Drug and alcohol dependence reports最新文献_第5页

High-risk use of prescription opioids among patients treated for alcohol problems in New York State. A repeated cross-sectional study, 2005–2018 纽约州因酒精问题接受治疗的患者中处方阿片类药物的高风险使用情况。2005-2018 年重复横断面研究

Drug and alcohol dependence reports

Pub Date : 2024-09-01 DOI: 10.1016/j.dadr.2024.100278

Tzu-Yin Kuo , Chi-Hua Lu , Zackary Falls , Gail Jette , Walter Gibson , Peter L. Elkin , Kenneth E. Leonard , Edward M. Bednarczyk , David M. Jacobs

Background

Patients with alcohol use disorder (AUD) and high-risk opioid use are at risk of serious complications. The purpose of this study was to estimate the prevalence of and factors associated with high-risk opioid use in patients with an alcohol use problem from 2005 to 2018.

Methods

This repeated cross-sectional study analyzed data from first admissions for alcohol treatment (2005–2018) to the NYS Office of Addiction Services and Supports merged with Medicaid Claims Data. High-risk opioid use was defined as opioid dose ≥50 morphine mg equivalents (MME) per day; opioid prescriptions overlapping ≥7 days; opioids for chronic pain >90 days or opioids for acute pain >7 days.

Results

Patients receiving ≥50 MME increased from 690 to 3226 from 2005 to 2010; then decreased to 2330 in 2018. From 2005–2011, patients with opioid prescriptions overlapping ≥7 days increased from 226 to 1594 then decreased to 892 in 2018. From 2005–2010, opioid use >7 days for acute pain increased from 133 to 970 and plateaued after 2010. From 2005–2018, patients who received opioids >90 days for chronic pain trended from 186 to 1655. White patients, females, age 36–55, patients with chronic and acute pain diagnoses had the highest rates of high-risk use.

Conclusions

The prevalence of high-risk opioid use in patients with alcohol use problems increased from 2005 to 2011, and generally decreased after 2010. However, prevalence of opioids >90 days for chronic pain trended up from 2005 to 2018. High-risk opioid use among patients with AUD emphasizes the need to develop interventional strategies to improve patient care.

背景酒精使用障碍（AUD）和高危阿片类药物使用患者面临严重并发症的风险。本研究的目的是估算2005年至2018年酒精使用问题患者中高风险阿片类药物使用的流行率及其相关因素。方法这项重复性横断面研究分析了纽约州成瘾服务与支持办公室与医疗补助索赔数据合并后的首次入院酒精治疗数据（2005-2018年）。高风险阿片类药物使用的定义是：阿片类药物剂量每天≥50吗啡毫克当量（MME）；阿片类药物处方重叠≥7天；阿片类药物用于慢性疼痛>90天或阿片类药物用于急性疼痛>7天。结果从2005年到2010年，接受≥50 MME的患者从690人增加到3226人；然后减少到2018年的2330人。2005-2011年，阿片类药物处方重叠≥7天的患者从226人增至1594人，然后降至2018年的892人。2005-2010年，阿片类药物用于急性疼痛的>7天从133天增加到970天，2010年后趋于平稳。2005-2018年，因慢性疼痛而接受阿片类药物治疗>90天的患者从186人增至1655人。白人患者、女性、36-55 岁、诊断为慢性疼痛和急性疼痛的患者的高危使用率最高。结论2005 年至 2011 年，有饮酒问题的患者中阿片类药物的高危使用率有所上升，2010 年后普遍下降。然而，从2005年到2018年，阿片类药物>90天用于慢性疼痛的流行率呈上升趋势。有酗酒问题的患者中阿片类药物的高风险使用强调了制定干预策略以改善患者护理的必要性。

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引用次数: 0

Impact of COVID-19 on MOUD retention in a sample of rural primary care patients: A secondary analysis of electronic health records COVID-19对农村初级保健患者MOUD保留率的影响：对电子健康记录的二次分析

Drug and alcohol dependence reports

Pub Date : 2024-09-01 DOI: 10.1016/j.dadr.2024.100276

Stacy Calhoun , Huiying Guo , Zhe Fei , Chunqing Lin , Sarah E. Clingan , Yuhui Zhu , Larissa J. Mooney , Yih-Ing Hser

Introduction

There is limited research examining factors impacting MOUD retention in rural settings, especially within the context of the COVID-19 pandemic. Using electronic health records data collected as part of a NIDA Clinical Trials Network study (CTN-0102), this study explored how the onset of the COVID-19 pandemic may have impacted MOUD retention in a sample of 563 rural primary care patients.

