Journal of substance use and addiction treatment最新文献

{"title":"Pharmacological treatments for co-occurring PTSD and substance use disorders: A systematic review","authors":"Megan Swannell ,&nbsp;Richard C.J. Bradlow ,&nbsp;Daniel Pham ,&nbsp;Jessica Gabriel ,&nbsp;Yasmin Manahan ,&nbsp;Shalini Arunogiri","doi":"10.1016/j.josat.2024.209601","DOIUrl":"10.1016/j.josat.2024.209601","url":null,"abstract":"<div><h3>Introduction</h3><div>Post-traumatic stress disorder and substance use disorders commonly co-occur and are associated with worse health outcomes. Currently, only psychosocial therapies are specifically recommended for use in the co-occurring population, but these come with numerous barriers to access and engagement. This study aims to identify potential pharmacological treatments to enhance treatment options and outcomes for this population.</div></div><div><h3>Methods</h3><div>This systematic review identified studies on pharmacological treatment of co-occurring PTSD and SUD in humans, using validated outcome measurements, with study design of RCT, observational study, case control study or cohort study.</div></div><div><h3>Results</h3><div>29 studies were identified for inclusion, looking at a range of 16 pharmacotherapies. A majority concentrated on alcohol use disorders and males, with many focused on the veteran population.</div></div><div><h3>Conclusions</h3><div>This is an area for further research, inclusive of more SUDs, genders and civilians. Future studies utilizing consistent dosing, populations and measurement outcomes will allow for future meta-analysis.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"169 ","pages":"Article 209601"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822763","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":"Exploring heterogeneity in recovery from substance use disorder following mindfulness-based relapse prevention: A latent profile analysis","authors":"David I.K. Moniz-Lewis ,&nbsp;Katie Witkiewitz","doi":"10.1016/j.josat.2024.209537","DOIUrl":"10.1016/j.josat.2024.209537","url":null,"abstract":"<div><h3>Introduction</h3><div>Substance use disorder (SUD) recovery is heterogeneous. Yet, over the last 50 years, substance use treatment providers and researchers have often defined success as sustained abstinence from substance use. An often overlooked but equally valid pathway to recovery for persons with SUD is non-abstinent recovery. However, most of the literature on non-abstinent recovery exists for individuals with alcohol use disorder (AUD) with few studies of non-abstinent recovery for other types of SUD. Literature exploring the mechanisms that lead to non-abstinent recovery is also lacking. As such, the current study aimed to examine recovery profiles for individuals (<em>N</em> = 454) recruited in two randomized clinical trials comparing mindfulness-based relapse prevention with cognitive-behavioral relapse prevention and/or treatment as usual.</div></div><div><h3>Methods</h3><div>Latent profile analysis empirically derived profiles of recovery following outpatient aftercare SUD treatment. Multinomial logistic regression examined associations between treatment assignment and recovery profile, including potential psychological mediators (e.g., mindfulness) and contextual moderators (e.g., annual household income).</div></div><div><h3>Results</h3><div>Analyses supported four recovery profiles: (1) low-functioning frequent substance use; (2) low-functioning infrequent substance use; (3) high-functioning frequent substance use; (4) high-functioning infrequent substance use. There were no significant interaction effects of race or ethnicity by treatment type, or household income by treatment type, in predicting recovery profiles. Trait mindfulness, craving, and psychological flexibility failed to mediate the association between treatment assignment and recovery profile; however, there were statistically significant differences in trait mindfulness with individuals expected to be classified in the low-functioning infrequent substance use profile showing significantly lower levels of trait mindfulness compared to individuals in the two high-functioning profiles.</div></div><div><h3>Conclusions</h3><div>Findings suggest that recovery from SUD is heterogeneous, and profiles of recovery based on dimensions of substance use and functioning can be identified across a variety of SUD, including among people with co-occurring SUD. Additionally, trait mindfulness appears to be a differentiating factor across recovery profiles. Further research is needed to explore how psychological and social factors may moderate and influence both abstinent and non-abstinent forms of recovery.