Drug and alcohol dependence reports最新文献_第7页

Substance use and use disorders among Veterans on long-term opioid therapy 长期阿片类药物治疗的退伍军人的物质使用和使用障碍

Drug and alcohol dependence reports

Pub Date : 2025-05-19 DOI: 10.1016/j.dadr.2025.100347

Thye Peng Ngo , Salomeh Keyhani , Samuel Leonard , Katherine J. Hoggatt

Background

Few studies have reported on the prevalence and health risks associated with substance use and substance use disorder (SU/SUD) in Veterans who use long-term opioid therapy (LTOT). We leveraged health record data to estimate SU/SUD prevalence and its association with mortality among Veterans on LTOT.

Methods

We conducted a secondary analysis of cohort data for Veterans on LTOT within Veterans Health Administration outpatient settings (2014–2019). SU/SUD was defined as a positive screen for risky alcohol use; a positive urine drug screen for cannabis, benzodiazepines, or stimulants; or a documented SUD diagnosis. We fit Cox models for all-cause mortality, fatal overdose, and traumatic deaths, comparing Veterans on LTOT with SU/SUD vs. LTOT-only.

Results

One in four (25.0 %) Veterans on LTOT have risky alcohol use, tested positive for other substances, or had a diagnosed SUD. Alcohol was the most common SU/SUD (9.8 %), followed by sedative (8.1 %), cannabis (6.6 %), and stimulant (0.6 %). Relative to Veterans on LTOT only, mortality rates were higher for Veterans on LTOT with cannabis (HR=1.16, 95 % CI=1.03, 1.30), sedative (HR=1.29, 95 % CI=1.10, 1.52), or stimulant SU/SUD (HR=1.54, 95 % CI=1.17, 2.02). Fatal overdose rates were higher for LTOT with alcohol (HR=1.43, 95 % CI=1.10, 1.86), sedatives (HR=1.40, 95 % CI=1.04, 1.91), or stimulant SU/SUD (HR=3.29, 95 % CI=1.60, 6.77). LTOT with sedative SU/SUD was associated with traumatic death rates (HR=1.30, 95 % CI=1.05, 1.61).

Conclusion

Substance co-use is common among Veterans on LTOT and is associated with elevated mortality and overdose risks. Comprehensive screening and targeted interventions may be needed.

背景很少有研究报道使用长期阿片类药物治疗（LTOT）的退伍军人中物质使用和物质使用障碍（SU/SUD）的患病率和健康风险。我们利用健康记录数据来估计SU/SUD患病率及其与LTOT退伍军人死亡率的关系。方法对2014-2019年退伍军人健康管理局门诊门诊退伍军人LTOT队列数据进行二次分析。SU/SUD被定义为危险饮酒的阳性筛查；尿液中大麻、苯二氮卓类药物或兴奋剂呈阳性；或有记录的SUD诊断。我们拟合全因死亡率、致死性用药过量和创伤性死亡的Cox模型，比较LTOT联合SU/SUD治疗的退伍军人与仅LTOT治疗的退伍军人。结果四分之一（25.0%）的LTOT退伍军人有危险的酒精使用，其他物质检测呈阳性，或诊断为SUD。酒精是最常见的SU/SUD(9.8%)，其次是镇静剂（8.1%）、大麻（6.6%）和兴奋剂（0.6%）。与仅使用LTOT的退伍军人相比，使用LTOT的退伍军人的死亡率更高，大麻（HR=1.16, 95% CI=1.03, 1.30）、镇静剂（HR=1.29, 95% CI=1.10, 1.52）或兴奋剂SU/SUD （HR=1.54, 95% CI=1.17, 2.02）。酒精（HR=1.43, 95% CI=1.10, 1.86）、镇静剂（HR=1.40, 95% CI=1.04, 1.91）或兴奋剂SU/SUD （HR=3.29, 95% CI=1.60, 6.77）的LTOT致死过量率较高。LTOT合并镇静SU/SUD与创伤性死亡率相关（HR=1.30, 95% CI=1.05, 1.61）。结论药物共同使用在LTOT退伍军人中很常见，并与死亡率升高和用药过量风险相关。可能需要全面筛查和有针对性的干预措施。

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引用次数: 0

Substance use and mental health characteristics among pregnant individuals with medical and non-medical benzodiazepine use early in pregnancy 怀孕早期医疗和非医疗使用苯二氮卓类药物的孕妇的物质使用和心理健康特征

Drug and alcohol dependence reports

Pub Date : 2025-05-16 DOI: 10.1016/j.dadr.2025.100345

Ayesha C. Sujan , Natalie E. Slama , Brian T. Bateman , Deborah Ansley , Carley Castellanos , Kelly C. Young-Wolff

Background

Research to date evaluating the safety of benzodizapine use during pregnancy has shown mixed results and has relied on self-report or filled prescription data, which are unlikely to capture non-medical use and, consequently, could bias results. Therefore, research on non-medical benzodiazepine use during pregnancy is needed.

