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Peer recovery support services (PRSS) integrated into hospital settings may support the initiation of outpatient treatment. This study aimed to evaluate the impact of PRSS in patients with opioid use disorder (OUD) and identify characteristics associated with receptiveness to coaching and treatment placement.
We reviewed the medical records of inpatients treated over a 4-year period at a tertiary-care center. Outcomes examined included accepted PRSS coach visit, initiation of medications for opioid use disorders (MOUD), and referral to or scheduling of treatment.
There were 5050 documented hospital encounters during which 3010 patients with OUD were approached for a visit by a PRSS coach. Of these patients, 65.4% initiated MOUD in the hospital, 29.0% received a referral for MOUD, and 54.8% accepted an appointment for treatment or rehabilitation services, all of which were considered successful outcomes. Patients who accepted a visit with a PRSS coach had a higher rate of successful outcomes than patients who declined a visit (60.8% vs. 17.1%, p < .001), and were more likely to receive MOUD (26.9% vs. 6.7%, p < .001). Younger age and admission from an emergency setting were associated with PRSS interaction and treatment initiation.
We observed a notable relationship between peer coaching and initiating MOUD or scheduling further treatment, suggesting an augmented state of patient readiness to embrace transformative changes toward recovery after interaction with PRSS.
The demonstrated relationship between PRSS and MOUD initiation in this population helps justify the use, funding, and expansion of PRSS programs.
Extended-release injectable naltrexone (XR-naltrexone) is an effective relapse prevention treatment of patients with opioid use disorder (OUD), but retention remains a problem. Previous trials have either only calculated the association of one or two predictors or used claims-based datasets with only limited data to identify these characteristics. This analysis tested multiple baseline and clinical predictors for association with early retention on XR-naltrexone using combined data from five consecutive studies enrolling patients with active opioid use.
Bivariate associations between patients' demographic and clinical characteristics at baseline and during the weeks after the first XR-naltrexone injection, and receipt of a second injection were calculated (n = 200). Significant factors were included in a multivariable logistic regression model.
148/200 participants (74%) received the second injection. Lower Hamilton-Depression Scale (HAM-D) scores after the first injection were significantly associated with receiving a second injection in univariate and multivariable analysis. The following factors were significantly associated with receipt of the second injection in the univariate but not in the multivariable model: longest period of abstinence 1–11 months, use of cocaine in the 7 days before enrollment, use of alcohol or cocaine in the week after first injection, lower severity of cravings for opioids after first injection, lower self-report withdrawal scores after the first injection.
Depressive symptoms after first XR-naltrexone injection are associated with nonreceipt of a second injection. Clinicians should educate patients about this risk and monitor for possible depression symptoms after the first injection.
Family involvement is increasingly recognised as important to the treatment and recovery of individuals with substance use disorders. While affected family members (AFMs) can play a critical role in enhancing treatment engagement and improving outcomes, there is limited understanding of their characteristics and how these relate to whether their relative with substance use problems (RSU) is receiving treatment. This study examines factors associated with the treatment status of RSU, based on reports from and characteristics of AFMs who sought support through a public family programme.
Records of 4471 AFMs who sought support from a family support programme in Brazil were analysed.
For 81.9% of AFMs, the RSU was not in treatment at the time of entry. AFMs with RSUs in treatment were more likely to be older, male, cohabiting with the RSU, and reported fewer negative symptoms, better understanding of addiction, and less conflict over substance use. RSUs in treatment were more likely to be female, educated, and have dual alcohol and drug use problems.
Findings highlight factors linked to treatment status and offer directions for future research on substance use treatment and family dynamics.
By analysing a large sample of AFMs, this study offers empirical support for the role of family context and interpersonal dynamics in treatment access. These insights highlight the importance of integrating family-based approaches into substance use intervention strategies.
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.
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.
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.
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.
Although there is currently no standardized treatment or antidote, this review will aid ongoing research to address these gaps in xylazine management.
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.
To update the literature and better characterize co-use in older age using nationally representative data.
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.
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.
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.
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)).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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