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

Substance use, stigma, and coping in treatment: A qualitative study of participant perspectives 药物使用、病耻感和治疗中的应对：参与者视角的定性研究

IF 2.9

Drug and alcohol dependence reports

Pub Date : 2025-09-17 DOI: 10.1016/j.dadr.2025.100380

Kaylia Carroll , Charles Ashley Warnock , Ashlin Ondrusek , Frances J. Griffith , Adam Viera , Noah Hopkins , Carmen Muniz-Almaguer , Cathy Jian , Carson F. Ferrara , Jessica Muilenburg , Trace Kershaw

Background

This study explores experiences of stigma in substance use treatment, coping strategies, and the contexts in which individuals feel stigmatized due to current or past substance use. Semi-structured interviews were conducted with 55 individuals enrolled in substance use treatment programs within two distinct geographical areas of the U.S., Northeast and Southeast. Data were collected from February to October 2023. Themes were organized by the Health Stigma and Discrimination Framework. Five themes were identified: 1.) Interpersonal drivers of stigma participants described feeling stigmatized by treatment staff, healthcare practitioners, and family; 2.) Substance- and method-specific stigmatization: participants reported feeling greater stigma from the use of criminalized substances and substances used intravenously, compared to non-criminalized substances and non-injection use methods; 3.) Coping approaches: participants identified active (e.g., prayer, meditation, exercise) and avoidant (e.g., laughing it off) strategies to manage stigmatizing experiences; 4.) Rejection of stereotypes: participants described empathetic views of people who use substances, even as they acknowledged that treatment environments often reinforce stigmatizing practices; 5.) Recovery-oriented care: participants felt less stigmatized and more comfortable with treatment providers with lived experience. Data for this study did not indicate differences by study site. Recommendations include prioritizing providers with lived experience, training healthcare workers in culturally responsive care, and integrating coping strategies and harm reduction into treatment to reduce stigma.

本研究探讨了药物使用治疗中的耻辱经历、应对策略以及个体因当前或过去的药物使用而感到耻辱的背景。在美国东北部和东南部两个不同的地理区域，对55名参加药物使用治疗项目的个人进行了半结构化访谈。数据收集时间为2023年2月至10月。主题是由健康耻辱和歧视框架组织的。确定了五个主题：1)耻辱感的人际驱动因素参与者描述了被治疗人员、卫生保健从业人员和家庭所耻辱感；2)。特定物质和方法的污名化：参与者报告说，与非犯罪物质和非注射使用方法相比，使用犯罪物质和静脉注射使用物质感到更大的污名化；3)。应对方法：参与者确定了积极（如祈祷、冥想、锻炼）和回避（如一笑置之）的策略来管理污名化的经历；4)。拒绝刻板印象：参与者描述了对吸毒者的同情看法，即使他们承认治疗环境往往会加强污名化做法；5)。以康复为导向的护理：参与者对有生活经验的治疗提供者感到更少的耻辱和更舒适。本研究的数据没有显示不同研究地点的差异。建议包括优先考虑有实际经验的提供者，对卫生保健工作者进行文化响应性护理培训，并将应对策略和减少伤害纳入治疗以减少耻辱感。

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引用次数: 0

Prevalence and factors associated with tobacco and cannabis co-use in France: Results from a national representative survey 法国烟草和大麻共同使用的流行率和相关因素：一项全国代表性调查的结果

IF 2.9

Drug and alcohol dependence reports

Pub Date : 2025-09-16 DOI: 10.1016/j.dadr.2025.100381

Tangui Barré , Vincent Di Beo , Camelia Protopopescu , Emmanuel Lahaie , Raphaël Andler , Viêt Nguyen-Thanh , Anne Pasquereau , Patrizia Carrieri , François Beck

Background and aims

Tobacco use is a leading global risk factor for premature mortality. Cannabis-related harms are well documented, and its co-use with tobacco may hinder smoking cessation efforts. Moreover, tobacco use may amplify certain cannabis-related harms. To inform targeted interventions, we provided estimates of tobacco and cannabis co-use prevalence and correlates in France.

Methods

Using data from a 2021 nationwide representative sample of French population aged 18–64 years, we estimated the prevalence of tobacco and cannabis co-use. Co-use was defined as reporting daily cigarette smoking and at least monthly cannabis use. We used multinomial logistic regression models to identify factors associated with co-use.

