Addiction最新文献

{"title":"System-frame interventions to prevent gambling harms and beyond.","authors":"Tobias Hayer","doi":"10.1111/add.70626","DOIUrl":"https://doi.org/10.1111/add.70626","url":null,"abstract":"","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alcohol consumption and health-related economic inactivity among working-age adults in England: A population study, 2014 to 2025.","authors":"Sarah E Jackson, Melissa Oldham, Annie Britton, Jamie Brown","doi":"10.1111/add.70633","DOIUrl":"https://doi.org/10.1111/add.70633","url":null,"abstract":"<p><strong>Background/aims: </strong>In England, the proportion of adults not in work due to long-term illness or disability has risen sharply in recent years. This study examined differences in trends in health-related economic inactivity between 2014 and 2025 by level of alcohol consumption.</p><p><strong>Design: </strong>Repeated cross-sectional analysis of data from a nationally representative, monthly survey conducted between March 2014 and May 2025.</p><p><strong>Setting: </strong>England.</p><p><strong>Participants: </strong>162 935 adults aged 18-64.</p><p><strong>Measurements: </strong>Health-related economic inactivity was defined as self-reporting being out of work due to long-term illness or disability. Alcohol consumption was classified using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) into five risk levels: non-drinker (score of 0), low risk (1-4), increasing risk (5-7), higher risk (8-10) and possible dependence (11-12). Logistic regression was used to model time trends adjusted for age and gender. Modelled estimates were then extrapolated to the adult population of England using national population and drinking prevalence estimates. Secondary analyses were conducted using the full AUDIT and a measure of heavy episodic drinking.</p><p><strong>Results: </strong>Between 2014 and 2025, the prevalence of health-related economic inactivity more than doubled among non-drinkers (from 4.9% to 10.0%; a 104% increase) and low-risk drinkers (from 2.3% to 4.7%; a 104% increase), and increased by 50% among those drinking at increasing-risk levels (from 1.8% to 2.7%). In contrast, it remained relatively stable among those drinking at high-risk levels (from 3.2% to 2.9%; a 9% decrease) and declined among those drinking at levels indicating possible dependence (from 5.4% to 3.4%; a 37% decrease). This pattern of results was consistent across different measures of alcohol use (AUDIT-C classifications, full AUDIT, heavy episodic drinking). However, when accounting for population growth and increases in the overall prevalence of riskier drinking, the absolute numbers of increasing- and high-risk drinkers and those with possible dependence who reported health-related economic inactivity increased from 229 000 to 318 000.</p><p><strong>Summary: </strong>The prevalence of economic inactivity due to long-term illness and disability among working-age adults in England between 2014 and 2025 more than doubled among non-drinkers and low-risk drinkers while remaining stable or declining among those drinking at higher-risk levels, likely reflecting reverse causality and broader shifts in the population composition of drinkers in recent years.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Substance use, related harms and public health responses in Colombia: A national profile.","authors":"Julián Andrés Fernández-López, Julian Santaella-Tenorio, Isabel Cristina Casas, Víctor Hugo Muñoz, Jhoan Sebastián Zapata","doi":"10.1111/add.70627","DOIUrl":"https://doi.org/10.1111/add.70627","url":null,"abstract":"<p><strong>Aims: </strong>To provide a comprehensive national profile of substance use patterns, drug-related harms, treatment and harm reduction responses, and policy developments in Colombia, and to analyze how public health reforms coexist with historically prohibitionist frameworks.</p><p><strong>Methods: </strong>We synthesized data from national household, school, and university surveys, epidemiological surveillance systems, official statistics, policy documents, and peer-reviewed research. Evidence was analyzed to describe trends in substance use, overdose and related harms, treatment access, harm reduction initiatives, and the broader legal and institutional context.</p><p><strong>Results: </strong>Alcohol, tobacco, and cannabis remain the most widely used substances in Colombia, while emerging synthetic drugs and opioid use have increased pressure on health and social services. Drug-related harms, including overdose and mental health problems, show significant regional and socioeconomic disparities. Although treatment coverage and harm reduction interventions, including community-based programs and supervised consumption services, have expanded in recent years, access remains uneven, particularly in rural and peripheral areas. Colombia's contemporary drug policy reflects a hybrid governance model in which constitutional protections of personal autonomy and recent harm reduction reforms coexist with enforcement-oriented practices shaped by illicit drug markets, armed conflict, and territorial inequality.