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"169 ","pages":"Article 209537"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402230","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":"Vortioxetine improves illness severity for cannabis users with anxiety and depressive symptoms in a 6-month randomized controlled study","authors":"Albert Kar Kin Chung,&nbsp;Cheuk Yin Tse,&nbsp;Gladys Kwan Yin Yeung,&nbsp;Sau Wan Tang,&nbsp;Wing-Man Chan,&nbsp;Johnson Kai Chun Law","doi":"10.1016/j.josat.2024.209607","DOIUrl":"10.1016/j.josat.2024.209607","url":null,"abstract":"<div><h3>Introduction</h3><div>Cannabis use and misuse have mental health implications, particularly affecting mood and anxiety symptoms. Vortioxetine, a potent serotonin partial agonist/antagonist reuptake inhibitor antidepressant, has well-established effects in treating depressive and anxiety disorders and may serve as a potential treatment for individuals with cannabis use disorder and comorbid mood symptoms. In the current study, we aimed to investigate the efficacy of vortioxetine for cannabis users with anxiety and depressive symptoms alongside their cannabis dependence.</div></div><div><h3>Methods</h3><div>This 6-month prospective, randomized controlled interventional pilot study investigated if vortioxetine could improve cannabis dependence, comorbid anxiety and/or depressive symptoms, and cognitive and functional outcomes in individuals using cannabis. Participants were randomized to receive either vortioxetine (<em>N</em> = 11) or standard treatment (<em>N</em> = 19).</div></div><div><h3>Results</h3><div>Participants taking vortioxetine (mean dose 10 mg/day) showed significant improvement on clinician-observed overall mood states over time (<em>p</em> &lt; .05) but not on their self-reported anxiety or depressive symptoms. Cannabis users receiving standard treatment did not exhibit similar improvement. No significant differences were found on cannabis dependence, cognition and functional outcomes between the two groups otherwise.</div></div><div><h3>Conclusions</h3><div>The results suggest that the multimodal antidepressant vortioxetine may benefit cannabis users with depressive and anxiety symptoms in ameliorating their overall mood state.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"169 ","pages":"Article 209607"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822767","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":"Gaps in smoking cessation counseling administered by healthcare providers to BIPOC gay men who smoke daily in the U.S.","authors":"Natalie Kelley ,&nbsp;Dale Dagar Maglalang ,&nbsp;Riley Suh ,&nbsp;Mariel S. Bello ,&nbsp;Cora de Leon ,&nbsp;Ethan Moitra ,&nbsp;Jasjit S. Ahluwalia","doi":"10.1016/j.josat.2024.209590","DOIUrl":"10.1016/j.josat.2024.209590","url":null,"abstract":"<div><h3>Background</h3><div>Black, Indigenous, and People of Color (BIPOC) racial/ethnic groups, sexual minorities (SM), and men have higher odds of smoking, less access to smoking cessation education and services, and lower smoking cessation rates than their white, heterosexual, and women counterparts. The purpose of this study is to examine the experiences of BIPOC gay men in accessing smoking cessation counseling from their healthcare providers and understand the facilitators and barriers to smoking cessation.</div></div><div><h3>Methods</h3><div>This study analyzed data from BIPOC gay men who smoke daily via social media and organizational listservs throughout the United States and conducted semi-structured individual qualitative interviews. Two trained coders used thematic analysis to analyze the data.</div></div><div><h3>Results</h3><div>Findings identified three overarching themes: 1) Sources of Information, 2) Facilitators and Barriers, and 3) Areas of Improvement for Smoking Cessation Counseling. Participants reported trusting advice from community members over healthcare providers regarding smoking cessation counseling. They also felt that the smoking cessation advice received from healthcare providers was, at times, confusing and inadequate. Identity concordance between patient and healthcare provider helped participants feel seen by their provider, which motivated them to engage in smoking cessation counseling. Finally, participants suggested improvements for smoking cessation counseling for BIPOC gay men such as integrating mental health support in smoking cessation services, accountability for patients, and providing harm reduction alternatives instead of smoking cessation only.</div></div><div><h3>Conclusion</h3><div>BIPOC gay men who smoke daily value the importance of receiving culturally adaptive and gender-affirming care from healthcare providers who share their identities when receiving smoking cessation and harm reduction counseling.