American Journal on Addictions最新文献

{"title":"Cannabis involvement in posttraumatic stress disorder emergency department visits after cannabis legalization.","authors":"Laurent Perrault-Sequeira, Michael Pugliese, Rachael MacDonald-Spracklin, Jennifer Xiao, Stephen McCarthy, Daniel T Myran","doi":"10.1111/ajad.70014","DOIUrl":"https://doi.org/10.1111/ajad.70014","url":null,"abstract":"<p><strong>Background and objectives: </strong>Individuals with posttraumatic stress disorder (PTSD) have an elevated risk of cannabis use disorder. However, the effect of cannabis legalization on use among individuals with PTSD is unclear. We evaluated changes in cannabis involvement in emergency department (ED) visits for PTSD after medical and nonmedical legalization in Ontario, Canada.</p><p><strong>Methods: </strong>This repeated cross-sectional study used health administrative data to identify all ED visits for PTSD among Ontario residents aged 10-105 between 2008 and 2022 (n = 15.7 million). We identified PTSD ED visits with a co-diagnosis of cannabis (main exposure) or alcohol (control condition) and examined changes across four policy periods (medical legalization with restrictions, expanded medical legalization, nonmedical legalization with restrictions, and nonmedical commercial expansion) using Poisson models.</p><p><strong>Results: </strong>Among 381,450 PTSD ED visits, 4593 (1.29%) co-involved cannabis and 11,625 (3.05%) co-involved alcohol. Rates of cannabis involvement in PTSD ED visits increased by 151% (Incidence Rate Ratio [IRR]: 2.51; 95% CI: 2.24, 2.82) between the first and last policy periods (0.13 vs. 0.33 per 100,000 individuals), while alcohol-involvement increased by 58% (IRR: 1.58; 95% CI: 1.47, 1.68). Cannabis involvement in PTSD ED visits increased steadily over the study period, with no significant association between policy periods and this trend.</p><p><strong>Discussion and conclusions: </strong>Cannabis involvement in PTSD ED visits has increased over time during a period of liberalization of cannabis policy, but may be attributed to increased access and normalization rather than policy changes directly.</p><p><strong>Scientific significance: </strong>Findings underscore the need for improved detection of and targeted interventions for disordered cannabis use among individuals with PTSD in regions with legalized cannabis.</p>","PeriodicalId":7762,"journal":{"name":"American Journal on Addictions","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Series: Magnitude and duration of fentanyl and xylazine detection in the urine of persons with opioid use disorder.","authors":"Helen E Bird, William A Clarke, Craig W Hendrix, Kelly E Dunn, Andrew S Huhn","doi":"10.1111/ajad.70015","DOIUrl":"https://doi.org/10.1111/ajad.70015","url":null,"abstract":"<p><strong>Background/objectives: </strong>The pharmacology of fentanyl and xylazine is not characterized in persons regularly exposed to illicit fentanyl. This case series presents individual-level urine pharmacokinetics of fentanyl, norfentanyl, and xylazine in persons with opioid use disorder (OUD).</p><p><strong>Methods: </strong>Participants (N = 11) provided urine samples (n = 95) for quantitative analysis. Terminal half-lives and predicted detection times were calculated.</p><p><strong>Results: </strong>Urinary half-life ranges were: fentanyl 1.5-28.7 h, norfentanyl 5.2-27.4 h, and xylazine 1.1-25.2 h. Predicted detection window ranges were: fentanyl 13.0-130.9 h (0.5-5.5 days), norfentanyl 64.8-255.9 h (2.7-10.7 days), and xylazine 13.8-123.4 h (0.6-5.1 days).</p><p><strong>Discussion/conclusions: </strong>Persons are presenting with a high magnitude of drug exposure that lends to an extended duration of urinary detection.</p><p><strong>Significance: </strong>First characterization of urinary excretion in persons with OUD.</p>","PeriodicalId":7762,"journal":{"name":"American Journal on Addictions","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 24-year course of substance use disorders in patients with borderline personality disorder and personality-disordered comparison subjects.","authors":"Mary C Zanarini, Christina M Temes, Isabel V Glass, Frances R Frankenburg, Garrett M Fitzmaurice, Brandon T Unruh, Roger D Weiss","doi":"10.1111/ajad.70012","DOIUrl":"https://doi.org/10.1111/ajad.70012","url":null,"abstract":"<p><strong>Background and objectives: </strong>The purpose of this study is to detail the long-term course of substance use disorders (SUDs) among patients with borderline personality disorder (BPD) and subjects with other personality disorders (OPD).</p><p><strong>Methods: </strong>Two hundred and ninety patients with BPD and 72 subjects with OPD were assessed at baseline and 12 contiguous waves of follow-up as part of the McLean Study of Adult Development (MSAD). The SCID-I for DSM-III-R Axis I disorders was administered 13 times (at baseline admission and at 12 follow-up periods). Kaplan-Meier analyses were used to assess time-to-remission (2-12 years in length), time-to-recurrence (2-12 years after first remission), and cumulative time-to-new onsets of alcohol and drug use disorders.