Journal of Addiction Medicine最新文献

{"title":"Increased Wound Prevalence in those Exposed to Xylazine and Fentanyl Compared to Those Exposed to Fentanyl: An Observational Study.","authors":"Carolanne E Semancik","doi":"10.1097/ADM.0000000000001429","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001429","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study is to determine the difference, if any, in prevalence of wounds in individuals who were exposed to xylazine and fentanyl compared to individuals who were exposed to fentanyl and not xylazine.</p><p><strong>Methods: </strong>A large inpatient substance use disorder specialty hospital provided medical records over an 8-month period from July 2023 to February 2024. Individuals were admitted to an American Society of Addiction Medicine 3.7 level of care where a urine drug screen and skin assessment was conducted on admission. If the urine screen noted a presence of fentanyl, the sample was then tested for xylazine exposure. Patients were considered positive for wounds on admission to treatment if any wound was noted during the skin assessment during the admission process.</p><p><strong>Results: </strong>A total of 282 medical records were identified. A chi square test of association was completed and revealed a statistically significant association between xylazine exposure and wounds (P = 0.002, odds ratio = 2.420, 95% confidence interval = 1.376-4.254).</p><p><strong>Conclusions: </strong>This study provides early support for the previously theorized connection between xylazine exposure and wounds.</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":"142769039","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":"Buprenorphine Salivary Gland Accumulation Sustaining High Oral Fluid Exposure and Increasing the Risk of Streptococcus mutans Biofilm Formation.","authors":"Zicong Zheng, Jie Chen, Songpol Srinual, Vesna Tumbas Šaponjac, Taijun Yin, Bing-Yan Wang, Rongjin Sun, Ming Hu","doi":"10.1097/ADM.0000000000001401","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001401","url":null,"abstract":"<p><strong>Objectives: </strong>The US Food and Drug Administration (FDA) issued a warning about buprenorphine-induced dental caries of unknown mechanism in 2022. To investigate the potential mechanism, the association between local buprenorphine exposure and dental biofilm formation will be explored in this study.</p><p><strong>Methods: </strong>Female F344 rats were dosed with sublingual buprenorphine film or intravenous injection to explore the oral cavity exposure of the buprenorphine. The buprenorphine distribution in salivary glands after the sublingual and intravenous administration was also evaluated. To investigate the effects of buprenorphine exposure on dental caries formation, buprenorphine's impact on the biofilm formation of S. mutans in vitro was measured.</p><p><strong>Results: </strong>The absolute sublingual bioavailability of buprenorphine in rats was 17.8% with a high ratio of oral fluid exposure to blood concentration in the pharmacokinetic study. Salivary gland concentrations of buprenorphine and its active metabolite norbuprenorphine were significantly higher than their blood concentrations after both sublingual (s.l.) and intravenous (i.v.) administration. Correlation analysis showed that the oral fluid concentration of buprenorphine and norbuprenorphine was highly correlated to salivary gland concentration rather than blood concentration. These data indicate that the salivary gland serves as an accumulation organ for buprenorphine, allowing prolonged oral fluid exposure to buprenorphine. Lastly, buprenorphine and its metabolites contributed to the biofilm formation of S. mutans in high concentration.</p><p><strong>Conclusions: </strong>Sublingual administration substantially increased the salivary gland distribution of buprenorphine and norbuprenorphine. Depot effects following sublingual dosing and salivary gland accumulation likely sustained high oral fluid exposure to buprenorphine and stimulated the biofilm formation of S. mutans.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769013","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":"Collaborating With Jails to Provide Community-Based Medication for Opioid Use Disorder: Qualitative Perspectives from MOUD Treatment Providers.","authors":"Ekaterina Pivovarova, Bianca Y Planas Garcia, Peter D Friedmann, Thomas J Stopka, Claudia Santelices, Elizabeth A Evans","doi":"10.1097/ADM.0000000000001420","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001420","url":null,"abstract":"<p><strong>Objectives: </strong>As carceral settings increasingly offer medications for opioid use disorders (MOUD), community-based providers will need to navigate relationships with correctional agencies to ensure continuity of MOUD upon release. Although collaboration has been identified as critical between agencies, limited research is available that details how providers can work with jails. We describe the perspectives of MOUD providers about their experiences collaborating with jails that had recently begun to offer MOUD.</p><p><strong>Methods: </strong>We conducted hour-long interviews with 36 MOUD providers from 18 community-based agencies. Exploration, Preparation, Implementation, and Sustainment (EPIS) concepts informed data collection and analysis.</p><p><strong>Results: </strong>MOUD providers described agency-specific (inner context) factors that facilitated collaboration, including staffing (employing staff with knowledge of co-occurring conditions) and agency culture (adaptability to change, recognition of gaps in services, being judgment-free). Providers also reported external factors as facilitators, such as broad community support of MOUD services and provision of training about MOUD to jail staff. Holding regular meetings, with a dedicated contact person, helped to overcome communication problems. However, the fragmentation of in-jail treatment services, exacerbated by jails' contracting with different healthcare providers, made it difficult to coordinate re-entry and establish agency relationships. Actively and intentionally building interagency partnerships and collaborating across interagency cultural and structural differences were bridging factors that developed and sustained collaborations.</p><p><strong>Conclusions: </strong>Our findings offer promising suggestions for establishing collaborations with carceral partners, including assessing internal agency conditions, seeking external community supports, committing to actively engaging and sustaining collaborations, and using interagency differences to develop mutually beneficial relationships.