Journal of substance use and addiction treatment最新文献_第2页

Effects on alcohol and substance use of a school-based training intervention for adolescents with ADHD 针对多动症青少年的校本培训干预对酗酒和使用药物的影响。

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-10-02 DOI: 10.1016/j.josat.2024.209523

Introduction

Adolescents with attention-deficit/hyperactivity disorder (ADHD) may be at risk for early, escalating patterns of alcohol and substance use via academic, peer, and familial impairment. Existing school-based interventions for youth with ADHD effectively target these risk factors, yet their effects on alcohol and substance use have not been explored. We examined the immediate and long-term alcohol and substance use outcomes of an evidence-based school-based intervention for adolescents with ADHD.

Method

A total of 186 (M_age = 15, 79% boys, 78% White, 11% Hispanic) adolescents with ADHD were randomized to either a school-based training intervention targeting academic and social skills or a treatment-as-usual control group. A subset of youth was followed into emerging adulthood (5 year follow-up; n = 73). Participants reported on their alcohol and substance use behaviors and problems at post-treatment, 6-month follow-up, and 5-year follow-up.

Results

Two-part hurdle models controlling for prior use and demographics indicated treatment was associated with improvements in substance use outcomes among youth using any substances at 6-month follow-up (β = −0.45). However, among youth reporting any alcohol use at the 5-year follow-up, treatment was associated with worse alcohol use problems relative to the control condition (β = 0.27). Approximately 22% of intervention participants met criteria for risky drinking behavior compared to 5% of participants in the control group.

Conclusion

We found mixed evidence that a school-based intervention associated with positive outcomes on academic, social, and emotional functioning for adolescents with ADHD also prevented adverse alcohol and substance use outcomes. These unexpected results serve as a call for extended follow-up periods to identify the durability of intervention benefits and potential for downstream iatrogenic effects. Additional research is needed to identify school-based intervention strategies that can effectively deter substance use risk among select populations.

导言：患有注意力缺陷/多动障碍（ADHD）的青少年可能会因为学业、同伴和家庭的影响而面临酗酒和滥用药物的风险。现有的针对注意力缺陷/多动症青少年的校本干预措施能有效地针对这些风险因素，但其对酒精和药物使用的影响尚未得到探讨。我们研究了一项针对多动症青少年的循证校本干预措施对酗酒和药物使用的直接和长期影响：共有 186 名患有多动症的青少年（年龄 = 15 岁，79 % 为男孩，78 % 为白人，11 % 为西班牙裔）被随机分配到针对学习和社交技能的校本培训干预组或照常治疗对照组。对其中一部分青少年进行了跟踪调查，直至其成年（跟踪调查 5 年；n = 73）。参与者在治疗后、6 个月随访和 5 年随访时报告了他们的酒精和药物使用行为及问题：结果：控制先前使用情况和人口统计学特征的两部分障碍模型表明，在 6 个月的随访中，治疗与使用任何药物的青少年的药物使用结果改善相关（β = -0.45）。然而，在随访 5 年并报告任何酒精使用情况的青少年中，治疗与对照组相比与酒精使用问题的恶化有关（β = 0.27）。大约 22% 的干预参与者达到了危险饮酒行为的标准，而对照组的参与者只有 5%：我们发现，有混合证据表明，一项以学校为基础的干预措施对患有多动症的青少年的学业、社交和情绪功能产生了积极的影响，同时也防止了酗酒和使用药物的不良后果。这些出乎意料的结果要求我们延长随访期，以确定干预效果的持久性和下游先天性影响的可能性。还需要进行更多的研究，以确定能有效阻止特定人群使用药物风险的校本干预策略。

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引用次数: 0

“I feel like I'm always on edge”: Perceptions of parole supervision by parolees with substance use disorders "我感觉自己总是提心吊胆"：有药物使用障碍的假释人员对假释监督的看法。

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-10-02 DOI: 10.1016/j.josat.2024.209529

Introduction

While extant research has looked at parole and its various actors as an institution, few studies recount the parole experience from the perspective of parolees. Additionally, despite the prevalence of substance use disorders (SUDs) within the criminal justice system, research that assesses the additional challenges this population faces throughout parole supervision is even scarcer.

Methods

To address this gap, we analyze in-depth qualitative interviews (n = 51) conducted with reentering men with SUDs as they navigate parole in Pennsylvania. Three independent coders identified all narratives relating to a broad theme of “parole and probation experiences.” The authors then completed iterative rounds of more fine-grained independent coding within that theme.

Results

Our results emphasize that SUDs present a significant barrier to reentry success, and the tension of surveillance and revocation is amplified for those enduring simultaneous reentry and recovery. Importantly, our respondents regard parole officers more positively than they view parole as an institution, yet this perception of officers does not equate to provision of reintegration and recovery support. Respondents perceive that parole presents unnecessary additional hurdles to their reentry success, and their perceived risk level impacts their surveillance intensity.

