Drug and alcohol dependence reports最新文献_第9页

Fentanyl, carfentanil and other fentanyl analogues in Canada’s illicit opioid supply: A cross-sectional study 加拿大非法阿片类药物供应中的芬太尼、卡芬太尼和其他芬太尼类似物：横断面研究

Drug and alcohol dependence reports

Pub Date : 2024-05-23 DOI: 10.1016/j.dadr.2024.100240

Robert A. Kleinman

Background

Despite the increase in fentanyl-involved overdose deaths in Canada, there have been no national-level studies evaluating the proportion of illicit opioids containing fentanyl or fentanyl analogues in Canada.

Methods

This cross-sectional exploratory study characterized trends in fentanyl, carfentanil and other fentanyl analogues within opioids seized by law enforcement agencies in Canada from 2012 to 2022 and submitted to the Health Canada Drug Analysis Service (DAS). Analyses were stratified by province/region. Mann-Kandell tests were used to test for trends.

Results

A total of 157,616 samples containing any opioid (“opioid-containing samples”) were submitted to the DAS from Canadian provinces between 2012 and 2022, of which 81,165 (51.5%) contained fentanyl or a fentanyl analogue. The percentage of opioid-containing samples that were positive for fentanyl or a fentanyl analogue increased from 3.0% (95% CI: 2.6–3.4%) in 2012–68.3% (67.7–68.9%) in 2022 (p < 0.001 for trend). The percentage of opioid-containing samples that were positive for fentanyl or a fentanyl analogue increased between 2012 and 2022 in all regions. In 2022, the percentage of samples containing fentanyl or an analogue followed an east-to-west gradient: 15.8% (13.3–18.6%) of samples in Atlantic Canada and 84.7% (83.6–85.7%) in British Columbia. Carfentanil was present in 4.9% (4.6–5.2%) of opioid-containing samples in Canada in 2022 and 19.7% (18.3–21.2%) of opioid-containing samples in Alberta.

Conclusions

The illicit opioid supply in Canada increasingly contains toxic synthetic opioids. As of 2022, important regional differences existed in the illicit opioid supply in Canada.

方法这项横断面探索性研究描述了 2012 年至 2022 年期间加拿大执法机构缉获并提交给加拿大卫生部药物分析处 (DAS) 的阿片类药物中芬太尼、卡芬太尼和其他芬太尼类似物的趋势。分析按省/地区进行分层。结果 2012 年至 2022 年间，加拿大各省共向 DAS 提交了 157,616 份含有任何阿片类药物的样本（"含阿片类药物样本"），其中 81,165 份（51.5%）含有芬太尼或芬太尼类似物。芬太尼或芬太尼类似物呈阳性的含阿片类药物样本的百分比从 2012 年的 3.0% (95% CI: 2.6-3.4%) 增加到 2022 年的 68.3% (67.7-68.9%)（p < 0.001 为趋势）。2012 年至 2022 年期间，所有地区含有阿片类药物的样本中芬太尼或芬太尼类似物呈阳性的百分比均有所上升。2022 年，含有芬太尼或芬太尼类似物的样本比例呈东西梯度分布：加拿大大西洋地区为 15.8%（13.3-18.6%），不列颠哥伦比亚省为 84.7%（83.6-85.7%）。2022 年，卡芬太尼出现在加拿大 4.9%（4.6-5.2%）的含阿片样本中，出现在艾伯塔省 19.7%（18.3-21.2%）的含阿片样本中。截至 2022 年，加拿大阿片类药物非法供应存在重大地区差异。

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引用次数: 0

Pilot findings on the real-world performance of xylazine test strips for drug residue testing and the importance of secondary testing methods 关于用于药物残留检测的甲氧苄啶试纸实际性能和辅助检测方法重要性的试验结果

Drug and alcohol dependence reports

Pub Date : 2024-05-06 DOI: 10.1016/j.dadr.2024.100241

Erin Thompson , Jessica Tardif , Merci Ujeneza , Adina Badea , Traci C. Green , Haley McKee , Michelle McKenzie , Ju Nyeong Park

Background

Xylazine is a sedative found increasingly in the illicit fentanyl supply that can cause hypotension, bradycardia, necrosis and death. This pilot examined the real-world performance of BTNX xylazine test strips (XTS) in drug residue samples.

