Journal of studies on alcohol and drugs最新文献

{"title":"Parenteral Buprenorphine for Opioid Withdrawal: A Case Series.","authors":"Anthony Spadaro, Julia Nath, Travis Mok, Clement Chen, Lewis Nelson, Cynthia Santos","doi":"10.15288/jsad.24-00099","DOIUrl":"10.15288/jsad.24-00099","url":null,"abstract":"<p><strong>Objective: </strong>Buprenorphine is the standard of care for the treatment of opioid withdrawal. However, when sublingual (SL) administration is not appropriate or practical, parenteral administration by the intravenous (IV) or intramuscular (IM) route may be a reasonable substitute. Although buprenorphine was previously used intravenously for the treatment of pain, current practitioners have limited experience with its parenteral use.</p><p><strong>Method: </strong>This is a case series using a retrospective chart review of patients at an urban public hospital who received IV or IM buprenorphine for the treatment of opioid withdrawal. A query of the electronic health record was performed to identify patients who had received IV or IM buprenorphine from January 2020 to December 2021. Charts were reviewed for patient demographics, medical history, substance use history, urine drug screens, clinical scenario, indication for parenteral buprenorphine, dose of buprenorphine, vital sign trends, and any measure of change in withdrawal.</p><p><strong>Results: </strong>Eight patients were identified. The most frequent initial dose of parenteral buprenorphine was 0.3 mg, and if buprenorphine needed to be re-dosed, it was most commonly administered every 6 hours. The most common indications for use were delirium or intractable nausea and vomiting related to opioid withdrawal. Withdrawal improved in six of the eight cases and often allowed for subsequent use of SL buprenorphine. There were no adverse effects identified.</p><p><strong>Conclusions: </strong>Parenteral buprenorphine was successfully used to treat opioid withdrawal in a select group of patients. Further studies are needed to identify the optimal use parameters of parenteral buprenorphine.</p>","PeriodicalId":17159,"journal":{"name":"Journal of studies on alcohol and drugs","volume":" ","pages":"410-415"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349042","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":"Effects of Expanding Direct-to-Consumer Alcohol Home Delivery Policies: Evidence From 18 States of Increases in Alcohol Use and Consequences.","authors":"Jimikaye B Courtney, McKenna Roudebush, Rebecca S Williams, Melissa J Cox, Kurt M Ribisl","doi":"10.15288/jsad.24-00273","DOIUrl":"10.15288/jsad.24-00273","url":null,"abstract":"<p><strong>Objective: </strong>After the COVID-19 pandemic onset, several U.S. states passed legislation to begin or expand direct-to-consumer (DTC) alcohol home delivery. We examined changes in DTC use and associations between DTC use, drinking patterns, and negative consequences by different DTC policies.</p><p><strong>Method: </strong>We conducted a cross-sectional, retrospective survey of 5,360 U.S. adults who consumed alcohol (ages 21-62 years), using an online Qualtrics survey panel. Participants were recruited from 18 states representing four DTC policy groupings pertaining to on- and off-premises outlets (no DTC, no change in existing DTC policy, new DTC policy, expanded DTC policy). DTC use and drinking patterns (average drinks/week, binge drinking days/month) were self-reported for four pandemic-related periods at pre- (2019-February 2020), early (March-May 2020), mid- (June 2020-March 2021), and late pandemic (April 2021-October 2023). Participants self-reported the total number of negative drinking consequences (out of 17) they experienced during the entire pandemic. Multivariate regressions examined time and policy group predicting DTC use, time and DTC use predicting drinking patterns, and DTC use and drinks/week predicting negative consequences.</p><p><strong>Results: </strong>Compared to adults in states with no delivery, odds of DTC use were highest among adults in states that expanded DTC policies (odds ratio [OR] = 2.11, 95% confidence interval [CI] [1.78, 2.50]). DTC use was associated with consuming approximately 4.43 (<i>p</i> < .001) more average drinks per week, more binge days per month (incidence rate ratio [IRR] = 1.33, 95% CI [1.27, 1.39]), and more negative consequences (IRR = 1.28, 95% CI [1.17, 1.39]), controlling for current drinking.