American Journal on Addictions最新文献_第5页

Health care service utilization and drug overdose death: A national nested case–control registry study 医疗服务利用率与吸毒过量死亡：全国巢式病例对照登记研究。

IF 2.5 4区医学 Q2 SUBSTANCE ABUSE

American Journal on Addictions

Pub Date : 2024-08-26 DOI: 10.1111/ajad.13630

Linn Gjersing MPH, PhD, Ellen J. Amundsen PhD

Background and Objectives

More knowledge is needed to identify and reach those at overdose risk with preventive measures. We examined past 12-month health service utilization, identified the most frequently utilized service, explored this utilization in more detail, and examined correlates of overdose death.

Methods

A population-based nested case–control registry study including all drug overdose deaths (1 January 2010 to 31 December 2018) in Norway through the Cause of Death Registry (n = 2388). The year-, age- and gender-matched controls included through a population registry (n = 21,465). Data cross-linked with population and patient registries. Multivariable conditional logistic regression analyses estimated the likelihood of overdose death.

Results

The cases (vs. controls) attended a higher median number of services (3 vs. 1). The General Practitioner (GP) was the most utilized service. The majority (55.7%) of cases had 11–50 encounters, while the majority (60.7%) of the controls had 1–5 encounters. No high school diploma, no employment, urban living, social welfare benefits/disability pension, single-person household, recent incarceration, multiple health service utilization and frequent GP encounters, as well psychological and certain physical diagnoses were correlates of overdose death among the GP attenders.

Discussion and Conclusions

The cases had utilized more services than the controls and the GP was the most frequently utilized service. In addition to low socioeconomic status, psychological and certain physical diagnoses were correlates of overdose death.

Scientific Significance

This is the first national case–control registry study to document the high utilization of multiple primary and secondary health care services before drug overdose death, as well as reasons for attendance and correlates of overdose death.

背景和目标：我们需要更多的知识来识别用药过量风险人群并采取预防措施。我们研究了过去 12 个月的医疗服务使用情况，确定了最常使用的服务，更详细地探讨了这种使用情况，并研究了用药过量死亡的相关因素：这是一项基于人群的嵌套病例对照登记研究，通过死因登记（n = 2388）纳入了挪威所有药物过量死亡病例（2010 年 1 月 1 日至 2018 年 12 月 31 日）。通过人口登记（n = 21465）纳入与年份、年龄和性别匹配的对照。数据与人口登记处和患者登记处交叉关联。多变量条件逻辑回归分析估计了用药过量死亡的可能性：病例（与对照组相比）接受服务的中位数较高（3 次与 1 次）。全科医生（GP）是使用最多的服务。大多数病例（55.7%）的就诊次数为 11-50 次，而大多数对照组病例（60.7%）的就诊次数为 1-5 次。没有高中文凭、没有工作、居住在城市、领取社会福利/残疾抚恤金、单人家庭、近期入狱、多次使用医疗服务、频繁就诊全科医生以及心理和某些身体诊断是全科医生就诊者用药过量死亡的相关因素：病例比对照组使用了更多的服务，而全科医生是使用最频繁的服务。除了社会经济地位低之外，心理和某些身体诊断也与吸毒过量死亡有关：这是首个全国性病例对照登记研究，记录了吸毒过量死亡前对多种初级和二级医疗服务的高利用率，以及就诊原因和吸毒过量死亡的相关因素。

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引用次数: 0

Alcohol use disorder, cannabis use disorder, and eating disorder symptoms among male and female college students 男女大学生中的酒精使用障碍、大麻使用障碍和饮食失调症状。

IF 2.5 4区医学 Q2 SUBSTANCE ABUSE

American Journal on Addictions

Pub Date : 2024-08-17 DOI: 10.1111/ajad.13634

Eric R. Pedersen PhD, Ireland M. Shute BA, Keegan D. Buch BA, Reagan E. Fitzke BS, Katherine A. Berry MS, Denise D. Tran PhD, Stuart B. Murray PhD

Background and Objectives

Eating disorders (EDs) and substance use disorders are prevalent among college students in the United States, with underlying common mechanisms suggesting co-occurrence of these in the student population. As treatment prognosis of EDs improves when they are identified and treated with early intervention, it is essential to understand which substance use behaviors associate with EDs in students.