Methods

This study was nested within a drug checking service in Rhode Island. We tested unmeasured drug residue dissolved in 5 mL of distilled water using XTS and Liquid Chromatography Quadrupole Time-of-Flight Mass Spectrometry (LC-QTOF-MS). Analyses compared XTS and LC-QTOF-MS results to calculate XTS detection of xylazine in residue.

Results

Among 41 residue samples, xylazine was detected in 11% by the XTS and 44 % by the laboratory. The LC-QTOF-MS detected xylazine in 18 samples: 4 major, 9 minor, 5 trace by volume relative to the whole sample. The XTS disagreed with the LC-QTOF-MS by indicating a negative result in 77.8 % (N=14) of the samples but never indicated a positive when the LC-QTOF-MS reported xylazine’s absence. The XTS correctly detected xylazine 22 % of the time, however, this increased to 100 % of the time if xylazine was a major active component.

Conclusions

In this study, the BTNX XTS often disagreed with LC-QTOF-MS by indicating a negative result, likely due to the dilution levels used and sample composition. The XTS may not be accurate in detecting residual amounts of xylazine, especially if xylazine is not a dominant component of the tested sample. Given the novelty of BTNX’s XTS products, we recommend XTS only be used in conjunction with other advanced drug checking modalities for residue testing.

背景在非法供应的芬太尼中发现越来越多的羟嗪是一种镇静剂，可导致低血压、心动过缓、坏死和死亡。这项试验检验了 BTNX 异丙嗪试纸 (XTS) 在药物残留样本中的实际表现。我们使用 XTS 和液相色谱四极杆飞行时间质谱法 (LC-QTOF-MS) 对溶解在 5 毫升蒸馏水中的未测量药物残留进行了检测。分析比较了 XTS 和液相色谱-QTOF-MS 的结果，以计算 XTS 在残留物中检测到的哒嗪。LC-QTOF-MS 在 18 个样品中检测到了二甲嗪：与整个样品相比，4 个主要，9 个次要，5 个痕量。XTS 与 LC-QTOF-MS 的检测结果不一致，在 77.8% 的样品（N=14）中显示出阴性结果，但当 LC-QTOF-MS 报告不含二甲苯嗪时，XTS 从未显示出阳性结果。结论在本研究中，BTNX XTS 与 LC-QTOF-MS 的检测结果经常不一致，显示为阴性，这可能与使用的稀释水平和样品成分有关。XTS 可能无法准确检测出残留的甲苯嗪，尤其是当甲苯嗪不是被测样品的主要成分时。鉴于 BTNX XTS 产品的新颖性，我们建议 XTS 只能与其他先进的药物残留检测方法结合使用。

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引用次数: 0

Substance use stigma: A systematic review of measures and their psychometric properties 药物使用耻辱感：对测量方法及其心理测量特性的系统回顾

Drug and alcohol dependence reports

Pub Date : 2024-05-06 DOI: 10.1016/j.dadr.2024.100237

Angelica Spata , Ishita Gupta , M. Kati Lear , Karsten Lunze , Jason B. Luoma

Background

Instruments to measure substance use stigma are emerging, however little is known regarding their psychometric properties. While research has evolved to view substance use stigma as a context sensitive international phenomenon that is embedded within cultures, validated self-report measures are lacking and comprehensive reviews of the existing measures are extremely limited. In this systematic review of substance use stigma and shame measures, we aim to contextualize results from existing research, lay the groundwork for future measurement development research, and provide a thorough resource for research scientists currently designing studies to measure substance use stigma.

Methods

We searched three databases using Boolean search terms for psychometric evaluations of measures of substance use stigma and shame and evaluated the quality/psychometric properties using an adaptation of the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) systematic review guidelines.

Results

We identified 18 measures of substance use stigma. Overall, most measures had minimal psychometric assessments and none of the measures met all domains of the COSMIN measure quality criteria. However, most studies reported satisfactory factor analyses and internal consistency scores.

Conclusions

Most measures of substance use stigma and shame had psychometric assessment across a limited range of criteria and no measures of structural substance use stigma were found. The most reported psychometric properties were structural validity and convergent validity. We suggest future researchers investigate test-retest reliability and cross-cultural validity for existing substance use stigma measures, as well as develop and evaluate novel measures assessing structural stigma of substance use.

