Substance use & addiction journal最新文献

{"title":"Medication for Opioid Use Disorders (MOUD) Providers' Experiences with Recovery Courts: Qualitative Study of Individual and Systemic Factors Impacting Interagency Collaboration.","authors":"Ekaterina Pivovarova, Faye S Taxman, Alexandra K Boland, Barbara Andraka-Christou, Barbara A De La Cruz, David Smelson, Stephenie C Lemon, Peter D Friedmann","doi":"10.1177/29767342241297745","DOIUrl":"https://doi.org/10.1177/29767342241297745","url":null,"abstract":"<p><strong>Background: </strong>Recovery courts mandate substance use disorder treatment as an alternative to prosecution or incarceration but lack internal resources to offer treatment. Hence, recovery courts must rely on community-based providers to ensure access to care. Interagency collaborations between recovery courts and providers of medications for opioid use disorders (MOUD) are often challenging. This qualitative study aimed to understand community-based MOUD providers' perspectives on collaboration with recovery courts.</p><p><strong>Methods: </strong>Semi-structured, hourlong interviews were conducted with 24 providers from 11 community agencies about their experiences and perceptions of working with recovery courts. Consolidated Framework for Implementation Research informed study design, coding, and analysis.</p><p><strong>Results: </strong>At the individual-level domain, lack of knowledge about recovery courts and overall negative impressions of the criminal legal system were impediments to collaboration. Inner setting factors such as staffing shortages and provider roles in establishing therapeutic relationships limited active engagement in interagency collaboration. Outer setting domains such as communication barriers (eg, requirement of multiple release forms, lack of knowledge about who needed what information and when) and nonresponse from the courts were frequently referenced. Providers, however, also noted that direct experience with recovery court staff, especially in person, and recognition of mutual agency goals to ensure individuals receive proper care and remain in the community served as facilitators.</p><p><strong>Discussion: </strong>While interagency collaboration is essential to ensuring that individuals in recovery courts can access MOUD, providers identify individual- and system-level barriers that impact collaboration with recovery courts. Results from providers mirror findings from recovery court staff that note communication barriers, distrust toward external agencies, and limited resources for active collaboration. Findings highlight areas where implementation strategies to improve collaboration can be targeted to ensure that individuals in recovery courts can access and remain in MOUD treatment.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342241297745"},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775961","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":"Comparative Effectiveness of Buprenorphine/Naloxone and Methadone on Methamphetamine/Amphetamine Use Among People with Opioid Use Disorder in Canada.","authors":"Jenna Langlois, Nadia Fairbairn, Didier Jutras-Aswad, Bernard Le Foll, Keith Ahamad, Ron Lim, M Eugenia Socías","doi":"10.1177/29767342241298044","DOIUrl":"https://doi.org/10.1177/29767342241298044","url":null,"abstract":"<p><strong>Background: </strong>It has been suggested that opioid agonist therapy (OAT) may have a secondary benefit of reducing methamphetamine/amphetamine use. However, current evidence is limited and conflicting, and little is known on the impacts of different OATs on methamphetamine/amphetamine use. The aim of this study was to examine the comparative effectiveness of buprenorphine/naloxone and methadone on methamphetamine/amphetamine use among individuals with opioid use disorder (OUD) initiating OAT in Canada.</p><p><strong>Methods: </strong>Data for this study were derived from a 24-week pan-Canadian pragmatic trial conducted between 2017 and 2020 comparing supervised methadone versus flexible take-home dosing buprenorphine/naloxone models of care among OUD. Generalized linear mixed models were used to evaluate the independent effect of treatment (ie, methadone or buprenorphine/naloxone) and time in treatment (ie, week 2 through 24, continuous) on methamphetamine/amphetamine use (measured by urine drug test and self-report using Timeline Follow-Back).</p><p><strong>Results: </strong>The sample included 210 participants that initiated OAT, of which 130 (61.9%) were using methamphetamine/amphetamine at baseline. In multivariable analysis, neither treatment nor time in treatment were significantly associated with the odds of methamphetamine/amphetamine use (adjusted odds ratio [AOR] = 0.61, 95% confidence interval [CI] = 0.34-1.08, <i>P</i> = .092; and AOR = 0.73, CI = 0.40-1.28, <i>P</i> = .283, respectively). No interaction between treatment and time in treatment was observed for methamphetamine/amphetamine use (<i>P</i> = .367).</p><p><strong>Conclusion: </strong>Methamphetamine/amphetamine use was common among this sample of people with OUD initiating OAT in Canada. Over the 24-week study period, buprenorphine/naloxone and methadone were not associated with a quantifiable change in methamphetamine/amphetamine use among this sample population. The observation of less methamphetamine/amphetamine use in the buprenorphine/naloxone arm warrants further research.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342241298044"},"PeriodicalIF":0.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756082","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":"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":"https://doi.org/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":"29767342241300797"},"PeriodicalIF":0.