American Journal on Addictions最新文献

Background and Objectives

Xylazine, an alpha-2-adrenergic agonist, has been increasingly implicated in substance use and overdose crises. However, little is known about its effects on humans. With the growing public health crisis surrounding xylazine, it has become important to recognize and promptly manage symptoms of xylazine toxicity, withdrawal, and overdose. We conducted a systematic review to consolidate the existing literature on the topics, aiming to identify gaps and propose evidence-based actions for managing patients.

Methods

Published literature from 1957 to 2024 was searched to identify studies focusing on the management of xylazine intoxication, withdrawal, overdose, and dependence in humans. PRISMA guidelines and JBI critical appraisal tools were used to ensure the methodological quality of the included studies and reduce bias in study selection. Thirty-four studies were included in this review.

Results

Xylazine misuse was common among men aged 19–45 years and was more likely to be used with other substances than alone. The doses ranged from 40 to 4300 mg, with no established toxic dosing. Supportive care included treatment with naloxone, alpha-2 agonists, and GABAergic medications. There is no antidote or evidence-based treatment recommendations.

Discussion and Conclusions

This systematic review consolidated the outcomes and proposed guidelines from xylazine management trials. It can serve as a reference for providers to promptly manage xylazine toxicity, withdrawal, and overdose symptoms to improve patient outcomes.

Scientific Significance

Although there is currently no standardized treatment or antidote, this review will aid ongoing research to address these gaps in xylazine management.

Background

Adults in later life (ages 50+) are disproportionately impacted by tobacco morbidity and mortality. While tobacco prevalence has stagnated, cannabis use prevalence is rising at higher rates for older (vs. younger) age groups.

Objective

To update the literature and better characterize co-use in older age using nationally representative data.

Methods

National Survey on Drug Use and Health 2015–2019 data were used to assess the prevalence of past-month tobacco-only, cannabis-only, and tobacco and cannabis co-use among adults 50+ years (N = 43,963) in late middle-age (50–64) and older adulthood (65+ years). Multinomial logistic regressions explored sociodemographic/health characteristics associated with past-month co-use and cannabis-only use (vs. tobacco-only). We characterized past-year healthcare visits by use patterns.

Results

One in five adults 50+ years reported past-month tobacco and/or cannabis use. Past-month co-use was higher in middle-age (3.5%) than older age (0.8%). Co-use was more likely among individuals reporting fair/poor health (vs. excellent/very good) (adjusted risk ratio [aRRR] = 1.27, 95% confidence interval [CI] = 1.01, 1.60), and with past-year mental illness (aRRR = 1.67, 95% CI = 1.39, 2.01). Cannabis-only use (vs. tobacco-only) was more likely among those with mental illness, yet less likely among those with good or fair/poor health than excellent/very good health. Most (90.2%) had any past-year healthcare contact, with all visit types overrepresented by tobacco-only use.

Conclusion and Scientific Significance

Older U.S. adults with poorer physical and mental health were more likely to report past-month co-use than tobacco-only. These data uniquely describe the prevalence and characteristics of adults 50+ years in the U.S. who co-use tobacco and cannabis use.

Background and Objectives

Synthetic cannabinoids (SCs) cause adverse physiological and psychological effects. There is little information about current SC use in the general United States (U.S.) population (i.e., nonclinical samples). The current study investigated the frequency and characteristics of SC use in a nonclinical U.S. sample and investigated potential motivations for use via the Acquired Preparedness Model (APM) of addiction (i.e., impulsivity, positive outcome expectancies (POEs)).

Methods

In this cross-sectional study, adults who endorsed past-year SC use (n = 232) completed an online survey. Descriptive statistics were performed to examine characteristics of the sample. Mediation analyses were performed to examine the relationship between facets of impulsivity (Sensation Seeking, Positive Urgency, Negative Urgency, Total Impulsivity) and frequency of SC use with POEs as a mediating variable.

Results

The mean age of the sample was 41 years old (SD = 13.36) and 62.9% identified as male. The mean frequency of past-year SC use was 83 days (SD = 93.1). Greater Sensation Seeking was the only facet of impulsivity significantly associated with a higher frequency of SC use. POEs were not significantly associated with the frequency of SC use and did not mediate the relationship between impulsivity and frequency of SC use.

Discussion and Conclusions

U.S. adults with past-year SC use reported using SC to manage stress, anxiety, and pain. Greater Sensation Seeking was associated with greater frequency of past-year SC use.

