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Select Drug Category Stimulants Topic Treatment Abstract Detail Clinical - Experimental Abstract Category Original Research A double-blind, two-stage, placebo-controlled trial of extended-release injectable naltrexone plus oral extended-release bupropion (BUP+NTX) for methamphetamine (MA) use disorder showed that BUP+NTX in the first 6 weeks of the trial was linked to superior increases in negative urine tests compared to placebo, but subsequent changes in weeks 7-12 was unknown. Therefore, this study aimed to estimate changes in testing MA-negative in those receiving BUP+NTX for the full 12 weeks of the study compared to placebo. Piecewise mixed effects logistic regression was used to estimate change in odds of providing a negative urine test at twice weekly study visits over 12 weeks, comparing BUP+NTX to placebo. By trial design, a subset of the placebo group who did not show a response in stage 1 (weeks 1-6) was re-randomized 1:1 to either receive BUP+NTX or stay in placebo during stage 2 (weeks 7-12). For this analysis, to minimize any bias due to change in composition of the placebo group in stage 2, we simulated the subset of those re-randomized to BUP+NTX as if they had stayed in placebo in stage 2. Participants who received BUP+NTX in both stages showed additional increases in stage 2 in their probability of testing MA-negative (0.11; 95% CI [0.04, 0.19]). Over the full 12 weeks, the total increase in probability of testing MA-negative was 0.26 (95% CI [0.14, 0.38]) in those receiving BUP+NTX. In contrast, participants who received placebo in both stages increased in probability of testing MA-negative by 0.16 (95% CI [0.08, 0.24]) by week 12. Analyses suggest continued treatment with BUP+NTX after 6 weeks is associated with additional reduction in MA use up to 12 weeks, warranting further investigation about the benefits of increased duration of BUP+NTX treatment for MA use disorder. [ABSTRACT FROM AUTHOR]

Background: Men who have sex with men with histories of homophobic victimization bear heightened risk of unstable housing and methamphetamine use. However, it is unclear whether unstable housing explains the link between homophobic victimization and methamphetamine use in this group. The present study aims to test associations between homophobic victimization, unstable housing, and recent methamphetamine use across 24 months in a cohort of men of color who have sex with men (MoCSM).Methods: Our analysis stems from data of 1342 person-visits from 401 MoCSM participating in an ongoing cohort study. We performed a lagged multilevel negative binominal regression to test the association between past homophobic victimization and recent unstable housing, and a lagged multilevel ordered logistic regression to test the association between past homophobic victimization recent methamphetamine use. We then performed a path analysis to test whether recent unstable housing mediates the association between past homophobic victimization and recent methamphetamine use.Results: Findings showed homophobic victimization associated significantly with increased odds of unstable housing (IRR = 1.70, 95% CI [1.35, 2.14], p < 0.001) and recent methamphetamine use (OR = 1.40, 95% CI [1.15, 1.71], p = 0.001). Mediation analysis indicated that past homophobic victimization was indirectly associated with recent methamphetamine use via unstable housing (OR = 1.06 (95% CI [1.01, 1.11], p = 0.010).Conclusion: Our findings suggest that homophobic victimization and unstable housing should be addressed alongside treatment and prevention of methamphetamine use in MoCSM. [ABSTRACT FROM AUTHOR]

Objective: This study tested the hypothesis that reported frequency of methamphetamine use is significantly associated with measures of social adversity, sexual risk behaviors, chronic health conditions, bacterial STIs and HIV-related factors among diverse men who have sex with men (MSM).Methods: Data were 2428 visits from 515 mSTUDY participants (261 people living with HIV; 254 HIV-negative). mSTUDY is an ongoing longitudinal study of racially/ethnically diverse MSM in Los Angeles County. Logistic regression with random intercepts modeled associations between self-reported past 6-month methamphetamine use (none, monthly or less, weekly or more) with reported adverse social outcomes (unemployment, housing instability, intimate partner violence), sexual risk behaviors, chronic health conditions, and biomarkers of bacterial STIs (chlamydia, gonorrhea, or syphilis) and detectable HIV viral load (among HIV-positive). Models controlled for confirmed HIV-serostatus.Results: Prevalence of reported monthly or less methamphetamine use was 19%; weekly or more use was 18%. Multivariable models showed escalating odds of adverse social outcomes and sexual risk behaviors (p's < 0.001) with increased methamphetamine use frequency. Frequency of methamphetamine use associated with increased odds of a positive bacterial STI test (p < .001), detectable viral load (in HIV-positive participants) (p < .001), renal condition (p = .047), neurological condition (p = .008), and psychological condition (p = .001).Conclusions: Findings show cross-sectional links between reported methamphetamine use frequency and adverse social and health outcomes among MSM in Los Angeles and suggest there may be fewer social and physical health harms corresponding to less frequent use of methamphetamine in this group. [ABSTRACT FROM AUTHOR]