</p><p><strong>Results: </strong>Both study groups achieved high rates of remission (ranging from 12-year long to 2-year long) from alcohol use disorder (AUD) (BPD: 64%-91%; OPD: 80%-100%) and drug use disorder (DUD) (BPD: 71%-100%; OPD: 75%-100%). Recurrences (following 12-year long and 2-year long remissions) of AUD (BPD: 24%-63%; OPD: 46%-70%) and DUD (BPD: 28%-67%; OPD: 0%-38%) were not uncommon. Cumulative rates of new onsets during the 24 years of prospective follow-up of AUD (BPD: 5%-27%; OPD: 2%-10%) and DUD (BPD: 5%-21%; OPD: 7%-18%) were less common.</p><p><strong>Discussion and conclusions: </strong>Remissions of alcohol and drug use disorders among borderline patients are very common but recurrences are not uncommon. Results also suggest that new onsets of these disorders are relatively rare.</p><p><strong>Scientific significance: </strong>The course of SUDs in those with BPD is more complex than found in prior shorter-term studies.</p>","PeriodicalId":7762,"journal":{"name":"American Journal on Addictions","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case series: Symptom-inhibited fentanyl induction (SIFI) onto treatment-dose opioid agonist therapy in a community setting.","authors":"Pouya Azar, Jane J Kim, Ruth Davison, Zoran Barazanci, Martha J Ignaszewski, James S H Wong, Jessica Machado, Marianne Harris, Michael Krausz, Nickie Mathew, Andrew Herring, Julio S G Montaner","doi":"10.1111/ajad.70011","DOIUrl":"https://doi.org/10.1111/ajad.70011","url":null,"abstract":"<p><strong>Background and objectives: </strong>Existing opioid agonist therapy (OAT) guidelines are far from sufficient to address rising opioid tolerances and potency of the unregulated opioid market in North America. Inadequate starting doses of OAT are a universally recognized barrier for people who use fentanyl. Our objectives are to present a novel induction protocol called symptom-inhibiting fentanyl induction (SIFI) that uses rapid intravenous fentanyl administration to inhibit symptoms of opioid withdrawal.</p><p><strong>Methods: </strong>We describe two cases highlighting the potential clinical utility of SIFI.</p><p><strong>Results: </strong>This case series demonstrates two safe and successful transitions onto higher-than-standard doses of methadone and slow-release oral morphine harnessing an emerging approach of SIFI in a community clinic setting.</p><p><strong>Discussion and conclusions: </strong>These results support emerging evidence that SIFI is safe and feasible to meet patients' opioid requirements and facilitate rotation onto OAT. Further studies are needed to increase the generalizability of these findings.</p><p><strong>Scientific significance: </strong>Safe transitions onto treatment-dose OAT are of heightened clinical importance at a time when fentanyl and high-potency synthetic opioids are now the norm. SIFI is a novel induction method that could address significant gaps in the currently available OAT options in the fentanyl era.</p>","PeriodicalId":7762,"journal":{"name":"American Journal on Addictions","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe gamma-hydroxybutyrate withdrawal with delirium, hemodynamic lability, and rhabdomyolysis: A case series.","authors":"Cara M Borelli, Newman Kessler, Daniel Suter, Annie Levesque","doi":"10.1111/ajad.70013","DOIUrl":"https://doi.org/10.1111/ajad.70013","url":null,"abstract":"<p><strong>Background and objectives: </strong>Gamma-hydroxybutyrate (GHB) use is clinically important in both the settings of overdose and withdrawal. GHB withdrawal varies in severity, and although mild cases can be managed outpatient, there are a range of presentations that include progression to severe withdrawal that require inpatient hospitalization.</p><p><strong>Methods: </strong>We report a case series of two patients with severe GHB withdrawal who experienced complications of delirium, hemodynamic lability, and rhabdomyolysis and describe the treatment of these two cases of complex withdrawal.</p><p><strong>Results: </strong>The first patient was successfully treated with a combination of a benzodiazepine taper and symptom-triggered benzodiazepines with baclofen as an adjunct. The second patient had more severe symptoms and required intubation with a midazolam infusion, dexmedetomidine infusion, phenobarbital, baclofen, and a combination of a benzodiazepine taper and symptom-triggered benzodiazepines.</p><p><strong>Discussion and conclusions: </strong>This case series highlights the potential complications of GHB withdrawal including delirium, hemodynamic lability, and rhabdomyolysis. Although rare in the United States, those working in addiction should have familiarity with the clinical course and complications of severe GHB withdrawal.</p><p><strong>Scientific significance: </strong>As one of the few detailed reports on severe GHB withdrawal and its potential complications, our findings extend the current body of literature by detailing the successful application of a multi-modal treatment of severe GHB withdrawal.