Substance use & addiction journal最新文献

{"title":"State Policies Targeting Patient Brokering and Deceptive Marketing of Substance Use Disorder Treatment.","authors":"Melissa M Garrido, Kiersten Strombotne, PhiYen Nguyen, Steven D Pizer, Austin B Frakt","doi":"10.1177/29767342241279194","DOIUrl":"10.1177/29767342241279194","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize state laws targeting patient brokering and deceptive marketing of substance use disorder (SUD) treatment.</p><p><strong>Background: </strong>Patient brokering and deceptive marketing of SUD treatment leads to poor outcomes for individuals with SUD, including relapse- or overdose-related hospitalizations, ED visits, or death. In response, several states within the United States have passed laws targeting unethical practices of SUD treatment in recent years. The context in which these laws were passed has not been previously described. The extent to which states engaged in recovery residence regulation that also pass patient brokering and deceptive marketing laws is unknown.</p><p><strong>Methods: </strong>We conducted a descriptive study and identified state laws relating to patient brokering and deceptive marketing that were enacted and effective as of December 31, 2022. Using a model state law for addressing unethical SUD treatment practices as a guide, we developed a taxonomy to describe the laws' elements, including covered entities, prohibited activities, and penalties. We used descriptive statistics to characterize variation across current laws.</p><p><strong>Results: </strong>All patient brokering laws explicitly mention referrals to SUD treatment facilities, and most specify that both individuals and facilities are prohibited from paying, receiving, or soliciting referrals in exchange for fees or commissions. All deceptive marketing laws prohibit making false or misleading statements about the nature of services provided. Beyond these common features, there is wide variability in the degree to which states specifically prohibit other patient brokering and deceptive marketing activities (e.g., indirect offerings, lead generation, or kickback schemes involving laboratories).</p><p><strong>Conclusions: </strong>State policies targeting patient brokering and deceptive marketing may be useful for preventing instances of unethical SUD treatment practices. We constructed a taxonomy to characterize elements of patient brokering and deceptive marketing laws and facilitate future evaluations of their effectiveness.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"320-327"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336010","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":"The Lookout Project: A Student-Run Mail-Based Overdose Response Kit Distribution Program Through Social Media During COVID-19.","authors":"Shelby A Shaughnessy, Katherine C Hankes, Victoria Garrow, John A Hopper, Chin Hwa Dahlem","doi":"10.1177/29767342241288985","DOIUrl":"10.1177/29767342241288985","url":null,"abstract":"<p><strong>Background: </strong>Naloxone distribution and overdose education are key preventive strategies to reduce opioid overdose deaths. This paper describes the development and evaluation of The Lookout Project (TLP), a 501(c)(3) organization led by college students and based in Ann Arbor, Michigan. This research aimed to examine the outreach of TLP with hopes of creating a reproducible mail-based kit distribution program for college student-run organizations to replicate.</p><p><strong>Methods: </strong>TLP used a targeted social media advertising campaign to ask participants 7 multiple-choice questions concerning their demographics, previous incarcerations, experiences with intranasal naloxone (IN), and if they had watched the optional informational video in the opioid overdose response kit (OORK) order form.</p><p><strong>Results: </strong>TLP's team distributed over 900 OORKs from August 3, 2020, to January 4, 2022, first by word of mouth and then through social media advertising that began on February 13, 2021. Of the 657 respondents who agreed to participate in research, the majority identified as white (76.0%, n = 400), did not identify with any specified ethnicity group (60.2%, n = 318), were female (60.8%, n = 356), were between the ages of 18 and 22 (35.4%, n = 209), had not been previously incarcerated (95.6%, n = 564), and did watch the hyperlinked video detailing how to respond to an overdose (74.7%, n = 438). Additionally, several kit recipients (2.8%, n = 19) responded to a follow-up survey. Of those, 7 people reported using the IN provided by TLP to reverse an overdose (36.8%, n = 7).</p><p><strong>Conclusion: </strong>TLP, a nonprofit organization founded by college students, shows potential for informing other student-run organizations about naloxone distribution programs using social media advertising.