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“Now that I'm here, I actually have the stability and the time to really think about stuff like that”: Perspectives on medications for opioid use disorder in low-threshold harm reduction housing “现在我在这里,我实际上有了稳定和时间来真正思考这样的事情”:低阈值减害住房中阿片类药物使用障碍药物的观点
IF 1.9 0 PSYCHOLOGY, CLINICAL Pub Date : 2025-09-25 DOI: 10.1016/j.josat.2025.209810
Avik Chatterjee , Sabrina S. Rapisarda , Joseph Silcox , Sofia Zaragoza , Charlie Summers , Andrew Rolles , Sarah Kosakowski , Traci C. Green
Sweeping of encampments is one policy approach to the growing visibility of homelessness and substance use in U.S. cities but is associated with increased overdose deaths. In 2022, to mitigate the impacts of a sweep, the City of Boston created seven harm reduction housing (HRH) sites to accommodate displaced individuals. HRH sites offered on-site or off-site medications for opioid use disorder (MOUD). As part of a broader parent study, we recruited 28 residents from HRH sites previously enrolled in a survey for semi-structured interviews, exploring their experiences with housing, the current HRH site, substance use, service access, overdose, MOUD, and more. We engaged in an inductive thematic analysis of the MOUD interview data. Four themes emerged from thematic analysis: (1) HRH sites afforded participants on-site access and linkages that facilitated MOUD initiation and retention; (2) when off-site, location, transportation and accessibility issues limited MOUD access; (3) MOUD prescribing policies at HRH sites were uniquely low-threshold; and (4) HRH-related MOUD engagement shaped health-related outcomes. Participants reported that HRH facilitated ease of access and delivery of MOUD both on and off site, raised considerations about how MOUD is accessed through HRH, and described how MOUD through HRH changed their substance use behaviors, health, and quality of life. Government entities that opt to clear encampments as a policy approach to address homelessness and substance use should also implement HRH interventions that facilitate MOUD access in conjunction. Such an approach would mitigate known harms associated with sweeps.
清理营地是解决美国城市中无家可归和吸毒问题日益突出的一种政策方法,但与吸毒过量死亡人数的增加有关。2022年,为了减轻清扫的影响,波士顿市创建了7个减少伤害的住房(HRH)点,以容纳流离失所的人。HRH网站提供现场或非现场药物治疗阿片类药物使用障碍(mod)。作为更广泛的家长研究的一部分,我们招募了28名来自HRH站点的居民进行半结构化访谈,探索他们在住房,当前HRH站点,物质使用,服务获取,过量使用,mod等方面的经历。我们对mod采访数据进行了归纳性专题分析。从专题分析中得出了四个主题:(1)人力资源网站为参与者提供了现场访问和联系,促进了mod的发起和保留;(2)当非现场、地点、交通和可达性问题限制mod访问时;(3)医院处方政策具有独特的低阈值;(4)与健康相关的mod参与塑造了健康相关的结果。参与者报告说,HRH促进了在现场和非现场获取和提供mod的便利性,提出了关于如何通过HRH获取mod的考虑,并描述了通过HRH获得mod如何改变他们的药物使用行为、健康和生活质量。选择将清理营地作为解决无家可归和药物使用问题的政策方法的政府实体也应实施促进mod访问的人力资源干预措施。这种方法将减轻已知的与扫荡有关的危害。
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引用次数: 0
Overdose risk profiles in pregnancy: Latent class analysis of pregnant individuals with opioid use disorder. 妊娠期过量用药风险概况:阿片类药物使用障碍孕妇的潜在分类分析。
IF 1.9 0 PSYCHOLOGY, CLINICAL Pub Date : 2025-09-25 DOI: 10.1016/j.josat.2025.209809
Elysha Cash, Gerald Cochran, Marcela C Smid, Jasmin E Charles, Grace Humiston, Yingjia Wei, Nicole Mauerman, Kristi Carlston, Grace Broussard, Britnee Sengpraseut, Peter R Martin, T John Winhusen

Introduction: Given the continued rise in opioid exposed pregnancies and overdose during the postnatal period, it is critical to identify risk characteristics among this population to enable clinicians to better tailor interventions. This exploratory study sought to develop a deeper understanding of overdose risk characteristics among pregnant people with opioid use disorder and which characteristics may contribute to differing risk profiles.

Methods: Design and participants. This exploratory secondary analysis utilized baseline data from a large-scale national multi-site randomized controlled trial that compared two buprenorphine formulations among treatment seeking pregnant individuals with opioid use disorder.

Assessments: For risk group identification, the Personal Opioid-Overdose Risk Survey was used. Trauma history experience was assessed using the Trauma History Screen and substance use history was captured using the DSM-5 Checklist and Treatment Services Review V6.

