Drug and alcohol dependence reports最新文献

{"title":"Impact of COVID-19 on MOUD retention in a sample of rural primary care patients: A secondary analysis of electronic health records","authors":"Stacy Calhoun ,&nbsp;Huiying Guo ,&nbsp;Zhe Fei ,&nbsp;Chunqing Lin ,&nbsp;Sarah E. Clingan ,&nbsp;Yuhui Zhu ,&nbsp;Larissa J. Mooney ,&nbsp;Yih-Ing Hser","doi":"10.1016/j.dadr.2024.100276","DOIUrl":"10.1016/j.dadr.2024.100276","url":null,"abstract":"<div><h3>Introduction</h3><p>There is limited research examining factors impacting MOUD retention in rural settings, especially within the context of the COVID-19 pandemic. Using electronic health records data collected as part of a NIDA Clinical Trials Network study (CTN-0102), this study explored how the onset of the COVID-19 pandemic may have impacted MOUD retention in a sample of 563 rural primary care patients.</p></div><div><h3>Methods</h3><p>Cox regression model was applied to examine if COVID-19 was related to treatment retention, controlling for demographics, clinic, insurance type, and other diagnoses. The independent variable was the number of days between the patient’s first MOUD prescription date during the pre-COVID observation period (10/1/2019–3/13/2020) and the start of the COVID-19 pandemic. The dependent variable was retention on MOUD, defined as the time from the first MOUD prescription documented during the pre-COVID observation period to the first break in consecutive MOUD prescriptions (right censored at 180 days).</p></div><div><h3>Results</h3><p>The findings demonstrated that there was a reduced risk of a prescription break for every 10-day increase in the time from the first documented MOUD prescription to the onset of the COVID-19 pandemic (HR = 0.96, 95 % CI = 0.92–0.99; <em>p</em> = 0.011).</p></div><div><h3>Conclusions</h3><p>While the data did not include complete treatment histories to determine who was new to MOUD treatment, the findings suggest that patients whose first documented MOUD prescription in the dataset was closer to the onset of the pandemic had a greater likelihood of experiencing retention challenges. This underscores the importance for clinics to establish comprehensive contingency plans for future emergencies to ensure uninterrupted MOUD treatment and support, particularly for individuals in the early stabilization phase of their recovery.</p></div>","PeriodicalId":72841,"journal":{"name":"Drug and alcohol dependence reports","volume":"12 ","pages":"Article 100276"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S277272462400060X/pdfft?md5=598f3721d84bf71bc517a95b2657abdc&pid=1-s2.0-S277272462400060X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122860","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":"The substance use disorder treatment gap among US college students: Findings from the 2021 National Survey on Drug Use and Health","authors":"Emily Pasman ,&nbsp;Lisa Blair ,&nbsp;Marvin A. Solberg ,&nbsp;Sean Esteban McCabe ,&nbsp;Ty Schepis ,&nbsp;Stella M. Resko","doi":"10.1016/j.dadr.2024.100279","DOIUrl":"10.1016/j.dadr.2024.100279","url":null,"abstract":"<div><h3>Background</h3><p>Substance use and substance use disorders (SUD) are prevalent among college students. Information about the gap between substance use treatment need versus treatment receipt can guide efforts to increase service access. This study examined past-year DSM-5 SUD and receipt of treatment among US college students.</p></div><div><h3>Methods</h3><p>Past-year DSM-5 SUD and treatment receipt were estimated among a sample of 6115 college students aged 16 and older and a comparison group of non-students from the 2021 National Survey on Drug Use and Health, weighted to be nationally representative. Among the college student sample, multiple logistic regression was used to identify factors associated with past-year SUD. Bivariate analyses were used to compare socio-demographic and substance use differences between college students who received treatment and those who had an SUD but did not receive treatment.</p></div><div><h3>Results</h3><p>Weighted prevalence of past-year SUD among college students was 21.8 %. Only 4.6 % of students who had an SUD received treatment in any setting. Relative to non-students with SUD, proportionately fewer college students with SUD received treatment. Among college students, age, sex, past-year psychological distress, and past-year substance use were significantly associated with past-year SUD; and receipt of treatment differed significantly by age, insurance type, level of education, and enrollment status. College students who received treatment had greater prevalence of stimulant, opioid, tranquilizer, and poly-SUDs and more severe SUD symptomology than those who did not receive treatment.