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"169 ","pages":"Article 209590"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775092","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":"Effects of optimism and stage of change on alcohol use and problems among sexual minority men with HIV participating in a brief motivational interviewing intervention","authors":"Benjamin L. Berey ,&nbsp;Nadine R. Mastroleo ,&nbsp;David W. Pantalone ,&nbsp;Kenneth H. Mayer ,&nbsp;Peter M. Monti ,&nbsp;Christopher W. Kahler","doi":"10.1016/j.josat.2024.209599","DOIUrl":"10.1016/j.josat.2024.209599","url":null,"abstract":"<div><h3>Introduction</h3><div>Disseminating effective alcohol interventions for sexual minority men (SMM) with HIV remains a crucial public health endeavor. Motivational interviewing (MI) interventions are an established approach to reducing alcohol use, yet more research is needed to determine predictors of MI treatment outcomes and underlying mechanisms related to sustained behavior change among SMM with HIV. This pre-registered secondary analysis tested whether action-related stage of change mediated effects of a MI intervention on future alcohol use and problems among SMM with HIV, and whether individual differences in trait optimism moderated these associations.</div></div><div><h3>Methods</h3><div>SMM with HIV who engaged in frequent alcohol use (<em>N</em> = 180) were randomized to MI or assessment-only treatment as usual (TAU). Participants completed a semi-structured Timeline Follow-Back interview to measure past-month alcohol use as well as self-reports assessing stage of change, trait optimism, and alcohol problems at baseline and 3- and 12-months post-baseline.</div></div><div><h3>Results</h3><div>Structural equation models controlling for baseline alcohol use and stage of change indicated that 3-month action significantly mediated effects of MI on 12-month drinks per week. Likewise, the indirect effect of 3-month action was moderated by higher levels of trait optimism. When employment status, education level, and annual family/household income were included as covariates in the model, being employed significantly predicted 12-month alcohol use, and mediation and moderated mediation effects were no longer statistically significant. Stage of change did not mediate effects of MI on 12-month alcohol problems, and this indirect effect was not moderated by trait optimism.</div></div><div><h3>Conclusions</h3><div>The present study provides further evidence supporting action-related stage of change as a mechanism linking MI to alcohol use reductions. Results demonstrated that SMM with HIV who were more optimistic tended to take more action towards reducing their alcohol use and suggest that MI-based interventions may benefit from integrating components aimed at augmenting patients' optimism. Yet, covarying for current economic status substantially impacted findings and underscores the need to critically consider how broader socioecological contexts can impact treatment outcomes.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"169 ","pages":"Article 209599"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822622","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":"Quit attempts, use of smoking cessation treatments and quitting intention among treatment seekers in rural areas","authors":"Weijia Li ,&nbsp;Christine L. Paul ,&nbsp;Amanda L. Baker ,&nbsp;Judith Byaruhanga ,&nbsp;Jason Dizon ,&nbsp;Simon Chiu ,&nbsp;Flora Tzelepis","doi":"10.1016/j.josat.2024.209603","DOIUrl":"10.1016/j.josat.2024.209603","url":null,"abstract":"<div><h3>Introduction</h3><div>Rural populations have higher rates of tobacco use but are less likely to use evidence-based smoking cessation treatments than urban residents. There is limited evidence on the use of smoking cessation treatments and the factors associated with their use in rural populations. This study explored quit attempts, use of smoking cessation treatments, quitting intention and associated factors among rural residents seeking smoking cessation treatment.</div></div><div><h3>Methods</h3><div>Participants were adult rural or remote residents of New South Wales, Australia who enrolled in a randomized trial of smoking cessation treatment (<em>n</em> = 1244). Participants completed an online baseline survey assessing quit attempts, quitting intention, and prior use of smoking cessation treatments. Multivariable logistic regressions that adjusted for other variables examined associations and derived odds ratios.</div></div><div><h3>Results</h3><div>Almost half (48.3 %) of participants made a quit attempt in the last 12 months, and 44.6 % intended to quit in the next 30 days. Women (OR = 0.74, 95 % CI 0.56–0.99), Australian-born participants (OR = 0.67, 95 % CI 0.45–0.99) and those with moderate (OR = 0.53, 95 % CI 0.40–0.71) or high (OR = 0.42, 95 % CI 0.28–0.63) nicotine dependence had significantly lower odds of making a quit attempt in the last 12 months. Among participants who had ever made a quit attempt, most had used pharmacotherapies (82.2 %) or behavioral interventions (68.3 %) during any quit attempt. Participants with moderate (OR = 1.96, 95 % CI 1.37–2.79) or high (OR = 3.27, 95 % CI 1.66–6.45) nicotine dependence and chronic conditions (OR = 1.45, 95 % CI 1.00–2.11) had significantly greater odds of pharmacotherapy use while those who drank alcohol daily or almost daily (OR = 0.46, 95 % CI 0.26–0.81) had significantly lower odds of pharmacotherapy use. Those with moderate (OR = 1.38, 95 % CI 1.02–1.87) or high (OR = 3.31, 95 % CI 1.94–5.66) nicotine dependence, university education (OR = 1.47, 95 % CI 1.04–2.07), moderate (OR = 1.63, 95 % CI 1.19–2.22) or high (OR = 1.73, 95 % CI 1.12–2.68) financial stress, and anxiety (OR = 1.61, 95 % CI 1.16–2.22) had significantly greater odds of using behavioral treatments whereas those with depression (OR = 0.66, 95 % CI 0.47–0.92) had significantly lower odds.