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Predictors of Risky Sexual Behaviors Among Female Adolescents and Young Adults Seeking Withdrawal Management Treatment: A Lifestyle-routine Activities Theory Approach. 在寻求戒断管理治疗的女性青少年和年轻成人中,危险性行为的预测因素:一种生活方式-日常活动理论方法。
IF 3.2 3区 医学
Journal of Addiction Medicine Pub Date : 2025-08-01 DOI: 10.1097/ADM.0000000000001551
Sharon Rabinovitz, Sara Kalimi, Maayan Nagar
{"title":"Predictors of Risky Sexual Behaviors Among Female Adolescents and Young Adults Seeking Withdrawal Management Treatment: A Lifestyle-routine Activities Theory Approach.","authors":"Sharon Rabinovitz, Sara Kalimi, Maayan Nagar","doi":"10.1097/ADM.0000000000001551","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001551","url":null,"abstract":"<p><strong>Objectives: </strong>This study examines prevalence and predictors of risky sexual behaviors (RSBs) among female adolescents and young adults admitted to withdrawal management treatment (WM) for substance use disorders (SUD), a critical point where addressing co-occurring risk behaviors could considerably enhance treatment outcomes and recovery. Utilizing lifestyle-routine activities theory (LRAT), we aimed to identify vulnerability factors contributing to sexual victimization.</p><p><strong>Methods: </strong>A 1:1 sample (n = 194; ~45%) was drawn from all admissions over 5 years to the sole national acute WM unit serving females aged 13-34. Data were collected through clinical intake interviews and standardized questionnaires, assessing substance use, mental health, social context, and risky sexual experiences.</p><p><strong>Results: </strong>Sexual victimization and RSBs (eg, unprotected or transactional sex) were highly prevalent, with 89% reporting experiencing sexual assault and 84.9% engaging in at least one recent RSB. Notably, 28% reported participating in 6-7 RSB types. Significant RSB predictors included earlier SUD diagnosis, poor mental health, limited social support, and strained parental relationships. SUD severity (β = 0.15, P = 0.042), peer drug use (β = 0.31, P < 0.001), and living on the street (β = 0.15, P = 0.048) significantly increased the likelihood of multiple RSBs.</p><p><strong>Conclusions: </strong>Findings underscore the importance of integrated, trauma-informed approaches in SUD treatment among young females. The complex interplay between trauma exposure, substance use, and RSBs, influenced by environmental factors, necessitates comprehensive treatment strategies encompassing these co-occurring risk domains simultaneously. LRAT offers a valuable framework for understanding how disrupted environments and diminished protective factors contribute to vulnerability. Implementing tailored, trauma-informed care may enhance recovery while addressing broader public health implications.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neurological Injury and Outcomes in Fentanyl-related Cardiac Arrest. 芬太尼相关性心脏骤停的神经损伤和预后。
IF 3.2 3区 医学
Journal of Addiction Medicine Pub Date : 2025-08-01 DOI: 10.1097/ADM.0000000000001554
Matheus Otero, Jonathan Shih, Bo Zhou, Shital Ghandi, Jason Talbott, Neel S Singhal, Evan Calabrese, Dominica Randazzo, Phillip O Coffin, Jesse Claude Hemphill, Edilberto Amorim
{"title":"Neurological Injury and Outcomes in Fentanyl-related Cardiac Arrest.","authors":"Matheus Otero, Jonathan Shih, Bo Zhou, Shital Ghandi, Jason Talbott, Neel S Singhal, Evan Calabrese, Dominica Randazzo, Phillip O Coffin, Jesse Claude Hemphill, Edilberto Amorim","doi":"10.1097/ADM.0000000000001554","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001554","url":null,"abstract":"<p><strong>Objectives: </strong>Fentanyl has become the primary drug responsible for fatal overdoses in most urban US regions. Information about the impact of fentanyl-related overdose in neurological outcomes after cardiac arrest (CA) compared with other etiologies of CA is limited.</p><p><strong>Methods: </strong>Retrospective review of medical records from adult patients with out-of-hospital CA who had admission drug testing for fentanyl and opioids from August 2019 to June 2021. Good outcome was defined as a Cerebral Performance Category score of 1-2 at discharge. χ2 was used for group comparison.