Journal: BMC Primary Care, 2024, doi: 10.1186/s12875-024-02609-9
Authors: Stephanie A. Hooker, Colleen Starkey, Gavin Bart, Rebecca C. Rossom, Sheryl Kane, & Anthony W. Olson
Abstract:
Background: Medications for opioid use disorder (MOUD), including buprenorphine, are effective treatments for opioid use disorder (OUD) and reduce risk for overdose and death. Buprenorphine can be prescribed in outpatient primary care settings to treat OUD; however, prior research suggests adherence to buprenorphine in these settings can be low. The purpose of this study was to identify the rates of and factors associated with buprenorphine adherence among patients with OUD in the first six months after a new start of buprenorphine.
Methods: Data were extracted from the electronic health record (EHR) from a large integrated health system in the upper Midwest. Patients with OUD (N = 345; Mean age = 37.6 years, SD 13.2; 61.7% male; 78% White) with a new start of buprenorphine between March 2019 and July 2021 were included in the analysis. Buprenorphine adherence in the first six months was defined using medication orders; the proportion of days covered (PDC) with a standard cut-point of 80% was used to classify patients as adherent or non-adherent. Demographic (e.g., age, sex, race and ethnicity, geographic location), service (e.g., encounters, buprenorphine formulations and dosage) and clinical (e.g., diagnoses, urine toxicology screens) characteristics were examined as factors that could be related to adherence. Analyses included logistic regression with adherence group as a binary outcome.
Results: Less than half of patients were classified as adherent to buprenorphine (44%). Adjusting for other factors, male sex (OR = 0.34, 95% CI = 0.20, 0.57, p < .001) and having an unexpected positive for opioids on urine toxicology (OR = 0.42, 95% CI = 0.21, 0.83, p < .014) were associated with lower likelihood of adherence to buprenorphine, whereas being a former smoker (compared to a current smoker; OR = 1.82, 95% CI = 1.02, 3.27, p = .014) was associated with greater likelihood of being adherent to buprenorphine.
Conclusions: These results suggest that buprenorphine adherence in primary care settings may be low, yet male sex and smoking status are associated with adherence rates. Future research is needed to identify the mechanisms through which these factors are associated with adherence.
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Journal: Addiction, 2024, doi: 10.1111/add.16624
Authors: Jonathan Livingstone-Banks, Nicola Lindson, & Jamie Hartmann-Boyce
Abstract:
Aims: To summarise systematic reviews on tobacco addiction published by the Cochrane Tobacco Addiction Group (CTAG) from 2021 to 2023.
Methods: We identified all new and updated Cochrane Reviews published by CTAG between 2021 and 2023. We present key results from these reviews and discuss promising avenues for future research.
Results: CTAG published five new reviews and one overview of reviews, and updated eight reviews. Review evidence showed that all main pharmacotherapies (varenicline, cytisine, bupropion and nicotine replacement therapy [NRT], especially when patches are combined with fast acting forms like gum) are effective for smoking cessation, as are nicotine e-cigarettes. Evidence suggested similar magnitude of effects of varenicline, cytisine, and nicotine e-cigarettes; these emerged as the most effective treatments. Evidence also supported behavioural counselling and financial incentives for smoking cessation. Secondary analyses of the Cochrane review of e-cigarettes for smoking cessation showed over half of participants assigned to e-cigarette conditions were still using them at six months or longer, that biomarkers of potential harm significantly reduced in people switching from smoking to vaping or to dual use, and that there was insufficient evidence to draw associations between e-liquid flavours and smoking cessation. Findings on mindfulness-based interventions, interventions delivered by dental and primary care professionals, interventions to prevent weight gain after smoking cessation, and interventions for waterpipe cessation were less certain. Reviews of observational evidence showed that smoking cessation reduced cardiovascular events and mortality in people living with cardiovascular disease, and improved mental health.
Conclusions: Nicotine replacement therapy (especially patches combined with fast acting forms), varenicline, cytisine, bupropion, nicotine e-cigarettes, behavioural counselling, and financial incentives are all effective ways to help people quit smoking. Quitting smoking improves mental health and reduces cardiovascular events and mortality in people living with cardiovascular disease.
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Journal: Translational Psychiatry, 2024, doi: 10.1038/s41398-024-03060-1
Authors: David Zammit Dimech, Audrey-Ann Zammit Dimech, Mark Hughes, & Ludvic Zrinzo
Abstract:
Background: Pharmaco-psychiatric techniques remain the mainstay, first line treatments in substance use disorders (SUD), assisting in detoxification but largely ineffective at reducing dependence. The path to rehabilitation and freedom from addiction often proves uncertain and laborious for both patients and their significant others. Relapse rates for multiple substances of abuse are considerable and the number of SUD patients is on the increase worldwide.
