Drug and alcohol dependence最新文献

{"title":"Inter-individual divergence in thresholds for detecting opioid effects: Within-subject human laboratory evidence of a testable behavioral phenotype","authors":"Greer McKendrick ,&nbsp;Caitlyn J. Durgin ,&nbsp;Andrew S. Huhn ,&nbsp;Cecilia L. Bergeria ,&nbsp;Patrick H. Finan ,&nbsp;Denis Antoine ,&nbsp;Kelly E. Dunn","doi":"10.1016/j.drugalcdep.2025.112644","DOIUrl":"10.1016/j.drugalcdep.2025.112644","url":null,"abstract":"<div><div>Variations in inter-individual response to opioid medications has not been well-investigated in prospective, empirical designs or in persons who have no learned experience with opioids or current pain conditions. These analyses categorized response to opioids during rigorous human laboratory experimental conditions. Healthy individuals (N = 75) with little to no prior opioid exposure completed a 5-day residential study wherein they received triple-blinded doses of placebo or oral hydromorphone (2<!--> <!-->mg, 4<!--> <!-->mg, 8<!--> <!-->mg). Outcomes included a series of general and specific visual analog scale (VAS) ratings completed by participants and blinded observers, physiological endpoints, and analgesic responses to laboratory-evoked pain. The lowest dose at which participants endorsed &gt; 20 point change in self-reported “Drug Effect” VAS ratings from baseline was used to define the following opioid sensitivity thresholds: 2<!--> <!-->mg (“Low Threshold”, N = 9), 4<!--> <!-->mg (“Medium”; N = 29), and 8<!--> <!-->mg (“High”, N = 14); a “No Threshold” group (N = 31) did not endorse any effects at any dose. Main effects of sensitivity threshold existed for most participant-reported responses and conformed to threshold categories in dose-dependent ways. In contrast, no main effects of sensitivity threshold were observed for blinded observer ratings, physiological endpoints, or evoked analgesic responses, such that hydromorphone produced dose-dependent opioid agonist effects for all participants that diverged from their self-reported experience. These data provide the most granular assessment of inter-individual differences in opioid response among persons with little or no lifetime opioid exposure or existing pain condition. All participants experienced dose-dependent changes in opioid agonist responses, yet their self-awareness of these effects varied and 30 % of participants endorsed no awareness of opioid exposure at any dose. These data demonstrate a consistent and reliable divergence between the subjective experience of opioids from rigorously-assessed physiological, observable, and analgesic responses. Testable implications of these outcomes are discussed.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"271 ","pages":"Article 112644"},"PeriodicalIF":3.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611109","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":"People entering opioid substance use treatment have low rates of naloxone knowledge and possession","authors":"Erin Bredenberg ,&nbsp;Heather Olsen ,&nbsp;Michael Ladka ,&nbsp;Kyle Beekman ,&nbsp;Joshua C. Black ,&nbsp;Matthew S. Ellis ,&nbsp;Andrew A. Monte","doi":"10.1016/j.drugalcdep.2025.112645","DOIUrl":"10.1016/j.drugalcdep.2025.112645","url":null,"abstract":"<div><h3>Background and aims</h3><div>Deaths from opioid overdose are increasing in the United States (US) and distribution of the opioid antagonist naloxone is one key strategy to reduce mortality. In this cross-sectional survey, we assess the association of high-risk behaviors with possession of naloxone and knowledge of where to find it.</div></div><div><h3>Setting and participants</h3><div>5663 adults entering treatment for opioid use disorder at facilities throughout the US during the calendar year 2022 were surveyed.</div></div><div><h3>Analysis</h3><div>Using a logistic regression analysis, we compared self-reported ownership of naloxone and knowledge of where to find naloxone between individuals with different self-reported types and routes of opioid use, as well as those with a history of opioid overdose compared to those without.