Journal of Addiction Medicine最新文献

{"title":"Brief Report on Outpatient Treatment of Adolescent Opioid Use Disorder.","authors":"Sivabalaji Kaliamurthy, Emma Straton, Prianka Kumar, Anna Carleen","doi":"10.1097/ADM.0000000000001391","DOIUrl":"10.1097/ADM.0000000000001391","url":null,"abstract":"<p><strong>Objectives: </strong>Adolescents are experiencing an increase in substance-related overdose fatalities, with most attributed to fentanyl and an increase in the prevalence of opioid use disorder (OUD). We know little about the characteristics of adolescents who use fentanyl, develop OUD, and seek addiction treatment. Here, we present demographic data and retention data on adolescent patients (≤18 years) who were treated at a pediatric addiction clinic.</p><p><strong>Methods: </strong>We included all patients who presented to an intake appointment at the pediatric addiction clinic between January 3, 2023, and October 17, 2023, and were diagnosed with OUD. We collected data on demographics, decision to start medicine for OUD (MOUD), choice of MOUD, and retention in treatment based on clinic visits at 1 month and 3 months postintake.</p><p><strong>Results: </strong>Patients are consisted of 24 adolescents ( Mage at intake = 16.8 ± 1.0 years, 67% Hispanic/Latinx, 75% public insurance) who met the criteria for moderate to severe OUD with known fentanyl use. All were offered MOUD, and 21 patients agreed to MOUD treatment; 16 adolescents selected buprenorphine/naloxone, and 5 selected naltrexone. At 3 months postintake, 14 patients (58%) were retained in treatment.</p><p><strong>Conclusions: </strong>Adolescent and family acceptance of MOUD treatment was high, and most patients were retained in treatment at 3 months postintake. More studies are needed to understand how to retain and support adolescent patients in outpatient treatment for OUD given the emergence of fentanyl.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"230-232"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500743","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":"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":"195-201"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","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":"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":"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":"187-194"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","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}

{"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":"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":"202-207"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895813/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importance of Modifiable Factors to Infant Health in the Context of Prenatal Opioid Use Disorder.","authors":"Deborah B Ehrenthal, Yi Wang, Russell S Kirby","doi":"10.1097/ADM.0000000000001389","DOIUrl":"10.1097/ADM.0000000000001389","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study is to estimate the contributions of common and modifiable risk factors to birth outcomes of individuals with prenatal opioid use disorder (OUD).</p><p><strong>Methods: </strong>We conducted an observational cohort study of all Wisconsin Medicaid-covered singleton live births from 2011-2019. Using Blinder-Oaxaca decomposition for continuous, and the Fairlie extension for categorical outcomes, we estimated the contributions of comorbidities, tobacco use, pre-pregnancy body mass index (BMI), and gestational weight gain (GWG) to birthweight for gestational age (BW-GA) percentile associated with prenatal OUD and the risk of small for gestational age (SGA), net of other factors.</p><p><strong>Results: </strong>Among 216,684 births, the 5184 (2.4%) with OUD had greater prevalence of tobacco use, a lower average pre-pregnancy BMI (26.7 kg/m 2 , SD = 0.09 versus 28.4 kg/m 2 , SD = 0.02), and on average 2.0 pounds less GWG, when compared to those without OUD. The predicted mean BW-GA percentile among infants with OUD exposure was 11.2 (95% CI 10.5, 11.9) points lower than those without; 62.3% (95% CI 57.4, 67.1) of this difference could be explained by the variables included in the full model and the largest contribution of the explained portion came from the higher prevalence of tobacco use followed by the contributions of comorbidities, GWG, and pre-pregnancy BMI.</p><p><strong>Conclusions: </strong>More than half of the difference in BW-GA percentile, and risk of SGA associated with prenatal OUD, could be attributed to modifiable factors and not opioids. Moreover, potentially modifiable factors including tobacco use and measures reflecting nutritional status contributed to a majority of the explained portion.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"157-164"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Pain Associated Alcohol Use Disorder Among Participants in a Small Clinical Trial.","authors":"Dale Terasaki, Joseph W Frank, Joseph Schacht","doi":"10.1097/ADM.0000000000001393","DOIUrl":"10.1097/ADM.0000000000001393","url":null,"abstract":"","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"236-237"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500744","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":"Racial and Ethnic Disparities in Referral Rejection From Postacute Care Facilities Among People With Opioid Use Disorder in Massachusetts.","authors":"Sophie Rosenmoss, Marc LaRochelle, Benjamin Bearnot, Zoe Weinstein, Kaku So-Armah, Patience Moyo, Shapei Yan, Alexander Y Walley, Simeon D Kimmel","doi":"10.1097/ADM.0000000000001390","DOIUrl":"10.1097/ADM.0000000000001390","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study was to examine the association between Black, White, and Hispanic or Latino race and ethnicity and referral rejection from private postacute care facilities among hospitalized individuals with opioid use disorder (OUD).</p><p><strong>Methods: </strong>In this retrospective cohort study, we linked electronic postacute care referrals from Boston Medical Center in 2018 to electronic medical record data, which we used to ascertain OUD status and race and ethnicity. Using multivariable logistic regression, we examined the association between Black, White, and Hispanic or Latino race and ethnicity and referral rejection, adjusting for individual-level characteristics including medication for opioid use disorder treatment type and for facility-level factors using facility random effects.