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752811","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":"https://doi.org/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":"29767342241293334"},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","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":"Mandated Substance Use Disorder Treatment in Qatar: An Innovative Model of Care.","authors":"Majid Alabdulla, Shuja Mohd Reagu, Nirvana Chandrappa, Zeeshan Sheikh, Ahmad Alater, Suhair Yousuf, Nimesh Samarasinghe","doi":"10.1177/29767342241288433","DOIUrl":"https://doi.org/10.1177/29767342241288433","url":null,"abstract":"<p><strong>Background: </strong>Qatar has struggled with substance use disorders among its population. Qatar has maintained a relative political and social stability, which has informed a dramatic restructuring of its health and social care services with emphasis on being led by international best practice and primacy of patient rights. However, the rehabilitative model for substance use, which Qatar has placed emphasis on so far, has been based upon voluntary engagement of people who use substances. This has led to lack of provision of care to a significant proportion of patients with substance use disorders in addition to system-wide disagreements around models of care.</p><p><strong>Methods: </strong>This study employed a retrospective patient record review of 163 patients admitted to the Umm Slal Treatment and Rehabilitation Center between January 2022 and October 2023. The data were systematically analyzed to evaluate the effectiveness of the innovative Recovery Journey model.</p><p><strong>Results: </strong>The majority of patients (61.3%) were aged 20 to 29, with 54% unemployed or students. Methamphetamine (77.3%) and cannabis (76.1%) were the most commonly used substances. Notable comorbidities included drug-induced psychosis (29.4%) and depression (19.5%). Most patients (90%) had previous treatment encounters. The Recovery Journey model, consisting court-mandated detoxification and stabilization, residential rehabilitation, and community-based continuing care, facilitated treatment completion for 91 out of 149 patients advancing from detoxification to rehabilitation. Challenges included managing complex co-occurring disorders and aligning multidisciplinary team working efforts.</p><p><strong>Conclusion: </strong>The innovative Recovery Journey model at the Umm Slal Treatment and Rehabilitation Center demonstrated promising results in treating individuals with substance use disorders. While initial outcomes are encouraging, challenges related to stakeholder engagement, treatment adherence, and post-discharge care remain. This model emphasizes the importance of balancing directed care with patient autonomy and may serve as a framework for similar initiatives in the region. Further research into and adaptation of cultural contexts are essential for optimizing treatment outcomes.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342241288433"},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684039","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":"Case Report: Dust Remover Inhalant Use Disorder in an Individual in Early Remission from Alcohol Use Disorder Treated with Naltrexone.","authors":"India A Reddy, Javier Ballester","doi":"10.1177/29767342241297436","DOIUrl":"https://doi.org/10.1177/29767342241297436","url":null,"abstract":"<p><strong>Background: </strong>Inhalants are a very diverse class of substances with a highly prevalent recreational use. Difluroethane (DFE) is a psychoactive ingredient present in several propellants and dust remover products. Past reports have described the toxicological effects of this compound, but its addictive potential is poorly described in the literature.</p><p><strong>Case: </strong>We present a case report (N = 1) of an adult man who very rapidly developed a severe inhalant use disorder (IUD), in the context of an early remission of an alcohol use disorder (AUD). He received treatment with naltrexone in a residential treatment program. He provided verbal and written consent for the publication of this case report.</p><p><strong>Discussion: </strong>This is the first follow-up case of dust remover-IUD treated with naltrexone described in the literature. This case is clinically important for several reasons, including its atypical age of presentation, rapid progression, medical consequences, and positive response to multimodal treatment. The easy availability and lack of regulation of many inhalants, such as DFE, combined with the inability to be detected in regular screening tests, make this phenomenon a potential public health threat. We hypothesize that, consistent with previous reports, there might be a common neurobiological signature between AUD and IUD.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342241297436"},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684032","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":"A Hospital-Based Intervention to Improve Access to Buprenorphine for Patients with Opioid Use Disorder.","authors":"Matthew Fine, Leeza Hirt Wilner, Cameron K Ormiston, Linda Wang, Trevor G Lee, Michael Herscher","doi":"10.1177/29767342241292416","DOIUrl":"10.1177/29767342241292416","url":null,"abstract":"<p><strong>Background: </strong>Opioid use disorder (OUD) is often under-addressed in hospitalized patients. In the absence of formal addiction consult services, volunteer physician-led models can increase access to inpatient OUD treatment. This paper describes a novel, volunteer physician-led interprofessional approach to identifying patients with OUD, initiating buprenorphine, and linking to office-based opioid treatment.</p><p><strong>Methods: </strong>The intervention took place from April 2018 to August 2020 at a large, urban, tertiary care center and teaching hospital in New York, NY that does not have an addiction consult service. Hospitalized patients with OUD were identified by provider-driven referrals or an automated daily patient list generated by a bioinformatics search algorithm. Eligible patients with OUD were started on buprenorphine during their hospitalization and linked to primary care-based buprenorphine treatment. Patients were followed longitudinally via chart review to assess follow-up clinic rates at >30 days, >60 days, >90 days, >6 months, >12 months, and >24 months after discharge.</p><p><strong>Results: </strong>Over a 2-year period, 178 patients were evaluated, 88 were eligible for inpatient buprenorphine, and 47 were started on buprenorphine while hospitalized. Sixty-seven patients were referred to a post-discharge visit at a primary care practice, 29 (43%) of whom attended an appointment at least 30 days after discharge. Of these, 22 (76%) returned at >60 days and 20 (69%) at 6 months. At the 1-year time point, 16 of a possible 17 patients (94%) and 15 of a possible 16 patients (94%) were still engaged in care at 2 years.