American Journal on Addictions最新文献

Background and Objectives

Although concurrent stimulant use is common among people with opioid use disorder (OUD), there is little evidence on its impacts on opioid agonist therapy (OAT) outcomes. This study sought to determine the impact of baseline methamphetamine/amphetamine use on discontinuation of OAT among individuals with prescription-type OUD (POUD) initiating methadone or buprenorphine/naloxone as part of a pragmatic randomized trial in Canada.

Methods

Secondary analysis of a pan-Canadian pragmatic trial conducted between 2017 and 2020 comparing supervised methadone versus flexible take-home dosing buprenorphine/naloxone models of care. Cox proportional hazard models were used to evaluate the effect of baseline methamphetamine/amphetamine use (measured by urine drug test [UDT]) on two discontinuation outcomes (i.e., assigned OAT discontinuation, any OAT discontinuation).

Results

Two hundred nine (n = 209) participants initiated OAT, of which 96 (45.9%) had positive baseline methamphetamine/amphetamine UDT. Baseline methamphetamine/amphetamine use was associated with shorter median times in assigned OAT (21 vs. 168 days, hazard ratio [aHR] = 2.45, 95% confidence interval [CI] = 1.60–3.76) and any OAT (25 days vs. 168 days, aHR = 2.06, CI = 1.32–3.24). No interaction between methamphetamine/amphetamine and assigned OAT was observed for either outcome (p > .05).

Conclusion and Scientific Significance

This study offers novel insights on the impact of methamphetamine/amphetamine use on OAT outcomes among people with POUD. Methamphetamine/amphetamine use was common and was associated with increased risk of OAT discontinuation. Supplementary interventions, including treatment for stimulant use, are needed to improve retention in OAT and optimize treatment outcomes in this population.

Background and Objectives

Risky substance use (RSU) is common among people with chronic pain and is associated with worse pain treatment outcomes. Nonopioid treatment is recommended, but it is unknown whether people with RSU use different or fewer pain treatment modalities. This study describes use of different pain treatments by veterans with and without RSU and those receiving versus not receiving opioid medication.

Methods

Veterans (N = 924) who filed service-connected disability claims related to musculoskeletal conditions and rated their pain four or higher on the Numeric Rating Scale, reported on 25 different pain services in the preceding 90 days. Recent RSU was identified via Alcohol, Smoking, and Substance Involvement Test (ASSIST) cutoffs and/or nail sample toxicology.

Results

Overall, RSU was not associated with number of provider-delivered or self-delivered pain modalities. Over-the-counter medications (71%), self-structured exercise (69%), and nonopioid prescription medications (38%) were the most used modalities. Veterans receiving prescribed opioids (8.4%) were more likely to see primary care, receive injections, and attend exercise and/or meditation classes, compared to those without opioid prescriptions.

Discussion and Conclusions

Opioid and nonopioid pain treatment utilization did not differ based on RSU, and those prescribed opioids were more likely to engage in other nonopioid pain treatments. Regardless of RSU, veterans appear willing to try provider-delivered (58%) and self-delivered (79%) pain treatment.

Scientific Significance

In this first-ever evaluation of 25 different pain treatment modalities among veterans with and without RSU, people with RSU did not use less treatment modalities.

Background and Objectives

Cocaine is a highly addictive substance, and with no approved medication for cocaine use disorder (CUD), leading to a heavy burden. Despite validated psychosocial treatments, relapse rates after detoxification are very high in CUD. Few consistent factors can predict abstinence after detoxification. Our study, therefore, aimed at identifying factors predicting abstinence among CUD patients after inpatient detoxification.

Methods

Eighty-one CUD inpatients were included during detoxification and characterized for clinical and sociodemographic data at baseline and at a follow-up of 3 months after discharge, including a standard measure of their abstinence duration from cocaine. We performed Cox univariate analyzes to determine the factors associated with abstinence maintenance, followed by a multivariate Cox regression to identify independent predictors.

Results

Abstinence maintenance was shorter in patients injecting cocaine (hazard ratio [HR] = 5.16, 95% confidence interval [CI]: 2.01–13.27, p < .001) and using cocaine heavily in the month before inclusion (HR = 1.03, 95% CI: 1.00–1.06, p = .046). Conversely, abstinence maintenance was longer in patients with longer inpatient detoxification stays (HR = 0.96, 95% CI: 0.94–0.99, p = .015) and prescribed with selective serotonin reuptake inhibitors (SSRIs) (HR = 0.30, 95% CI: 0.16–0.56, p < .001).

