug and alcohol dependence reports

Pub Date : 2024-09-30 DOI: 10.1016/j.dadr.2024.100286

Michael P. Ramirez , Gregory M. Lucas , Kathleen R. Page , Katie Zook , Miles Landry , Amanda Rosecrans , Robert Harris , Suzanne M. Grieb , Oluwaseun Falade-Nwulia , William Clarke , Susan G. Sherman , Brian W. Weir

Background

Longitudinal studies of future overdose risk among people who inject drugs (PWID) are needed to inform planning of targeted overdose preventions in the United States.

Methods

The Integrating Services to Improve Treatment and Engagement (INSITE) study followed 720 PWID between June 2018 and August 2019 to evaluate the delivery of mobilized healthcare services in Baltimore, Maryland. The present analyses used logistic regression to identify baseline characteristics predictive of non-fatal or fatal overdose during the 6-month follow-up among 507 participants with overdose information. Non-fatal overdoses were self-reported and fatal overdoses were identified through the National Death Index.

Results

At baseline, 121 (23 %) reported an overdose in the prior 6 months. Between baseline and follow-up, 66 (13 %) participants reported a non-fatal overdose and 6 (1 %) experienced a fatal overdose. Overdose during follow-up was positively associated with overdose in the 6 months prior to baseline (6.70 aOR; 95 % CI: 3.51, 12.78) and more than 6 months prior to baseline (2.49 aOR; 95 % CI: 1.52, 4.08) versus no prior overdose. Overdose during follow-up was also positively associated with buprenorphine treatment (2.37 aOR; CI: 1.08, 5.21) and negatively associated with non-prescribed methadone at baseline (0.59 aOR; 0.38, 0.93).

Conclusions

Identifying and intervening with PWID who experienced a recent overdose could reduce short-term elevated risk of future overdose. However, as other PWID reported never experiencing an overdose at baseline nonetheless experienced an overdose during follow-up, targeted approaches should be complemented with population-level interventions. Overdose risk implications of buprenorphine treatment and non-prescribed methadone are also discussed.

背景需要对注射吸毒者（PWID）未来的用药过量风险进行纵向研究，以便为美国有针对性的用药过量预防规划提供信息。方法2018年6月至2019年8月期间，整合服务以改善治疗和参与（INSITE）研究对720名PWID进行了随访，以评估马里兰州巴尔的摩市动员医疗保健服务的提供情况。本分析采用逻辑回归法来确定 507 名有用药过量信息的参与者在 6 个月随访期间可预测非致命或致命用药过量的基线特征。非致命性用药过量是自我报告的，致命性用药过量是通过国家死亡指数确定的。在基线和随访期间，66 名参与者（13%）报告了非致命性用药过量，6 名参与者（1%）报告了致命性用药过量。随访期间用药过量与基线前 6 个月内用药过量（6.70 aOR；95 % CI：3.51, 12.78）和基线前 6 个月以上用药过量（2.49 aOR；95 % CI：1.52, 4.08）呈正相关。随访期间用药过量还与丁丙诺啡治疗呈正相关（2.37 aOR; CI: 1.08, 5.21），与基线时未使用美沙酮呈负相关（0.59 aOR; 0.38, 0.93）。然而，由于其他吸毒成瘾者在基线报告中称从未出现过吸毒过量，但在随访期间却出现过吸毒过量，因此在采取有针对性的方法的同时，还应辅以人群干预措施。此外，还讨论了丁丙诺啡治疗和非处方美沙酮的用药过量风险影响。

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引用次数: 0

Covid-19 vaccination status and beliefs of individuals with co-occurring serious mental illness and alcohol use disorder 并发严重精神疾病和酒精使用障碍者的 Covid-19 疫苗接种状况和信念

Drug and alcohol dependence reports

Pub Date : 2024-09-24 DOI: 10.1016/j.dadr.2024.100284

Mohammad Keshtkar , Diana Tyutyunnyk , Paige King , Katharine Palmer , Mariah Brigman , Julianne D. Jett , Rachael Beck , Sara C. Parent , Richard Ries , Sterling M. McPherson , Naomi S. Chaytor , John M. Roll , Douglas L. Weeks , Michael G. McDonell

Objective

The study objective was to determine factors associated with obtaining COVID-19 vaccination in people with co-occurring alcohol use disorder (AUD) and serious mental illness (SMI).