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769018","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":"False-Positive Phosphatidylethanol Results Due to Blood Transfusion and Implications in the Process of Liver Transplantation Selection.","authors":"Jessica A S Wang, Giovani V Cruz Cruz, Akshay Shetty, Darlene Esquivel, Sammy Saab, Steven Shoptaw, Julio Meza","doi":"10.1097/ADM.0000000000001424","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001424","url":null,"abstract":"<p><strong>Abstract: </strong>Phosphatidylethanol (PEth) testing is becoming increasingly common as a tool to assess for alcohol consumption in the practice of addiction medicine. Its potential to be an objective measure of ethanol exposure is appealing; however, the field has yet to develop a complete understanding of the factors that can influence a PEth level. Here we describe 3 patient cases in which blood transfusion within the preceding 28 days was the reason that PEth studies were positive in patients undergoing liver transplant evaluation. These patients all had in-depth evaluations by physicians on an addiction medicine consult service and were believed abstinent from alcohol. In the field of liver transplant, even a mildly elevated PEth level can result in listing delay or even liver transplant candidacy denial. Further study is needed to understand how PEth is impacted by medical procedures and events such as blood transfusion if we are to maintain a just and ethical practice in the setting of addiction and transplant medicine.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769036","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":"Development and Evaluation of the Global Appraisal of Individual Needs Quick Version 4 (GAIN-Q4) for ASAM Dimension Ratings and Placement Recommendations for Adolescents and Adults.","authors":"Michael L Dennis, Siara I Sitar, Kathryn C Modisette, Barbara D Estrada, Justine W Welsh","doi":"10.1097/ADM.0000000000001413","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001413","url":null,"abstract":"<p><strong>Objectives: </strong>This article describes the development and evaluation of the Global Appraisal of Individual Needs Quick Version 4 (GAIN-Q4) for the American Society of Addiction Medicine (ASAM) 4th edition patient placement dimension ratings and level of care placement recommendations. The research questions are as follows: (1) Can the GAIN-Q4 replicate recommendations from the prior longer instrument within adolescents and adults? (2) What are the substantive differences in the results by age?</p><p><strong>Methods: </strong>The 35- to 45-minute GAIN-Q4 was developed through modification of the GAIN-Q3 and evaluated in terms of its ability to predict ASAM dimensional ratings and level of care placement recommendations from the 60- to 120-minute GAIN-I instrument. Data were obtained from participants who are adolescents aged 12 to 17 years (n = 101,897) and adults 18 years and older (n = 204,711) interviewed between 2002 and 2018 across 530 US sites. Reliability between measures was assessed with Cohen's κ statistic within age group; substantive differences by age were evaluated with logistic regression and χ2.</p><p><strong>Results: </strong>The ability of the 35- to 45-minute GAIN-Q4 measure to predict ASAM 6 dimensional ratings from the 60- to 120-minute GAIN-I was excellent (κ > 0.8) for 4 dimensions, good (0.6-0.79) for 1, and fair for 1 (0.4-0.59) - both for adolescents and young adults. κ for general level of care placement to ASAM levels of care was excellent for both adolescents and young adults.</p><p><strong>Conclusions: </strong>The GAIN-Q4 demonstrates the ability to predict ASAM dimensional ratings and general level of care placement reliably when compared to the lengthier GAIN-I measure. These results highlight that clinicians using the GAIN-Q4 measure will be equipped to evaluate patients from a wide variety of sources with an accurate and reliable screening tool.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769030","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":"The Use of Oral Phenobarbital Loading for the Management of Alcohol Withdrawal Syndrome in an Outpatient Setting: A Case Report.","authors":"Erin Hamilton, Braden Bouchard","doi":"10.1097/ADM.0000000000001435","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001435","url":null,"abstract":"<p><strong>Abstract: </strong>Alcohol withdrawal syndrome is most frequently treated with benzodiazepines, but due to their short half-life, tapering prescriptions are frequently required for outpatients, which presents challenges to both clinicians and patients. Our local health system has had significant success treating alcohol withdrawal in the emergency department with phenobarbital loading doses. As patients also present in alcohol withdrawal to our outpatient addictions clinic, we have adapted our emergency department intravenous protocol to a staggered, oral loading protocol for the treatment of mild and moderate alcohol withdrawal syndrome in the community setting. In this case report, we successfully treat a 36-year-old man with mild alcohol withdrawal symptoms using this approach and without requiring a tapering sedative prescription.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769085","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":"Response to: \"Prevalence of Kratom Use Disorder Among Kratom Consumers\".","authors":"David A Gorelick","doi":"10.1097/ADM.0000000000001419","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001419","url":null,"abstract":"","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769068","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":"Response to Gorelick.","authors":"Katherine Hill, Oliver Grundmann, Kirsten E Smith, Corneliu N Stanciu","doi":"10.1097/ADM.0000000000001418","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001418","url":null,"abstract":"","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769065","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":"Too Early to Define Treatment-Refractory Addiction.","authors":"Nicholaus J Christian","doi":"10.1097/ADM.0000000000001415","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001415","url":null,"abstract":"","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769092","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":"Response to Christian.","authors":"Eric C Strain","doi":"10.1097/ADM.0000000000001414","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001414","url":null,"abstract":"","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769078","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}