Analyses: Latent class analysis identified unique subgroups of participants based on overdose risk factors. Latent class group membership was associated with trauma history and substance use characteristics using logistic and stepwise logistic regression.

Results: Three distinct classes of overdose risk emerged: the tolerance and polysubstance/alcohol use (HIGH-ALC) class (n = 14, 10 %), synthetic opioid and polysubstance use (LOW-ALC/FENT) class (n = 65, 46.4 %), and the low risk (LOW-RISK) class (n = 61, 43.6 %). The HIGH-ALC class reported the most (non-opioid) substance use in the last 12 months with 6 times higher odds of marijuana use (95 % CI, 1.01-35.67) and 17.48 times higher odds of cocaine use (95 % CI, 3.45-88.48) compared to the LOW-RISK class. The LOW-ALC/FENT class (n = 65, 46.4 %) had the highest reports of childhood physical abuse, greater odds of experiencing intimate partner violence regarding recovery (OR = 4.82, 95 % CI = 1.90-12.26), and greater odds of a threat to safe living (OR = 3.35, 95 % CI = 0.72-15.66). The LOW-RISK class (n = 61, 43.6 %) had the lowest reports of polysubstance use in the last 12 months and the least reports of both childhood sexual trauma and adulthood sexual trauma.

Conclusions: Through better understanding distinct patient overdose risk profiles, healthcare providers can deliver more targeted prevention interventions to address individual needs and improve maternal outcomes.

Trial registration: NCT03918850.

导言:鉴于阿片类药物暴露妊娠和产后用药过量的持续上升,确定这一人群的风险特征,使临床医生能够更好地定制干预措施至关重要。本探索性研究旨在深入了解阿片类药物使用障碍孕妇的过量风险特征,以及哪些特征可能导致不同的风险概况。方法:设计与参与者。这项探索性的二次分析利用了一项大规模国家多地点随机对照试验的基线数据,该试验比较了寻求阿片类药物使用障碍孕妇治疗的两种丁丙诺啡配方。评估:对于风险群体的识别,使用了个人阿片类药物过量风险调查。使用创伤史筛查评估创伤史经验,使用DSM-5检查表和治疗服务评估V6获取物质使用史。分析:潜在分类分析确定了基于过量危险因素的参与者的独特亚组。使用逻辑回归和逐步逻辑回归,潜在类别群体成员与创伤史和物质使用特征相关。结果:出现了三个不同的过量风险类别:耐受性和多物质/酒精使用(高alc)类别(n = 14,10 %),合成阿片类药物和多物质使用(低alc /FENT)类别(n = 65, 46.4%)和低风险(低风险)类别(n = 61, 43.6%)。在过去的12个月中,高alc组报告了最多的(非阿片类)物质使用,大麻使用的几率是低风险组的6倍(95% CI, 1.01-35.67),可卡因使用的几率是低风险组的17.48倍(95% CI, 3.45-88.48)。LOW-ALC/FENT组(n = 65, 46.4%)有最高的儿童身体虐待报告,在康复过程中经历亲密伴侣暴力的几率更大(OR = 4.82, 95% CI = 1.90-12.26),对安全生活的威胁几率更大(OR = 3.35, 95% CI = 0.72-15.66)。低风险组(n = 61, 43.6%)在过去12个月内使用多种药物的报告最少,儿童期和成人期性创伤的报告最少。结论:通过更好地了解不同的患者用药过量风险概况,医疗保健提供者可以提供更有针对性的预防干预措施,以满足个人需求并改善产妇结局。试验注册:NCT03918850。
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引用次数: 0
TOC (update) TOC(更新)
IF 1.9 0 PSYCHOLOGY, CLINICAL Pub Date : 2025-09-16 DOI: 10.1016/S2949-8759(25)00183-3
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引用次数: 0
Feasibility of direct induction onto long-acting injectable buprenorphine 直接诱导制备长效注射丁丙诺啡的可行性。
IF 1.9 0 PSYCHOLOGY, CLINICAL Pub Date : 2025-09-16 DOI: 10.1016/j.josat.2025.209808
Thileepan Naren , Dean Membrey , Paul MacCartney , Ryan D'Cunha , Suzanne Nielsen , Sarah Garry

Introduction

When first introduced, induction onto long-acting injectable buprenorphine (LAIB) required a period of stabilization on sublingual buprenorphine, presenting a key treatment barrier for some patients. Recent regulatory changes allow for direct induction on a low-dose weekly LAIB preparation, yet few studies have examined direct induction onto higher dose weekly and monthly LAIB formulations. To address this gap, this case series reports on 129 patients who were commenced directly onto any LAIB preparation.