</p></div><div><h3>Conclusion</h3><p>Additional efforts are needed to engage college students with SUDs in acceptable, evidence-based treatment services.</p></div>","PeriodicalId":72841,"journal":{"name":"Drug and alcohol dependence reports","volume":"12 ","pages":"Article 100279"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772724624000635/pdfft?md5=1ea92bfa926074e0816d71b3492e1a1a&pid=1-s2.0-S2772724624000635-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122861","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":"A review of the landscape of state Tobacco 21 laws: Key components, research challenges, and future directions","authors":"","doi":"10.1016/j.dadr.2024.100236","DOIUrl":"10.1016/j.dadr.2024.100236","url":null,"abstract":"<div><h3>Background</h3><p>To understand the impact of laws raising minimum legal sales age for tobacco products to age 21, researchers and policymakers need to recognize how recommended policy components vary across states. This paper identified and reviewed policy components across 43 jurisdictions that have enacted Tobacco 21 (T21) laws since 2015.</p></div><div><h3>Methods</h3><p>Using NexisUni’s database of state laws and legislation, we evaluated T21 laws in effect as of January 2024 and assessed for the incorporation of six components recommended in proposed model legislation: 1) age verification; 2) tobacco retailer licensing; 3) provisions to suspend or revoke a license; 4) unannounced inspections; 5) retailer civil or criminal penalties; and 6) provisions that allow for more stringent local laws.</p></div><div><h3>Results</h3><p>Only one state included all six components we reviewed, including limiting penalties to civil fines. All jurisdictions included a provision to change the legal sales age of purchase and 37 imposed requirements on retailers to verify identification. Thirty-eight jurisdictions had licensing programs, but only 31 included license suspension or revocation provisions for underage sales. Twenty-three jurisdictions preempt localities from imposing more stringent requirements. Twenty-five jurisdictions use a mix of civil and criminal or solely criminal penalties and 21 jurisdictions have penalties for underage purchasers.</p></div><div><h3>Conclusions</h3><p>Our database of recommended T21 components with effective dates can be merged with other datasets to facilitate policy evaluation. We discuss ways to enhance research and data collection in this area, and recommend that states update MLSA laws to adopt all recommended policy components.</p></div>","PeriodicalId":72841,"journal":{"name":"Drug and alcohol dependence reports","volume":"12 ","pages":"Article 100236"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772724624000209/pdfft?md5=682022b6a1013384cc6b429290ebeeac&pid=1-s2.0-S2772724624000209-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775932","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":"Perceptions, barriers, and facilitators of cannabis screening during pregnancy and labor: A qualitative study","authors":"K. Skelton ,&nbsp;S. Nyarko ,&nbsp;S. Iobst","doi":"10.1016/j.dadr.2024.100274","DOIUrl":"10.1016/j.dadr.2024.100274","url":null,"abstract":"<div><h3>Background</h3><p>Cannabis is the most commonly used federally illicit substance during pregnancy. Yet, little is known about women’s lived experiences of being screened for cannabis use during pregnancy.</p></div><div><h3>Objective</h3><p>To explore perceptions of cannabis use during pregnancy and childbirth, including experiences of being screened for cannabis use during the intrapartum period.</p></div><div><h3>Methods</h3><p>We conducted a phenomenological qualitative study using semi-structured, online interviews with 16 English-speaking women who gave birth at a U.S. hospital within the past three months. After transcription of interview recordings, two coders analyzed data using inductive thematic analysis. We also generated descriptive statistics for sociodemographic characteristics and cannabis use behaviors.