Journal of Addiction Medicine最新文献

{"title":"Increased Risks of Major Cardiac Adverse Events in Stimulant Use Disorder as Compared With Other Substance Use Disorders: A Propensity-score Matching Cohort Study.","authors":"Nicolas Garel, Kyle T Greenway, Paola Lavin, C William Pike, Rebecca Hyde, Didier Jutras-Aswad, Steven D Tate, Anna Lembke","doi":"10.1097/ADM.0000000000001461","DOIUrl":"10.1097/ADM.0000000000001461","url":null,"abstract":"<p><strong>Objectives: </strong>Individuals with stimulant use disorders (StSUDs) present an elevated risk of cardiovascular complications compared with the general population. However, it remains unclear whether, within the subpopulation of individuals with substance use disorders (SUDs), those specifically affected by StSUDs face even higher cardiovascular complications.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the EVERSANA databank, spanning from January 2015 to December 2023. The EVERSANA data set comprises deidentified electronic health record data aggregated and standardized across the United States. Participants included patients diagnosed with SUDs, encompassing alcohol, cannabis, opioids, stimulants, tobacco, hallucinogens, sedative-hypnotics, or inhalants. We employed the International Classification of Disease 10th (ICD-10) version codes to define the presence of StSUD and SUD. Major adverse cardiac events (MACE) were assessed, and Cox proportional hazard ratios were adjusted using high-dimensional propensity score (hdPS) matching to account for potential confounders.</p><p><strong>Results: </strong>Among 137,106 patients with SUD, 7706 (5.6%) had StSUD. The cohort was 50.2% female, 53.0% non-White, with a mean age of 49.1 years (SD±15). After adjustment, stimulant users exhibited significantly higher MACE rates (HR=1.37, 95% CI: 1.22-1.53, P <0.001), including an elevated risk of death (HR=1.23, 95% CI: 1.02-1.47, P =0.026).</p><p><strong>Conclusion: </strong>Individuals with StSUD face increased MACE compared with those with nonstimulant SUDs.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440950","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":"Pediatricians' Attitudes Toward and Use of Terminology About Mothers With Opioid Use Disorder.","authors":"Jessica A Ratner, Barbara H Chaiyachati, Neera Shah Demharter, Meghan Gannon, Jobayer Hossain, Olivia Larkin, Jennifer M McAllister, Fateh Peera, Davida M Schiff, Erica M S Sibinga, Jessica F Rohde, Neera K Goyal","doi":"10.1097/ADM.0000000000001467","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001467","url":null,"abstract":"<p><strong>Objectives: </strong>Stigmatizing experiences for mothers with opioid use disorder (OUD) may impede health care engagement. We sought to characterize attitudes and terminology use among pediatric primary care clinicians as a potential target for improvement.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey of 1004 clinicians at 28 clinics affiliated with 7 US residency programs (April to June 2022). Survey questions focused on trust, blame, and support for mothers with OUD were adapted from prior studies of self-reported attitudes, and terminology was categorized as preferred versus nonpreferred based on national recommendations. Frequencies were tabulated, and a 2-stage process of factor analysis and k-means clustering was used to group respondents by attitudinal responses. Multivariable logistic regression evaluated the association between participant characteristics and attitudinal groups.</p><p><strong>Results: </strong>Of 272 respondents (response rate 27.1%), most were female, non-Hispanic White residents; the distribution of clinical roles was similar among nonrespondents. Use of nonpreferred terminology was infrequent, although over 69% reported usual or occasional use of \"substance abuse.\" Analyses supported clustering respondents across 3 main constructs of trust, blame, and support. About 27% were categorized as having a low level of blame, and about 38% had a high level of trust. Adjusting for covariates, high trust was associated with confidence in training to provide care for opioid-exposed children (adjusted odds ratio [AOR] 1.84, P=0.04), and low blame was associated with education on OUD stigma (AOR 3.43, P=0.001).</p><p><strong>Conclusions: </strong>Pediatrician attitudes reflecting mistrust and blame toward mothers with OUD are not uncommon but may be addressed through training and education.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440855","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 Inequities in the Receipt of Medications to Treat Opioid Use Disorder Among Pregnant People: A Meta-analysis.","authors":"Grace Gerdts, Katherine Sale, Phyllis Raynor, Davida M Schiff, Mishka Terplan, Elsie Bush, Nichole Nidey","doi":"10.1097/ADM.0000000000001465","DOIUrl":"10.1097/ADM.0000000000001465","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this meta-analysis is to examine inequities in the receipt of medications for opioid use disorder (MOUD) by race and ethnicity among pregnant people.