背景用于测量药物使用耻辱感的工具不断涌现，但人们对这些工具的心理测量特性知之甚少。虽然研究已逐渐将药物使用羞辱视为一种对环境敏感的国际现象，并将其嵌入文化之中，但却缺乏经过验证的自我报告测量方法，对现有测量方法的全面回顾也极为有限。在这篇关于药物使用耻辱感和羞耻感测量方法的系统性综述中，我们旨在对现有研究结果进行背景分析，为未来的测量开发研究奠定基础，并为目前正在设计药物使用耻辱感测量方法的研究科学家提供全面的资源。方法我们使用布尔检索词检索了三个数据库中有关药物使用耻辱感和羞耻感测量方法的心理测量学评估，并使用基于共识的健康测量工具选择标准（COSMIN）系统性审查指南进行了质量/心理测量学特性评估。总体而言，大多数测量方法的心理测量学评估都很有限，没有一种测量方法符合 COSMIN 测量质量标准的所有领域。然而，大多数研究都报告了令人满意的因子分析和内部一致性得分。结论大多数药物使用耻辱感和羞耻感测量方法的心理测量评估标准范围有限，没有发现结构性药物使用耻辱感测量方法。报告最多的心理测量特性是结构效度和收敛效度。我们建议未来的研究人员调查现有物质使用耻辱感测量方法的测试再测试可靠性和跨文化有效性，并开发和评估评估物质使用结构耻辱感的新型测量方法。

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引用次数: 0

Estimating changes in overdose death rates from increasing methamphetamine supply in Ohio: Evidence from crime lab data 估算俄亥俄州因甲基苯丙胺供应增加而导致的吸毒过量死亡率的变化：来自犯罪实验室数据的证据

Drug and alcohol dependence reports

Pub Date : 2024-04-27 DOI: 10.1016/j.dadr.2024.100238

Daniel Rosenblum , Jeffrey Ondocsin , Sarah G. Mars , Dennis Cauchon , Daniel Ciccarone

Background

We investigate the relationship between the supply of methamphetamine and overdose death risk in Ohio. Ohio and the overall US have experienced a marked increase in overdose deaths from methamphetamine combined with fentanyl over the last decade. The increasing use of methamphetamine may be increasing the risk of overdose death. However, if people are using it to substitute away from more dangerous synthetic opioids, it may reduce the overall risk of overdose death.

Methods

Ohio’s Bureau of Criminal Investigation’s crime lab data include a detailed list of the content of drug samples from law enforcement seizures, which are used as a proxy for drug supply. We use linear regressions to estimate the relationship between the proportion of methamphetamine in lab samples and unintentional drug overdose death rates from January 2015 through September 2021.

Results

Relatively more methamphetamine in crime lab data in a county-month has either no statistically significant relationship with overdose death rates (in small and medium population counties) or a negative and statistically significant relationship with overdose death rates (in large population counties). Past overdose death rates do not predict future increases in methamphetamine in crime lab data.

Conclusions

The results are consistent with a relatively higher supply of methamphetamine reducing the general risk of overdose death, possibly due to substitution away from more dangerous synthetic opioids. However, the supply of methamphetamine appears unrelated to the past illicit drug risk environment. The non-lethal and yet serious health effects of MA use were not explored and, thus, even if the presence of MA reduces the population-level overdose mortality rate, the rise of other adverse health effects may counteract any public health benefits of fewer deaths.