Conclusions

The information gleaned through inclusion of perspectives from those enduring parole supervision calls for a critical assessment of current parole practices. Further, the current approach to SUDs within community supervision criminalizes relapse without provision of treatment resources or support.

导言：虽然现有的研究将假释及其各种参与者视为一种制度，但很少有研究从假释人员的角度来叙述假释经历。此外，尽管药物使用障碍（SUDs）在刑事司法系统中十分普遍，但评估这一人群在整个假释监管期间所面临的额外挑战的研究却少之又少：为了填补这一空白，我们分析了宾夕法尼亚州对患有 SUD 的男性假释犯进行的深度定性访谈（n = 51）。三位独立编码者确定了所有与 "假释和缓刑经历 "这一广泛主题相关的叙述。然后，作者在该主题范围内完成了多轮更精细的独立编码：结果：我们的研究结果强调，药物依赖性精神障碍是重返社会取得成功的重大障碍，对于那些同时经历重返社会和康复的人来说，监视和撤销缓刑的矛盾更加突出。重要的是，我们的受访者对假释官的评价比对假释机构的评价更积极，但对假释官的这种看法并不等同于提供重返社会和康复支持。受访者认为假释对他们重返社会的成功造成了不必要的额外障碍，而他们认为的风险水平影响了他们的监视强度：通过纳入假释监管对象的观点所收集到的信息要求我们对当前的假释实践进行批判性评估。此外，目前在社区监管范围内处理吸毒成瘾问题的方法将复吸定为刑事犯罪，而不提供治疗资源或支持。

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引用次数: 0

Healing is messy: A lived experience manuscript 治愈是一团糟：生活经验手稿。

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-09-29 DOI: 10.1016/j.josat.2024.209527

引用次数: 0

Attributes of higher- and lower-performing hospitals in the Consult for Addiction Treatment and Care in Hospitals (CATCH) program implementation: A multiple-case study 在 "医院戒毒治疗和护理咨询"（CATCH）计划实施过程中表现较好和较差医院的特征：多案例研究。

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-09-28 DOI: 10.1016/j.josat.2024.209528

Introduction

Six hospitals within the New York City public hospital system implemented the Consult for Addiction Treatment and Care in Hospitals (CATCH) program, an interprofessional addiction consult service. A stepped-wedge cluster randomized controlled trial tested the effectiveness of CATCH for increasing initiation and engagement in post-discharge medication for opioid use disorder (MOUD) treatment among hospital patients with opioid use disorder (OUD). The objective of this study was to identify facility characteristics that were associated with stronger performance of CATCH.

Methods

This study used a mixed methods multiple-case study design. The six hospitals in the CATCH evaluation were each assigned a case rating according to intervention reach. Reach was considered high if ≥50 % of hospitalized OUD patients received an MOUD order. Cross-case rating comparison identified attributes of high-performing hospitals and inductive and deductive approaches were used to identify themes.

Results

Higher-performing hospitals exhibited attributes that were generally absent in lower-performing hospitals, including (1) complete medical provider staffing; (2) designated office space and resources for CATCH; (3) existing integrated OUD treatment resources; and (4) limited overlap between the implementation period and COVID-19 pandemic.

Conclusions

Hospitals with attributes indicative of awareness and integration of OUD services into general care were generally higher performing than hospitals that had siloed OUD treatment programs. Future implementations of addiction consult services may benefit from an increased focus on hospital- and community-level buy-in and efforts to integrate MOUD treatment into general care.

导言：纽约市公立医院系统内的六家医院实施了 "医院成瘾治疗与护理咨询"（CATCH）计划，这是一项跨专业成瘾咨询服务。一项阶梯式分组随机对照试验测试了 CATCH 在提高医院阿片类药物使用障碍（OUD）患者出院后接受阿片类药物使用障碍（MOUD）治疗的启动和参与度方面的有效性。本研究的目的是确定与 CATCH 更佳表现相关的设施特征：本研究采用混合方法多案例研究设计。参与 CATCH 评估的六家医院均根据干预效果进行了个案评级。如果≥50%的住院 OUD 患者收到了 MOUD 订单，则认为干预覆盖率高。交叉病例评级比较确定了高绩效医院的属性，并使用归纳和演绎方法确定了主题：结果：表现较好的医院具有表现较差的医院普遍不具备的特征，包括：（1）医疗服务人员配备齐全；（2）为CATCH指定了办公场所和资源；（3）现有的OUD综合治疗资源；以及（4）实施期与COVID-19大流行之间的重叠有限：结论：与实施孤立的 OUD 治疗计划的医院相比，具有 OUD 服务意识并将 OUD 服务整合到普通护理中的医院的绩效普遍较高。今后实施成瘾咨询服务时，应更加注重医院和社区层面的认同，并努力将 MOUD 治疗纳入普通护理中。

