Addiction Science & Clinical Practice最新文献

{"title":"Comparison of heroin and fentanyl use in US nationally representative surveys.","authors":"Jarratt D Pytell, Paul J Christine, Katherine LeMasters, Karilynn M Rockhill, Joshua C Black, Richard C Dart, Ingrid A Binswanger","doi":"10.1186/s13722-025-00539-0","DOIUrl":"10.1186/s13722-025-00539-0","url":null,"abstract":"<p><strong>Background: </strong>Given the opioid overdose crisis, surveillance of evolving opioid use patterns is critical to the effective deployment of mitigation strategies. The National Survey on Drug Use and Health (NSDUH) provided the first annual US estimate of illicitly manufactured fentanyl (IMF) use in 2022. However, as a household survey, NSDUH may not capture the full extent of population heroin and IMF use. We compare estimates of past-year heroin and IMF use and correlates of use in NSDUH and the Survey of Non-Medical Use of Prescription Drugs (NMURx) survey which employ an alternate sampling strategy.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of the 2022 NSDUH and NMURx. NSDUH samples respondents using a probability-based approach targeting community-dwelling individuals, while NMURx samples respondents using an opt-in, online survey panel. US adults ages 18 years and older were included. The main outcomes were differences in the weighted percentage of population reporting past-year use of heroin, IMF, and either heroin or IMF between the surveys. Secondary outcomes were the patterns of association of past-year heroin or IMF use with comorbid substance use, treatment utilization, and demographic characteristics between the surveys. Data were analyzed March to June 2024.</p><p><strong>Results: </strong>NSDUH (n = 47,100 respondents) had a lower proportion of respondents who identified as non-Hispanic White and graduated college, and a higher proportion with past week employment than NMURx (N = 59,041 respondents). Past-year use of heroin, IMF, and either heroin or IMF were lower in the NSDUH than the NMURx. NSDUH estimated 0.52% (95% CI: 0.40%, 0.69%) %) of the US population used either heroin or IMF in the past year compared to 1.05% (95% CI: 0.97%, 1.14 0) in NMURx. In regression models, stimulant and benzodiazepine use were consistently associated with increased heroin or IMF use across both surveys.</p><p><strong>Conclusions and relevance: </strong>The estimated prevalence of heroin or IMF use was nearly 50% higher in the NMURx compared to NSDUH. These results highlight the importance of using complementary surveillance approaches to obtain accurate estimates of the prevalence and patterns of heroin or IMF use.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"13"},"PeriodicalIF":3.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pilot study of twice-weekly group-based written exposure therapy for veterans in residential substance use treatment: effects on PTSD and depressive symptoms.","authors":"Natalia Van Doren, Fang-Hsi Chang, Amanda Nguyen, Kevin R McKenna, Derek D Satre, Shannon Wiltsey-Stirman","doi":"10.1186/s13722-024-00531-0","DOIUrl":"10.1186/s13722-024-00531-0","url":null,"abstract":"<p><strong>Background: </strong>Posttraumatic stress disorder (PTSD) is highly comorbid with substance use disorders (SUDs), resulting in high prevalence of PTSD among individuals in residential SUD care. However, there is limited research on integrating trauma treatment into residential SUD care settings. The aim of the present project was to conduct an initial evaluation of the effects of group-based Written Exposure Therapy (WET) on PTSD and depressive symptoms that was integrated into programming for individuals in residential SUD treatment.</p><p><strong>Methods: </strong>Participants were 48 Veterans with comorbid PTSD-SUD from a 28 day residential SUD program at a Veterans Affairs Medical Center. Eligible participants were enrolled in 5 sessions of WET, delivered twice-weekly in an adapted group format. PTSD symptoms and depressive symptoms were assessed at each session with the Posttraumatic Stress Disorder Checklist, DSM-5 version (PCL-5) and the Patient Health Questionnaire (PHQ-9).</p><p><strong>Results: </strong>Over 5 months, 76.2% of the target population were successfully enrolled. Of the enrolled sample, 48 participants, 92% (n = 44) completed 3 sessions, while 56% (n = 28) completed 5 sessions. Generalized Estimating Equations (GEE) showed significant within-person reductions in PTSD symptoms over time, with an average decrease of 3.18 per session (χ² = 23.21, p = .006) and moderate effect sizes (d = 0.46 and d = 0.51 at mid- and post-treatment). In addition, there were significant reductions in depressive symptoms within-persons over time, with an average per-session reduction of 1.13 (χ² = 23.10, p = .006).