Results

Among the 18,288 study participants, 71.8 % reported no use of cannabis or tobacco (‘no-use’ group), 22.3 % tobacco mono-use, 1.4 % cannabis mono-use, and 4.5 % co-use of both substances. Individuals who co-used reported a more frequent cannabis use than those who mono-used cannabis. Having financial difficulties was significantly associated with co-use, compared to tobacco and cannabis mono-use. After multivariable adjustment, the odds of co-use compared with ‘no-use’ was 2.3 times higher for participants with a poor health status, and 3.0 times higher for those with financial difficulties. Reporting a major depressive episode and unhealthy alcohol use were also significantly associated with co-use.

Conclusions

The clinical management of individuals who co-use tobacco and cannabis should include comprehensive assessments of physical and mental health, as well as alcohol consumption. Interventions to reduce co-use-related harms should also address the adverse social conditions experienced by this population.

背景和目的烟草使用是全球过早死亡的主要危险因素。大麻相关的危害是有据可查的，它与烟草的共同使用可能会阻碍戒烟的努力。此外，烟草使用可能会放大某些与大麻有关的危害。为了告知有针对性的干预措施，我们提供了法国烟草和大麻共同使用患病率和相关因素的估计。方法使用2021年法国18-64岁人口的全国代表性样本数据，我们估计了烟草和大麻共同使用的流行程度。共同使用被定义为报告每天吸烟和至少每月使用大麻。我们使用多项逻辑回归模型来确定与共同使用相关的因素。结果在18288名研究参与者中，71.8%的人报告不使用大麻或烟草（“不使用”组），22.3%的人单一使用烟草，1.4%的人单一使用大麻，4.5%的人同时使用两种物质。共同使用大麻的人比单独使用大麻的人报告更频繁地使用大麻。与单一使用烟草和大麻相比，经济困难与共同使用密切相关。在多变量调整后，健康状况不佳的参与者与“不使用”的参与者相比，共同使用的几率高出2.3倍，经济困难的参与者高出3.0倍。报告重度抑郁发作和不健康饮酒也与共同使用显著相关。结论烟草和大麻共同使用个体的临床管理应包括对身心健康和酒精消费的综合评估。减少共同使用相关危害的干预措施还应解决这一人群所经历的不利社会条件。

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引用次数: 0

Identifying Opioid Treatment Programs in Medicaid claims data to support quality improvement 确定医疗补助索赔数据中的阿片类药物治疗项目，以支持质量改进

IF 2.9

Drug and alcohol dependence reports

Pub Date : 2025-09-11 DOI: 10.1016/j.dadr.2025.100379

Barrett Wallace Montgomery, Tami L. Mark, William Dowd, Chelsea Katz, Dylan DeLisle, Thanh Lu, Minglu Sun, Gary A. Zarkin

In the United States, opioid treatment programs (OTPS) are the only provider type licensed to dispense methadone. Recently, U.S. regulators revised OTPs regulations with the aim of making OTP treatment more patient-centered and improving retention in treatment. Creating OTPs retention measures across all OTPs in the U.S. would give OTPs an important window into their retention rates relative to benchmarks and help identify which policies and procedures are most effective in improving retention. In the United States, insurance claims data are one of the few data sources available to create these metrics. Claims data include national provider identifiers; however, the Federal agency that regulates OTPs does not make public which national provider identifiers are associated with OTPs. This study investigated whether other variables captured in Medicaid claims could be used to identify OTPs. We identified two variables: methadone dispensing procedure codes and methadone clinic taxonomy codes, which identified 80 % and 66.8 % of the count of Medicaid-participating OTPs.Place of service and bill type codes were recently added to claims data and may be useful in the future. Methadone can reduce overdose deaths by 50 % but only if patients are maintained on methadone long enough. OTP metrics created with insurance claims data would facilitate efforts to improve retention and outcomes. This study identifies a practical way to identify OTPs in claims data to support such measures in the absence of a Federal list of OTPs and their national provider identifiers.

在美国，阿片类药物治疗项目（OTPS）是唯一获得许可分发美沙酮的提供者类型。最近，美国监管机构修订了OTP法规，旨在使OTP治疗更加以患者为中心，并提高治疗的保留率。在美国所有otp中创建otp留存率指标，将为otp提供一个重要的窗口，让他们了解相对于基准的保留率，并帮助确定哪些政策和程序最有效地提高了保留率。在美国，保险索赔数据是可用于创建这些指标的少数数据源之一。索赔数据包括国家提供商标识符；然而，监管otp的联邦机构并没有公开哪些国家供应商标识符与otp相关联。本研究调查了医疗补助申请中捕获的其他变量是否可以用于识别otp。我们确定了两个变量：美沙酮配药程序代码和美沙酮诊所分类代码，这两个变量分别确定了80%和66.8%的参加医疗补助的otp数量。服务地点和账单类型代码最近被添加到索赔数据中，将来可能会很有用。美沙酮可以减少50%的过量死亡，但前提是患者需要长期服用美沙酮。使用保险理赔数据创建的准时率指标将有助于提高员工留存率和结果。本研究确定了一种实用的方法来识别索赔数据中的otp，以支持在缺乏联邦otp列表及其国家提供者标识符的情况下采取此类措施。

