Journal of Addiction Medicine最新文献

{"title":"Self-Harm as a Contributor to the Opioid Epidemic: Data From the Toxicology Investigators Consortium Registry.","authors":"Stephanie T Weiss, Xiaobai Li, Kim Aldy, Paul M Wax, Jeffrey Brent","doi":"10.1097/ADM.0000000000001433","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001433","url":null,"abstract":"<p><strong>Objectives: </strong>Although considerable focus has been placed on understanding the causes of opioid drug overdoses, the intentions for such overdoses are not well characterized. We investigated the motivations behind nonfatal opioid exposures resulting in serious adverse health outcomes.</p><p><strong>Methods: </strong>We analyzed prospectively collected data on nonfatal opioid overdoses in the multicenter Toxicology Investigators Consortium (ToxIC) Core Registry between 2014 and 2021. Included patients were age ≥11 years with serious toxicity after use of pharmaceutical and/or nonpharmaceutical opioids for whom the reasons for opioid exposure were determined. Pharmaceutical opioids were defined as United States Food and Drug Administration-approved medications. All other opioids were classified as nonpharmaceuticals.</p><p><strong>Results: </strong>The 5250 cases meeting the criteria were 56.6% male with a median age of 36 years (IQR, 26-50). There were 2960 (56.4%) opioid misuse cases and 1456 (27.7%) self-harm attempts. Within the self-harm group, 1242 (85.3%) were suicidal, and 1187 (95.6%) of these used pharmaceutical opioids in their suicide attempt. Only 94 (4.2%) patients using nonpharmaceutical opioids did so in a suicide attempt. Pharmaceutical opioid suicide attempts as a percent of all registry cases peaked between 2015 and 2017 and fell dramatically thereafter (P = 0.005). For comparison, benzodiazepine overdoses similarly decreased (P = 0.003), whereas non-opioid analgesic or antidepressant overdoses increased.</p><p><strong>Conclusions: </strong>A majority of serious opioid overdoses were sequelae of opioid misuse, but over a quarter were intentional self-harm attempts, primarily involving pharmaceutical opioids. Decreased prescribing of opioids and benzodiazepines after 2016-2017 may have resulted in decreased pharmaceutical opioid and benzodiazepine misuse and self-harm attempts. Similar trends were not seen for nonpharmaceutical opioids.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846735","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}

{"title":"Patterns of Medication for Opioid Use Disorder During Pregnancy, 7 Clinical Sites, MATernaL and Infant clinical NetworK (MAT-LINK), 2014-2021.","authors":"Emmy L Tran, Amanda N Dorsey, Kathryn Miele, Suzanne M Gilboa, Lucas Gosdin, Mishka Terplan, Pilar M Sanjuan, Neil S Seligman, Tanner Wright, Elisha M Wachman, Marcela Smid, Michelle Henninger, Lawrence Leeman, Patrick D Schneider, Kara Rood, Judette M Louis, Sarah Caveglia, Autumn Davidson, Julie Shakib, Hira Shrestha, Dana M Meaney-Delman, Shin Y Kim","doi":"10.1097/ADM.0000000000001426","DOIUrl":"10.1097/ADM.0000000000001426","url":null,"abstract":"<p><strong>Objectives: </strong>To describe patterns of medication for opioid use disorder (MOUD) during pregnancies in the opioid use disorder (OUD) cohort of MAT-LINK, a sentinel surveillance network of pregnancies at US clinical sites.</p><p><strong>Methods: </strong>Seven clinical sites providing care for pregnant people with OUD collected electronic health record data. Pregnancies were included in this analysis if (1) the pregnancy outcome occurred between January 2014 and August 2021, (2) the person had OUD, and (3) there was any electronic health record-documented MOUD during pregnancy. Analyses describing MOUD type, demographic characteristics, and timing during pregnancy were performed.</p><p><strong>Results: </strong>Among 3911 pregnancies with any documented MOUD, more than 90% of pregnancies with methadone were to publicly insured people, which was greater than percentages for pregnancies with other MOUD. Buprenorphine with naloxone and naltrexone were two MOUD types that were increasingly common among pregnant people in recent years. In most pregnancies, prenatal care and MOUD were first documented in the same trimester. During the first, second, and third trimesters, there were 37%, 61%, and 91% of pregnancies with MOUD, respectively. Approximately 87% (n = 3412) had only 1 documented MOUD type, versus 2 or 3 types. However, discontinuity in MOUD across trimesters was still observed.</p><p><strong>Conclusions: </strong>In MAT-LINK's OUD cohort, the overall frequency of MOUD improved over the course of pregnancy. Contextual factors, such as insurance status and year of pregnancy outcome, might influence MOUD type. Prenatal care and MOUD might be facilitators for one another; however, there are still opportunities to improve early linkage and continuous access to both prenatal care and MOUD during pregnancy.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813271","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}

