Substance abuse最新文献

{"title":"\"I'm Clean and Sober, But Not Necessarily Free\": Perceptions of Buprenorphine Among Patients in Long-Term Treatment.","authors":"Jessica J Wyse, Travis I Lovejoy, Adam J Gordon, Katherine Mackey, Anders Herreid-O'Neill, Benjamin J Morasco","doi":"10.1177/08897077231165625","DOIUrl":"10.1177/08897077231165625","url":null,"abstract":"<p><strong>Background: </strong>Patients receiving buprenorphine for the treatment of opioid use disorder (OUD) experience a roughly 50% reduction in mortality risk relative to those not receiving medication. Longer periods of treatment are also associated with improved clinical outcomes. Despite this, patients often express desires to discontinue treatment and some view taper as treatment success. Little is known about the beliefs and medication perspectives of patients engaged in long-term buprenorphine treatment that may underlie motivations to discontinue.</p><p><strong>Methods: </strong>This study was conducted at the VA Portland Health Care System (2019-2020). Qualitative interviews were conducted with participants prescribed buprenorphine for ≥2 years. Coding and analysis were guided by directed qualitative content analysis.</p><p><strong>Results: </strong>Fourteen patients engaged in office-based buprenorphine treatment completed interviews. While patients expressed strong enthusiasm for buprenorphine as a medication, the majority expressed the desire to discontinue, including patients actively tapering. Motivations to discontinue fell into 4 categories. First, patients were troubled by perceived side effects of the medication, including effects on sleep, emotion, and memory. Second, patients expressed unhappiness with being \"dependent\" on buprenorphine, framed in opposition to personal strength/independence. Third, patients expressed stigmatized beliefs about buprenorphine, describing it as \"illicit,\" and associated with past drug use. Finally, patients expressed fears about buprenorphine unknowns, including potential long-term health effects and interactions with medications required for surgery.</p><p><strong>Conclusions: </strong>Despite recognizing benefits, many patients engaged in long-term buprenorphine treatment express a desire to discontinue. Findings from this study may help clinicians anticipate patient concerns and can be used to inform shared decision-making conversations regarding buprenorphine treatment duration.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"44 1","pages":"41-50"},"PeriodicalIF":3.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11132627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9850651","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":"Perioperative Management of Extended-Release Buprenorphine: A Narrative Review and Case Series.","authors":"Thomas R Hickey,&nbsp;Thomas Meeks,&nbsp;Heather Oxentine,&nbsp;Dong Chan Park,&nbsp;Audrey Abelleira,&nbsp;Ellen Edens,&nbsp;Adam J Gordon,&nbsp;Gregory Acampora","doi":"10.1177/08897077231167043","DOIUrl":"https://doi.org/10.1177/08897077231167043","url":null,"abstract":"Background: Perioperative management of formulations of buprenorphine used for the treatment of opioid use disorder and/or pain are common clinical challenges. Care strategies are increasingly recommending continuation of buprenorphine while administering multimodal analgesia including full agonist opioids. While this “simultaneous strategy” is relatively simple for the shorter-acting sublingual buprenorphine formulation, best practices are needed for the increasingly prescribed extended-release buprenorphine (ER-buprenorphine). To our knowledge there are no prospective data to guide perioperative management of patients on ER-buprenorphine. Herein we provide a narrative review, report on the perioperative experiences of a series of patients maintained on ER-buprenorphine, and propose recommendations for perioperative ER-buprenorphine management based on best evidence, clinical experience, and our judgments. Cases: Here we present clinical data describing the perioperative experiences of patients maintained on extended-release buprenorphine who recently underwent a variety of surgeries ranging from outpatient inguinal hernia repair to multiple inpatient surgeries for source control in sepsis, at different medical centers throughout the United States. These patients were identified via an email solicitation to substance use disorder treatment providers throughout a nationwide healthcare system, requesting cases of patients maintained on extended-release buprenorphine who had recently undergone surgery. We report here on all of the cases received. Discussion: Extrapolating from these and recently published case reports, we describe an approach to perioperative management of extended-release buprenorphine.","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"44 1","pages":"96-103"},"PeriodicalIF":3.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10152824","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 Creation of an Addiction Nursing Fellowship Program for Registered Nurses: A Unique Approach to Enhancing the Addiction-Treatment Workforce.","authors":"Jason M Fox,&nbsp;Kristin Wason,&nbsp;Donna Beers,&nbsp;Maggie Faulds,&nbsp;Nicole Lincoln,&nbsp;Mary Tomanovich,&nbsp;Nancy W Gaden,&nbsp;Miriam Komaromy Md","doi":"10.1177/08897077231169566","DOIUrl":"https://doi.org/10.1177/08897077231169566","url":null,"abstract":"<p><p>In 2020, Boston Medical Center and the Grayken Center for Addiction launched an addiction nursing fellowship to enhance registered nurses' knowledge and skills related to the care of patients with substance use disorders and to improve patient experience and outcomes. This paper describes the development and essential components of this innovative fellowship, to our knowledge the first of its kind in the United States, with the goal of facilitating replication in other hospital settings.