Drug and alcohol dependence最新文献

{"title":"Enhanced pharmacokinetic and pharmacodynamic effects of combining p-fluorofentanyl and fentanyl","authors":"Jeremy R. Canfield,&nbsp;Kayla K. Fry,&nbsp;Jon E. Sprague","doi":"10.1016/j.drugalcdep.2025.112710","DOIUrl":"10.1016/j.drugalcdep.2025.112710","url":null,"abstract":"<div><div>In 2023, the Ohio Bureau of Criminal Investigation reported <em>para</em>-fluorofentanyl (<em>p</em>FF) co-occurring with fentanyl 99 % of the time. Similarly, the state of Michigan also reported 99 % of decedents testing positive for <em>p</em>FF also tested positive for fentanyl. The rationale behind this co-occurrence has not been elucidated. One theory postulates <em>p</em>FF to be a coincidental inclusion while other evidence suggests <em>p</em>FF is an intentional addition. In the present study, the pharmacokinetic (PK) and pharmacodynamic (PD) effects of the co-administration of <em>p</em>FF and fentanyl were examined in male Sprague-Dawley rats. Fentanyl and <em>p</em>FF (50, 100 and 200 μg/kg, sc.) resulted in dose-dependent effects on antinociception as measured by tail flick latency and hypothermia. The co-administration of fentanyl (100 μg/kg) and <em>p</em>FF (100 μg/kg) was found to have enhanced antinociceptive potency compared to equivalent doses (200 μg/kg) of either compound administered singularly, and an enhanced hypothermic response compared to an equivalent individual dose of fentanyl. Fentanyl co-administered with <em>p</em>FF resulted in fentanyl having a significantly greater AUC_0-∞and C_max and significantly lower Cl_p/F and V_D/F than <em>p</em>FF. No significant differences were seen in the PK parameters between fentanyl and <em>p</em>FF when administered singularly. The brain to plasma ratio of <em>p</em>FF was significantly lower in the hippocampus and striatum when co-administered with fentanyl compared to singular administration of <em>p</em>FF. The potentiation of the hypothermic response and increase in AUC_0-∞ and C_max of fentanyl (suggesting prolonged exposure) when these drugs are co-administered over given individually suggest they are combined to enhance toxicity.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"272 ","pages":"Article 112710"},"PeriodicalIF":3.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of drug and sexual HIV transmission risk behaviors: A latent class analyses of men and women who inject drugs and are living with HIV in Kazakhstan","authors":"Trena I. Mukherjee ,&nbsp;Tara McCrimmon ,&nbsp;Sholpan Primbetova ,&nbsp;Meruyert Darisheva ,&nbsp;Assel Terlikbayeva ,&nbsp;Nabila El-Bassel","doi":"10.1016/j.drugalcdep.2025.112707","DOIUrl":"10.1016/j.drugalcdep.2025.112707","url":null,"abstract":"<div><h3>Introduction</h3><div>Central Asia has one of the fastest-growing HIV epidemics globally. Suboptimal anti-retroviral treatment (ART) coverage and viral suppression among people who inject drugs (PWID) and are living with HIV increase transmission risk to injection and sexual partners. Men and women may have distinct patterns of HIV transmission risk behaviors, but little is known about how these behaviors co-occur. This paper identifies HIV transmission risk typologies among PWID and examines associated health outcomes by sex.</div></div><div><h3>Methods</h3><div>Between February 2017 and June 2019, we recruited 450 men and 166 women (N = 616) PWID living with HIV in Kazakhstan. Latent class analysis identified heterogenous patterns of injection and sexual risk behaviors. Multinomial logistic regression examined how criminal-justice involvement, drug use and health outcomes varied by risk patterns.</div></div><div><h3>Results</h3><div>ART coverage was 71 % and viral suppression was 43 %, with little variation by sex. Among men, latent classes included: No injection &amp; Low Sexual Risk (41.8 %), Injection &amp; Sexual Risk (36.4 %), and Low Injection &amp; High Injection Risk (21.8 %) behaviors. Both injection risk classes were associated with higher odds of detention, drug use, and overdose. Among women, classes included: Low Injection &amp; Sexual Risk (60.7 %), Sex Work Behaviors &amp; Injection Risk (8.4 %), High Injection &amp; Sexual Risk (30.7 %) behaviors. Sex Work Behaviors &amp; Injection Risk was associated with higher odds of detention, heroin use, and verbal police harassment.