Methods

Cox regression model was applied to examine if COVID-19 was related to treatment retention, controlling for demographics, clinic, insurance type, and other diagnoses. The independent variable was the number of days between the patient’s first MOUD prescription date during the pre-COVID observation period (10/1/2019–3/13/2020) and the start of the COVID-19 pandemic. The dependent variable was retention on MOUD, defined as the time from the first MOUD prescription documented during the pre-COVID observation period to the first break in consecutive MOUD prescriptions (right censored at 180 days).

Results

The findings demonstrated that there was a reduced risk of a prescription break for every 10-day increase in the time from the first documented MOUD prescription to the onset of the COVID-19 pandemic (HR = 0.96, 95 % CI = 0.92–0.99; p = 0.011).

Conclusions

While the data did not include complete treatment histories to determine who was new to MOUD treatment, the findings suggest that patients whose first documented MOUD prescription in the dataset was closer to the onset of the pandemic had a greater likelihood of experiencing retention challenges. This underscores the importance for clinics to establish comprehensive contingency plans for future emergencies to ensure uninterrupted MOUD treatment and support, particularly for individuals in the early stabilization phase of their recovery.

导言：对影响农村地区MOUD保留率的因素的研究十分有限，尤其是在COVID-19大流行的背景下。本研究利用作为 NIDA 临床试验网络研究（CTN-0102）一部分而收集的电子健康记录数据，在 563 名农村初级保健患者样本中探讨了 COVID-19 大流行可能会如何影响 MOUD 的保留率。方法应用 Cox 回归模型来检验 COVID-19 是否与治疗保留率有关，同时控制人口统计学、诊所、保险类型和其他诊断。自变量是患者在 COVID 前观察期（10/1/2019-3/13/2020）首次开具 MOUD 处方日期与 COVID-19 大流行开始日期之间的天数。因变量为MOUD的保留时间，定义为从COVID前观察期内记录的首个MOUD处方到连续MOUD处方首次中断的时间（右删减180天）。结果研究结果表明，从记录的首个MOUD处方到COVID-19大流行开始的时间每增加10天，处方中断的风险就会降低（HR = 0.结论虽然数据不包括完整的治疗史，无法确定哪些患者是首次接受 MOUD 治疗，但研究结果表明，数据集中首次记录的 MOUD 处方距离大流行开始的时间更近的患者更有可能面临保留处方的挑战。这突出表明，诊所必须为未来的紧急情况制定全面的应急计划，以确保不间断的MOUD治疗和支持，特别是对处于早期稳定康复阶段的患者。

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引用次数: 0

The substance use disorder treatment gap among US college students: Findings from the 2021 National Survey on Drug Use and Health 美国大学生药物使用障碍治疗差距：2021 年全国药物使用和健康状况调查的结果

Drug and alcohol dependence reports

Pub Date : 2024-09-01 DOI: 10.1016/j.dadr.2024.100279

Emily Pasman , Lisa Blair , Marvin A. Solberg , Sean Esteban McCabe , Ty Schepis , Stella M. Resko

Background

Substance use and substance use disorders (SUD) are prevalent among college students. Information about the gap between substance use treatment need versus treatment receipt can guide efforts to increase service access. This study examined past-year DSM-5 SUD and receipt of treatment among US college students.

Methods

Past-year DSM-5 SUD and treatment receipt were estimated among a sample of 6115 college students aged 16 and older and a comparison group of non-students from the 2021 National Survey on Drug Use and Health, weighted to be nationally representative. Among the college student sample, multiple logistic regression was used to identify factors associated with past-year SUD. Bivariate analyses were used to compare socio-demographic and substance use differences between college students who received treatment and those who had an SUD but did not receive treatment.

Results

Weighted prevalence of past-year SUD among college students was 21.8 %. Only 4.6 % of students who had an SUD received treatment in any setting. Relative to non-students with SUD, proportionately fewer college students with SUD received treatment. Among college students, age, sex, past-year psychological distress, and past-year substance use were significantly associated with past-year SUD; and receipt of treatment differed significantly by age, insurance type, level of education, and enrollment status. College students who received treatment had greater prevalence of stimulant, opioid, tranquilizer, and poly-SUDs and more severe SUD symptomology than those who did not receive treatment.

Conclusion

Additional efforts are needed to engage college students with SUDs in acceptable, evidence-based treatment services.