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引用次数: 0

Isradipine enhancement of virtual reality cue exposure therapy is effective for individuals with higher baseline cue-induced craving 以色列地平增强虚拟现实线索暴露疗法对基线较高的线索诱导渴望的个体有效

IF 2.9

Drug and alcohol dependence reports

Pub Date : 2025-09-05 DOI: 10.1016/j.dadr.2025.100378

Santiago Papini , Cara C. Young , Richard A. Brown , Haruka Minami , Hitoshi Morikawa , Michael W. Otto , John D. Roache , Jasper A.J. Smits

Introduction

Evidence based treatments for smoking cessation have high recurrence rates. Targeting cue-induced craving, a strong predictor of smoking recurrence, may be critical to promoting sustained abstinence. We previously found that isradipine, an FDA-approved antihypertensive, enhanced the effect of virtual reality cue exposure therapy (VR-CET) on cue-induced craving. In this secondary analysis we tested whether this augmentation strategy was more beneficial for participants with high (relative to low) baseline cue-induced craving.

Methods

After a 24-h abstinence challenge, participants (N = 78) completed a single session of VR-CET with isradipine or placebo, and returned for a 24-h follow-up to repeat the procedure in a medication-free state. We conducted a moderator analysis to test the hypothesis that the effect of isradipine on cue-induced craving at follow-up would be larger among participants with higher (relative to lower) baseline cue-reactivity.

Results

In the model of cue-induced craving at follow-up, the Group × Baseline cue-reactivity interaction was significant, p = .045. Among participants with higher baseline cue-induced craving, isradipine resulted in a large, significant reduction in mean craving in the follow-up session (M difference = −18.17, 95 % CI [−31.38, −4.95], p = .01, d = −1.46). Among participants with lower baseline cue-induced craving, results were not significantly different across groups (M difference = 1.38, 95 % CI [−12.98, 15.75], p = .85, d = 0.11).

Conclusions

Results suggest isradipine enhances VR-CET, particularly for individuals with higher baseline levels of cue-induced craving. Future studies testing prevention strategies that target higher cue-induced craving with isradipine to reduce rates of smoking recurrence are warranted.

基于证据的戒烟治疗有很高的复发率。针对提示诱导的渴望，一个强有力的预测吸烟复发，可能是促进持续戒烟的关键。我们之前发现，fda批准的抗高血压药物isradipine可以增强虚拟现实提示暴露疗法（VR-CET）对提示诱导的渴望的效果。在这一次要分析中，我们测试了这种增强策略是否对高（相对于低）基线线索诱导渴望的参与者更有益。方法：在24小时的戒除挑战后，参与者（N = 78）使用isradipine或安慰剂完成了单次VR-CET，并在无药物状态下进行24小时的随访，重复该过程。我们进行了一个调节分析来检验假设，即在基线线索反应性较高（相对于较低）的参与者中，伊斯拉地平对线索诱导渴望的影响会更大。结果在线索诱导渴望模型中，基线组与基线组的线索-反应性交互作用显著，p = 0.045。在基线线索诱导的渴望较高的参与者中，伊斯拉地平在随访期间显著降低了平均渴望(M差= - 18.17,95% CI [- 31.38, - 4.95], p =。01, d =−1.46)。在基线较低的线索诱导渴望的参与者中，结果各组间无显著差异(M差= 1.38,95% CI [- 12.98, 15.75], p =。85, d = 0.11)。结论：结果表明，isradipine可增强VR-CET，特别是对于基线水平较高的线索诱导渴望的个体。未来的研究测试了针对更高的线索诱导的渴望的预防策略，以减少吸烟复发率是有必要的。

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引用次数: 0

Factors associated with cannabis use disorder among Australians using prescribed and illicitly-sourced medical cannabis 在使用处方和非法来源的医用大麻的澳大利亚人中，与大麻使用障碍有关的因素

IF 2.9

Drug and alcohol dependence reports

Pub Date : 2025-09-01 DOI: 10.1016/j.dadr.2025.100362

Llewellyn Mills , Jonathon C. Arnold , Iain S. Mcgregor , Nicholas Lintzeris

Background

People who use cannabis medically do so more frequently than those who use nonmedically, potentially placing them at higher risk of cannabis use disorder (CUD). Prescription involves receiving guidance from doctors how best to administer medication; however, it remains unknown whether prescribed medical cannabis is associated with reduced incidence of CUD compared to illicit.