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"364-368"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515900","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":"Screening for Nonmedical Use and Misuse of Prescription Medication by Adolescents.","authors":"Sharon Levy, Machiko Minegishi, Melissa Brogna, Jennifer Ross, Geetha Subramaniam, Elissa R Weitzman","doi":"10.1177/29767342241292419","DOIUrl":"10.1177/29767342241292419","url":null,"abstract":"<p><strong>Background: </strong>Several screening tools have been developed to identify youth with alcohol, cannabis, and tobacco/nicotine use disorders, although less attention has been paid to other substances, including the nonmedical use of prescription medication or prescription medication misuse.</p><p><strong>Objective: </strong>To evaluate the proportion of youth reporting the use of substances other than alcohol, cannabis, and nicotine on 3 screening tools that have been developed and validated for identifying alcohol, cannabis, and nicotine use disorders among adolescent primary care patients.</p><p><strong>Methods: </strong>Adolescents (N = 757) from primary care pediatric practices were randomized to complete substance use screening tools (Screening to Brief Intervention [S2BI, N = 242], Brief Screener for Alcohol, Tobacco, and Other Drugs [BSTAD, N = 253], Tobacco, Alcohol, Prescription Medication, and Other Substance Use [TAPS, N = 262]) and then complete a brief electronic assessment battery and a structured diagnostic interview that assessed for past-year use of opioids and benzodiazepines. A total of 716 adolescents with complete data for each screening tool and the structured interview were analyzed for this report.</p><p><strong>Results: </strong>Rates of the nonmedical use of prescription medication or prescription medication misuse varied by tool: S2BI: 20 (8.5%), BSTAD: 4 (1.7%), and TAPS: 3 (1.3%). No participant endorsed benzodiazepine or opioid use on the World Mental Health Composite International Diagnostic Interview Substance Abuse Module.</p><p><strong>Conclusion: </strong>Rates of reporting the nonmedical use of prescription medication or prescription medication misuse vary by screen, and some exceed national estimates. Nonmedical use of prescription medication or prescription medication misuse may be more common than previously reported, although some responses may be false positives. Refining questions could elucidate an especially concerning behavior given widespread fentanyl contamination.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"357-363"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775975","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":"Identifying Patients at Risk for Alcohol-Exposed Pregnancies: The Importance of Addressing Multiple Risk Factors.","authors":"Bonnie G McRee, Bridget L Hanson, Janice Vendetti, Diane K King, Iwona Pawlukiewicz, Erin Berry, Jessica Johnson, Deanna Marshall, Lauren Rosato, Karen Steinberg Gallucci, Corrie Whitmore","doi":"10.1177/29767342241267086","DOIUrl":"10.1177/29767342241267086","url":null,"abstract":"<p><strong>Background: </strong>The increasing prevalence of fetal alcohol spectrum disorders is a critical public health issue. Two behaviors, consuming alcohol and using less effective pregnancy prevention, may result in alcohol-exposed pregnancies (AEPs) in individuals who can become pregnant. In the context of alcohol screening and brief intervention (SBI) services, cutoff scores on widely used alcohol risk assessments (eg, Alcohol Use Disorders Identification Test, U.S. version [USAUDIT]) may fail to identify individuals whose relatively low alcohol consumption may still put them at risk for an AEP due to their pregnancy prevention method.</p><p><strong>Methods: </strong>To identify this gap in alcohol SBI service delivery, we examined data from 2 reproductive healthcare systems implementing alcohol SBI, to explore the prevalence of individuals who met both of the following risk conditions: reported any alcohol use on the USAUDIT and a pregnancy prevention method less than 88% effective. Electronic health records for individuals aged 18 to 49 presenting for preventive care in 2021 were analyzed.</p><p><strong>Results: </strong>Of 11 567 screened, 7638 reported some alcohol use, but screened at a lower-risk level and were not flagged to receive an alcohol-focused brief intervention (BI). Of these, 1477 were using a method of pregnancy prevention that was less than 88% effective. In addition, 118 of the 1676 who screened positive on the USAUDIT were using less effective contraception and did not receive a BI. In summary, the number of individuals at risk of an AEP who did not receive an alcohol BI was 1595 (13.8%) of the total patients screened for at-risk alcohol use.</p><p><strong>Conclusions: </strong>There is a need for system modifications to assess multiple behaviors simultaneously and alert providers when a combination of behaviors increases a specific health risk, such as an AEP. Tailored alcohol BIs that include the risks/benefits of various pregnancy prevention methods to reduce AEPs provide opportunities to enhance the reach of standard alcohol SBI services.