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"44 1","pages":"24-31"},"PeriodicalIF":3.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10152826","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":"Psychostimulant Misuse Among American Indian, Alaskan Native, or Native Hawaiian College Students in the U.S. From 2015 to 2019","authors":"Fares Qeadan, Sydney Ross, William A Barbeau, Erin F Madden, Kamilla L Venner, Kevin English","doi":"10.1177/11782218231209667","DOIUrl":"https://doi.org/10.1177/11782218231209667","url":null,"abstract":"Introduction: This study examines factors associated with psychostimulant misuse, including polysubstance use and social factors, among the understudied American Indian/Alaska Native/Native Hawaiian (AI/AN/NH) college student population. Methods: Data were from the 2015 to 2019 American College Health Association-National College Health Assessment IIc (ACHA-NCHA IIc) survey. Multivariable logistic regression models and odds ratios were used to estimate associations between psychostimulant misuse and potential risk and protective factors among AI/AN/NH college students, including licit and illicit substance use, social support, relationship factors, exposure to violence or abuse, mental health symptoms, drug and alcohol education, and sample demographics. Results: Opioid misuse among AI/AN/NH college students significantly increased the odds of using psychostimulants. Specifically, for cocaine use, the adjusted odds ratio (aOR) was 3.17 with a 95% confidence interval (C.I.) of 2.17 to 4.63; for methamphetamine use, the aOR was 38.87 (95% C.I. 19.24-78.52). For amphetamine misuse among non-Tobacco users, the aOR was 5.47 (95% C.I. 3.49-8.55), while among Tobacco users, the aOR was 2.65 (95% C.I. 2.07-3.41). For cocaine and other stimulant misuse, the aOR was 3.64 (95% C.I. 2.30-5.67). Additionally, the use of other types of licit and illicit substances was associated with greater odds of psychostimulant use and misuse. Conversely, factors such as age, living on campus, and residing in parental/guardian housing were linked with lower odds of psychostimulant use and misuse. Conclusion: Substance use prevention and treatment interventions targeting AI/AN/NH college students should address polysubstance use, including the combined use of opioids and psychostimulants. Substance use interventions should not be siloed to focus narrowly on single substances but rather should leverage potential protective factors against substance use, such as promoting supportive campus and family living conditions and other social support networks, in broad efforts to reduce multiple forms of substance use among AI/AN/NH students.","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135710312","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":"Training Providers of People Who Use Drugs to Offer Hepatitis C Treatment: A Washington State Initiative.","authors":"Jocelyn R James,&nbsp;Judith I Tsui","doi":"10.1177/08897077231167047","DOIUrl":"https://doi.org/10.1177/08897077231167047","url":null,"abstract":"<p><p>To address hepatitis C infection (HCV) treatment gaps among people who use drugs (PWUD), a statewide initiative trained buprenorphine waiver trainers to offer an optional HCV treatment module to waiver trainees. Five of twelve trained buprenorphine trainers went on to conduct HCV sessions at waiver trainings, reaching 57 trainees. Word-of-mouth led to multiple additional presentations by the project team, suggesting an unmet need for more education about treating HCV among PWUD. A post-session survey suggested that participant views on the importance of treating HCV among PWUD changed and that almost all felt confident to treat uncomplicated HCV. While limitations of this evaluation include that no baseline survey was conducted and that the survey response rate was low, findings suggest that among providers who care for PWUD, limited training may be adequate to change views about treating HCV. Future research is needed to explore models of care that will support providers to prescribe lifesaving direct-acting antiviral medications to PWUD with HCV.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"44 1","pages":"86-90"},"PeriodicalIF":3.