Methods

Using a sample of 471 college students recruited for a study on high risk drinking (i.e., students needed to pregame regularly to be included), we explored the associations between ED symptomatology and two common substances used in this population: alcohol and cannabis. As most research on EDs focuses on female students only or does not separate out males and females, we examined whether sex assigned at birth moderated the association between ED symptomatology and substance use outcomes.

Results

About one-third (32.4%) of the sample screened positive for an ED, with females significantly more likely to screen positive. Males were significantly more likely to screen positive for an alcohol or cannabis use disorder. Screening positive for an ED associated with cannabis use frequency and cannabis use disorder symptoms, but not with alcohol outcomes. Sex moderated the association between ED and cannabis use disorder symptoms, with positive ED screen male students experiencing the highest cannabis use disorder symptoms.

Discussion and Conclusions

It is necessary to further assess how sex differences in substance use and ED symptomatology inform each other.

Scientific Significance

Findings underscore the need to assess and screen for cannabis use disorder among students who screen positive for an ED, and, more specifically, with focused attention on male students with ED symptoms.

背景和目的：饮食失调（ED）和药物使用失调在美国大学生中非常普遍，其潜在的共同机制表明这两种疾病在学生群体中同时存在。如果能及早发现并进行干预治疗，饮食失调症的治疗预后会有所改善，因此了解哪些药物使用行为与学生的饮食失调症有关至关重要：方法：我们利用一项高风险饮酒研究招募的 471 名大学生样本（即学生需要定期参加赛前活动），探讨了 ED 症状与该人群中常用的两种物质：酒精和大麻之间的关联。由于有关 ED 的研究大多只关注女学生，或者没有将男女学生区分开来，因此我们研究了出生时的性别是否会调节 ED 症状与药物使用结果之间的关系：约有三分之一（32.4%）的样本筛查出 ED 阳性，其中女性筛查出 ED 阳性的几率明显更高。男性在酒精或大麻使用障碍筛查中呈阳性的几率明显更高。ED 筛查呈阳性与大麻使用频率和大麻使用障碍症状有关，但与酒精结果无关。性别调节了酒精中毒与大麻使用障碍症状之间的关系，酒精中毒筛查呈阳性的男生大麻使用障碍症状最高：有必要进一步评估药物使用和 ED 症状的性别差异如何相互影响：科学意义：研究结果强调，有必要在 ED 筛查呈阳性的学生中评估和筛查大麻使用障碍，更具体地说，要重点关注有 ED 症状的男生。

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引用次数: 0

Dexmedetomidine HCL (BXCL501) as a potential treatment for alcohol use disorder and comorbid PTSD: A phase 1b, placebo-controlled crossover laboratory study 右美托咪定盐酸盐（BXCL501）作为酒精使用障碍和合并创伤后应激障碍的一种潜在治疗方法：1b期安慰剂对照交叉实验室研究。

IF 2.5 4区医学 Q2 SUBSTANCE ABUSE

American Journal on Addictions

Pub Date : 2024-08-16 DOI: 10.1111/ajad.13637

Ismene L. Petrakis MD, Tracy Nolen PhD, Nathan Vandergrift PhD, Shawn Hirsch MPH, John H. Krystal MD, Michael De Vivo PhD, Jeff Sabados MBA, Emily Pisani BA, Jenelle Newcomb BA, Thomas R. Kosten MD

Background and Objectives

Noradrenergic dysregulation is important in the pathophysiology of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD); pharmacotherapies targeting adrenergic function have potential as treatment for comorbidity. Dexmedetomidine (sublingual film formulation—BXCL501; IGALMI) is a highly potent, selective ⍺2-adrenergic receptor agonist and may be superior to other pharmacotherapeutic approaches. A within subjects, phase 1b safety laboratory study was conducted to evaluate adverse effects of BXCL501 when combined with alcohol; BXCL501's potential efficacy was also explored.

Methods

Heavy drinker participants with a diagnosis of or who were at risk for PTSD participated in three separate test days which included pretreatment with BXCL501 (40 µg, 80 µg or placebo) administered in a randomized, double-blind fashion, followed by three testing conditions: alcohol cue reactivity, trauma-induced reactivity, and IV ethanol administration. Safety outcomes included blood pressure (BP) and sedation. Exploratory outcomes included alcohol craving, trauma-induced anxiety and craving and subjective effects of alcohol.

