American Journal on Addictions最新文献

Background and objectives: Despite elevated overdose risk in rural communities, rural/urban differences in overdose risk factors are understudied among women with criminal legal system involvement. This study examines substance use and overdose among incarcerated women.

Methods: Women (N = 900) were randomly selected from nine Kentucky jails, screened, and interviewed as part of a larger study. Bivariate analyses were used to identify group differences.

Results: Rural women were less likely to report pre-incarceration overdose and to receive emergency services post-overdose. Substance use also varied.

Conclusions and scientific significance: Results underscore the importance of Opioid Overdose Education and Naloxone Distribution in rural communities.

Background and objectives: Opioid toxicity remains a significant public health issue in the United States, with naloxone serving as a key intervention to reverse toxicity effects. This study aims to identify demographic predictors across the naloxone cascade-a framework comprising awareness, beliefs, access, availability, and possession of naloxone-among U.S. adults, using data from the National Center for Health Statistics Rapid Survey System.

Methods: We conducted a cross-sectional survey of U.S. adults aged 18 and older (n = 7046, weighted total = 257,926,944 representing the U.S. adult population) between October to November 2023. Multivariable logistic regression analyses identified predictors across each naloxone cascade, adjusted for age, sex, education, race, and poverty status.

Results: Awareness of naloxone was high (75.1%), but only 53.2% were aware of its availability over-the-counter, and 5.6% reported carrying it. Female participants showed higher awareness (OR: 1.29; 95% CI: 1.12-1.48), while participants aged 60 years and over were significantly less likely to carry naloxone (OR: 0.55; 95% CI: 0.32-0.94). Significant disparities observed across racial and socioeconomic groups, with Non-Hispanic Blacks and Hispanics had lower awareness levels than Non-Hispanic Whites.

Discussion and conclusions: Despite high awareness, naloxone possession remains low, especially among older adults and racial minorities. Tailored public health interventions are needed to improve naloxone distribution and accessibility in underserved populations.

Scientific significance: This study identified important demographic predictors and gaps in naloxone possession across U.S. adult populations, offering insights to inform public health strategies to reduce opioid toxicity deaths.

Background and objectives: Medetomidine is a sedative approved by the FDA for veterinary use, but it is not authorized for human use. Its increasing presence alongside illegal opioids like fentanyl contributes to a rise in fatal overdoses across the U.S. While it is more potent than xylazine, knowledge surrounding medetomidine's role as an adulterant remains limited. This review investigates existing human data regarding its illicit use and overdose symptoms and highlights the evolving issue.

Methods: This review compiles case reports, law enforcement findings, and human studies to assess the role of medetomidine in opioid overdoses. We emphasize overdose symptoms, treatment challenges, and clinical outcomes, drawing from cases in U.S. cities experiencing rising overdose rates associated with this sedative.

Results: The review reveals a troubling trend of increasing fatalities related to medetomidine adulteration, particularly in urban areas. Medetomidine's sedative effects complicate the management of opioid overdoses, often leaving many cases unrecognized due to the overlap of symptoms. The rising incidents of seizures and deaths underscore the urgent need for public health action.

Discussion and conclusions: The growing use of medetomidine as an opioid adulterant calls for further research, increased awareness among healthcare professionals and emergency responders, and enhanced diagnostic screening methods. Specific treatment protocols for medetomidine overdoses are crucial, and laboratory testing should be expanded to identify this substance.

Scientific significance: This review highlights the growing prevalence of medetomidine, which has surpassed xylazine also in some areas, and advocates for strengthened public health efforts to address this emerging crisis.

Background and objectives: Cannabis use is increasing in the United States, and, on average, those consuming medical cannabis report more frequent cannabis use than those who use recreationally. The present analyses focus on the prevalence and correlates of working under the influence of cannabis (WUIC) amongst individuals with chronic pain who use cannabis medically.