Methods

The present study used data from a large, healthcare system with universal screening for prenatal substance use via urine toxicology tests and information on filled prescriptions. We first evaluated the prevalence of pregnancies with non-medical benzodiazepine use (positive urine toxicology test and no filled prescriptions in the past year) and medical benzodiazepine use (positive urine toxicology test and >1 filled prescription in the past year). We also evaluated the presence of co-occurrence of substance use and mental health conditions among these pregnancies.

Results

Our results showed that benzodiazepine use during early pregnancy was rare (<1 % had a positive toxicology test). However, more than one-third of those with a positive toxicology test did not have a filled prescription (i.e., had non-medical use) We also found similar rates of substance use and mental health conditions among pregnancies with medical and non-medical benzodiazepine use.

Conclusion

Our results suggest that research relying on prescription data alone and the medical system may be missing pregnant individuals using benzodiazepines. This points to a need for additional measures and screenings (e.g., urine toxicology tests) in both research and clinical settings. Our findings also underscore a need for additional services for pregnant individuals with both medical and non-medical benzodiazepine use.

迄今为止评估妊娠期间使用苯二氮卓安全性的研究显示出好坏参半的结果，并且依赖于自我报告或填写的处方数据，这些数据不太可能涵盖非医疗使用，因此可能会导致结果偏差。因此，有必要对妊娠期间非医用苯二氮卓类药物的使用进行研究。方法本研究使用的数据来自一个大型医疗保健系统，该系统通过尿液毒理学测试和处方填写信息对产前药物使用进行普遍筛查。我们首先评估了非药物苯二氮卓类药物使用（尿液毒理学试验阳性，过去一年中没有处方）和药物苯二氮卓类药物使用（尿液毒理学试验阳性，过去一年中有1张处方）的怀孕发生率。我们还评估了这些孕妇中药物使用和精神健康状况共存的情况。结果本研究结果显示，妊娠早期使用苯二氮卓类药物的孕妇极少（毒理学试验阳性占1%）。然而，超过三分之一的毒理学测试呈阳性的孕妇没有处方（即非医疗使用）。我们还发现，在医疗和非医疗使用苯二氮卓类药物的孕妇中，物质使用和精神健康状况的比例相似。结论仅依靠处方数据和医疗系统的研究可能会遗漏使用苯二氮卓类药物的孕妇。这表明需要在研究和临床环境中采取额外的措施和筛查（例如，尿液毒理学测试）。我们的研究结果还强调需要为医疗和非医疗使用苯二氮卓类药物的孕妇提供额外的服务。

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引用次数: 0

Exploring the impact of a medication adherence intervention on recovery and mental health outcomes: A secondary analysis of the MAT-PLUS pilot RCT 探索药物依从性干预对康复和心理健康结果的影响：MAT-PLUS试点RCT的二次分析