Results

Ten of twelve randomized participants competed the entire study. BXCL501 (80 µg) was associated with expected mild changes in BP and sedation; administration with alcohol did not affect those parameters. There were no clinically significant adverse effects. BXCL501 attenuated trauma-induced anxiety and attenuated subjective effects of alcohol.

Discussions and Conclusions

BXCL501 is safe for use in humans who may drink alcohol while undergoing treatment. BXCL501 may be explored as a potential treatment for PTSD and AUD.

Scientific Significance

This is the first study to provide scientific support for BXCL501's potential to treat PTSD and comorbid AUD.

背景和目的：去甲肾上腺素能失调是创伤后应激障碍（PTSD）和酒精使用障碍（AUD）的重要病理生理机制；针对肾上腺素能功能的药物疗法具有治疗合并症的潜力。右美托咪定（舌下膜制剂-BXCL501；IGALMI）是一种高效、选择性的2-肾上腺素能受体激动剂，可能优于其他药物治疗方法。研究人员在受试者中开展了一项 1b 期安全性实验室研究，以评估 BXCL501 与酒精合用时的不良反应；同时还探讨了 BXCL501 的潜在疗效。方法：被诊断为创伤后应激障碍或有此风险的酗酒者参加了三个独立的测试日，包括以随机、双盲方式使用 BXCL501（40 µg、80 µg 或安慰剂）进行预处理，然后进行三种测试条件：酒精线索反应性、创伤诱导反应性和静脉注射乙醇。安全性结果包括血压（BP）和镇静。探索性结果包括酒精渴求、创伤诱发的焦虑和渴求以及酒精的主观影响：12名随机参与者中有10人完成了整个研究。BXCL501（80 µg）与预期的轻微血压变化和镇静有关；与酒精同时服用不会影响这些参数。没有明显的临床不良反应。BXCL501减轻了创伤引起的焦虑，并减轻了酒精的主观影响：讨论与结论：BXCL501可安全用于在治疗期间可能饮酒的人群。BXCL501可作为创伤后应激障碍和AUD的潜在治疗药物：这是第一项为 BXCL501 治疗创伤后应激障碍和合并 AUD 的潜力提供科学支持的研究。

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引用次数: 0

Opioid agonist treatment outcomes among individuals with a history of nonfatal overdose: Findings from a pragmatic, pan-Canadian, randomized control trial 有非致命性用药过量史者的阿片类激动剂治疗效果：一项务实的泛加拿大随机对照试验的结果。

IF 2.5 4区医学 Q2 SUBSTANCE ABUSE

American Journal on Addictions

Pub Date : 2024-08-10 DOI: 10.1111/ajad.13635

Hannah Crepeault MSc, Lianping Ti PhD, Paxton Bach MD, MSc, Evan Wood MD, PhD, FRCPC, Didier Jutras-Aswad MD, MSc, Bernard Le Foll MD, PhD, MSc, Ron Lim MD, Maria E. Socias MD, MSc

Background and Objectives

History of nonfatal overdose (NFO) is common among people who use opioids, but little is known about opioid agonist treatment (OAT) outcomes for this high-risk subpopulation. The objective of this study was to investigate the relative effectiveness of buprenorphine/naloxone and methadone on retention and suppression of opioid use among individuals with opioid use disorder (OUD) and history of NFO.

Methods

Secondary analysis of a pan-Canadian pragmatic trial comparing flexible take-home buprenorphine/naloxone and supervised methadone for people with OUD and history of NFO. Logistic regression was used to examine the impact of OAT on retention in the assigned or in any OAT at 24 weeks and analysis of covariance was used to examine the mean difference in opioid use between treatment arms.

Results

Of the 272 randomized participants, 155 (57%) reported at least one NFO at baseline. Retention rates in the assigned treatment were 17.7% in the buprenorphine/naloxone group and 18.4% in the methadone group (adjusted odds ratio [AOR] = 0.54, 95% CI: 0.17–1.54). Rates of retention in any OAT were 28% and 20% in the buprenorphine/naloxone and methadone arms, respectively (AOR = 1.55, 95% CI: 0.65–3.78). There was an 11.9% adjusted mean difference in opioid-free urine drug tests, favoring the buprenorphine/naloxone arm (95% CI: 3.5–20.3; p = .0057).