背景大学生中普遍存在药物使用和药物使用障碍（SUD）。有关药物使用治疗需求与接受治疗之间的差距的信息可以为提高服务可及性提供指导。本研究调查了美国大学生中过去一年的 DSM-5 SUD 和接受治疗的情况。方法对 6115 名 16 岁及以上的大学生样本和来自 2021 年全国药物使用和健康调查的非学生对比组进行了估计，并对全国代表性进行了加权。在大学生样本中，使用多元逻辑回归来确定与过去一年 SUD 相关的因素。使用双变量分析比较了接受治疗的大学生与有 SUD 但未接受治疗的大学生在社会人口学和药物使用方面的差异。只有 4.6% 的有 SUD 的学生接受了任何形式的治疗。相对于未患有药物滥用症的学生，患有药物滥用症的大学生接受治疗的比例较低。在大学生中，年龄、性别、过去一年的心理困扰和过去一年的药物使用与过去一年的 SUD 有显著相关性；接受治疗的情况因年龄、保险类型、教育水平和入学状况的不同而有显著差异。接受治疗的大学生与未接受治疗的大学生相比，兴奋剂、阿片类药物、镇静剂和多重性 SUD 的发病率更高，SUD 症状更严重。

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引用次数: 0

A review of the landscape of state Tobacco 21 laws: Key components, research challenges, and future directions 各州烟草 21 世纪法律概览》：主要内容、研究挑战和未来方向

Drug and alcohol dependence reports

Pub Date : 2024-09-01 DOI: 10.1016/j.dadr.2024.100236

Background

To understand the impact of laws raising minimum legal sales age for tobacco products to age 21, researchers and policymakers need to recognize how recommended policy components vary across states. This paper identified and reviewed policy components across 43 jurisdictions that have enacted Tobacco 21 (T21) laws since 2015.

Methods

Using NexisUni’s database of state laws and legislation, we evaluated T21 laws in effect as of January 2024 and assessed for the incorporation of six components recommended in proposed model legislation: 1) age verification; 2) tobacco retailer licensing; 3) provisions to suspend or revoke a license; 4) unannounced inspections; 5) retailer civil or criminal penalties; and 6) provisions that allow for more stringent local laws.

Results

Only one state included all six components we reviewed, including limiting penalties to civil fines. All jurisdictions included a provision to change the legal sales age of purchase and 37 imposed requirements on retailers to verify identification. Thirty-eight jurisdictions had licensing programs, but only 31 included license suspension or revocation provisions for underage sales. Twenty-three jurisdictions preempt localities from imposing more stringent requirements. Twenty-five jurisdictions use a mix of civil and criminal or solely criminal penalties and 21 jurisdictions have penalties for underage purchasers.

Conclusions

Our database of recommended T21 components with effective dates can be merged with other datasets to facilitate policy evaluation. We discuss ways to enhance research and data collection in this area, and recommend that states update MLSA laws to adopt all recommended policy components.

背景为了解将烟草产品最低法定销售年龄提高至 21 岁的法律的影响，研究人员和政策制定者需要认识到各州推荐的政策内容有何不同。本文确定并审查了自 2015 年以来已颁布 Tobacco 21（T21）法律的 43 个司法管辖区的政策内容。方法利用 NexisUni 的州法律和立法数据库，我们评估了截至 2024 年 1 月生效的 T21 法律，并评估了建议的示范立法中建议的六项内容的纳入情况：1) 年龄验证；2) 烟草零售商许可证；3) 暂停或吊销许可证的规定；4) 突击检查；5) 对零售商的民事或刑事处罚；6) 允许制定更严格的地方法律的规定。所有辖区都包含了改变合法销售购买年龄的规定，37 个辖区对零售商提出了核实身份的要求。38 个辖区制定了许可计划，但只有 31 个辖区对未成年人销售行为做出了暂停或吊销执照的规定。23 个辖区禁止地方实施更严格的要求。25 个司法管辖区混合使用民事和刑事处罚或仅使用刑事处罚，21 个司法管辖区对未成年购买者进行处罚。我们讨论了加强该领域研究和数据收集的方法，并建议各州更新 MLSA 法律，采纳所有建议的政策内容。

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引用次数: 0

Perceptions, barriers, and facilitators of cannabis screening during pregnancy and labor: A qualitative study 孕期和分娩期大麻筛查的认知、障碍和促进因素：定性研究

Drug and alcohol dependence reports

Pub Date : 2024-09-01 DOI: 10.1016/j.dadr.2024.100274

K. Skelton , S. Nyarko , S. Iobst

Background

Cannabis is the most commonly used federally illicit substance during pregnancy. Yet, little is known about women’s lived experiences of being screened for cannabis use during pregnancy.

Objective

To explore perceptions of cannabis use during pregnancy and childbirth, including experiences of being screened for cannabis use during the intrapartum period.

Methods

We conducted a phenomenological qualitative study using semi-structured, online interviews with 16 English-speaking women who gave birth at a U.S. hospital within the past three months. After transcription of interview recordings, two coders analyzed data using inductive thematic analysis. We also generated descriptive statistics for sociodemographic characteristics and cannabis use behaviors.

Findings

Most participants were 25–34 years of age (75 %, n=12), Black (75.00 %. n=12), and had less than a bachelor’s degree (68.75 %, n=14). Participants reported low-risk perceptions of cannabis use during pregnancy and often used cannabis to alleviate mental health conditions and pain during pregnancy and childbirth. Women reported mixed perceptions of harm, using cannabis as a medicine and because they were addicted, being fearful of disclosing cannabis use due to potential involvement of child welfare and protective services, and perceiving negative provider communication a barrier to disclosing cannabis use.