背景我们调查了俄亥俄州的甲基苯丙胺供应与吸毒过量死亡风险之间的关系。在过去十年中，俄亥俄州和整个美国因甲基苯丙胺与芬太尼混合使用而过量死亡的人数明显增加。越来越多地使用甲基苯丙胺可能会增加用药过量死亡的风险。但是，如果人们使用甲基苯丙胺来替代更危险的合成阿片类药物，则可能会降低用药过量死亡的总体风险。方法俄亥俄州犯罪调查局的犯罪实验室数据包括一份执法部门查获的毒品样本含量的详细清单，该清单被用作毒品供应的替代物。我们使用线性回归法估算了从 2015 年 1 月到 2021 年 9 月期间实验室样本中甲基苯丙胺的比例与意外吸毒过量死亡率之间的关系。结果在一个县-月的犯罪实验室数据中，甲基苯丙胺含量相对较高与吸毒过量死亡率之间要么没有统计学意义上的显著关系（在人口规模较小和中等的县），要么与吸毒过量死亡率之间存在统计学意义上的显著负相关关系（在人口规模较大的县）。在犯罪实验室数据中，过去的吸毒过量死亡率并不能预测未来甲基苯丙胺的增加。结论结果表明，甲基苯丙胺供应量的相对增加降低了吸毒过量死亡的总体风险，这可能是由于替代了更危险的合成阿片类药物。然而，甲基苯丙胺的供应似乎与过去的非法药物风险环境无关。没有探讨使用甲基苯丙胺对健康造成的非致命但却严重的影响，因此，即使甲基苯丙胺的存在降低了人口过量吸毒的死亡率，但其他不利健康影响的增加可能会抵消死亡人数减少带来的任何公共健康益处。

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引用次数: 0

Prevalence and predictors of medication for opioid use disorder among reproductive-aged women 育龄妇女阿片类药物使用障碍的患病率和预测因素

Drug and alcohol dependence reports

Pub Date : 2024-04-26 DOI: 10.1016/j.dadr.2024.100239

Jennifer K. Bello , Nathaniel A. Dell , Aaron M. Laxton , Mary Conte , Lynn Chen

Background

Women of reproductive age would benefit from treatment of opioid use disorder (OUD) prior to pregnancy to improve maternal and infant outcomes. In this study, we aimed to identify the prevalence of medication for OUD (MOUD) and characterize correlates of MOUD receipt among 12–49-year-old women with OUD seeking treatment in publicly funded substance use disorder treatment programs at the time of their first treatment episode.

Methods

This cross-sectional study explores the demographic and clinical characteristics of women of reproductive age with OUD receiving publicly funded substance use treatment services. We used data from the concatenated 2015–2021 Treatment Episode Data Set–Admissions (TEDS-A), which documents demographic and clinical characteristics of patient admissions to publicly funded substance use treatment services in the United States.

Results

In the sample of females aged 12–49 with no prior treatment admissions and primary OUD (n=325,512), 40.53% received MOUD (n=131,930), including 39.40% of non-pregnant women (n=115,315) and 52.79% of pregnant women (n=8423). Pregnant women had significantly higher odds of receiving MOUD (aOR = 2.42, 95%CI: 2.30, 2.54) compared to non-pregnant women. Non-white race, treatment setting, and treatment self-referral were also associated with higher levels of MOUD.

Conclusions

We identified a significant unmet need among both pregnant and non-pregnant women with OUD seeking care in publicly funded treatment clinics. While women who are pregnant are significantly more likely to receive evidence-based treatment with MOUD, still 47.21% of pregnant women did not receive MOUD. All reproductive-aged women with OUD should be offered evidence-based treatment options, including MOUD.

背景育龄妇女在怀孕前接受阿片类药物使用障碍（OUD）治疗将有利于改善母婴结局。在这项研究中，我们旨在确定 12-49 岁患有阿片类药物使用障碍（OUD）的女性在首次接受治疗时在公共资助的药物使用障碍治疗项目中接受药物治疗的流行率，并描述接受药物治疗的相关因素。我们使用了 2015-2021 年治疗事件数据集-入院治疗（TEDS-A）的数据，该数据集记录了美国接受政府资助的药物使用治疗服务的患者的人口统计学和临床特征。结果在 12-49 岁、之前未接受过治疗且患有原发性 OUD 的女性样本中（n=325,512），40.53% 接受了 MOUD（n=131,930），其中包括 39.40% 的非怀孕女性（n=115,315）和 52.79% 的怀孕女性（n=8423）。与非孕妇相比，孕妇接受 MOUD 的几率明显更高（aOR = 2.42，95%CI：2.30，2.54）。非白人种族、治疗环境和治疗自我转介也与较高的 MOUD 相关。虽然怀孕妇女接受以循证医学为基础的 "MOUD "治疗的可能性明显增加，但仍有 47.21% 的怀孕妇女没有接受 "MOUD "治疗。应为所有患有 OUD 的育龄妇女提供循证治疗方案，包括 MOUD。