</p><p><strong>Summary: </strong>Colombia illustrates both the opportunities and the structural constraints of public health-oriented drug policy in middle-income countries deeply embedded in transnational drug economies. Strengthening surveillance systems, expanding territorially adapted services, and integrating health policy with broader social and development strategies will be essential to consolidate more coherent and equitable responses.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in the transition from cannabis use to use disorder by decade of first use: Findings from the Australian National Mental Health and Wellbeing surveys.","authors":"Jack Wilson, Siobhan O'Dean, Christina Marel, Olivia Dobson, Matthew Sunderland, Steph Kershaw, Tara Gückel, Emma Krogh Devine, Tim Slade, Maree Teesson, Emily Stockings","doi":"10.1111/add.70608","DOIUrl":"https://doi.org/10.1111/add.70608","url":null,"abstract":"<p><strong>Background and aims: </strong>As cannabis becomes increasingly accessible and products more potent, it is critical that we understand how this may impact the risk of transitioning from cannabis use to cannabis use disorder (CUD). We aimed to examine whether the risk and speed of transition from cannabis use to CUD differ by decade of first cannabis use.</p><p><strong>Method: </strong>Cross-sectional surveys. Data were drawn from the two most recent Australian National Surveys of Mental Health and Wellbeing (NSMHWB; age range: 16-85): 2007 (n = 8841) and 2020-22 (n = 15 893). Among participants who had ever used cannabis (n = 4731), the number of years from age of first use to age of first CUD onset were calculated, with those never experiencing a CUD censored at age of interview. Participants were then grouped by their decade of first cannabis use (<1980s; 1980s, 1990s, 2000s, ≥2010s). Survival analysis was performed to estimate the accumulative risk of CUD. Cox proportional hazards models examined whether decade of first use was associated with speed of progression from first use to first CUD while controlling for demographic, other substance use disorders (SUD), mental health disorders, and mental health service use.</p><p><strong>Results: </strong>Across 1-, 5-, and 10-years following first use, the risk of developing CUD was consistently lowest among those who initiated before 1980 (cumulative risk [CR] = 0.07, 0.16, 0.18 respectively) and highest among those who initiated in the 1990s (CR = 0.12, 0.25, 0.28 respectively) and 2000s (CR = 0.13, 0.24, 0.26 respectively), although confidence intervals overlapped at earlier time points. After adjusting for demographics, other SUDs, mental health disorders, and mental health service use characteristics, those initiating cannabis use in the 1990s [HR = 1.47; 95% confidence interval (CI): 1.08-1.99], 2000s (HR 1.37; 95%CI 1.05-1.81) and 2010 ≥ (HR 1.70; 95%CI 1.13-2.56) exhibited statistically significantly elevated hazards of CUD relative to those first using cannabis prior to 1980.</p><p><strong>Summary: </strong>The risk and speed of transitioning from first cannabis use to cannabis use disorder appears to be greatest in those individuals initiating use after 1980. This increased risk may be partially driven by more potent cannabis products and easier access, which has important implications for cannabis regulation and the design of early intervention.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification and quantification of Δ-9-tetrahydrocannabinol and the synthetic cannabinoid MDMB-4en-PINACA in edible products seized by United Kingdom police in 2024.","authors":"Matthew Gardner, Kathryn Proctor, Martha Old, Gyles Cozier, Oliver Sutcliffe, Jennifer Scott, Stephen M Husbands, Tom P Freeman, Peter Sunderland, Christopher R Pudney","doi":"10.1111/add.70611","DOIUrl":"https://doi.org/10.1111/add.70611","url":null,"abstract":"<p><strong>Background and aims: </strong>Cannabis edible products are increasingly being sold on the illicit market around the world. Use of these products, typically labelled as containing Δ-9-tetrahydrocannabinol (THC), has been linked to adverse health effects, particularly amongst adolescents. Here, we aimed to conduct the first study to quantify the THC content of cannabis edibles seized by United Kingdom (UK) police forces. We also sought to identify and quantify other drugs present, perform a visual analysis of packaging designs and evaluate the effectiveness of a field-portable device for rapid drug identification directly from the surface of edible products.</p><p><strong>Design: </strong>Edible products were obtained by convenience sampling from Merseyside and Avon & Somerset police forces during 2024. Sample bias was considered in the analysis and reporting.</p><p><strong>Setting and cases: </strong>A total of 79 individual edibles originating from 31 products were analysed. From 31 products, 24 featured unique packaging designs. For the remaining seven products, duplicate designs were analysed to assess variability. Analysis was performed in laboratory settings at the University of Bath.