Conclusions and Scientific Significance

Among adults with OUD and a history of overdose, overall retention rates were low but improved when retention in any treatment was considered. These findings highlight the importance of flexibility and patient-centered care to improve retention and other treatment outcomes in this population.

背景和目的：在使用阿片类药物的人群中，非致命性过量（NFO）病史很常见，但人们对这一高风险亚人群的阿片类激动剂治疗（OAT）结果却知之甚少。本研究的目的是调查丁丙诺啡/纳洛酮和美沙酮对患有阿片类药物使用障碍（OUD）并有NFO病史的患者保持和抑制阿片类药物使用的相对效果：方法：对一项泛加拿大实用性试验进行二次分析，该试验比较了灵活的丁丙诺啡/纳洛酮带回家治疗和美沙酮监督治疗对阿片类药物使用障碍（OUD）和NFO病史患者的效果。采用逻辑回归法考察了OAT对在24周内保留指定或任何OAT的影响，并采用协方差分析法考察了治疗臂之间阿片类药物使用的平均差异：在 272 名随机参与者中，有 155 人（57%）在基线时报告至少服用过一次非阿片类药物。丁丙诺啡/纳洛酮组在指定治疗中的保留率为17.7%，美沙酮组为18.4%（调整赔率[AOR] = 0.54，95% CI：0.17-1.54）。丁丙诺啡/纳洛酮组和美沙酮组在任何 OAT 中的保留率分别为 28% 和 20%（AOR = 1.55，95% CI：0.65-3.78）。调整后的无阿片类药物尿检平均值差异为11.9%，丁丙诺啡/纳洛酮治疗组更胜一筹（95% CI：3.5-20.3；P = .0057）：在患有 OUD 并有用药过量史的成年人中，总体保留率较低，但如果考虑到保留任何治疗，则保留率会有所提高。这些研究结果凸显了灵活性和以患者为中心的护理对改善该人群的保留率和其他治疗效果的重要性。

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引用次数: 0

State-level racial and ethnic disparities in buprenorphine treatment duration in the United States 美国各州在丁丙诺啡治疗时间上的种族和民族差异。

IF 2.5 4区医学 Q2 SUBSTANCE ABUSE

American Journal on Addictions

Pub Date : 2024-08-06 DOI: 10.1111/ajad.13638

Huiru Dong PhD, Erin J. Stringfellow PhD, Mohammad S. Jalali PhD

Background and Objectives

National trends reveal a concerning escalation in racial and ethnic disparities in buprenorphine treatment duration for opioid use disorder. However, the extent of such disparities at the state level remains largely unexplored. This study aims to examine such disparities at the state level.

Methods

We analyzed 9,040,620 buprenorphine prescriptions dispensed between January 2011 and December 2020 from IQVIA Longitudinal Prescription data. The primary outcome was the difference in median treatment duration between White people and racial and ethnic minorities. We also included a second outcome measurement to quantify the difference in median treatment duration among episodes lasting ≥180 days. Using quantile regressions, we examined racial and ethnic disparities in treatment duration, adjusting for the patient's age, sex, payment type, and calendar year of the treatment episode. All analyses were conducted at the state level.

Results

Our study revealed substantial statewide variations in racial and ethnic disparities. Specifically, 21 states showed longer treatment durations for White people across all episodes, and eight states displayed similar trends among episodes lasting ≥180 days. Five states exhibited longer treatment durations for White people in both overall and long-term episodes. Fifteen states showed no racial and ethnic disparities.

Conclusion and Scientific Significance

These results are among the first to indicate substantial statewide variations in racial and ethnic disparities in buprenorphine treatment episode duration, providing a critical foundation for targeted interventions to enhance buprenorphine treatment, especially in states confronting such pronounced racial and ethnic disparities.

