medRxiv - Addiction Medicine最新文献

{"title":"National trends in drug overdose mortality in Asian American, Native Hawaiian, and Pacific Islander populations, 2018-2022","authors":"David T. Zhu, Andrew Park","doi":"10.1101/2024.09.17.24313831","DOIUrl":"https://doi.org/10.1101/2024.09.17.24313831","url":null,"abstract":"ABSTRACT Background\u0000Drug overdose deaths have surged over the past two decades, disproportionately impacting racial/ethnic minority populations. Yet, little is known about drug overdose patterns among Asian American and Native Hawaiian/Pacific Islander (AANHPI) populations. Methods\u0000We obtained data on drug overdose deaths and population totals from the CDC WONDER Multiple Cause of Death database and American Community Survey between 2018 and 2022. We calculated crude mortality rates per 100,000, stratified by sex, US Census Division, and drug types: prescription opioids, heroin, fentanyl, cocaine, methamphetamine, and benzodiazepines. Additionally, we conducted disaggregated analyses for six Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) and three NHPI subgroups (Hawaiian, Guamanian, Samoan). Results\u0000In 2022, there were 1226 drug overdose deaths among Asian Americans and 154 among NHPI individuals. The crude mortality rate for NHPI individuals (17.52 per 100,000; 95% CI: 14.76-20.29) tripled that of Asian Americans (5.85 per 100,000; 95% CI: 5.52-6.18). Fentanyl was the leading cause of overdose deaths among Asian Americans (3.17 per 100,000; 95% CI: 2.93-3.41), whereas methamphetamine was predominant among NHPI individuals (11.38 per 100,000; 95% CI: 9.15-13.61). Among Asian American subgroups, Japanese Americans had the highest mortality rate (9.90 per 100,000; 95% CI: 9.61-10.2), and among NHPI subgroups, Guamanians had the highest rates (43.16 per 100,000; 95% CI: 39.05-48.24). Conclusions\u0000These findings underscore the urgent need for culturally competent harm reduction services, mental health and addiction treatment, and social services, addressing structural barriers that perpetuate drug overdose disparities in AANHPI communities. Keywords\u0000Drug Overdose; Asian American; Native Hawaiian; Pacific Islander; Disaggregated; Racial Disparities","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Validity of Drinking Behaviour for Identifying Alcohol Use Disorder: Findings from a Nationally Representative Sample of Community Adults and an Inpatient Clinical Sample","authors":"Molly L Garber, Andriy Samokhvalov, Yelena Chorny, Onawa Labelle, Brian Rush, Jean Costello, James MacKillop","doi":"10.1101/2024.09.14.24313683","DOIUrl":"https://doi.org/10.1101/2024.09.14.24313683","url":null,"abstract":"Background and Aims: Alcohol consumption is an inherent feature of alcohol use disorder (AUD), and drinking characteristics may be diagnostically informative. This study had three aims: (1) to examine the classification accuracy of several drinking quantity/frequency indicators in a large representative sample of U.S. community adults; (2) to extend the findings to a clinical sample of adults; and (3) to examine potential sex differences. Design: In cross-sectional epidemiological and clinical datasets, receiver operating characteristic (ROC) curves were used to evaluate diagnostic classification using area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Measurements: Classifiers included measures of quantity/frequency (e.g., drinks/drinking day, largest drinks/drinking day, number of drinking days, and heavy drinking frequency). The clinical criterion (reference standard) was AUD diagnostic status per structured clinical interview (community sample) or a symptom checklist (clinical sample). Setting and Participants: Two samples were examined: a large, nationally representative random sample of U.S. community adults who reported past-year drinking (N=25,778, AUD=20%) and a clinical sample from a Canadian mental health and addictions inpatient treatment centre (N=1,341, AUD=82%). Findings: All drinking indicators performed much better than chance at classifying AUD (AUCs=0.60-0.92, ps<.0001). Heavy drinking frequency indicators performed optimally in both the community (AUCs=0.78-0.87; accuracy=0.72-0.80) and clinical (AUC=0.85-0.92; accuracy =0.77-0.89) samples. Collectively, the most discriminating drinking behaviors were number of heavy drinking episodes and exceeding drinking low-risk guidelines. No substantive sex differences in optimal cut-offs or variable performance were observed. Conclusions: Quantitative drinking indices performed well at classifying AUD in both a nationally representative and large inpatient sample, robustly identifying AUD at rates much better than chance and above accepted benchmarks, with limited differences by sex. These findings broadly support the potential clinical utility of quantitative drinking indicators, such