</p><p><strong>Conclusions: </strong>Our findings suggest that expanding DTC delivery policies increased alcohol accessibility, and DTC use was associated with increases in excessive alcohol use and consequences. Such data can inform future decisions about states' DTC alcohol policies.</p>","PeriodicalId":17159,"journal":{"name":"Journal of studies on alcohol and drugs","volume":" ","pages":"330-339"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730567","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":"Age-Related Changes in Past-Month Alcohol, Cannabis, and Simultaneous Use in a Statewide Sample of Young Adults in Washington State.","authors":"Anne M Fairlie, Brian H Calhoun, Charles B Fleming, Miranda L M Delawalla, Griselda Martinez, Max A Halvorson, Isaac C Rhew, Jason R Kilmer, Katarina Guttmannova","doi":"10.15288/jsad.24-00065","DOIUrl":"10.15288/jsad.24-00065","url":null,"abstract":"<p><strong>Objective: </strong>It is unknown whether age-related decreases in substance use (maturing out) are observed in the legalized cannabis context. This study evaluated age-related changes in past-month alcohol use frequency, cannabis use frequency, and any simultaneous alcohol and marijuana/cannabis (SAM) use among young adults who engaged in the respective substance use behavior.</p><p><strong>Method: </strong>Young adults residing in Washington State at enrollment (<i>N</i> = 6,509; 68.3% female; ages 18-25) provided 3-5 years of annual data in a longitudinal, cohort-sequential design from 2015 to 2019, a period after nonmedical cannabis was legalized and implemented. Multilevel growth models were conducted; poststratification weights were applied to make the sample more similar to the Washington young adult general population in demographic characteristics.</p><p><strong>Results: </strong>Among those who reported alcohol use at one or more time points, days of alcohol use increased from age 18 to approximately age 25 and then decreased until age 30. Among those who reported cannabis use at one or more time points, days of cannabis use increased from age 18 until approximately age 23 and then decreased until age 30. Among those who reported SAM use at one or more time points, the probability of SAM use increased from age 18 until approximately age 24 and then decreased until age 30. Age-related changes in SAM use were largely explained by concurrent changes in alcohol and cannabis use frequency.</p><p><strong>Conclusions: </strong>Maturing out was observed for alcohol, cannabis, and SAM use among those who used each respective substance, with evidence that age-related changes in SAM use were tied to alcohol and cannabis use frequency.</p>","PeriodicalId":17159,"journal":{"name":"Journal of studies on alcohol and drugs","volume":" ","pages":"367-377"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141913024","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":"Identifying Three Psilocybin Use Patterns by Frequency and Quantity.","authors":"Bethany A Gray, Olivia L Bolts, Deborah Fidler, Mark Prince","doi":"10.15288/jsad.23-00312","DOIUrl":"10.15288/jsad.23-00312","url":null,"abstract":"<p><strong>Objective: </strong>Patterns of psilocybin use in nonclinical settings are not well described in the literature. Psilocybin use can involve infrequent, large (i.e., macro) doses that produce hallucinogenic effects. In addition, some people report psilocybin use at particularly small (i.e., micro), sub-perceptual doses. Given the heterogeneity in reported use metrics, we sought to determine whether there are identifiable patterns of psilocybin use based on participants' self-described typical use frequencies and quantities and to describe how demographic characteristics are associated with each pattern of use.</p><p><strong>Method: </strong>Participants were recruited from online communities via Reddit.com. We used latent profile analysis to discern psilocybin use patterns defined by frequency and quantity of use. The analytic sample consisted of 664 participants (75.6% U.S. residents; 83.1% White; 67.2% male).</p><p><strong>Results: </strong>The chipper profile (18%) was associated with approximately 1 to 4 annual uses and using between 0.75 g and 1.0 g of dehydrated, psilocybin-containing mushrooms. The tripper profile (64%) was associated with approximately 2 to 6 annual uses and self-reported use quantities between 2 and 4 g. The micro-doser profile (18%) was related to substantively higher psilocybin use frequencies than the other profiles (between 2 and 4 times a week) and a lower range of preferred quantities (between 0.25 g and 0.75 g). In addition, profiles differed by certain demographic measurements, lifetime psilocybin use, and timing of psilocybin use.