</p><p><strong>Measurements: </strong>Visual inspection of packaging. Screening of edible products using liquid chromatography coupled with high-resolution tandem mass spectrometry (LC-HR-MS/MS). Quantification of THC and the synthetic cannabinoid (SC) MDMB-4en-PINACA using LC-HR-MS/MS following a previously described sample preparation method. Evaluation of a field-portable fluorescence and photochemical degradation-based device for detecting THC and SCs directly on the surface of edible products.</p><p><strong>Results: </strong>Visual analysis revealed 19/24 (79%) edible products unique in design featured packaging that mimicked popular confectionery brands. THC was detected in 70/79 (88.6%) individual edibles analysed with a median dose per edible of 13.71 mg (interquartile range = 8.57 mg). We show that 65/68 (95%) edibles labelled with a claimed THC dose contained less than 55% of content stated. Substantial inter-product variability (e.g. 6.07-29.22 mg THC in edibles labelled as 75 mg) and intra-product variability (dose difference >5 mg THC between items in the same pack for 8/25 packs) were found. One product was shown to contain the SC MDMB-4en-PINACA (mean 11.27 mg/edible) instead of THC. The portable device demonstrated 94% accuracy (100% on solid sweets/chocolates) in identifying THC/SC content compared with LC-HR-MS/MS.</p><p><strong>Summary: </strong>llicit edible products seized in the United Kingdom appear to use misleading packaging attractive to children, appear to exhibit variable and inaccurate Δ-9-tetrahydrocannabinol (THC) dosing and can potentially contain synthetic cannabinoids instead of THC. Field-portable detection technology shows promise for rapid, point-of-care drug identification.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A decade of cannabis-related hospital admissions in Victoria, Australia: A retrospective observational study.","authors":"Myfanwy Graham, Janneke Berecki-Gisolf, Jane Hayman, Adrian Carter, Shalini Arunogiri, Suzanne Nielsen","doi":"10.1111/add.70601","DOIUrl":"https://doi.org/10.1111/add.70601","url":null,"abstract":"<p><strong>Background and aims: </strong>Over the past decade, there has been increased lifetime use of illicit and medical cannabis, underscoring the need to examine public health impacts. This includes reports of increased cannabis-related psychosis. In this context, this study aimed to determine all cannabis-related hospital admissions in Victoria, Australia, over a 10-year period to characterise poisonings and mental health harms.</p><p><strong>Design: </strong>This is a retrospective observational study of the Victorian Admitted Episodes Dataset (VAED) records, which include all hospital admissions in the state of Victoria and are supplied by the Victorian Department of Health.</p><p><strong>Setting: </strong>Victoria, Australia.</p><p><strong>Cases: </strong>Hospital records for poisoning (diagnosis code T40.7) and mental health and behavioural disorders (diagnosis codes F12.0-F12.9) related to use of cannabis for the period July 2013 to June 2023 were selected for this study.</p><p><strong>Measurements: </strong>Crude and age-standardised rates per 100 000 population are reported. Net percentage change over the 10-year study window was estimated using generalised linear models with a log-population offset, contrasting the final year (2022/2023) against the baseline (2013/2014).</p><p><strong>Results: </strong>There were 39 565 cannabis-related admissions in the 10-year period, including 7263 admissions where cannabis-related harm was the principal diagnosis. The age-standardised rate per 100 000 population was 63.6 for all cannabis-related harm admissions and 11.7 for principal diagnosis cases. The peak annual rate for all cannabis-related harm was observed in 2020/2021 (77.3 per 100 000). There was a 49.0% (P < 0.0001) increase in the rate of hospital admissions with a cannabis-related principal diagnosis, when comparing 2022/2023 with baseline (2013/2014). Overall, harmful use (diagnosis code F12.1) was the most common cannabis-related mental and behavioural disorder. Psychotic disorder (F12.5) was the most common principal diagnosis only (40.1%; n = 2909/7263). When considering principal diagnosis only, the rates were highest in males aged 15-24 years (36.9/100 000), followed by females in the same age group (20.5/100 000). While most principal diagnosis cases involved males, a greater percentage change between the first and last years of the study period was observed for females (+75.1%, P < 0.0001) compared with males (+34.6%, P = 0.003).</p><p><strong>Summary: </strong>Hospital admissions with a cannabis-related principal diagnosis were 49% higher in Victoria, Australia, in 2022/2023 than in 2013/2014, with the highest rates among people aged 15-24 years and a larger relative increase among females than males; however, trends were non-linear, with admission rates peaking in 2020/2021.