Discussion and Conclusions

Patients with severe CUD may require longer inpatient stays to achieve abstinence. Regarding SSRI prescription, more specific studies are needed to provide stronger recommendations about their use in clinical practice.

Scientific Significance

Our findings suggest several modifiable factors to improve inpatient treatment response in CUD. As there are no specific recommendations about the optimal duration of inpatient stay, our results could pave the way for evidence-based guidelines.

Background and Objectives

Legalization of medical marijuana has increased unintentional exposure to marijuana in young children.

We aim to explore the sociodemographic disadvantage profile, prevalence, and clinical presentation of children diagnosed with unintentional exposure to marijuana.

Methods

We conducted a retrospective chart abstraction of 121 children (aged 0–6) seen at the Emergency Department (ED) at a single tertiary hospital center in Dayton, Ohio between January 01, 2010 and January 09, 2022.

Results

Majority were female (62.8%), white (50.4%), and with Medicaid as their primary insurance (84.3%). The median age at exposure was 1.8 years. There was a 14-fold increase in unintentional marijuana cases pre-2017 (7 cases) versus post-2017 (114 cases), the year of legalization of medical marijuana in the state of Ohio. Majority of the patients were using public assistance (66.4%). 26.7% of the cases had a prior social work consultation and 38.1% had a prior children services consultation. 51.3% of the children had a social disadvantage index score of 3 or greater (range 0–5) with higher scores indicating greater disadvantage.

Discussion and Conclusions

The number of patients presenting to the ED at the hospital has increased 14-fold since the legalization of medical marijuana in Ohio. Half of the children displayed a higher sociodemographic disadvantage index score.

Scientific Significance

Our study is the first study investigating the sociodemographic profile of children exposed to marijuana. The findings of this study may be utilized to inform policy for safely dispensing recreational and medicinal marijuana products and focus the efforts on families with sociodemographic disadvantage.

Background and Objectives

Experiencing sexism is related to more alcohol-related problems, presumably via drinking to cope with negative affect associated with experiencing sexism. Yet no known studies have directly tested whether the relation of sexism to alcohol problems occurs via relevant negative emotions and drinking to cope with negative emotions. Given that sexism is a type of negative evaluation, social anxiety may be one type of negative affect that plays a role in sexism's relation with drinking behaviors.

Method

This study tested whether sexism was related to alcohol-related problems via the serial effects of social anxiety and coping-motivated alcohol use among 836 cis-female undergraduates who endorsed past-month alcohol use.

Results

Past-year experiences with sexism were positively correlated with coping and conformity-motivated alcohol use, alcohol problems (but not peak estimated blood alcohol content, eBAC), social anxiety, and depression. After statistically controlling for depression and peak eBAC, sexism was indirectly related to alcohol problems via the serial effects of social anxiety and drinking motives (coping, conformity).

Discussion and Conclusions

Results highlight the important role of social anxiety and drinking to cope with negative emotions and to fit in with peers who drink in relation of sexism with alcohol-related problems.

Scientific Significance

This is the first known study to find that experiences of sexism are related to alcohol problems via the serial effects of social anxiety and coping and conformity-motivated drinking. This is also the first known study to find that sexism is related to more conformity-motivated drinking.

Background and Objectives

Recent increases in methamphetamine use among people seeking treatment for opioid use disorder (OUD) has created significant demand for effective approaches to support this clinical population. This study assessed the extent to which office-based opioid treatment (OBOT) patients, who were diagnosed with methamphetamine use disorder (MUD), engaged with providers.

Methods

A retrospective analysis was conducted of adult patients (n = 470) seeking treatment for OUD who attended at least one visit between March 2020 and March 2023 at a rural regional OBOT provider. Approximately one quarter (28.7%) of patients were diagnosed with MUD in addition to receiving an OUD diagnosis. Bivariate methods and multivariate negative binomial regression models were estimated to examine the associations between clinical measures and the numbers of office visits, peer visits, and telehealth visits.

Results

Regression results indicated patients who met criteria for MUD in addition to OUD attended a higher rate of peer visits (incidence rate ratio [IRR] = 2.63, p = .036) when compared to patients who did not meet criteria for MUD. In contrast, patients with MUD and OUD diagnoses displayed significantly lower (IRR = 0.68, p < .001) engagement rates through fewer office visits relative to those who did not meet MUD criteria.

Discussion and Conclusions

Patients seeking treatment for OUD who meet criteria for MUD are more likely to engage through peer support specialists rather than office visits.

Scientific Significance

This study demonstrates the ways patients who meet criteria for OUD and MUD engage with providers to receive treatment.