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引用次数: 0

The effect of a pilot brief educational intervention on preferences regarding treatments for opioid use disorder 试点简短教育干预对阿片类药物使用障碍治疗偏好的影响

Drug and alcohol dependence reports

Pub Date : 2024-04-24 DOI: 10.1016/j.dadr.2024.100235

Emaun Irani , Colin Macleod , Stephanie Slat , Adrianne Kehne , Erin Madden , Kaitlyn Jaffe , Amy Bohnert , Pooja Lagisetty

Purpose

Negative perceptions around medications for opioid use disorder (MOUD) amongst the public could deter patients with opioid use disorder (OUD) from engaging with MOUD. Thus, we evaluated whether a brief intervention could improve preferences for MOUD in people who may or may not use opioids.

Methods

We employed a pre-post design to assess the effect of a brief educational intervention on preferences for methadone, buprenorphine, naltrexone, and non-medication treatment in an online sample of US adults stratified by race, who may or may not use opioids. Respondents ranked their preferences in OUD treatment before and after watching four one-minute educational videos about treatment options. Changes in treatment preferences were analyzed using Bhapkar’s test and post hoc McNemar’s tests. A binary logistic generalized estimating equation (GEE) assessed factors associated with preference between treatments.

Results

The sample had 530 responses. 194 identified as White, 173 Black, 163 Latinx. Treatment preferences changed significantly towards MOUD (p<.001). This effect was driven by changes toward buprenorphine (OR=2.38; p<.001) and away from non-medication treatment (OR=0.20; p<.001). There was no significant difference in effect by race/ethnicity. People with lower opioid familiarity were significantly more likely to change their preferences towards MOUD following the intervention.

Conclusion

Respondent preferences for MOUD increased following the intervention suggesting that brief educational interventions can change treatment preferences towards MOUD. These findings offer insights into perceptions of OUD treatment in a racially stratified sample and serve as a foundation for future educational materials that target MOUD preferences in the general public.

目的公众对阿片类药物使用障碍（MOUD）药物的负面看法可能会阻碍阿片类药物使用障碍（OUD）患者接受 MOUD 治疗。因此，我们评估了简短的干预措施能否改善可能使用或不使用阿片类药物的人对阿片类药物使用障碍治疗的偏好。我们采用了前后期设计来评估简短的教育干预措施对美沙酮、丁丙诺啡、纳曲酮和非药物治疗偏好的影响，受访者是按种族分层的美国成年人，可能使用或不使用阿片类药物。受访者在观看四段一分钟的治疗方案教育视频之前和之后，对他们的 OUD 治疗偏好进行了排序。使用巴普卡检验和事后 McNemar 检验分析了治疗偏好的变化。二元逻辑广义估计方程 (GEE) 评估了与治疗偏好相关的因素。其中 194 人为白人，173 人为黑人，163 人为拉丁裔。治疗偏好在很大程度上向 MOUD 转变（p< .001）。这一影响主要来自于对丁丙诺啡的偏好（OR=2.38；p< .001）和对非药物治疗的偏好（OR=0.20；p< .001）。不同种族/族裔在效果上没有明显差异。对阿片类药物熟悉程度较低的人在接受干预后更有可能改变对 "牟利治疗 "的偏好。结论受访者在接受干预后对 "牟利治疗 "的偏好有所增加，这表明简短的教育干预可以改变对 "牟利治疗 "的治疗偏好。这些发现有助于深入了解种族分层样本对 OUD 治疗的看法，并为未来针对大众 MOUD 偏好的教育材料奠定了基础。

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引用次数: 0

Cannabis use among adolescents and young adults during the COVID-19 pandemic: A systematic review COVID-19大流行期间青少年和年轻成年人吸食大麻的情况：系统回顾

Drug and alcohol dependence reports

Pub Date : 2024-04-16 DOI: 10.1016/j.dadr.2024.100232

Yuni Tang , Brenna Kirk , Folawiyo Olanrewaju , Christiaan G. Abildso , Erin L. Winstanley , Christa L. Lilly , Toni M. Rudisill

Background

A systematic review of the literature was performed to summarize cannabis use among adolescents and young adults during the COVID-19 pandemic. Special focus was given to the prevalence of cannabis use during COVID-19, as well as factors that may explain changes in cannabis consumption patterns.