as routine patient assessment via electronic medical records.","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcranial magnetic stimulation of dorsomedial prefrontal cortex for cocaine use disorder: A pilot study","authors":"Heather E Webber, L. Elliot Hong, João Quevedo, Michael F Weaver, Joy M Schmitz, Scott D Lane","doi":"10.1101/2024.09.16.24313754","DOIUrl":"https://doi.org/10.1101/2024.09.16.24313754","url":null,"abstract":"Cocaine use disorder (CUD) is a difficult-to-treat condition with no FDA-approved medications. Recent work has turned to brain stimulation methods to help rectify hypofrontality and dopamine reward system changes often observed in individuals with CUD. Preliminary studies using transcranial magnetic stimulation (TMS) have demonstrated promising results, but there is room for optimization of the stimulation site, stimulation pattern, and identification of relevant biomarkers of TMS effects. The current pilot study aimed to test the feasibility, safety, and preliminary effects of a double-blind, sham-controlled, cross-over, acute design using intermittent theta burst stimulation to dorsomedial prefrontal cortex (dmPFC) on electroencephalogram (EEG) as intermediate outcome assessment in CUD patients. This small pilot enrolled five individuals with moderate-to-severe CUD for feasibility and proof-of-concept. Participants completed safety, psychometric, and EEG measures before and after receiving two sessions of active or sham TMS to dmPFC on two separate days. All five participants completed all the study tasks and found the TMS to be tolerable. The side effects were minimal and consistent with an acute TMS design. Visible changes were observed in the electrical activity of the brain during a monetary guessing task, while minimal changes in psychometric measures were observed. These results indicate the feasibility and safety of the current approach and suggest that dmPFC is a viable target for treating CUD. Future work should expand upon these findings in a randomized controlled clinical trial.","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and Facilitators to Community Pharmacist-Provided Injectable Naltrexone for Formerly Incarcerated Individuals During Community Reentry in Wisconsin","authors":"Jason Scott Chladek, Michelle A Chui","doi":"10.1101/2024.09.13.24313637","DOIUrl":"https://doi.org/10.1101/2024.09.13.24313637","url":null,"abstract":"Medications for opioid use disorder (MOUD), including injectable naltrexone, are a key component in the treatment of opioid use disorder (OUD). These medications are especially important for individuals transitioning out of correctional facilities and back into their communities, as individuals receiving MOUD are 85% less likely to die due to drug overdose in the first month post-release and have a 32% lower risk of rearrest. Unfortunately, few formerly incarcerated individuals have access to MOUD upon reentry, incurring a 40-fold greater likelihood of overdose following release compared to the general population. While 84% of Wisconsin jails offering MOUD offer naltrexone, less than half provide linkage to community treatment for reentering individuals. In Wisconsin, community pharmacists have the authority to provide naltrexone injections. However, they have not been explored as a resource for improving access to this medication for formerly incarcerated individuals. As a first step, the goal of this study was to understand the barriers and facilitators impacting access to community pharmacist-provided injectable naltrexone for this patient population during community reentry period. The researcher conducted semi-structured interviews with 18 individuals representing five stakeholder groups. Deductive and inductive content analysis were used to identify barrier and facilitator categories across the five levels of the Socioecological Model. Overall, participants discussed factors at every level, and many barriers and facilitators confirmed findings from existing literature focused on MOUD access for formerly incarcerated individuals. Participants also identified factors more specific to community pharmacies, including 1) lack of interagency collaboration between pharmacists, prescribers, and correctional facilities and 2) lack of awareness of community pharmacist-provided MOUD services. Future research should explore interventions to address the barriers identified in this study and improve connections between community pharmacists and formerly incarcerated individuals. This work can help ensure that these individuals are given the chance to successfully reintegrate into society.","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuroimaging Biomarkers in Addiction","authors":"Hamed Ekhtiari, Arshiya Sangchooli, Owen Carmichael, F. Gerard Moeller, Patricio O’Donnell, Maria Oquendo, Martin P. Paulus, Diego