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引用次数: 0

Perspectives of physicians and doulas on shared decision-making and decision counseling in the treatment of pregnant women with opioid use disorders 医生和助产士对治疗阿片类药物使用障碍孕妇的共同决策和决策咨询的看法。

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-09-28 DOI: 10.1016/j.josat.2024.209526

Introduction

Research about the application of shared decision-making (SDM) in the context of Medication Assisted Treatment (MAT) for pregnant women with opioid use disorder (OUD) is limited. The objectives of our study were to 1) examine facilitators of and barriers to SDM for the initiation of MAT in clinical practice and 2) evaluate the receptivity of clinicians and doulas involved in the care of women with OUD to the use of an online software application to facilitate SDM about MAT.

Methods

This qualitative study utilized semi-structured interviews with consenting physicians and doulas who provided care for pregnant women with OUD between November 2021 and May 2022. Participants were asked about factors influencing SDM in practice. In addition, the study asked participants about the feasibility of using the Jefferson Decision Counseling Guide© (JDCG) to educate pregnant women with OUD as to the benefits and risks of undergoing MAT versus no treatment and to help patients clarify their treatment preference. The study recorded the interview and transcribed it verbatim using Rev. transcription services. The study used thematic analyses to code the data and identify key barriers and facilitators of SDM and perceptions of the SDM tool.

Results

Nineteen participants completed interviews. The study identified several barriers to SDM including time constraints, lack of decision counseling tools at points of care, and patients presenting in an actively high state or withdrawing. Peer workers or other trained personnel, giving patients more time, and comfort in decision counseling are examples of facilitators identified by the participants of the study. Participants believed that the counseling tool could facilitate conversations with patients and should be integrated into the workflow.

Conclusion

In this qualitative study, we identified several barriers and facilitators of SDM to initiate MAT for pregnant women with OUD. Our findings indicate that there are challenges and opportunities for healthcare systems to increase SDM in this marginalized patient population. Feedback from participants highlighted their receptivity to the use of SDM tools to facilitate meaningful conversations in various settings that can guide decision making about care.

导言：关于共同决策（SDM）在阿片类药物使用障碍（OUD）孕妇药物辅助治疗（MAT）中的应用的研究十分有限。我们的研究目标是：1）研究临床实践中启动 MAT 的 SDM 的促进因素和障碍；2）评估参与 OUD 妇女护理的临床医生和助产士对使用在线软件应用促进 MAT SDM 的接受程度：这项定性研究采用半结构化访谈的方式，在 2021 年 11 月至 2022 年 5 月期间，对同意为 OUD 孕妇提供护理的医生和陪护进行了访谈。参与者被问及在实践中影响 SDM 的因素。此外，研究还向参与者询问了使用《杰斐逊决策咨询指南》（Jefferson Decision Counseling Guide©，JDCG）教育 OUD 孕妇接受 MAT 治疗与不接受治疗的益处和风险的可行性，并帮助患者明确其治疗偏好。研究使用 Rev. 转录服务对访谈进行录音并逐字转录。研究采用主题分析法对数据进行编码，并确定 SDM 的主要障碍和促进因素以及对 SDM 工具的看法：19 名参与者完成了访谈。研究发现了 SDM 的几个障碍，包括时间限制、护理点缺乏决策咨询工具、患者处于积极亢奋状态或退缩。同伴工作者或其他训练有素的人员、给予患者更多时间以及决策咨询中的舒适感是研究参与者发现的促进因素。参与者认为，咨询工具可以促进与患者的对话，并应纳入工作流程：在这项定性研究中，我们发现了为患有 OUD 的孕妇启动 MAT 的 SDM 的若干障碍和促进因素。我们的研究结果表明，医疗保健系统在增加这一边缘化患者群体的 SDM 方面面临着挑战和机遇。参与者的反馈强调了他们对使用 SDM 工具的接受程度，以促进在各种环境下进行有意义的对话，从而指导有关护理的决策。

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引用次数: 0

Health service utilization, substance use treatment response, and death in patients with opioid use disorder and comorbid hepatitis C findings from prospective cohort study with administrative database linkage 前瞻性队列研究与行政数据库关联的发现：阿片类药物使用障碍和合并丙型肝炎患者的医疗服务利用、药物使用治疗反应和死亡情况。

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-09-26 DOI: 10.1016/j.josat.2024.209524

Background

Among patients with opioid use disorder (OUD), high rates of overdose and death have been reported in subgroups with Hepatitis C Virus (HCV). Evidence on the comorbid effect of HCV on clinical and substance use trajectories has been limited by small sample sizes, short follow-up, and heavy reliance on administrative data which lacks granularity on important prognostic factors. Additionally, few studies include populations on substance use treatment.

Aim

To establish the impact of HCV exposure (antibody positivity) on health care utilization patterns, substance use treatment response, and death in a cohort of patients with OUD on opioid agonist therapy (OAT).