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10152827","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":"Examining Systems, Substance Use, and Disenfranchisement: Overview and Proceedings of the 2022 AMERSA Conference.","authors":"Sarah M Bagley,&nbsp;Rebecca Northup,&nbsp;Kristin Wason,&nbsp;Jeffrey Bratberg,&nbsp;Adam J Gordon,&nbsp;Elizabeth Oliva","doi":"10.1177/08897077231169569","DOIUrl":"https://doi.org/10.1177/08897077231169569","url":null,"abstract":"The mission of AMERSA, Inc., the Association of Multidisciplinary Education and Research in substance use and Addiction, is to improve the health and well-being through leadership and advocacy in substance use education, research, clinical care, and policy.1,2 AMERSA has held an annual meeting since its origination over 45 years ago in 1976. In June of 2021, AMERSA’s Board of Directors approved a strategic plan to set a course and guide leadership of the organization through 2024. AMERSA’s overarching goals are to: (1) promote and advance multidisciplinary engagement, education, mentorship, and leadership among those who teach, study, advocate, and provide clinical care in the field of substance use and addiction; (2) champion antiracism, equity, and inclusion for persons who are disproportionately affected by unhealthy substance use; and (3) enhance the organizational infrastructure to support AMERSA’s mission. With the mission and goals in mind, AMERSA members met from November 9 to 12, 2022 in Boston, MA for an inspiring 46th Annual Meeting that highlighted the latest evidence focused on improving the lives of individuals and communities affected by substance use through education, clinical care, research, and policy advances. This was the first in-person meeting since 2019. The theme of the 2022 AMERSA annual conference was Examining Systems, Substance Use and Disenfranchisement. The focus was particularly timely given The White House release of the 2022 National Drug Control Strategy3 in which President Biden specifically identified “a new era of drug policy centered on individuals and communities. . . .[which] lays out, there is so much more we can do to expand access to evidence-based prevention, harm reduction, treatment, and recovery services. . . .” (p. 5). The National Drug Control Strategy specifically states, “We are changing how we help people when it comes to drug use, by meeting them where they are with high-impact harm reduction services and removing barriers to effective treatment for addiction, while addressing the underlying factors that lead to substance use disorder head on.” For the first time in history, harm reduction was a key priority for the Office of National Drug Control Policy. This shift supports individualized care that truly meets people where they are, enabling them to access services across the spectrum of substance use that enhance health and safety. 1169569 SAJXXX10.1177/08897077231169569Substance AbuseBagley et al. research-article2023","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"44 1","pages":"4-11"},"PeriodicalIF":3.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9850645","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":"A National Study of Homelessness, Social Determinants of Health, and Treatment Engagement Among Outpatient Medication for Opioid Use Disorder-Seeking Individuals in the United States.","authors":"Marina Gaeta Gazzola, Iain D Carmichael, Nicholaus J Christian, Xiaoying Zheng, Lynn M Madden, Declan T Barry","doi":"10.1177/08897077231167291","DOIUrl":"10.1177/08897077231167291","url":null,"abstract":"<p><strong>Background: </strong>Homelessness is an important social determinant of health (SDOH), impacting health outcomes for many medical conditions. Although homelessness is common among people with opioid use disorder (OUD), few studies systematically evaluate homelessness and other SDOH among people enrolled in standard of care treatment for OUD, medication for opioid use disorder (MOUD), or examine whether homelessness affects treatment engagement.</p><p><strong>Methods: </strong>Using data from the 2016 to 2018 U.S. Treatment Episode Dataset Discharges (TEDS-D), patient demographic, social, and clinical characteristics were compared between episodes of outpatient MOUD where homelessness was reported at treatment enrollment versus independent housing using pairwise tests adjusted for multiple testing. A logistic regression model examined the relationship between homelessness and treatment length and treatment completion while accounting for covariates.</p><p><strong>Results: </strong>There were 188 238 eligible treatment episodes. Homelessness was reported in 17 158 episodes (8.7%). In pairwise analysis, episodes involving homelessness were significantly different from those involving independent living on most demographic, social, and clinical characteristics, with significantly greater social vulnerability in most SDOH variables (<i>P</i>'s < .05). Homelessness was significantly and negatively associated with treatment completion (coefficient = -0.0853, <i>P</i> < 0.001, 95% CI = [-0.114, -0.056], OR = 0.918) and remaining in treatment for greater than 180 days (coefficient = -0.3435, <i>P</i> < 0.001, 95% CI = [-0.371, -0.316], OR = 0.709) after accounting for covariates.</p><p><strong>Conclusions: </strong>Patients reporting homelessness at treatment entry in outpatient MOUD in the U.S. represent a clinically distinct and socially vulnerable population from those not reporting homelessness. Homelessness independently predicts poorer engagement in MOUD confirming that homelessness may be an independent predictor for MOUD treatment discontinuation nationally.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"44 1","pages":"62-72"},"PeriodicalIF":3.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9850649","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":"Implementation and Evaluation of Primary Care Team Participation in Opioid Use Disorder Learning Sessions.","authors":"Cory Lutgen,&nbsp;Elisabeth Callen,&nbsp;Elise Robertson,&nbsp;Tarin Clay,&nbsp;Melissa K Filippi","doi":"10.1177/08897077231174675","DOIUrl":"https://doi.org/10.1177/08897077231174675","url":null,"abstract":"<p><strong>Introduction: </strong>Previous studies show that some primary care clinicians do not feel equipped to treat patients with opioid use disorder (OUD). This study addressed the gaps in confidence and knowledge of primary care physicians and other participants (i.e., participants who were not physicians) in diagnosing, treating, prescribing, and educating patients with OUD through interactive learning sessions.