American Journal of Drug and Alcohol Abuse最新文献

{"title":"Patient experiences with outpatient opioid use disorder treatment before and during COVID-19: results from a survey of Medicaid members.","authors":"Sarah J Marks, Huyen Pham, Neil McCray, Jennifer Palazzolo, Ashley Harrell, Jason Lowe, Chethan Bachireddy, Lauren Guerra, Peter J Cunningham, Andrew J Barnes","doi":"10.1080/00952990.2024.2328543","DOIUrl":"10.1080/00952990.2024.2328543","url":null,"abstract":"<p><p><i>Background:</i> Payers are increasingly interested in quality improvement for opioid use disorder (OUD) treatment, including incorporating patient experiences. Medicaid is the largest payer for OUD treatment, yet we know little about the treatment benefits Medicaid members report, how these vary across members, or changed with the COVID-19 pandemic.<i>Objective:</i> To examine Medicaid members' report of outpatient treatment benefits, employment, and housing outcomes before and during the pandemic.<i>Methods:</i> A representative sample of 1,032 Virginia Medicaid members (52% women) receiving OUD treatment completed a survey of treatment benefits, health status and social needs. A reported treatment benefit index was created based on seven self-reported items. Multivariable linear regression models, pooled and stratified by time (pre-COVID-19/COVID-19), assessed member characteristics associated with reported treatment benefit, employment and housing outcomes.<i>Results:</i> Members reported strong treatment benefit (mean: 21.8 [SD: 5.9] out of 28 points) and improvements in employment (2.4 [1.3] out of 5) and housing (2.8 [1.2] out of 5). After adjustment, mental distress (regression coefficient: -3.00 [95% CI:-3.97;-2.03]), polysubstance use (-1.25 [-1.99;-0.51]), and food insecurity (-1.00 [-1.71;-0.29]), were associated with decreased benefits from treatment. During COVID-19, justice-involved individuals reported decreased benefits (-2.17 [-3.54; -0.80]) compared to before the pandemic (-0.09 [-1.4-;1.24] <i>p</i> < .05).<i>Conclusions:</i> Medicaid members receiving outpatient OUD treatment reported positive treatment benefits, and housing and employment outcomes. However, those with comorbid health and social conditions often benefited the least. As payers move toward quality improvement and value-based purchasing initiatives, collecting and integrating patient reported outcomes into quality metrics is critical.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"357-370"},"PeriodicalIF":2.7,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140958868","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":"Missouri's Overdose Field Report: descriptive analysis, survival trends, and naloxone dosing patterns from a community-based survey tool, 2018-2022.","authors":"Zach Budesa, Kyle Vance, Ryan Smith, Ryan Carpenter, Devin Banks, Lauren Green, Brandon D L Marshall, Bruce R Schackman, Xiao Zang, Rachel Winograd","doi":"10.1080/00952990.2024.2358046","DOIUrl":"10.1080/00952990.2024.2358046","url":null,"abstract":"<p><p><i>Background:</i> Missouri's Overdose Field Report (ODFR) is a community-based reporting system which intends to capture overdoses which may not be otherwise recorded.<i>Objectives:</i> Describe the factors related to non-fatal overdoses reported to Missouri's ODFR.<i>Methods:</i> This study used a descriptive epidemiological approach to examine the demographics and circumstances of overdoses reported to the ODFR. We used binary logistic regression to evaluate factors associated with survival and ordinal logistic regression to evaluate factors associated with number of doses used. Factors were chosen based on their relevance to overdose education and survival, and naloxone distribution.<i>Results:</i> Between 2018 and 2022, 12,225 overdoses (67% male; 78% White) were reported through the ODFR, with a 96% (n = 11,225) survival rate. Overdose survival (ps < .02) was associated with younger age (OR = .58), no opioid and stimulant co-involvement (OR = .61), and private location (OR = .48). Intramuscular naloxone in particular was associated with a significantly higher odds of survival compared to nasal naloxone (OR = 2.11). An average of 1.6 doses of naloxone per incident were administered. Additional doses were associated (ps < .02) with being older (OR = .45), female (OR = .90), nasal naloxone (versus intravenous) (OR = .65), and the belief fentanyl was present (OR = 1.49).