{"title":"Repetitive Transcranial Magnetic Stimulation for Alcohol Craving in Alcohol Use Disorders: A Meta-analysis.","authors":"Michael Treiber, Eva-Maria Tsapakis, Konstantinos Fountoulakis","doi":"10.1097/ADM.0000000000001416","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001416","url":null,"abstract":"<p><strong>Aims: </strong>We aimed to evaluate the immediate and up to 3 months' effect of multiple-session repetitive transcranial magnetic stimulation (rTMS) on alcohol craving in AUD.</p><p><strong>Methods: </strong>We performed a systematic review and random effects meta-analysis. We included randomized controlled trials with at least 10 sessions of rTMS and postintervention alcohol craving assessment. We evaluated the immediate and up to 3 months' effects of active rTMS versus sham stimulation.</p><p><strong>Results: </strong>Twelve studies met inclusion criteria, including 475 participants across both treatment and control groups. rTMS reduced alcohol craving over sham stimulation immediately post-treatment (SMD = -0.79, 95% CI: -1.53 to -0.04, P = 0.04, I2 = 93%). Concerning a maintenance effect, our meta-analysis revealed a medium effect for active rTMS in reduction of alcohol craving at 3-month follow-up (SMD = -0.44, 95% CI: -0.77 to 0.11, P < 0.01, I2 = 38%). Our subgroup analysis revealed that rTMS targeting the medial prefrontal cortex (SMD = -2.12, 95% CI: -4.34 to 0.09, P = 0.06, I2 = 94%) may be more effective than stimulating the right dorsolateral prefrontal cortex (SMD = -1.04, 95% CI: -2.56 to 0.48, P = 0.18, I2 = 96%) or left dorsolateral prefrontal cortex (SMD = -0.27, 95% CI: -0.60 to 0.05, P = 0.10, I2 = 0%) immediately after treatment.</p><p><strong>Conclusion: </strong>A minimum of 10 sessions of rTMS reduced alcohol craving immediately after treatment; this effect seems to be sustained over a 3-month period. We provide limited evidence of superiority for rTMS targeting the medial prefrontal cortex.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813272","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}

{"title":"Lessons Learned Through Adaptation of a Model Successful during the COVID Pandemic: Expanding HIV Self-testing for Persons Who Use Drugs.","authors":"Alicia Huerta, Ella Salim, Haley V Bonilla, Sarah E Miller, Sabrina A Assoumou","doi":"10.1097/ADM.0000000000001432","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001432","url":null,"abstract":"<p><strong>Abstract: </strong>The US overdose crisis is driving a surge in HIV diagnoses among persons who inject drugs (PWID). Innovative approaches are needed to address this increase in cases. Although HIV self-testing (HIVST) was hailed as a potential \"game-changer\" upon initial approval by the Food and Drug Administration over a decade ago, this convenient testing modality has not reached its full potential to impact the HIV epidemic. Nevertheless, lessons regarding self-testing for infectious diseases from the COVID-19 pandemic present an opportunity to increase HIVST uptake and reach current US goals of Ending the HIV Epidemic (EHE) by 2030. In this commentary, we first discuss facilitators and barriers of HIVST for PWID. We then explore how lessons regarding self-testing during the COVID-19 pandemic can allow us to realize the potential of HIVST for PWID. We conclude by suggesting the future utilization of HIVST to address 2 EHE pillars, rapid diagnosis of HIV cases and cluster identification.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813270","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}