Methods

Survey responses were obtained from 135 adults with SMI seeking community-based AUD treatment about their primary series vaccination status, COVID-19 preventative practices, vaccination motivators, reasons for vaccine hesitancy, and strategies to increase vaccination uptake. Vaccinated and unvaccinated groups were compared. Responses to survey items with nominal or Likert scales were analyzed with chi-square tests of association. Logistic regression was employed to determine predictors of vaccine status.

Results

Seventy-nine percent (n=107) of participants reported they were vaccinated. A higher proportion of vaccinated participants believed COVID-19 was a serious disease. While both groups adopted preventative hygiene practices at similar rates (e.g., washing hands), vaccinated participants engaged in more interpersonal practices directly involving others (e.g., wearing masks and avoiding crowds). The strongest vaccine motivator was protecting personal health, while the primary reason for hesitancy was potential side effects. Most unvaccinated participants endorsed increased safety information availability (61.1 %) and living with a high-risk-for-severe-infection individual (55.6 %) as reasons to overcome hesitancy.

Conclusions

Vaccination rates, motivators, and hesitancy reasons were similar to the general United States population. Strategies to increase vaccination in this high-risk population should include education on vaccine safety and side effects and the impacts of COVID-19 and other respiratory illnesses on others.

方法：对 135 名寻求社区 AUD 治疗的成人 SMI 患者进行调查，了解他们的初级系列疫苗接种情况、COVID-19 预防措施、疫苗接种动机、疫苗接种犹豫不决的原因以及提高疫苗接种率的策略。对已接种疫苗组和未接种疫苗组进行了比较。对采用名义或李克特量表的调查项目的回答进行了相关性的卡方检验分析。结果79%（107 人）的参与者表示他们已接种疫苗。较高比例的接种者认为 COVID-19 是一种严重疾病。虽然两组参与者采取预防性卫生措施（如洗手）的比例相近，但接种疫苗的参与者采取了更多直接涉及他人的人际交往措施（如戴口罩和避开人群）。接种疫苗的最大动机是保护个人健康，而犹豫不决的主要原因是潜在的副作用。大多数未接种者认为，增加安全信息的可获得性（61.1%）和与严重感染高危人群生活在一起（55.6%）是克服犹豫的原因。提高这一高风险人群疫苗接种率的策略应包括疫苗安全性和副作用以及 COVID-19 和其他呼吸道疾病对他人的影响等方面的教育。

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引用次数: 0

Prenatal cannabis exposure in the clinic and laboratory: What do we know and where do we need to go? 临床和实验室中的产前大麻暴露：我们知道些什么，还需要做些什么？

Drug and alcohol dependence reports

Pub Date : 2024-09-18 DOI: 10.1016/j.dadr.2024.100282

Lani Cupo , Karen A. Dominguez-Cancino , José Ignacio Nazif-Munoz , M. Mallar Chakravarty

Coincident with the legalisation of cannabis in many nations, rates of cannabis use during pregnancy have increased. Like prior investigations on smoking and alcohol, understanding how prenatal cannabis exposure (PCE) impacts offspring outcomes across the lifespan will be critical for informing choices for pregnant people, clinicians, and policy makers alike. A thorough characterization of the life-long impacts is especially urgent for supporting all of these stakeholders in the decision-making process. While studies in humans bring forth the most direct information, it can be difficult to parse the impact of PCE from confounding variables. Laboratory studies in animal models can provide experimental designs that allow for causal inferences to be drawn, however there can be challenges in designing experiments with external validity in mirroring real-world exposure, as well as challenges translating results from the laboratory back to the clinic. In this literature review, we first highlight what is known about patterns of cannabis use during pregnancy. We then seek to lay out updates to the current understanding of the impact of PCE on offspring development informed by both human and nonhuman animal experiments. Finally we highlight opportunities for information exchange among the laboratory, clinic, and policy, identifying gaps to be filled by future research.