背景和目的：全国趋势表明，在阿片类药物使用障碍的丁丙诺啡治疗时间方面，种族和民族差异正在不断扩大，令人担忧。然而，州一级的这种差异程度在很大程度上仍未得到探讨。本研究旨在考察州一级的这种差异：我们分析了 IQVIA 纵向处方数据中 2011 年 1 月至 2020 年 12 月期间开出的 9040620 张丁丙诺啡处方。主要结果是白人与少数种族和族裔之间中位治疗时间的差异。我们还纳入了第二项结果测量，以量化持续时间≥180 天的发作的中位治疗持续时间差异。通过量子回归，我们研究了治疗持续时间的种族和民族差异，并对患者的年龄、性别、付款类型和治疗发作的日历年进行了调整。所有分析均在州一级进行：结果：我们的研究揭示了全州范围内种族和民族差异的巨大差异。具体而言，有 21 个州的白人在所有治疗过程中都表现出较长的治疗持续时间，有 8 个州在持续时间超过 180 天的治疗过程中表现出类似的趋势。5个州的白人在所有病程和长期病程中的治疗时间都较长。15个州没有显示出种族和民族差异：这些结果首次表明，在丁丙诺啡治疗发作持续时间方面，各州的种族和民族差异很大，这为采取有针对性的干预措施以加强丁丙诺啡治疗提供了重要基础，尤其是在面临如此明显的种族和民族差异的各州。

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引用次数: 0

Racial and ethnic differences in self-reported barriers to substance use treatment among emergency department patients 急诊科患者自我报告的药物使用治疗障碍的种族和民族差异。

IF 2.5 4区医学 Q2 SUBSTANCE ABUSE

American Journal on Addictions

Pub Date : 2024-08-05 DOI: 10.1111/ajad.13631

Neha Jia Ahmad MD, MPH, Hannah Shapiro BS, Margaret L. Griffin PhD, Roger D. Weiss MD, Wendy L. Macias-Konstantopoulos MD, MPH, MBA

Background and Objectives

As overdose rates rise among non-White Americans, understanding barriers to substance use disorder (SUD) treatment access by race and ethnicity is important. This study explores self-reported barriers to SUD treatment by race and ethnicity in emergency department (ED) populations.

Methods

We conducted a secondary, exploratory analysis of a randomized trial of patients not seeking SUD treatment who endorsed active drug use at six academic EDs. Responses to the Barriers to Treatment Inventory were compared by race, ethnicity, and drug severity, using χ² tests (N = 858), followed by adjusted logistic regression models.

Results

Absence of a perceived drug problem (39% non-Hispanic Black, 38% Hispanic, 50% non-Hispanic White; p ≤ .001) was the most prevalent barrier to SUD treatment. Non-Hispanic Black participants were less likely to state that they could handle their drug use on their own (OR = 0.69, CI = 0.50–0.95), and were more likely to report disliking personal questions than non-Hispanic White participants (OR = 1.49, CI = 1.07–2.09). Non-Hispanic Black participants were less likely than Hispanic participants to agree that treatment availability (OR = 0.46, CI = 0.28–0.76) and family disapproval (OR = 0.38, CI = 0.16–0.91) were treatment barriers.

Discussion and Conclusions

Screening and counseling may help address the barrier, common to all groups, that drug use was not seen as problematic. Expanding access to diverse treatment options may also address the range of barriers reported by our study population.

Scientific Significance

Our study is one of the first in the U.S. to examine both individual and structural barriers to accessing treatment and to examine the association with drug use severity by race/ethnicity.

背景和目标：随着非白人美国人用药过量率的上升，了解不同种族和族裔在获得药物使用障碍（SUD）治疗方面的障碍非常重要。本研究探讨了急诊科（ED）人群中不同种族和族裔自我报告的 SUD 治疗障碍：我们对六家学术性急诊室中未寻求 SUD 治疗但认可积极吸毒的患者进行了随机试验的二次探索性分析。使用χ2检验（N = 858）比较了不同种族、民族和毒品严重程度的患者对治疗障碍量表的反应，然后使用调整后的逻辑回归模型进行分析：没有发现毒品问题（39% 非西班牙裔黑人、38% 西班牙裔、50% 非西班牙裔白人；P ≤ .001）是接受 SUD 治疗最普遍的障碍。与非西班牙裔白人参与者相比，非西班牙裔黑人参与者不太可能表示他们可以自己处理吸毒问题（OR = 0.69，CI = 0.50-0.95），并且更可能表示不喜欢个人问题（OR = 1.49，CI = 1.07-2.09）。与西班牙裔参与者相比，非西班牙裔黑人参与者不太可能同意治疗的可获得性（OR = 0.46，CI = 0.28-0.76）和家庭的不认可（OR = 0.38，CI = 0.16-0.91）是治疗障碍：讨论和结论：筛查和咨询可能有助于解决所有群体共同面临的障碍，即认为吸毒没有问题。扩大获得各种治疗选择的机会也可以解决我们的研究对象所报告的一系列障碍：我们的研究是美国第一项同时研究获得治疗的个人障碍和结构性障碍，并按种族/民族研究其与吸毒严重程度的关系的研究。