Drug and alcohol dependence reports

Pub Date : 2025-05-16 DOI: 10.1016/j.dadr.2025.100346

Kevin Wenzel , Julia Thomas , Jennifer Carrano , Jennifer Stidham , Marc Fishman

Background

Substance use disorders (SUDs) including opioid use disorder (OUD) and alcohol use disorder (AUD) contribute to significant morbidity and mortality in the United States. Pharmacotherapy treatment, including extended-release naltrexone (XR-NTX), is underutilized in large part due to poor treatment retention. The MAT-PLUS (Medication Adherence Therapy: Psychosocial Leverage Using a Significant other) intervention combines assertive outreach, significant other involvement, and low-barrier access to medicine to improve retention on XR-NTX, and has shown promising results in a pilot RCT. Methods: This report explored secondary outcomes from the MAT-PLUS pilot RCT (NCT03567356) to determine the impact of the intervention on recovery experience as measured by the Recovery Assessment Scale (RAS) and mental health indicators as measured by the patient health questionnaire- somatic, anxiety, depression scale (PHQ-SADS) on N = 41 participants. Results: A series of repeated measures mixed ANOVAs did not find evidence of an effect of the MAT-PLUS intervention on these outcomes. Although total RAS scores did not improve over time in either condition, an independent samples t-test at the post-intervention follow up suggested some evidence of a possible treatment effect on two subscales of the RAS: 1) Not being dominated by symptoms and 2) Goal and success orientation. Discussion: The results of this study suggest that mental health symptoms are attenuated during treatment, whether usual care or the MAT-PLUS intervention, but that recovery indicators did not improve with treatment. Approaches to SUD care, including the MAT-PLUS intervention, should be refined to target improvements in recovery capital in addition to focusing on symptom reduction.

在美国，包括阿片类药物使用障碍（OUD）和酒精使用障碍（AUD）在内的物质使用障碍（sud）导致了显著的发病率和死亡率。药物治疗，包括缓释纳曲酮（XR-NTX），在很大程度上由于治疗保留不良而未得到充分利用。MAT-PLUS（药物依从性治疗：使用重要他人的社会心理杠杆）干预结合了自信的外展、重要他人的参与和低障碍的药物获取，以提高XR-NTX的保留率，并在一项试点随机对照试验中显示出有希望的结果。方法：本报告探讨MAT-PLUS先导RCT （NCT03567356）的次要结局，以确定干预对N = 41名参与者的康复体验（以康复评估量表（RAS）测量）和患者健康问卷-躯体、焦虑、抑郁量表（PHQ-SADS）测量的心理健康指标的影响。结果：一系列重复测量混合方差分析没有发现MAT-PLUS干预对这些结果有影响的证据。尽管在两种情况下，RAS总分都没有随时间的推移而提高，但干预后随访的独立样本t检验表明，在RAS的两个分量表上可能存在治疗效果的一些证据：1)不受症状支配；2)目标和成功取向。讨论：本研究的结果表明，无论是常规护理还是MAT-PLUS干预，心理健康症状在治疗期间有所减轻，但恢复指标并未随着治疗而改善。SUD的治疗方法，包括MAT-PLUS干预，除了注重症状减轻外，还应针对恢复资本的改善进行改进。

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引用次数: 0

Care management staff perspectives on stigma and barriers to substance use treatment experienced by latine adults who use substances 护理管理人员对拉丁裔成人药物使用所经历的耻辱和药物使用治疗障碍的看法

Drug and alcohol dependence reports

Pub Date : 2025-05-10 DOI: 10.1016/j.dadr.2025.100342

Christina S. Lee , Erika G. Cordova-Ramos , Damaris J. Rohsenow , Kim T. Mueser , Christine A. Pace , Rosemarie Martin , Suzanne M. Colby , Victoria Lopez , Melanie Morris , Jake R. Morgan , Ari Kriegsman , Mari-Lynn Drainoni

Background

Stigma related to substance use or addiction contributes to health care inequality. Structural stigma - embedded in societal conditions, policies, practices, and cultural norms - has been less studied than interpersonal (e.g., provider bias) and individual level stigma processes. The perspectives of staff working with patients who navigate health care systems can help to identify substance use stigma at the structural and interpersonal levels. The study aimed to examine staff perceptions of structural and interpersonal stigma processes, their association with barriers to substance use disorder (SUD) care, the interplay between different levels of stigma, and their impacts at the individual level.

Methods

Care management staff (n = 20, 75 % community health workers, CHWs) from a complex care management program were interviewed about the challenges Latine compared to non-Latine patients faced in accessing care for substance use treatment. Thematic analysis was used to analyze interview transcripts. The Structural Stigma framework was used to guide analysis.

Results

Structural and interpersonal stigma processes as well as intersectional stigma were associated with barriers to SUD care. Latine patients were reported as being frequently affected by intersecting systems of oppression due to multiple stigmatized identities (e.g., persons with substance use and as immigrants) than non-Latine patients. Structural and interpersonal stigma processes were associated with self-stigma and hindered help-seeking behaviors.

Conclusion

Care management staff offer unique perspectives into how stigma at multiple levels is experienced by patients and perpetuated. Stigma processes may discourage the initiation of needed substance use care among Latine persons experiencing oppression.