<i>Conclusion:</i> Our reporting form provides a comprehensive picture of the events surrounding reported overdoses, including factors associated with survival, how much naloxone was used, and the effects of respondents believing fentanyl was involved. Missouri's report can provide support for current naloxone dosing, contextualize refusing post-overdose transport, and can be used to improve overdose response by community and first responders.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"413-425"},"PeriodicalIF":2.7,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11305909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452013","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":"Withdrawal catastrophizing scale: initial psychometric properties and implications for the study of opioid use disorder and hyperkatifeia.","authors":"Orman Trent Hall, Michael Vilensky, Julie E Teater, Craig Bryan, Kara Rood, Julie Niedermier, Parker Entrup, Stephanie Gorka, Anthony King, David A Williams, K Luan Phan","doi":"10.1080/00952990.2023.2298257","DOIUrl":"https://doi.org/10.1080/00952990.2023.2298257","url":null,"abstract":"<p><p><i>Background:</i> Discovery of modifiable factors influencing subjective withdrawal experience might advance opioid use disorder (OUD) research and precision treatment. This study explores one factor - withdrawal catastrophizing - a negative cognitive and emotional orientation toward withdrawal characterized by excessive fear, worry or inability to divert attention from withdrawal symptoms.<i>Objectives:</i> We define a novel concept - withdrawal catastrophizing - and present an initial evaluation of the Withdrawal Catastrophizing Scale (WCS).<i>Methods:</i> Prospective observational study (<i>n</i> = 122, 48.7% women). Factor structure (exploratory factor analysis) and internal consistency (Cronbach's α) were assessed. Predictive validity was tested via correlation between WCS and next-day subjective opiate withdrawal scale (SOWS) severity. The clinical salience of WCS was evaluated by correlation between WCS and withdrawal-motivated behaviors including risk taking, OUD maintenance, OUD treatment delay, history of leaving the hospital against medical advice and buprenorphine-precipitated withdrawal.<i>Results:</i> WCS was found to have a two-factor structure (distortion and despair), strong internal consistency (α = .901), and predictive validity - Greater withdrawal catastrophizing was associated with next-day SOWS (r_s (99) = 0.237, <i>p</i> = .017). Withdrawal catastrophizing was also correlated with risk-taking behavior to relieve withdrawal (r_s (119) = 0.357, <i>p</i> < .001); withdrawal-motivated OUD treatment avoidance (r_s (119) = 0.421, <i>p</i> < .001), history of leaving the hospital against medical advice (r_s (119) = 0.373, <i>p</i> < .001) and buprenorphine-precipitated withdrawal (r_s (119) = 0.369, <i>p</i> < .001).<i>Conclusion:</i> This study provides first evidence of <i>withdrawal catastrophizing</i> as a clinically important phenomenon with implications for the future study and treatment of OUD.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"1-13"},"PeriodicalIF":2.7,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177358","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":"Ethanol causes non-communicable disease through activation of NLRP3 inflammasome: a review on mechanism of action and potential interventions.","authors":"Ruizi Liu, Bin Zhao, Jie Zhao, Meng Zhang","doi":"10.1080/00952990.2023.2297349","DOIUrl":"10.1080/00952990.2023.2297349","url":null,"abstract":"<p><p><i>Background:</i> Ethanol exposure has been suggested to be implicated in the initiation and progression of several non-communicable diseases (NCD), including neurological disorders, diabetes mellitus, alcoholic liver disease, gastric injury, pancreatitis, and atherosclerosis. Recent findings show that the NACHT, LRR, and PYD domains-containing protein 3 (NLRP3) inflammasome is involved in the progression of ethanol-induced NCDs.<i>Objective:</i> The aim of this review was to summarize the research progress on NCDs associated with the action of the NLRP3 inflammasome by ethanol and potential interventions, with a specific focus on preclinical literature.<i>Methods:</i> A literature search was conducted on PubMed using the keywords \"[ethanol] and [NLRP3]\" up until January 2023. Articles describing cases of NCDs caused by ethanol and associated with the NLRP3 inflammasome were included.