Journal of substance use and addiction treatment最新文献

{"title":"I will always be a mother. Now, I am an advocate","authors":"Amy Bogert,&nbsp;Jack J. Lu","doi":"10.1016/j.josat.2025.209724","DOIUrl":"10.1016/j.josat.2025.209724","url":null,"abstract":"<div><h3>Background</h3><div>Mason Bogert lived a brilliant life. His struggle with co-occurring substance use and mental health conditions culminated into lifelong paths of recovery for him and his mother, Amy Bogert.</div></div><div><h3>Methods</h3><div>Amy shares her lived experience as Mason's parent and caregiver alongside a national context of youth co-occurring disorder prevalence and resulting effects. Best practice and evidence-based strategies are identified, such as family involvement, integrated treatment, and youth-empowered community level prevention.</div></div><div><h3>Results</h3><div>Presently, Amy focuses on advocacy for youth co-occurring and substance use care across a continuum of prevention, integrated treatment, and recovery services. Amy's deepest hope is that youth, like Mason, and their loved ones experience less isolation and more opportunities in preventing the progression of co-occurring and substance use disorders.</div></div><div><h3>Conclusions</h3><div>Evidence-based youth co-occurring prevention and integrated treatment services are essential for youth and their families.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"175 ","pages":"Article 209724"},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167424","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":"TOC (update)","authors":"","doi":"10.1016/S2949-8759(25)00093-1","DOIUrl":"10.1016/S2949-8759(25)00093-1","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"173 ","pages":"Article 209714"},"PeriodicalIF":0.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932129","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":"C2: editorial board","authors":"","doi":"10.1016/S2949-8759(25)00092-X","DOIUrl":"10.1016/S2949-8759(25)00092-X","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"173 ","pages":"Article 209713"},"PeriodicalIF":0.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932128","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":"Counseling as a complement to buprenorphine treatment for opioid use disorder: A retrospective observational study of patient outcomes","authors":"Tianjie Zhu ,&nbsp;Md. Noor-E-Alam ,&nbsp;Md Mahmudul Hasan ,&nbsp;Leonard D. Young ,&nbsp;Gary J. Young","doi":"10.1016/j.josat.2025.209719","DOIUrl":"10.1016/j.josat.2025.209719","url":null,"abstract":"<div><h3>Introduction</h3><div>This study investigated the clinical benefit of counseling as a complement to buprenorphine treatment for opioid use disorder (OUD). The research addresses a critical gap in understanding whether counseling, when received concurrently with buprenorphine, can enhance patient outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using data from the Massachusetts Department of Public Health's Public Health Data Warehouse (PHD). The study included patients who initiated buprenorphine treatment between January 2015 and December 2019. Investigators measured outcomes including medication adherence, treatment discontinuation, and opioid-related overdose over a 12-month period. We evaluated the effectiveness of counseling based on whether patients attended a minimum of three sessions in the first three months of buprenorphine treatment. We employed multivariate logistic regression and propensity score matching to analyze the data.</div></div><div><h3>Results</h3><div>The study sample comprised 32,688 patients with 8871 (27 %) receiving counseling concomitantly with buprenorphine. Results from the regression analyses showed that counseling was associated with 17 % lower likelihood of poor medication continuity (OR = 0.83, 95 % CI = 0.78–0.87) and 21 % lower likelihood of treatment discontinuation (OR = 0.79, 95 % CI = 0.75–0.83). Counseling was not associated with the odds of opioid-related overdose. Additional results from sensitivity analyses pointed to a dose-response relationship for counseling within the parameters studied.</div></div><div><h3>Conclusions</h3><div>Findings suggest that counseling, when combined with buprenorphine treatment for OUD is associated with better patient outcomes in terms of medication continuity and treatment retention. However, the impact of counseling on opioid-related overdose risk was inconclusive, highlighting the need for further research to understand its role in overdose prevention.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"175 ","pages":"Article 209719"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043370","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":"Relationship between opioid use disorder during pregnancy, delivery-related outcomes, and healthcare utilization in Michigan Medicaid, 2012–2021","authors":"Clayton J. Shuman ,&nbsp;Xiaosong Zhang ,&nbsp;Stephanie V. Hall ,&nbsp;Anca Tilea ,&nbsp;Sarah J. Clark ,&nbsp;Ashlee J. Vance ,&nbsp;Anna Courant ,&nbsp;Kara Zivin","doi":"10.1016/j.josat.2025.209720","DOIUrl":"10.1016/j.josat.2025.209720","url":null,"abstract":"<div><h3>Introduction</h3><div>Pregnant individuals with opioid use disorder (OUD) deliver &gt;20,000 infants annually in the United States, with serious health consequences for perinatal individuals and their infants. This study compares delivery-related outcomes and healthcare utilization among Michigan Medicaid-enrolled perinatal individuals with and without an OUD diagnosis.