Methods

This multi-center prospective cohort study recruited adult patients with OUD on OAT from 57 substance use treatment centers in Ontario, Canada. The study collected substance use outcomes, and classified patients with ≥50 % positive opioid urine screens over one year of follow-up as having poor treatment response. Additional data obtained via linkage with ICES administrative databases evaluated the relationship between HCV status, healthcare service utilization, and death over 3 years of follow-up. Multiple logistic regression models established the adjusted impact of HCV on various outcomes.

Results

Among recruited participants (n = 3430), 44.10 % were female with a mean age of 38.64 years (Standard deviation: 10.96). HCV was prevalent in 10.6 % of the cohort (n = 365). Methadone was used most often (83.9 %, n = 2876), followed by sublingual buprenorphine (16.2 %, n = 554). Over the three-year follow-up, 5.3 % of patients died (n = 181). Unadjusted results reveal rates of hospitalization (all-cause, mental-health related, critical care) and emergency department visits (mental health-related), were significantly higher among HCV patients. Associations diminished in adjusted models. Active injection drug use exhibited the highest predictive risk for all outcomes.

Conclusion

A high degree of acute physical and mental illness and its resulting health service utilization burden is concentrated among patients with OUD and comorbid HCV. Future research should explore the role for targeted interventions and how best to implement integrated healthcare models to better address the complex health needs of HCV populations who inject drugs.

背景：据报道，在阿片类药物使用障碍（OUD）患者中，丙型肝炎病毒（HCV）亚群的用药过量率和死亡率较高。由于样本量小、随访时间短以及严重依赖行政数据，缺乏重要预后因素的粒度，因此有关丙型肝炎病毒对临床和药物使用轨迹的合并影响的证据一直受到限制。目的：在接受阿片类激动剂治疗（OAT）的 OUD 患者队列中，确定 HCV 暴露（抗体阳性）对医疗保健利用模式、药物使用治疗反应和死亡的影响：这项多中心前瞻性队列研究从加拿大安大略省的 57 家药物使用治疗中心招募了正在接受 OAT 治疗的 OUD 成年患者。研究收集了药物使用结果，并将随访一年内阿片类药物尿检阳性率≥50%的患者归类为治疗反应不佳。通过与 ICES 行政数据库链接获得的其他数据评估了随访 3 年期间 HCV 感染状况、医疗服务利用率和死亡之间的关系。多重逻辑回归模型确定了HCV对各种结果的调整影响：在招募的参与者（n = 3430）中，44.10% 为女性，平均年龄为 38.64 岁（标准差：10.96）。10.6%的参与者（n = 365）感染了丙型肝炎病毒。美沙酮使用率最高（83.9%，n = 2876），其次是舌下丁丙诺啡（16.2%，n = 554）。在三年的随访中，5.3%的患者死亡（n = 181）。未经调整的结果显示，HCV 患者的住院率（全因、精神健康相关、重症监护）和急诊就诊率（精神健康相关）明显较高。在调整模型中，相关性有所减弱。积极使用注射毒品对所有结果的预测风险最高：结论：急性身心疾病及其导致的医疗服务使用负担主要集中在 OUD 和合并 HCV 的患者中。未来的研究应探索有针对性的干预措施的作用，以及如何最好地实施综合医疗保健模式，以更好地满足注射毒品的 HCV 患者复杂的健康需求。

{"title":"Health service utilization, substance use treatment response, and death in patients with opioid use disorder and comorbid hepatitis C findings from prospective cohort study with administrative database linkage","authors":"","doi":"10.1016/j.josat.2024.209524","DOIUrl":"10.1016/j.josat.2024.209524","url":null,"abstract":"<div><h3>Background</h3><div>Among patients with opioid use disorder (OUD), high rates of overdose and death have been reported in subgroups with Hepatitis C Virus (HCV). Evidence on the comorbid effect of HCV on clinical and substance use trajectories has been limited by small sample sizes, short follow-up, and heavy reliance on administrative data which lacks granularity on important prognostic factors. Additionally, few studies include populations on substance use treatment.</div></div><div><h3>Aim</h3><div>To establish the impact of HCV exposure (antibody positivity) on health care utilization patterns, substance use treatment response, and death in a cohort of patients with OUD on opioid agonist therapy (OAT).</div></div><div><h3>Methods</h3><div>This multi-center prospective cohort study recruited adult patients with OUD on OAT from 57 substance use treatment centers in Ontario, Canada. The study collected substance use outcomes, and classified patients with ≥50 % positive opioid urine screens over one year of follow-up as having poor treatment response. Additional data obtained via linkage with ICES administrative databases evaluated the relationship between HCV status, healthcare service utilization, and death over 3 years of follow-up. Multiple logistic regression models established the adjusted impact of HCV on various outcomes.</div></div><div><h3>Results</h3><div>Among recruited participants (<em>n</em> = 3430), 44.10 % were female with a mean age of 38.64 years (Standard deviation: 10.96). HCV was prevalent in 10.6 % of the cohort (<em>n</em> = 365). Methadone was used most often (83.9 %, <em>n</em> = 2876), followed by sublingual buprenorphine (16.2 %, <em>n</em> = 554). Over the three-year follow-up, 5.3 % of patients died (<em>n</em> = 181). Unadjusted results reveal rates of hospitalization (all-cause, mental-health related, critical care) and emergency department visits (mental health-related), were significantly higher among HCV patients. Associations diminished in adjusted models. Active injection drug use exhibited the highest predictive risk for all outcomes.</div></div><div><h3>Conclusion</h3><div>A high degree of acute physical and mental illness and its resulting health service utilization burden is concentrated among patients with OUD and comorbid HCV. Future research should explore the role for targeted interventions and how best to implement integrated healthcare models to better address the complex health needs of HCV populations who inject drugs.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333910","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