</p><p><strong>Conclusions: </strong>Psilocybin use in nonclinical settings is heterogeneous. We identified three profiles that differed on frequency and quantity of use and their associated demographic characteristics. Next steps are to identify factors that affect one's likelihood of experiencing particular use outcomes and to explore use variability.</p>","PeriodicalId":17159,"journal":{"name":"Journal of studies on alcohol and drugs","volume":" ","pages":"378-390"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036068","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 Relationship Between Alcohol Availability and Drink-Driving Policies and Admissions to Substance Use Disorder Treatment During Pregnancy.","authors":"Pamela J Trangenstein, Nancy F Berglas, Meenakshi S Subbaraman, William C Kerr, Sarah Roberts","doi":"10.15288/jsad.23-00414","DOIUrl":"10.15288/jsad.23-00414","url":null,"abstract":"<p><strong>Objective: </strong>Pregnancy-specific alcohol policies are widely adopted yet have limited effectiveness and established risks. It is unknown whether general population alcohol policies are effective during pregnancy. This study investigated associations between general population policies and alcohol treatment admission rates for pregnant people specifically.</p><p><strong>Method: </strong>Data are from the Treatment Episodes Data Set-Admissions and state-level policy data for 1992-2019 (<i>n</i> = 1,331 state-years). The primary outcome was treatment admissions where alcohol was the primary substance, and the secondary outcome included admissions where alcohol was any substance. There were five policy predictors: (a) government spirits monopoly, (b) ban on Sunday sales, (c) grocery store sales, (d) gas station sales, and (e) blood alcohol concentration (BAC) laws. Covariates included poverty, unemployment, per capita cigarette consumption, state and year fixed effects, and state-specific time trends.</p><p><strong>Results: </strong>In models with alcohol as the primary substance, prohibiting spirits sales in grocery stores (vs. allowing heavy beer [>3.2% alcohol by volume] and spirits) had lower treatment admission rates (incidence rate ratio [IRR] = 0.88, 95% CI [0.78, 0.99], <i>p</i> = .028). States with BAC laws at .10% (vs. no law) had higher treatment admission rates (IRR = 1.24, 95% CI [1.08, 1.43], <i>p</i> = .003). When alcohol was any substance, prohibiting spirits sales in grocery stores (vs. allowing heavy beer and spirits) was again associated with lower treatment admission rates (IRR = 0.89, 95% CI [0.80, 0.98], <i>p</i> = .021), but there was no association for BAC laws.</p><p><strong>Conclusions: </strong>Restrictions on grocery store spirits sales and BAC laws were associated with lower and higher alcohol treatment admission rates among pregnant people, respectively, suggesting that general population alcohol policies are relevant for pregnant people's treatment utilization.</p>","PeriodicalId":17159,"journal":{"name":"Journal of studies on alcohol and drugs","volume":" ","pages":"349-357"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893640","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":"Associations Between Readmission and Length of Stay in the Acute Admission Unit for Patients With Alcohol-Related Diagnoses: A Cohort Study.","authors":"Nanna F Skov, Gitte B Tygesen, Marianne Lisby","doi":"10.15288/jsad.23-00395","DOIUrl":"10.15288/jsad.23-00395","url":null,"abstract":"<p><strong>Objective: </strong>Patients with an alcohol-related diagnosis in emergency departments (EDs) are at high risk of readmission. Evidence shows an association between alcohol-related admissions and a wide range of diseases and disorders. Understanding the risk factors for readmission and the association with length of stay in the ED may help identify those who would benefit from targeted interventions. Thus, the hypothesis of this study is that patients with alcohol-related diagnoses and a short length of stay in the ED have a higher risk for readmission. Therefore, this study aimed to investigate the association between length of stay in the ED and 30-day readmission for patients with alcohol-related acute admissions, as well as to uncover possible risk factors for 30-day readmission.