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study among Michigan Medicaid enrollees aged 15–44 who delivered a live infant between 2012 and 2021.</div></div><div><h3>Results</h3><div>The cohort included 218,890 deliveries among 170,002 individuals enrolled continuously in Michigan Medicaid for nine months before delivery and up to three months postpartum. Of those, 3.26 % had an OUD diagnosis during this analytic period. Perinatal individuals with OUD identified primarily as White (82.9 %), lived in urban areas (77.2 %), and had a lower income (68.6 %). Among individuals with OUD, 31 % had another behavioral health diagnosis and 55.1 % received a prescription for a psychotropic medication. Of those with OUD, 47.4 % received a prescription for medication for OUD. Deliveries with OUD versus without OUD had a lower probability of cesarean delivery (aOR = 0.89) but higher odds of preterm delivery (aOR = 1.31). Those with OUD had higher likelihood of ambulatory (aOR = 1.99), ED/observational (aOR = 1.19), psychotherapy (aOR = 5.48), and substance use disorder care (aOR = 27.05) visits than those without OUD.</div></div><div><h3>Conclusions</h3><div>Medicaid-enrolled perinatal individuals in Michigan with OUD had higher rates of preterm birth and healthcare utilization compared to those without OUD. Clinicians and policymakers should target early detection and tailored, coordinated treatment to better address the needs of these individuals.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"175 ","pages":"Article 209720"},"PeriodicalIF":0.0,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906110","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":"Role of ketamine in the treatment of substance use disorders: A systematic review","authors":"Reinhard Janssen-Aguilar ,&nbsp;Shakila Meshkat ,&nbsp;Ilya Demchenko ,&nbsp;Yanbo Zhang ,&nbsp;Andrew Greenshaw ,&nbsp;Walter Dunn ,&nbsp;Robert Tanguay ,&nbsp;Leah M. Mayo ,&nbsp;Jennifer Swainson ,&nbsp;Rakesh Jetly ,&nbsp;Venkat Bhat","doi":"10.1016/j.josat.2025.209705","DOIUrl":"10.1016/j.josat.2025.209705","url":null,"abstract":"<div><h3>Background and aims</h3><div>Substance Use Disorders (SUDs) involve diminished control, risky use, impaired social interactions, and physical dependence. Despite their global prevalence and burden, treatment options remain limited. Ketamine (KET), an NMDA receptor antagonist, may aid SUD treatment by modulating glutamatergic neurotransmission. This systematic review evaluates KET's role in SUD treatment.</div></div><div><h3>Methods</h3><div>This review surveyed three databases until June 2024, including 14 studies with 551 participants.</div></div><div><h3>Results</h3><div>Among the 14 studies, 6 focused on alcohol, 3 on cocaine, 4 on opioids, and 1 on cannabis. Seven studies (50 %) combined KET with psychotherapy, while seven (50 %) focused solely on KET's pharmacological effects. KET dose ranges varied from 0.11 mg/kg to 2.0 mg/kg and study primary endpoints ranged from less than a day to two years. The results of the included studies demonstrated KET's efficacy across various SUDs. In Alcohol Use Disorder (AUD), KET reduced withdrawal symptoms and benzodiazepine requirements. In Cocaine Use Disorder (CUD), KET decreased craving and increased abstinence rates. In Opioid Use Disorder (OUD), high-dose KET psychotherapy (KPT) improved abstinence and reduced craving. In Cannabis Use Disorder (CNUD), KET reduced weekly use and increased abstinence confidence.</div></div><div><h3>Conclusions</h3><div>Conclusion: While preliminary studies suggest that KET may have short-term benefits in treating SUDs, the evidence remains limited by small sample sizes and a lack of randomized trials. Further research with larger, well-controlled studies is needed to determine optimal dosing, clarify mechanisms of action, and assess long-term efficacy and potential risks, including abuse liability, before broader clinical implementation can be recommended.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"175 ","pages":"Article 209705"},"PeriodicalIF":0.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying emergency department patients at high risk for opioid overdose using natural language processing and machine learning","authors":"Amanda Sharp ,&nbsp;Gareth J. Parry ,&nbsp;Gabriel Ríos Pérez ,&nbsp;Brian O. Mullin ,&nbsp;Xinyu Yang ,&nbsp;Anika Kumar ,&nbsp;Timothy Creedon ,&nbsp;Michael Flores ,&nbsp;Christopher M. Fischer ,&nbsp;Zev Schuman-Olivier ,&nbsp;Margo Moyer ,&nbsp;Nathaniel M. Tran ,&nbsp;Benjamin L. Cook","doi":"10.1016/j.josat.2025.209718","DOIUrl":"10.1016/j.josat.2025.209718","url":null,"abstract":"<div><h3>Introduction</h3><div>Emergency departments (ED) are potential sites for identifying and treating individuals at high risk for opioid overdose. This study used machine learning (ML)-based models to predict opioid overdose death in the 12 months after an ED visit.