</p><p><strong>Conclusion: </strong>Findings demonstrate that brief, group-delivered WET is feasible and shows promise for addressing PTSD and depressive symptoms in residential SUD treatment. Results of the present evaluation could inform further efficacy testing and implementation of PTSD treatment into residential SUD settings.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"11"},"PeriodicalIF":3.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peer-assisted telemedicine hepatitis-C treatment for people who use drugs in rural communities: a mixed methods study.","authors":"Kim Hoffman, Gillian Leichtling, Sarah Shin, Andrew Seaman, Tonhi Gailey, Hunter C Spencer, P Todd Korthuis","doi":"10.1186/s13722-025-00541-6","DOIUrl":"10.1186/s13722-025-00541-6","url":null,"abstract":"<p><strong>Background: </strong>The increase in opioid use disorder among young, nonurban people has fueled sharp rises in hepatitis C virus (HCV) infections. Innovative treatment models are needed that circumvent healthcare system barriers for people who use drugs (PWUD), particularly in rural areas. The Oregon HOPE TeleHCV study randomized PWUD living with HCV in rural Oregon to peer-facilitated and streamlined telemedicine HCV treatment (Peer TeleHCV) versus enhanced usual care (EUC) and assessed sustained virologic response at 12 weeks post treatment (SVR12). Peer Support Specialists (peers) conducted HCV screening in the community, facilitated pretreatment evaluation and linkage to telemedicine HCV treatment clinicians, and supported Peer TeleHCV study participants in HCV medication adherence. A qualitative investigation queried telemedicine clinicians and peers about their experiences with the implementation of the model and key drivers of implementation effectiveness.</p><p><strong>Methods: </strong>Two remote audio/video recorded focus groups were conducted, one with the study's clinicians and one with the peers. Participants were asked their views of key elements for successful implementation and outcomes of the Peer TeleHCV model. Group interviews lasted one hour. Recordings were professionally transcribed for thematic analysis with a mixed deductive and inductive framework, using Atlas.ti. Patients were surveyed about their interactions and satisfaction with peers.</p><p><strong>Results: </strong>Quantitative data (n = 78) indicated patients had high levels of satisfaction with and support from the peers. Three themes were identified from the qualitative data (n = 12) including. (1) Key peer-level elements such as providing support during potentially difficult lab draws, creating a peer-facilitated \"bubble of trust\" between patients and clinicians, enabling technology access, conducting outreach to maintain contact and support treatment retention, and facilitating stabilizing wrap-around services (e.g., housing vouchers) (2) Key clinician-level factors such as capacity for unscheduled peer-facilitated appointments, having dedicated time for case consults with peers, and clinicians trained in working with PWUD and skilled in identifying related clinical concerns (3) Key systems-level elements such as standing lab orders, challenges related to specialty pharmacies and Medicaid managed care organizations, and streamlined communication strategies between peers and clinicians.</p><p><strong>Conclusion: </strong>All participants reported that the Peer TeleHCV model built trust and eased barriers for PWUD initiating and remaining in HCV treatment. This low-barrier model makes space for PWUD to receive HCV treatment, regardless of drug use. Implementing support from peer specialists, telemedicine technology, and streamlined testing and treatment strategies may connect more rural PWUD living with HCV with the cure.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"10"},"PeriodicalIF":3.7,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting primary care clinicians in caring for patients with alcohol use disorder: study protocol for Records for Alcohol Care Enhancement (RACE), a factorial four-arm randomized trial.","authors":"Kara M Magane, Richard Saitz, Sarah Fielman, Marc R LaRochelle, Christopher W Shanahan, Christine A Pace, Michael LaValley, Kaley Penington, Skylar Karzhevsky, Emily Hurstak","doi":"10.1186/s13722-024-00526-x","DOIUrl":"10.1186/s13722-024-00526-x","url":null,"abstract":"<p><strong>Background: </strong>Unhealthy alcohol use, a spectrum of use inclusive of risky consumption and alcohol use disorder (AUD), is a leading cause of preventable death in the United States. Most people with unhealthy alcohol use do not receive evidence-based treatment. This four-arm factorial design randomized trial will assess whether population health management (PHM) and clinical care management (CCM) support for primary care providers (PCPs) are associated with improved AUD treatment engagement among their patients, beyond electronic health record (EHR) prompting and decision support alone.