</p><p><strong>Results: </strong>Neurological prognosis evaluation was pursued for 233 patients, and 61 (26.2%) met criteria for good outcome. Thirty-six (15.45%) patients tested positive for fentanyl and 13 for other opioids (5.58%). The proportion of good outcomes was similar between groups (fentanyl 22.2%, other opioids 38.5%, nonopioid 26.1%, P = 0.52). Fewer fentanyl-related CA had bystander cardiopulmonary resuscitation (19.4% vs other opioids 38.5% vs nonopioid 43.8%, P = 0.02) shockable rhythms (2.9%, 16.7%, 25%, P = 0.01) or corneal reflexes 72 hours after CA (25.8%, 66.7%, 39.8%, P = 0.046), but no difference was seen for pupillary response at 72 hours (P = 0.17). More fentanyl-related CA cases had signs of severe brain dysfunction on EEG with burst suppression (54.8%, 0%, 39.4%, P = 0.01).</p><p><strong>Conclusions: </strong>Cardiac arrest associated with fentanyl use was linked to decreased rates of bystander cardiopulmonary resuscitation, increased incidence of nonshockable Rhythms, and greater neurological injury as indicated by electroencephalography (EEG) suppression measures. However, the proportion of good neurological outcomes (CPC: 1-2) was similar across groups.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Medication Approaches for Patients With Opioid Use Disorders: Differences Between Primary Care Clinics and Specialty Addiction Treatment Programs. 阿片类药物使用障碍患者的药物治疗方法:初级保健诊所和专业成瘾治疗方案之间的差异。
IF 3.2 3区 医学
Journal of Addiction Medicine Pub Date : 2025-08-01 DOI: 10.1097/ADM.0000000000001556
Berkeley Franz, James H Ford, Hannah Cheng, Hélène Chokron Garneau, Kimberley Mount, Mark P McGovern
{"title":"Medication Approaches for Patients With Opioid Use Disorders: Differences Between Primary Care Clinics and Specialty Addiction Treatment Programs.","authors":"Berkeley Franz, James H Ford, Hannah Cheng, Hélène Chokron Garneau, Kimberley Mount, Mark P McGovern","doi":"10.1097/ADM.0000000000001556","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001556","url":null,"abstract":"<p><strong>Objectives: </strong>Efforts to increase access to highly effective medications for opioid use disorder (MOUD) have largely focused on primary care. Ironically, many specialty addiction treatment programs have yet to adopt MOUD. To bring MOUD access to scale, researchers need to better understand medication practices across these 2 major portals of care for patients with opioid use disorder (OUD). In this study, our team examined baseline prescribing data from 62 primary care clinics and specialty addiction treatment programs (SATPs) participating in MOUD implementation endeavors across 2 states.</p><p><strong>Methods: </strong>Our primary outcomes included MOUD prescribing practices, measured by the integrating medications for addiction treatment (IMAT), which includes 7 dimensions of guideline-adherent delivery of MOUD, and an additional subscale on low threshold care. We also measured reach of MOUD to patients and adoption as the number of current MOUD prescribers. Secondary outcomes included community characteristics surrounding each type of organization. Descriptive statistics and bivariate tests explored differences between primary and specialty care settings.</p><p><strong>Results: </strong>SATPs had lower MOUD capacity and implementation as compared with primary care clinics. Specialty settings also had lower organizational support for low threshold prescribing. SATPs were located in counties with higher overdose rates, higher unemployment, fewer MOUD prescribers, and with more opioid prescriptions per capita.</p><p><strong>Conclusions: </strong>SATPs have lower MOUD implementation capacity than their primary care counterparts and are more likely to be in counties with greater OUD-related needs, economic distress, and fewer treatment resources. Selecting more precise implementation support strategies for SATPs that are late adopters of MOUD is a major need.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Feasibility of an Inpatient Split-Dose Rapid Methadone Induction Protocol for Pregnant Individuals. 孕妇住院分次快速美沙酮诱导方案的可行性。
IF 3.2 3区 医学
Journal of Addiction Medicine Pub Date : 2025-08-01 DOI: 10.1097/ADM.0000000000001548
Erin C Nacev, Kristin C Prewitt, Wei-Teng Yang, Eleasa Sokolski, James Michael Winer, Vania Rudolf, Honora Englander, Patricia Liu