</p><p><strong>Methods: </strong>PubMed and Embase were searched for studies examining the relationship between race and ethnicity and the receipt of MOUD during pregnancy. Studies were included if they were observational in nature and reported sufficient data to ascertain effect measures. Random-effects meta-analyses were conducted to estimate the pooled odds ratios (OR) with 95% CIs.</p><p><strong>Results: </strong>Fourteen studies were included with data on 157,208 individuals. Receipt of MOUD among Black (pooled OR: 0.35, 95% CI: 0.23, 0.55) and Hispanic (pooled OR: 0.60, 95% CI: 0.40, 0.89) pregnant people was significantly lower compared to their White counterparts. Among all other racial and ethnic categories, receipt of MOUD was nonsignificantly lower compared to White pregnant people (pooled OR: 0.79, 95% CI: 0.56, 1.12). Ten studies utilized self-reported race and ethnicity, and 3 studies reported data on well-defined racial and ethnic categories outside of White, Black, and Hispanic.</p><p><strong>Conclusions: </strong>There is strong evidence of racial and ethnic inequities in the receipt of MOUD during pregnancy. We hypothesize these inequities to be caused by structural and interpersonal racism impacting the quality of care for pregnant people with opioid use disorder. Increased use of self-identified race and ethnicity alongside improved reporting of racial and ethnic categories beyond Black, White, and Hispanic is needed in future research to better understand and measure constructs related to racism.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440944","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":"Post Void Residuals: Medications for Opioid Use Disorder, Patient Outcomes, and How Not to Get Fooled by Urine Toxicology Results.","authors":"Jarratt D Pytell, David A Fiellin","doi":"10.1097/ADM.0000000000001466","DOIUrl":"10.1097/ADM.0000000000001466","url":null,"abstract":"<p><p>As opioid-related mortality has increased in the United States, greater emphasis has been placed on ensuring access to medications for opioid use disorder(MOUD) and improving outcomes. While abstinence using urine toxicology testing was a mainstay of assessing MOUD treatment outcomes, there have been major shifts in clinical, research, and public health communities away from placing untoward emphasis on these metrics. Herein we challenge the purported objective truth of urine testing and highlight how we can be easily fooled into thinking a patient is or is not abstinent. We highlight the potential value of patient-reported outcomes (PROMs) that are easily obtained and may more accurately reflect the benefits of MOUD, such as decreases in overdose, retention in treatment, and improved health outcomes.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440927","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 Dyadic Association Between Patient Overdose Risk and Family Attitudes Toward Medications for Opioid Use Disorder.","authors":"Kevan Shah, Katherine Nameth, Jasmin Choi, Lane Burgette, Karen Chan Osilla","doi":"10.1097/ADM.0000000000001464","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001464","url":null,"abstract":"<p><strong>Objectives: </strong>Strong social support is beneficial in the care of patients with opioid use disorder. While medications for opioid use disorder (MOUD) are the gold standard treatment for OUD, the beliefs of support persons (SP; family, friend, partner of the individual) about MOUD can influence whether a person initiates and adheres to MOUD.</p><p><strong>Methods: </strong>We examined dyadic baseline data (n=219) of patients receiving buprenorphine treatment and their identified SP across five community health clinics in California. We evaluated SP attitudes about and familiarity with MOUD using 5 items and patient risk via sum scores on an opioid overdose risk assessment scale. We conducted multiple linear regression models using opioid overdose risk score as the outcome and SP attitudes as predictors, controlling for SP age, sex, and race as covariates.</p><p><strong>Results: </strong>The majority of SPs (80%) reported being at least somewhat familiar with MOUD, which was associated with patients who had lower opioid overdose risk scores. SPs who reported agreement with the belief statement that people should be able to stop their opioid use on their own without medication were associated with patients with higher opioid overdose risk scores (P=0.048). When adjusting for covariates, only increased familiarity with MOUD and lower patient overdose risk remained significant (P=0.028).</p><p><strong>Conclusions: </strong>Efforts that aim to promote familiarity with and decrease stigmatizing attitudes toward MOUD may be beneficial in both building support in the patient-SP relationship and potentially reducing overdose risk among patients with OUD.