<i>Results:</i> After removing duplicates, 35 articles were included in this review. These studies, mostly conducted in animals or in vitro, provide evidence that ethanol can contribute to the development of NCDs, such as neurological disorders, alcoholic liver disease, gastric injury, pancreatitis, and atherosclerosis, by activating the NLRP3 inflammasome. Ethanol exposure primarily triggers NLRP3 inflammasome activation by influencing the TRL/NF-κB, ROS-TXNIP-NLRP3 and P2X7 receptor (P2X7R) signaling pathways. Several natural extracts and compounds have been found to alleviate NCDs caused by ethanol consumption by inhibiting the activation of the NLRP3 inflammasome.<i>Conclusion:</i> Preclinical research supports a role for ethanol-induced NLRP3 inflammasome in the development of NCDs. However, the clinical relevance remains uncertain in the relative absence of clinical studies.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"139-149"},"PeriodicalIF":2.7,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139490936","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":"Experiencing violence and other predictors of within-person same-day use of multiple substances in youth: a longitudinal study in emergency settings.","authors":"Vivian H Lyons, Matthew G Myers, Rebecca M Cunningham, Marc A Zimmerman, Patrick M Carter, Maureen A Walton, Jason Goldstick","doi":"10.1080/00952990.2024.2307546","DOIUrl":"10.1080/00952990.2024.2307546","url":null,"abstract":"<p><p><i>Background:</i> Although experiencing violence is a risk factor for substance use among youth, its association with same-day use of multiple substances (a form of polysubstance use) and mitigating factors is less well understood.<i>Objectives:</i> To identify whether prosocial factors modified the effect of experiencing violence on the frequency of same-day use, and examine gender-specific risk/protective factors for same-day use.<i>Methods:</i> We analyzed longitudinal data from a cohort of youth who use drugs aged 14-24 (<i>n</i> = 599; 58% male) presenting to an urban emergency department between 2009-2011 and assessed biannually for two years. Using Poisson-generalized linear models with person-level fixed effects, we estimated within-person associations between self-reported experiencing violence and same-day use and analyzed gender and peer/parent support as effect modifiers. We adjusted for negative peer influence, parental drug and alcohol use, family conflict, anxiety and depression, and age.<i>Results:</i> Overall, positive parental support corresponded to lower rates of same-day use (rate ratio [RR]:0.93, 95% CI:0.87-0.99) and experiencing violence was associated with higher rates of same-day use (RR:1.25, 95% CI:1.10-1.41). Violence exposure was a risk factor among males (RR:1.42, 95% CI:1.21-1.66), while negative peer influences and parental substance use were risk factors among females (RR:1.63, 95% CI:1.36-1.97 and RR:1.58, 95% CI:1.35-1.83, respectively). Positive peer support reduced the association between violence exposure and same-day use among males (RR:0.69, 95% CI:0.57-0.84, <i>p</i> < .05).<i>Conclusions:</i> Tailored interventions may address gender differences in coping with experiencing violence - including interventions that promote parental support among males and reduce influence from parental substance use among females.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"218-228"},"PeriodicalIF":2.7,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337408","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":"Willingness to provide a hair sample for drug testing: results from an anonymous multi-city intercept survey.","authors":"Nae Y Won, Brittney Jabot, Anna Wang, Joseph J Palamar, Linda B Cottler","doi":"10.1080/00952990.2024.2309654","DOIUrl":"10.1080/00952990.2024.2309654","url":null,"abstract":"<p><p><i>Background:</i> Hair provision for drug testing can provide secondary measurement to complement self-reported drug use data, thereby providing a more accurate representation of an individual's drug use. Understanding factors associated with hair provision offers valuable insights into recruitment methods.<i>Objective:</i> To identify demographic and drug-related correlates of providing hair samples in a multi-site venue-intercept study.