</div></div><div><h3>Conclusion</h3><div>PWID living with HIV in Kazakhstan exhibit high-risk behaviors and low viral suppression. Distinct patterns by sex underscore the need for tailored harm reduction strategies and retention in HIV care.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"272 ","pages":"Article 112707"},"PeriodicalIF":3.9,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring psychedelic experiences among people who regularly use methamphetamine: Findings from an international survey","authors":"Dilara Bahceci ,&nbsp;Krista Siefried ,&nbsp;Maureen Steele ,&nbsp;Mary Harrod ,&nbsp;Georgina Bell ,&nbsp;Monica J. Barratt ,&nbsp;Christopher R. Nicholas ,&nbsp;Anthony Rodgers ,&nbsp;Peter S. Hendricks ,&nbsp;Christopher S. Stauffer ,&nbsp;Paul Liknaitzky ,&nbsp;Jonathan Brett","doi":"10.1016/j.drugalcdep.2025.112699","DOIUrl":"10.1016/j.drugalcdep.2025.112699","url":null,"abstract":"<div><h3>Objective</h3><div>Methamphetamine use disorder, associated with significant morbidity and mortality, has limited effective treatments. Psychedelic-assisted psychotherapy shows promise, but data on its safety and efficacy in this population are limited. This exploratory study describes the demographic, substance use, and mental health characteristics of people who used methamphetamine and psychedelics and the context and outcomes of their psychedelic experiences.</div></div><div><h3>Methods</h3><div>A retrospective survey collected data on demographics, substance use patterns, mental health, and psychedelic use. Binomial logistic regression explored associations of post-psychedelic positive mood and social functioning ('increased'/'not increased') and substance use ('reduced'/'not reduced') with demographics, psychosocial factors, mental health, substance use patterns, and psychedelic use context.</div></div><div><h3>Results</h3><div>Among 268 participants, 48.5 % had a diagnosed mental illness, 45.1 % were at risk of suicide, 61.2 % reported psychotic symptoms, 45.1 % had high-risk methamphetamine use, and 82.1 % had taken substances other than methamphetamine and psychedelics. Most psychedelic experiences were unplanned (52.6 %), recreationally motivated (73 %), and combined with other drugs (52.6 %). Post-experience, participants reported improved mood (59.3 %) and social functioning (49.6 %), and reduced use of methamphetamine (34.0 %) and other substances (35.1 %). Forward planning and less challenging experiences were linked to improved mood (aOR 1.84, <em>p</em> = 0.048; aOR 2.21, <em>p</em> = 0.012) and reduced substance use (aOR 2.27, <em>p</em> = 0.008; aOR 3.58, <em>p</em> &lt; 0.001).</div></div><div><h3>Discussion</h3><div>Psychedelic use among people who use methamphetamine may improve mood and social function, and reduce substance use. The complex findings highlight the potential importance of psychosocial and environmental factors (“set and setting”) in determining outcomes, underscoring the need for controlled clinical trials and tailored harm reduction strategies.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"272 ","pages":"Article 112699"},"PeriodicalIF":3.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain glutathione levels and associations with recent drinking in treatment-naïve individuals with alcohol use disorder versus light drinkers","authors":"James J. Prisciandaro ,&nbsp;Joseph P. Schacht ,&nbsp;Andrew P. Prescot ,&nbsp;Raymond F. Anton","doi":"10.1016/j.drugalcdep.2025.112705","DOIUrl":"10.1016/j.drugalcdep.2025.112705","url":null,"abstract":"<div><h3>Background and aims</h3><div>Repeated ethanol exposure produces excess oxidative stress resulting in cellular damage, with glutathione (GSH), the brain’s primary antioxidant, conferring a critical first line of defense. This study aimed to compare brain GSH levels between treatment-naïve individuals with Alcohol Use Disorder (AUD) and light drinking control participants (LD). This study also aimed to evaluate associations of brain GSH levels with recent heavy drinking in AUD and LD participants.