Methods

The protocol of this systematic review was registered. Articles from seven publication databases were searched in January 2022. The inclusion criteria for studies were as follows: 1) published in English; 2) study instruments needed to include items on COVID-19; 3) conducted after January 1st, 2020; 4) published in a peer-reviewed journal, dissertation, or thesis; 5) study population ≤25 years of age; 6) study designs were limited to observational analytical studies; 7) measured cannabis use. This review excluded other reviews, editorials, and conference abstracts that were not available as full text manuscripts. Independent review, risk of bias assessment, and data abstraction were performed by two authors.

Results

Fifteen articles from the United States (n=11) and Canada (n=4) were included in this review. The findings of this review showed that the prevalence of cannabis use during the pandemic among adolescents and young adults were mixed. Some mental health symptoms, including depression and anxiety, were identified as the most commonly reported reasons for increased cannabis use during the pandemic.

Conclusions

This review highlights the inconsistencies in the prevalence of cannabis use among adolescents and young adults during the pandemic. Therapeutic interventions for mental health and continued public health surveillance should be conducted to understand the long-term effects of cannabis use among adolescents and young adults.

背景对文献进行了系统回顾，以总结 COVID-19 大流行期间青少年和年轻成年人的大麻使用情况。特别关注 COVID-19 期间大麻使用的流行率，以及可能解释大麻消费模式变化的因素。2022 年 1 月，对七个出版物数据库中的文章进行了检索。研究的纳入标准如下：1）以英语发表；2）研究工具需包含 COVID-19 的项目；3）在 2020 年 1 月 1 日之后进行；4）发表在同行评审期刊、论文或论著中；5）研究人群年龄≤25 岁；6）研究设计仅限于观察分析研究；7）测量大麻使用情况。本综述排除了无法获得全文稿件的其他综述、社论和会议摘要。独立审查、偏倚风险评估和数据摘要由两位作者完成。结果来自美国（11 篇）和加拿大（4 篇）的 15 篇文章被纳入本综述。综述结果表明，大流行期间青少年和年轻成年人吸食大麻的普遍程度参差不齐。包括抑郁和焦虑在内的一些精神健康症状被认为是大流行期间大麻使用增加的最常见原因。应开展心理健康治疗干预和持续的公共卫生监测，以了解青少年和青壮年吸食大麻的长期影响。

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引用次数: 0

The interacting effects of depression symptoms and sweet flavoring on the rewarding and reinforcing value of cigarillo use among young adults 抑郁症状和甜味对年轻人使用雪茄的奖励和强化价值的交互影响

Drug and alcohol dependence reports

Pub Date : 2024-04-09 DOI: 10.1016/j.dadr.2024.100234

Janet Audrain-McGovern , Olivia Klapec , Fodie Koita , Divya Manikandan , Matthew D. Stone

Background

Young adults 18–24 years old have the highest prevalence of cigarillo use, exposing young adults to comparable or higher nicotine levels and many of the same toxicants as combustible cigarettes. Identifying individual and product characteristics that increase the potential for persistent use is warranted. We sought to examine the interacting effects of depression symptoms and sweet flavoring on the rewarding and reinforcing value of cigarillo use.

Methods

86 young adults (18–24 years old, 73.3 % male, 38.4 % White, 33.7 % Black, and 27.9 % Other) completed three laboratory visits assessing the subjective rewarding value (exposure paradigm), relative reinforcing value (computerized choice task), and absolute reinforcing value (ad libitum cigarillo smoking session) of sweet-flavored versus non-flavored cigarillos. Depression symptoms were measured with the 20-item Center for Epidemiologic Studies of Depression Scale and treated as a continuous variable.

Results

General linear models with the appropriate family link tested differences in depressive symptomology for each outcome. Irrespective of flavor, greater cigarillo subjective reward was reported across increasing depressive symptomology (B=.0.03 [95%CI=0.00, 0.05], p=.017). Across symptom levels, no significant differences were observed in the subjective reward and relative and absolute reinforcing values of sweet-flavored versus non-flavored cigarillos (p’s >.05).