</div></div><div><h3>Conclusions</h3><div>Some sub-groups had lower odds of using smoking cessation treatments. Understanding if particular barriers hinder use of smoking cessation treatments among certain sub-groups of rural residents is needed.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"169 ","pages":"Article 209603"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822688","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":"Just an unfair score: Perceptions of gender inequity in the treatment of substance use disorders among women involved in the criminal legal system","authors":"A.A. Jones ,&nbsp;K. Brant ,&nbsp;R.E. Bishop ,&nbsp;S. Strong-Jones ,&nbsp;D.A. Kreager","doi":"10.1016/j.josat.2024.209587","DOIUrl":"10.1016/j.josat.2024.209587","url":null,"abstract":"<div><h3>Introduction</h3><div>Increasing overdose deaths and criminal legal involvement among women necessitate women-specific solutions to curb the adverse consequences of substance use disorders (SUDs). The current study is the pre-implementation phase of an implementation science study that works with various stakeholders—affected women, criminal legal professionals, and SUD treatment professionals—to identify and address high-priority needs for criminal-legal involved women with SUDs.</div></div><div><h3>Methods</h3><div>This study uses semi-structured interviews (<em>N</em> = 42) administered in 2022 to women with a history of SUD and criminal legal involvement (<em>n</em> = 20), SUD treatment professionals (<em>n</em> = 12), and criminal legal professionals (<em>n</em> = 10). Interviews focused on participants' history of substance use and criminal legal involvement, facilitators and barriers to initiating and completing treatment, and gender-specific issues encountered during treatment and criminal legal involvement. Drawing on the social ecological model of health, analyses identified gender-specific challenges impacting criminal-legal involved women's treatment and recovery processes.</div></div><div><h3>Results</h3><div>Participants identified five gender-specific challenges impacting women across social ecological levels. At the relational level, challenges stemmed from women's roles as mothers and from victimization within healthcare and criminal legal settings; at the community level, from unequal resource allocation for treatment; and at the societal level, from stigma associated with certain intersectional identities and cultural norms that constrict job opportunities. Participants noted that providing women with effective care coordination and women-specific guidelines and spaces within the criminal-legal system could mitigate some of these challenges.</div></div><div><h3>Discussion</h3><div>Findings highlight the need to consider gender-specific challenges faced across relational, community, and societal levels when implementing medical interventions and criminal legal proceedings for women. Given these findings and extant literature, the authors are developing an all-female, trauma-informed intervention that includes case management with female certified recovery specialists who are in recovery and have navigated the criminal legal system. By reducing some of the gender-specific barriers identified in this study, this future intervention aims to improve the substance use and criminal legal outcomes of participating women.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"169 ","pages":"Article 209587"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775039","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(24)00307-2","DOIUrl":"10.1016/S2949-8759(24)00307-2","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"169 ","pages":"Article 209595"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143163596","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":"Redefining low-threshold buprenorphine access in an integrated mobile clinic program: Factors associated with treatment retention","authors":"Robert Harris ,&nbsp;Norberth Stracker ,&nbsp;Molly Rice ,&nbsp;Anne St. Clair ,&nbsp;Kathleen Page ,&nbsp;Amanda Rosecrans","doi":"10.1016/j.josat.2024.209586","DOIUrl":"10.1016/j.josat.2024.209586","url":null,"abstract":"<div><h3>Introduction</h3><div>The Spot mobile clinic provides low-threshold buprenorphine integrated with clinical and social services in Baltimore City, MD. In 2021, The Spot modified practices to improve engagement including providing extended prescriptions, reducing frequency of toxicology testing, giving up to six months to stabilize on medication, offering maximum doses (up to 32 mg total) daily, and utilizing telemedicine. This study characterizes care retention by examining both the total time in care and the percentage of time with buprenorphine prescription coverage during these practice changes, and examines factors associated with retention.