</div></div><div><h3>Design setting and participants</h3><div>Secondary analyses were conducted on cross-sectional neuroimaging data from (<em>n</em> = 20) treatment-naïve individuals with AUD and (<em>n</em> = 20) demographically matched LD participants at a medical university in South Carolina, USA.</div></div><div><h3>Measurements</h3><div>CSF-corrected and water-referenced GSH levels from dorsal anterior cingulate cortex (dACC) acquired via proton MR spectroscopy and past 14-day number of heavy drinking days (nHDD) acquired via Time-Line Followback interview.</div></div><div><h3>Findings</h3><div>Significantly higher dACC GSH/water levels were observed in AUD participants (<em>M</em> = 0.88, <em>SD</em> = 0.16) than in LD participants (<em>M</em> = 0.70, <em>SD</em> = 0.16, <em>F</em> = 12.00, <em>p</em> &lt; 0.001; Cohen’s <em>d</em> = 1.10). A<em>d</em>ditionally, there was a significant interaction between GSH/water levels and participant group (<em>F</em> = 5.71, <em>p</em> = 0.022), such that higher GSH/water levels were associated with lower nHDD in AUD (<em>r</em> = -0.46, <em>p</em> = 0.040) but not LD (<em>r</em> = 0.24, <em>p</em> = 0.329) <em>p</em>articipants.</div></div><div><h3>Conclusions</h3><div>The findings from this preliminary study are consistent with an interpretation of compensatory GSH upregulation in response to moderate oxidative stress in treatment-naïve individuals with AUD, adding unique support to oxidative stress models of alcohol-related cellular damage and highlighting the potential promise of antioxidant treatments for AUD.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"272 ","pages":"Article 112705"},"PeriodicalIF":3.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Designer benzodiazepines: Availability, motives, and fatalities. A systematic narrative review of human studies","authors":"Jan van Amsterdam ,&nbsp;Wim van den Brink","doi":"10.1016/j.drugalcdep.2025.112708","DOIUrl":"10.1016/j.drugalcdep.2025.112708","url":null,"abstract":"<div><h3>Background</h3><div>Studies on illegal drug use often include the use of regular benzodiazepines (BZDs), i.e., BZDs of pharmaceutical quality, obtained either via diversion or prescription. However, since two decades, designer benzodiazepines (DBZDs) are emerging on the illicit drug markets. DBZDs are generally illegally produced, short-acting, highly potent, cheap benzodiazepines that are easy available on street markets or the internet. In this systematic review we describe the availability, motives and fatalities related to DBZDs.</div></div><div><h3>Method</h3><div>Systematic narrative review of 109 eligible studies, including 37 studies on availability, 29 studies on motives, and 56 studies on drug related deaths.</div></div><div><h3>Results</h3><div>In many countries the prevalence of DBZDs on the illegal drug market is increasing. (D)BZDs are particularly popular among users of opioids, because they intensify and/or prolong the euphoric effect of opioids. In addition, patients on opioid agonist treatment (OAT) may use benzodiazepines to self-medicate withdrawal symptoms, anxiety and/or poor sleep quality. Although (D)BZDs are safe drugs when used alone, concurrent use of benzodiazepines and opioids is extremely dangerous, because it may lead to fatal overdoses, especially when illegally manufactured fentanyls (IMFs) are polluted with DBZDs.</div></div><div><h3>Discussion</h3><div>In some countries, the concurrent use of (D)BZDs and opioids has resulted in many overdose deaths. Meanwhile, clinical guidelines recommend reluctance to prescribe benzodiazepines to people who use drugs, including those in OAT. However, such measures seem to facilitate the DBZD market as an unintended side-effect. Increasing OAT-availability with drug use counselling and monitoring together with take-home naloxone kits should, therefore, be considered.