Methods

Data came from a 2022–23 online anonymous cross-sectional survey of Australians who had used medical cannabis. We examined differences between respondents who use Prescribed medical cannabis and respondents who use Illicit medical cannabis in demographic characteristics, patterns of use, and odds of meeting DSM-5 criteria for Any-CUD (≥2/11 criteria) and Moderate-Severe-CUD (≥4/11). Bayesian penalised regression models were used to identify the most important factors associated with CUD.

Results

Of 1796 respondents, 43 % met Any- and 17 % Moderate-Severe CUD criteria. In bivariate analyses, respondents who sourced illicit medical cannabis were more likely to meet criteria for Any CUD (53 % vs 41 %, OR=1.6 [CI: 1.3, 2.0]) and Moderate-Severe CUD (25 % vs 15 %, OR=2.0 [CI: 1.5, 2.6]) than those who were prescribed; however, with other factors controlled for, age, frequency-of-use, mental health, THC content, route of administration, and proportion of medical vs nonmedical cannabis use were more important correlates than whether medical cannabis was prescribed or illicitly sourced.

Conclusions

CUD is common amongst people who use medical cannabis. While CUD was less prevalent among people who obtained it on prescription than those who obtained it illicitly, other factors such as the concomitant use of cannabis for nonmedical reasons were a more important correlate with CUD.

背景医用大麻使用者比非医用大麻使用者使用大麻的频率更高，这可能使他们面临更高的大麻使用障碍（CUD）风险。处方包括接受医生的指导，如何最好地给药；然而，与非法大麻相比，医用处方大麻是否与减少CUD发病率有关，目前尚不清楚。方法数据来自2022-23年对使用医用大麻的澳大利亚人进行的在线匿名横断面调查。我们检查了使用处方医用大麻的受访者和使用非法医用大麻的受访者在人口统计学特征、使用模式以及符合DSM-5中任何- cud（≥2/11标准）和中-重度- cud（≥4/11）标准的几率方面的差异。贝叶斯惩罚回归模型用于识别与CUD相关的最重要因素。结果在1796名受访者中，43%的人符合任何和17%的中重度CUD标准。在双变量分析中，采购非法医用大麻的受访者比处方者更有可能符合任何CUD（53%对41%，OR=1.6 [CI: 1.3, 2.0]）和中重度CUD（25%对15%，OR=2.0 [CI: 1.5, 2.6]）的标准；然而，在控制其他因素的情况下，年龄、使用频率、心理健康、四氢大麻酚含量、给药途径以及医用大麻与非医用大麻的比例是比医用大麻是处方还是非法来源更重要的相关因素。结论在医用大麻使用者中，scud是常见的。虽然CUD在通过处方获得的人群中比非法获得的人群患病率低，但其他因素，如因非医疗原因同时使用大麻，与CUD的关系更为重要。

{"title":"Factors associated with cannabis use disorder among Australians using prescribed and illicitly-sourced medical cannabis","authors":"Llewellyn Mills , Jonathon C. Arnold , Iain S. Mcgregor , Nicholas Lintzeris","doi":"10.1016/j.dadr.2025.100362","DOIUrl":"10.1016/j.dadr.2025.100362","url":null,"abstract":"<div><h3>Background</h3><div>People who use cannabis medically do so more frequently than those who use nonmedically, potentially placing them at higher risk of cannabis use disorder (CUD). Prescription involves receiving guidance from doctors how best to administer medication; however, it remains unknown whether prescribed medical cannabis is associated with reduced incidence of CUD compared to illicit.</div></div><div><h3>Methods</h3><div>Data came from a 2022–23 online anonymous cross-sectional survey of Australians who had used medical cannabis. We examined differences between respondents who use Prescribed medical cannabis and respondents who use Illicit medical cannabis in demographic characteristics, patterns of use, and odds of meeting DSM-5 criteria for Any-CUD (≥2/11 criteria) and Moderate-Severe-CUD (≥4/11). Bayesian penalised regression models were used to identify the most important factors associated with CUD.</div></div><div><h3>Results</h3><div>Of 1796 respondents, 43 % met Any- and 17 % Moderate-Severe CUD criteria. In bivariate analyses, respondents who sourced illicit medical cannabis were more likely to meet criteria for Any CUD (53 % vs 41 %, OR=1.6 [CI: 1.3, 2.0]) and Moderate-Severe CUD (25 % vs 15 %, OR=2.0 [CI: 1.5, 2.6]) than those who were prescribed; however, with other factors controlled for, age, frequency-of-use, mental health, THC content, route of administration, and proportion of medical vs nonmedical cannabis use were more important correlates than whether medical cannabis was prescribed or illicitly sourced.</div></div><div><h3>Conclusions</h3><div>CUD is common amongst people who use medical cannabis. While CUD was less prevalent among people who obtained it on prescription than those who obtained it illicitly, other factors such as the concomitant use of cannabis for nonmedical reasons were a more important correlate with CUD.</div></div>","PeriodicalId":72841,"journal":{"name":"Drug and alcohol dependence reports","volume":"16 ","pages":"Article 100362"},"PeriodicalIF":2.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144922364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Opioid biomarkers in urine as reliable and valid correlates of opium use characteristics: A 10-year longitudinal assessment 尿液中的阿片类生物标志物作为鸦片使用特征的可靠和有效的相关性：一项10年的纵向评估