Objective: To assess efficacy of deep brain stimulation (DBS) as a therapeutic solution for SUDs.
Methods: A systematic electronic database search of PubMed and EMBASE retrieved DBS addiction-focused studies on humans, of which a total of 26 (n = 71) from 2007 to 2023 were deemed eligible, including the first randomized controlled trial (RCT) in this field. This review was prospectively registered with PROSPERO: CRD42023411631.
Results: In addressing SUDs, DBS targeting primarily the nucleus accumbens (NAcc), with or without the anterior limb of the internal capsule, presented encouraging levels of efficacy in reducing cravings and consumption, followed by remission in some subjects, but still reporting relapses in 73.2% of patients.
Conclusions: For treatment-refractory addictions DBS use seems limited to reducing cravings with a satisfactory degree of success, yet not clinically consistent in inducing abstinence, suggesting involvement of factors unaffected by DBS intervention. Furthermore, costs and the scale of the problem are such that DBS is unlikely to have a significant societal impact. Nevertheless, DBS may provide insight into the biology of addiction and is worthy of further research using increased methodological rigor, standardized outcome measures, and pre-established surgical protocols.
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Journal: Harm Reduction Journal, 2024, doi: 10.1186/s12954-024-01046-2
Authors: Erin E. Gould, Siddhi S. Ganesh, & Rachel Carmen Ceasar
Abstract:
Background: Cannabis is the most common illicit substance used in pregnancy. As use continues to increase, understanding peoples’ behaviors surrounding cannabis use during pregnancy is needed to improve maternal and child health outcomes. The aim of this study was to better understand pregnant individuals’ perceptions and knowledge of cannabis use and use patterns as well as the social and environmental factors that may influence their use.
Methods: We conducted interviews with 19 participants between December 2022 and March 2023. Individuals self-identified as BIPOC (Black, Indigenous, People of Color), were over 21 years of age, spoke English or Spanish, resided in California, and had used cannabis during pregnancy in the last 0-2 years. Using qualitative, constructivist grounded theory methods, we analyzed the contexts that contributed to participants’ lived experiences surrounding cannabis use behaviors during pregnancy.
Results: Participants reported making conscious decisions to responsibly manage their cannabis use during pregnancy to minimize potential harm to the fetus. Participants prioritized making what they perceived to be safer adjustments to their use of cannabis: (1) changing the amount of cannabis used, (2) changing the types of cannabis products used, and (3) changing sources of cannabis procurement.
Discussion: Our findings show that pregnant individuals are seeking information about safe cannabis use beyond medical supervision and are open to altering their cannabis consumption patterns. However, they are unable to find trustworthy and evidence-based harm reduction practices which can be implemented to mitigate harm to their unborn children. A harm reduction approach is needed in the field of maternal cannabis use to promote positive maternal and fetal health outcomes.
Conclusions: More data is needed on comprehensive harm reduction approaches to cannabis use during pregnancy. This requires implementation of education on these topics in healthcare settings presented by prenatal care clinicians.
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Journal: Drug and Alcohol Dependence Reports, 2024, doi: 10.1016/ j.dadr. 2024.100271
Authors: Faith Adams, Karmiella S. Ferster, Laurel S. Morris, Marc N. Potenza, Iliyan Ivanov, & Muhammad A. Parvaz
Abstract:
Background: Positive and negative alcohol expectancies (PAEs and NAEs, respectively) and impulsivity are key risk factors for the onset of alcohol use. While both factors independently contribute to alcohol initiation, the developmental aspects of AEs and their nuanced relationship with impulsivity are not adequately understood. Understanding these relationships is imperative for developing targeted interventions to prevent or delay alcohol use onset in youth.
Methods: This study utilized the Adolescent Brain Cognitive Development cohort to examine how PAEs and NAEs develop over time and relate to each other. We also explored how self-reported and behavioral impulsivity at baseline (~10 years old) are associated with the longitudinal development of PAEs and NAEs in youth Ages 11, 12, and 13 (n = 7493; 7500; and 6981, respectively), as well as their time-specific relationships.
Results: Findings revealed while PAEs increased steadily over all three years, NAEs increased from ages 11-12 and then remained unchanged between 12 and 13. Overall, PAEs and NAEs were inversely related. Moreover, PAEs positively correlated with sensation seeking and lack of premeditation, while NAEs negatively correlated with positive urgency. Interestingly, a time-specific association was observed with PAEs and lack of perseverance, with a stronger correlation to PAEs at Age 11 compared to Age 12.
Conclusions: Overall, this study provides valuable insights into the divergent developmental trajectory of PAEs and NAEs, and their overall and time-specific associations with impulsivity. These findings may guide focused and time-sensitive prevention and intervention initiatives, aiming to modify AEs and reduce underage drinking.
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