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"452-460"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importance of Fetal Alcohol Spectrum Disorders Prevention and Intervention.","authors":"Tom Donaldson, Elizabeth P Dang, Marilyn Pierce-Bulger, Kathleen T Mitchell, Andy R Kachor, Rosa Arvizu","doi":"10.1177/29767342241300797","DOIUrl":"10.1177/29767342241300797","url":null,"abstract":"<p><p>The consumption of alcohol and other substances during pregnancy can impair prenatal development. While scientifically informed public health measures have raised awareness of the risks of harmful prenatal substance exposures, the use of alcohol and other substances during pregnancy continues to rise. The successful dissemination of consistent messaging, health care professional education and training, and universal implementation of clinical interventions may help reduce drinking in pregnancy and prevent fetal alcohol spectrum disorders (FASDs), a constellation of developmental disabilities and birth defects caused by alcohol use during pregnancy. Alcohol screening and brief intervention (alcohol SBI) is an evidence-based preventive practice that enables early identification of excessive drinking and intervention prior to serious consequences. Routine clinical implementation of alcohol SBI has been shown to effectively reduce excessive alcohol consumption among adults, including pregnant people. Many barriers prevent widespread implementation of the practice: a lack of health care professional knowledge of the prevalence and implications of prenatal alcohol exposure, stigma surrounding individuals who use substances potentially harmful to their pregnancy, resistance to public health messages encouraging alcohol avoidance during pregnancy, and discomfort and hesitancy with alcohol SBI procedures among practitioners. The Centers for Disease Control and Prevention (CDC) leads the public health effort to prevent alcohol use during pregnancy and improve identification of and care for children living with FASDs. CDC partners with health systems, health care professional associations, universities, and community-based networks to promote alcohol SBI as an effective but underused preventive health service. This special section consisting of 6 articles including this introductory commentary represents the efforts of 11 CDC projects and their partners to demonstrate the rationale for FASD prevention and intervention, engage health care disciplines to expand prevention messaging and education for providers, develop practical approaches for implementing alcohol SBI in diverse clinical settings, and prevent alcohol use in pregnancy and FASDs.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"413-420"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"SafetyNet\": Evaluation of a Recovery Coach and Paramedic Intervention Following Naloxone Resuscitation From an Opioid Overdose.","authors":"Daniel Joseph, Carolyn Brokowski, Gail D'Onofrio, Sandy Bogucki, Joanne McGovern, Rebecca Allen, James Dziura, David C Cone, Michael V Pantalon","doi":"10.1177/29767342241266412","DOIUrl":"10.1177/29767342241266412","url":null,"abstract":"<p><strong>Objective: </strong>Emergency department (ED)-initiated buprenorphine has proven efficacy, but many patients are reluctant to begin this treatment. This study evaluated SafetyNet, a program using a 2-person, recovery coach and paramedic (RCP) intervention postoverdose to reduce subsequent opioid overdose, engage patients in medications for opioid use disorder (MOUD), and reduce illicit drug use.</p><p><strong>Methods: </strong>We conducted a prospective nonrandomized study in individuals who experienced opioid overdoses, received naloxone, but subsequently declined buprenorphine initiation in the ED. Each participant was followed by an RCP team that performed a brief negotiation interview (BNI) to motivate engagement in treatment, peer-recovery coaching to encourage recovery-related activities, and health education around medical concerns by trained paramedics. Participants were followed-up at 30 and 180 days. The primary hypothesized outcome was reduction in overdose events; the secondary hypothesized outcomes were engagement in MOUD and reduction in opioid positive urine tests.</p><p><strong>Results: </strong>Eighty-one patients were enrolled and received BNIs; 45 (56%; 95% CI: 44-67) had at least 1 follow-up encounter. Twenty participants (25%; 95% CI: 16-36) had at least 1 overdose during follow-up. Fifty-five participants (68%; 95% CI: 57-78) were confirmed to have engaged in some form of medication treatment. Differences in subsequent overdose events (<i>P</i> = .95), engagement in MOUD (<i>P</i> = .49), and rates of opioid-positive urine toxicology rates within 30 days (<i>P</i> = .44) and between 31 and 180 days (<i>P</i> = .46) were not significantly different when comparing those who did and did not follow-up.