Methods

A retrospective audit and analysis of the electronic medical record at an urban low-threshold primary healthcare service providing care to a marginalized population of people who inject drugs in Melbourne, Victoria. The study extracted data for all patients who were commenced directly onto LAIB between 1st January 2024 to 31st December 2024.

Results

The study identified patients (n = 129) commenced directly onto any formulation of LAIB. Four patients (3 %) experienced precipitated withdrawal post direct induction onto LAIB, requiring unplanned medical review and symptomatic management but not hospitalization. No other adverse reactions were identified. Most (n = 85, 65.9 %) returned for their next LAIB dose with 57.4 % (n = 74) retained in LAIB treatment at three months.

Conclusion

This case series provides evidence that direct induction onto LAIB is feasible with rates of precipitated withdrawal similar to those previously reported for sublingual buprenorphine induction. Given the benefits of direct induction, in suitably screened patients this could be considered to be a preferred method of LAIB induction.
简介:首次引入时,诱导使用长效注射丁丙诺啡(LAIB)需要一段时间的舌下丁丙诺啡稳定,这对一些患者来说是一个关键的治疗障碍。最近的变化允许直接诱导低剂量每周LAIB制剂,但很少有研究检查直接诱导高剂量每周和每月LAIB制剂。为了解决这一差距,本病例系列报告了129例直接开始使用任何LAIB制剂的患者。方法:对维多利亚州墨尔本的一个城市低门槛初级卫生保健服务机构的电子病历进行回顾性审计和分析,该机构为边缘人群注射毒品提供服务。该研究提取了2024年1月1日至2024年12月31日期间直接开始接受LAIB治疗的所有患者的数据。结果:该研究确定了患者(n = 129)直接开始使用任何配方的LAIB。4例患者(3 %)在直接诱导LAIB后出现急性停药,需要计划外的医学检查和症状管理,但未住院。未发现其他不良反应。大多数(n = 85 %,65.9% %)返回进行下一次LAIB剂量治疗,其中57.4% % (n = 74)在三个月时保留LAIB治疗。结论:本病例系列提供的证据表明,直接诱导到LAIB是可行的,其沉淀戒断率低于先前报道的舌下丁丙诺啡诱导。考虑到直接诱导的好处,在适当筛选的患者中,这可以被认为是诱导LAIB的首选方法。
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引用次数: 0
C2: editorial board C2:编辑部
IF 1.9 0 PSYCHOLOGY, CLINICAL Pub Date : 2025-09-16 DOI: 10.1016/S2949-8759(25)00182-1
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引用次数: 0
Exploring social connections and mental well-being among members of a sober active community: A social network analysis 探索清醒活跃社区成员之间的社会联系和心理健康:社会网络分析。
IF 1.9 0 PSYCHOLOGY, CLINICAL Pub Date : 2025-09-13 DOI: 10.1016/j.josat.2025.209801
Megan S. Patterson , Yunlin Zhou , Anjorin E. Adeyemi , Shuai Ma , Linlin Luo , Allison N. Francis , Zhenning Kang , Katie M. Heinrich , Tyler Prochnow

Introduction

Addiction is a complex and pervasive condition which affects physical, social, and mental health. Research consistently shows that social support and social networks are key to the addiction recovery process (defined as a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential) and recovery communities available outside of or in conjunction to formal treatment are effective in providing such support. This study investigated social networks and psychological distress among members of The Phoenix, a sober active community that incorporates group-based exercise (e.g., CrossFit) into the recovery process.

Methods

Using Social Network Analysis (SNA), we analyzed relationships within The Phoenix CrossFit programs in Denver, Colorado (N = 35) and Wichita, Kansas (N = 42). Linear Network Autocorrelation Models (LNAMs) assessed whether social network positions and connections related to psychological distress among members, and Exponential Random Graph Models (ERGMs) explored factors that explained the presence of supportive relationships between Phoenix members.

Results

Network centrality, such as being identified as a source of support (i.e., in-degree), was associated with lower psychological distress, while peripheral positions correlated with higher psychological distress in both networks. Additionally, individuals experiencing higher psychological distress tended to seek more supportive connections, whereas those with lower distress were more frequently nominated as supportive figures.