</div></div><div><h3>Findings</h3><div>Patients reporting fentanyl, heroin, and more than one type of opioid use had higher rates of naloxone possession than those reporting oxycodone use alone. Patients that reported injection drug use were more likely to possess (61 %) and know where to get (77 %) naloxone than those who did not inject drugs (44 % possessed and 58 % knew where to find naloxone, p &lt; 0.001 for each comparison). Patients with a self-reported history of overdose were more likely to possess (59 %) and know where to get (77 %) naloxone than those without a history of overdose (42 % and 55 % respectively, p &lt; 0.001 for each comparison).</div></div><div><h3>Conclusions</h3><div>Gaps in naloxone possession and knowledge persist amongst patients entering treatment for opioid use disorder. Additional efforts to expand naloxone ownership are critical, including comprehensive educational programs, involvement of community-based organizations, and bystander training.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"271 ","pages":"Article 112645"},"PeriodicalIF":3.9,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600538","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":"School party culture as a driver of cocaine use among Norwegian adolescents: A cross-classified multilevel analysis","authors":"Lars Roar Frøyland ,&nbsp;Willy Pedersen ,&nbsp;Frøydis Enstad ,&nbsp;Tilmann von Soest","doi":"10.1016/j.drugalcdep.2025.112627","DOIUrl":"10.1016/j.drugalcdep.2025.112627","url":null,"abstract":"<div><h3>Background</h3><div>Adolescent substance use typically occurs within peer contexts and is influenced by characteristics of neighborhoods and the cultural environments of the schools adolescents attend. This study aimed to (i) examine variation in cocaine use among adolescents in Oslo, Norway, based on neighborhood of residence and high school affiliation; (ii) assess the significance of school-based party cultures; and (iii) identify individual-level correlates.</div></div><div><h3>Methods</h3><div>The study used data from the Young in Oslo 2023 survey, which collected information from a population-based sample of senior high school students (<em>n</em> = 9741) residing in 95 neighborhoods and attending 25 schools. Participants completed e-questionnaires with information on cocaine use, neighborhood and school affiliation, school-based party cultures, sociodemographic variables, and potential correlates of cocaine use. The data were analyzed using cross-classified multilevel models (CCMM).</div></div><div><h3>Results</h3><div>Of all adolescents, 9.3 % had used cocaine in the previous year. A CCMM including neighborhood and school showed an intraclass correlation coefficient (ICC) of 0.004 for neighborhood and 0.106 for school, indicating that 10.6 % of the variance in cocaine use was linked to school affiliation, while neighborhood variations were negligible. Including school party culture decreased the ICC for school to 0.055, suggesting this measure accounted for half the school-level variance. Further adjustments for individual-level correlates reduced the ICC to 0.028. The most significant individual factors were male gender, alcohol intoxication, and peers use of illicit drugs.</div></div><div><h3>Conclusions</h3><div>Certain youth milieus characterized by heavy-drinking boys and school-based party cultures increased cocaine use. Targeting these environments may be effective in prevention work.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"271 ","pages":"Article 112627"},"PeriodicalIF":3.9,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between risk propensity and substance use: A multilevel meta-analysis","authors":"Chia-Wen Wang ,&nbsp;Joey Elizabeth Yeo ,&nbsp;Yiyun Shou","doi":"10.1016/j.drugalcdep.2025.112640","DOIUrl":"10.1016/j.drugalcdep.2025.112640","url":null,"abstract":"<div><h3>Background</h3><div>Substance use and its related disorders represent a significant global health concern. Risk propensity has been identified as a factor influencing substance use.</div></div><div><h3>Methods</h3><div>Multilevel meta-analysis was applied to quantitatively synthesise studies examining the associations between risk propensity and substance use and to identify potential factors that influence these relationships.