</p></div><div><h3>Findings</h3><p>Most participants were 25–34 years of age (75 %, n=12), Black (75.00 %. n=12), and had less than a bachelor’s degree (68.75 %, n=14). Participants reported low-risk perceptions of cannabis use during pregnancy and often used cannabis to alleviate mental health conditions and pain during pregnancy and childbirth. Women reported mixed perceptions of harm, using cannabis as a medicine and because they were addicted, being fearful of disclosing cannabis use due to potential involvement of child welfare and protective services, and perceiving negative provider communication a barrier to disclosing cannabis use.</p></div><div><h3>Conclusions</h3><p>Findings underscore the importance of patient education about adverse maternal and neonatal health outcomes of prenatal cannabis use, regardless of whether disclosure occurs. To facilitate disclosure of use, close attention should be paid to verbal and non-verbal communication when screening and counseling women during pregnancy and childbirth. Additional studies are needed to further examine patient-provider cannabis-related communication, with a focus on identifying discriminatory behaviors and practices resulting in health inequities.</p></div>","PeriodicalId":72841,"journal":{"name":"Drug and alcohol dependence reports","volume":"12 ","pages":"Article 100274"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772724624000581/pdfft?md5=b7abc18621ec0e2b948c2e8cebfca4fa&pid=1-s2.0-S2772724624000581-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096084","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":"Higher prevalence of polysubstance use among older lesbian, and gay US adults","authors":"Luis M. Mestre ,&nbsp;Marney A. White ,&nbsp;Becca R. Levy ,&nbsp;Krysten W. Bold","doi":"10.1016/j.dadr.2024.100281","DOIUrl":"10.1016/j.dadr.2024.100281","url":null,"abstract":"<div><h3>Introduction</h3><p>Polysubstance use (i.e., the use of more than one substance) is a major public health concern in the US that disproportionately hinders those from marginalized groups by sexual identity and age. Little research has examined this concern among lesbian, gay, and bisexual (LGB) older adults, and no study has measured past-30 day polysubstance use prevalence among these groups. The objective was to examine polysubstance use among older LGB adults compared to their heterosexual same-age peers and younger LGB counterparts.</p></div><div><h3>Methods</h3><p>We used the National Survey of Drug Use and Health 2021 and 2022 datasets with an analytic sample of 86,254 participants<strong>.</strong> Past-30 day polysubstance use prevalence was survey-weighted and adjusted by sociodemographic factors. We constructed Weighted multinomial models to compare polysubstance use between older LGB adults (65+ years old) with their same-age heterosexual and younger LGB counterparts.</p></div><div><h3>Results</h3><p>Older Gay/Lesbian adults had a significantly higher polysubstance use prevalence than their heterosexual counterparts (OR = 27.94; p &lt;0.001) while heterosexual participants showed a decline in polysubstance use with age (OR = 0.27; p &lt; 0.001). Polysubstance use among gay/lesbian (OR = 0.67; p = 0.491) and bisexual (OR = 1.04; p = 0.969) older adults did not significantly differ from their younger counterparts.</p></div><div><h3>Conclusions</h3><p>Polysubstance use is a public health concern for older gay/lesbian adults. Interventions are needed to address polysubstance use for older LGB adults, including early detection of polysubstance use and prevention strategies that are age and LGB inclusive.</p></div>","PeriodicalId":72841,"journal":{"name":"Drug and alcohol dependence reports","volume":"12 ","pages":"Article 100281"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772724624000659/pdfft?md5=c01c88cb4eb0c2c762003f3dae411861&pid=1-s2.0-S2772724624000659-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142172470","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":"Effects of isolation stress and voluntary ethanol exposure during adolescence on ethanol and nicotine co-use in adulthood using male rats","authors":"Jakob D. Shaykin ,&nbsp;Lidia N. Olyha ,&nbsp;Catherine E. Van Doorn ,&nbsp;Joshua D. Hales ,&nbsp;Cassie M. Chandler ,&nbsp;Deann M. Hopkins ,&nbsp;Kimberly Nixon ,&nbsp;Joshua S. Beckmann ,&nbsp;James R. Pauly ,&nbsp;Michael T. Bardo","doi":"10.1016/j.dadr.2024.100277","DOIUrl":"10.1016/j.dadr.2024.100277","url":null,"abstract":"<div><h3>Background</h3><p>Alcohol use in adolescence may increase susceptibility to substance use disorders (SUDs) in adulthood. This study determined if voluntary ethanol (EtOH) consumption during adolescence, combined with social isolation, alters the trajectory of EtOH and nicotine intake during adulthood, as well as activating brain neuroinflammation.