Conclusions

Young adults with elevated depression find cigarillos more rewarding but not more reinforcing. They are not more vulnerable than young adults with lower symptom levels to sweet cigarillo flavoring. Public health prevention campaigns and tobacco product regulations aimed at preventing the initiation and escalation of young adult cigarillo use may impact young adults broadly.

背景18-24岁的年轻人使用雪茄烟的比例最高，他们会接触到与可燃卷烟相当或更高水平的尼古丁和许多相同的有毒物质。我们有必要找出增加持续使用可能性的个人和产品特征。我们试图研究抑郁症状和甜味对吸食雪茄烟的奖赏和强化价值的交互影响。方法86名年轻成年人（18-24岁，73.3%为男性，38.4%为白人，33.7%为黑人，27.9%为其他族裔）完成了三次实验室访问，评估甜味雪茄烟和无甜味雪茄烟的主观奖赏价值（暴露范式）、相对强化价值（计算机化选择任务）和绝对强化价值（自由吸食雪茄烟）。抑郁症状采用 20 项抑郁症流行病学研究中心量表进行测量，并作为连续变量处理。无论口味如何，当抑郁症状不断加重时，雪茄烟的主观愉悦感会增加（B=0.03 [95%CI=0.00, 0.05]，P=0.017）。在不同症状水平下，甜味雪茄与非甜味雪茄的主观奖赏、相对和绝对强化价值均无显著差异（p's >.05）。他们并不比症状水平较低的年轻人更容易受到甜味雪茄烟的影响。公共卫生预防活动和烟草产品法规旨在防止年轻人开始使用和升级使用雪茄烟，这可能会对年轻人产生广泛的影响。

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引用次数: 0

Reduced emergency department use among insured individuals receiving extended-release buprenorphine in a health system setting 在医疗系统环境下，接受缓释丁丙诺啡治疗的投保人使用急诊室的情况有所减少

Drug and alcohol dependence reports

Pub Date : 2024-04-07 DOI: 10.1016/j.dadr.2024.100233

Bobbi Jo H. Yarborough , Scott P. Stumbo , Shannon L. Janoff , Erin M. Keast , Michael C. Leo , Sarah J. Leitz

Introduction

Extended-release buprenorphine (XR-Bup) is associated with reduced opioid use and opioid negative urine drug screens. Little is known about its use in outpatient addiction care provided within health systems.

Methods

Individuals prescribed XR-Bup were identified from electronic health records; chart abstraction was conducted. Primary outcome was all-cause emergency department (ED) use. Secondary outcomes included ED use or inpatient stays for mental health or substance use, ED use for any other cause, discontinuation reasons, and drug substitution. Statistical comparisons used nonparametric tests from related samples (McNemar’s test and Wilcoxon matched pair tests) to test outcomes six months prior and 6 months following XR-Bup initiation.

Results

152 individuals had an XR-Bup order, 126 received >1 injection. Among those consistently insured 6 months prior to and following XR-Bup initiation (n=99), the mean number of injections following initiation was 3.95; one-third received 6 doses in the 6 months. The proportion of individuals using ED services for all causes declined (41% prior vs. 28% following XR-Bup initiation, p<.05); similar results were found for secondary ED use outcomes. The proportion of individuals requiring inpatient treatment for mental health or substance use also declined (46% vs. 16%, p<.01). Common reasons for discontinuing XR-Bup included losing insurance (21%) or cost (11%). The most common non-prescribed substances used during treatment were opioids (n=31) and THC (n=20).

Conclusions

In this non-randomized retrospective observational study, use of XR-Bup was associated with reduced ED use 6 months following initiation. XR-Bup may help health systems reduce use of costly ED services.

导言延长释放丁丙诺啡（XR-Bup）与减少阿片类药物使用和阿片类药物阴性尿检有关。方法：从电子健康记录中确定开具 XR-Bup 处方的个人，并进行病历摘录。主要结果是全因使用急诊科（ED）。次要结果包括因精神健康或药物使用而使用急诊室或住院、因任何其他原因使用急诊室、停药原因和药物替代。统计比较使用了相关样本的非参数检验（McNemar 检验和 Wilcoxon 配对检验）来检验 XR-Bup 使用前 6 个月和使用后 6 个月的结果。在开始使用 XR-Bup 之前 6 个月和之后 6 个月持续投保的人员（人数=99）中，开始使用后的平均注射次数为 3.95 次；三分之一的人在这 6 个月中接受了 6 次注射。因各种原因使用急诊室服务的人数比例有所下降（使用 XR-Bup 前为 41%，使用后为 28%，p< .05）；二次使用急诊室的结果也与此类似。因精神健康或药物使用而需要住院治疗的患者比例也有所下降（46% 对 16%，p< .01）。停用 XR-Bup 的常见原因包括失去保险（21%）或费用（11%）。在这项非随机回顾性观察研究中，使用XR-Bup与开始治疗6个月后减少ED使用有关。XR-Bup可帮助医疗系统减少使用昂贵的急诊室服务。