</p><p><strong>Methods: </strong>PCPs from an urban safety-net hospital-based primary care clinic are randomized to one of four groups (1) EHR best practice advisory (BPA) and clinical decision support tools for unhealthy alcohol use (BPA), (2) BPA plus population health manager support, (3) BPA plus clinical care manager support, and (4) all three. All PCPs will have access to the EHR BPA and decision support tools which provide chart-based advisories and order set navigation. PCPs assigned to receive PHM support will receive quarterly panel-level feedback on AUD treatment metrics for their patients. PCPs assigned to receive CCM support will receive CCM facilitation of AUD treatment processes including medication counseling, referrals, and support through direct patient interactions. The primary outcome will be the percent of patients engaged in AUD treatment among those with a new AUD diagnosis on a PCP's panel. Secondary outcomes include the percent of patients with a new diagnosis of AUD who (1) initiated AUD treatment, (2) were prescribed AUD medications within 90 days, and (3) numerical counts of a range of AUD health services (outpatient encounters, specialty AUD care encounters, referrals, and acute healthcare utilization) in this sample. We will assess the primary outcome and the acute healthcare utilization secondary outcomes using Medicaid claims; the remaining secondary outcomes will be assessed using EHR data.</p><p><strong>Discussion: </strong>The study will evaluate how a targeted EHR innovation alone, compared with population health and care management enhancements alone or in combination, impact engagement in AUD treatment, a national quality of care measure. Findings will advance understanding of supports needed to improve systems of care for AUD in general settings.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier/registration number (NCT number): NCT05492942.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"9"},"PeriodicalIF":3.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"There's always somebody that you can identify with\": a qualitative study of patient perspectives on buprenorphine group medical visits.","authors":"Mariya Masyukova, Benjamin T Hayes, Teresa López-Castro, Aaron D Fox","doi":"10.1186/s13722-025-00540-7","DOIUrl":"10.1186/s13722-025-00540-7","url":null,"abstract":"<p><strong>Background: </strong>Buprenorphine (BUP) treatment has been successfully integrated into primary care and other general medical settings; however, potential BUP prescribers frequently report inadequate training and resources to provide psychosocial counseling as barriers to providing care. Group medical visits, which combine psychosocial support and chronic condition management, have been described for BUP treatment, but few studies have explored what is gained and/or lost by offering BUP treatment in groups instead of individual visits.</p><p><strong>Methods: </strong>Five focus groups with 3-11 participants each were conducted at an urban community health center that housed a mature office-based BUP treatment program. Participants were persons with opioid use disorder (OUD) who had previously received BUP treatment. A semi-structured interview guide covered the following domains: experience with BUP, experience with group counseling, and preferences for BUP in a group format or individual setting. Qualitative analysis followed a modified grounded theory approach.</p><p><strong>Results: </strong>Of 33 participants, 28 were male, median age range was 50-54, 20 identified as Hispanic/Latinx, and 24 reported past experiences with substance use disorder treatment groups. Four main themes were: (1) Groups can address the psychological aspects of addiction; (2) Groups introduce positive peer support; (3) Balancing OUD treatment and management of other chronic conditions; (4) Groups must be voluntary.</p><p><strong>Conclusions: </strong>Findings demonstrate that many persons with OUD taking BUP desire assistance with recovery skills, peer support, and learning about the risks and benefits of BUP. Group medical visits can efficiently deliver these services in primary care, but findings also emphasize that group counseling will be best received when voluntary and group members are committed and authentic.