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441031","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":"Perinatal Substance Use-Related Content at Major Addiction Scientific Conferences: An Analysis of Oral Presentation Sessions.","authors":"Kevin Y Xu, Hendrée E Jones, Caitlin E Martin, Marcela C Smid, Max Jordan Nguemeni Tiako, Mishka Terplan, Elizabeth E Krans","doi":"10.1097/ADM.0000000000001438","DOIUrl":"10.1097/ADM.0000000000001438","url":null,"abstract":"<p><strong>Background: </strong>Substance use is a leading cause of pregnancy-associated death in the US. It is not known if the amount of perinatal content at national addiction science conferences reflects the research and education being done in this area nationally.</p><p><strong>Methods: </strong>We analyzed oral presentation sessions at five major addiction scientific conferences from 2021 to 2023 (American Academy of Addiction Psychiatry [AAAP], American Society of Addiction Medicine [ASAM], Association for Multidisciplinary Education and Research in Substance use and Addiction [AMERSA], College on Problems of Drug Dependence [CPDD], Research Society on Alcohol [RSA]) closely affiliated with organizations involved with substance use-related research and funding. Conference programs were searched using an inductive framework to identify sessions focused on pregnancy or the postpartum period. Available session materials were reviewed, coded, and categorized into three mutually exclusive groups: 1) dedicated to the perinatal period, 2) containing some perinatal content, but were not dedicated to the perinatal period, and 3) sessions with no perinatal content.</p><p><strong>Results: </strong>Across >3,000 speakers, less than 10% of sessions (76/788) contained perinatal substance use-related content. Among these, 4.7% (39/788) sessions were dedicated to the perinatal period, with the common topic covered being epidemiologic data on long-term infant neurodevelopmental outcomes following in utero drug exposure (n = 22). An additional 37 had some perinatal content but were not primarily focused on perinatal substance use. Among sessions dedicated to the perinatal period, only two covered overdoses.</p><p><strong>Discussion: </strong>Sessions dedicated to the perinatal period may not adequately reflect the diverse real-world needs of birthing people with substance use disorders. Whereas included sessions commonly covered neurodevelopmental outcomes (ie, fetal alcohol spectrum disorders), overdose and the postpartum period were seldom covered.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440866","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":"We Drove to the Moon: Ensuring Methadone Access in Rural Kentucky through Peer Transportation.","authors":"Amanda Fallin-Bennett, Trevor Moffitt, Sharon L Walsh, Michelle Lofwall, Jennifer Miles, Clinton Underwood, Kayla Combs, Laura C Fanucchi","doi":"10.1097/ADM.0000000000001459","DOIUrl":"10.1097/ADM.0000000000001459","url":null,"abstract":"<p><p>Methadone, a gold standard treatment for opioid use disorder, faces limited access due to federal regulations restricting its dispensing to licensed opioid treatment programs (OTPs). Transportation is a critical barrier reported by rural area residents, where the distances to OTPs are over six times farther than for urban residents. To overcome this barrier in rural Kentucky, the HEALing (Helping to End Addiction Long-termSM) Communities Study (HCS) partnered with Voices of Hope, a local recovery community organization, to develop a peer transportation program as part of the Recovery Coach Linkage and Retention Programs. The transportation program ran from 6/2021 to 12/2022 in 8 KY HCS counties and funded peer drivers (ie, individuals in recovery) to provide transportation to medication for opioid use disorder appointments and recovery-related services. Peer drives transported 197 participants 232,700 miles; most (78.5%) were to a single OTP in rural Madison County, KY, over 550 days. The program was an innovative solution. Peer drivers had greater flexibility and a broader scope of work compared to traditional options like Medicaid-provided nonemergency medical transportation. Furthermore, peer drivers could transport participants in unconventional locations, as outlined in the presented case study, and build rapport with participants through sharing lived experience. Implementing similar, peer-based transportation programs is a novel solution to a critical need.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440974","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 Pattern Recognition to Augment Traditional Monitoring in the Prevention of Opioid Overdose Harm.","authors":"Rakesh Patel, Anne Marie Hopkins, Basil Matta, William C Wilson, Hoomai Sayed, Linus Park, Gabriel E Dilanji","doi":"10.1097/ADM.0000000000001444","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001444","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study was to investigate the correlation of a pattern recognition algorithm to the opioid overdose intervention activities of trained medical staff at a safe consumption site (SCS).