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引用次数: 0

Sociodemographic and patient reported outcomes by racial and ethnicity status among participants in a randomized controlled trial for methamphetamine use disorder 甲基苯丙胺使用障碍随机对照试验参与者中按种族和民族状况分列的社会人口学结果和患者报告结果

Drug and alcohol dependence reports

Pub Date : 2024-04-06 DOI: 10.1016/j.dadr.2024.100230

Chukwuemeka N. Okafor , Thomas Carmody , Angela L. Stotts , Gavin Bart , Taryn L. Mayes , Tara Karns-Wright , Madhukar Trivedi , Steve Shoptaw , Jennifer S. Potter

Background

There has been a significant increase in methamphetamine use and methamphetamine use disorder (Meth UD) in the United States, with evolving racial and ethnic differences.

Objectives

This secondary analysis explored racial and ethnic differences in baseline sociodemographic and clinical characteristics as well as treatment effects on a measure of substance use recovery, depression symptoms, and methamphetamine craving among participants in a pharmacotherapy trial for Meth UD.

Methods

The ADAPT-2 trial (ClinicalTrials.gov number, NCT03078075; N=403; 69% male) was a multisite, 12-week randomized, double-blind, trial that employed a two-stage sequential parallel design to evaluate the efficacy of combination naltrexone (NTX) and oral bupropion (BUP) vs. placebo for Meth UD. Treatment effect was calculated as the weighted mean change in outcomes in the NTX-BUP minus placebo group across the two stages of treatment.

Results

Of the 403 participants in the ADAPT-2 trial, the majority (65%) reported non-Hispanic White, while 14%, 11% and 10% reported Hispanic, non-Hispanic Black, and non-Hispanic other racial and ethnic categories respectively. At baseline non-Hispanic Black participants reported less severe indicators of methamphetamine use than non-Hispanic White. Treatment effects for recovery, depression symptoms and methamphetamine cravings did not significantly differ by race and ethnicity.

Conclusions

Although we found racial and ethnic differences at baseline, our findings did not show racial and ethnic differences in treatment effects of NTX-BUP on recovery, depression symptoms and methamphetamine cravings. However, our findings also highlight the need to expand representation of racial and ethnic minority groups in future trials.

背景在美国，甲基苯丙胺的使用和甲基苯丙胺使用障碍（Meth UD）明显增加，而且种族和民族差异也在不断扩大。目的这项二次分析探讨了基线社会人口学和临床特征方面的种族和民族差异，以及甲基苯丙胺使用障碍药物治疗试验参与者在药物使用恢复措施、抑郁症状和甲基苯丙胺渴求方面的治疗效果。方法ADAPT-2试验（ClinicalTrials.gov编号：NCT03078075；N=403；69%为男性）是一项多地点、为期12周的随机双盲试验，采用了两阶段顺序平行设计，以评估纳曲酮（NTX）和口服安非他明（BUP）联合疗法与安慰剂相比对甲基苯丙胺依赖症的疗效。ADAPT-2试验的403名参与者中，大多数（65%）为非西班牙裔白人，而西班牙裔、非西班牙裔黑人和非西班牙裔其他种族和民族分别占14%、11%和10%。在基线上，非西班牙裔黑人参与者报告的甲基苯丙胺使用指标不如非西班牙裔白人严重。结论虽然我们发现基线时存在种族和民族差异，但我们的研究结果并未显示 NTX-BUP 对康复、抑郁症状和甲基苯丙胺渴求的治疗效果存在种族和民族差异。然而，我们的研究结果也强调了在未来的试验中扩大少数种族和族裔群体代表性的必要性。

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引用次数: 0