</p><p><strong>Methods: </strong>The American Academy of Family Physicians National Research Network held monthly OUD learning sessions from September 2021 to March 2022 with physicians and other participants (n = 31) from 7 practices. Participants took baseline (n = 31), post-session (n = 11-20), and post-intervention (n = 21) surveys. Questions focused on confidence, knowledge, among others. We used non-parametric tests to compare individual responses pre-versus-post participation as well as to compare responses between groups.</p><p><strong>Results: </strong>All participants experienced significant changes in confidence and knowledge for most topics covered in the series. When comparing physicians to other participants, physicians had greater increases in confidence in dosing and monitoring for diversion (<i>P</i> = .047), but other participants had greater increases in confidence in the majority of topic areas. Physicians also had greater increases in knowledge than other participants in dosing and monitoring for safety (<i>P</i> = .033) and dosing and monitoring for diversion (<i>P</i> = .024), whereas other participants had greater increases in knowledge in most remaining topics. Participants agreed that sessions provided practical knowledge, except for relevancy of the case study portion of the session to current practice (<i>P</i> = .023) and the session improved participant ability to care for patients (<i>P</i> = .044).</p><p><strong>Conclusion: </strong>Through participating in interactive OUD learning sessions, knowledge and confidence increased among physicians and other participants. These changes may impact participants' decisions to diagnose, treat, prescribe, and educate patients with OUD.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"44 1","pages":"51-61"},"PeriodicalIF":3.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10152822","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":"More Effective Communication During Inpatient Addiction Treatment.","authors":"David E Marcovitz,&nbsp;Kristopher A Kast","doi":"10.1177/08897077231165064","DOIUrl":"https://doi.org/10.1177/08897077231165064","url":null,"abstract":"<p><p>In this commentary, the authors argue that historical approaches to inpatient addiction treatment favoring more confrontational, expert-centric, or paternalistic undercurrents continue to permeate the hidden curriculum in medical training. These older approaches unfortunately continue to inform how many trainees learn to approach inpatient addiction treatment. The authors go on to provide several examples of how clinical challenges specific to inpatient addiction treatment can be addressed by employing principles of motivational interviewing, harm reduction, and psychodynamic thought. Key skills are described including accurate reflection, recognition of countertransference, and assisting patients to sit with important dialectics. The authors call for greater training of attending physicians, precepting advanced practice providers, and trainees across these disciplines, as well as further study of whether systematic improvements in such provider communication may alter patient outcomes.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"44 1","pages":"12-16"},"PeriodicalIF":3.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9850646","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 Associations of Adverse Childhood Experiences (ACEs) With Substance Use in Young Adults: A Systematic Review","authors":"Ivan Sebalo, Michaela Poslt Königová, Martina Sebalo Vňuková, Martin Anders, Radek Ptáček","doi":"10.1177/11782218231193914","DOIUrl":"https://doi.org/10.1177/11782218231193914","url":null,"abstract":"Introduction: Young adulthood is a transitional period between adolescence and adulthood. Due to the unique pressures of taking on a new social role and associated uncertainties, young adults are at heightened risk for drug and alcohol use. Furthermore, adverse childhood experiences (ACEs) increases the likelihood of using maladaptive coping strategies such as using substances to avoid or soothe negative emotions. The current review aimed to summarize the associations between exposure to ACEs before the age of 18 years and subsequent drug or alcohol use between the ages of 18 and 25 years. Methods: The review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search of the Web of Science, PubMed, and PsycINFO databases was conducted in February 2022. Results: The initial search yielded 7178 articles, with 777 duplicates. Consequently, 6401 titles were inspected for relevance. After reading the full text, 88 articles were included in the review. Conclusion: This review provides clear evidence that exposure to multiple ACEs is a robust risk factor for the use of alcohol, cannabis and other drugs by young adults. Poor self-regulation and maladaptive coping strategies were identified as mechanisms explaining this link; however, further detailed research is needed.","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"104 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135506007","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}