Background: Preclinical studies suggest that the non-selective phosphodiesterase inhibitor, Ibudilast (IBUD) may contribute to the treatment of methamphetamine (METH) use disorder through the attenuation of METH-induced inflammatory markers such as adhesion molecules, sICAM-1 and sVCAM-1, and cytokines, IL-6 and TNF-α.Objective: The present study aimed to test whether treatment with IBUD can attenuate peripheral markers of inflammation during a METH challenge in an inpatient clinical trial of 11 patients.Methods: This trial followed a randomized, within-subjects crossover design where participants received a METH challenge, during which five participants were treated with placebo then with IBUD, while the remaining six participants were treated with IBUD prior to placebo. Mixed effects regression modeled changes in peripheral markers of inflammation-sICAM-1, sVCAM-1, TNF-α, IL-6, MIF, and cathepsin D-by treatment condition, with measurements at baseline, 60 min post-METH infusion, and 360 min post-METH infusion.Results: While on placebo, sICAM-1, sVCAM-1, and cathepsin D significantly increased by 60 min post-METH infusion, while IL-6 significantly increased 360 min post-METH infusion. Treatment with IBUD significantly reduced METH-induced levels of sICAM-1, sVCAM-1, and cathepsin D at 60 min post-METH infusion.Conclusions: Our findings demonstrate that IBUD attenuated acute pro-inflammatory effects of METH administration, which may have implications for treatment of METH use disorder. [ABSTRACT FROM AUTHOR]

Starting in 2008, Vietnam's national MMT program expanded quickly, but it is struggling with increasing attrition rates and poor adherence among patients. Several studies have reported on MMT retention and adherence, but no overview has yet been published. The objective of this study is to fill that gap and to review factors associated with retention and adherence in MMT in Vietnam. A systematic search was conducted using databases of literature - Pubmed, Cochrane, Scopus, Academic search premiere, and SoINDEX. Peer-reviewed empirical studies with full text in English discussing retention attrition and adherence regarding MMT in Vietnam were selected. The results were synthesized using qualitative methods. Adherence and retention rates varied among the 11 included studies. In general, patients in mountainous provinces had lower adherence and retention rates than those in big cities. Retention rates decreased with the studies' follow-up period and had a downward trend over time. Factors associated with adherence and retention can be classified into three groups: individual, community, and institutional factors. Important individual factors areage, education, awareness of MMT and HIV, and co-occurring disorders and comorbidities. Stigma is the major community risk factor, and methadone daily dose, the distance between home and clinic, and clinic's service hours are the three most important institutional factors. The literature reviewed identifies important factors associated with MMT adherence and retention in Vietnam. The findings suggest further research exploring both subjective and objective factors and more policies to remove social and structural barriers to enhance treatment outcomes. • In Vietnam, MMT adherence and retention rates have a downward trend over time and are lower in mountainous provinces. • Factors associated with adherence and retention are at individual, community, and institutional levels. • Important individual-level factors are age, education, awareness of MMT and HIV, co-occurring disorders, and comorbidities. • Stigma is the major community risk factor. • Suboptimal methadone doses, distance to clinic, and clinic service hours are the three most important institutional factors. [ABSTRACT FROM AUTHOR]

Introduction: Marijuana use is common among persons living with HIV, but whether it's use increases the risk of type 2 diabetes in this population has not been explored.Objective: To determine whether self-reported marijuana use is associated with incident type 2 diabetes in women and men living with and at risk for HIV.Methods: We analyzed data from the Women's Interagency HIV Study (WIHS) and Multicenter AIDS Cohort Study (MACS), between 2000-2017 (WIHS) and 1999-2017 MACS. The association between self-reported marijuana use and incident type 2 diabetes was analyzed using time-dependent Cox regression models among 3578 and 2682 participants in the WIHS and MACS respectively.Results: Over the follow-up period, 452 (WIHS) and 326 (MACS) incident type 2 diabetes cases occurred. In multivariable models, the hazard ratios, collectively indicate a reduced risk of type 2 diabetes, in marijuana users compared to none users, although all associations were not statistically significant. The results were similar for HIV-positive and HIV-negative participants in both cohorts.Conclusions: In this prospective analysis of nearly 20 years of data for women and men with and at risk for HIV in the WIHS and MACS, although we found a pattern of reduced risk of type 2 diabetes among self-reported marijuana users, the associations were not statistically significant. To better inform clinical decisions and legal policy regarding marijuana use in this population, further longitudinal investigations that biologically quantify marijuana use to assess risk for incident diabetes is warranted. [ABSTRACT FROM AUTHOR]