Conclusions

Findings underscore the importance of patient education about adverse maternal and neonatal health outcomes of prenatal cannabis use, regardless of whether disclosure occurs. To facilitate disclosure of use, close attention should be paid to verbal and non-verbal communication when screening and counseling women during pregnancy and childbirth. Additional studies are needed to further examine patient-provider cannabis-related communication, with a focus on identifying discriminatory behaviors and practices resulting in health inequities.

背景大麻是孕期最常使用的联邦违禁药物。方法我们采用半结构化在线访谈的方式对 16 名过去三个月内在美国医院分娩的英语妇女进行了现象学定性研究。在转录访谈录音后，两名编码员采用归纳式主题分析法对数据进行了分析。我们还对社会人口特征和大麻使用行为进行了描述性统计。研究结果大多数参与者的年龄在 25-34 岁之间（75%，人数=12），黑人（75.00%，人数=12），学历低于学士学位（68.75%，人数=14）。参与者报告称，在怀孕期间使用大麻的风险较低，她们经常使用大麻来缓解精神健康状况以及怀孕和分娩期间的疼痛。妇女对大麻的危害认识不一，有的将大麻作为药物使用，有的将大麻成瘾，有的因儿童福利和保护服务机构可能介入而害怕披露大麻使用情况，还有的认为提供者的负面沟通是披露大麻使用情况的障碍。为促进披露使用情况，在筛查和咨询孕产妇时应密切关注语言和非语言沟通。还需要进行更多的研究来进一步检查患者与提供者之间与大麻有关的交流，重点是确定导致健康不平等的歧视性行为和做法。

{"title":"Perceptions, barriers, and facilitators of cannabis screening during pregnancy and labor: A qualitative study","authors":"K. Skelton , S. Nyarko , S. Iobst","doi":"10.1016/j.dadr.2024.100274","DOIUrl":"10.1016/j.dadr.2024.100274","url":null,"abstract":"<div><h3>Background</h3><p>Cannabis is the most commonly used federally illicit substance during pregnancy. Yet, little is known about women’s lived experiences of being screened for cannabis use during pregnancy.</p></div><div><h3>Objective</h3><p>To explore perceptions of cannabis use during pregnancy and childbirth, including experiences of being screened for cannabis use during the intrapartum period.</p></div><div><h3>Methods</h3><p>We conducted a phenomenological qualitative study using semi-structured, online interviews with 16 English-speaking women who gave birth at a U.S. hospital within the past three months. After transcription of interview recordings, two coders analyzed data using inductive thematic analysis. We also generated descriptive statistics for sociodemographic characteristics and cannabis use behaviors.</p></div><div><h3>Findings</h3><p>Most participants were 25–34 years of age (75 %, n=12), Black (75.00 %. n=12), and had less than a bachelor’s degree (68.75 %, n=14). Participants reported low-risk perceptions of cannabis use during pregnancy and often used cannabis to alleviate mental health conditions and pain during pregnancy and childbirth. Women reported mixed perceptions of harm, using cannabis as a medicine and because they were addicted, being fearful of disclosing cannabis use due to potential involvement of child welfare and protective services, and perceiving negative provider communication a barrier to disclosing cannabis use.</p></div><div><h3>Conclusions</h3><p>Findings underscore the importance of patient education about adverse maternal and neonatal health outcomes of prenatal cannabis use, regardless of whether disclosure occurs. To facilitate disclosure of use, close attention should be paid to verbal and non-verbal communication when screening and counseling women during pregnancy and childbirth. Additional studies are needed to further examine patient-provider cannabis-related communication, with a focus on identifying discriminatory behaviors and practices resulting in health inequities.</p></div>","PeriodicalId":72841,"journal":{"name":"Drug and alcohol dependence reports","volume":"12 ","pages":"Article 100274"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772724624000581/pdfft?md5=b7abc18621ec0e2b948c2e8cebfca4fa&pid=1-s2.0-S2772724624000581-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Higher prevalence of polysubstance use among older lesbian, and gay US adults 美国老年女同性恋和男同性恋使用多种物质的比例较高

Drug and alcohol dependence reports

Pub Date : 2024-09-01 DOI: 10.1016/j.dadr.2024.100281

Luis M. Mestre , Marney A. White , Becca R. Levy , Krysten W. Bold

Introduction

Polysubstance use (i.e., the use of more than one substance) is a major public health concern in the US that disproportionately hinders those from marginalized groups by sexual identity and age. Little research has examined this concern among lesbian, gay, and bisexual (LGB) older adults, and no study has measured past-30 day polysubstance use prevalence among these groups. The objective was to examine polysubstance use among older LGB adults compared to their heterosexual same-age peers and younger LGB counterparts.