Scientific Significance

The present study is novel for its examination of SC in a nonclinical, adult sample and the use of the APM to examine motivations for SC use.

Background and Objectives

Often patients with opioid use disorder (OUD) do not receive needed treatment; in part, this is due to the lack of available clinicians who treat OUD. To address the workforce gap, this study assessed OUD-related training for physicians and healthcare team members using the Project Extension for Community Healthcare Outcomes® (Project ECHO) model in a primary care, team-based setting.

Methods

Twelve 1-h virtual Project ECHO sessions were held from April 2023 through March 2024. Twenty practices and 130 participants participated. Baseline and endpoint surveys, and brief post-session surveys were collected. Descriptive statistics, non-parametric tests, and Likert scales were used for survey questions. Analyses were performed at the group and individual level, and by role over time, using Mann–Whitney U tests, Wilcoxon Signed Rank tests, and Quade's ANCOVA, respectively. Sensitivity analyses were also completed.

Results

Participants self-reported confidence and knowledge significantly increased at the individual, group, and role level. The greatest increases were seen on the topics of treating patients with fentanyl or co-occurring hepatitis C, office-based treatments, and behavioral health/counseling.

Discussion and Conclusions

Primary care team-based educational models have the potential to increase confidence and knowledge among participants, which may contribute to bridging care gaps for patients with OUD.

Scientific Significance

To our knowledge, this is one of the first studies to use Project ECHO across clinical teams. This study demonstrates that accessible team-based learning can strengthen self-reported confidence and knowledge and potentially contribute to increased role recognition, and strengthen the approach to opioid use disorder patient care.

Background and Objectives

Cannabis use is associated with psychotic disorder onset and exacerbation. This study examines how continued cannabis use affects depressive symptoms, psychotic symptoms, and suicidal behaviors following cannabis-induced first-episode psychosis (FEP).

Methods

Sixty-five participants (aged 16–50 years) with FEP were recruited from psychiatric inpatient facilities in northern Italy. Participants were categorized into two groups: non-cannabis users (NCU) and cannabis users (CU), based on substance use during the 9-month follow-up. Twenty-one participants (32.3%) were lost to follow-up, with a final sample of 44 subjects (NCU = 22, CU = 22). Assessments were conducted at baseline, 3 months, and 9 months using PANSS, CDSS, SSI, and GAF scales).

Results

CU exhibited persistently higher depression (CDSS) and suicidality (SSI) scores than NCU throughout follow-up, with significant differences at both 3 months (CDSS: p = .000006; SSI: p < .001) and 9 months (CDSS: p = .0000001; SSI: p < .001). Positive psychotic symptoms improved in both groups, though CU showed slower recovery and higher relapse rates (59.9% vs. 18.8%). PANSS positive subscale scores remained significantly higher in CU at 3 months (p = .001) and 9 months (p < .0002). GAF scores improved significantly only in NCU (p = .024 at 9 months).

Discussion and Conclusions

Continued cannabis use adversely affects depressive and psychotic symptoms and suicidality in FEP patients, while cannabis cessation is associated with improved clinical outcomes.

Scientific Significance

This study tracks depressive symptoms, suicidality, and psychotic manifestations in cannabis-induced FEP, demonstrating that continued use is associated with treatment-resistant depressive symptoms even when psychotic symptoms improve, highlighting the need for integrated clinical approaches.

Background and Objectives

Several medications for alcohol use disorder (MAUDs) are recommended to treat alcohol use disorder (AUD) in the Veterans Affairs (VA) guidelines. This study descriptively characterized treatment patterns and healthcare resource utilization (HCRU) among VA patients with AUD treated with VA-recommended MAUDs.

Methods

Veterans Health Administration data (VHA; 08/01/2013–11/30/2019) were used to identify 31,384 adults aged ≥18 years with AUD who initiated disulfiram (n = 2115), acamprosate (n = 3756), oral naltrexone (n = 25,082), or extended-release naltrexone (XR-NTX; n = 431) following AUD diagnosis. Study measures, stratified by medication received, included treatment adherence (proportion of days covered), discontinuation, and HCRU over 1 year.