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic pain treatment experiences and barriers among opioid agonist treatment participants who inject drugs: A qualitative study.","authors":"Jie Yang, Shelley Walker, Amy G McNeilage, Peter Higgs, Louisa Picco, Paul Dietze, Suzanne Nielsen","doi":"10.1111/add.70629","DOIUrl":"https://doi.org/10.1111/add.70629","url":null,"abstract":"<p><strong>Background and aim: </strong>Co-occurring chronic pain affects nearly half of people receiving opioid use disorder (OUD) treatment. Although this pain is often severe, it is usually inadequately managed. Stigma and clinical complexity associated with OUD are thought to further restrict access to pain care. This study examined barriers to pain treatment from the perspectives of people with both chronic pain and OUD.</p><p><strong>Methods: </strong>A qualitative study was conducted using semi-structured interviews with 20 adults with lived experience of chronic pain and opioid agonist treatment (OAT) (i.e. prescribed methadone or buprenorphine) for OUD, across three sites in Melbourne, Australia. Interviews were conducted in person, between December 2024 and February 2025. Interviews were audio-recorded and transcribed verbatim. NVivo 15 was used to manage and organise the transcripts. Data were analysed using reflexive thematic analysis informed by Levesque et al.'s patient-centred access to healthcare framework.</p><p><strong>Results: </strong>Three interrelated themes were identified regarding barriers to accessing pain care among people with chronic pain and OUD. \"Misalignment between health systems and everyday life\" highlighted issues such as fragmented service delivery, limited coordination between pain and addiction services, and inconsistent pathways for referral and ongoing care. 'Stigma, distrust and exclusion in pain care' reflected participants' experiences of perceived and enacted stigma within healthcare settings, contributing to reduced help-seeking, delayed disclosure of pain and reluctance to engage with services. 'Deprioritised pain care in the context of OAT' illustrated how pain was often not systematically assessed or treated in addiction-focused care, with OUD frequently taking precedence over pain-related concerns.</p><p><strong>Conclusion: </strong>Pain care for people with opioid use disorder (OUD) appears to be influenced by intersecting structural, social and clinical barriers, including socioeconomic disadvantage and stigma. Pain management is reported as being deprioritised within OUD treatment contexts, with inconsistent attention to the assessment and treatment of chronic pain.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nicotine replacement therapy sampling for cigarette cessation in dental care: A National Dental Practice-Based Research Network cluster randomized clinical trial.","authors":"Sandra J Japuntich, Pearl Fang, Tamara Lischka, Emily Welle, Melissa Adkins-Hempel, Devyn Fernholz, Rosa Gerdts, Natalia Gutierrez Sacasa, Arthur Truong, Sarah Basile, Denis Nyongesa, Ning Smith, Donald Brad Rindal, Dorota T Kopycka-Kedzierawski, Sarah Helseth, Douglas Levy, Jennifer Dahne, Peggy Richardson, Matthew Carpenter","doi":"10.1111/add.70618","DOIUrl":"10.1111/add.70618","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and aims: &lt;/strong&gt;Cigarette smoking is detrimental to oral health. Oral health professionals rarely prescribe smoking cessation medications. Nicotine replacement therapy sampling (NRTS), providing brief starter courses of NRT, could improve provision of NRT and promote cessation. The aim of the Free Samples for Health (FreSH) study was to test the effectiveness of NRTS compared with enhanced usual care on long-term abstinence from combustible tobacco.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Two-group, pragmatic, cluster (dental practice) randomized clinical trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The study was conducted in the Midwest and Northeast nodes of the United States' National Dental Practice-Based Research Network in 59 dental practices. Practices were randomized to intervention condition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Participants (recruited June 2023-June 2025) were adult patients of network practices who smoke cigarettes daily [n = 1196; NRTS n = 486, comparison group (ET) n = 710; 59% female; 71% White].&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention and comparator: &lt;/strong&gt;All participants received Ask-Advise-Refer: oral health practitioners asked smoking status, advised quitting and referred to state tobacco quitlines. Participants in the NRTS group were given a 2-week supply of 14 mg nicotine patches and 4 mg nicotine lozenges; participants in the ET group were given an electric toothbrush.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Participants were surveyed after their visit and at 1, 3 and 6 months post enrollment. The primary outcome was 7-day point-prevalence abstinence measured 6 months post enrollment confirmed via expired breath carbon monoxide (CO) &lt; 6 p.p.m. Secondary outcomes included quit attempts, short-term abstinence, NRT and quitline use. Covariates included stage of change, confidence, readiness and cigarettes per day.