</p><p><strong>Method: </strong>The study used a retrospective cohort design and was carried out from March 1, 2019, to January 31, 2020. The inclusion criteria were being at least 18 years old, admitted to an ED, and having an alcohol-related primary or secondary diagnosis (based on <i>International Statistical Classification of Diseases and Related Health Problems, 10th ed</i>. [ICD-10] codes). Patients were followed for 30 days after discharge from initial hospitalization to identify associations between length of stay and 30-day readmission.</p><p><strong>Results: </strong>We included 1,174 patients and found that 17% (95% CI [15, 20]) of the patients admitted with an alcohol-related primary or secondary diagnosis were readmitted within 30 days. The hazard ratio (HR) for readmission increased with length of stay when compared with admission ≤24 hours; admission >24-48 hours HR 1.50 (95% CI [1.08, 2.08]), admission >48 hours HR 2.08 (95% CI [1.23, 3.52]).</p><p><strong>Conclusions: </strong>The study revealed that patients with alcohol-related diagnoses were at a higher risk of ED readmission the longer they stayed in the ED. Furthermore, the risk of readmission increased if patients had a medical or psychiatric diagnosis before admission or lived alone.</p>","PeriodicalId":17159,"journal":{"name":"Journal of studies on alcohol and drugs","volume":" ","pages":"402-409"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017894","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":"Commissioned Articles, Perspectives, and the Invisible College of Substance Use Research.","authors":"Denis M McCarthy","doi":"10.15288/jsad.25-00084","DOIUrl":"10.15288/jsad.25-00084","url":null,"abstract":"","PeriodicalId":17159,"journal":{"name":"Journal of studies on alcohol and drugs","volume":" ","pages":"321-322"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586013","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":"Differences in Alcohol-Related Variables Between Individuals Who Engage in Food and Alcohol Disturbance (FAD) Behaviors and Those Who Only Use Alcohol: The Role of FAD-Motives.","authors":"Alison Looby, Katherine A Berry, Mark A Prince, Luke Herchenroeder, Adrian J Bravo, Bradley T Conner, Laura J Holt, Ty S Schepis, Ellen W Yeung","doi":"10.15288/jsad.24-00067","DOIUrl":"10.15288/jsad.24-00067","url":null,"abstract":"<p><strong>Objective: </strong>Food and alcohol disturbance (FAD) is the use of any compensatory behavior (e.g., skipping meals) within the context of a drinking episode. FAD has two underlying motives: to enhance the effects of alcohol (FAD-AE) and/or compensate for calories consumed from alcohol (FAD-CC). Prior work finds that FAD is positively associated with alcohol-related outcomes; however, it is unclear whether FAD confers increased risk above alcohol use alone and whether there are differences in alcohol outcomes by FAD-motive. Thus, the present study evaluated alcohol use patterns (i.e., past-month quantity/frequency, binge use, consequences, and drinking motives) by FAD status and FAD-motives.</p><p><strong>Method: </strong>Data were from the Stimulant Norms and Prevalence 2 (SNAP2) study, which included 5,809 undergraduates from six U.S. universities. Participants were grouped into four categories: Alcohol-Only, FAD-AE, FAD-CC, and FAD-both (i.e., both FAD-AE and FAD-CC motives). Ordinary least squares regression was used for drinking motives, and quasi-Poisson regressions were used for other outcomes.</p><p><strong>Results: </strong>Alcohol use quantity, frequency, binge use, and consequences were all greatest in the FAD-both group and lowest in the alcohol-only group, with the FAD-AE and FAD-CC groups intermediate and not significantly different from each other. To illustrate, the FAD-both group had 47%, 33%, and 25% greater alcohol-related consequences than the alcohol-only, FAD-CC, and FAD-AE groups, respectively. This stepwise pattern held for drinking motives, with fewer significant differences.</p><p><strong>Conclusions: </strong>Engagement in FAD is linked to an increased likelihood of poor alcohol outcomes versus alcohol use alone, and FAD for both motives represents the highest risk group.</p>","PeriodicalId":17159,"journal":{"name":"Journal of studies on alcohol and drugs","volume":" ","pages":"461-468"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289856","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":"Mental Health Modulates Associations Between Institutional Belonging and Substance Use Risk.","authors":"Danny Rahal, Kristin J Perry, Stephanie T Lanza","doi":"10.15288/jsad.23-00382","DOIUrl":"10.15288/jsad.23-00382","url":null,"abstract":"<p><strong>Objective: </strong>The present study aimed to characterize profiles of mental health, incorporating indicators of both psychopathology and well-being, among college students and determine whether institutional belonging differentially relates to past-month substance use by mental health profile.