</div></div><div><h3>Results</h3><div>A total of 323 effect sizes, 186 independent samples, and 148 studies were included in this meta-analysis. The results showed that risk propensity was statistically positively associated with substance use (r = 0.116), as well as with all three main types of substances, including tobacco (r = 0.092), alcohol (r = 0.114), and drugs (r = 0.115). Such a link was not significantly different across substance types. Moderator analyses showed that the type of risk propensity assessments and age of the study samples moderated the association between risk propensity and one or more types of substance use.</div></div><div><h3>Conclusions</h3><div>The findings underscore the importance of considering the role of risk propensity in the initiation of substance use and developing early interventions to prevent substance use. Future interventions could consider early detection and targeted intervention for young people with a heightened risk propensity.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"271 ","pages":"Article 112640"},"PeriodicalIF":3.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intermittent theta burst to the left dorsolateral prefrontal cortex promoted decreased alcohol consumption and improved outcomes in those with alcohol use disorder: A randomized, double-blind, placebo-controlled clinical trial","authors":"Timothy C. Durazzo ,&nbsp;Eric P. Kraybill ,&nbsp;Lauren H. Stephens ,&nbsp;Daniel M. McCalley ,&nbsp;Keith Humphreys ,&nbsp;April C. May ,&nbsp;Claudia B. Padula","doi":"10.1016/j.drugalcdep.2025.112641","DOIUrl":"10.1016/j.drugalcdep.2025.112641","url":null,"abstract":"<div><h3>Background</h3><div>Over 60 % of individuals with alcohol use disorder (AUD) resume hazardous drinking within 6 months post-treatment, necessitating the development of more efficacious interventions. Accumulating evidence suggests transcranial magnetic stimulation (TMS) is a promising intervention for AUD. This randomized, double-blind, placebo-controlled trial assessed the efficacy of intermittent theta burst (iTBS), a form of TMS, as an adjunct treatment for AUD.</div></div><div><h3>Methods</h3><div>Forty-nine Veterans with AUD (48 males, 1 female) were recruited from residential AUD and substance use disorder treatment. Participants were randomized to 20 sessions of Active (n = 25) or Sham (n = 24) iTBS (1200 pulses/session), targeting the left dorsolateral prefrontal cortex (DLPFC) administered over 14 days or less. Five participants were withdrawn unrelated to iTBS procedure adverse events. Participant alcohol/substance use was monitored for 6-months following final iTBS session.</div></div><div><h3>Results</h3><div>Relative to participants who received Sham iTBS, those who received Active iTBS showed a significantly greater reduction in percent heavy drinking days and a trend for higher rate of continuous abstinence over 6-months. Among participants who resumed alcohol consumption, those in the Active group demonstrated significantly lower quantity and duration of alcohol consumption than Sham. Pre-study alcohol consumption variables were not related to post-iTBS treatment outcomes.</div></div><div><h3>Conclusions</h3><div>Findings indicated that Active left DLPFC iTBS, delivered over approximately 2-weeks, was a safe and efficient intervention for AUD that promoted significantly reduced heavy drinking and improved clinical outcomes compared to Sham over 6-months post-iTBS. This study provides novel data to inform and power future larger-scale, multi-site clinical trials employing iTBS for AUD.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"270 ","pages":"Article 112641"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548308","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":"Across the spectrum: Acute alcohol responses in young adults with mild, moderate, and severe alcohol use disorder","authors":"Riya Thomas ,&nbsp;Nathan Didier ,&nbsp;Rachel Nordgren ,&nbsp;Layne Robinson ,&nbsp;Ashley Vena ,&nbsp;Andrea C. King","doi":"10.1016/j.drugalcdep.2025.112629","DOIUrl":"10.1016/j.drugalcdep.2025.112629","url":null,"abstract":"<div><h3>Background</h3><div>Little is known about acute subjective and physiological responses to alcohol in individuals with alcohol use disorder (AUD), particularly as it pertains to the spectrum of AUD severity. This study examined acute biphasic alcohol response phenotypes in participants with mild, moderate, and severe AUD.