{"title":"Feasibility of an Inpatient Split-Dose Rapid Methadone Induction Protocol for Pregnant Individuals.","authors":"Erin C Nacev, Kristin C Prewitt, Wei-Teng Yang, Eleasa Sokolski, James Michael Winer, Vania Rudolf, Honora Englander, Patricia Liu","doi":"10.1097/ADM.0000000000001548","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001548","url":null,"abstract":"<p><strong>Objectives: </strong>Opioid use disorder (OUD) is associated with adverse perinatal outcomes. Pregnant patients often require higher doses of methadone, including split-dosing, due to physiologic changes, and stabilization is critical. Little guidance exists for methadone titration in this population, and hospitalization offers a unique opportunity to rapidly initiate methadone. This report describes our experience with inpatient split-dose, rapid methadone induction among high-risk pregnancies at 1 tertiary care center.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of hospitalized pregnant individuals with OUD seen by our interprofessional addiction medicine consult service between June 2023 and July 2024. We included patients who were initiated on the rapid inpatient split dose methadone protocol, which includes dose recommendations (maximum 70 mg day 1, 80 mg day 2, 100 mg day 3, 120 mg day 4, and 140 mg day 5) and strict inclusion and exclusion criteria.</p><p><strong>Results: </strong>Fourteen unique pregnant patients received the protocol. Average total daily doses of methadone on days 1-5 were 57, 80, 85, 93, and 105 mg, respectively. The titration for one patient was slowed for asymptomatic bradycardia; otherwise, there were no adverse events. After discharge, 12 patients (86%) attended an opioid treatment program (OTP) intake, and 8 (57%) remained on methadone at 30 days postdischarge. Of patients who were discharged on split-dose methadone and followed up at an OTP, all were continued on split-dosing by the OTP.</p><p><strong>Conclusions: </strong>Inpatient split dose, rapid methadone initiation for appropriately selected pregnant individuals is feasible. Posthospitalization OTP retention rates were comparable to the general population, highlighting the need for more support for this vulnerable population.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Severe Fentanyl Withdrawal Associated With Medetomidine Adulteration: A Multicenter Study From Philadelphia, PA. 严重芬太尼戒断与美托咪定掺假相关:一项来自宾夕法尼亚州费城的多中心研究
IF 3.2 3区 医学
Journal of Addiction Medicine Pub Date : 2025-08-01 DOI: 10.1097/ADM.0000000000001560
Kory S London, Samantha Huo, Lauren Murphy, TaReva Warrick-Stone, Dennis Goodstein, Maeve Montesi, Meg Carter, Sabrina Butt, Karen Alexander, Wayne Satz, Abriana Tasillo, Lin Xu, Maya Arora, Emily Casey, Rita McKeever, Margaret Lowenstein, Philip Durney, Brendan Hart, Jeanmarie Perrone
{"title":"Severe Fentanyl Withdrawal Associated With Medetomidine Adulteration: A Multicenter Study From Philadelphia, PA.","authors":"Kory S London, Samantha Huo, Lauren Murphy, TaReva Warrick-Stone, Dennis Goodstein, Maeve Montesi, Meg Carter, Sabrina Butt, Karen Alexander, Wayne Satz, Abriana Tasillo, Lin Xu, Maya Arora, Emily Casey, Rita McKeever, Margaret Lowenstein, Philip Durney, Brendan Hart, Jeanmarie Perrone","doi":"10.1097/ADM.0000000000001560","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001560","url":null,"abstract":"<p><strong>Objectives: </strong>Medetomidine, a potent veterinary α2-adrenergic agonist, has emerged as an adulterant in the illicit fentanyl supply in Philadelphia, PA. Accompanying this change, a severe withdrawal syndrome, distinct from opioid and more comparable to dexmedetomidine withdrawal, emerged. We describe it.</p><p><strong>Methods: </strong>A multicenter case series is described across 3 hospital systems in Philadelphia between September 2024 and April 2025. The cohort included patients who reported opioids as the primary drug of choice, who presented with opioid withdrawal complicated by severe sympathetic activation and required hospitalization. Data extraction from the electronic health record included demographics, clinical outcomes, and confirmatory toxicology in a subset.</p><p><strong>Results: </strong>Two hundred nine patients met the inclusion criteria; the median age was 38 years and 29% were female. Intensive care unit (ICU) admission occurred in 77.5%, with 20.1% requiring intubation. Symptoms were often refractory to traditional opioid withdrawal management, and 73.7% received dexmedetomidine infusion. In the cohort subset with toxicology testing (n=43), 100% had fentanyl and medetomidine metabolites, while xylazine metabolites were not always present (24, 55.8%). Severe complications included encephalopathy (35.4%), myocardial injury (28.7%), and rarely seizures (5%). Patients suffered from severe withdrawal, with a median maximum recorded Clinical Opiate Withdrawal Score (COWS) score of 23.</p><p><strong>Conclusions: </strong>This study describes individuals experiencing severe withdrawal, temporally associated with medetomidine-adulterated fentanyl exposure. Clinicians should be alert to the limitations of standard withdrawal protocols for fentanyl or opioids and the need for aggressive α2-agonist therapies, such as dexmedetomidine. As medetomidine continues to spread in the illicit drug supply, adapting clinical and public health responses will be critical.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Concept of Treatment-refractory Addiction: Drawing on Psychiatric Insights to Improve Addiction Research. 治疗难治性成瘾的概念:利用精神病学的见解来改善成瘾研究。