A. Pizzagalli, Tatiana Ramey, Joseph Schacht, Mehran Zare-Bidoky, Anna Rose Childress, Kathleen Brady","doi":"10.1101/2024.09.02.24312084","DOIUrl":"https://doi.org/10.1101/2024.09.02.24312084","url":null,"abstract":"As a neurobiological process, addiction involves pathological patterns of engagement with substances and a range of behaviors with a chronic and relapsing course. Neuroimaging technologies assess brain activity, structure, physiology, and metabolism at scales ranging from neurotransmitter receptors to large-scale brain networks, providing unique windows into the core neural processes implicated in substance use disorders. Identified aberrations in the neural substrates of reward and salience processing, response inhibition, interoception, and executive functions with neuroimaging can inform the development of pharmacological, neuromodulatory, and psychotherapeutic interventions to modulate the disordered neurobiology. Based on our systematic search, 409 protocols registered on ClinicalTrials.gov include the use of one or more neuroimaging paradigms as an outcome measure in addiction, with the majority (N=268) employing functional magnetic resonance imaging (fMRI), followed by positron emission tomography (PET) (N=71), electroencephalography (EEG) (N=50), structural magnetic resonance imaging (MRI) (N=35) and magnetic resonance spectroscopy (MRS) (N=35). Furthermore, in a PubMed systematic review, we identified 61 meta-analyses including 30 fMRI, 22 structural MRI, 8 EEG, 7 PET, and 3 MRS meta-analyses suggesting potential biomarkers in addictions. These studies can facilitate the development of a range of biomarkers that may prove useful in the arsenal of addiction treatments in the coming years. There is evidence that these markers of large-scale brain structure and activity may indicate vulnerability or separate disease subtypes, predict response to treatment, or provide objective measures of treatment response or recovery. Neuroimaging biomarkers can also suggest novel targets for interventions. Closed or open loop interventions can integrate these biomarkers with neuromodulation in real-time or offline to personalize stimulation parameters and deliver the precise intervention. This review provides an overview of neuroimaging modalities in addiction, potential neuroimaging biomarkers, and their physiologic and clinical relevance. Future directions and challenges in bringing these putative biomarkers from the bench to the bedside are also discussed.","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142225104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overdoses with Xylazine and Fentanyl Recorded in Pennsylvania’s Overdose Information Network","authors":"Manuel Cano, David T. Zhu, Yesenia Aponte-Meléndez, Pedro Mateu-Gelabert, Alex S. Bennett","doi":"10.1101/2024.08.29.24312792","DOIUrl":"https://doi.org/10.1101/2024.08.29.24312792","url":null,"abstract":"<strong>Objectives</strong> This descriptive study examined suspected xylazine co-involvement in law enforcement-recorded fentanyl overdoses in Pennsylvania (excluding Philadelphia), focusing on other drug involvement, naloxone administration, and survival.","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive Dysfunction in the Addictions (CDiA): A Neuron to Neighbourhood Collaborative Research Program on Executive Dysfunction and Functional Outcomes in Outpatients Seeking Treatment for Addiction","authors":"Yuliya S. Nikolova, Anthony C. Ruocco, Daniel Felsky, Shannon Lange, Thomas D. Prevot, Erica Vieira, Daphne Voineskos, Jeffrey D. Wardell, Daniel M. Blumberger, Kevan Clifford, Ravinder Naik Dharavath, Philip Gerretsen, Ahmed N. Hassan, Sheila K. Jennings, Bernard LeFoll, Osnat Melamed, Joshua Orson, Peter Pangarov, Leanne Quigley, Cayley Russell, Kevin Shield, Matthew E. Sloan, Ashley Smoke, Victor Tang, Diana Valdes Cabrera, Wei Wang, Samantha Wells, Rajith Wickramatunga, Etienne Sibille, Lena C. Quilty, CDiA Program Study Group","doi":"10.1101/2024.08.30.24312806","DOIUrl":"https://doi.org/10.1101/2024.08.30.24312806","url":null,"abstract":"<strong>Background</strong> Substance use disorders (SUDs) are pressing global public health problems. Executive functions (EFs) are prominently featured in mechanistic models of addiction. However, there remain significant gaps in our understanding of EFs in SUDs, including the dimensional relationships of EFs to underlying neural circuits, molecular biomarkers, disorder heterogeneity, and functional ability. To improve health outcomes for people with SUDs, interdisciplinary clinical, preclinical and health services research is needed to inform policies and interventions aligned with biopsychosocial models of addiction. Here, we introduce Cognitive Dysfunction in the Addictions (CDiA), an integrative team-science and translational research program, which