{"title":"Exploring Opioid Use Disorder Outcomes by Quantitative Urinalysis: Post Hoc Analysis of a Phase 3 Randomized Clinical Trial.","authors":"Stefan Peterson, Edward V Nunes, Michelle R Lofwall, Sharon L Walsh, Fredrik Tiberg","doi":"10.1097/ADM.0000000000001405","DOIUrl":"10.1097/ADM.0000000000001405","url":null,"abstract":"<p><strong>Objectives: </strong>Opioid use disorder (OUD) is a global concern. Urine drug screening uses opioid immunoassays to monitor OUD treatment response but is limited to yes/no results. Analytical cutoff variation complicates interstudy comparisons. This study investigated whether quantitative urinalysis can provide additional clinically meaningful treatment efficacy information and assessed the impact of different cutoffs on treatment differences.</p><p><strong>Methods: </strong>Quantitative urine drug test data were analyzed from a randomized, active-controlled, parallel-group, double-blind, 31-week phase 3 trial (N = 428; December 29, 2015, to October 19, 2016) assessing CAM2038 subcutaneous (SC) buprenorphine (BPN) extended-release injections compared to daily sublingual (SL) BPN/naloxone (BPN/NX) tablets, and equivalent placebos, in OUD treatment (NCT02651584). Urine samples were analyzed by gas or liquid chromatography with mass spectrometry. The European Medicines Agency (EMA)-directed primary endpoint, based on opioid detection above the lower limit of quantification (LLOQ), was explored using different cutoffs.</p><p><strong>Results: </strong>Using the LLOQ, the mean percentage of opioid-negative samples was 35.1% and 28.4% for CAM2038 and SL BPN/NX, respectively (mean difference [95% confidence interval], 6.7% [-0.1% to 13.6%]). Using standard cutoffs (1 ng/mg creatinine [fentanyl/norfentanyl], 300 ng/mg creatinine [other opioids]), results were 41.2% and 32.2% (9.0% [1.8%-16.1%]). Increasing cutoffs led to greater differences favoring CAM2038. Significant differences in mean concentrations over time and cumulative distribution of exposure to different opioids also favored CAM2038. The difference in fentanyl exposure between treatments was nonsignificant.</p><p><strong>Conclusions: </strong>Quantitative urinalysis provides insights into opioid use beyond assessment of abstinence. Study outcomes are impacted by analytical thresholds, which should be carefully considered when designing, interpreting, and comparing clinical trial results.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769033","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}

{"title":"Heterogeneity in Prescription Opioid Misuse Motives by Age in Adolescents and Young Adults in the United States.","authors":"Ty S Schepis, Jason A Ford, Philip T Veliz, Brady T West, Sean Esteban McCabe","doi":"10.1097/ADM.0000000000001428","DOIUrl":"10.1097/ADM.0000000000001428","url":null,"abstract":"<p><strong>Objective: </strong>Adolescent (12-17 years) and young adult (18-25 years) prescription opioid misuse (POM) is linked to poor health outcomes. We investigated how POM motives vary across these ages and the potential links between motives and other substance use, mental health, and sociodemographic characteristics to help guide screening and prevention.</p><p><strong>Methods: </strong>Pooled 2015-2019 US National Survey on Drug Use and Health data were used, with 137,858 participants. Cross-tabulations estimated prevalence of individual motives and motive category by age. Mutually exclusive motive categories were no past-year POM, pain relief only, pain/sleep/relax (ie, some combination of only these motives), and any non-self-treatment motives (eg, get high, experiment). Logistic regression models evaluated links between motive category and sociodemographic, mental health, and substance use (eg, alcohol, cannabis, nicotine, other prescription misuse) outcomes by age group, versus reference groups of no past-year POM or pain relief only.</p><p><strong>Results: </strong>Pain relief was the most common POM motive (estimated at >50% at all ages), but POM for non-self-treatment motives was the most common category after 14 years. POM for non-self-treatment motives had the highest adjusted odds ratios (aORs) of all substance use and mental health characteristics (eg, past-year substance use disorder aORs of 6.11 in adolescents [95% confidence interval (CI), 4.23-8.85] and 4.81 [95% CI, 4.01-5.77] in young adults, versus the pain relief only reference).</p><p><strong>Conclusions: </strong>POM for any non-self-treatment motives is linked to the highest prevalence of other substance use and mental health concerns, whereas POM for pain relief also signals a need for substance use and mental health screening.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800698","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}