IF 3.2 3区 医学
Journal of Addiction Medicine Pub Date : 2025-08-01 DOI: 10.1097/ADM.0000000000001559
Albert Burgess-Hull
{"title":"The Concept of Treatment-refractory Addiction: Drawing on Psychiatric Insights to Improve Addiction Research.","authors":"Albert Burgess-Hull","doi":"10.1097/ADM.0000000000001559","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001559","url":null,"abstract":"<p><p>The concept of treatment-refractory addiction (TRA), while relatively new to the addiction field, is a well-established concept in other areas of medicine and psychiatry. Recent commentaries have highlighted the need for clearer conceptualization and definition of TRA. This commentary argues that conceptual frameworks established in other psychiatric domains (eg, depression, schizophrenia, obsessive-compulsive disorder) can and should inform the development of criteria and strategies for identifying and addressing TRA in substance use disorders (SUDs). Central to this effort is the recognition that treatment response variability is the norm rather than the exception in SUD care. Conceptualizations and definitions of TRA should seek to distinguish true refractoriness from suboptimal or incomplete treatment exposure, which can arise from inadequate treatment exposure or adherence, and consider whether nonresponse is present from the start (primary refractoriness) or emerges over time (secondary refractoriness). Advanced analytic methods, including unsupervised clustering, offer opportunities to characterize heterogeneity in treatment outcomes in aggregate or over time, identify patient subgroups that do not benefit from standard therapies, and explore underlying mechanisms of nonresponse. By integrating lessons learned from other psychiatric disorders, addiction scientists can develop more precise definitions of TRA, which will ultimately inform the development of diagnostic/prognostic frameworks, and targeted interventions.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Role of Childhood Trauma in Chronic Pain and Substance Use Among Individuals Receiving Methadone Treatment for Opioid Use Disorder. 在接受美沙酮治疗阿片类药物使用障碍的个体中,儿童创伤在慢性疼痛和物质使用中的作用。
IF 3.2 3区 医学
Journal of Addiction Medicine Pub Date : 2025-07-29 DOI: 10.1097/ADM.0000000000001553
Gabriel P A Costa, Jocelyn Ra, Julia Meyerovich, Brian Pittman, Julio C Nunes, Joao P De Aquino
{"title":"The Role of Childhood Trauma in Chronic Pain and Substance Use Among Individuals Receiving Methadone Treatment for Opioid Use Disorder.","authors":"Gabriel P A Costa, Jocelyn Ra, Julia Meyerovich, Brian Pittman, Julio C Nunes, Joao P De Aquino","doi":"10.1097/ADM.0000000000001553","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001553","url":null,"abstract":"<p><strong>Objectives: </strong>This study explored the correlations between childhood trauma, chronic pain, and substance use among individuals receiving methadone for opioid use disorder (OUD). We hypothesized that, among individuals with OUD, a history of childhood trauma would correlate with more severe pain and substance use compared with those without such history.</p><p><strong>Methods: </strong>We conducted a cross-sectional study of 82 individuals receiving methadone for OUD. Participants completed the Childhood Trauma Questionnaire (CTQ) to assess childhood trauma exposure, the Brief Pain Inventory (BPI) to characterize chronic pain, and the Timeline Followback (TLFB) method to assess substance use in the past 28 days. Correlation analyses and ANOVA examined the relationships between these variables.</p><p><strong>Results: </strong>Higher childhood trauma scores correlated with greater pain severity (r = 0.27, P = 0.03), increased alcohol consumption (r = 0.25, P = 0.04), and earlier age of cannabis initiation (r = -0.45, P < 0.001). Among trauma subscales, emotional abuse most closely correlated with greater pain severity (r = 0.33, P = 0.008) and interference (r = 0.28, P = 0.03), and alcohol consumption (r = 0.28, P = 0.02). Individuals who used cannabis reported significantly higher levels of emotional abuse (P = 0.04), sexual abuse (P = 0.03), and physical neglect (P = 0.02) compared with those who did not. Conversely, our analysis did not reveal significant correlations between childhood trauma and heroin, tobacco, cocaine, or stimulant use.</p><p><strong>Conclusions: </strong>Childhood trauma correlated with greater pain severity and interference, higher alcohol use, earlier cannabis initiation, and increased likelihood of cannabis use among individuals receiving methadone for OUD. These findings suggest the importance of integrating trauma-focused assessment and treatment into OUD treatment programs.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Implementing a Collaborative Approach to Caring for Patients With Substance Use Disorders Requiring Outpatient Parenteral Antimicrobial Therapy After Discharge. 实施协作的方法来照顾病人的物质使用障碍需要门诊静脉抗菌药物治疗出院后。