随着大麻在许多国家的合法化，孕期使用大麻的比例也在增加。与之前对吸烟和饮酒的调查一样，了解产前大麻暴露（PCE）如何影响后代一生的结果，对于为孕妇、临床医生和政策制定者的选择提供信息至关重要。要在决策过程中为所有这些利益相关者提供支持，就尤其迫切需要对其终生影响进行全面描述。虽然人体研究能提供最直接的信息，但要从混杂变量中分辨出多氯化联苯醚的影响却很困难。动物模型的实验室研究可以提供实验设计，从而得出因果推论，但在设计具有外部有效性的实验以反映真实世界的暴露情况方面可能存在挑战，而且将实验室结果转化为临床结果也存在挑战。在这篇文献综述中，我们首先强调了目前已知的孕期大麻使用模式。然后，我们试图通过人类和非人类动物实验，介绍目前对 PCE 对后代发育影响的最新认识。最后，我们强调了实验室、临床和政策之间的信息交流机会，确定了未来研究需要填补的空白。

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引用次数: 0

How substance use preferences and practices relate to fentanyl exposure among people who use drugs in Rhode Island, USA 美国罗德岛州吸毒者的药物使用偏好和习惯与芬太尼暴露的关系

Drug and alcohol dependence reports

Pub Date : 2024-09-01 DOI: 10.1016/j.dadr.2024.100280

Leah C. Shaw , Katie B. Biello , Jane A. Buxton , Jacqueline E. Goldman , Scott E. Hadland , Susan G. Sherman , Yu Li , Alexandria Macmadu , Brandon D.L. Marshall

Background

Over 107,000 people died in the United States (U.S.) from drug overdose in 2022, with over one million overdose deaths since 1999. The U.S. drug market is characterized by a highly toxic, unregulated, and rapidly changing supply. Understanding the extent of exposure to fentanyl among people who use drugs (PWUD) will guide public health interventions aimed to decrease overdose.

Methods

We utilized baseline data from the Rhode Island Prescription and Illicit Drug Study, a randomized controlled trial of harm reduction-oriented interventions for PWUD in Rhode Island from 2020 to 2023. We evaluated sociodemographic and drug use-related covariates and examined fentanyl presence in urine drug testing (UDT). We built a classification and regression tree (CART) model to identify subpopulations with the highest likelihood of fentanyl presence in UDT.

Results

Among 446 participants, those with fentanyl present in UDT tended to be younger, non-Hispanic white, and had recently injected drugs (p<0.05 for all). The CART analysis demonstrated a large variation in sample sub-groups’ likelihood of fentanyl presence in UDT, from an estimated probability of 0.09 to 0.90. Expected recent fentanyl exposure was the most important predictor of fentanyl in UDT.

Conclusions

Univariate analyses and CART modeling showed substantial variation in the presence of fentanyl in UDT among PWUD. Harm reduction services for people actively injecting drugs and drug checking programs based on capacity-building, empowerment, and targeted towards those not yet engaged in services are urgently needed to support PWUD in navigating the current volatile drug supply.

背景2022 年，美国有超过 107,000 人死于吸毒过量，自 1999 年以来，因吸毒过量死亡的人数已超过 100 万。美国毒品市场的特点是毒性大、不受监管、供应变化快。了解吸毒者（PWUD）接触芬太尼的程度将为旨在减少用药过量的公共卫生干预措施提供指导。方法我们利用了罗德岛处方药和非法药物研究的基线数据，该研究是 2020 年至 2023 年针对罗德岛州吸毒者（PWUD）的以减少危害为导向的干预措施的随机对照试验。我们评估了社会人口学和药物使用相关协变量，并检查了尿液药物检测（UDT）中的芬太尼含量。我们建立了一个分类和回归树 (CART) 模型，以确定尿液毒品检测中出现芬太尼可能性最高的亚人群。结果在 446 名参与者中，尿液毒品检测中出现芬太尼的人往往更年轻、为非西班牙裔白人，并且最近注射过毒品（所有数据的 p<0.05）。CART 分析表明，样本亚群在 UDT 中出现芬太尼的可能性差异很大，估计概率从 0.09 到 0.90 不等。结论多元分析和 CART 建模显示，在注射吸毒者中，未干注射器中含有芬太尼的情况存在很大差异。目前迫切需要为积极注射毒品的人群提供减低伤害服务，以及基于能力建设和赋权的毒品检查计划，并以尚未参与服务的人群为目标，以帮助注射毒品的人群应对当前不稳定的毒品供应。

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引用次数: 0