Methods

We used the National Survey of Drug Use and Health 2021 and 2022 datasets with an analytic sample of 86,254 participants. Past-30 day polysubstance use prevalence was survey-weighted and adjusted by sociodemographic factors. We constructed Weighted multinomial models to compare polysubstance use between older LGB adults (65+ years old) with their same-age heterosexual and younger LGB counterparts.

Results

Older Gay/Lesbian adults had a significantly higher polysubstance use prevalence than their heterosexual counterparts (OR = 27.94; p <0.001) while heterosexual participants showed a decline in polysubstance use with age (OR = 0.27; p < 0.001). Polysubstance use among gay/lesbian (OR = 0.67; p = 0.491) and bisexual (OR = 1.04; p = 0.969) older adults did not significantly differ from their younger counterparts.

Conclusions

Polysubstance use is a public health concern for older gay/lesbian adults. Interventions are needed to address polysubstance use for older LGB adults, including early detection of polysubstance use and prevention strategies that are age and LGB inclusive.

导言使用多种药物（即使用一种以上的药物）是美国的一个主要公共健康问题，它对那些因性身份和年龄而被边缘化的群体造成了极大的影响。很少有研究对老年女同性恋、男同性恋和双性恋（LGB）群体的这一问题进行调查，也没有研究对这些群体在过去 30 天内使用多种药物的流行率进行测量。我们使用了 2021 年和 2022 年全国药物使用与健康调查数据集，分析样本为 86,254 名参与者。对过去 30 天的多种药物使用流行率进行了调查加权，并根据社会人口因素进行了调整。我们构建了加权多项式模型，以比较老年 LGB 成年人（65 岁以上）与同龄异性恋者和年轻 LGB 成年人的多种药物使用情况。结果老年同性恋者的多种药物使用率显著高于异性恋者（OR = 27.94; p <0.001），而异性恋者的多种药物使用率则随着年龄的增长而下降（OR = 0.27; p <0.001）。老年男同性恋/女同性恋（OR = 0.67; p = 0.491）和双性恋（OR = 1.04; p = 0.969）使用多种物质的情况与年轻时没有显著差异。需要采取干预措施来解决老年同性恋、双性恋和变性者使用多种药物的问题，包括早期发现使用多种药物的情况，以及采取兼顾年龄和同性恋、双性恋和变性者的预防策略。

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引用次数: 0

Effects of isolation stress and voluntary ethanol exposure during adolescence on ethanol and nicotine co-use in adulthood using male rats 利用雄性大鼠研究青春期隔离应激和自愿接触乙醇对成年后乙醇和尼古丁共同使用的影响

Drug and alcohol dependence reports

Pub Date : 2024-08-21 DOI: 10.1016/j.dadr.2024.100277

Jakob D. Shaykin , Lidia N. Olyha , Catherine E. Van Doorn , Joshua D. Hales , Cassie M. Chandler , Deann M. Hopkins , Kimberly Nixon , Joshua S. Beckmann , James R. Pauly , Michael T. Bardo

Background

Alcohol use in adolescence may increase susceptibility to substance use disorders (SUDs) in adulthood. This study determined if voluntary ethanol (EtOH) consumption during adolescence, combined with social isolation, alters the trajectory of EtOH and nicotine intake during adulthood, as well as activating brain neuroinflammation.

Methods

Adolescent male isolate- and group-housed rats were given 0.2 % saccharin/20 % EtOH (Sacc/EtOH) or water using intermittent 2-bottle choice; controls were given water in both bottles (n=17–20 per group). Some rats from each group (n=5–6) were euthanized one week later to measure autoradiographic [³H]PK-11195 binding, an indicator of microglial reactivity, and the remainder (n=11–14 per group) were tested in adulthood in 2-bottle choice, followed by nicotine self-administration using an incremental fixed ratio (FR) schedule with Sacc/EtOH and water concurrently available.

Results

Isolation housing increased adolescent intake of Sacc/EtOH, but the increase did not produce an observable neuroimmunological response in brain. Adolescent EtOH exposure decreased adult intake of both Sacc/EtOH and unsweetened EtOH, with isolate-housed rats showing a greater effect than group-housed rats. In the co-use model, a cross-price economic demand analysis revealed a substitutional relationship between Sacc/EtOH and nicotine, but no effect of adolescent Sacc/EtOH exposure. Compared to group-housed rats, isolate-housed rats were more sensitive to the changing price of nicotine and showed greater substitutability of Sacc/EtOH for nicotine.

Conclusion

The current results suggest that adolescent EtOH exposure per se, with or without isolation stress, does not likely explain the enhanced risk for either alcohol or nicotine use later in life.