Conclusions

These results highlight the potential of community-based recovery resources like The Phoenix to foster social networks that promote mental well-being.
成瘾是一种影响身体、社会和心理健康的复杂而普遍的疾病。研究一致表明,社会支持和社会网络是成瘾康复过程的关键(定义为一个改变的过程,通过这个过程,个人改善了他们的健康和健康,过着自我导向的生活,努力发挥他们的全部潜力),在正式治疗之外或与正式治疗相结合的康复社区可以有效地提供这种支持。这项研究调查了凤凰社(The Phoenix)成员的社交网络和心理困扰。凤凰社是一个清醒的活跃社区,将团体锻炼(如CrossFit)纳入康复过程。方法:使用社会网络分析(SNA),我们分析了科罗拉多州丹丹市(N = 35)和堪萨斯州威奇托市(N = 42)Phoenix CrossFit项目之间的关系。线性网络自相关模型(LNAMs)评估了社会网络位置和联系是否与成员之间的心理困扰有关,指数随机图模型(ERGMs)探讨了解释凤凰社成员之间支持关系存在的因素。结果:网络中心性,如被认定为支持来源(即程度),与较低的心理困扰相关,而外围位置与两个网络中较高的心理困扰相关。此外,经历较高心理困扰的个体倾向于寻求更多的支持性联系,而那些心理困扰程度较低的个体则更经常被提名为支持性人物。结论:这些结果突出了以社区为基础的康复资源,如凤凰社,在促进心理健康的社会网络方面的潜力。
{"title":"Exploring social connections and mental well-being among members of a sober active community: A social network analysis","authors":"Megan S. Patterson ,&nbsp;Yunlin Zhou ,&nbsp;Anjorin E. Adeyemi ,&nbsp;Shuai Ma ,&nbsp;Linlin Luo ,&nbsp;Allison N. Francis ,&nbsp;Zhenning Kang ,&nbsp;Katie M. Heinrich ,&nbsp;Tyler Prochnow","doi":"10.1016/j.josat.2025.209801","DOIUrl":"10.1016/j.josat.2025.209801","url":null,"abstract":"<div><h3>Introduction</h3><div>Addiction is a complex and pervasive condition which affects physical, social, and mental health. Research consistently shows that social support and social networks are key to the addiction recovery process (defined as a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential) and recovery communities available outside of or in conjunction to formal treatment are effective in providing such support. This study investigated social networks and psychological distress among members of <em>The Phoenix</em>, a sober active community that incorporates group-based exercise (e.g., CrossFit) into the recovery process.</div></div><div><h3>Methods</h3><div>Using Social Network Analysis (SNA), we analyzed relationships within <em>The Phoenix</em> CrossFit programs in Denver, Colorado (N = 35) and Wichita, Kansas (N = 42). Linear Network Autocorrelation Models (LNAMs) assessed whether social network positions and connections related to psychological distress among members, and Exponential Random Graph Models (ERGMs) explored factors that explained the presence of supportive relationships between <em>Phoenix</em> members.</div></div><div><h3>Results</h3><div>Network centrality, such as being identified as a source of support (i.e., in-degree), was associated with lower psychological distress, while peripheral positions correlated with higher psychological distress in both networks. Additionally, individuals experiencing higher psychological distress tended to seek more supportive connections, whereas those with lower distress were more frequently nominated as supportive figures.</div></div><div><h3>Conclusions</h3><div>These results highlight the potential of community-based recovery resources like <em>The Phoenix</em> to foster social networks that promote mental well-being.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"179 ","pages":"Article 209801"},"PeriodicalIF":1.9,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066599","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
Decisional needs of intensive care unit survivors with alcohol use disorder considering alcohol treatment: A qualitative study 重症监护病房酒精使用障碍幸存者考虑酒精治疗的决策需要:一项定性研究。
IF 1.9 0 PSYCHOLOGY, CLINICAL Pub Date : 2025-09-12 DOI: 10.1016/j.josat.2025.209798
Kelsey Hills-Dunlap , Christopher E. Knoepke , Daniel D. Matlock , Ellen L. Burnham , Marc Moss , Sarah E. Jolley , Caroline K. Tietbohl

Introduction

Alcohol use disorder (AUD) is a common and serious medical condition with substantial global public health impact, and it is prevalent among patients admitted to intensive care units (ICUs) in the United States. Many ICU survivors with AUD report motivation to change their drinking, however, few receive alcohol treatment. We sought to understand the decision support needs of ICU survivors with AUD when faced with choices about alcohol treatment options.

Methods

In this qualitative study, we completed 17 semi-structured interviews with hospitalized patients with AUD recruited from two urban hospitals in the United States after an alcohol-related ICU admission. We used a reflexive thematic analysis and a deductive and inductive coding approach, with a-priori codes developed from the Ottawa Decision Support Framework.