</p><p><strong>Conclusion: </strong>There were no differences in rates of subsequent overdose, MOUD engagement, or positive urine toxicology screens in our intervention. However, 68% of participants engaged in outpatient MOUD, a treatment associated with fewer overdose events, particularly fatal ones. Substantial limitations occurred due to the COVID pandemic, and sample size estimates were not met. Further research is needed to investigate potential benefits of the SafetyNet program.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"302-312"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142020097","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":"Redesigning a Stopped Clinical Trial as an Emulated Trial Using Real-World Data to Explore the Effectiveness of Slow-Release Oral Morphine as a Treatment for Opioid Use Disorder.","authors":"Rohan Anand, Stephanie Penta, Zishan Cui, Nadia Fairbairn, M Eugenia Socias","doi":"10.1177/29767342241279167","DOIUrl":"10.1177/29767342241279167","url":null,"abstract":"<p><p>Canada is currently experiencing a problematic opioid crisis with increasing mortality rates. Traditional randomized controlled trials (RCTs) that examine the effectiveness of pharmacological treatment options for people with opioid use disorder (OUD) are challenging to conduct. An increasingly popular methodology is through the implementation of emulated clinical trials, a methodology in which key elements of a \"target\" RCT are replicated using previously collected healthcare-based data. They can possibly address some of the common challenges found in the conduct of RCTs, such as prolonged timelines, high cost, and poor participant recruitment. In effect, emulated trials accelerate knowledge generation by producing real-world evidence that can be akin to phase 3 effectiveness trials, without any need to recruit live participants or administer investigational products. During the COVID-19 pandemic, several trials were stopped due to increased pandemic-related research restrictions, leaving important questions about OUD treatment unanswered. In this commentary, we describe the transition of a traditional RCT to an emulated trial spurred by challenges posed by the COVID-19 pandemic. We describe our transition using a notable published framework with regards to the population sample, interventions, outcomes, and proposed analyses. This commentary aims to help other researchers and trialists apply emulated trials in substance use research and beyond, emphasizing the role of this methodology in clinical research and advancing scientific knowledge that could be otherwise lost or unattainable.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"384-390"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485235","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":"Disparities in Receipt of Medications for Opioid Use Disorder Before and During the COVID-19 Pandemic in the US Veterans Health Administration.","authors":"Minhee L Sung, Casey León, Joel I Reisman, Kirsha S Gordon, Robert D Kerns, Wenjun Li, Weisong Liu, Avijit Mitra, Hong Yu, William C Becker","doi":"10.1177/29767342241293334","DOIUrl":"10.1177/29767342241293334","url":null,"abstract":"<p><strong>Background: </strong>Populations disproportionately impacted by the opioid epidemic are less likely to receive medications for opioid use disorder (MOUD; OUD). The COVID-19 pandemic exacerbated these disparities. We performed an ecological survey of subpopulations to compare differences in MOUD receipt among Veterans with OUD before versus during the pandemic.</p><p><strong>Methods: </strong>Using 2 cross-sections of 2 time periods of national Veterans Health Administration electronic health record data, we calculated proportions of Veterans with any MOUD receipt by demographics, Elixhauser comorbidity index, and natural language processing (NLP)-derived substance use and social determinants of health in each time period. We evaluated differences in MOUD receipt before and during the pandemic by patient characteristics using Chi-square and Cohen's <i>h</i> for effect size.</p><p><strong>Results: </strong>Among 62 195 patients with OUD before the pandemic, the proportion prescribed MOUD increased from 46.5% before to 47.5% (<i>P</i> = .0003) during the pandemic. Statistically significant increased receipt of MOUD was observed for patients who were ≥55 years, men, White, with Elixhauser comorbidity indices of 2 and ≥5, and with NLP-derived indicators of substance use. There was a decrease that did not achieve statistical significance in MOUD receipt from before to during the pandemic for patients who were women, Black, Latinx, and food insecure.</p><p><strong>Conclusions: </strong>The proportions of patients with OUD prescribed MOUD increased from before to during the pandemic. However, Veterans who were women, Black, Latinx, and food insecure did not experience these increases. These patients may benefit from interventions such as targeted outreach efforts to improve MOUD engagement to reduce OUD harms.