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;While there was no condition effect on CO-confirmed abstinence at 6 months post intervention [NRTS: 8.4%, ET: 8.0%; adjusted odds ratio (aOR) = 1.04, 95% confidence interval (CI) = 0.65-2.09], the NRTS intervention statistically significantly increased NRT use across all timepoints (NRTS: 50%, ET: 13%; aOR = 7.39, 95% CI = 5.29-10.31) and quit attempts at all timepoints (NRTS: 58%, ET: 49%; aOR = 1.46, 95% CI = 1.06-2.02). There was a statistically significant effect of NRTS on self-reported 7-day point-prevalence abstinence at 1 month post enrollment (NRTS: 12.8%, ET: 9.0%; aOR = 1.72, 95% CI = 1.03-2.88). There was no difference in quitline use. Practices assigned to the NRTS condition recruited notably fewer participants (t = 2.11, P = 0.04).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary: &lt;/strong&gt;Free nicotine replacement therapy (NRT) samples are not sufficient to improve long-term smoking abstinence in dental patients; however, NRT samples increase engagement with quitting behaviors and may serve as a starting point toward quitting. Low recruitment in the NRT sampling group demonstrates dis","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing opioid use for chronic pain with a group-based intervention: Economic evaluation using randomised controlled trial data.","authors":"Sheeja Manchira Krishnan, Vijay S Gc, Tom Bromilow, Joe W E Moss, Katie Booth, Harbinder K Sandhu, Andrea Manca, Cynthia Paola Iglesias Urrutia","doi":"10.1111/add.70534","DOIUrl":"https://doi.org/10.1111/add.70534","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and aims: &lt;/strong&gt;Long-term strong opioid use for chronic non-malignant pain (CNMP) represents a significant public health challenge, associated with reduced health-related quality of life (HRQoL) and increased mortality. The Improving the Wellbeing of people with Opioid Treated CHronic pain (I-WOTCH) trial demonstrated that a multicomponent intervention supporting opioid withdrawal in people with CNMP successfully reduced opioid consumption compared with best usual care (BUC), without adversely affecting perceived pain levels. This study aimed to assess the value-for-money of the strategies tested in the I-WOTCH trial, from the perspective of the United Kingdom National Health Service (NHS) and Personal and Social Services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting and participants: &lt;/strong&gt;Within-trial cost-consequence (CCA) and model-based cost-effectiveness analyses (CEA), over one year and lifetime horizons, respectively. Data were sourced from the I-WOTCH trial, which recruited 608 participants from 191 primary care centres in England between May 2017 and January 2019 and followed them up for up to 12 months. Participants received either BUC or 3 group sessions (lasting one day each) led by a trained intervention nurse and by a lay person with CNMP and lived experience with opioid tapering. These sessions, designed to develop self-management skills, were supplemented by ongoing one-to-one support from nursing and lay personnel during follow-up. We used a probabilistic state-transition model to predict expected quality-adjusted life years (QALYs) and costs (in UK £) of each strategy over the lifetime of an individual. Model input parameters were derived mostly from the I-WOTCH trial. Opioid-related excess mortality and fracture rates were extracted from the literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Individual-level healthcare resource use and generic HRQoL [measured using the EuroQOL five dimensions questionnaire (Equation 5D)] were collected at baseline, 4, 8 and 12 months, and analysed to estimate total costs and health consequences for the I-WOTCH and BUC groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;I-WOTCH had higher costs and similar HRQoL outcomes compared with BUC at 12 months. When accounting for long-term reductions in mortality and morbidity from decreased exposure to strong opioids, our long-term model predicted I-WOTCH to yield higher costs and higher QALYs than BUC over the patient's lifetime, resulting in a base case incremental cost-effectiveness ratio of £29 543/QALY (2019 prices). Results were sensitive to structural assumptions in the model (i.e. cohort starting age, treatment effect weaning rate). Our probabilistic sensitivity analysis found I-WOTCH to have a 50% probability of being cost-effective compared with BUC for willingness-to-pay thresholds ranging between 0 and £100 000/QALY.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The Improving the Wellbeing of people with Opioid Treated CHronic pain intervention supp","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tobacco control needs a balanced response, not a false choice between enforcement and harm reduction: A response to commentaries.","authors":"Ron Borland, James Martin, Edward Jegasothy, Ben Youdan, Wayne Hall","doi":"10.1111/add.70635","DOIUrl":"https://doi.org/10.1111/add.70635","url":null,"abstract":"","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149101353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}