</p><p><strong>Results: </strong>We identified 159 hospitalizations from 141 individuals with OUD referred to private postacute medical care, corresponding to 1272 referrals to 244 facilities. Hospitalizations comprised 53 (33%) non-Hispanic Black, 28 (18%) Hispanic or Latino, and 78 (49%) non-Hispanic White individuals. In adjusted analyses, referrals for non-Hispanic Black individuals had significantly higher odds of rejection compared to referrals for non-Hispanic White individuals (adjusted odds ratio 1.83, 95% confidence interval [1.24, 2.69], P = 0.002). There were no significant differences between referrals for Hispanic or Latino individuals and non-Hispanic White individuals (adjusted odds ratio 1.11, 95% confidence interval [0.67, 1.84], P = 0.69).</p><p><strong>Conclusions: </strong>Among people with OUD referred to private postacute care in Massachusetts, non-Hispanic Black individuals were more likely to be rejected compared to non-Hispanic White individuals, demonstrating racism in postacute care admissions. Efforts to address discrimination against people with OUD in postacute care admissions must also address racial equity.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"165-171"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603280","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":"Predictors of Participation in Prenatal Substance Use Assessment, Counseling, and Treatment Among Pregnant Individuals in Prenatal Settings Who Use Cannabis.","authors":"Gwen T Lapham, Felicia W Chi, Kelly C Young-Wolff, Deborah Ansley, Carley Castellanos, Monique B Does, Asma H Asyyed, Allison Ettenger, Cynthia I Campbell","doi":"10.1097/ADM.0000000000001399","DOIUrl":"10.1097/ADM.0000000000001399","url":null,"abstract":"<p><strong>Objectives: </strong>Assessment and counseling are recommended for individuals with prenatal cannabis use. We examined characteristics that predict prenatal substance use assessment and counseling among individuals who screened positive for prenatal cannabis use in prenatal settings.</p><p><strong>Methods: </strong>Electronic health record data from Kaiser Permanente Northern California's Early Start perinatal substance use screening, assessment, and counseling program was used to identify individuals with ≥1 pregnancies positive for prenatal cannabis use. Outcomes included completion of a substance use assessment and among those assessed, attendance in Early Start counseling only or Addiction Medicine Recovery Services (AMRS) treatment. Predictors included demographics and past-year psychiatric and substance use disorder diagnoses evaluated with GEE multinomial logistic regression.</p><p><strong>Results: </strong>The sample included 17,782 individuals with 20,398 pregnancies positive for cannabis use (1/2011-12/2021). Most pregnancies (80.3%) had an assessment. Individuals with Medicaid, anxiety, depression and tobacco use disorders, compared to those without, had higher odds and those with greater parity, older age (≥35) and in later trimesters, had lower odds of assessment. Among 64% (n = 10,469) pregnancies needing intervention based on assessment, most (88%) attended Early Start counseling only or AMRS (with or without Early Start). Greater parity and later trimester assessment was associated with lower odds, while Medicaid was associated with higher odds of Early Start counseling. Nearly all diagnosed psychiatric and substance use disorders were associated with higher odds of AMRS treatment.</p><p><strong>Conclusions: </strong>A comprehensive prenatal substance use program engaged most pregnant individuals with prenatal cannabis use in substance use assessment and counseling. Opportunities to improve care gaps remain.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"179-186"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"5-Day Injectable Extended-release Buprenorphine Initiation in Non-opioid-tolerant Individuals in a Carceral Setting: A Case Series.","authors":"Matt Perdue, Reza Hosseini Ghomi, Paul Rees, Eric Arzubi","doi":"10.1097/ADM.0000000000001387","DOIUrl":"10.1097/ADM.0000000000001387","url":null,"abstract":"<p><strong>Background: </strong>Injectable extended-release buprenorphine (XR-Bup) addresses several barriers to the implementation of treatment with medications for opioid use disorder (MOUD) in carceral settings due to lower risk of diversion and reduced operational procedures. However, there is no standardized approach or guideline for initiating sublingual buprenorphine (SL-Bup) and transitioning to XR-Bup in persons with opioid use disorder (OUD) who are not actively using opioids, a clinical scenario commonly encountered in carceral settings.</p><p><strong>Methods: </strong>We conducted a retrospective case series of non-opioid-tolerant men with OUD at a Montana Department of Corrections facility who initiated XR-Bup using a 5-day induction protocol between May 1, 2023, and November 1, 2023. Primary outcome was receipt of the initial XR-Bup injection. Secondary outcomes were toleration of SL-Bup induction protocol and active continuation of XR-Bup at time of discharge.</p><p><strong>Results: </strong>Sixteen individuals initiated the SL-Bup induction protocol, and all were successfully transitioned to XR-Bup with no severe adverse effects. There were no required dose changes or severe adverse effects from SL-Bup induction. Two (12%) elected to discontinue XR-Bup due to commonly reported adverse effects. Fourteen (88%) remained on XR-Bup at discharge.</p><p><strong>Conclusions: </strong>Five-day induction of SL-Bup and transition to XR-Bup may be considered for non-opioid-tolerant individuals with OUD in carceral settings.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"227-229"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346997","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: \"Chronic Pain Associated Alcohol Use Disorder Among Participants in a Small Clinical Trial\".","authors":"Nicholas J Bush, Erin Ferguson, Emily Zale, Jeff Boissoneault","doi":"10.1097/ADM.0000000000001394","DOIUrl":"10.1097/ADM.0000000000001394","url":null,"abstract":"","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"238"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500745","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}