</div></div><div><h3>Methods</h3><div>The study merged electronic health records (EHR), including clinical notes, of adult patients admitted to an urban safety net ED from 2011 to 2018 with opioid overdose-related mortality tables from 2012 to 2019. The sample includes all patients who experienced an opioid overdose related death (<em>n</em> = 729) and a subset of ED patients that did not (<em>n</em> = 4927). A mutual information classification algorithm was employed for feature selection. Predictive XGBoost, random forest, and regression models trained on 70 % of the sample with the reduced feature matrix and validated on a test set (30 % of sample).</div></div><div><h3>Results</h3><div>Feature selection reduced the feature matrix from 1336 to 50 features, with 37 originating from EHR clinical notes. Using a probability of &gt;0.5 as a predictor of opioid overdose death, all models demonstrated satisfactory calibration and excellent accuracy, precision, and recall across all models (averaging 92 % accuracy, 75 % precision and 57 % recall).</div></div><div><h3>Conclusion</h3><div>ML algorithms based on structured and unstructured EHR can successfully classify patients at risk of fatal opioid overdose. Prospectively, these tools can be used to identify patients that may benefit from interventions to reduce their risk of opioid overdose death. The development of these predictive models may improve the timeliness and efficacy of clinical decision making and ED-initiated services for opioid use disorders.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"175 ","pages":"Article 209718"},"PeriodicalIF":0.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929639","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":"Missouri naloxone distribution 2017–2023: Evaluation and implications of applying a naloxone saturation model","authors":"Kyle Vance B.A. ,&nbsp;Brandon Park B.A. ,&nbsp;Rithvik Kondai B.A. ,&nbsp;Lauren Green MSW ,&nbsp;Traci C. Green Ph.D. ,&nbsp;Brandon D.L. Marshall Ph.D. ,&nbsp;Rachel P. Winograd Ph.D.","doi":"10.1016/j.josat.2025.209708","DOIUrl":"10.1016/j.josat.2025.209708","url":null,"abstract":"<div><h3>Introduction</h3><div>Overdose deaths have increased sharply in the past five years. States have implemented overdose education and naloxone distribution (OEND) initiatives to mitigate overdose deaths at a population level. <span><span>Irvine et al. (2022)</span></span> proposed a model to estimate amounts of naloxone needed to meaningfully reduce opioid overdose mortality (defined as naloxone saturation) by distributing it through: 1) community-based, 2) pharmacy-initiated, and 3) provider-based access points. In the most recent rounds of State Opioid Response grant applications, the Substance Abuse and Mental Health Services Administration (SAMHSA) required plans to reach naloxone saturation. Though SAMHSA funding has supported the growth of Missouri-based OEND, the outcomes of applying such a model are yet to be evaluated.</div></div><div><h3>Methods</h3><div>We used descriptive statistics and visual inspection to evaluate Missouri's naloxone distribution across agency types and years. Missouri's naloxone output was compared to observed opioid overdose fatalities and the naloxone need estimated by the model, which was at least 31,000 two-dose kits distributed through community-based settings to reach saturation.</div></div><div><h3>Results</h3><div>Missouri distributed over 400,000 naloxone kits from 2017 to 2023. In 2021, Missouri distributed 32,486 kits, passing the annual saturation threshold. Overall, street outreach/harm reduction services received the most naloxone (38.9 %), followed by treatment providers (13.6 %), recovery community centers (12.6 %), and social service providers (11.6 %). Missouri's opioid overdose death rate slowed in 2022 and began to discernibly decrease in 2023.</div></div><div><h3>Conclusions</h3><div>Missouri's naloxone distribution exceeded established saturation targets and evolved to include a wide variety of community access points, eventually coinciding with opioid overdose mortality reductions. Given the significant variability in overdose risk across populations and regions, the increasingly potent and volatile drug supply emerging since 2017, and the persistent risk of solitary drug use, more comprehensive response strategies are needed and saturation models should be updated to incorporate more specific geographic, racial/ethnic, and programmatic distribution targets.