{"title":"Drug-induced Liver Injury Due to Medications for Alcohol Use Disorder: Results From the DILIN Prospective Study.","authors":"Harish Gopalakrishna, Marwan Ghabril, Jiezhun Gu, Yi Ju Li, Robert J Fontana, David E Kleiner, Christopher Koh, Naga Chalasani","doi":"10.1097/ADM.0000000000001421","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001421","url":null,"abstract":"<p><strong>Objectives: </strong>Concerns about drug-induced liver injury (DILI) may deter physicians from prescribing medications for alcohol use disorder (MAUD). We aim to explore DILI due to MAUD in Drug-Induced Liver Injury Network (DILIN) prospective study.</p><p><strong>Methods: </strong>High-confidence DILI cases (ie, definite, highly likely, or probable) due to MAUD in DILIN prospective study (2004-2024) were included. Demographic, clinical, laboratory data, and 6-month outcomes were analyzed. HLA allele frequency (AF) of disulfiram cases was compared to matched controls with DILI due to non-MAUD (DILI controls).</p><p><strong>Results: </strong>Among 1975 high-confidence cases, 13 were attributed to MAUD (11 disulfiram; 1 naltrexone and 1 baclofen; and none from acamprosate). Median age was 45 years, with 77% female and 85% White. All had hepatocellular injury. In disulfiram group, the median time for DILI occurrence was 34 days. Eight patients developed jaundice, with 3 fatal or near-fatal cases (2 liver transplantation and 1 liver-related death). Five (71%) patients with severe or fatal disulfiram DILI had underlying liver disease. AF for HLA-C*01:02 (OR, 6.29; P = 0.02) and DRB1*09:01 (OR, 10.16; P = 0.02) were significantly higher in disulfiram cases than in DILI controls. DILI from baclofen and naltrexone was mild and self-limited with no chronic DILI.</p><p><strong>Conclusions: </strong>Disulfiram is the leading cause of DILI among MAUD and is most common in women. Disulfiram can cause severe DILI and is associated with HLA-C*01:02 and DRB1*09:01. Baclofen and naltrexone can cause mild to moderate self-limited DILI. There were no cases of acamprosate. These findings suggest DILI due to MAUD are less frequent.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800691","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}

{"title":"Withdrawal Signs and Symptoms Among Patients Positive for Fentanyl With and Without Xylazine.","authors":"Ryan Alexander, Chinelo Agwuncha, Christopher Wilson, Joshua Schrecker, Andrew Holt, Rebecca Heltsley","doi":"10.1097/ADM.0000000000001423","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001423","url":null,"abstract":"<p><strong>Background: </strong>Xylazine is not approved for human use, yet it has emerged as a common adulterant of illicit fentanyl. It is currently unclear whether there is a withdrawal syndrome associated with xylazine and the potential impact of fentanyl coexposure.</p><p><strong>Methods: </strong>A retrospective cohort study of patients with opioid use disorder admitted to an inpatient medically monitored withdrawal facility was performed. Patients positive for fentanyl were compared to patients copositive for fentanyl and xylazine. Outcomes were self-directed discharge and completion of treatment. Independent variables included Clinical Opioid Withdrawal Scale (COWS) scores, heart rate, and blood pressure. Associations between individuals with or without xylazine were measured.</p><p><strong>Results: </strong>Among 71 patients admitted for opioid withdrawal management positive for fentanyl, 51.4% were copositive with xylazine. There was no difference detected in average COWS scores (P = 0.12-0.78) or average heart rate (P = 0.33-0.80) between groups. Xylazine copositive patients had higher average systolic blood pressure on days 1 (129.0 vs 123.0, P = 0.01) and 2 (127.9 vs 116.3, P = 0.04) although unclear if clinically meaningful. Individuals copositive for xylazine were less likely to complete treatment (43.2% vs 55.9%, P = 0.23) and more likely to have self-directed discharge (67.6% vs 44.1%; OR, 2.64; 95% CI, 1.0-6.9) although not statistically significant.</p><p><strong>Conclusions: </strong>Among 71 patients admitted for medically monitored withdrawal, individuals who were copositive for xylazine at the time of admission had higher average blood pressure and were more likely to have a self-directed discharge. Additional research is needed to determine the impact of xylazine on withdrawal.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769116","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}