<i>Methods:</i> We utilized venue-intercept sampling for our Rapid Street Reporting study across 12 US cities between January and November 2022. Participants reported past 12-month drug use and were asked if they would provide a hair sample. We conducted multivariable (generalized linear model with logit link) analyses on demographics and drug use characteristics correlated to hair provision for drug testing.<i>Results:</i> Among 3,045 participants, 55.8% were male, 13.6% provided hair samples. Compared to males, those identifying as \"other gender\" had higher odds of hair collection (adjusted odds ratio = 2.24, 95% confidence interval: 1.28-3.80). Participants identifying as Black (aOR = 0.32, CI: 0.23-0.45) or \"other race\" (aOR = 0.50, 95% CI: 0.29-0.80) had lower odds of providing hair than those identifying as White. All levels of reported drug use - one drug (aOR=1.50, 95% CI: 1.15-1.96), two-three drugs (aOR=1.51, 95% CI: 1.11-2.05), four or more (aOR = 2.13, 95% CI: 1.50-3.01) - had higher odds of providing hair samples than those reporting no drug use. Similar associations applied to reporting cannabis use with or without another drug (aOR = 1.52-1.81, 95% CI: 1.15-2.38).<i>Conclusion:</i> Differential hair provision based on participant sex, race/ethnicity, and drug use may introduce biases in drug testing, limiting generalizability to individuals from minority backgrounds.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"261-268"},"PeriodicalIF":2.7,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11052666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319567","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":"Targeting the Nlrp3 inflammasome as potential treatment for ethanol-induced non-communicable diseases.","authors":"Paul D Drew","doi":"10.1080/00952990.2024.2332951","DOIUrl":"10.1080/00952990.2024.2332951","url":null,"abstract":"","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"125-127"},"PeriodicalIF":2.7,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337411","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":"Evaluation of an online SBIRT training program.","authors":"Joseph G Pickard, Carissa van den Berk-Clark, Sharon D Johnson, Miriam Taylor","doi":"10.1080/00952990.2023.2286582","DOIUrl":"10.1080/00952990.2023.2286582","url":null,"abstract":"<p><p><i>Background:</i> While human ecosystem disruptions have happened in the past, the COVID-19 pandemic is the first situation to warrant such a large, world-wide transition to online education. The pandemic has increased the need for intervention with people in varying stages of substance use disorders.<i>Objectives:</i> In response to the need for more evidence-based, online educational and training options to address this need, this study used pre-posttest evaluations to determine the efficacy of an online training for a specific evidence-based intervention, Screening, Brief Intervention, and Referral to Services (SBIRT).<i>Methods:</i> Social Work students from two universities completed a 4-hour, online training in SBIRT which included a pre/posttest, demographic variables, a satisfaction scale, and a measure of self-efficacy. Mixed Effects Linear regression was used to model the repeated measures of SBIRT knowledge and efficacy, while a linear regression model was used to measure the relationship between satisfaction and participant characteristics.<i>Results:</i> Participants were mostly female (85.9%), mostly White/Caucasian (72.9%), and most already had a bachelor's degree (50%) or higher (9.6%). Individuals who were White, non-Hispanic/Latinx, or had master's level or doctoral level mental health training were more likely to have higher SBIRT scores. Those with the highest levels of self-efficacy had the lowest change scores on the knowledge test. Overall, there was an almost threefold increase in SBIRT knowledge posttraining, indicating the viability of this training format, which is similar to findings from studies of in-person trainings of SBIRT which also found increases in SBIRT knowledge.<i>Conclusion:</i> Recommendations based on the results are provided to encourage improved student outcomes from this type of e-learning.