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"174 ","pages":"Article 209708"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906561","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":"Use of harm reduction practices by state-licensed specialty substance use treatment programs","authors":"Isha K. Desai ,&nbsp;Kathryn Burke ,&nbsp;Yuzhong Li ,&nbsp;Valerie Ganetsky ,&nbsp;Olivia K. Sugarman ,&nbsp;Noa Krawczyk ,&nbsp;Kenneth A. Feder","doi":"10.1016/j.josat.2025.209711","DOIUrl":"10.1016/j.josat.2025.209711","url":null,"abstract":"<div><h3>Introduction</h3><div>Specialty substance use treatment programs may adopt harm reduction practices to protect the health of their patients with opioid use disorder (OUD). Two such harm reduction strategies are distributing naloxone to clients and refraining from discharging clients if they have positive urine drug screens for drugs. The purpose of this study was to understand the prevalence of programs that adopt each of these harm reduction practices and the characteristics of clients attending programs that adopt both practices in a sample of state-licensed substance use treatment programs in New Jersey.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional survey of specialty treatment programs in New Jersey about a) naloxone dispensing and b) use of urine toxicology screens in client discharge decisions. We linked this survey to the treatment programs' administrative records of client admissions for OUD treatment between July 2021 to June 2022 (<em>n</em> = 14,838). We estimated the proportion of programs that reported that they adopted each practice. We then examined program and client characteristics associated with applying these harm reduction practices using regression methods.</div></div><div><h3>Results</h3><div>Of 108 programs included in this analysis, 55.6 % dispensed naloxone and 50.9 % did not consider toxicology screens in discharge decisions. Opioid treatment programs (OTP) were significantly more likely to adopt both harm reduction practices than non-OTPs. Clients referred by correctional programs, as opposed to self-referred to treatment, were significantly less likely to attend a program that used either harm reduction practice.</div></div><div><h3>Conclusions</h3><div>Our findings suggest efforts are needed to increase adoption of harm reduction practices in SUD treatment settings, especially that are not OTPs, and programs serving clients referred by the criminal justice system.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"174 ","pages":"Article 209711"},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887697","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":"Perspectives of treatment providers overseeing substance use disorder treatment among transition-age adults, aged 18–25 years","authors":"Josh Aleksanyan ,&nbsp;Zobaida Maria ,&nbsp;Diego Renteria ,&nbsp;Adetayo Fawole ,&nbsp;Ashly E. Jordan ,&nbsp;Vanessa Drury ,&nbsp;Sam Kowala ,&nbsp;Jamie del Rosario ,&nbsp;Patricia Lincourt ,&nbsp;Maria L. Morris-Grove ,&nbsp;Sueun Hong ,&nbsp;Sugy Choi ,&nbsp;Charles J. Neighbors","doi":"10.1016/j.josat.2025.209704","DOIUrl":"10.1016/j.josat.2025.209704","url":null,"abstract":"<div><h3>Introduction</h3><div>Transition-age (TA) adults, aged 18–25, have the highest prevalence of substance use disorder (SUD) among all age groups yet they are less likely to seek treatment and more likely to discontinue it than older adults, making them a high-priority treatment population. While structural barriers and varying expectations of recovery may affect treatment initiation, insights from providers working with TA adults can reveal what further impels and impedes treatment engagement.</div></div><div><h3>Methods</h3><div>We conducted two focus groups with 14 front-line treatment providers, representing urban and rural outpatient, residential, and inpatient SUD care settings across New York State. Providers were selected through stratified sampling using restricted-access treatment registry data. A semi-structured interview guide facilitated discussions, and transcripts were analyzed to identify key themes.</div></div><div><h3>Results</h3><div>Providers report that TA adults prefer briefer, innovative treatment approaches over traditional modalities like A.A./12-step recovery, driven by a desire to rebuild their lives through education and career. Post-pandemic social disruptions were cited as exacerbating engagement challenges and increasing the need for integrating mental health support. Providers highlighted the potential of technology to enhance treatment engagement, though expressed concerns regarding social isolation and the fraying of childhood safety nets and support systems (e.g., housing) undermining successful treatment outcomes and transitions to adulthood more broadly.</div></div><div><h3>Conclusions</h3><div>Providers report and perceive various challenges—unmet mental health needs, social alienation, and housing insecurity—that impede TA adults from successful SUD treatment. Understanding providers' perceptions of the needs of young adults can inform patient and clinical decision-making, lead to the development of innovative treatment approaches tailored to TA adults and contribute to improved health outcomes over the life course.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"174 ","pages":"Article 209704"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906560","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}