</p><p><strong>Conclusion: </strong>This intervention represents a proof of principle, adaptable model for identifying patients with OUD and engaging patients in primary care-based buprenorphine treatment. Limitations to consider include the sustainability of a volunteer-based initiative and that retention rates for 1 to 2 years post-discharge may be more indicative of the strengths of office-based opioid treatment itself as opposed to in-hospital engagement and the intervention.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342241292416"},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142650109","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":"Practice Changes 6 Months Following a Physical Therapist Training Program Regarding Opioid Use and Misuse Screening and Assessment: A Qualitative Study.","authors":"John Magel, Elizabeth Siantz, Priscilla Blosser, Julie M Fritz, Paul Hartman, Jason M Beneciuk, Adam J Gordon","doi":"10.1177/29767342241292259","DOIUrl":"https://doi.org/10.1177/29767342241292259","url":null,"abstract":"<p><strong>Background: </strong>The U.S. Preventive Services Task Force recommends that all healthcare providers be trained to screen for misuse and/or opioid use disorder. An opioid misuse training program for physical therapists was developed and implemented. The purposes of this research were to (1) understand whether the participants found the training useful, (2) understand if they instituted practice changes that resulted from the training, and (3) understand barriers to implementing the skills learned in the training.</p><p><strong>Methods: </strong>Four separate 30-minute virtual training sessions were provided (1 session every 2 weeks). The topics included an introduction to the opioid crisis, screening, assessing, and communicating with patients and with the healthcare team about opioid misuse. A final training manual was distributed after the final training session at which time participants were asked to implement what they learned in the training. Semi-structured interviews were conducted with all training program participants (n = 13) approximately 6 months after the final training session. Rapid content analysis was used to understand the perceptions of and barriers to implementing what the physical therapists learned in the training.</p><p><strong>Results: </strong>Generally, the participants found the training important and useful and strengthened their perceptions of physical therapists' role in screening for opioid misuse. Compared to the opioid misuse-related content of the training, most found it easier to implement general opioid-related content such as asking whether their patients were taking an opioid. Few participants screened any of their patients for opioid misuse. Barriers to implementation included concerns about how the patient might respond to being asked about their opioid use.</p><p><strong>Conclusion: </strong>These findings provide insight into physical therapists' perceptions of an opioid misuse training program and the challenges with implementing what they learned in the program. Future training could incorporate activities such as role-playing to improve participants' comfort with screening for opioid misuse.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342241292259"},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635731","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":"One Third of Alcohol Use Disorder Diagnoses are Missed by ICD Coding.","authors":"Laura Mercurio, Augusto Garcia, Stephanie Ruest, Susan J Duffy, Carsten Eickhoff","doi":"10.1177/29767342241288112","DOIUrl":"https://doi.org/10.1177/29767342241288112","url":null,"abstract":"<p><strong>Background/significance: </strong>Alcohol use carries significant morbidity and mortality, yet accurate identification of alcohol use disorder (AUD) remains a multi-layered problem for both researchers and clinicians.</p><p><strong>Objective: </strong>To fine-tune a language model to AUD in the clinical narrative and to detect AUDs not accounted for by ICD-9 coding in the MIMIC-III database.</p><p><strong>Materials and methods: </strong>We applied clinicalBERT to unique patient discharge summaries. For classification, patients were divided into nonoverlapping groups stratified by the presence/absence of AUD ICD diagnosis for model training (80%), validation (10%), and testing (10%). For detection, the model was trained (80%) and validated (20%) on 1:1 positive/negative patients, then applied to remaining negative patient population. Physicians adjudicated 600 samples from the full model confidence spectrum to confirm AUD by Diagnostic and Statistical Manual of Mental Disorders-V criteria.</p><p><strong>Results: </strong>The model exhibited the following characteristics (mean, standard deviation): precision (0.9, 0.02), recall (0.65, 0.03), F-1 (0.75, 0.02), area under the receiver operating curve (0.97, 0.01), and area under the precision-recall curve (0.86, 0.01). Adjudication produced an estimated 4% under-documentation rate for the total study population. As model confidence increased, AUD under-documentation rate rose to 30% of the number of patients identified as positive by ICD-9 coding.</p><p><strong>Conclusion: </strong>Our model improves the identification of patients meeting AUD criteria, outperforming ICD codes in detecting cases of AUD. Detection discrepancy between ICD and free-text highlights clinician <i>under documentation</i>, not under recognition. Adjudication revealed model over-sensitivity to language around substance use, withdrawal, and chronic liver disease; future study requires application to a broader set of patient age and acuity. This model has the potential to improve rapid identification of patients with AUD and enhance treatment allocation.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342241288112"},"PeriodicalIF":0.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607931","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":"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":"https://doi.org/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":"29767342241289797"},"PeriodicalIF":0.0,"publicationDate":"2024-10-27","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}