</p></div><div><h3>Methods</h3><p>Adolescent male isolate- and group-housed rats were given 0.2 % saccharin/20 % EtOH (Sacc/EtOH) or water using intermittent 2-bottle choice; controls were given water in both bottles (n=17–20 per group). Some rats from each group (n=5–6) were euthanized one week later to measure autoradiographic [³H]PK-11195 binding, an indicator of microglial reactivity, and the remainder (n=11–14 per group) were tested in adulthood in 2-bottle choice, followed by nicotine self-administration using an incremental fixed ratio (FR) schedule with Sacc/EtOH and water concurrently available.</p></div><div><h3>Results</h3><p>Isolation housing increased adolescent intake of Sacc/EtOH, but the increase did not produce an observable neuroimmunological response in brain. Adolescent EtOH exposure <em>decreased</em> adult intake of both Sacc/EtOH and unsweetened EtOH, with isolate-housed rats showing a greater effect than group-housed rats. In the co-use model, a cross-price economic demand analysis revealed a substitutional relationship between Sacc/EtOH and nicotine, but no effect of adolescent Sacc/EtOH exposure. Compared to group-housed rats, isolate-housed rats were more sensitive to the changing price of nicotine and showed greater substitutability of Sacc/EtOH for nicotine.</p></div><div><h3>Conclusion</h3><p>The current results suggest that adolescent EtOH exposure <em>per se</em>, with or without isolation stress, does not likely explain the enhanced risk for either alcohol or nicotine use later in life.</p></div>","PeriodicalId":72841,"journal":{"name":"Drug and alcohol dependence reports","volume":"12 ","pages":"Article 100277"},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772724624000611/pdfft?md5=f38da31d21d4fa1e5d2a3e0c4bed9efb&pid=1-s2.0-S2772724624000611-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142040035","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":"A pilot pragmatic randomized controlled trial of a nicotine metabolite ratio-guided smoking cessation intervention in a lung health and screening program","authors":"Scott D. Siegel ,&nbsp;Ross Budziszewski ,&nbsp;Essie Layton ,&nbsp;Brian Nam ,&nbsp;Robert Schnoll","doi":"10.1016/j.dadr.2024.100275","DOIUrl":"10.1016/j.dadr.2024.100275","url":null,"abstract":"<div><h3>Introduction</h3><p>Patients with pulmonary nodules detected through lung cancer screening or as incidental findings are often followed in lung health and screening programs. The use of personalized pharmacotherapy for smoking cessation informed by the nicotine metabolite ratio (NMR), a measure of nicotine metabolism, has not yet been evaluated in this setting. This pilot randomized controlled trial (RCT) evaluated the feasibility of conducting a larger trial.</p></div><div><h3>Methods</h3><p>Through a pragmatic RCT design, participants were recruited from a Mid-Atlantic lung health and screening program. Eligible participants smoked &gt;5 cigarettes per day and completed a blood draw to determine NMR before being randomized to standard or NMR-guided care treatment arms. Standard care participants were offered nicotine replacement therapy (NRT) or varenicline and a referral to phone-based smoking cessation counseling. NMR-guided participants received standard care except they were provided a personalized medication recommendation based on their NMR. Study outcomes included measures of feasibility, medication uptake, and treatment matching (i.e., uptake of the optimal medication).</p></div><div><h3>Results</h3><p>More than 80 % of 205 screened patients were eligible. However, only 37 (22 %) of these patients enrolled in the study, with a mean age of 65 years, 43 % female, and 25 % Black. Nearly all patients who declined cited a disinterest in smoking cessation. Participants in both treatment arms had high rates of medication uptake (68 %), with NMR-guided participants showing a trend towards greater treatment matching (55 % vs. 29 %).</p></div><div><h3>Conclusions</h3><p>The results of this pilot study provide support for conducting a larger RCT of an NMR-guided smoking cessation intervention in a lung health and screening setting. Consideration should be given to augmenting the intervention to address barriers to study entry.