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"272 ","pages":"Article 112708"},"PeriodicalIF":3.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"De facto opioids: Characterization of novel 7-hydroxymitragynine and mitragynine pseudoindoxyl product marketing","authors":"Katherine Hill ,&nbsp;Edward W. Boyer ,&nbsp;Oliver Grundmann ,&nbsp;Kirsten E. Smith","doi":"10.1016/j.drugalcdep.2025.112701","DOIUrl":"10.1016/j.drugalcdep.2025.112701","url":null,"abstract":"<div><h3>Background</h3><div>Within the past year, the online sale of semi-synthetic products containing chemicals derived from mitragynine, kratom’s primary alkaloid: 7-hydroxymitragynine (7-OH) and mitragynine pseudoindoxyl (MP) has emerged. Both are highly selective mu opioid receptor agonists undetectable or not present in fresh kratom leaves and may, as constituents of novel product formulations, pose public health risks.</div></div><div><h3>Method</h3><div>Between September 2024-February 2025 we abstracted from websites of vendors selling 7-OH and MP products information about these products, including formulation types, dose/serving size, cost, and effect, health, and drug claims</div></div><div><h3>Results</h3><div>We identified 304 7-OH and MP semi-synthetic products. Most (82.2 %) were 7-OH-only products formulated as chewable/sublingual tablets, shots, or gummies; 14.5 % were combination 7-OH-MP, and 3.3 % MP-only. MP and 7-OH-MP combination products were almost uniformly marketed as “kratom” while 92.0 % of 7-OH-only products were advertised as such. Across products’ online marketing content, 73.3 % made effect claims, most often promising increased focus and/or providing relaxation. Functional claims of pain and anxiety relief were made by 37.8 % of products while 12.5 % of made drug claims. The mean cost per recommended dose/serving was $3.97; MP products had a mean cost closer to $5 per recommended dose/serving. Several products had names alluding to prescription opioids.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"272 ","pages":"Article 112701"},"PeriodicalIF":3.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telehealth tDCS to reduce cannabis use: A pilot RCT in multiple sclerosis as a framework for generalized use","authors":"Giuseppina Pilloni ,&nbsp;Shayna Pehel ,&nbsp;Timothy Ko ,&nbsp;Carrie Sammarco ,&nbsp;R. Erik Charlson ,&nbsp;Colleen A. Hanlon ,&nbsp;Leigh Charvet","doi":"10.1016/j.drugalcdep.2025.112706","DOIUrl":"10.1016/j.drugalcdep.2025.112706","url":null,"abstract":"<div><h3>Introduction</h3><div>Cannabis use is rising in the United States. Up to 30 % of individuals who use cannabis develop cannabis use disorder (CUD), for which there are no FDA-approved treatments. This randomized controlled trial (RCT) evaluated the feasibility and efficacy of a novel, one-month telehealth intervention of remotely supervised tDCS (RS-tDCS) paired with mindfulness meditation. This home-based telehealth intervention was evaluated in a cohort of women with multiple sclerosis (MS), a vulnerable subpopulation of adults with high rates of CUD.</div></div><div><h3>Methods</h3><div>The intervention included 20 home-based RS-tDCS sessions targeting the left DLPFC, delivering 2.0<!--> <!-->mA for 20<!--> <!-->minutes, paired with guided mindfulness meditation. Sessions were conducted 5 days per week for four weeks. Fifty-two women with MS and CUD (age: 44 ± 10 years) consented to participate; 47 were randomized 2:1 to active or sham tDCS. Feasibility was assessed via retention and adherence, while preliminary efficacy was measured by cannabis use, withdrawal symptoms, and MS-related symptom scales.</div></div><div><h3>Results</h3><div>Of 47 randomized participants (31 active, 16 sham), 39 (83 %) completed the intervention. The active tDCS group showed significant reductions in weekly cannabis use (Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory, DFAQ-CU: 5.3 ± 2.4 vs. 3.9 ± 2.7 days, p = 0.014) and withdrawal symptoms (CWS: p &lt; 0.001). A trend toward reduced MS-related symptoms was observed (SymptoMScreen: p = 0.031). Cognitive performance improvement at the end of the intervention was significant in the active group (p = 0.011 vs. p = 0.172), supporting functional benefits of reduced cannabis use.