背景青少年时期饮酒可能会增加成年后药物使用障碍（SUD）的易感性。本研究确定青春期自愿摄入乙醇（EtOH）是否会与社会隔离相结合，从而改变成年后摄入EtOH和尼古丁的轨迹，以及是否会激活脑神经炎症。方法采用间歇性双瓶选择法，给青春期雄性隔离饲养大鼠喂食0.2%糖精/20% EtOH（Sacc/EtOH）或水；给对照组大鼠喂食两瓶水（每组17-20只）。每组中的一些大鼠（n=5-6）在一周后被安乐死，以测量自显影[3H]PK-11195结合（一种小神经胶质细胞反应性指标），其余大鼠（每组n=11-14）在成年后进行双瓶选择测试，然后使用递增固定比率（FR）时间表进行尼古丁自我给药，同时提供Sacc/EtOH和水。结果隔离饲养增加了青少年对Sacc/EtOH的摄入量，但这种增加并没有在大脑中产生可观察到的神经免疫反应。青少年时期接触乙醇会降低成年大鼠对Sacc/EtOH和无糖乙醇的摄入量，隔离饲养大鼠比集体饲养大鼠受到的影响更大。在共同使用模型中，交叉价格经济需求分析表明，Sacc/EtOH和尼古丁之间存在替代关系，但青少年Sacc/EtOH暴露没有影响。与集体饲养的大鼠相比，隔离饲养的大鼠对尼古丁价格的变化更加敏感，并显示出 Sacc/EtOH 与尼古丁之间更大的替代性。

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引用次数: 0

A pilot pragmatic randomized controlled trial of a nicotine metabolite ratio-guided smoking cessation intervention in a lung health and screening program 在肺部健康和筛查项目中开展尼古丁代谢物比率指导戒烟干预的实用随机对照试验

Drug and alcohol dependence reports

Pub Date : 2024-08-17 DOI: 10.1016/j.dadr.2024.100275

Scott D. Siegel , Ross Budziszewski , Essie Layton , Brian Nam , Robert Schnoll

Introduction

Patients with pulmonary nodules detected through lung cancer screening or as incidental findings are often followed in lung health and screening programs. The use of personalized pharmacotherapy for smoking cessation informed by the nicotine metabolite ratio (NMR), a measure of nicotine metabolism, has not yet been evaluated in this setting. This pilot randomized controlled trial (RCT) evaluated the feasibility of conducting a larger trial.

Methods

Through a pragmatic RCT design, participants were recruited from a Mid-Atlantic lung health and screening program. Eligible participants smoked >5 cigarettes per day and completed a blood draw to determine NMR before being randomized to standard or NMR-guided care treatment arms. Standard care participants were offered nicotine replacement therapy (NRT) or varenicline and a referral to phone-based smoking cessation counseling. NMR-guided participants received standard care except they were provided a personalized medication recommendation based on their NMR. Study outcomes included measures of feasibility, medication uptake, and treatment matching (i.e., uptake of the optimal medication).

Results

More than 80 % of 205 screened patients were eligible. However, only 37 (22 %) of these patients enrolled in the study, with a mean age of 65 years, 43 % female, and 25 % Black. Nearly all patients who declined cited a disinterest in smoking cessation. Participants in both treatment arms had high rates of medication uptake (68 %), with NMR-guided participants showing a trend towards greater treatment matching (55 % vs. 29 %).

Conclusions

The results of this pilot study provide support for conducting a larger RCT of an NMR-guided smoking cessation intervention in a lung health and screening setting. Consideration should be given to augmenting the intervention to address barriers to study entry.

导言通过肺癌筛查或偶然发现肺部结节的患者通常会在肺部健康和筛查项目中接受随访。通过尼古丁代谢物比值（NMR）（一种尼古丁代谢测量指标）进行个性化戒烟药物治疗的应用尚未在这种情况下进行评估。这项试点随机对照试验（RCT）评估了开展更大规模试验的可行性。方法通过务实的 RCT 设计，从大西洋中部的肺部健康和筛查项目中招募参与者。符合条件的参与者每天吸烟 5 支，在随机分配到标准或 NMR 指导护理治疗组之前完成抽血以确定 NMR。标准治疗组的参与者接受尼古丁替代疗法（NRT）或伐尼克兰（varenicline）治疗，并接受电话戒烟咨询。NMR 指导参与者接受标准护理，但会根据他们的 NMR 向他们提供个性化的药物建议。研究结果包括可行性、药物服用量和治疗匹配度（即最佳药物服用量）。然而，这些患者中只有 37 人（22%）参加了研究，平均年龄为 65 岁，43% 为女性，25% 为黑人。几乎所有拒绝的患者都表示对戒烟不感兴趣。两个治疗组的参与者都有较高的服药率（68%），NMR 指导下的参与者显示出更大的治疗匹配趋势（55% 对 29%）。结论这项试点研究的结果为在肺部健康和筛查环境中开展更大规模的 NMR 指导下戒烟干预 RCT 提供了支持。应考虑加强干预措施，以解决进入研究的障碍。

