Drug and alcohol dependence最新文献

{"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}

{"title":"Thematic analysis of medical examiner narratives to understand the socio-spatial context, recency of drug use, and likely mechanism of stimulant toxicity deaths","authors":"Finn Black ,&nbsp;Vanessa M. McMahan ,&nbsp;Yi-Shin G. Chang ,&nbsp;Luke N. Rodda ,&nbsp;Phillip O. Coffin","doi":"10.1016/j.drugalcdep.2025.112700","DOIUrl":"10.1016/j.drugalcdep.2025.112700","url":null,"abstract":"<div><h3>Background</h3><div>Drug toxicity as a cause of death is challenging to establish and may be based on limited evidence, especially in deaths attributed to stimulants. We developed a method for characterizing stimulant deaths, focusing on potential mechanisms and opportunities for intervention.</div></div><div><h3>Methods</h3><div>We used medical examiner case narratives and medical records from a mixed methods study of fatal acute stimulant toxicity in San Francisco. We coded case narratives for circumstances surrounding death events, including physical location, bystander presence, decedent disposition, and evidence of recent street drug use; medical records provided data on potential mechanism of death when not present in case narratives.</div></div><div><h3>Results</h3><div>Of 101 deaths (70 stimulants-no-opioids, 31 stimulants-fentanyl), 85 were unwitnessed, including 69 unwitnessed deaths in spaces inaccessible to bystanders. Drug use was observed before collapse in 1 of 14 witnessed stimulant-no-opioid and 1 of 2 witnessed stimulant-fentanyl deaths. Among unwitnessed events, scene evidence of drug use was found in 36 of 56 stimulant-no-opioid and 25 of 29 stimulant-fentanyl deaths. Twelve of 14 witnessed stimulant-no-opioid deaths and none of two witnessed stimulant-fentanyl deaths included an apparent cardiovascular or cerebrovascular event.</div></div><div><h3>Conclusions</h3><div>Deaths occurred in physically and socially isolated contexts, limiting opportunities for bystander intervention. Compared to stimulant-fentanyl deaths, stimulant-no-opioid deaths may be more likely to be witnessed and involve a cardiovascular event, and less likely to involve recent drug use. Applying a thematic analysis of medical examiner records to a larger sample, including other opioid deaths, could guide prevention strategies.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"272 ","pages":"Article 112700"},"PeriodicalIF":3.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143904333","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":"Development and preliminary testing of a secure large language model-based chatbot for brief alcohol counseling in young adults","authors":"Brian Suffoletto ,&nbsp;Duncan B. Clark ,&nbsp;Christine Lee ,&nbsp;Michael Mason ,&nbsp;Jordan Schultz ,&nbsp;Irvin Szeto ,&nbsp;Denise Walker","doi":"10.1016/j.drugalcdep.2025.112697","DOIUrl":"10.1016/j.drugalcdep.2025.112697","url":null,"abstract":"<div><h3>Objective</h3><div>Young adults face elevated risks from alcohol use yet encounter significant barriers to accessing evidence-based interventions. Large language models (LLMs) represent a promising advancement for delivering personalized behavioral interventions, but their application to alcohol counseling remains unexplored. This study evaluated the development and preliminary outcomes of a Secure GPT-4-powered text-based Motivational Interviewing Conversational Agent (MICA).</div></div><div><h3>Method</h3><div>Using a prospective single-arm pilot design, we evaluated MICA across two phases (Phase I: n = 8; Phase II: n = 37), editing the LLM prompts between Phases. Participants aged 18–25 who reported consuming ≥ 10 standard alcohol units weekly completed a counseling session with MICA. We evaluated safety and compared MI fidelity (relational and technical sub-scales of the Client Evaluation of MI [CEMI]) and usability (System Usability Scale) between Phases. We also explored surrogate measures of effectiveness (i.e. proportion of change talk to sustain talk from session logs) and qualitative feedback themes.</div></div><div><h3>Results</h3><div>No unsafe responses were observed. MI fidelity improved significantly in the CEMI relational sub-scale from Phase I to II (67.2 % to 82.6 %, p = 0.03). Usability remained consistently high across phases (Phase I: 85.4; Phase II: 80.9; p = 0.45). The proportion of within-session change talk was also consistently high (Phase I: 65.2 %; Phase II: 75.8 %; p = 0.10).</div></div><div><h3>Conclusions</h3><div>This study provides preliminary evidence that LLM-based chatbots can deliver MI-adherent alcohol interventions that are both acceptable to young adults and maintain high MI fidelity. Future research should employ randomized controlled designs with longer follow-up periods to evaluate impact on drinking outcomes.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"272 ","pages":"Article 112697"},"PeriodicalIF":3.