IF 3.2 3区 医学
Journal of Addiction Medicine Pub Date : 2025-07-29 DOI: 10.1097/ADM.0000000000001562
Sara C Keller, Rawan Abdel Galil, Jessa R Brenon, Lauren G Buzzalino, Alex Hessel, Denise de Brito, Jennifer Townsend, William F Wright, Armani M Hawes, Oluwaseun Falade-Nwulia, Megan E Buresh
{"title":"Implementing a Collaborative Approach to Caring for Patients With Substance Use Disorders Requiring Outpatient Parenteral Antimicrobial Therapy After Discharge.","authors":"Sara C Keller, Rawan Abdel Galil, Jessa R Brenon, Lauren G Buzzalino, Alex Hessel, Denise de Brito, Jennifer Townsend, William F Wright, Armani M Hawes, Oluwaseun Falade-Nwulia, Megan E Buresh","doi":"10.1097/ADM.0000000000001562","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001562","url":null,"abstract":"<p><strong>Objectives: </strong>Injection-related infections (IRI) are common and often require treatment with prolonged intravenous antibiotics via outpatient parenteral antimicrobial therapy (OPAT). However, patients with substance use disorders (SUD) being treated for IRI with OPAT receive suboptimal postdischarge care. We describe a novel program to co-locate OPAT and SUD supports at skilled nursing facilities (SNFs) in a pilot program to improve clinical outcomes.</p><p><strong>Methods: </strong>We performed a retrospective chart review of patients with a history of SUD discharged from 2 academic medical centers 2021-2023 to SNFs, including those discharged to pilot SNF and SNFs that were not in a pilot program. We use descriptive statistics to report sociodemographic variables, OPAT outcomes, and SUD outcomes.</p><p><strong>Results: </strong>Twenty-six patients were discharged to a pilot program SNF, and 172 were discharged to an alternative SNF. Patients discharged to pilot program SNFs went to infectious diseases appointments 73% of the time, versus 51% for alternative SNFs. Patients discharged to pilot program SNFs had a 15% 30-day hospital readmission rate and an 8% infection relapse rate, versus 21% and 22% at the alternative SNFs, respectively. Rates of self-directed discharge from SNFs were similar between groups.</p><p><strong>Conclusions: </strong>We detail successful implementation of an innovative approach to the care of patients with SUD requiring OPAT at SNFs. More work is needed to evaluate outcomes from similar initiatives and determine how to sustainably scale-up interventions for these patients.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Quetiapine: A Novel Additive to the Illicit Heroin Supply in Los Angeles. 奎硫平:洛杉矶非法海洛因供应的一种新型添加剂。
IF 4.2 3区 医学
Journal of Addiction Medicine Pub Date : 2025-07-25 DOI: 10.1097/ADM.0000000000001552
Joseph R Friedman, Caitlin A Molina, Ruby Romero, Elise M Pyfrom, Meghan G Appley, Carla Marienfeld, Edward Sisco, Chelsea L Shover
{"title":"Quetiapine: A Novel Additive to the Illicit Heroin Supply in Los Angeles.","authors":"Joseph R Friedman, Caitlin A Molina, Ruby Romero, Elise M Pyfrom, Meghan G Appley, Carla Marienfeld, Edward Sisco, Chelsea L Shover","doi":"10.1097/ADM.0000000000001552","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001552","url":null,"abstract":"<p><strong>Introduction: </strong>The rise of the \"fourth wave\" of the US overdose crisis has been characterized by the increasing polysubstance use of illicit opioids combined with other drug classes. Polysubstance combinations are increasingly better understood through community-based drug checking. Here we share findings from a drug checking program in Los Angeles, California, highlighting quetiapine-a commonly used atypical antipsychotic-as a novel additive in heroin samples.</p><p><strong>Methods: </strong>This study leveraged data from a community-based drug checking program in Los Angeles, CA. Substance determination was performed through direct analysis in real-time mass spectrometry (DART-MS). Fisher exact tests were used to assess differences in heroin samples containing versus not containing quetiapine.