</div></div><div><h3>Conclusions</h3><div>This pilot RCT supports the feasibility and preliminary efficacy of telehealth tDCS in a medical subpopulation. Studying women with MS highlights its potential for large-scale RCTs and clinical use.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"272 ","pages":"Article 112706"},"PeriodicalIF":3.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse clinical effects associated with the use of synthetic cannabinoids: A systematic review","authors":"Mariana M. Prete ,&nbsp;Gabriel T.B. Feitosa ,&nbsp;Maria A.T. Ribeiro ,&nbsp;T.M. Fidalgo ,&nbsp;Zila M. Sanchez","doi":"10.1016/j.drugalcdep.2025.112698","DOIUrl":"10.1016/j.drugalcdep.2025.112698","url":null,"abstract":"<div><div>Synthetic cannabinoids (SCs) are potent agonists of CB1 and CB2 receptors, with affinities approximately 100 times greater than that of natural cannabis. This increased potency is associated with severe clinical outcomes, including psychosis, dependence, and various autonomic disturbances, such as seizures and rhabdomyolysis. The objective of this study was to synthesize the existing literature on the clinical effects of SCs, emphasizing health risks and identifying knowledge gaps. Following PRISMA guidelines, a comprehensive search was conducted across three databases—PubMed, Embase, and Lilacs—resulting in 944 studies. Eligible articles focused on clinical effects associated to SC use, while exclusion criteria encompassed studies unrelated to clinical outcomes, other reviews, animal studies, and those concentrating solely on psychiatric symptoms or therapeutic uses of SCs. In total, 49 studies published between 2010 and 2022 were included, representing diverse populations and study designs. Participants were predominantly young adult males, although ages ranged from 12 to 72 years. SCs' clinical effects predominantly affected the neurological and cardiovascular systems, with common symptoms including seizures, altered consciousness, tachycardia, and hypertension. Hospital and ICU admissions varied, reflecting the complex nature of SC toxicity. Compared to cannabis, SC use was linked to more severe cardiovascular and neurological complications. Additional rare complications included thromboembolic events, immune thrombocytopenic purpura, and psychiatric disturbances. This review highlights the urgent need for targeted public health policies to mitigate the risks associated with SC use and improve medical management. It also stresses the importance of further controlled studies to elucidate the underlying mechanisms of these clinical effects and their pharmacological basis.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"272 ","pages":"Article 112698"},"PeriodicalIF":3.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manifestations of potential xylazine withdrawal: A retrospective cohort study with nested case series","authors":"Ashish P. Thakrar ,&nbsp;Samantha J. Zwiebel ,&nbsp;Paul J. Christine ,&nbsp;Anthony Spadaro ,&nbsp;M.Holliday Davis ,&nbsp;Ranvir Bhatia ,&nbsp;Natasa Rohacs ,&nbsp;Lin Xu ,&nbsp;Jeanmarie Perrone ,&nbsp;Margaret Lowenstein","doi":"10.1016/j.drugalcdep.2025.112681","DOIUrl":"10.1016/j.drugalcdep.2025.112681","url":null,"abstract":"<div><h3>Purpose</h3><div>The alpha₂-agonist xylazine is an increasingly common adulterant of illicitly manufactured fentanyl. A potential xylazine withdrawal syndrome (XWS) is poorly characterized. We assessed for XWS.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of all hospitalized patients with urine GC-MS xylazine testing performed at three academic hospitals in Philadelphia, PA from 3/2022–2/2023. We used linear and logistic regression to compare peak systolic blood pressure, peak heart rate, and intensive care unit (ICU) admissions for patients with vs. without xylazine detected. Additionally, addiction specialist physicians assessed for candidate signs and symptoms of XWS (otherwise unexplained agitation, elevated blood pressure or heart rate, diaphoresis, tremor) using chart review.