{"title":"Methadone-Buprenorphine Transfers Using Low Dosing of Buprenorphine: An Open-Label, Nonrandomized Clinical Trial.","authors":"Chris Tremonti, James Blogg, Nazila Jamshidi, Ricky Harjanto, Nicholas Miles, Charlotte Ismay, Robert Page, Llew Mills, Nicholas Buckley, Varan Perananthan, Nicholas Lintzeris, Paul Haber","doi":"10.1097/ADM.0000000000001379","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001379","url":null,"abstract":"<p><strong>Aims: </strong>To compare a low-dosing protocol to standard practice for methadone-buprenorphine transfers.</p><p><strong>Methods: </strong>We undertook a nonrandomized open-label clinical trial across 8 sites from NSW, Australia. Participants prescribed methadone wishing to transfer to buprenorphine could either choose or be randomized to a low-dose transfer or standard care transfer as per NSW health guidelines. The low-dose protocol started at 0.2 mg BD and increased to 16 mg on day 6, with flexible dosing thereafter. The primary outcome was continuation of buprenorphine 1 week post-transfer. Binary logistic regression was used to access the primary outcome with demographic differences between the groups included as covariates.</p><p><strong>Results: </strong>There were 117 participants who commenced the study, 101 in the low-dose arm and 16 in standard care. Mean methadone dose was 82 mg in the low-dose arm and 46 mg in standard care. The primary outcome was met by 81 participants in the low-dose arm (80%) and 13 participants in standard care (81%). There was no significant between-arm difference in the odds of the primary outcome (OR = 2.22; 95% CI: 0.45-10.91; P = 0.327). Four participants (4%) in the low-dose arm experienced precipitated withdrawal against 1 (6%) in standard care. Higher methadone dose decreased the odds of successful transfer by 20% (OR = 0.8 per 10 mg methadone; 95% CI: 0.7-0.99; P = 0.04). Withdrawal scores between the 2 arms were similar.</p><p><strong>Conclusions: </strong>We were unable to detect a difference between low dosing and standard care for methadone to buprenorphine transfers. Increasing methadone dose was a predictor of success; setting (ambulatory or inpatient) was not.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769045","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}

{"title":"Pregnancy and Pregnancy Outcomes in a National Population Cohort of Patients Treated for Substance Use Disorders.","authors":"Anne Line Bretteville-Jensen, Jenny Williams","doi":"10.1097/ADM.0000000000001404","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001404","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives of this study were to i) provide population-level prevalence rates of pregnancy, birth, elective termination, and miscarriage among females treated for SUDs and their demographic counterparts and ii) examine associations between SUD treatment and pregnancy and elective terminations.</p><p><strong>Methods: </strong>Data were analyzed from a prospective registry-linkage study of all females (15-45 years) recorded as treated for SUDs in the Norwegian Patient Registry over a 2-year period (n = 6470) and a non-treated frequency-matched cohort of females from the general population (n = 6286). Pregnancy and pregnancy outcomes over a 4-year follow-up were retrieved from the Norwegian Patient Registry. Multivariable logistic regression models tested for associations of SUD treatment with pregnancy and with elective termination among pregnant females.</p><p><strong>Results: </strong>Annual pregnancy and elective termination rates per 1000 females were significantly higher for the SUD cohort than the non-treated cohort (94.2 vs 71.3 for pregnancy, P < 0.001; 54.7 vs 17.8 for elective termination, P < 0.001), the annual birth rate was lower for the SUD cohort (25.3 vs 41.8, P < 0.001), and the rate of miscarriage did not differ across cohorts. Multivariable analysis showed that SUD treatment was associated with a significant increase in the odds of pregnancy (adjusted Odds Ratio 1.34, Confidence Interval [1.18-1.54]) and the odds of an elective termination, conditional on pregnancy (aOR 2.55, Confidence Interval [1.97-3.29]).</p><p><strong>Conclusions: </strong>Females treated for SUDs had substantially higher odds of pregnancy and elective terminations than the non-treated cohort. To improve their reproductive health, targeted interventions such as free long-acting contraception and integration of family planning guidance into substance use treatment should be considered.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769055","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}