</p><p><strong>Results: </strong>Of n=52 samples containing heroin, n=13 (25.0%) contained quetiapine. Among quetiapine-positive heroin samples, n=4 (30.8%) contained fentanyl, compared with n=27 (69.2%) quetiapine-negative heroin samples (P=0.022). No significant differences were observed between quetiapine-positive and negative samples with respect to xylazine, cocaine, or methamphetamine prevalence. All quetiapine-positive samples were identified by clients as expected to contain black tar heroin, and no clients reported expecting their samples to contain quetiapine. Anecdotally, some participants identified increased euphoria and \"pins and needles\" sensations from quetiapine-positive samples.</p><p><strong>Conclusions: </strong>This small observational study provides the first drug-checking-based evidence in the academic literature-to our knowledge-of quetiapine as an additive to the illicit heroin supply. The presence of quetiapine was associated with less fentanyl adulteration and may reflect an alternative augmentation strategy. Further confirmatory studies are needed to assess the degree to which this phenomenon exists in other locations and the potential health implications.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stigmatizing Language in Large Language Models for Alcohol and Substance Use Disorders: A Multimodel Evaluation and Prompt Engineering Approach. 酒精和物质使用障碍的大型语言模型中的污名化语言:多模型评估和快速工程方法。
IF 4.2 3区 医学
Journal of Addiction Medicine Pub Date : 2025-07-24 DOI: 10.1097/ADM.0000000000001536
Yichen Wang, Kelly Hsu, Christopher Brokus, Yuting Huang, Nneka Ufere, Sarah Wakeman, James Zou, Wei Zhang
{"title":"Stigmatizing Language in Large Language Models for Alcohol and Substance Use Disorders: A Multimodel Evaluation and Prompt Engineering Approach.","authors":"Yichen Wang, Kelly Hsu, Christopher Brokus, Yuting Huang, Nneka Ufere, Sarah Wakeman, James Zou, Wei Zhang","doi":"10.1097/ADM.0000000000001536","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001536","url":null,"abstract":"<p><strong>Objectives: </strong>Large language models (LLMs) are increasingly used in health care communication but can inadvertently perpetuate stigmatizing language toward individuals with alcohol and substance use disorders. Despite growing interest in LLM performance, a focused evaluation of their propensity for SL and strategies to mitigate it remains lacking.</p><p><strong>Methods: </strong>We generated 60 clinically relevant questions [\"prompts\"; 20 each for alcohol use disorder (AUD), alcohol-associated liver disease (ALD), and substance use disorder (SUD)] and tested 14 LLMs. Two physicians independently assessed all responses for stigmatizing language using guidelines from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism; discrepancies were resolved by a third physician. We employed iterative prompt engineering (PE)-a process of strategically crafting input instructions to guide model outputs towards nonstigmatizing language-to reduce stigmatizing language by incorporating a list of specific terms to avoid and identifying model-specific pitfalls. We compared the prevalence of SL in responses to native prompts (baseline, unengineered) versus engineered prompts, adjusting for word count in multivariate analyses.</p><p><strong>Results: </strong>Of 840 responses generated from native prompts, 297 (35.4%) contained stigmatizing language, totaling 592 terms. With prompt engineering, only 53 (6.3%) of 840 responses contained stigmatizing language, comprising 104 terms. Prompts on topic of ALD yielded higher odds of stigmatizing language than those addressing AUD (adjusted odds ratio, 2.11; 95% CI, 1.47-3.02; P < 0.001), whereas prompts on substance use disorder (SUD) did not differ significantly from AUD (adjusted odds ratio, 1.17; 95% CI, 0.81-1.69; P = 0.40). Prompt engineering reduced the likelihood of stigmatizing language by 88% in univariate analysis (P < 0.001), and this effect persisted after adjusting for word count (adjusted odds ratio, 0.15; 95% CI, 0.11-0.20; P < 0.001).</p><p><strong>Conclusions: </strong>LLMs frequently generated stigmatizing language when discussing alcohol-related and substance use-related conditions, potentially undermining patient-centered care. However, targeted prompt engineering substantially reduced stigmatizing language occurrences across diverse models. These findings emphasize the need for ongoing model refinement and structured prompting strategies to ensure stigma-free language in health care communication.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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