</p><p><strong>Methods: </strong>Continuous physiological data were collected using the Masimo Radius PPG pulse oximeter from volunteer users of nonprescribed, unregulated opioids at a SCS. The algorithm retrospectively calculated opioid-induced respiratory depression (OIRD) severity scores (Opioid Halo scores) were compared to interventions recorded by SCS staff.</p><p><strong>Results: </strong>The study included data prospectively collected from 167 individuals, who underwent 370 sessions of intravenous injection of nonprescribed, unregulated opioids (Fentanyl). Interventions were documented for 150 sessions (~41%) by the SCS staff. The remaining 220 sessions had no interventions documented. The algorithm demonstrated a strong correlation with the intervention activities (Spearman ρ = 0.80, P < 0.001). The area under the receiver operating curve for the correlation with intervention activities (ie, supplemental oxygen or naloxone administration) was 0.94. The OIRD severity scores were significantly higher (P < 0.001) in sessions requiring interventions compared to nonintervention sessions.</p><p><strong>Conclusions: </strong>In this study, the algorithm generated OIRD severity scores had a strong correlation with the intervention activities provided by SCS staff who were blinded to the study pulse oximeter and algorithm scores. This suggests that the algorithm may be useful in detecting severe opioid-induced respiratory depression for which intervention is needed.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254286","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":"Medication for Opioid Use Disorder for Hospitalized Patients at Six New York City Public Hospitals with an Addiction Consult Service.","authors":"Yasna Rostam-Abadi, Jennifer McNeely, Thaddeus Tarpey, Jasmine Fernando, Noa Appleton, Adetayo Fawole, Medha Mazumdar, Roopa Kalyanaraman Marcello, Caroline Cooke, Johanna Dolle, Samira Siddiqui, Daniel Schatz, Carla King","doi":"10.1097/ADM.0000000000001450","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001450","url":null,"abstract":"<p><strong>Objectives: </strong>We explored medications for opioid use disorder treatment (MOUD) utilization in six New York City public hospitals that implemented the \"Consultation for Addiction Care and Treatment in Hospitals (CATCH)\" program.</p><p><strong>Methods: </strong>CATCH rolled out between October 2018 and February 2020. Data from the electronic health record were analyzed for the first year post-implementation. Eligible cases included adults with an opioid-related diagnosis admitted to inpatient departments served by CATCH, with a stay of ≥1 night. Patients were classified as receiving an MOUD order if there was at least 1 order of buprenorphine, methadone, or naltrexone. Logistic regression modeled the impact of CATCH consults on MOUD orders, controlling for demographic and clinical characteristics with hospital as a random effect.</p><p><strong>Result: </strong>Among 2117 eligible patients, 71.4% were male, with a mean age of 51.2 years, and 27.2% identified as Black, 21.2% as White, and 34.5% as Hispanic. MOUD was ordered in 60.9% of admissions, and 41.5% had a completed CATCH consult. Patients identified as Black had lower odds of receiving a MOUD order than those identified as White (OR: 0.52, 95% CI: 0.38-0.71; P < 0.001). Patients with a CATCH consult had higher odds of receiving a MOUD order (OR: 3.22, 95% CI: 2.54-4.07; P < 0.001).</p><p><strong>Conclusion: </strong>Majority of patients in our sample received a MOUD order, with higher odds among those with a CATCH consult. Further research is needed on the drivers of racial disparities in MOUD, and other contextual, organizational, and population-specific barriers and facilitators contributing to receipt of hospital-based addiction consult services and MOUD.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254066","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":"Clinical Considerations for Engagement and Retention of Nonabstinent Patients in Care.","authors":"Maureen P Boyle, Eman Gibson, Jackie Lien, Samuela Manages, Sarah Mohr, Colleen Ryan, Gary Tsai","doi":"10.1097/ADM.0000000000001455","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001455","url":null,"abstract":"<p><p>Despite the overall low rates of treatment participation, patients with substance use disorders (SUD) are regularly dissuaded from initiating treatment until they are willing and able to commit to sustained abstinence from all substances. To improve population outcomes, it is important to reach those who are not engaged in treatment and increase retention of those who do engage in care. To do this, treatment providers must proactively engage individuals in care, including those who are uninterested or ambivalent about treatment, and design services with the intention of increasing patient retention.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255755","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}