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引用次数: 0

Tianeptine-involved emergency department visits, fatal overdoses, and substance seizures in Tennessee, 2021–2023 2021-2023 年田纳西州涉及天麻素的急诊就诊、过量致死和药物缉获情况

Drug and alcohol dependence reports

Pub Date : 2024-08-14 DOI: 10.1016/j.dadr.2024.100272

Haley L. Hershey, Edward M. Onyango, Kate Durst, Jessica Korona-Bailey, Sutapa Mukhopadhyay

Background

Tianeptine is an antidepressant that acts as an agonist to the mu-opioid receptor and enhances serotonin reuptake. Tianeptine has been legally sold as an antidepressant in some countries but is not approved for any medical use by the U.S. Food and Drug Administration (FDA). Tianeptine is not a federally controlled substance, but became a schedule II substance in Tennessee on July 1, 2022. This publication aims to describe the prevalence of tianeptine-involved emergency department visits, fatal overdoses, and substance seizures in Tennessee from 2021 to 2023.

Methods

We conducted a study to examine the prevalence of tianeptine-involved emergency department visits and fatal overdoses in Tennessee using data for 2021 to 2023 from the Tennessee Electronic Surveillance System for the Early Notification of Community based Epidemics (ESSENCE) database and the Tennessee State Unintentional Drug Overdose Reporting System (SUDORS). Substance seizure data from National Forensic Laboratory Information System (NFLIS) are included.

Results

Our search of ESSENCE, SUDORS, and NFLIS yielded 50 tianeptine-involved emergency department visits, 6 tianeptine-involved fatal overdoses, and 19 tianeptine substance seizures respectively. Demographic information is provided for the emergency department visits and tianeptine-involved fatal overdoses. Discharge diagnosis and clinical symptomology information are provided for the emergency department visits.

Conclusion

Emergency department visits and fatal overdoses involving tianeptine have occurred in Tennessee despite tianeptine becoming a schedule II substance. Among emergency department visits, tianeptine use is most commonly associated with gastrointestinal and psychological symptoms. All fatal cases where tianeptine was detected involved other substances, suggesting tianeptine plays a role in polysubstance use.

背景噻奈普汀是一种抗抑郁药，可作为μ-阿片受体的激动剂，并能促进血清素的再摄取。噻奈普汀在一些国家作为抗抑郁药合法销售，但未获美国食品药品管理局（FDA）批准用于任何医疗用途。噻奈普汀不是联邦管制物质，但在田纳西州于 2022 年 7 月 1 日成为附表 II 物质。本出版物旨在描述 2021 年至 2023 年田纳西州涉及噻奈普汀的急诊就诊率、致命过量和药物缉获情况。方法我们利用田纳西州社区流行病早期通知电子监控系统（ESSENCE）数据库和田纳西州无意药物过量报告系统（SUDORS）中 2021 年至 2023 年的数据，对田纳西州涉及噻奈普汀的急诊就诊率和致命药物过量进行了研究。结果我们对 ESSENCE、SUDORS 和 NFLIS 的搜索分别发现了 50 次涉及噻奈普汀的急诊就诊、6 次涉及噻奈普汀的致命过量用药和 19 次噻奈普汀药物缉获。提供了急诊就诊者和噻奈普汀致死过量者的人口统计学信息。结论尽管噻奈普汀已被列入附表 II，但田纳西州仍发生了涉及噻奈普汀的急诊就诊和致命过量中毒事件。在急诊就诊病例中，使用噻奈普汀最常见的症状是胃肠道症状和心理症状。所有检出噻奈普汀的致命病例都涉及其他物质，这表明噻奈普汀在多种物质的使用中发挥了作用。