与药物使用或成瘾相关的耻辱感导致医疗保健不平等。与人际（如提供者偏见）和个人层面的耻辱感过程相比，结构性耻辱感（嵌入社会条件、政策、实践和文化规范中）的研究较少。在卫生保健系统中与患者打交道的工作人员的观点可以帮助在结构和人际层面确定物质使用耻辱。本研究旨在探讨员工对结构和人际耻辱过程的看法，它们与物质使用障碍（SUD）护理障碍的关系，不同程度的耻辱之间的相互作用，以及它们在个体层面的影响。方法对来自一个复杂护理管理项目的管理人员（n = 20, 75%的社区卫生工作者，CHWs）进行访谈，了解拉丁裔患者与非拉丁裔患者在获得药物使用治疗方面面临的挑战。访谈笔录采用专题分析。结构柱头框架用于指导分析。结果结构型、人际型以及交叉型耻感与SUD护理障碍相关。据报道，与非拉丁裔患者相比，拉丁裔患者由于多重污名化身份（例如，药物使用者和移民）而经常受到交叉压迫系统的影响。结构和人际污名过程与自我污名和阻碍求助行为有关。结论：护理管理人员提供了独特的视角，了解患者如何在多个层面经历并延续耻辱。污名化过程可能会阻碍在遭受压迫的拉丁人中开始所需的物质使用护理。

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引用次数: 0

Access to and predictors of substance use treatment and support among people experiencing incarceration in the United States: Analysis of a national cross-sectional study 在美国经历监禁的人中获得药物使用治疗和支持的途径和预测因素：一项全国性横断面研究的分析

Drug and alcohol dependence reports

Pub Date : 2025-05-08 DOI: 10.1016/j.dadr.2025.100343

Samuel J. Chen , Harold A. Pollack , Elizabeth M. Salisbury-Afshar , Mai T. Pho

Substance use-related overdose continues to be one of the leading causes of preventable death in the U.S. People returning from prisons and jails are at heightened risk. Certain substance use treatment methods in carceral facilities – especially medication for opioid use disorder (MOUD) – have shown promise in reducing overdose rates. Treatment availability has been under-studied, with past research often measuring whether facilities offer treatment, but not whether individuals actually receive it. This study used individual-level data to characterize who qualifies for prison-based treatment, who receives it, and what factors affect one’s likelihood of being treated, drawing from the most recent nationally-representative U.S. Survey of Prison Inmates. Descriptive statistics indicate that people with substance use disorder (SUD) who entered American prisons from 2014 to 2016 had lower levels of educational attainment, employment and housing, and higher levels of physical and mental illness. Just 13 % of individuals with SUD received any form of substance use treatment in prison; pharmacotherapies like methadone were almost nonexistent (<1 %). In controlled analysis, individuals who self-identified as Non-Hispanic Black or Hispanic had lower odds of receiving any treatment or support compared to Non-Hispanic White individuals. People convicted of a violent offense had lower odds of treatment than those convicted of other classes of crimes. These novel findings indicate that, in 2016, America’s prison-based substance use treatment had both poor accessibility and inequitable distribution. This raises concerns that, even as facility-level availability of modalities like MOUD continues to expand, certain groups may be left out without attention to individual-level availability.

在美国，与药物使用有关的过量使用仍然是导致可预防死亡的主要原因之一。从监狱和拘留所返回的人面临着更高的风险。在监狱设施中，某些物质使用治疗方法——特别是针对阿片类药物使用障碍（mod）的药物治疗——在降低过量吸毒率方面显示出了希望。治疗的可用性一直没有得到充分的研究，过去的研究通常衡量的是设施是否提供治疗，而不是个人是否真正接受治疗。这项研究使用了个人层面的数据来描述谁有资格接受监狱治疗，谁接受了治疗，以及哪些因素影响了一个人接受治疗的可能性，这些数据来自最近具有全国代表性的美国监狱囚犯调查。描述性统计数据显示，2014年至2016年进入美国监狱的物质使用障碍（SUD）患者的受教育程度、就业和住房水平较低，身体和精神疾病水平较高。只有13%的SUD患者在监狱中接受过任何形式的药物使用治疗；美沙酮等药物治疗几乎不存在（1%）。在对照分析中，与非西班牙裔白人相比，自我认定为非西班牙裔黑人或西班牙裔的人接受任何治疗或支持的几率更低。被判暴力犯罪的人比被判其他类型犯罪的人得到治疗的几率更低。这些新发现表明，2016年美国基于监狱的药物使用治疗可及性差，分配不公平。这引起了人们的关注，即使像mod这样的设施级别的可用性继续扩大，某些群体可能会在没有关注个人级别可用性的情况下被排除在外。