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"173-180"},"PeriodicalIF":2.7,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139974114","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":"Alcohol-related non-fatal motor vehicle crash injury in the US from 2019 to 2022.","authors":"Nae Y Won, Andrew J McCabe, Linda B Cottler","doi":"10.1080/00952990.2024.2309336","DOIUrl":"10.1080/00952990.2024.2309336","url":null,"abstract":"<p><p><i>Background:</i> Information on recent alcohol-related non-fatal motor vehicle crash (MVC) injuries is limited.<i>Objectives:</i> To analyze alcohol-related non-fatal MVC injuries, 2019-2022, considering COVID-19 and Stay-at-Home policies.<i>Methods:</i> State-level counts of alcohol-related non-fatal MVC injuries (involving individuals age 15+) from Emergency Medical Services data in 18 US states, chosen for comprehensive coverage, were analyzed for the annual rate. The total non-fatal MVC injury count in each state served as the denominator. We used analysis of variance to evaluate annual rate changes from 2019 to 2022 and used robust Poisson regression to compare annual mean rates to the 2019 baseline, pre-pandemic, excluding Quarter 1 due to COVID-19's onset in Quarter 2. Additional Poisson models compared rate changes by 2020 Stay-at-Home policies.<i>Results:</i> Data from 18 states were utilized (<i>N</i> = 1,487,626, 49.5% male). When evaluating rate changes of alcohol-related non-fatal MVC injuries from period 1 (Q2-4 2019) through period 4 (Q2-4 2022), the rate significantly increased from period 1 (2019) to period 2 (2020) by 0.024 (<i>p</i> = .003), then decreased from period 2 to period 4 (2022) by 0.016 (<i>p</i> = .04). Compared to the baseline (period 1), the rate in period 2 was 1.27 times higher. States with a 2020 Stay-at-Home policy, compared to those without, had a 30% lower rate (<i>p</i> = .05) of alcohol-related non-fatal MVC injuries. States with partial and mandatory Stay-at-Home policies had a 5.2% (<i>p</i> = .01) and 10.5% (<i>p</i> < .001) annual rate decrease, respectively.<i>Conclusion:</i> Alcohol-related non-fatal MVC injury rates increased initially (2019-2020) but decreased thereafter (2020-2022). Stay-at-home policies effectively reduced these rates.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"252-260"},"PeriodicalIF":2.7,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140132971","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":"Opioid-induced hypogonadism in opioid use disorder, its role in negative reinforcement, and implications for treatment and retention.","authors":"Avery F McGuirt, Christina A Brezing","doi":"10.1080/00952990.2023.2292012","DOIUrl":"10.1080/00952990.2023.2292012","url":null,"abstract":"<p><p>Hypogonadism is a highly prevalent complication of chronic opioid use associated with a constellation of affective, algesic, and cognitive symptoms as well as decreased quality of life. Given that the mainstays of pharmacologic opioid use disorder (OUD) treatment - methadone and buprenorphine - are themselves agonists or partial agonists at the mu opioid receptor, opioid-induced hypogonadism (OIH) remains an underappreciated clinical concern throughout the course of OUD treatment. Prominent theoretical frameworks for OUD emphasize the importance of negative reinforcement and hyperkatifeia, defined as the heightened salience of negative emotional and motivational states brought on by chronic opioid use. In this perspective article, we highlight the striking parallels between the symptom domains of hyperfakifeia and hypogonadism in males, who comprise the vast majority of existing clinical research on OIH. By extension we propose that future research and ultimately clinical care should focus on the identification and treatment of OIH in OUD patients to help address the longstanding paradox of poor treatment retention despite efficacious therapies, particularly in the setting of the current opioid overdose epidemic driven by high potency synthetic opioids such as fentanyl. We then review evidence from chronic pain patients that testosterone replacement provides clinically significant benefits to men with OIH. Finally, using this framework, we compare extant OUD therapeutics and discuss critical gaps in the clinical literature-including the relative dearth of data regarding hypothalamic-pituitary-gonadal function in females who use opioids-where future study should be focused.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"132-138"},"PeriodicalIF":2.7,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139698683","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}