Results

Mean time to treatment discontinuation was high for all MAUDs but longest for XR-NTX (92 vs. 55–59 days; all p < .001). Relative to the year preceding AUD diagnosis, treatment with MAUDs was associated with fewer hospitalizations (XR-NTX: 0.48 vs. 0.42; oral naltrexone: 0.58 vs. 0.47; acamprosate: 0.67 vs. 0.60; disulfiram: 0.63 vs. 0.57) and more outpatient visits per patient (XR-NTX: 20.0 vs. 36.0; oral naltrexone: 19.0 vs. 30.0; acamprosate: 19.0 vs. 31.0; disulfiram: 17.0 vs. 29.0).

Conclusion

Among veterans with AUD, this descriptive analysis found that MAUD use was associated with reduced hospitalizations, and XR-NTX was associated with a longer treatment duration versus oral MAUDs.

Scientific Significance

This real-world study is among the first to describe clinical characteristics, treatment patterns, and HCRU in VHA patients who initiated MAUDs when all MAUDs were included in the VHA formulary.

Background

Over the past 15 years, most states have legalized the medical use of cannabis. Since then, daily use nearly tripled while the number of adults dying by suicide increased by 31%. Key studies found a greater suicidal intensity associated with cannabis use (CU) in adolescents. Adult associations have been understudied. The purpose of this study was to evaluate associations between CU and suicidal ideation intensity (SII) in adults.

Methods

We examined 530 psychiatric inpatients ages 18 and above using the Columbia-Suicide Severity Rating Scale and the Alcohol, Smoking and Substance Involvement Screening Test for CU. We conducted a path analysis model of moderating and mediating factors, including psychiatric comorbidity, emotional regulation, psychological flexibility, and polygenic risk scores for externalization, CU, and suicide.

Results

Sixteen percent of the participants had no suicidality, 34.3% reported suicidal ideation, and 49.6% reported a prior suicide attempt. CU was found to be associated with lower risk of SII for females (p = .026) but not for males (p = .525), and increased CU was associated with greater risk of SII with lower psychological flexibility in males (p = .049) but not females (p = .628).

Conclusions

CU was associated with increased SII among psychiatric inpatients, with sex-specific patterns and potential mediation by psychological flexibility. Further studies exploring specific amounts, duration of use, and time frames of CU during adolescence and adulthood may provide insights into its associated risks, especially as legalization expands.

Scientific significance

Patterns of past and current CU may increase understanding of mechanisms predicting increased SII in adult male psychiatric inpatients.

Background and Objectives

Within substance use research, religion and spirituality (r/s) have been understudied in relation to harm reduction approaches. We perform a literature review to characterize various intersections between r/s and harm reduction.

Methods

We searched major databases, Google Scholar, and other sources for academic articles and gray literature on the intersection between r/s and harm reduction. We describe areas of overlap and tension as well as analyze the results using three tiers of proximity to lived/living experience.

Results

Of the 457 papers identified, 169 met final inclusion. Of these, 100 papers contained discussion of alignment between religious or spiritual values and harm reduction values, 39 discussed strategic uses of religious or spiritual resources, 22 discussed harm reduction practices in relation to substances with religious/spiritual relevance, such as psychedelics, and 8 discussed religious/spiritual support for harm reduction workers. Eighteen noted that content was coproduced with persons with lived/living experience, 75 of them noted content was informed by relationship with persons with lived/living experience, and in 76 no such engagement was mentioned.

Discussion and Conclusions

The relevance of r/s is not limited to abstinence-based models and has significance in the harm reduction literature.

Scientific Significance

This is the first systematic study of the complex intersection between r/s and harm reduction. The results point to opportunities to further understand r/s as both barrier to and resource for harm reduction efforts, as well as how proximity to those with lived/living experience may influence alignment with harm reduction values.

Background and Objectives

Clinical follow-up data after substance use disorder (SUD) treatment provides important information about treatment effectiveness, yet compliance is a challenge. We compared financial incentives for obtaining follow-up data from adults receiving inpatient SUD treatment.

Methods

Participants (N = 237) were randomized to receive a guaranteed incentive, raffle-based incentive, or no incentive for completing a 1-month follow-up assessment.

Logistic regression tested the effect of incentives on follow-up completion.

Results

Those in the raffle condition had >2 times higher odds of completing a follow-up assessment compared to those in the no-incentive or guaranteed-incentive conditions.

Discussion and Conclusions

The raffle-based financial incentive was most effective in obtaining follow-up data.

Scientific Significance

Raffle-based incentives may improve follow-up after treatment and help clinicians evaluate SUD treatment outcomes.