Results

Participants described any prior experience with alcohol treatment decisions and their current decision-making process regarding engagement with alcohol treatment after ICU admission. In our analysis, we developed four themes and associated subthemes: (1) Decisional needs included knowledge of alcohol's impact on health issues, awareness of treatment options, and trust in the recovery process; (2) Priorities regarding treatment options centered on cost, lifestyle integration, and personal experiences with addiction among treatment program staff; (3) Values regarding the decision making process included a sense of autonomy, relatedness to information providers, and productive involvement of social supports; (4) Decision aids should incorporate video formats to deliver transparent information regarding alcohol treatment options.

Conclusions

Decisional needs of ICU survivors with AUD who are considering alcohol treatment reflect the importance of patient-centered information and consideration of patient preferences and values in alcohol treatment decisions. These findings will inform the development of an alcohol treatment decision aid to address these decisional needs and facilitate engagement with alcohol treatment for ICU survivors with AUD.
酒精使用障碍(AUD)是一种常见且严重的医疗状况,具有重大的全球公共卫生影响,在美国重症监护病房(icu)住院的患者中很普遍。许多患有AUD的ICU幸存者报告有改变饮酒习惯的动机,然而,很少有人接受酒精治疗。我们试图了解患有AUD的ICU幸存者在面对酒精治疗选择时的决策支持需求。方法:在这项定性研究中,我们完成了17例半结构化访谈,访谈对象是来自美国两家城市医院因酒精相关的ICU住院的AUD患者。我们使用了反思性主题分析和演绎和归纳编码方法,以及从渥太华决策支持框架开发的先验代码。结果:参与者描述了任何先前的酒精治疗决策经验,以及他们在ICU入院后关于酒精治疗的当前决策过程。在我们的分析中,我们制定了四个主题和相关的次级主题:(1)决策需求包括酒精对健康问题影响的知识、对治疗方案的认识以及对康复过程的信任;(2)治疗方案的优先选择集中在成本、生活方式整合和治疗项目人员的个人成瘾经历;(3)关于决策过程的价值观包括自主意识、与信息提供者的关系和社会支持的生产性参与;(4)辅助决策工具应采用视频格式,提供有关酒精治疗方案的透明信息。结论:考虑酒精治疗的AUD ICU幸存者的决策需求反映了在酒精治疗决策中以患者为中心的信息和考虑患者偏好和价值观的重要性。这些发现将为酒精治疗决策辅助的发展提供信息,以解决这些决策需求,并促进患有AUD的ICU幸存者参与酒精治疗。
{"title":"Decisional needs of intensive care unit survivors with alcohol use disorder considering alcohol treatment: A qualitative study","authors":"Kelsey Hills-Dunlap ,&nbsp;Christopher E. Knoepke ,&nbsp;Daniel D. Matlock ,&nbsp;Ellen L. Burnham ,&nbsp;Marc Moss ,&nbsp;Sarah E. Jolley ,&nbsp;Caroline K. Tietbohl","doi":"10.1016/j.josat.2025.209798","DOIUrl":"10.1016/j.josat.2025.209798","url":null,"abstract":"<div><h3>Introduction</h3><div>Alcohol use disorder (AUD) is a common and serious medical condition with substantial global public health impact, and it is prevalent among patients admitted to intensive care units (ICUs) in the United States. Many ICU survivors with AUD report motivation to change their drinking, however, few receive alcohol treatment. We sought to understand the decision support needs of ICU survivors with AUD when faced with choices about alcohol treatment options.</div></div><div><h3>Methods</h3><div>In this qualitative study, we completed 17 semi-structured interviews with hospitalized patients with AUD recruited from two urban hospitals in the United States after an alcohol-related ICU admission. We used a reflexive thematic analysis and a deductive and inductive coding approach, with a-priori codes developed from the Ottawa Decision Support Framework.</div></div><div><h3>Results</h3><div>Participants described any prior experience with alcohol treatment decisions and their current decision-making process regarding engagement with alcohol treatment after ICU admission. In our analysis, we developed four themes and associated subthemes: (1) Decisional needs included knowledge of alcohol's impact on health issues, awareness of treatment options, and trust in the recovery process; (2) Priorities regarding treatment options centered on cost, lifestyle integration, and personal experiences with addiction among treatment program staff; (3) Values regarding the decision making process included a sense of autonomy, relatedness to information providers, and productive involvement of social supports; (4) Decision aids should incorporate video formats to deliver transparent information regarding alcohol treatment options.</div></div><div><h3>Conclusions</h3><div>Decisional needs of ICU survivors with AUD who are considering alcohol treatment reflect the importance of patient-centered information and consideration of patient preferences and values in alcohol treatment decisions. These findings will inform the development of an alcohol treatment decision aid to address these decisional needs and facilitate engagement with alcohol treatment for ICU survivors with AUD.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"179 ","pages":"Article 209798"},"PeriodicalIF":1.9,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066658","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
Post-overdose outreach programs in Massachusetts before and after the onset of the COVID-19 pandemic 在COVID-19大流行爆发前后,马萨诸塞州的过量用药后外展计划。
IF 1.9 0 PSYCHOLOGY, CLINICAL Pub Date : 2025-09-10 DOI: 10.1016/j.josat.2025.209799
Alexander Y. Walley , Jiayi Wang , C. To , MaryKate Duska , Stephen Murray , Moriah Wiggins , Andrew Rolles , Shapei Yan , Sarah Kosakowski , Sarah M. Bagley , Ziming Xuan , Justeen Hyde , Scott W. Formica