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"8"},"PeriodicalIF":3.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives of substance use disorder counselors on the benefits and drawbacks of medications for opioid use disorder.","authors":"Nicholas C Cardamone, Rebecca E Stewart, Kyle M Kampman, Steven C Marcus","doi":"10.1186/s13722-025-00537-2","DOIUrl":"10.1186/s13722-025-00537-2","url":null,"abstract":"<p><strong>Background: </strong>Medications for opioid use disorder (MOUD) are among the best tools available to combat the opioid epidemic. Yet, use of MOUD among people with opioid use disorder (OUD) remains low. Interventions to increase MOUD access in the United States have largely focused on improving organizational capacity and addressing funding barriers, yet stigma toward MOUD may inhibit uptake even where MOUD is readily available. Non-prescribing substance use disorder (SUD) treatment professionals (e.g. counselors) likely have considerable influence on a client's choice to initiate and adhere to MOUD, but beliefs that counselors convey about MOUD in interaction with clients are understudied. The current study explores what advantages and disadvantages that counselors communicate about buprenorphine, methadone, and naltrexone.</p><p><strong>Methods: </strong>From June to December 2021, we surveyed counselors from publicly-funded SUD treatment agencies under a municipality-wide mandate to offer MOUD to all clients with OUD. Counselors were asked to describe, in a free-response format, the most important advantages and disadvantages to communicate to their clients about taking buprenorphine, methadone, and naltrexone. Counselor responses were coded for one or more advantage and disadvantage.</p><p><strong>Results: </strong>A total of 271 SUD counselors from 29 agencies in the Philadelphia Metropolitan Area completed the survey, generating 1,995 advantages and disadvantages across three types of MOUD. The most frequently reported advantage across all three types of MOUD was their ability to reduce cravings and illicit drug use. The most frequently reported disadvantage related to the potential for some types of MOUD to develop long-term medication dependence.</p><p><strong>Conclusions: </strong>As the availability and variety of MOUD treatment options continue to expand, it is important that SUD counselors are equipped with evidence-based recommendations for OUD care. We identified misalignments with the MOUD-prescribing evidence base and stigmatizing language toward MOUD within counselors' responses, highlighting the potential to refine training materials for MOUD and mitigate stigmatizing beliefs.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"7"},"PeriodicalIF":3.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"mHealth Incentivized Adherence Plus Patient Navigation (MIAPP): protocol for a pilot randomized controlled trial to improve linkage and retention on buprenorphine for hospitalized patients with methamphetamine use and opioid use disorder.","authors":"Elenore P Bhatraju, Devin N Kennedy, Alexander J Gojic, Matthew Iles-Shih, Joseph O Merrill, Jeffrey H Samet, Kevin A Hallgren, Judith I Tsui","doi":"10.1186/s13722-025-00538-1","DOIUrl":"10.1186/s13722-025-00538-1","url":null,"abstract":"<p><strong>Background: </strong>Initiation of buprenorphine for treatment of opioid use disorder (OUD) in acute care settings improves access and outcomes, however patients who use methamphetamine are less likely to link to ongoing treatment. We describe the intervention and design from a pilot randomized controlled trial of an intervention to increase linkage to and retention in outpatient buprenorphine services for patients with OUD and methamphetamine use who initiate buprenorphine in the hospital.</p><p><strong>Methods: </strong>The study is a two-arm pilot randomized controlled trial (N = 40) comparing the mHealth Incentivized Adherence Plus Patient Navigation (MIAPP) intervention to treatment as usual. Development of the MIAPP intervention was guided by the information-motivation-behavioral skills model and combines financial rewards via mobile health-based adherence monitoring with the \"human touch\" of a patient navigator. Participants receive financial incentives for submitting videos of themselves taking buprenorphine via smartphone. The Patient Navigator reviews videos and provides treatment adherence coaching, care coordination and motivational enhancement. The intervention is introduced prior to hospital discharge and is offered for 30 days. The primary outcome is linkage to outpatient buprenorphine care within 30 days of hospital discharge. Secondary outcomes include retention on buprenorphine 90 days post discharge, hospital readmissions, and past 30-day methamphetamine use.