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引用次数: 0

Assessment of the associative determinants of tolerance to the effects of cannabis extract on exploratory behavior in rats 对大麻提取物对大鼠探索性行为影响的耐受相关决定因素的评估

Drug and alcohol dependence reports

Pub Date : 2025-05-07 DOI: 10.1016/j.dadr.2025.100344

Felipe I. Varas , Gonzalo Miguez , Vanetza E. Quezada-Scholz , Esperanza Ibáñez-Jiménez , Camila Aguilar , Simón Ramírez , Jonathan Badilla , Felipe Alfaro , Francisca Bertin , Javier Bustamante , Rocío Angulo , José A. Fuentealba , Alvaro Vergés , Mario A. Laborda

Experimental evaluation of cannabis tolerance has lacked an associative learning approach, focusing primarily on physiological variables. The present study assessed acute effects, chronic tolerance, and contextual specificity, exploring a potential associative component underlying cannabis tolerance. Sixteen adult Sprague-Dawley rats of both sexes were assigned to two groups, one receiving vaporized administrations of cannabis and the other receiving the vehicle substance, in two different counterbalanced contexts. An initial measurement was performed to assess acute effects, followed by four measurements to evaluate the development of chronic tolerance, and a final measurement to test the context specificity of tolerance, comparing the responses to the usual administration context and a novel context. Ten behaviors were analyzed in an open field. Acute effects were observed in seven indicators, corresponding to greater exploration activity in the group that received the drug compared to the control group. In five of these, the data also showed the development of chronic tolerance to the effects of cannabis on exploration, which was indicated by a progressive decrease in exploratory activity in the drug group. However, no evidence of context specificity was found in any variables in which chronic tolerance was observed. We discuss factors that may be related to the lack of contextual specificity of cannabis tolerance. Together, our findings show that a single administration of cannabis induces acute effects, and repeated exposure leads to chronic tolerance, ultimately reducing exploratory behavior.

大麻耐受性的实验评估缺乏一种联想学习方法，主要关注生理变量。本研究评估了急性效应、慢性耐受性和上下文特异性，探索大麻耐受性的潜在关联成分。16只成年雄性大鼠被分为两组，一组接受蒸发的大麻，另一组接受载体物质，在两种不同的平衡环境中。初步测量用于评估急性效应，随后进行四次测量以评估慢性耐受性的发展，最后测量用于测试耐受性的环境特异性，比较常规给药环境和新环境的反应。在一个开阔的场地上分析十种行为。在七个指标中观察到急性效应，与对照组相比，接受药物治疗的组有更大的探索活动。在其中的五个实验中，数据还显示了对大麻对探索的影响的慢性耐受性的发展，这表明了药物组的探索活动逐渐减少。然而，在观察到慢性耐受性的任何变量中，没有发现上下文特异性的证据。我们讨论了可能与大麻耐受性缺乏上下文特异性相关的因素。总之，我们的研究结果表明，单次服用大麻会产生急性效应，反复接触会导致慢性耐受性，最终减少探索行为。

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引用次数: 0

Reported outcomes from a community naloxone training and distribution program 报告社区纳洛酮培训和分发计划的结果

Drug and alcohol dependence reports

Pub Date : 2025-05-06 DOI: 10.1016/j.dadr.2025.100341

Kevin Frederiks , Maxwell Everett , Kristen Gilmore Powell , N. Andrew Peterson , Suzanne Borys , Donald K. Hallcom , Nina A. Cooperman

The United States opioid epidemic is an enormous public health crisis, claiming over 500,000 lives between 1999 and 2020. However, the increased availability of naloxone has saved many lives and led to the development of community-based naloxone training and distribution programs. We developed a naloxone education and distribution program in New Jersey in 2017. This program provides a 60-minute training for community members in various settings, such as police departments, community centers, etc. Participants were instructed to call the training and distribution program if they used their naloxone kit, and the program would replace it. Callers were asked a short survey about behaviors during the naloxone administration and overdose outcome. From January 2018 through June 2022, 191 calls to report an overdose and request a new kit were received. Overall, 70 (37 %) of the reported naloxone administrations were by police, 38 (20 %) family/friends, and 50 (26 %) strangers. The most common actions taken during the overdose included: 162 (85 %) calling EMS; 161 (84 %) staying with the person who overdosed until EMS arrived; and 131 (69 %) checking the individual who overdosed for signs of breathing. Individuals who helped with an overdose were able to revive the person in 172 (90 %) of the reported overdoses. Our data suggests that participants in these programs will use naloxone for opioid overdoses whether the victim is known to the participant or a stranger. Future research should focus on understanding outcomes of and behaviors during overdose episodes that are not reported to the program.