Purpose

To describe the characteristics of Massachusetts post-overdose outreach programs before and after the onset of the COVID-19 pandemic and identify program adaptations and practices.

Methods

We surveyed Massachusetts post-overdose programs about programming onset, funding, outreach encounters, naloxone distribution, medication for opioid use disorder (MOUD) referrals, and program practices before and after the onset of the COVID-19 pandemic. We calculated frequencies and summary statistics for program characteristics and practices. We compared programs that started before and after the onset of the COVID-19 pandemic using Pearson Chi-squared and Fisher's Exact tests.

Results

As of July 2022, we identified 256 programs active in 242 (69 %) of Massachusetts' 351 municipalities. Before March 2020, 160 “pre-pandemic onset” programs were active. After March 2020, 96 “post-pandemic onset” programs started. In 2022, most were grant funded (89 % (227/256)). Initial survivor contact was attempted via phone (79 % (201/256)) and text (47 % (120/256)), most commonly by a recovery coach (77 % (196/256)). Most programs offered fentanyl test strips and naloxone. Some programs, more commonly pre-pandemic onset, offered safer smoking and injecting supplies. Among the 160 pre-pandemic onset programs, new practices included recommending virtual spotting (44 % (70/160)), facilitating MOUD telemedicine (24 % (39/160)), outreach for people using cocaine and methamphetamine (42 % (67/160)), and referring to race and ethnicity congruent services (31 % (50/160)).

Conclusion

Massachusetts post-overdose outreach programs expanded following the COVID-19 pandemic onset. Services and innovations included resources to reduce harms from the unregulated drug supply (e.g., fentanyl test strips) and more inclusive outreach (e.g., include people using stimulants and race and ethnicity congruent services).
目的:描述马萨诸塞州在COVID-19大流行发生前后的过量用药后外展项目的特点,并确定项目的调整和实践。方法:我们调查了马萨诸塞州药物过量后项目的规划开始、资金、外展遭遇、纳洛酮分发、阿片类药物使用障碍(mod)转诊药物以及COVID-19大流行发生前后的项目实践。我们计算了频率和程序特征和实践的汇总统计。我们使用皮尔逊卡方检验和费雪精确检验比较了COVID-19大流行爆发前后开始的项目。结果:截至2022年7月,我们在马萨诸塞州351个城市的242个(69 %)中确定了256个项目。在2020年3月之前,160个“大流行前发病”项目处于活跃状态。2020年3月之后,96个“大流行后发病”项目启动。在2022年,大多数是拨款资助的(89% %(227/256))。通过电话(79 %(201/256))和短信(47 %(120/256))尝试与幸存者进行初步联系,最常见的是由恢复教练(77 %(196/256))联系。大多数项目提供芬太尼试纸和纳洛酮。一些项目,更常见的是在大流行爆发前,提供更安全的吸烟和注射用品。在160个大流行开始前的方案中,新的做法包括建议虚拟发现(44% %(70/160))、促进mod远程医疗(24% %(39/160))、向使用可卡因和甲基苯丙胺的人提供外展服务(42% %(67/160))以及参照符合种族和族裔的服务(31% %(50/160))。结论:马萨诸塞州在COVID-19大流行爆发后扩大了用药过量后的外展计划。服务和创新包括用于减少不受管制的药物供应(例如芬太尼试纸条)的危害的资源和更具包容性的外展(例如,包括使用兴奋剂的人以及符合种族和族裔的服务)。
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引用次数: 0
U.S. states opting out of expanded methadone take-home policies and associated mortality 美国各州选择退出扩大美沙酮带回家政策和相关死亡率。
IF 1.9 0 PSYCHOLOGY, CLINICAL Pub Date : 2025-09-06 DOI: 10.1016/j.josat.2025.209800
Victor Roy , Michele J. Buonora , Cristina Murray-Krezan , Anthony Fabio , Paul J. Joudrey

Background

Historically, federal regulations limited take-home methadone doses largely due to concerns about methadone-related overdose. In response to the COVID-19 pandemic, an emergency federal policy in March 2020 permitted states to expand take-home methadone doses. Our objective was to utilize state-level variation in take-home expansion to compare changes in methadone related overdose death rates among states that opted into and then out of expanded take-home dosing with states that opted into and continued the policy.