</p><p><strong>Method: </strong>Students (<i>N</i> = 4,018; 59.5% female, 74.7% White) completed a survey regarding mental health (i.e., anxiety symptoms, depressive symptoms, stress, flourishing, academic confidence), institutional belonging, and whether they had engaged in any binge drinking of alcohol and use of cannabis and nicotine products, including nicotine vaping, over the past month.</p><p><strong>Results: </strong>Latent profile analyses indicated five profiles of mental health with differing levels of psychopathology and well-being. Greater institutional belonging was only related to higher odds of binge drinking among students in profiles characterized by average or high well-being, irrespective of psychopathology. Among students with overall poor mental health, higher institutional belonging was related to higher odds of nicotine use. Results were generally invariant to campus and year in college.</p><p><strong>Conclusions: </strong>Our findings highlight that both positive and negative aspects of mental health should be considered when assessing college students' substance use. Greater institutional belonging may incur risk for substance use differentially by mental health, with respect to binge drinking for those with high levels of positive well-being and nonvaping nicotine use for those with overall poor mental health. Because associations emerged between belonging and substance use risk, institutions could consider implementing or raising awareness of alcohol-free, inclusive activities to ensure that students can feel a sense of belonging while abstaining from drinking.</p>","PeriodicalId":17159,"journal":{"name":"Journal of studies on alcohol and drugs","volume":" ","pages":"424-435"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000289","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":"Male Predominance in West Virginia Unintentional Overdose Deaths Is Influenced by Alcohol and Co-Intoxicants.","authors":"Zheng Dai, Marie A Abate, Mohammad A Al-Mamun, James C Kraner, Allen R Mock, Gordon S Smith","doi":"10.15288/jsad.24-00054","DOIUrl":"10.15288/jsad.24-00054","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to examine sex differences in overdose (OD) mortality based on substances involved.</p><p><strong>Method: </strong>We conducted a retrospective database analysis of West Virginia OD decedents (12,666 unintentional OD deaths, 2005-early 2023). Exposures were substances judged to contribute to death. The main outcome measure was determination of male to female death ratios with varying co-intoxicant involvement, particularly related to alcohol and fentanyl. Secondary outcomes included associations of fentanyl concentrations with alcohol concentrations and male sex, including fentanyl and inactive metabolite norfentanyl concentration variability between sexes.</p><p><strong>Results: </strong>Alcohol co-intoxication in OD deaths was associated with higher male:female death ratios, from 2.0 (alcohol absent) to 3.3 (alcohol present). There was a greater increase over time in alcohol involvement in recent deaths involving females compared with males (relative increases of 52% vs. 6%, respectively). Male:female ratios with alcohol and fentanyl co-involvement ranged from 5.9:1 (only two drugs involved) to 2.4:1 (≥5 substances), with females significantly more likely to have multiple substances contributing to death. Overall, males had statistically significantly larger fentanyl to norfentanyl median concentration ratios compared with females (8.8 vs. 6.9, respectively). Multivariable analyses found that alcohol presence was associated with a statistically significant 22% reduction in predicted fentanyl concentrations.</p><p><strong>Conclusions: </strong>Male:female ratios in unintentional OD deaths were higher with greater alcohol involvement and lower with fewer co-intoxicants. Fentanyl and norfentanyl concentration differences by sex were observed. It is important to determine possible contributors to sex differences in OD death rates to better target prevention and treatment initiatives.</p>","PeriodicalId":17159,"journal":{"name":"Journal of studies on alcohol and drugs","volume":" ","pages":"358-366"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289797","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}