aims to fill these knowledge gaps and facilitate research discoveries to enhance treatments for people living with SUDs.","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Naloxone Administration and Survival in Overdoses Involving Opioids and Stimulants: An Analysis of Law Enforcement Data from 63 Pennsylvania Counties","authors":"Manuel Cano, Abenaa Jones, Sydney M. Silverstein, Raminta Daniulaityte, Frank LoVecchio","doi":"10.1101/2024.08.27.24312661","DOIUrl":"https://doi.org/10.1101/2024.08.27.24312661","url":null,"abstract":"<strong>Background</strong> In consideration of rising deaths from opioid-stimulant-involved overdoses in the United States, this study explored rates of naloxone administration and survival in opioid overdoses with versus without stimulants co-involved.","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"87 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating experiences of stigma and its impact on substance use recovery among residents of recovery residences in the United States: A scoping review protocol. BSGH020","authors":"Gamji Rabiu Abu-Ba'are, Sahil Hogarty, Osman Wumpini Shamrock, Holly Russell, Kate Manchisi, Van Smtih, Amy Mericle","doi":"10.1101/2024.08.22.24312414","DOIUrl":"https://doi.org/10.1101/2024.08.22.24312414","url":null,"abstract":"The objective of this scoping review is to systematically review the literature on stigma experienced by residents in recovery residences and its impact on substance use recovery outcomes. The review will use the PRISMA-ScR framework to identify studies focused on stigma and recovery in recovery residences published in English within the United States since 2000, including qualitative, quantitative, and mixed-methods studies. Data will be extracted and analyzed thematically to identify gaps in the literature and inform future research and policy development. Preliminary findings suggest that stigma, including labeling and discrimination, significantly hinders recovery by promoting secrecy and withdrawal among residents. Proximity to recovery residences has been shown to reduce community stigma, indicating the potential for better integration and acceptance. This study aims to provide a comprehensive understanding of stigma in recovery residences, its effects on substance use recovery, and recommendations for creating supportive recovery environments. The significance of this study lies in its potential to inform policy, practice, and research, highlighting the need for stigma reduction to improve recovery outcomes in recovery residences. By addressing gaps in the literature, the findings will contribute to developing more effective interventions and supportive environments for individuals recovering from substance use.","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National consensus statement on opioid agonist treatment in custodial settings","authors":"Jocelyn Chan, Jon Cook, Michael Curtis, Adrian Dunlop, Ele Morrison, Suzanne Nielsen, Rebecca Winter, Thileepan Naren","doi":"10.1101/2024.08.15.24312029","DOIUrl":"https://doi.org/10.1101/2024.08.15.24312029","url":null,"abstract":"Introduction\u0000Opioid use and dependence are prevalent among incarcerated people, contributing to elevated rates of overdose and other harms in this population. Opioid agonist treatment (OAT) has been demonstrated as an effective intervention to mitigate these risks. However, challenges to health care implementation in the custodial sector result in suboptimal and variable access to OAT in prisons nationally. Main recommendations\u0000Among a national multi-disciplinary expert panel, we conducted a modified Delphi study which yielded 19 recommendations to government, relevant health authorities and custodial health services. These recommendations cover five core domains: induction or continuation of OAT, OAT options and administration, transition of care to the community, special populations, organisational support. Key recommendations include prompt recognition and treatment of opioid withdrawal, active linkage to community-based OAT providers upon release, and ensuring appropriate organisational support through local protocols, adequate funding, and monitoring of key program indicators.\u0000Changes in management as a result of this statement\u0000This consensus statement addresses a significant gap in national policy on OAT in Australian prisons. The recommendations set forth best practice standards grounded in evidence and expert consensus. We expect that implementing these recommendations will enhance the quality, consistency, and continuity of OAT both within prison and upon release. Optimizing OAT provision is crucial for improving health outcomes and addressing overdose, which is the leading cause of death among people released from prison.","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}