Drug and Alcohol Dependence

BackgroundEvaluating the opioid use disorder (OUD) care cascade can improve OUD treatment retention and care. ObjectivesTo identify risk and protective factors for retention among patients in OUD treatment. MethodsWe conducted a retrospective cohort study among patients diagnosed with OUD using data from the Rhode Island (RI) All-Payer Claims Database from 2011 to 2019. Patients who initiated treatment (Stage 2) were classified into sub-stages of retention (Stage 3) corresponding to multistate...

ObjectivesPeople experiencing homelessness are at increased risk for addiction, with substance use both a cause and response to homelessness. Street Medicine (SM) programs provide decentralized, low-barrier care to people experiencing homelessness and have begun to offer medication for opioid use disorder (MOUD). Literature on MOUD initiation via SM is nascent. This study investigated the impact of SM-initiated MOUD on ED utilization among people experiencing homelessness in a mid-sized US city....

BackgroundAlthough treatment for opioid use disorder (OUD) often yields high adherence during pregnancy, the risk of returning to opioid misuse during postpartum is high. There are currently no relapse prevention programs tailored to this unique time period. ObjectivesUsing a prospective cohort study, we seek to identify hormones and/or infant caregiving approaches as predictors of postpartum opioid misuse. As a first step in dissemination of results, this report contains a detailed account of ...

BackgroundIn both the U.S. and U.K., after a period of decline, prevalence of cocaine use has been increasing since 2012 and is now the second leading cause of overdose death from an illicit drug. However, psychosocial treatments for cocaine use disorders are limited, and no pharmacotherapy is approved by regulatory bodies in the U.S. or Europe. We performed a comprehensive meta-analysis to assess treatments impacts on cocaine use. MethodsWe performed a meta-analysis of clinical trials that inc...

QuestionThe opioid epidemic causes massive morbidity, and males have substantially greater overdose mortality rates than females. It is unclear whether there are sex-related disparities at different stages in the trajectory of opioid use disorders, in "real world" settings. GoalTo determine sex disparities in non-medical opioid use (NMOU) at the end of outpatient medication-assisted treatment (MAT), using nationally representative data. DesignObservational epidemiological study of publicly fun...

BackgroundLong-acting injectable buprenorphine (LAIB) has been positioned as a potentially transformative option for opioid use disorder (OUD), in part because patient experiences reported in qualitative studies emphasize reduced daily burden, increased "freedom," reduced stigma, and fewer pressures related to diversion--while also noting barriers such as insufficient information, early adverse experiences, and concerns about coercion. MethodsWe conducted a cross-sectional online survey of adul...

Background and AimsAdolescents with opioid use disorder (OUD) are an understudied and vulnerable population. We examined the association between age and six-month treatment retention, and whether any such association was moderated by medication treatment. MethodsIn this retrospective cohort study, we used an insurance database with OUD treatment claims from 2006-2016. We examined 261,356 OUD treatment episodes in three age groups: adolescents (ages 12-17), young adults (18-25) and older adults ...

BackgroundAccess to medications for opioid use disorder (MOUD) in the U.S. is highly restricted. In March 2020, to reduce transmission of COVID-19, SAMHSA issued emergency regulations allowing up to two weeks of take-home doses for most patients. ObjectivesWe evaluated the benefits and unintended consequences of these new regulations expanding take-home eligibility to inform MOUD policy post-pandemic MethodsWe conducted a mixed-methods evaluation of an opioid treatment program in San Francisco...

Opioid-related deaths are a national problem that have increased over the past two decades. Multiple policy interventions have been enacted to decrease opioid misuse and expand treatment. The Comprehensive Addiction and Recovery Act (CARA) was passed in July 2016, just before declaring the opioid epidemic a National Emergency in 2017. CARA was enacted to combat the opioid epidemic by providing more funding yearly for items including but not limited to prevention, treatment, and opioid overdose r...

Background and AimsCocaine use disorder (CUD) is an increasingly widespread concern worldwide. Various pharmacological treatments have been investigated for CUD, but their efficacy remains unclear, and none have been licensed for treatment. Therefore, we assessed the comparative effectiveness, safety, and acceptability of pharmacological interventions for the treatment of CUD and prevention of relapse. DesignSystematic review and network meta-analyses of double-blind randomized controlled trial...