</div></div><div><h3>Results</h3><div>Of 121 xylazine tests, each among unique patients (mean age 44.6 years, 33.1 % female), 73 (60 %) were positive. Xylazine detection was not associated with differences in peak systolic blood pressure or heart rate, but was associated with lower odds of ICU admission (aOR 0.24, 95 % CI 0.09–0.60). Among 73 patients with xylazine detected, chart review determined 54 (74.0 %) did not have candidate signs of XWS, 12 (16.4 %) were indeterminate, and 5 (6.8 %) were excluded due to severe critical illness. Two patients (2.7 %) had otherwise unexplained blood pressure and heart rate elevation consistent with possible XWS. Co-occurring opioid, benzodiazepine, and alcohol withdrawal were common.</div></div><div><h3>Conclusions</h3><div>In a cohort of hospitalized patients, there was no association between xylazine detection and vital sign instability, xylazine detection was associated with lower ICU admission rate, and chart review did not detect distinct signs or symptoms of XWS.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"272 ","pages":"Article 112681"},"PeriodicalIF":3.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143911642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatial epidemiology of nonfatal overdose in a community-based cohort of marginalized women in Vancouver, British Columbia (2014–2022)","authors":"Shira Goldenberg ,&nbsp;Esteban J. Valencia ,&nbsp;Ofer Amram ,&nbsp;Kate Shannon ,&nbsp;Kirstin Kielhold ,&nbsp;Charlie (Haouxan) Zhou ,&nbsp;Kathleen Deering","doi":"10.1016/j.drugalcdep.2025.112670","DOIUrl":"10.1016/j.drugalcdep.2025.112670","url":null,"abstract":"<div><h3>Background</h3><div>Given limited data regarding the spatial epidemiology of overdose among women amid the current overdose crisis, we evaluated (1) changes in spatiotemporal clustering of overdose over time, (2) the association between residential proximity to overdose clusters and recent nonfatal overdose, and (3) the association between ‘risk environment’ features and residential proximity to overdose clusters.</div></div><div><h3>Methods</h3><div>Questionnaire data were from a merged community-based cohort of marginalized women who use drugs in Vancouver, Canada (09/2014–08/2022). Emerging hotspot analysis was used to classify residential proximity to spatiotemporal clusters of nonfatal overdose and kernel density estimation was used to visualize the spatiotemporal distribution of nonfatal overdose clustering over the 8-year study. Statistical analyses drew on bivariate and multivariable logistic regression using generalized estimating equations (GEE).</div></div><div><h3>Findings</h3><div>Over eight years, among 650 participants (3461 observations), 37·2 % experienced a nonfatal overdose at least once. Annual period prevalence of nonfatal overdose increased from 9·1 % in 2014–15 to 25·6 % in 2021–2022. The highest-density clusters were in Vancouver’s Downtown Eastside/Strathcona neighborhoods, where clusters became larger and more dispersed from 2016-onwards. Residential proximity to overdose clusters was associated with higher odds of recent nonfatal overdose. ‘Risk environment’ features of unstable housing, unsafe sleeping environments, and physical violence were associated with elevated odds of residential proximity to overdose clusters.</div></div><div><h3>Interpretation</h3><div>Marginalized women face a high and rising burden of nonfatal overdose, which is influenced by the ‘risk environments’ in which they reside. Scale-up of geographically tailored overdose prevention services, harm reduction, and programs addressing violence and housing are needed.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"272 ","pages":"Article 112670"},"PeriodicalIF":3.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}