Methods: Adults were recruited from medical cannabis certification clinics in Michigan and individuals who were employed in the past 6 months were included in the analytic sample (N = 362). Unadjusted and adjusted logistic regressions were estimated to examine factors associated with WUIC. Descriptive analyses examined WUIC by types of employment.

Results: WUIC was reported by 34% (n = 123) of employed medical cannabis patients. After adjusting for other factors, older age and having episodes of 6+ drinks were significantly associated with lower odds of WUIC. History of driving under the influence of cannabis, reporting three+ hours high on cannabis per day, and using 0.5 oz+ of cannabis per week were all significantly associated with higher odds of WUIC.

Discussion and conclusions: Amongst individuals who use cannabis for pain and are in the workforce, WUIC is relatively common. This may be particularly concerning in jobs that are safety-sensitive. Prevention efforts for WUIC might focus on those who use cannabis several times per day and might consider how to balance the needs for pain management with workplace-related roles.

Scientific significance: The current study extends knowledge around the prevalence and characteristics of individuals using medical cannabis who engage in WUIC.

Background and objectives: Few studies have longitudinally investigated suicide risk (SR) in opioid use disorder (OUD). This investigation administered three screening tools to individuals with OUD to compare rates of and variables associated with SR over 12 months.

Methods: 121 individuals meeting criteria for OUD within the past 3 years were administered Item #9 of Patient Health Questionnaire-9 (PHQ-Item-9), the twelfth item of DSM-5-TR Self-Rated Level 1 Cross-Cutting Measure (CCSM-Item-12), and the Ask Suicide-Screening Questions (ASQ) to detect SR at Day 0 and Months 6 and 12. A partitioned generalized methods of moment (GMM) model identified variables associated with SR.

Results: At Day 0, screen-positive rates for SR were 30% for ASQ, 12.4% for PHQ-Item-9, and 4.1% for CCSM-Item-12. Rates were similar at Months 6 and 12. Variables significantly associated with SR by PHQ-Item-9 were intentional overdose history (p < .001), poor sleep (p < .001), meeting criteria for psychosis (p < .001), and meeting criteria for mania (p = .005). Variables significantly associated with SR by ASQ were intentional overdose history (p < .001), female gender (p = .003), meeting criteria for psychosis (p = .001), and total PHQ-9 score (p = .032). Too few participants endorsed SR by CCSM-Item-12 to be included.

Discussion and conclusions: In the OUD population, screening positive for SR was unchanged over 1 year, but detection rates varied by screening tool. History of intentional opioid overdose is independently associated with screening positive for SR.

Scientific significance: This is the first study to evaluate SR in the OUD population using more than one screening tool, and to show an association of history of intentional opioid overdose with SR.

Background and objectives: The United States has been experiencing a deadly epidemic of fatal drug overdose (OD), including among emerging/young adults. We aimed to examine intentional OD (IOD) among young adults receiving methadone maintenance treatment for opioid use disorders (OUD).

Method: Thirty-three participants (18-26 years old) with OUD completed measures of drug use, OD, depression, and suicidal behavior. Between-group differences were analyzed using independent samples t-test and χ² test for continuous and dichotomous data, respectively. Regression analysis was employed to predict the magnitude of intent to die before the most recent OD.

Results: Forty-two percent of the sample had a history of a suicide attempt (SA). Of those, 78% reported >1 IOD. Participants with SA history had a significantly higher depression severity (p = .01), were younger at the onset of opioid use (p = .04) and were less likely to be Hispanic (p = .03) relative to those without SA history. The magnitude of intent to die before the most recent OD was predicted by (a) number of lifetime SAs (p < .001), (b) likelihood that participant thought they would OD before their most recent OD (p = .009), and (c) number of days using illicit opioids in the last 30 (p = .02).

Conclusions and scientific significance: These findings indicate a high prevalence of IOD among young adults enrolled in clinical services. Awareness of suicidal intent as a predictor of OD would improve prevention-intervention methods for the reduction of morbidity and mortality among them. This is the first reported study to examine IOD among emerging/young adults with OUD.

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