IF 2.9

Drug and alcohol dependence reports

Pub Date : 2025-08-30 DOI: 10.1016/j.dadr.2025.100377

Mahdokht Naghash , Rebecca L. Shaner , Hossein Poustchi , Gholamreza Roshandel , Katrice D. Williams , Abraham Tuachi , Farin Kamangar , Paolo Boffetta , Christian C. Abnet , Elizabeth I. Hamelin , Neal D. Freedman , Reza Malekzadeh , Arash Etemadi

Background

Biomarkers can clarify the mechanistic bases of health effects associated with opiate use and improve evaluating dose-response relationships by quantifying the absorbed dose through different routes and patterns of use, supporting the generalizability of opium research findings to broader opioid use.

Methods

We recruited 449 individuals who used opium and 66 individuals who did not, 10 years after baseline evaluation in a cohort study. At both time points, we collected self-reported characteristics of opium use (route, frequency, type, and dose) and measured urinary concentrations of codeine, hydrocodone, hydromorphone, morphine, morphine-3-glucuronide, and morphine-6-glucuronide in spot urine samples. We used multivariate linear regression models to determine the independent effects of each opium use characteristic on biomarker concentrations. Reliability of biomarker concentrations over the 10-year interval was assessed using intraclass correlation coefficients (ICCs) from linear mixed-effect models.

Results

At the follow-up, 229 (51.0 %) subjects used opium by ingestion, which showed a significant shift compared with baseline (24.4 % ingestion). In adjusted models, opium ingestion, daily use, and presence of opioid use disorder (OUD) were associated with higher concentrations of all opioid biomarkers compared with opium smoking, non-daily use, and absence of OUD, respectively. All opioid biomarkers showed significant dose-response relationships relative to self-reported doses. Biomarker concentrations peaked when opium was used 3–4 h before sample collection and declined afterwards, remaining detectable for several days. Biomarker measurements were reliable (ICCs between 0.69 and 0.78) over the 10-year interval.

Conclusions

Opioid biomarkers are valid markers of lifetime history, route, frequency, dose, and recency of opium use and OUD diagnosis, and demonstrate good long-term reliability.

生物标志物可以阐明与阿片类药物使用相关的健康影响的机制基础，并通过量化不同途径和使用模式的吸收剂量来改善评估剂量-反应关系，支持鸦片研究结果推广到更广泛的阿片类药物使用。方法：在基线评估10年后，我们在队列研究中招募了449名使用鸦片的个体和66名未使用鸦片的个体。在这两个时间点，我们收集了自我报告的鸦片使用特征（途径、频率、类型和剂量），并测量了尿样中可待因、氢可酮、氢吗啡酮、吗啡、吗啡-3-葡糖苷和吗啡-6-葡糖苷的尿浓度。我们使用多元线性回归模型来确定每个鸦片使用特征对生物标志物浓度的独立影响。使用线性混合效应模型的类内相关系数（ICCs）评估10年期间生物标志物浓度的可靠性。结果随访中，229例（51.0%）的受试者摄入鸦片，与基线（24.4%）相比有显著变化。在调整后的模型中，鸦片摄入、日常使用和阿片样物质使用障碍（OUD）的存在与所有阿片样物质生物标志物的浓度分别高于鸦片吸烟、非日常使用和不存在OUD。所有阿片类药物生物标志物均与自我报告的剂量表现出显著的剂量-反应关系。在采集样本前3-4小时使用鸦片时，生物标志物浓度达到峰值，随后下降，可检测数天。在10年的时间间隔内，生物标志物测量是可靠的（ICCs在0.69至0.78之间）。结论类鸦片生物标志物是鸦片使用史、途径、频率、剂量、近期及OUD诊断的有效标志物，具有良好的长期可靠性。