</p></div>","PeriodicalId":72841,"journal":{"name":"Drug and alcohol dependence reports","volume":"12 ","pages":"Article 100275"},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772724624000593/pdfft?md5=d79c29b25b9801f1c86756d08289f8f7&pid=1-s2.0-S2772724624000593-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142012922","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":"Tianeptine-involved emergency department visits, fatal overdoses, and substance seizures in Tennessee, 2021–2023","authors":"Haley L. Hershey,&nbsp;Edward M. Onyango,&nbsp;Kate Durst,&nbsp;Jessica Korona-Bailey,&nbsp;Sutapa Mukhopadhyay","doi":"10.1016/j.dadr.2024.100272","DOIUrl":"10.1016/j.dadr.2024.100272","url":null,"abstract":"<div><h3>Background</h3><p>Tianeptine is an antidepressant that acts as an agonist to the mu-opioid receptor and enhances serotonin reuptake. Tianeptine has been legally sold as an antidepressant in some countries but is not approved for any medical use by the U.S. Food and Drug Administration (FDA). Tianeptine is not a federally controlled substance, but became a schedule II substance in Tennessee on July 1, 2022. This publication aims to describe the prevalence of tianeptine-involved emergency department visits, fatal overdoses, and substance seizures in Tennessee from 2021 to 2023.</p></div><div><h3>Methods</h3><p>We conducted a study to examine the prevalence of tianeptine-involved emergency department visits and fatal overdoses in Tennessee using data for 2021 to 2023 from the Tennessee Electronic Surveillance System for the Early Notification of Community based Epidemics (ESSENCE) database and the Tennessee State Unintentional Drug Overdose Reporting System (SUDORS). Substance seizure data from National Forensic Laboratory Information System (NFLIS) are included.</p></div><div><h3>Results</h3><p>Our search of ESSENCE, SUDORS, and NFLIS yielded 50 tianeptine-involved emergency department visits, 6 tianeptine-involved fatal overdoses, and 19 tianeptine substance seizures respectively. Demographic information is provided for the emergency department visits and tianeptine-involved fatal overdoses. Discharge diagnosis and clinical symptomology information are provided for the emergency department visits.</p></div><div><h3>Conclusion</h3><p>Emergency department visits and fatal overdoses involving tianeptine have occurred in Tennessee despite tianeptine becoming a schedule II substance. Among emergency department visits, tianeptine use is most commonly associated with gastrointestinal and psychological symptoms. All fatal cases where tianeptine was detected involved other substances, suggesting tianeptine plays a role in polysubstance use.</p></div>","PeriodicalId":72841,"journal":{"name":"Drug and alcohol dependence reports","volume":"12 ","pages":"Article 100272"},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772724624000568/pdfft?md5=c290d8c7ca288a1dc128918644d9b123&pid=1-s2.0-S2772724624000568-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142044944","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":"Perceptions of a naloxone leave behind program among emergency medical services personnel in Michigan, USA","authors":"Jason Brian Gibbons ,&nbsp;Olivia K. Sugarman ,&nbsp;Lauren Byrne ,&nbsp;Samantha J. Harris ,&nbsp;Hridika Shah ,&nbsp;Eric G. Hulsey ,&nbsp;Julie Rwan ,&nbsp;Esther Mae Rosner ,&nbsp;Anthony Pantaleo ,&nbsp;Emily Bergquist ,&nbsp;Brendan Saloner","doi":"10.1016/j.dadr.2024.100273","DOIUrl":"10.1016/j.dadr.2024.100273","url":null,"abstract":"<div><h3>Introduction</h3><p>In 2020, Michigan implemented its first Naloxone Leave-Behind Program for Emergency Medical Service (EMS) field providers. Under the program, EMS field providers leave naloxone kits to individuals aged 15 or older they encounter in the field who have overdosed, who indicate they have a substance use disorder, or exhibit signs of opioid use and/or to bystanders, friends, or family that are present at the encounter.</p></div><div><h3>Methods</h3><p>Survey of EMS field providers and administrators to assess perspectives on the Michigan NLB program. Comparisons of perspectives between field providers and administrators working in EMS agencies operating in medical control authorities (MCAs) participating in the NLB program (i.e., participating agencies) with field providers and administrators working for EMS agencies serving non-participating MCAs.