美国的阿片类药物流行是一场巨大的公共卫生危机，在1999年至2020年期间夺走了50多万人的生命。然而，纳洛酮可获得性的提高挽救了许多生命，并导致了以社区为基础的纳洛酮培训和分发计划的发展。我们于2017年在新泽西州开发了纳洛酮教育和分发计划。该项目在警察局、社区中心等不同场所为社区成员提供60分钟的培训。参与者被告知，如果他们使用了纳洛酮包，就打电话给培训和分发计划，该计划将替换它。打电话的人被要求对纳洛酮服用期间的行为和过量的结果进行简短的调查。从2018年1月到2022年6月，接到了191个报告药物过量并要求提供新试剂盒的电话。总的来说，报告的纳洛酮用药中有70例（37%）是警察，38例（20%）是家人/朋友，50例（26%）是陌生人。过量服用期间最常见的措施包括：162例（85%）呼叫EMS；161人（84%）与服药过量的人待在一起，直到急救人员到达；131人（69%）检查服药过量的人是否有呼吸迹象。在172例（90%）的过量用药案例中，帮助过量用药的人能够使患者苏醒。我们的数据表明，这些项目的参与者将使用纳洛酮治疗阿片类药物过量，无论受害者是参与者认识的还是陌生人。未来的研究应侧重于了解未向项目报告的过量发作的结果和行为。

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引用次数: 0

Trends in motives for attempts to reduce alcohol consumption among risky adult drinkers in England: A representative population survey, 2017–2024 英国高危成年饮酒者减少饮酒量的动机趋势：一项代表性人口调查，2017-2024

Drug and alcohol dependence reports

Pub Date : 2025-05-05 DOI: 10.1016/j.dadr.2025.100340

Dimitra Kale , Vera Buss , Melissa Oldham , Jamie Brown , Lion Shahab , Sarah Jackson

Background

Understanding the motives for reducing alcohol consumption, how they differ among various population groups, and how they have evolved over time is crucial for designing effective public health interventions. This study estimated time trends in motives for attempts to reduce alcohol consumption among risky adult drinkers in England between 2017 and 2024 and explored differences by sociodemographics and alcohol consumption levels.

Methods

Data came from a nationally representative survey (Alcohol Toolkit Study), assessing 11,974 risky adult drinkers (mean [Standard Deviation] age= 45.8 [15.7] years, 60.1 % men) who made a past-year reduction attempt between January/2017 and August/2024. Participants reported factors motivating their most recent attempt (not mutually exclusive). We estimated time trends in the proportion of attempts to reduce alcohol consumption motivated by health concerns, cost, social factors (i.e., peer influence/support) and health professional advice, and calculated prevalence ratios (PRs) to compare changes in prevalence across the whole time series.

Results

Over the time series, there was a small increase in the proportion of attempts motivated by health concerns (70.5–76.8 %; PR=1.09, 95 %CI1.01–1.18). Attempts motivated by cost and social factors nearly doubled (10.7–20.2 %; PR=1.89, 95 %CI1.37–2.60; 13.3–25.5 %; PR=1.92, 95 %CI1.46–2.52, respectively). Attempts driven by health professional advice increased (4.4–7.0 %; PR=1.57, 95 %CI0.96–2.57). Women, individuals from less advantaged social grades and with AUDIT-C 5–7 exhibited more pronounced changes in the proportion of attempts motivated by health concerns. Cost was a more consistent driver of attempts for those aged≥ 65.

Conclusions

Health concerns remain the most common motive for attempts to reduce alcohol consumption, but the proportion of attempts motivated by cost and social factors nearly doubled over the study period. These findings suggest the need for public health interventions that consider both economic and social influences alongside health concerns to better support alcohol reduction.