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引用次数: 0

A systematic review investigating prenatal cannabis and tobacco co-exposure: Impacts on neonatal, behavioral, cognitive and physiological outcomes 一项调查产前大麻和烟草共同暴露的系统综述：对新生儿、行为、认知和生理结果的影响

IF 2.9

Drug and alcohol dependence reports

Pub Date : 2025-08-29 DOI: 10.1016/j.dadr.2025.100376

Mathilde Argote , Leah Hilson , Maryam Sorkhou , Rachel A. Rabin

Background

Despite the high and increasing rates of cannabis and nicotine/tobacco product (NTP) use during pregnancy, the impact of their combined use on health outcomes in offspring remains poorly understood. Given the growing body of research on prenatal cannabis and NTP co-exposure and its effects on neonatal, behavioral, cognitive, and physiological outcomes in offspring, we conducted a systematic review to synthesize the existing literature and evaluate whether prenatal co-exposure results in additive and/or synergistic adverse effects compared to prenatal cannabis-only exposure and prenatal NTP-only exposure.

Methods

We searched Medline, Embase, and PsycINFO databases via OVID for human and animal studies examining the association between prenatal co-exposure and single-substance exposure on neonatal, behavioral, cognitive, and physiological outcomes in offspring.

Results

Of 3217 records identified, 46 articles were included in the review (human, n = 43; preclinical n = 3). For select neonatal outcomes, co-exposed infants exhibited a higher risk of compromised physical development and birth defects relative to infants with single-substance exposure. Behavioral outcomes, particularly emotion regulation/reactivity, and physiological outcomes demonstrated a similar pattern. In contrast, other neonatal outcomes (e.g., preterm birth and respiratory distress), and cognition were similar between the prenatal co-exposure and single-substance exposure groups.

Conclusions

This review suggests additive and/or synergistic adverse consequences associated with co-exposure on several outcomes in offspring relative to single substance exposure. These findings highlight the urgent need for prevention and treatment strategies addressing cannabis and NTP use in pregnant women. We discuss the limitations of the included studies and highlight key areas for future research.

尽管怀孕期间大麻和尼古丁/烟草制品（NTP）的使用率很高且不断上升，但它们的联合使用对后代健康结果的影响仍然知之甚少。鉴于关于产前大麻和NTP共暴露及其对后代新生儿、行为、认知和生理结果的影响的研究越来越多，我们进行了一项系统综述，综合现有文献，并评估产前共暴露与产前大麻暴露和产前NTP暴露相比是否会导致附加和/或协同不良反应。方法：我们通过OVID检索Medline、Embase和PsycINFO数据库中有关产前共暴露和单一物质暴露对后代新生儿、行为、认知和生理结果的关系的人和动物研究。结果在鉴定的3217条记录中，46篇文章被纳入综述（人类，n = 43；临床前n = 3）。对于特定的新生儿结局，与单一物质暴露的婴儿相比，共同暴露的婴儿表现出更高的身体发育受损和出生缺陷的风险。行为结果，特别是情绪调节/反应，和生理结果显示了类似的模式。相比之下，其他新生儿结局（如早产和呼吸窘迫）和认知在产前共暴露组和单一物质暴露组之间相似。结论：本综述表明，与单一物质暴露相比，共同暴露对后代的几种结局有附加性和/或协同性不良后果。这些发现突出表明，迫切需要制定预防和治疗战略，解决孕妇使用大麻和国家结核控制规划的问题。我们讨论了纳入研究的局限性，并强调了未来研究的重点领域。

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引用次数: 0

Relationship between Medicaid coverage design and receipt of medication for alcohol use disorder (MAUD): Probability of receipt increases based on comprehensiveness of plan 医疗补助覆盖设计与接受酒精使用障碍（MAUD）药物治疗的关系：基于计划的全面性，接受药物治疗的可能性增加

IF 2.9

Drug and alcohol dependence reports

Pub Date : 2025-08-22 DOI: 10.1016/j.dadr.2025.100374

Miguel Antonio Garcia Estrada , Shelby R. Steuart , Christina M. Andrews , Colleen M. Grogan , Olivia M. Hinds , Emily C. Lawler , Felipe Lozano-Rojas , Melissa A. Westlake , Lauren Peterson , Coady Wing , Amanda J. Abraham