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"369-376"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684035","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":"Multi-Level Approaches to Fetal Alcohol Spectrum Disorders Prevention Education and Training for Health Professionals.","authors":"Faith Ozer Green, Amy K Harlowe, Alexandra Edwards, Daniel P Alford, Hetal Choxi, Jacqueline S German, Diana Ling, Iwona Pawlukiewicz, Reshana Peterson, Kirk von Sternberg, Mary M Velasquez","doi":"10.1177/29767342241273397","DOIUrl":"10.1177/29767342241273397","url":null,"abstract":"<p><strong>Background: </strong>Alcohol-exposed pregnancies, which can lead to fetal alcohol spectrum disorders (FASDs), is one of the most common preventable causes of lifelong intellectual and developmental disabilities in the U.S. Healthcare teams can play a critical role in preventing FASDs; however, they are currently unprepared to do so. Training can remediate this problem. This article explores the different approaches to the education and training of healthcare providers around FASD prevention used by six Centers for Disease Control (CDC)-funded programs, and how they have been adapted to (1) the specific needs of the healthcare professionals and/or the clinical setting and (2) the challenges posed by the COVID-19 pandemic.</p><p><strong>Methods: </strong>This article offers an in-depth description and comparison of the models utilized by the programs described, detailing the challenges of each model as well as the adaptations made. Interdisciplinary collaboration and review highlights these models and offers a variety of solutions and lessons learned that can be implemented in similar practice settings and/or educational initiatives.</p><p><strong>Results: </strong>Based on organizational structure (i.e., national organization, educational institution, and clinical settings) and program purpose, different methods were employed for FASD education. Some programs were focused on FASD prevention through staff training and alcohol screening and brief intervention/clinical intervention and others were focused on broadscale professional education and awareness. Improvements were made on an ongoing basis as challenges related to COVID-19, staff shortages, and patient and clinician discomfort were identified, resulting in modifications to content and delivery modality (e.g., online forums and use of social media).</p><p><strong>Conclusion: </strong>FASD prevention education is wrought with a variety of challenges related to stigma, discomfort, and misinformation, which these programs encountered in a variety of ways.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"430-438"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosocial Impact of Suspected Xylazine-Associated Skin Wounds Among People Using Fentanyl, Philadelphia, 2022 to 2023.","authors":"Patrick J A Kelly, Amy B Jessop, Madison Scialanca, Katie Singley, Caseem C Luck, Ariel Hoadley, Jessica Meisner, Sarah B Bass","doi":"10.1177/29767342241289797","DOIUrl":"10.1177/29767342241289797","url":null,"abstract":"<p><strong>Background: </strong>The United States opioid crisis has been worsened by the emergence of fentanyl adulterated or associated with the veterinary sedative xylazine. Designated by the White House as an \"emerging threat to the US\" in 2023, xylazine use is associated with severe skin wounds.</p><p><strong>Methods: </strong>This research explored beliefs, concerns, and treatment behaviors for skin wounds among 93 participants recruited outside of a Philadelphia, Pennsylvania harm reduction agency who reported past-6-month history of a skin wound via a cross-sectional survey administered August-September 2022 (group 1; <i>n</i> = 33). Following a December 2022 Philadelphia Department of Public Health Report that indicated xylazine was becoming more prevalent in the Philadelphian drug supply, additional data was collected with new participants from February-March 2023 (group 2; <i>n</i> = 60) using the same survey. Participants were ≥18 years old, reported past-year fentanyl use, and spoke English. Our 17-item tool measured skin wound-related beliefs, concerns, treatment behaviors, and treatment sources. An open-response item explored why participants self-treat skin wounds.</p><p><strong>Results: </strong>Participants averaged 41 years old (SD = 9), slightly more than half were men (<i>n</i> = 54, 58%), 31% (<i>n</i> = 29) were non-White, and most (<i>n</i> = 66, 71%) were unhoused. Overall, 79% of participants self-treated skin wounds. Participants endorsed worry about limb loss (<i>n</i> = 77; 83%), wound shame (<i>n</i> = 76; 82%), and appearance changes (<i>n</i> = 80; 86%). Sixty participants (65%) reported waiting to see wound severity before seeking care. Forty-one participants (44%) delayed wound care because of withdrawal fears.</p><p><strong>Conclusions: </strong>People with probable xylazine-associated skin wounds have psychosocial concerns about and self-treat these wounds. Findings may be a harbinger of skin wound harm in other regions of the United States and internationally where xylazine is increasing.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"347-356"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515899","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}