{"title":"Tianeptine-involved emergency department visits, fatal overdoses, and substance seizures in Tennessee, 2021–2023","authors":"Haley L. Hershey, Edward M. Onyango, Kate Durst, Jessica Korona-Bailey, Sutapa Mukhopadhyay","doi":"10.1016/j.dadr.2024.100272","DOIUrl":"10.1016/j.dadr.2024.100272","url":null,"abstract":"<div><h3>Background</h3><p>Tianeptine is an antidepressant that acts as an agonist to the mu-opioid receptor and enhances serotonin reuptake. Tianeptine has been legally sold as an antidepressant in some countries but is not approved for any medical use by the U.S. Food and Drug Administration (FDA). Tianeptine is not a federally controlled substance, but became a schedule II substance in Tennessee on July 1, 2022. This publication aims to describe the prevalence of tianeptine-involved emergency department visits, fatal overdoses, and substance seizures in Tennessee from 2021 to 2023.</p></div><div><h3>Methods</h3><p>We conducted a study to examine the prevalence of tianeptine-involved emergency department visits and fatal overdoses in Tennessee using data for 2021 to 2023 from the Tennessee Electronic Surveillance System for the Early Notification of Community based Epidemics (ESSENCE) database and the Tennessee State Unintentional Drug Overdose Reporting System (SUDORS). Substance seizure data from National Forensic Laboratory Information System (NFLIS) are included.</p></div><div><h3>Results</h3><p>Our search of ESSENCE, SUDORS, and NFLIS yielded 50 tianeptine-involved emergency department visits, 6 tianeptine-involved fatal overdoses, and 19 tianeptine substance seizures respectively. Demographic information is provided for the emergency department visits and tianeptine-involved fatal overdoses. Discharge diagnosis and clinical symptomology information are provided for the emergency department visits.</p></div><div><h3>Conclusion</h3><p>Emergency department visits and fatal overdoses involving tianeptine have occurred in Tennessee despite tianeptine becoming a schedule II substance. Among emergency department visits, tianeptine use is most commonly associated with gastrointestinal and psychological symptoms. All fatal cases where tianeptine was detected involved other substances, suggesting tianeptine plays a role in polysubstance use.</p></div>","PeriodicalId":72841,"journal":{"name":"Drug and alcohol dependence reports","volume":"12 ","pages":"Article 100272"},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772724624000568/pdfft?md5=c290d8c7ca288a1dc128918644d9b123&pid=1-s2.0-S2772724624000568-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142044944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Perceptions of a naloxone leave behind program among emergency medical services personnel in Michigan, USA 美国密歇根州紧急医疗服务人员对纳洛酮留守计划的看法

Drug and alcohol dependence reports

Pub Date : 2024-08-14 DOI: 10.1016/j.dadr.2024.100273

Jason Brian Gibbons , Olivia K. Sugarman , Lauren Byrne , Samantha J. Harris , Hridika Shah , Eric G. Hulsey , Julie Rwan , Esther Mae Rosner , Anthony Pantaleo , Emily Bergquist , Brendan Saloner

Introduction

In 2020, Michigan implemented its first Naloxone Leave-Behind Program for Emergency Medical Service (EMS) field providers. Under the program, EMS field providers leave naloxone kits to individuals aged 15 or older they encounter in the field who have overdosed, who indicate they have a substance use disorder, or exhibit signs of opioid use and/or to bystanders, friends, or family that are present at the encounter.

Methods

Survey of EMS field providers and administrators to assess perspectives on the Michigan NLB program. Comparisons of perspectives between field providers and administrators working in EMS agencies operating in medical control authorities (MCAs) participating in the NLB program (i.e., participating agencies) with field providers and administrators working for EMS agencies serving non-participating MCAs.

Results

Most EMS field providers and administrators supported the Michigan NLB program. However, some were concerned about the unintended consequences of leaving behind naloxone, including the potential for recipients to use more drugs or be less likely to seek treatment. Perspectives of NLB program effectiveness were similar between EMS administrators and field providers. Participating administrators’ top-cited barrier to implementation was convincing field providers to leave behind naloxone, while non-participating administrators were concerned with stocking naloxone kits.

Conclusions

Additional engagement and training to address concerns by EMS field providers and administrators about the benefits of the NLB program are needed to expand program participation intensity. Streamlining naloxone procurement and increasing messaging about free access to naloxone for participating in the program may help increase adoption.

引言 2020 年，密歇根州首次针对紧急医疗服务 (EMS) 现场提供者实施了纳洛酮留守计划。根据该计划，现场急救医疗服务提供者会将纳洛酮药箱留给他们在现场遇到的 15 岁或 15 岁以上、用药过量、表示自己患有药物使用障碍或有阿片类药物使用迹象的人，以及/或当时在场的旁观者、朋友或家人。方法对现场急救医疗服务提供者和管理人员进行调查，以评估他们对密歇根州 NLB 计划的看法。比较在参与无证行医计划的医疗控制机构（MCA）工作的现场急救人员和管理人员（即参与机构）与在未参与 MCA 的急救机构工作的现场急救人员和管理人员的观点。然而，有些人担心留下纳洛酮会产生意想不到的后果，包括可能导致接受者使用更多药物或更少寻求治疗。急救服务管理人员和现场医疗服务提供者对 NLB 计划有效性的看法相似。参与计划的管理者认为实施计划的最大障碍是说服现场医疗服务提供者留下纳洛酮，而未参与计划的管理者则担心纳洛酮工具包的储备问题。简化纳洛酮的采购流程并增加有关参与该计划可免费获得纳洛酮的信息，可能有助于提高该计划的采用率。

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引用次数: 0