Alcohol use disorder (AUD) affects one in ten Americans. As one of the largest payers of AUD treatment in the United States, Medicaid managed care plays a key role in facilitating access to AUD treatment services and medications. However, little is known about how AUD coverage in Medicaid managed care organizations (MCOs) affects treatment receipt. We examined the relationship between the comprehensiveness of Medicaid MCO plan coverage of AUD treatment and receipt of medications for AUD (MAUD). We used Medicaid claims data from Kentucky (2016–2019); our final analytic sample consisted of 202,230 newly enrolled Medicaid beneficiaries. Kentucky quasi-randomly assigns Medicaid beneficiaries to one of five MCO plans with different AUD treatment coverage. We leveraged the random assignment to MCO plans using a Two-Stage Least Squares/Instrumental Variable (TSLS/IV) approach to estimate the effects of MCO plan comprehensiveness on receipt of MAUD. Diagnosis with AUD and receipt of MAUD was relatively uncommon— only 0.5 % of Medicaid beneficiaries were diagnosed with AUD and received MAUD across all plans. Results showed that for each additional AUD treatment modality covered, the probability of receiving MAUD increased by 6.7 % relative to the mean [mean: 0.5 %; difference per additional service/MAUD (in percentage points): 0.033; p < 0.05]. Expanding coverage in the least comprehensive MCO plan to match the most comprehensive plan would increase the probability of receiving MAUD by 47 %. Overall, study findings indicate that when insurance plans cover a broader array of AUD treatment services and medications, patients are more likely to receive MAUD.

十分之一的美国人患有酒精使用障碍（AUD）。作为美国AUD治疗的最大支付者之一，医疗补助管理医疗在促进获得AUD治疗服务和药物方面发挥着关键作用。然而，关于医疗补助管理医疗组织（MCOs）的AUD覆盖率如何影响治疗收入，人们知之甚少。我们检查了医疗补助MCO计划覆盖AUD治疗的全面性与AUD药物接收（MAUD）之间的关系。我们使用了肯塔基州（2016-2019）的医疗补助索赔数据；我们最终的分析样本包括202230名新登记的医疗补助受益人。肯塔基州准随机地将医疗补助受益人分配到五个不同澳元治疗覆盖的MCO计划之一。我们利用两阶段最小二乘/工具变量（TSLS/IV）方法对MCO计划进行随机分配，以估计MCO计划全面性对MAUD接收的影响。诊断为AUD并接受MAUD的情况相对少见——在所有计划中，只有0.5%的医疗补助受益人被诊断为AUD并接受MAUD。结果显示，每增加一种AUD治疗方式，接受MAUD的概率相对于平均值增加6.7%[平均值：0.5%；每项额外服务/ mau的差价（以百分点计）：0.033；p < 0.05]。扩大最不全面的MCO计划的覆盖范围以匹配最全面的计划，将使获得MAUD的可能性增加47%。总的来说，研究结果表明，当保险计划涵盖更广泛的AUD治疗服务和药物时，患者更有可能接受MAUD。

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引用次数: 0

Implementation of screening and assessment tools for diagnosing opioid use disorder: A systematic review 用于诊断阿片类药物使用障碍的筛查和评估工具的实施：系统回顾

IF 2.9

Drug and alcohol dependence reports

Pub Date : 2025-08-20 DOI: 10.1016/j.dadr.2025.100375

Audrey Lopez, Audrey Sarah Cohen, Francine Vega, Tiffany Champagne-Langabeer

Introduction

As the prevalence of opioid use disorder (OUD) continues to rise, early detection by medical professionals can often be the first step in linking individuals to treatment. This systematic review was designed to identify implemented OUD screening and assessment tools with studies published from January 2019 through June 2024, uncover common themes associated with implementation, and determine if these tools were recommended in clinical practice.

Methods

A systematic literature search was conducted within PubMed, EMBASE, and Web of Science using the keywords ‘opioid use disorder,’ ‘documentation,’ and ‘screening assessment tool.’ Three investigators independently reviewed titles, abstracts, and full-text articles for inclusion and exclusion criteria and inclusion within the study. The Johns Hopkins Evidence-Based Practice model was used to appraise evidence level, quality, and common themes.

Results

The initial literature search yielded 914 articles for review, with 19 remaining in the final selection. Of the 19 articles, 15 provided quantitative results of an implemented OUD screening or assessment tool, and 4 offered qualitative results about the value of implemented tools within a clinical practice. 15 of the articles recommended a screening or diagnostic assessment tool. Key themes included the insufficiency of a single assessment tool, inconsistent documentation of OUD diagnoses and symptoms, and variable tool completion.