</div></div><div><h3>Methods</h3><div>Study data was from the third cohort of the Chicago Social Drinking Project (N = 101, 50 % male; M age=27.1 years). AUD severity was determined based on the DSM-5; 20 % of participants had mild, 20 % had moderate, and 60 % had severe AUD. In a random-order, within-subject, oral alcohol administration paradigm, participants received a high alcohol dose (0.8<!--> <!-->g/kg), a very high alcohol dose (1.2<!--> <!-->g/kg), and placebo in separate sessions. Breath alcohol concentration (BrAC), subjective responses (liking, wanting, stimulation, and sedation), and cortisol levels were measured.</div></div><div><h3>Results</h3><div>Analyses revealed that, relative to those with mild AUD, both very high and high alcohol doses (<em>vs</em>. placebo) significantly increased liking, wanting, and stimulation in the severe AUD subgroup, with a dose-response relationship (very high dose &gt; high dose &gt; placebo) in the moderate AUD subgroup. Alcohol produced lower sedation in participants with moderate and severe AUD relative to mild AUD, suggestive of tolerance to alcohol’s sedating and fatiguing effects. Cortisol response to alcohol did not differ across groups, except for higher baseline levels in the severe AUD subgroup, which carried forward.</div></div><div><h3>Conclusions</h3><div>Taken together, these findings indicate that higher AUD severity is associated with enhanced sensitivity to alcohol’s positive effects, challenging traditional notions of global alcohol tolerance and reward deficit in people who drink excessively.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"271 ","pages":"Article 112629"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600539","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":"Tobacco treatment and policies in mental health and substance use treatment facilities in the US","authors":"Dian Gu ,&nbsp;Fan Xia ,&nbsp;Maya Vijayaraghavan","doi":"10.1016/j.drugalcdep.2025.112639","DOIUrl":"10.1016/j.drugalcdep.2025.112639","url":null,"abstract":"<div><h3>Background</h3><div>The prevalence of tobacco use among people with mental health and substance use disorders in the US is high. State- and facility-level factors could be associated with the provision of tobacco treatment and tobacco-free grounds policy in mental health and substance use treatment facilities. We estimated the latest prevalence of, and factors associated with tobacco treatment provision and tobacco-free grounds policies in these facilities.</div></div><div><h3>Methods</h3><div>This cross-sectional study used data from the 2021–2022 National Substance Use and Mental Health Services Survey. Two multivariate Poisson regression models with robust standard errors were employed to estimate state- and facility-level factors associated with two outcomes: 1) provision of any tobacco treatment (screening, behavior counseling, or pharmacotherapy), and 2) having a tobacco-free grounds policy.</div></div><div><h3>Results</h3><div>Among over 17,300 facilities, 87.2 % provided tobacco treatment, and 38.6 % implemented tobacco-free grounds policies. Private for-profit facilities were less likely to provide tobacco treatment (Adjusted Risk Ratio [ARR] 0.87, 95 % CI 0.86–0.89). Private for-profit and nonprofit facilities, those licensed by state or tribal health agencies, and those in tobacco nation states were less likely to implement tobacco-free grounds policies. In contrast, facilities with opioid treatment programs were more likely to achieve both outcomes.