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907661","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":"Patient characteristics associated with receipt of contingency management for stimulant use disorder in the Veterans Health Administration","authors":"Madeline C. Frost ,&nbsp;Lara N. Coughlin ,&nbsp;Lan Zhang ,&nbsp;Devin C. Tomlinson ,&nbsp;Lewei (Allison) Lin","doi":"10.1016/j.drugalcdep.2025.112683","DOIUrl":"10.1016/j.drugalcdep.2025.112683","url":null,"abstract":"<div><h3>Background</h3><div>Contingency management (CM) is the most effective available treatment for stimulant use disorder (StUD). The Department of Veterans Affairs (VA) rolled out the largest national CM implementation effort to date, but ongoing efforts are needed to increase CM receipt. To inform these efforts, it is important to understand the reach of CM implementation across patient characteristics. This exploratory analysis examined whether patient characteristics are associated with CM receipt among VA patients with StUD.</div></div><div><h3>Methods</h3><div>We extracted electronic health record data for patients with diagnosed StUD who received care 10/1/20–9/30/22 at VA facilities that had begun CM implementation (N = 93,960); CM receipt was measured during the year following patients’ index visit (first visit during 10/1/20–9/30/22). We examined whether sociodemographic characteristics, comorbidities, and prior non-CM StUD treatment utilization were associated with likelihood of receiving CM using multivariable logistic regression.</div></div><div><h3>Results</h3><div>Only 1 % (n = 1113) of the sample received CM. Patients were more likely to receive CM if they were age 30–64 (compared to age 18–29), Black (compared to White), service connected, experiencing homelessness/housing instability, had alcohol, opioid or other drug use disorders, or had more prior non-CM StUD psychotherapy visits or more prior StUD medication management visits. Patients were less likely to receive CM if they lived in rural areas, had posttraumatic stress disorder, or had ≥ 3 Elixhauser comorbidity conditions.</div></div><div><h3>Conclusions</h3><div>Ongoing efforts to increase CM receipt are needed, including increasing access for patients in rural areas and further work to understand specific barriers for patients with PTSD or a higher number of comorbidities.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"272 ","pages":"Article 112683"},"PeriodicalIF":3.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143911645","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":"Using a loose-leaf vaporizer to study tobacco-cannabis co-administration: A proof-of-concept study","authors":"Gideon St.Helen,&nbsp;Christopher Havel,&nbsp;Newton Addo,&nbsp;Nickole Criner,&nbsp;Peyton Jacob III,&nbsp;Neal Benowitz","doi":"10.1016/j.drugalcdep.2025.112678","DOIUrl":"10.1016/j.drugalcdep.2025.112678","url":null,"abstract":"<div><h3>Objective</h3><div>We examined differences in Δ-9-tetrahydrocannabinol (THC) and nicotine intake, pharmacokinetics, subjective and physiologic effects from use of cannabis only, tobacco only, and a mixture of cannabis and tobacco using a PAX-3 vaporizer.</div></div><div><h3>Methods</h3><div>Eight (7<!--> <!-->M, 1<!--> <!-->F) healthy adults who use both cannabis and tobacco participated in a 3-arm, within-subject study. Participants were administered 3 standardized puffs of cannabis only, tobacco only, or a 50–50 mixture with a PAX-3. Blood was collected and questionnaires were administered before and after the last puff.</div></div><div><h3>Results</h3><div>Average maximum plasma THC concentration (C_max) and area under the plasma THC concentration-time curve (AUC) were significantly higher after vaping the mixture compared to cannabis only [C_max: 25.7 ± 14.0<!--> <!-->ng/mL vs. 9.7 ± 6.5<!--> <!-->ng/mL, p &lt; 0.04 (mean±SD); AUC: 590 ± 555<!--> <!-->ng/mL•min vs. 306 ± 258<!--> <!-->ng/mL•min, p &lt; 0.02]. Similarly, plasma nicotine C_max and AUC_(0→360) were significantly higher after vaping the mixture compared to tobacco only [C_max: 1.6 ± 0.71<!--> <!-->ng/mL vs. 0.55 ± 0.32<!--> <!-->ng/mL, p &lt; 0.02; AUC: 135 ± 35.7<!--> <!-->ng/mL•min vs. 63.1 ± 25.4<!--> <!-->ng/mL•min, p &lt; 0.01]. Although elevated from use of the mixture, heart rate changes were not significantly different across study conditions. Subjective effects generally did not differ across study conditions, but this may have been due to the small sample size of the study.</div></div><div><h3>Conclusion</h3><div>Vaping cannabis and tobacco together leads to greater exposure to THC and nicotine than the substances by themselves. Despite differences in THC exposure, subjective effects and heart rate were not different between the mixture and cannabis only, indicating potential attenuation of THC-related effects by nicotine.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"272 ","pages":"Article 112678"},"PeriodicalIF":3.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907802","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}