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引用次数: 0

Age and gender differences in motives for z-drug misuse: Findings from the 2015 to 2019 NSDUH survey 滥用z类药物动机的年龄和性别差异：2015年至2019年国家人口与健康调查的结果。

IF 2.5 4区医学 Q2 SUBSTANCE ABUSE

American Journal on Addictions

Pub Date : 2024-08-03 DOI: 10.1111/ajad.13639

Robyn A. Ellis PhD, Emma Trapani BA, R. Kathryn McHugh PhD

Background and Objectives

Approximately 9% of people who are exposed to a nonbenzodiazepine sedative-hypnotic medication (“z-drug”) misuse this medication, yet, the reasons why people misuse z-drugs are not well-characterized.

Methods

Using population survey data, we examined gender and age differences in motives for z-drug misuse.

Results

Results suggested women and older adults have higher odds of misusing z-drugs for sleep, and young adults have higher odds of misusing for recreation.

Discussion and Conclusions

Although the majority of people who misuse z-drugs report misusing to manage sleep, this is particularly common in women and older adults.

Scientific Significance

Addressing inadequately treated sleep concerns may help mitigate z-drug misuse.

背景和目的：在接触过非苯二氮卓类镇静催眠药物（"z-drug"）的人群中，大约有9%的人滥用这种药物，然而，人们滥用z-drug的原因并没有得到很好的描述：方法：我们利用人口调查数据，研究了滥用 z 药物动机的性别和年龄差异：结果表明，女性和老年人因睡眠而滥用z药物的几率更高，而年轻人因娱乐而滥用z药物的几率更高：尽管大多数滥用z类药物的人表示滥用z类药物是为了控制睡眠，但这种情况在女性和老年人中尤为常见：科学意义：解决未得到充分治疗的睡眠问题可能有助于减少z类药物的滥用。

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引用次数: 0

A detox dilemma beyond benzodiazepines; clonidine's quandary in alcohol withdrawal management 苯二氮卓以外的戒毒困境；氯尼丁在酒精戒断治疗中的窘境。

IF 2.5 4区医学 Q2 SUBSTANCE ABUSE

American Journal on Addictions

Pub Date : 2024-08-03 DOI: 10.1111/ajad.13640

Matthew Johnson DO, MBA, Danielle Cosentino BS, Brian Fuehrlein MD, PhD

Background and Objectives

Benzodiazepines are the primary method of treatment of alcohol withdrawal, though the American Society of Addiction Medicine guidelines also include alternative agents for consideration. Observations in a Department of Veterans Affairs (VA) psychiatric emergency room noted consistent benzodiazepine use with an overall lack of use of alternative agents, even with low Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scores and in the absence of other concerning symptoms. Due to concerns of potential more-than-necessary benzodiazepine use, we analyzed adjunctive clonidine use for elevated blood pressure/pulse in alcohol withdrawal among this Veteran population.

Methods

This is a single-site VA retrospective chart review of the psychiatric emergency room from July 1, 2022, to June 30, 2023, focused on patients with alcohol withdrawal managed on a CIWA protocol. Excluding concurrent opioid withdrawal and clonidine as home medication, 167 patient charts were analyzed for this study.

Results

Among 167 patients, 99 (59.3%) had comorbid hypertension. A total of 614 medication doses were given for elevated CIWA (373, 60.8%) and elevated blood pressure/pulse (241, 39.2%). Of the 241 doses for elevated blood pressure/pulse, only 2.5% were clonidine. Among all benzodiazepine doses, 75.3% were given to patients with comorbid hypertension. Clonidine was administered to 3.0% of patients, making up 2.5% of total dosing.

Discussion and Conclusions

Alcohol withdrawal management lacks optimization. Integrating adjunctive medications could reduce potential benzodiazepine overuse effectively addressing elevated blood pressure/pulse.

Scientific Significance

This study sheds light on the potential underutilization of clonidine and its potential role in improving alcohol withdrawal syndrome management. By addressing elevated blood pressure/pulse and curbing potential overuse of benzodiazepines, it may contribute to further optimizing patient care.