了解减少酒精消费的动机，不同人群之间的差异，以及它们如何随着时间的推移而演变，对于设计有效的公共卫生干预措施至关重要。本研究估计了2017年至2024年间英国高危成年饮酒者试图减少饮酒量的动机的时间趋势，并探讨了社会人口统计学和酒精消费水平的差异。方法数据来自一项具有全国代表性的调查（酒精工具包研究），评估了11974名高危成年饮酒者（平均[标准差]年龄= 45.8[15.7]岁，60.1%为男性），这些人在2017年1月至2024年8月期间尝试减少饮酒量。参与者报告了促使他们最近尝试的因素（不是相互排斥的）。我们估计了由于健康问题、成本、社会因素（即同伴影响/支持）和健康专业建议而减少酒精消费的尝试比例的时间趋势，并计算了患病率（pr），以比较整个时间序列中患病率的变化。结果从时间序列来看，出于健康考虑而尝试自杀的比例略有上升(70.5 ~ 76.8%；Pr =1.09, 95% ci1.01-1.18)。出于成本和社会因素的尝试几乎翻了一番(10.7% - 20.2%；Pr =1.89, 95% ci1.37-2.60；13.3 - -25.5%;PR=1.92, 95% CI1.46-2.52)。由卫生专业建议驱动的尝试增加(4.4 - 7.0%；Pr =1.57, 95% ci0.96-2.57)。妇女、社会地位较低的人和审计- c为5-7的人因健康问题而企图自杀的比例变化更明显。对于年龄≥65岁的人来说，费用是更一致的驱动因素。健康问题仍然是试图减少酒精消费的最常见动机，但在研究期间，由成本和社会因素驱动的尝试比例几乎翻了一番。这些发现表明，需要采取公共卫生干预措施，考虑经济和社会影响以及健康问题，以更好地支持减少酒精。

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引用次数: 0

Methadone-involved overdose deaths in urban and rural communities before and after the public health emergency flexibilities for methadone take-home doses 美沙酮涉及城市和农村社区在突发公共卫生事件前后美沙酮带回家剂量的过量死亡

Drug and alcohol dependence reports

Pub Date : 2025-04-24 DOI: 10.1016/j.dadr.2025.100339

Rebecca Arden Harris , Judith A. Long , Yuhua Bao , Henry R. Kranzler , Jeanmarie Perrone , David S. Mandell

Background

To mitigate COVID-19 exposure risks in methadone clinics, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary modification of regulations in March 2020 to permit extended take-home methadone doses: up to 28 days of take-home methadone for stable patients and 14 days for those less stable. This study examined the association between the policy change and fatal methadone overdoses across the urban-rural continuum.

Methods

This interrupted time series analysis used the U.S. National Vital Statistics System (NVSS) 2018–2022 mortality data to examine monthly trends in methadone-involved overdose deaths before and after the policy change allowing more take-home methadone doses. Deaths were stratified into six urban-rural categories and by co-involvement of fentanyl.

Results

Prior to the policy change, trends in methadone-involved overdose deaths were either flat or declining across all urbanization categories. Following the policy change, deaths decreased significantly in Large Central Metro areas but increased in rural Micropolitan counties. No trend changes occurred in the other urban or rural categories. When stratified by fentanyl co-involvement, Large Central Metro areas experienced a decrease in methadone deaths with fentanyl, though not statistically significant, and a significant decrease without fentanyl. In rural Micropolitan counties, methadone deaths saw an increase with fentanyl co-involvement that did not reach significance, and a significant increase without fentanyl. Noncore counties saw a significant increase in deaths involving both methadone and fentanyl, with no notable change observed without fentanyl.

Conclusions

Results suggest the need to expand methadone access and treatment supports in underserved rural communities, recognizing that factors beyond the policy change may have contributed to the reported associations.