</div></div><div><h3>Conclusions</h3><div>Disparities exist in providing tobacco treatment and tobacco-free ground policies, particularly in privately owned facilities. Payers should incentivize the adoption of tobacco treatment and tobacco-free campus policies, and states should incorporate these requirements into licensure and/or accreditation standards for mental health and substance use treatment facilities.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"271 ","pages":"Article 112639"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600565","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":"The opioid epidemic in rural communities: Can telehealth increase access to medications for opioid use disorder and offset barriers to care?","authors":"Kathleen Meyers ,&nbsp;Shannon Herman,&nbsp;Heather Schuler,&nbsp;Carolyn Mun,&nbsp;Elena Bresani,&nbsp;Richard Koban Payne","doi":"10.1016/j.drugalcdep.2025.112628","DOIUrl":"10.1016/j.drugalcdep.2025.112628","url":null,"abstract":"<div><h3>Background</h3><div>Substance and opioid use disorder (SUD/OUD) treatment remains limited in rural communities. This paper examines rural telehealth use, its impact on medication for opioid use disorder (MOUD) provision, and issues that require attention for sustainment.</div></div><div><h3>Methods</h3><div>Ninety-two project directors of the Rural Communities Opioid Response Program’s (RCORP) consortia provided required data on service areas, service delivery, and grant performance. We combined these data with <em>National Survey of Drug Use and Health</em> and <em>U.S. Census Bureau’s American Community Survey</em> data to estimate the number of individuals in a service area who should have received MOUD based on the national prevalence of MOUD provision.</div></div><div><h3>Results</h3><div>Consortia reduced the number of rural counties without access to any OUD treatment by 49 % using telehealth. The number of consortia using telehealth increased by 72 % during the first year of the COVID-19 pandemic. Forty-two percent of rural consortia used telehealth to deliver MOUD. Consortia using telehealth for MOUD provision had significantly higher rates of individuals receiving MOUD and MOUD for 3 or more months compared with those not using telehealth for MOUD. They also had 4.5 times the odds of meeting the national prevalence of MOUD provision compared to those not using telehealth for MOUD. Barriers to telehealth use are reported herein.</div></div><div><h3>Conclusion</h3><div>Telehealth used to deliver MOUD increased MOUD access and retention in rural areas. Increasing the comfort level of telehealth-delivered services, helping staff understand the research on telehealth effectiveness and virtual drug screen protocols, and ensuring reimbursement will be critical for sustainment.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"271 ","pages":"Article 112628"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Buprenorphine-naloxone versus buprenorphine for opioid use disorder during pregnancy: A systematic review and meta-analysis","authors":"Fernanda Ribeiro de Lima ,&nbsp;Gabriela Oliveira Gonçalves Molino ,&nbsp;Mariano Gallo Ruelas ,&nbsp;Eduardo Cerchi Barbosa ,&nbsp;Pedro Henrique Costa Matos da Silva ,&nbsp;Felipe Bandeira de Melo Guimarães ,&nbsp;Arthur Bezerra Cavalcanti Petrucci ,&nbsp;Giovanna Hanike Santos da Silva ,&nbsp;Ângelo Eduardo Espíndola Sbardelotto ,&nbsp;Saulo Bernardo Lança ,&nbsp;Alicja Garbacka","doi":"10.1016/j.drugalcdep.2025.112632","DOIUrl":"10.1016/j.drugalcdep.2025.112632","url":null,"abstract":"<div><h3>Background</h3><div>The standard of care for treating opioid use disorder (OUD) during pregnancy includes either buprenorphine or methadone. Although buprenorphine-naloxone presents an alternative due to the reduced risk of misuse , evidence regarding its impact on pregnancy and infant health remains limited. This systematic review and meta-analysis aims to compare buprenorphine-naloxone <em>vs</em> buprenorphine alone for OUD during pregnancy, assessing gestational and neonatal outcomes.</div></div><div><h3>Methods</h3><div>We systematically searched MEDLINE, Embase, and Cochrane Library databases to identify studies comparing buprenorphine-naloxone versus buprenorphine for OUD during pregnancy. The primary outcome assessed was neonatal abstinence syndrome (NAS). Pooled risk ratios (RR) and mean differences (MD) with 95 % confidence intervals (CI) were calculated using R statistical software and quality assessment was performed following Cochrane recommendations.