Conclusion

Diagnosing OUD is complex and dynamic. This review highlights the value of screening and assessment tools in identifying individuals and initiating opioid use-related care. Future research should explore implementing artificial intelligence and patient-centered care to assist with OUD screening and assessment.

随着阿片类药物使用障碍（OUD）的患病率持续上升，医疗专业人员的早期发现往往是将个人与治疗联系起来的第一步。本系统评价旨在通过2019年1月至2024年6月发表的研究，确定已实施的OUD筛查和评估工具，揭示与实施相关的共同主题，并确定这些工具是否在临床实践中被推荐。方法以“阿片类药物使用障碍”、“文献”和“筛选评估工具”为关键词，在PubMed、EMBASE和Web of Science中进行系统的文献检索。三位研究者独立审查了标题、摘要和全文文章，以确定纳入和排除标准以及纳入研究。使用约翰霍普金斯循证实践模型来评估证据水平、质量和共同主题。结果初步文献检索共纳入914篇文献，最终纳入19篇文献。在这19篇文章中，15篇提供了实施OUD筛查或评估工具的定量结果，4篇提供了关于实施工具在临床实践中的价值的定性结果。其中15篇文章推荐了筛查或诊断评估工具。主要主题包括单一评估工具的不足，OUD诊断和症状的文件不一致，以及工具完成程度不一。结论超声诊断是一个复杂的动态过程。这篇综述强调了筛选和评估工具在识别个体和启动阿片类药物使用相关护理方面的价值。未来的研究应探索实施人工智能和以患者为中心的护理来协助OUD筛查和评估。

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引用次数: 0

Neurodevelopmental effects of perinatal exposure to cannabis on progeny: A narrative review 围产期接触大麻对后代神经发育的影响：一篇叙述性综述

IF 2.9

Drug and alcohol dependence reports

Pub Date : 2025-08-19 DOI: 10.1016/j.dadr.2025.100372

Chidimma Doris Azubuike , Oliver Grundmann , Amie J. Goodin

Objective

The certainty of effects on neurodevelopmental outcomes resulting from perinatal cannabis exposure is yet to be established. This review synthesizes current clinical and preclinical evidence on neurodevelopment and related functional outcomes in offspring exposed to cannabis during pregnancy or early childhood. Additionally, gaps in the literature and suggestions to bridge these gaps are provided.

Method

A PubMed database search identified highest level of evidence studies focusing on in utero and early childhood cannabis exposure using keywords broadly describing outcomes alongside informal, spontaneous, and reference searches to supplement search hits. Priority was given to recent clinical studies. Findings were categorized into cognitive measures (memory, attention, and executive functioning), and diagnosis of mental health disorders (including: autism spectrum disorder [ASD], Attention deficit and hyperactivity disorder [ADHD], depression, anxiety, learning delays, and school-related performance). `

Results

Findings on effects on cognition, autism, and learning are not consistent; however, compared to children who were unexposed, prenatally exposed children consistently have higher ADHD risk, and no significant association with anxiety and depression. Exposure to higher concentrations of tetrahydrocannabinol was found to be associated with more aggressive behavior in males compared to females.

Conclusion

Most findings on perinatal cannabis exposure remain inconclusive. To enhance our understanding of associated neurodevelopmental effects, future research should reassess exposure over time, employ standardized cognitive measures, use reliable exposure assessments, and methods that consider cannabis concentration and composition across generations.

目的围产期大麻暴露对神经发育结局的影响尚不明确。本综述综合了妊娠期或幼儿期接触大麻的后代神经发育和相关功能结局的当前临床和临床前证据。此外，还提供了文献中的差距和弥合这些差距的建议。方法PubMed数据库检索确定了关注子宫内和儿童早期大麻暴露的最高水平的证据研究，使用广泛描述结果的关键词以及非正式的、自发的和参考搜索来补充搜索结果。优先考虑最近的临床研究。研究结果分为认知测量（记忆、注意力和执行功能）和精神健康障碍诊断（包括：自闭症谱系障碍（ASD）、注意力缺陷和多动障碍（ADHD）、抑郁、焦虑、学习迟缓和学校相关表现）。结果对认知、自闭症和学习的影响并不一致；然而，与未暴露的儿童相比，产前暴露的儿童始终具有更高的ADHD风险，并且与焦虑和抑郁没有显著关联。研究发现，与女性相比，接触高浓度的四氢大麻酚与男性更具攻击性的行为有关。结论围产期大麻暴露的大多数发现仍不确定。为了加强我们对相关神经发育影响的理解，未来的研究应该重新评估长期暴露，采用标准化的认知测量，使用可靠的暴露评估，以及考虑大麻浓度和成分的方法。

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引用次数: 0