</div></div><div><h3>Methods</h3><div>This retrospective cohort study includes patients (<em>n</em> = 341) who received a buprenorphine prescription who initiated care on The Spot mobile clinic from September 2021 to October 2022, with follow-up through October 2023. We utilized the Cox proportional hazards model and Kaplan-Meier survival analyses to assess differences in care retention by the factors of patient demographics and clinical characteristics. Additionally, we performed sensitivity analyses using Poisson regression to examine differences between patients with 80 % or greater time with active prescription coverage versus &lt;80 % of time with active prescription coverage.</div></div><div><h3>Results</h3><div>After practice setting changes, retention in care at 90 days was 60 %. Patients whose maximum daily buprenorphine dose was 28 to 32 mg were 80 % less likely to discontinue treatment over the study period than those prescribed ≤16 mg (adjusted hazard ratio of discontinuation: 0.2 [95 % CI: 0.1–0.3]). Engaging in wound care or hepatitis C treatment was associated with higher retention in care, and individuals experiencing homelessness remained engaged at rates comparable to stably housed patients.</div></div><div><h3>Conclusion</h3><div>Practice changes aimed to improve access to patient-centered, low-threshold buprenorphine treatment may increase retention in care. Notably, higher doses of buprenorphine and integrated treatment with wound care and hepatitis C treatment were associated with increased retention. Due to gaps in patient care, retention metrics should incorporate total time in care as well as percentage of time with an active buprenorphine prescription.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"169 ","pages":"Article 209586"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775069","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":"Implementation of medications for opioid use disorder in U.S. emergency departments: A systematic review","authors":"Sarah E. Philbin ,&nbsp;Alexandra Harris ,&nbsp;Salva Balbale ,&nbsp;Lucy Bilaver ,&nbsp;Molly Beestrum ,&nbsp;Megan McHugh","doi":"10.1016/j.josat.2024.209600","DOIUrl":"10.1016/j.josat.2024.209600","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with opioid use disorder (OUD) experiencing withdrawal or nonfatal overdose often present to emergency departments (EDs). While professional societies endorse the initiation of evidence-based medications for OUD (MOUD) in the ED, low uptake persists. The purpose of this systematic review is to synthesize what is known about implementation of MOUD in EDs and to identify potential strategies to improve the uptake of MOUD in the ED.</div></div><div><h3>Methods</h3><div>We reviewed articles that examined implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, penetration, sustainability, and cost) of MOUD in United States EDs. Peer-reviewed studies that used quantitative, qualitative, or mixed methods approaches were eligible for inclusion.</div></div><div><h3>Results</h3><div>Twenty-seven articles met the inclusion criteria for one or more implementation outcomes. Forty-four percent (<em>n</em> = 11) reported on acceptability, 78 % (<em>n</em> = 21) reported on adoption, 26 % (<em>n</em> = 7) reported on appropriateness, and 15 % (<em>n</em> = 4) reported on feasibility. Eleven percent (<em>n</em> = 3) reported on fidelity, 7 % (n = 2) reported on penetration, and 7 % (n = 2) reported on sustainability. No articles reported on implementation cost. While physicians found MOUD acceptable, their comfort levels with the intervention varied. Rates of MOUD adoption were often low, but uptake may be facilitated by implementation strategies. MOUD may constrain ED time resources and exacerbate overcrowding, hindering appropriateness.</div></div><div><h3>Conclusion</h3><div>Results suggest that ED physicians and administrators have encountered barriers to the initiation of MOUD. There may be opportunities to overcome these implementation barriers using multi-component strategies consisting of educational interventions that address safety and monitoring and process interventions, such as clinical decision support systems.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"169 ","pages":"Article 209600"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824970","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}