</p></div><div><h3>Results</h3><p>Most EMS field providers and administrators supported the Michigan NLB program. However, some were concerned about the unintended consequences of leaving behind naloxone, including the potential for recipients to use more drugs or be less likely to seek treatment. Perspectives of NLB program effectiveness were similar between EMS administrators and field providers. Participating administrators’ top-cited barrier to implementation was convincing field providers to leave behind naloxone, while non-participating administrators were concerned with stocking naloxone kits.</p></div><div><h3>Conclusions</h3><p>Additional engagement and training to address concerns by EMS field providers and administrators about the benefits of the NLB program are needed to expand program participation intensity. Streamlining naloxone procurement and increasing messaging about free access to naloxone for participating in the program may help increase adoption.</p></div>","PeriodicalId":72841,"journal":{"name":"Drug and alcohol dependence reports","volume":"12 ","pages":"Article 100273"},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S277272462400057X/pdfft?md5=0cc2360a08b50576a791ad2ac1229ab3&pid=1-s2.0-S277272462400057X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142050401","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":"Synthetic opioids have disrupted conventional wisdom for treating opioid overdose","authors":"Phil Skolnick,&nbsp;Jordan Paavola,&nbsp;Christian Heidbreder","doi":"10.1016/j.dadr.2024.100268","DOIUrl":"10.1016/j.dadr.2024.100268","url":null,"abstract":"<div><p>More than 90 % of opioid overdose deaths in North America are now caused by synthetic opioids, and while they are not as prevalent in the European illicit drug market, there are indications that they may become so in the near future. Multiple publications have argued that neither higher doses of naloxone nor more potent opioid receptor antagonists are needed to reverse a synthetic opioid overdose. However, the unique physicochemical properties of synthetic opioids result in a very rapid onset of respiratory depression compared to opium-based molecules, reducing the margin of opportunity to reverse an overdose. While intravenous administration rapidly delivers the high naloxone concentrations needed to reverse a synthetic opioid overdose, this option is often unavailable to first responders. A translational mechanistic model of opioid overdose developed by the FDA’s Division of Applied Regulatory Science provides an unbiased approach to evaluate the effectiveness of overdose reversal strategies. Reports using this model demonstrated the naloxone tools (2<!--> <!-->mg intramuscular and 4<!--> <!-->mg intranasal) used by many first responders can result in an unacceptable loss of life following a synthetic opioid (fentanyl, carfentanil) overdose. Moreover, sequential (2.5<!--> <!-->minutes between doses) administration of up to four doses of intranasal naloxone was no more effective at reducing the incidence of cardiac arrest (a surrogate endpoint for lethality) than a single dose, suggesting that attempts at titration may not provide the rapid absorption required to reverse a synthetic opioid overdose. This model was also used to compare the effectiveness of intranasal naloxone to intranasal nalmefene, a recently FDA-approved opioid receptor antagonist with a more rapid absorption and a higher affinity at mu-opioid receptors compared to intranasal naloxone. Intranasal nalmefene resulted in large and clinically meaningful reductions in the incidence of cardiac arrest compared to intranasal naloxone. Furthermore, simultaneous administration of four doses of intranasal naloxone was needed to reduce the incidence of cardiac arrest to levels approaching those produced by a single dose of intranasal nalmefene. These data are consistent with evidence that synthetics have indeed disrupted conventional wisdom in the treatment of opioid overdose.</p></div>","PeriodicalId":72841,"journal":{"name":"Drug and alcohol dependence reports","volume":"12 ","pages":"Article 100268"},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772724624000520/pdfft?md5=e563221a6b5d3247084bdfa4c544c1ce&pid=1-s2.0-S2772724624000520-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142040036","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}