</div></div><div><h3>Results</h3><div>Six retrospective cohorts were included, encompassing 9348 mother-infant dyads, of whom 38.3 % received buprenorphine-naloxone. NAS requiring treatment (RR 0.77; 95 % CI 0.71–0.84; p &lt; 0.01) and small for gestational age infants (RR 0.86; 95 % CI 0.76–0.98; p = 0.03) were significantly less frequent in the buprenorphine-naloxone group. No significant differences were found between the groups for cesarean delivery (RR 1.04; 95 % CI 0.98–1.11; p = 0.20), low birth weight (RR 1.07; 95 % CI 0.91–1.24; p = 0.41), and preterm delivery (RR 1.07; 95 % CI 0.96–1.21; p = 0.22).</div></div><div><h3>Conclusion</h3><div>Pregnant people treated with buprenorphine-naloxone had neonates with a lower risk of small for gestational age and NAS. Further research is needed to confirm these findings and explore other pregnancy-related and neonatal outcomes.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"271 ","pages":"Article 112632"},"PeriodicalIF":3.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600491","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":"Assessing inequities in buprenorphine treatment across the care cascade","authors":"Alyssa S. Tilhou ,&nbsp;Sarah Gasman ,&nbsp;Jiayi Wang ,&nbsp;Katherine Standish ,&nbsp;Laura F. White ,&nbsp;Ally Cogan ,&nbsp;Morgan Devlin ,&nbsp;Marc Larochelle ,&nbsp;William G. Adams","doi":"10.1016/j.drugalcdep.2025.112636","DOIUrl":"10.1016/j.drugalcdep.2025.112636","url":null,"abstract":"<div><h3>Objective</h3><div>Describe buprenorphine treatment gaps across the care cascade by race, ethnicity, age, sex and key clinical characteristics.</div></div><div><h3>Design</h3><div>Observational cohort study of new opioid use disorder (OUD) treatment episodes, 1/1/15–12/31/21</div></div><div><h3>Participants</h3><div>Individuals 16–89 years at Boston Medical Center and affiliated Boston-area clinics with OUD or buprenorphine prescription following 90-day washout</div></div><div><h3>Main outcomes and measures</h3><div>Buprenorphine initiation (by 14d), engagement (second prescription by 34d), and retention (continuous buprenorphine through 180d without &gt;14d gap). Covariates: sex, race and ethnicity, age, past 12-month buprenorphine, past 12-month overdose, co-occurring substance use disorder (SUD) and psychiatric diagnosis.</div></div><div><h3>Results</h3><div>24,165 episodes (14,182 individuals) included the following characteristics: female (34.1 %); Black (21.5 %), Latino (16.2 %), White (59.2 %); 16–25 years (4.1 %), 65–89 years (4.9 %). Initiation, engagement and retention were low: 39.3 %, 19.3 %, and 12.4 %. In adjusted models, compared with males, females’ lower probability of overall retention reflected lower engagement conditional on initiation (41 % vs. 53 %; OR:0.61, 95 %CI:0.56–0.67, p &lt; 0.001). Black individuals’ lower probability of retention overall reflected lower initiation than White individuals (28 % vs 44 %; OR:0.50, 95 %CI:0.46–0.55, p &lt; 0.001). The retention disadvantage for younger and older groups reflected cascade-wide gaps. Lower overall retention associated with co-occurring SUDs reflected lower initiation (OUD only:46 %; OUD plus: alcohol:19 % OR:0.27, 95 %CI:0.21–0.34, p &lt; 0.001; sedatives:21 %, OR:0.31, 95 %CI:0.20–0.49, p &lt; 0.001; stimulants:25 %, OR:0.40, 95 %CI:0.33–0.48, p &lt; 0.001; ≥3 SUDs:25 %, OR:0.40, 95 %CI:0.37–0.43, p &lt; 0.001).</div></div><div><h3>Conclusions and relevance</h3><div>Inequities in buprenorphine use emerged across the care cascade with unique patterns by sociodemographic and clinical subgroup. Health systems aiming to reduce buprenorphine inequities should identify the optimal cascade step based on the population of interest.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"270 ","pages":"Article 112636"},"PeriodicalIF":3.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548297","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}