</p><p><strong>Discussion: </strong>Interventions are needed to increase linkage and retention to outpatient buprenorphine among hospitalized patients with OUD, especially for people who co-use methamphetamine. We will examine the MIAPP intervention to improve buprenorphine adherence and linkage to outpatient treatment in a pilot randomized controlled trial which will provide valuable insights about research approaches for hospitalized patients with substance use disorder.</p><p><strong>Trial registration number: </strong>NCT06027814. Date of Initial Release: 08/30/2023.</p><p><strong>Protocol version: </strong>03/21/2024.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"6"},"PeriodicalIF":3.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives and experiences regarding pre-exposure prophylaxis (PrEP) in a community sample of Veterans with unhealthy alcohol use: overall and across sexual orientation and gender identity.","authors":"Olivia V Fletcher, Kristine Beaver, Elizabeth J Austin, Jenna van Draanen, E Jennifer Edelman, Emily C Williams","doi":"10.1186/s13722-024-00533-y","DOIUrl":"10.1186/s13722-024-00533-y","url":null,"abstract":"<p><strong>Background: </strong>Unhealthy alcohol use is an independent, modifiable risk factor for HIV, but limited research addresses alcohol use and HIV prevention synergistically. Groups that experience chronic stigma, discrimination, and/or other marginalization, such as sexual and gender minoritized groups, may have enhanced HIV risk related to unhealthy alcohol use. We described awareness of and experiences with pre-exposure prophylaxis (PrEP) among a community sample of Veterans reporting unhealthy alcohol use (relative to those without), overall and across self-reported sexual orientation and gender identity.</p><p><strong>Methods: </strong>Using data collected from a national online survey of Veterans recruited via Facebook ads, community organizations, and listservs, we assessed variation in four PrEP outcomes (knowledge, experience, willingness, and conversations with doctors) across patterns of unhealthy alcohol use among all respondents reporting any lifetime drinking (n = 1,041) and then within sexual orientation and gender identity groups using Chi-square or Fisher's exact tests.</p><p><strong>Results: </strong>Among 1,041 eligible Veterans, 440 (42%) screened positive for unhealthy alcohol use. Veterans with unhealthy alcohol use were not more likely to have heard of PrEP (58.2% vs. 55.4%, p = 0.37), but trended toward more likely to have taken PrEP (7.5% vs. 5.0%, p = 0.09), to be willing to take PrEP (30.5% vs. 27.6%, p = 0.06), and to have spoken with a doctor about PrEP (11.4% vs. 7.7%, p = 0.04). Those with heavy episodic drinking also trended toward higher prevalence of PrEP awareness (60.0% vs. 54.6%, p = 0.09), and were more likely to have taken PrEP (8.3% vs. 4.7%, p = 0.02), to be willing to use PrEP (34.6% vs. 25.5%, p < 0.01), and to have had conversations with doctors about PrEP (12.7% vs. 7.2%, p < 0.01). Similar patterns were observed for severe unhealthy alcohol use and past-year frequent heavy episodic drinking. Generally, sexual/gender minoritized Veterans with unhealthy alcohol use reported more PrEP-affirming responses than those without but associations with unhealthy alcohol use were similar.</p><p><strong>Conclusions: </strong>Unhealthy alcohol use was prevalent, particularly among Veterans with minoritized sexual orientation/gender identity, but not clearly linked to increased PrEP-literacy and use despite its known status as an HIV risk factor. Across groups, > 25% of individuals were willing to take PrEP. Interventions targeting both alcohol use and HIV prevention should capitalize on this.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"5"},"PeriodicalIF":3.7,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rationale and design of a randomized clinical trial of integrated eHealth for PrEP and medications for opioid use disorders for women in the criminal legal system. The Athena study.","authors":"Jaimie P Meyer, Stacey Brunson, Carolina R Price, Morgan Mulrain, Julie Nguyen, Frederick L Altice, Tassos C Kyriakides, Karen Cropsey, Ellen Eaton","doi":"10.1186/s13722-024-00534-x","DOIUrl":"10.1186/s13722-024-00534-x","url":null,"abstract":"<p><strong>Background: </strong>Women involved in the criminal legal system have elevated rates of opioid use disorder, which is treatable, and HIV, which is preventable with pre-exposure prophylaxis (PrEP). There are significant social and structural barriers to integrated delivery of PrEP and medications for opioid use disorder (MOUD), limiting women's ability to access these life-saving interventions. In a two parallel-arm randomized controlled trial, we are assessing an innovative eHealth delivery model that integrates PrEP with MOUD and is tailored to meet the specific needs of women involved in the criminal legal system.