Background and Objectives

Although some studies have related social media use and depressive symptoms, little is known about the role of psychoactive substance use in this relationship. Therefore, this study aimed to estimate the association between time spent on social media (TSSM) and depressive symptoms and to examine whether this relationship is mediated by psychoactive substances in students.

Methods

Our cross-sectional analysis included a sample of students from a university in a large city in southern Brazil. The TSSM and tobacco frequency of consumption were self-reported. Depressive symptoms were assessed with the Patient Health Questionnaire. Alcohol and illicit drug-related risks were assessed with the Alcohol, Smoking and Substance Involvement Screening Test. Hayes's PROCESS macro was used for mediation analyses, adjusted for age, sex, body mass index and physical activity.

Results

A total of 3161 students were included, of which, 69.0% reported moderate to severe depressive symptoms. The association between TSSM and depressive symptoms was statistically significant and partially mediated by tobacco consumption (indirect effect [IE] = 0.05; 95% CI: 0.02–0.08), alcohol-related risk (IE = 0.19; 95% CI: 0.14–0.25), and illicit drug-related risk (IE = 0.08; 95% CI: 0.05–0.12).

Conclusion and Scientific Significance

Our data suggest a direct relationship between TSSM and depressive symptoms, with a partial mediation effect of psychoactive substance use. This study highlights the importance that public health initiatives aimed at preventing depressive problems in young adults should focus not only on TSSM, but also on controlling and reducing psychoactive substance use.

Background and Objectives

Limited longitudinal research has examined differential interpersonal and intrapersonal correlates of young adult use and use frequency of cigarettes, e-cigarettes, and cannabis. This study aimed to address these limitations.

Methods

We analyzed five waves of longitudinal data (2018–2020) among 3006 US young adults (M_age = 24.55, 44% male, 32% sexual minority, ~30% racial/ethnic minority). Two-part latent growth models examined likelihood of past-month cigarette, e-cigarette, and cannabis use (binary part) and days used (continuous part) and identified predictors (depressive symptoms, personality traits, adverse childhood experiences [ACEs], parental use) of baseline use and changes over time.

Results

Regarding baseline past-month use (27% cigarettes, 38% e-cigarettes, 39% cannabis), depressive symptoms, ACEs, and parental substance use predicted use outcomes (i.e., likelihood, frequency) for each product; extraversion predicted cigarette and e-cigarette use outcomes; openness predicted e-cigarette and cannabis use outcomes; conscientiousness negatively predicted cigarette and cannabis use outcomes; and agreeableness negatively predicted cannabis use frequency. Regarding longitudinal changes, conscientiousness predicted accelerated increase of cigarette use frequency at later timepoints; depressive symptoms predicted increases in likelihood of e-cigarette use but the association weakened over time; and parental cannabis use predicted decreased cannabis use frequency but the association weakened over time.

Discussion and Conclusions

Young adult substance use interventions should target high-risk subgroups and focus on distinct factors impacting use, including chronic, escalating, and decreasing use.

Scientific Significance

This study advances the literature regarding distinct predictors of different substance use outcomes and provides unique data to inform interventions targeting young adult cigarette, e-cigarette, and cannabis use.

Background and objectives

The provider–patient relationship is integral to medical practice and health outcomes, particularly among vulnerable patient populations. This study compared the provider–patient relationship among pregnant patients with opioid-use disorder (OUD), who did or did not have a history of moderate to severe trauma.

Methods

This was an exploratory data analysis of 119 patients enrolled in the Support Models for Addiction Related Treatment trial. Probable posttraumatic stress disorder (PTSD) was determined by a score ≥ 31 on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The provider–patient relationship was assessed at 26 ± 4 weeks of pregnancy using the Kim Alliance Scale (KAS). Multivariable regression was used to examine the association of KAS with probable PTSD among pregnant people with OUD.

Results

The mean KAS score for pregnant participants without probable PTSD (N = 88) was 61.4 (SD ± 2.8) and for pregnant participants with probable PTSD (N = 31) was 59.6 (SD ± 3.7). Results demonstrated significant differences in KAS scores between those with and without probable PTSD after adjusting for demographic variables. Adjusted mean total KAS scores and scores on Empowerment and Communication subscales were significantly lower among those with probable PTSD compared to those without (p = .04 and 0.02, respectively) but did not differ significantly on Collaboration and Integration subscales.

Conclusions and scientific significance

Analyses show an association between probable PTSD and provider–patient relationship among pregnant patients with OUD, with those with probable PTSD having a worse alliance with obstetric providers. This novel finding helps characterize the provider–patient relationship among a uniquely vulnerable population and can inform efforts to integrate trauma-informed practices into prenatal care.