State program enables the identification of factors associated with naloxone awareness, self-efficacy, and use for overdose reversal: A cross-sectional, observational study in an urban emergency department population 通过国家计划，可以确定与纳洛酮的认知度、自我效能以及使用纳洛酮逆转用药过量相关的因素：一项针对城市急诊科人群的横断面观察研究

N/A PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-09-17 DOI: 10.1016/j.josat.2024.209506

Introduction

To assist the state of Ohio in addressing the opioid epidemic, the Ohio Attorney General appointed experts in a variety of academic disciplines to the Scientific Committee on Opioid Prevention and Education (SCOPE). The focus of SCOPE is the application of scientific principles to the development of prevention and educational strategies for reducing substance use disorder and related harms (e.g., promoting naloxone awareness). Naloxone awareness is a step in the naloxone cascade, which is a useful model for understanding the sequential steps laypeople must take to prepare themselves to intervene using naloxone; other steps include training and previous administration experience. Prior work has explored correlates of these steps among individuals with risky substance use, but fewer studies have focused on broader populations containing potential bystanders (e.g., family and community members).

Methods

This study was a secondary data analysis of patients from three urban emergency departments. Subsamples differed across five models (n = 479–1208) and included opioid-exposed and -naïve participants. Logistic regression characterized clinically useful sociodemographic predictors (e.g., race, ethnicity, education, employment, housing status) of naloxone awareness, self-efficacy (which relates to training), and previous-overdose administration. Two additional logistic regressions tested associations between risk factors for witnessing an opioid overdose and two cascade steps (awareness and self-efficacy).

Results

Non-White race, Hispanic ethnicity, and lower education predicted not being aware of naloxone; non-White race also predicted lower naloxone self-efficacy, and older age predicted lack of previous-overdose administration. Having family members with risky opioid use was heavily associated with awareness, while personal substance-use behaviors and previous overdose witnessing were associated with both awareness and higher naloxone self-efficacy.

Conclusions

Characteristics associated with lower likelihood of completing each cascade step highlight opportunities for targeted interventions. Specifically, findings indicated the importance of expanding naloxone education and training programs to more diverse populations and to family members of individuals with risky opioid use. Further, these findings demonstrate how a state-funded program such as SCOPE can have a positive impact on identifying strategies that may assist in reducing mortality associated with opioid overdose.

导言为协助俄亥俄州应对阿片类药物流行病，俄亥俄州总检察长任命了多个学科的专家加入阿片类药物预防和教育科学委员会 (SCOPE)。SCOPE 的工作重点是将科学原理应用于制定预防和教育策略，以减少药物使用障碍和相关危害（例如，提高纳洛酮意识）。纳洛酮意识是纳洛酮级联中的一个步骤，它是一个有用的模型，可用于理解非专业人员为使用纳洛酮进行干预而必须采取的连续步骤；其他步骤包括培训和以往的使用经验。之前的工作已经探讨了这些步骤在高危吸毒者中的相关性，但很少有研究关注包含潜在旁观者（如家人和社区成员）的更广泛人群。子样本在五个模型（n = 479-1208）中有所不同，包括阿片类药物暴露者和未暴露者。逻辑回归描述了纳洛酮意识、自我效能（与培训有关）和先前用药过量的临床有用社会人口学预测因素（如种族、民族、教育、就业、住房状况）。另外两个逻辑回归测试了目睹阿片类药物过量的风险因素与两个级联步骤（意识和自我效能）之间的关联。结果非白人种族、西班牙裔和较低的教育程度预示着不知道使用纳洛酮；非白人种族也预示着纳洛酮自我效能较低，而年龄较大则预示着以前没有使用过过量纳洛酮。家庭成员有使用阿片类药物的风险与认识程度有很大关系，而个人药物使用行为和以前目睹过用药过量则与认识程度和较高的纳洛酮自我效能有关。具体而言，研究结果表明，将纳洛酮教育和培训计划扩展到更多不同人群以及有阿片类药物使用风险的个人的家庭成员非常重要。此外，这些研究结果还证明了由州政府资助的计划（如 SCOPE）如何能够对确定有助于降低阿片类药物过量相关死亡率的策略产生积极影响。