</p><p><strong>Methods: </strong>We will recruit and enroll 250 women involved in the criminal legal system with opioid use disorder across two diverse settings (New Haven, CT and Birmingham, AL). Participants will be randomized to (a) the \"Athena strategy,\" which includes a PrEP decision aid and integrated PrEP/MOUD delivery via eHealth; or (b) enhanced standard of care (SOC) that includes a decision aid-only. During 6-month follow-up, we will assess PrEP initiation as the primary clinical outcome and implementation outcomes that include acceptability, adoption, feasibility, fidelity, implementation cost, and sustainability.</p><p><strong>Discussion: </strong>Results could help determine if reducing the social and structural barriers to PrEP and MOUD for women involved in the criminal legal system will facilitate engagement in treatment and prevention services, thus alleviating health disparities.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov (NCT05547048). Registered September 15, 2022. https://clinicaltrials.gov/study/NCT05547048?term=NCT05547048&rank=1 .</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"4"},"PeriodicalIF":3.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient centered medication treatment for opioid use disorder in rural Vermont: a qualitative study.","authors":"Emily G Hichborn, Owen B Murray, Eilis I Murphy, Tess E Gallant, Sarah K Moore, Bethany M McLeman, John Saroyan, Anthony Folland, Megan Mitchell, Lisa A Marsch","doi":"10.1186/s13722-024-00529-8","DOIUrl":"10.1186/s13722-024-00529-8","url":null,"abstract":"<p><strong>Background: </strong>Opioid-related fatal overdoses are occurring at historically high levels and increasing each year. Accessible social and financial support are imperative to the initiation and success of treatment for Opioid Use Disorder (OUD). Medications for Opioid Use Disorder (MOUD) offer effective treatment but there are many more people with untreated OUD than receiving evidence-based medication. Patient-centered care is associated with increased care utilization for substance use disorders. This qualitative study explored the patient perspective of OUD care through a Patient-Centered Care (PCC) framework to illuminate patients' sense of engagement in care.</p><p><strong>Methods: </strong>Fifteen semi-structured telephone interviews were conducted from August through November of 2021 regarding patient experiences receiving MOUD in 13 Vermont Hub and Spoke clinics. Emergent themes were deductively mapped to PCC domains of Therapeutic Alliance, Individualized Care, Shared Decision-Making, and Holistic Care.</p><p><strong>Results: </strong>Participants indicated that PCC fostered engagement and often characterized MOUD clinics they no longer attended as lacking in PCC. Themes related to Therapeutic Alliance were the most prevalent and suggest pathways to retention. Individualizing care through flexible appointment scheduling was strongly valued, while inflexible scheduling fostered fear of not getting medication. Some participants indicated they were less likely to remain in care when providers did not include them in decisions about medication type, dose, or formulation. Participants also appreciated holistic biopsychosocial care and care referrals.</p><p><strong>Conclusions: </strong>Patient-centered MOUD care was important to participants and encouraged engagement in care. Prioritizing alliance with patients, adapting care to patient needs and preferences particularly when scheduling, including patients in medication decisions, and biopsychosocial attention to patients are congruent with patient perception of desirable MOUD care. Having this understanding of an established, leading MOUD treatment system may serve to benefit states looking to implement this model, or for states who are looking to improve the model they already have in place, potentially leading to higher treatment and retention rates.</p><p><strong>Trial registration: </strong>This was not a clinical trial involving an intervention, and therefore registration was not required.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"3"},"PeriodicalIF":3.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}