</p>","PeriodicalId":7762,"journal":{"name":"American Journal on Addictions","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender differences in circumstances associated with cannabis use.","authors":"Erin L Martin, Nathaniel L Baker, Viswanathan Ramakrishnan, Brian Neelon, Michael E Saladin, Aimee L McRae-Clark","doi":"10.1111/ajad.70000","DOIUrl":"https://doi.org/10.1111/ajad.70000","url":null,"abstract":"<p><strong>Background and objectives: </strong>Identifying circumstances associated with cannabis use is critical to the development of effective interventions for cannabis use disorder (CUD) and circumstances may differ by gender. The Inventory of Drug Taking Situations (IDTS) assesses the types of situations in which individuals most often use drugs through eight subscales: dealing with (1) Unpleasant Emotions; (2) Physical Discomfort; (3) Pleasant Emotions; (4) Testing Personal Control; (5) Urges/Temptations; (6) Conflict with Others; (7) Social Pressure; and (8) Pleasant Times with Others. The aims of this study were to determine if IDTS scores varied by gender in individuals with CUD, and to ascertain if behavioral factors such as cannabis use or stress were differentially associated with IDTS scores by gender.</p><p><strong>Methods: </strong>Baseline data were obtained from a study of 148 nontreatment-seeking individuals with CUD. Data included demographic characteristics, IDTS scores, self-reported past 90-day substance use, and measures of past-month and childhood stress.</p><p><strong>Results: </strong>Women reported using cannabis more than men in negative affective contexts, namely when experiencing conflict with others, testing personal control, physical discomfort, and unpleasant emotions. IDTS subscale scores associated with negative affect and pleasant emotions were positively associated with past 90-day cannabis use sessions across genders, use when experiencing negative affect was associated with childhood stress across genders, and use when experiencing unpleasant emotions was differentially associated with recent stress by gender.</p><p><strong>Conclusion and scientific significance: </strong>Findings suggest gender differences in circumstances associated with cannabis use with implications for therapeutic development for CUD.</p>","PeriodicalId":7762,"journal":{"name":"American Journal on Addictions","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse childhood experiences, insecure attachment, and appointment compliance in an outpatient addiction psychiatry treatment population.","authors":"Joanna E Chambers, Susan M Perkins, Kelly M Mosesso, Azziza Ahdoot, Camila L Arnaudo, R Andrew Chambers","doi":"10.1111/ajad.13673","DOIUrl":"https://doi.org/10.1111/ajad.13673","url":null,"abstract":"<p><strong>Background and objectives: </strong>Suffering adverse childhood experiences (ACEs) increases the probability of developing adult mental illness, addictions, and insecure attachment. This study determined how ACEs and insecure attachment are associated with each other, and how they may predict treatment engagement in an integrated dual diagnosis treatment clinic.</p><p><strong>Methods: </strong>A sample of n = 264 patients entering a university-affiliated addiction psychiatry clinic underwent diagnostic intakes supplemented by assessments of attachment styles (Anxious/Avoidant, using the 36-item Experiences in Close Relationships-Relationship Structures (ECR-RS) scale) and childhood adversity (10-item Adverse Childhood Experiences Questionnaire (ACE-Q) scale). Compliance with psychotherapy versus medication appointments was tracked for 6 months post intake.</p><p><strong>Results: </strong>ACE-Q scores (median of 4) were significantly associated with higher anxious and avoidant attachment scores and the number of mental health diagnoses. Only one in five patients obtained 75% or higher compliance rates with psychotherapy; two in five achieved 75% or higher compliance with medication appointments. Greater anxious attachment predicted lower show rates for both psychotherapy and medication appointments, whereas greater avoidant attachment predicted lower compliance for psychotherapy only.</p><p><strong>Discussion and conclusions: </strong>This study confirms the linkage of ACEs and insecure attachment patterns in dual-diagnosis patients seeking integrated addiction psychiatry care. Insecure attachment patterns differentially predicted lower appointment compliance, particularly for psychotherapies.</p><p><strong>Scientific significance: </strong>Childhood trauma and associated adult attachment dysfunction warrant further investigation not only as causes and correlates of mental illness and addiction but also for improving treatment engagement, therapeutic attachments, and recovery outcomes.