{"title":"State program enables the identification of factors associated with naloxone awareness, self-efficacy, and use for overdose reversal: A cross-sectional, observational study in an urban emergency department population","authors":"","doi":"10.1016/j.josat.2024.209506","DOIUrl":"10.1016/j.josat.2024.209506","url":null,"abstract":"<div><h3>Introduction</h3><p>To assist the state of Ohio in addressing the opioid epidemic, the Ohio Attorney General appointed experts in a variety of academic disciplines to the Scientific Committee on Opioid Prevention and Education (SCOPE). The focus of SCOPE is the application of scientific principles to the development of prevention and educational strategies for reducing substance use disorder and related harms (e.g., promoting naloxone awareness). Naloxone awareness is a step in the naloxone cascade, which is a useful model for understanding the sequential steps laypeople must take to prepare themselves to intervene using naloxone; other steps include training and previous administration experience. Prior work has explored correlates of these steps among individuals with risky substance use, but fewer studies have focused on broader populations containing potential bystanders (e.g., family and community members).</p></div><div><h3>Methods</h3><p>This study was a secondary data analysis of patients from three urban emergency departments. Subsamples differed across five models (<em>n</em> = 479–1208) and included opioid-exposed and -naïve participants. Logistic regression characterized clinically useful sociodemographic predictors (e.g., race, ethnicity, education, employment, housing status) of naloxone awareness, self-efficacy (which relates to training), and previous-overdose administration. Two additional logistic regressions tested associations between risk factors for witnessing an opioid overdose and two cascade steps (awareness and self-efficacy).</p></div><div><h3>Results</h3><p>Non-White race, Hispanic ethnicity, and lower education predicted not being aware of naloxone; non-White race also predicted lower naloxone self-efficacy, and older age predicted lack of previous-overdose administration. Having family members with risky opioid use was heavily associated with awareness, while personal substance-use behaviors and previous overdose witnessing were associated with both awareness and higher naloxone self-efficacy.</p></div><div><h3>Conclusions</h3><p>Characteristics associated with lower likelihood of completing each cascade step highlight opportunities for targeted interventions. Specifically, findings indicated the importance of expanding naloxone education and training programs to more diverse populations and to family members of individuals with risky opioid use. Further, these findings demonstrate how a state-funded program such as SCOPE can have a positive impact on identifying strategies that may assist in reducing mortality associated with opioid overdose.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142238771","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

An economic analysis of the cost of mobile units for harm reduction, naloxone distribution, and medications for opioid use disorder 对减少伤害、纳洛酮分发和阿片类药物使用障碍流动单位的成本进行经济分析

N/A PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-09-17 DOI: 10.1016/j.josat.2024.209517

Background & objective

Mobile substance use treatment units are effective approaches to increase treatment access and reduce barriers to opioid use disorder (OUD) care. However, little is known about the economic costs of maintaining and operating these units. This study aimed to estimate the economic costs of starting and maintaining mobile units providing harm reduction, overdose education and naloxone distribution (OEND), and medication for opioid use disorder (MOUD).

Methods

As part of the HEALing Communities Study, four communities in Massachusetts (Bourne/Sandwich, Brockton, Gloucester, Salem) implemented mobile units offering OEND and MOUD (buprenorphine and naltrexone only); each selected different services tailored to their community. All provided MOUD linkage via telehealth, but only one offered in-person MOUD prescribing on the unit. We retrospectively collected detailed resource utilization data from invoices to estimate the direct economic costs from August 2020 through June 2022. Cost components were categorized into start-up and operating costs. We calculated total economic cost over the study period and the average monthly operating cost.

Results

Implementing a mobile unit offering OEND and MOUD required a one-time median start-up cost of $59,762 (range: $52,062–$113,671), with 80 % of those costs attributed to the vehicle purchase. The median monthly operating cost was $14,464. The largest cost category for all mobile units was personnel costs. The monthly ongoing costs varied by community settings and services: approximately $5000 for two urban communities offering OEND and MOUD linkage via telehealth (Gloucester, Salem), $28,000 for a rural community (Bourne/Sandwich), and $23,000 for an urban community also providing in-person MOUD prescribing on the unit (Brockton).

Conclusion

The economic costs of mobile substance use treatment and harm reduction units are substantial but vary by community settings and services offered. Our results provide valuable community-level economic data to stakeholders and policymakers considering establishing and/or expanding mobile units with OEND and MOUD services. Further exploration of cost-effectiveness and efficiency should be considered across different settings.