Methods

We used an extended two-way fixed effects difference-in-differences (DID) approach. The intervention group included states that initially opted into and then out of expanded take-home dosing, while the comparison group included states that opted into and continued the policy. Our primary outcome was the average treatment effect on the treated states (ATET) using quarterly rate of methadone-related overdose deaths per 100,000 persons from April 2020 to December 2022. Data sources included a state policy review, CDC WONDER, and U.S. Census Bureau.

Results

The intervention group included three states that opted out of expanded take-home dosing, while the comparison group comprised 16 states maintaining the policy. We found no significant association between opting out of expanded take-home dosing and methadone-related overdose death rates [ATET = 0.02, 95 % CI = (−0.03, 0.47), p = 0.47]. Adjustments for non-methadone-related overdose variables yielded similar results.

Conclusion

States who continued expanded take-home methadone dosing did not subsequently experience a detectable increase in methadone-related overdose deaths relative to states that opted out of the policy. This evidence suggests that policies expanding methadone take-homes are safe at a population level, which can inform deliberations within states that currently maintain strict restrictions.
背景:历史上,联邦法规限制带回家的美沙酮剂量主要是由于担心美沙酮过量。为了应对COVID-19大流行,2020年3月的一项紧急联邦政策允许各州扩大美沙酮的带回家剂量。我们的目标是利用州层面上的变化来比较选择加入和退出扩大的带回家剂量的州与选择加入并继续该政策的州之间美沙酮相关的过量死亡率的变化。方法:采用扩展的双向固定效应差分法(DID)。干预组包括最初选择加入然后退出扩大的带回家剂量的州,而对照组包括选择加入并继续执行该政策的州。我们的主要结局是使用2020年4月至2022年12月每10万人中美沙酮相关过量死亡的季度率对治疗状态(ATET)的平均治疗效果。数据来源包括州政策审查、CDC WONDER和美国人口普查局。结果:干预组包括三个选择退出扩大带回家剂量的州,而对照组包括16个维持政策的州。我们发现选择退出扩大的带回家剂量与美沙酮相关的过量死亡率之间没有显著关联[ATET = 0.02,95 % CI = (-0.03,0.47),p = 0.47]。对与美沙酮无关的用药过量变量进行调整,也得到了类似的结果。结论:与退出政策的州相比,继续扩大美沙酮带回家剂量的州随后并未出现美沙酮相关过量死亡的可检测到的增加。这一证据表明,扩大美沙酮带回家的政策在人口水平上是安全的,这可以为目前保持严格限制的州的审议提供信息。
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引用次数: 0
The effects of psychostimulant prescription on opioid use disorder among people with co-occurring ADHD 精神兴奋剂处方对并发ADHD患者阿片类药物使用障碍的影响。
IF 1.9 0 PSYCHOLOGY, CLINICAL Pub Date : 2025-08-26 DOI: 10.1016/j.josat.2025.209794
Mohammad Yaseliani , Youngsuhk Jo , Lake Lindo , Jabed Al Faysal , Md Mahmudul Hasan

Importance

Attention-deficit/hyperactivity disorder (ADHD) is a condition often comorbid with substance use disorders. With the increase in opioid and stimulant overdoses, there remains concern regarding the appropriateness of psychostimulants for patients on maintenance therapy for opioid use disorder (OUD) with co-occurring ADHD.

Objectives

To assess the impact of psychostimulant use on outcomes of OUD maintenance therapy with buprenorphine based on rates of (1) treatment discontinuation and (2) opioid-related hospitalization.

Design, setting, and participants

This present investigation used a retrospective cohort study design consisting of a secondary analysis of data collected from IBM MarketScan Commercial claims from 2011 to 2021. Individuals were aged 12 to 64 with concurrent ADHD and OUD diagnosis receiving buprenorphine treatment.

Exposures

Presence of psychostimulant prescriptions.

Main outcomes and measures

Primary outcomes were buprenorphine discontinuation and opioid-related hospitalization.

Results

Study sample included 10,712 individuals with comorbid ADHD and OUD (mean age of 31.7 years, SD 10.9) who initiated buprenorphine maintenance therapy. 5190 individuals received psychostimulant prescriptions while 5522 individuals did not. Individuals who received psychostimulants demonstrated lower odds of buprenorphine discontinuation (OR = 0.669, 95 % CI = 0.610, 0.734) and hospitalization (OR = 0.493, 95 % CI = 0.418, 0.581). A one-unit increase in the psychostimulant fill count (IRR = 0.580, 95 % CI = 0.493, 0.683) was associated with a lower incidence rate of hospitalization.