Background and aimsExtended release buprenorphine injection (INJ-BUP) has been available in the United States since 2018. INJ-BUP has the potential to positively impact OUD treatment outcomes by providing additional treatment options and patient choice. We aimed to describe the availability and prescribing of INJ-BUP for Medicaid beneficiaries since its availability, nationwide and by state. MethodsTo assess availability, we measured the number of substance use disorder (SUD) facilities that of...

BackgroundThe COVID-19 pandemic strained healthcare facilities and the isolation and uncertainty associated with the pandemic compromised mental health around the world. The pandemic has also been associated with an exacerbation of the opioid crisis in the United States (US), and previous studies have reported changing trends in opioid misuse during the pandemic. Our study investigated naltrexone, a prescription drug used to treat alcohol and opioid use disorders by blocking opioid receptors to ...

BackgroundThe efficacy and safety of buprenorphine alone and in combination with naloxone for treatment of opioid dependence were evaluated in Federally-sponsored randomized clinical trials. Meta-analysis of pooled individual participant data provides an opportunity to identify multiple predictors of buprenorphine treatment outcome. MethodsWe selected six buprenorphine efficacy and safety trials from NIDAs Data Share database for analysis. Treatment, sociodemographic, and drug use history varia...

ImportanceRecently, the Food and Drug Administration gave pre-marketing approval to algorithm based on its purported ability to identify genetic risk for opioid use disorder. However, the clinical utility of the candidate genes comprising the algorithm has not been independently demonstrated. ObjectiveTo assess the utility of 15 variants in candidate genes from an algorithm intended to predict opioid use disorder risk. DesignThis case-control study examined the association of 15 candidate gene...

ImportanceDrug overdoses from opioids like fentanyl and heroin and stimulant drugs such as methamphetamine and cocaine are a major cause of mortality in the United States, with potential sex differences across the lifespan. ObjectiveTo determine overdose mortality for specific drug categories across the lifespan of males and females, using a nationally representative state-level sample. DesignState-level analyses of nationally representative epidemiological data on overdose mortality for speci...

BackgroundXylazine is a veterinary tranquilizer found in the unregulated drug supply in the United States. It appears alone or as an adulterant in fentanyl ("tranq dope"). Xylazines symptomatology is well described and includes skin and soft tissue damage, bradycardia, and loss of consciousness. However, little is known about whether and how substance use behaviors have changed as xylazines presence in street drugs has grown. MethodsWe conducted semi-structured in-depth interviews with people w...

BackgroundA growing population of working-aged men are not in employment, education, or training (NEET). The COVID-19 pandemic increased rates of substance use disorders (SUDs) and affected treatment seeking in the general population, but the COVID era substance use patterns among NEET men are unknown. MethodsWe estimated the prevalence and correlates of NEET status among working-aged (18-64) men using data from the 2022 National Survey on Drug Use and Health, a nationally representative survey...

Background and AimsAlcohol use disorder (AUD) remains a major public health concern, with persistent disparities in access to evidence-based treatment. This study aimed to examine associations between perceived discrimination in healthcare settings (PDHS), patient-clinician communication (PCC), and receipt of treatment for AUD, and compared these with sociodemographic and insurance-related factors. DesignCross-sectional analysis using structural equation modeling (SEM), logistic and multinomial...

BackgroundHigh rates of substance misuse during emerging adulthood require developmentally appropriate clinical programs. ObjectivesThis work outlines the development of an evidence-informed emerging adult outpatient substance use program, quality improvement process and protocol, and 1-year program insights. MethodsLiterature reviews, program reviews, environmental scans, and stakeholder consultations (including lived expertise) were used to develop the program. A 12-week emerging adult (17-2...

BackgroundThe COVID-19 pandemic has impacted people with substance use disorders (SUDs) worldwide and healthcare systems have reorganized their services in response to the pandemic. MethodsOne week after the announcement of the COVID-19 as a pandemic, in a global survey, 177 addiction medicine professionals described COVID-19-related health responses in their own 77 countries in terms of SUD treatment and harm reduction services. The health response is categorized around (1) managerial measures...