为了降低美沙酮诊所的COVID-19暴露风险，美国药物滥用和精神卫生服务管理局（SAMHSA）于2020年3月发布了一项临时修改规定，允许延长美沙酮带回家剂量：病情稳定的患者可携带美沙酮28天，病情不太稳定的患者可携带美沙酮14天。本研究考察了政策变化与城乡间致死性美沙酮过量用药之间的关系。方法使用美国国家生命统计系统（NVSS） 2018-2022年死亡率数据进行中断时间序列分析，检查政策改变前后美沙酮过量死亡的月度趋势，允许更多的美沙酮带回家剂量。根据芬太尼的共同参与，将死亡分为城乡六类。结果在政策改变之前，美沙酮相关的过量死亡趋势在所有城市化类别中要么持平，要么下降。政策改变后，大城市中心地区的死亡率显著下降，但农村小城市县的死亡率上升。其他城市或农村类别没有出现趋势变化。当按芬太尼联合用药进行分层时，大中心都会区芬太尼联合用药的美沙酮死亡率下降，尽管在统计学上不显著，但不服用芬太尼的美沙酮死亡率显著下降。在农村的小城市县，芬太尼联合用药时美沙酮死亡人数增加，但没有达到显著性，而非芬太尼的死亡率显著增加。非核心县涉及美沙酮和芬太尼的死亡人数显著增加，未涉及芬太尼的死亡人数没有显著变化。结论：研究结果表明，在服务不足的农村社区，需要扩大美沙酮的可及性和治疗支持，认识到政策变化以外的因素可能是导致报告关联的原因。

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引用次数: 0

Opioid medication doses among safer supply clients: Current safer supply doses and previous OAT experience 安全供应客户的阿片类药物剂量：目前的安全供应剂量和以前的OAT经验

Drug and alcohol dependence reports

Pub Date : 2025-04-23 DOI: 10.1016/j.dadr.2025.100338

Gillian Kolla , Kaitlin Fajber , Andrea Sereda , Cassidy Morris , Perri Deacon , Lauren E. Cipriano

Introduction

Safer opioid supply (SOS) is a harm reduction approach to prescribing pharmaceutical opioids to people at high risk of overdose from the toxic unregulated drug supply. Previous research demonstrates positive health outcomes and reductions in overdose mortality among SOS clients; however few reports describe previous opioid agonist treatment history prior to initiating SOS, or the medication combinations and doses prescribed within SOS programs.

Methods

We used convenience sampling to collect survey data from 95 SOS program clients in London, Canada. We use descriptive statistics to analyze survey data and report on OAT history prior to initiating SOS, including maximum methadone dose. We also report on current SOS medication combinations and doses.

Findings

Previous experience with OAT was common and reported by 87 % of SOS clients. Mean highest dose of methadone ever received was 95 mg (range: 20–200 mg), with close to 40 % reporting doses of ≥ 120 mg. 95 % of SOS clients reported prescriptions for immediate-release tablet hydromorphone; 28 % were receiving hydromorphone monotherapy; 68 % were receiving hydromorphone alongside a long-acting opioid, and 5 % receiving hydromorphone alongside 2 long-acting opioids. Total average milligram morphine equivalent (MME) doses of combination SOS prescriptions (MME 1616) were similar to high dose methadone (120 mg = MME 1440).

Conclusions

Previous high dose OAT experience was common among SOS clients prior to enrollment in the SOS program. Our results may inform the individualization of high dose opioid prescriptions for people with high tolerance due to exposure to unregulated fentanyl.

更安全的阿片类药物供应（SOS）是一种减少危害的方法，用于向因有毒不受管制的药物供应而有过量风险的人开具阿片类药物处方。先前的研究表明，SOS客户的健康结果积极，过量死亡率降低；然而，很少有报告描述在开始SOS之前的阿片类激动剂治疗史，或者在SOS计划中规定的药物组合和剂量。方法采用方便抽样法，对加拿大伦敦的95名SOS项目客户进行调查。我们使用描述性统计来分析调查数据，并报告开始SOS之前的OAT病史，包括最大美沙酮剂量。我们还报告了目前的SOS药物组合和剂量。研究发现，87%的SOS患者报告了OAT的既往经验。接受的平均最高剂量美沙酮为95 mg（范围：20-200 mg），接近40%的报告剂量≥120 mg。95%的SOS客户报告处方为氢吗啡酮速释片；28%接受氢吗啡酮单药治疗；68%的患者同时接受氢吗啡酮和长效阿片类药物治疗，5%的患者同时接受氢吗啡酮和2种长效阿片类药物治疗。联合SOS处方的总平均毫克吗啡当量（MME）剂量（MME 1616）与高剂量美沙酮（120 mg = MME 1440）相似。结论SOS患者在参加SOS项目前普遍有高剂量OAT的经历。我们的研究结果可能为由于暴露于不受管制的芬太尼而具有高耐受性的人提供高剂量阿片类药物处方的个体化。

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引用次数: 0