</p>","PeriodicalId":7762,"journal":{"name":"American Journal on Addictions","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Absorption of naloxone in patients prescribed buprenorphine-naloxone.","authors":"Ian Michel, Domenic Ochal, Aniket Paharia, Paul Jannetto, Scott Breitinger, Tyler Oesterle","doi":"10.1111/ajad.13674","DOIUrl":"https://doi.org/10.1111/ajad.13674","url":null,"abstract":"<p><strong>Background and objectives: </strong>When administered as prescribed, the naloxone component of buprenorphine-naloxone combination medications is putatively considered inert due to reduced naloxone bioavailability via transmucosal. However, there is a growing body of evidence to the contrary. The aim of our study is to determine the extent of naloxone absorption in a large cohort of patients receiving sublingual buprenorphine-naloxone.</p><p><strong>Methods: </strong>Using the Mayo Clinic Unified Data Platform, 425 patients prescribed sublingual buprenorphine/naloxone who received a controlled substance monitoring panel (CSMP) between January 1, 2022, and January 1, 2023 were identified and included. The CSMP is an immunoassay panel that confirms positive results quantitatively with gas chromatography mass spectrometry or liquid chromatography tandem mass spectrometry. This panel provides urinary detection for buprenorphine (cutoff: 5 ng/mL), naloxone (25 ng/mL), as well as their respective metabolites norbuprenorphine (5 ng/mL), norbuprenorphine-glucuronide (20 ng/mL), and naloxone-glucuronide (100 ng/mL).</p><p><strong>Results: </strong>Of our 425 patients, 76% had norbuprenorphine (n = 323), and 77% had norbuprenorphine-glucuronide (n = 327) in their toxicology tests, respectively. Naloxone-glucuronide was detected in 91% (n = 294) of the specimens with norbuprenorphine and 88.7% (n = 290) of the specimens with norbuprenorphine-glucuronide.</p><p><strong>Conclusion and scientific significance: </strong>To our knowledge, this is the largest study to date demonstrating the presence of naloxone metabolites in patients taking combined buprenorphine-naloxone medications. The results of this study refute the notion that naloxone absorption is negligible when administered in sublingual preparations. Further research on how this absorption impacts medication usage, dosing, adherence, and side effects is necessary.</p>","PeriodicalId":7762,"journal":{"name":"American Journal on Addictions","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does cyber dating abuse victimization predict next-day alcohol and cannabis use among college students?","authors":"Meagan J Brem, T J Shaw, Allison Tobar-Santamaria","doi":"10.1111/ajad.13672","DOIUrl":"https://doi.org/10.1111/ajad.13672","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cyber dating abuse (CDA) is prevalent on college campuses, with 43% of college students experiencing CDA each year. Yet, the potential impacts of CDA victimization on college students' health outcomes remain poorly understood. Informed by the self-medication hypothesis and longitudinal data linking dating abuse to substance use outcomes, the present study tested the hypothesis that CDA victimization positively associates with college students' next-day alcohol use (number of drinks consumed, odds of any drinking) and odds of cannabis use (yes/no). We also explored whether CDA's association with next-day substance use varied as a function of gender.</p><p><strong>Methods: </strong>Daily data on alcohol use, cannabis use, and CDA victimization were collected across 60 consecutive days from 236 undergraduates who were in dating relationships (73.73% cisgender women).</p><p><strong>Results: </strong>Multilevel modeling revealed gender differences. Among men, CDA victimization predicted next-day cannabis use (aOR = 7.34, p < .001), but negatively related to the number of drinks consumed the following day (B = -2.63, p < .001). Among women, CDA victimization did not relate to next-day cannabis or alcohol use. Regardless of gender, CDA victimization was unrelated to the odds of any drinking.</p><p><strong>Discussion and conclusions: </strong>College men are more likely to use cannabis the day after experiencing CDA victimization relative to other days. Targeting CDA and related aftermath may benefit college-based substance use intervention.</p><p><strong>Scientific significance: </strong>This is the first study to identify that cannabis use occurs subsequent to CDA victimization, which can inform college-based CDA and cannabis use prevention programming.</p>","PeriodicalId":7762,"journal":{"name":"American Journal on Addictions","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ORN Consultant Recruitment - Join A National Public Health Alliance","authors":"","doi":"10.1111/ajad.13671","DOIUrl":"https://doi.org/10.1111/ajad.13671","url":null,"abstract":"<p>Click on the PDF file for live links</p><p></p>","PeriodicalId":7762,"journal":{"name":"American Journal on Addictions","volume":"34 1","pages":"111"},"PeriodicalIF":2.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajad.13671","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143119988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}