背景& 目标流动药物使用治疗单位是增加治疗机会和减少阿片类药物使用障碍（OUD）治疗障碍的有效方法。然而，人们对维护和运营这些机构的经济成本知之甚少。作为 "健康社区研究"（HEALing Communities Study）的一部分，马萨诸塞州的四个社区（伯恩/桑德韦奇、布罗克顿、格洛斯特、塞勒姆）实施了提供 OEND 和 MOUD（仅丁丙诺啡和纳曲酮）的流动治疗单位；每个社区都选择了适合自己社区的不同服务。所有机构都通过远程医疗提供 MOUD 连接，但只有一家机构在流动站提供亲自开具 MOUD 处方的服务。我们回顾性地从发票中收集了详细的资源利用数据，以估算 2020 年 8 月至 2022 年 6 月期间的直接经济成本。成本构成分为启动成本和运营成本。我们计算了研究期间的总经济成本和平均每月运营成本。结果实施提供 OEND 和 MOUD 的移动设备所需的一次性启动成本中位数为 59,762 美元（范围：52,062-113,671 美元），其中 80% 的成本用于购买车辆。每月运营成本的中位数为 14,464 美元。所有流动单位的最大成本类别是人员成本。每月的持续成本因社区环境和服务而异：通过远程医疗提供 OEND 和 MOUD 连接的两个城市社区（格洛斯特和塞勒姆）约为 5000 美元，一个农村社区（伯恩/桑德威奇）为 28000 美元，一个城市社区还在流动治疗车上提供当面开具 MOUD 处方的服务（布罗克顿）为 23000 美元。我们的研究结果为考虑建立和/或扩大提供 OEND 和 MOUD 服务的流动治疗单位的利益相关者和决策者提供了宝贵的社区经济数据。应考虑在不同环境中进一步探讨成本效益和效率。

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引用次数: 0

Early-stage implementation of peer-led interventions for emergency department patients with substance use disorder: Findings from a formative qualitative evaluation 针对急诊科药物使用障碍患者的同伴引导干预措施的早期实施：形成性定性评估结果

N/A PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-09-13 DOI: 10.1016/j.josat.2024.209518

Introduction

Emergency department (ED)-based peer recovery coach (PRC) programs can improve access to substance use disorder treatment (SUD) for ED patients. As literature on early stages of PRC implementation is limited, we conducted a qualitative assessment of ED PRC program implementation from several US-based PRC programs focusing on barriers and facilitators for implementation and providing recommendations based on the findings.

Methods

We collected qualitative data from 39 key informants (peer recovery coaches, PRC program managers, ED physicians and staff, representatives of community-based organizations) via 6 focus groups and 21 interviews in February–December 2023. We transcribed audio-recordings and analyzed data using codebook thematic analysis.

Results

We identified the following major themes related to specific barriers and recommendations to address them. To facilitate timely linkage to PRCs, programs would regularly inform ED staff about the program and its linkage procedures, establish trust between PRC and ED staff, streamline the linkage procedures, and choose an “opt-out” linkage approach. To address barriers related to external referrals, programs use “warm handoff” and “warm line” strategies, maintain and update a comprehensive catalog of resources, and familiarize peer coaches with local service providers. Telehealth services implementation requires addressing logistical barriers, ensuring patients' privacy, and training peer coaches on building trust and rapport online. Peer coaches' wellness and quality of services can be improved by limiting PRC's workload, prioritizing quality over quantity, facilitating self-, peer- and professional care to mitigate stress and burnout; and, importantly, by providing supportive supervision and training to peer coaches and advocating for PRC team as an equal partner in the ED settings. To facilitate PRC program adoption and sustainment program managers engage local communities and program champions, seek diverse sources of funding, and advocate for structural changes to accommodate recruitment and retention of peer recovery coaches.

Conclusions

We compiled a wealth of best practices used by PRC programs to address numerous implementation barriers and challenges. These recommendations are intended for PRC program planners, managers and champions, hospital leadership, and state and local public health agencies leading SUD epidemic response.