Conclusions

In patients with a dual diagnosis of ADHD and OUD on buprenorphine therapy, treatment of ADHD with prescription psychostimulants is associated with improved adherence to buprenorphine and lower odds of opioid-related hospitalization.
重要性:注意缺陷和多动障碍(ADHD)通常与物质使用障碍共病。随着阿片类药物和兴奋剂过量使用的增加,人们仍然关注阿片类药物使用障碍(OUD)并发ADHD患者维持治疗的适当性。目的:基于(1)治疗停药率和(2)阿片类药物相关住院率,评估精神兴奋剂使用对丁丙诺啡维持OUD治疗结果的影响。设计、环境和参与者:本研究采用回顾性队列研究设计,包括对2011年至2021年从IBM MarketScan商业索赔中收集的数据进行二次分析。12至64岁同时患有ADHD和OUD诊断的个体接受丁丙诺啡治疗。暴露:存在精神兴奋剂处方。主要结局和措施:主要结局是丁丙诺啡停药和阿片类药物相关住院。结果:研究样本包括10,712例ADHD和OUD合并症患者(平均年龄32.2 岁,SD 11.2),他们开始了丁丙诺啡维持治疗。5190人服用了精神兴奋剂处方,5522人没有服用。接受精神兴奋剂的个体显示丁丙诺啡停药(OR 0.669(95 % CI 0.610至0.734))和住院(OR 0.493(95 % CI 0.418至0.581)的几率较低。精神兴奋剂填充计数增加1个单位(IRR = 0.580,95 % CI = 0.493,0.683)与住院率降低相关。结论:在接受丁丙诺啡治疗的ADHD和OUD双重诊断的患者中,处方精神兴奋剂治疗ADHD与改善对丁丙诺啡的依从性和降低阿片类药物相关住院的几率相关。
{"title":"The effects of psychostimulant prescription on opioid use disorder among people with co-occurring ADHD","authors":"Mohammad Yaseliani ,&nbsp;Youngsuhk Jo ,&nbsp;Lake Lindo ,&nbsp;Jabed Al Faysal ,&nbsp;Md Mahmudul Hasan","doi":"10.1016/j.josat.2025.209794","DOIUrl":"10.1016/j.josat.2025.209794","url":null,"abstract":"<div><h3>Importance</h3><div>Attention-deficit/hyperactivity disorder (ADHD) is a condition often comorbid with substance use disorders. With the increase in opioid and stimulant overdoses, there remains concern regarding the appropriateness of psychostimulants for patients on maintenance therapy for opioid use disorder (OUD) with co-occurring ADHD.</div></div><div><h3>Objectives</h3><div>To assess the impact of psychostimulant use on outcomes of OUD maintenance therapy with buprenorphine based on rates of (1) treatment discontinuation and (2) opioid-related hospitalization.</div></div><div><h3>Design, setting, and participants</h3><div>This present investigation used a retrospective cohort study design consisting of a secondary analysis of data collected from IBM MarketScan Commercial claims from 2011 to 2021. Individuals were aged 12 to 64 with concurrent ADHD and OUD diagnosis receiving buprenorphine treatment.</div></div><div><h3>Exposures</h3><div>Presence of psychostimulant prescriptions.</div></div><div><h3>Main outcomes and measures</h3><div>Primary outcomes were buprenorphine discontinuation and opioid-related hospitalization.</div></div><div><h3>Results</h3><div>Study sample included 10,712 individuals with comorbid ADHD and OUD (mean age of 31.7 years, SD 10.9) who initiated buprenorphine maintenance therapy. 5190 individuals received psychostimulant prescriptions while 5522 individuals did not. Individuals who received psychostimulants demonstrated lower odds of buprenorphine discontinuation (OR = 0.669, 95 % CI = 0.610, 0.734) and hospitalization (OR = 0.493, 95 % CI = 0.418, 0.581). A one-unit increase in the psychostimulant fill count (IRR = 0.580, 95 % CI = 0.493, 0.683) was associated with a lower incidence rate of hospitalization.</div></div><div><h3>Conclusions</h3><div>In patients with a dual diagnosis of ADHD and OUD on buprenorphine therapy, treatment of ADHD with prescription psychostimulants is associated with improved adherence to buprenorphine and lower odds of opioid-related hospitalization.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"179 ","pages":"Article 209794"},"PeriodicalIF":1.9,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981287","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}
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Journal of substance use and addiction treatment
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