背景和目的：苯二氮卓类药物是治疗酒精戒断的主要方法，但美国成瘾医学会的指南也将替代药物纳入考虑范围。退伍军人事务部（VA）精神科急诊室的观察结果表明，即使临床研究所酒精戒断评估（CIWA）评分较低且没有其他相关症状，也会持续使用苯二氮卓类药物，但总体上不使用替代药物。由于担心苯二氮卓类药物的使用可能超出必要范围，我们对退伍军人群体中使用氯尼丁辅助治疗酒精戒断时的血压/脉搏升高进行了分析：这是 2022 年 7 月 1 日至 2023 年 6 月 30 日期间退伍军人事务部对精神科急诊室进行的一次单一地点回顾性病历审查，重点关注根据 CIWA 方案管理的酒精戒断患者。本研究对 167 份患者病历进行了分析，其中不包括同时出现的阿片类药物戒断和作为家庭用药的氯尼替丁：结果：167 名患者中有 99 人（59.3%）合并高血压。针对 CIWA 升高（373 例，占 60.8%）和血压/脉搏升高（241 例，占 39.2%）共用药 614 次。在治疗血压/脉搏升高的 241 个剂量中，只有 2.5% 是氯硝西泮。在所有苯二氮卓类药物剂量中，75.3%用于合并高血压的患者。3.0%的患者使用了氯尼替丁，占总剂量的2.5%：讨论与结论：酒精戒断治疗缺乏优化。整合辅助用药可减少潜在的苯二氮卓类药物过度使用，有效解决血压/脉搏升高问题：本研究揭示了氯硝西泮可能存在的使用不足及其在改善酒精戒断综合征管理中的潜在作用。通过解决血压/脉搏升高问题并遏制苯二氮卓类药物的潜在过度使用，该研究可能有助于进一步优化患者护理。

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引用次数: 0

State inequities: Gaps in planned treatment for criminal legal referrals with opioid use disorder across two decades of US treatment admissions 各州的不平等：美国二十年来对患有阿片类药物使用障碍的刑事法律转介患者的计划治疗差距。

IF 2.5 4区医学 Q2 SUBSTANCE ABUSE

American Journal on Addictions

Pub Date : 2024-08-03 DOI: 10.1111/ajad.13636

Nicholas L. Bormann MD, Andrea N. Weber MD, MME, Tyler S. Oesterle MD, MPH, Benjamin Miskle PharmD, Alison C. Lynch MD, MS, Stephan Arndt PhD

Background and Objectives

Criminal-legal (CL) referrals to addiction treatment have historically had low utilization of medications for opioid use disorder (MOUD). While state differences have been reported, an in-depth longitudinal analysis of state-by-state differences is lacking.

Methods

The Substance Abuse and Mental Health Services Administration Treatment Episode Dataset-Admissions 2000–2020 provided data for individuals entering their initial treatment with an opioid as their primary substance. Outcome was planned use of MOUD, assessing odds ratio (OR) of CL referrals relative to non-CL referrals cumulatively over the 21-year period and as incremental change (change in relative disparity) using effect sizes, stratified by each state.

Results

2,187,447 cases met the criteria. Planned MOUD occurred in 37.7% of non-CL clients versus 6.5% of CL clients (OR = 0.11, 95% confidence interval = 0.11–0.12). For all clients, planned MOUD increased from 2000 (33.9%) to 2020 (44.8%). This increase was blunted within CL clients, increasing from 2000 (6.4%) to 2020 (13.3%). Rhode Island saw the greatest improvements in equity.

Discussion and Conclusions

While rates of planned MOUD increased over the 21 years, a significant disparity persisted among CL clients in most states. As opioid use disorders and opioid-related overdoses are more prevalent among those involved with the CL system, improving this has high impact.

Scientific Significance

Provides the most comprehensive analysis of state-by-state inequities in MOUD access for CL relative to non-CL referrals over a 21-year period through use of a national data set. Positive outliers are used as case examples for others to follow in pursuit of more equitable care.