导言：基于急诊科（ED）的同伴康复指导（PRC）项目可以改善急诊科患者获得药物使用障碍治疗（SUD）的机会。由于有关同伴康复教练项目早期实施阶段的文献有限，我们从几个美国的同伴康复教练项目中对急诊科同伴康复教练项目的实施情况进行了定性评估，重点关注实施过程中的障碍和促进因素，并根据评估结果提出建议。方法我们在 2023 年 2 月至 12 月期间通过 6 个焦点小组和 21 次访谈收集了 39 位关键信息提供者（同伴康复教练、同伴康复教练项目经理、急诊科医生和工作人员、社区组织代表）的定性数据。我们对录音进行了转录，并使用编码本主题分析法对数据进行了分析。结果我们确定了以下与具体障碍相关的主要主题以及解决这些障碍的建议。为便于及时与 PRC 建立联系，项目应定期向教育部门员工介绍项目及其联系程序，在 PRC 和教育部门员工之间建立信任，简化联系程序，并选择 "选择退出 "的联系方法。为了解决与外部转介相关的障碍，项目会使用 "温暖交接 "和 "温暖热线 "策略，维护和更新综合资源目录，并让同伴辅导员熟悉当地的服务提供者。远程保健服务的实施需要解决后勤障碍，确保患者的隐私，并培训同伴辅导员如何在网上建立信任和融洽的关系。通过限制同伴辅导员的工作量、重质不重量、促进自我、同伴和专业护理以减轻压力和职业倦怠，以及为同伴辅导员提供支持性监督和培训，并倡导同伴辅导员团队成为 ED 环境中的平等合作伙伴，可以提高同伴辅导员的健康水平和服务质量。为促进同伴康复项目的采用和持续发展，项目管理人员应与当地社区和项目支持者合作，寻求不同的资金来源，并倡导结构性改革，以适应同伴康复教练的招募和保留。这些建议适用于 PRC 项目的规划者、管理者和拥护者、医院领导层以及领导 SUD 流行病应对工作的州和地方公共卫生机构。

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引用次数: 0

Examining the impact of low magnitude incentives in contingency management protocols: Non-engagement in Petry et al. 2004 在应急管理协议中研究低幅度激励的影响：Petry 等人 2004 年的《不参与》。

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-09-12 DOI: 10.1016/j.josat.2024.209522

Introduction/method

Current federal regulations limit the use of incentives in contingency management (CM) interventions to a nominal total value (i.e., up to $75/patient/year in aggregate of federal funds). This limit represents a striking divergence from the magnitudes used in evidence-based CM protocols. In the present report, we re-analyze data from the Petry et al. (2004) study, which was designed to test the efficacy of two different magnitude CM protocols ($80 and $240 in 2004 dollars) relative to usual intensive outpatient services for treatment-seeking patients with cocaine use. Petry et al. (2004) found that the $240 condition [~$405 in 2024 dollars], but not the $80 condition [~$135 in 2024 dollars], improved abstinence outcomes relative to usual care. The lower-cost $80 condition is the closest condition to the current federal $75 limit that permits a head-to-head comparison of magnitudes. A re-analysis offers an opportunity to examine the impact of low magnitude protocols in more detail, specifically in terms of non-engagement with treatment (defined as absence of negative samples and thus not encountering incentives for abstinence).

Results

We found moderate to large effects favoring the $240 condition over both usual care (ds ranging 0.33 to 0.97) and the $80 condition (ds ranging 0.39 to 0.83) across various thresholds of non-engagement with the incentives/reinforcers for abstinence. Importantly, the $80 condition evidenced higher (worse) rates of non-engagement compared to the usual care condition (i.e., small and negative effect sizes ranging −0.30 to 0.14), though not reaching statistical significance.

Conclusions

These results suggest that CM protocols designed to stay within the federal limitation of $75 should be discouraged, and evidence-based protocols should be recommended along with the regulatory reforms necessary to support their implementation.

导言/方法：现行联邦法规规定，在应急管理（CM）干预中使用的激励措施不得超过名义总值（即每名患者每年的联邦基金总额不得超过 75 美元）。这一限制与以证据为基础的应急管理（CM）方案中使用的激励措施的总值相去甚远。在本报告中，我们重新分析了 Petry 等人（2004 年）的研究数据，该研究旨在测试两种不同规模的 CM 方案（按 2004 年美元计算，分别为 80 美元和 240 美元）对寻求治疗的可卡因使用患者的常规强化门诊服务的疗效。Petry 等人（2004 年）发现，与常规治疗相比，240 美元的治疗方案[约 405 美元（按 2024 年美元计算）]，而 80 美元的治疗方案[约 135 美元（按 2024 年美元计算）]不能改善戒断效果。成本较低的 80 美元条件是最接近当前联邦 75 美元限额的条件，允许进行正面的幅度比较。重新分析提供了一个机会，可以更详细地研究低额度方案的影响，特别是在不参与治疗方面（定义为没有负面样本，因此没有遇到鼓励禁欲的措施）：结果：我们发现，在不同的不参与禁欲激励/强化剂的临界值上，240 美元的方案比常规治疗方案（ds 介于 0.33 到 0.97 之间）和 80 美元的方案（ds 介于 0.39 到 0.83 之间）都有中等到较大的效果。重要的是，与常规护理条件相比，80 美元条件下的不参与率更高（更差）（即，效应大小为-0.30 至 0.14 的小负效应），但未达到统计学意义：这些结果表明，不应鼓励将医疗费用控制在联邦规定的 75 美元范围内，而应建议采用循证方案，并进行必要的监管改革，以支持这些方案的实施。

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引用次数: 0