背景和目标：刑事-法律（CL）转介到戒毒治疗机构的阿片类药物使用障碍（MOUD）药物使用率历来较低。虽然有报道称各州之间存在差异，但缺乏对各州差异的深入纵向分析：方法：美国药物滥用和心理健康服务管理局 2000-2020 年治疗病程数据集（Treatment Episode Dataset-Admissions 2000-2020）提供了以阿片类药物为主要药物进行初次治疗的患者数据。结果是计划使用 MOUD，评估 21 年间累计的 CL 转诊相对于非 CL 转诊的几率比 (OR)，以及使用效应大小的增量变化（相对差异的变化），按每个州进行分层。37.7%的非慢性病患者出现了计划性 MOUD，而慢性病患者仅为 6.5%（OR = 0.11，95% 置信区间 = 0.11-0.12）。在所有客户中，计划的 MOUD 从 2000 年（33.9%）增加到 2020 年（44.8%）。这一增长在CL客户中有所减弱，从2000年（6.4%）增加到2020年（13.3%）。罗得岛州在公平性方面的改善最大：虽然在这 21 年中，计划接受 MOUD 的比例有所上升，但在大多数州，CL 患者之间仍存在显著差异。由于阿片类药物使用障碍和与阿片类药物相关的过量使用在参与社区医疗系统的人群中更为普遍，因此改善这一状况具有重大影响：通过使用全国数据集，最全面地分析了各州在 21 年间，CL 相对于非 CL 转诊者在获得 MOUD 方面的不平等。将积极的异常值作为案例，供其他人效仿，以追求更公平的医疗服务。

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引用次数: 0

Understanding the role of cannabis use on cigarette dependence severity among individuals with e-cigarette and combustible tobacco dual use 了解使用大麻对电子烟和可燃烟草双重使用人群的卷烟依赖严重程度的影响。

IF 2.5 4区医学 Q2 SUBSTANCE ABUSE

American Journal on Addictions

Pub Date : 2024-07-11 DOI: 10.1111/ajad.13633

Julia D. Buckner PhD, Luke A. Vargo MA, Michael J. Zvolensky PhD

Background and Objectives

The use of both electronic and combustible cigarettes is related to greater rates of cannabis use. Further, cannabis use is associated with worse combustible smoking-related outcomes, yet little research has identified mechanisms underlying such relations. It may be that negative-affect-related transdiagnostic factors such as emotion dysregulation, anxiety sensitivity, and/or distress intolerance play a mechanistic role in the cannabis–tobacco interrelations.

Methods

The current study tested this hypothesis among 400 adults who endorsed dual use, 33% of whom endorsed current (past 3 months) cannabis use. We conducted analyses of variance and indirect effects model using the PROCESS v4.1 macro in SPSS version 29.

Results

Results indicated that participants who use cannabis reported greater difficulty with emotion regulation, anxiety sensitivity, and cigarette dependence severity. Cannabis use was related to cigarette dependence severity indirectly via difficulty with emotion regulation and anxiety sensitivity.

Discussion and Conclusions

These results indicate that specific transdiagnostic negative-affect-related factors of difficulty with emotion regulation and anxiety sensitivity are associated with cannabis use among adults who smoke combustible and electronic cigarettes.

Scientific Significance

Given that these transdiagnostic factors are malleable, these findings suggest targeting and engaging such mechanisms may offer novel behavioral change strategies for this high-risk population.

背景和目的：电子烟和可燃卷烟的使用与大麻使用率的增加有关。此外，大麻的使用与可燃卷烟相关结果的恶化有关，但很少有研究确定这种关系的内在机制。负面影响相关的跨诊断因素，如情绪失调、焦虑敏感和/或痛苦不耐，可能在大麻与烟草的相互关系中发挥了机制性作用：本研究在 400 名认可双重使用大麻的成年人中测试了这一假设，其中 33% 的人认可当前（过去 3 个月）使用大麻。我们使用 SPSS 29 版中的 PROCESS v4.1 宏进行了方差分析和间接效应模型：结果表明，吸食大麻的参与者在情绪调节、焦虑敏感性和香烟依赖严重程度方面遇到的困难更大。大麻的使用通过情绪调节困难和焦虑敏感性与香烟依赖严重程度间接相关：这些结果表明，在吸食可燃卷烟和电子卷烟的成年人中，情绪调节困难和焦虑敏感性等特定的跨诊断负效应相关因素与大麻使用有关：鉴于这些跨诊断因素具有可塑性，这些研究结果表明，针对和利用这些机制可能会为这一高风险人群提供新的行为改变策略。

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引用次数: 0