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Although alcohol and other drug use is increasingly the focus of policy and research efforts, there are challenges identifying and applying evidence‐based strategies to minimise harms for alcohol and other drugs in health care and community settings. These challenges include limited available research, variability across settings, and lack of 'fit' between research evidence and their intended settings. In this commentary, we describe a novel approach to develop and evaluate tailored, sustainable strategies to enhance the uptake of evidence‐based activities into health services and community settings. Our approach involves four key principles: (i) identifying evidence‐based alcohol and other drug harm minimisation strategies; (ii) partnering with local experts to identify and tailor strategies; (iii) implementing strategies into existing practice/infrastructure to build in sustainability; and (iv) using sustainable co‐designed outcome measures including value‐based health‐care principles to measure uptake, feasibility and acceptability, health outcomes and economic implications. We propose that this approach offers a way forward to enhance the relevance and suitability of research in health services and community settings and has potential to be applied in other sectors. [ABSTRACT FROM AUTHOR]

We investigated whether injecting drug use was a risk factor for methicillin resistance among inpatients with Staphylococcus aureus bloodstream infections (SABSIs) at an Australian health service. In 273 inpatients, 46 (16.9%) of SABSIs were methicillin‐resistant S. aureus (MRSA). MRSA was more frequent in those who had injected drugs in the past 6 months (20.6%) compared with other inpatients (15.7%). Injecting drug use was associated with a 4.82‐fold (95% confidence interval = 1.54–16.29) increased odds of MRSA after accounting for confounders. [ABSTRACT FROM AUTHOR]

Self‐induced extreme intoxication akin to automatism (SIEA) is a complicated and controversial legal concept resistant to jurisdictional consensus. In the United States, SIEA has, at times, been considered under the concept of "settled insanity.". In the United Kingdom, the defense may be allowed for specific intent crimes, though the defendant's awareness of the foreseeability of risk is addressed at trial. In Canada, recent jurisprudence has led to legal and practice landscape changes related to self‐induced extreme intoxication. Here, we provide an overview of automatism and an update on the Canadian perspective with a review of the facts and an analysis of the Supreme Court of Canada's landmark decision in R v. Brown, where the court permitted the SIEA defense to be utilized for general intent crimes and acquitted Matthew Winston Brown, a 26‐year‐old male with no history of mental illness, with respect to two counts of "break and enter" and one count of "aggravated assault." We review the social and legislative response to the changing case law as well as related implications for expert testimony, which may be provided by forensic mental health professionals. Given the judicial and legal implications of the recent changes for both perpetrators and victims of violent crime and given the dynamic international landscape on extreme intoxication in criminal law, the review is thought to be of interest to a broad category of stakeholders including policymakers and those working in forensic psychiatry and law. [ABSTRACT FROM AUTHOR]

Objectives: Although factors associated with alcohol use have been researched at a population level, descriptions of the alcohol and other drug (AOD) treatment-seeking population in New South Wales (NSW), Australia, are limited. This study addresses this gap by analyzing sociodemographic and health characteristics in the NSW AOD treatment-seeking population. Methods: Self-reported Australian Treatment Outcomes Profile data on substance use, health ratings, and sociodemographic factorswere acquired from public AOD services (offering services from counseling to ambulatory/inpatient withdrawal management) in 6 administrative health districts from 2016 to 2019 (n = 14,287). Gaussian and multiple logistic regressions were conducted to examine associations between these factors and alcohol consumption quantity. Results: Data were analyzed for patients seeking treatment for alcohol consumption specifically (n = 5929; median age, 44 years; 65% male). Valid alcohol consumption data were available for 5460 patients, among whom the mean volume of alcohol consumed was 311 standard drinks (3110 grams of ethanol) over the past 28 days and 15 standard drinks (150 grams of ethanol) per occasion. Higher volumes were consumed by males and those with recent experiences of violence and/or injecting drug use. Caring for children younger than 5 years and having above-median health ratings were associated with lower alcohol consumption. Conclusions: This study contributes to the characterization of the NSW public AOD treatment population and identifies associations between alcohol consumption, sociodemographic factors, and health ratings among people seeking treatment for alcohol consumption. Findings point towards multilevel assessment and comprehensive interventions for people engaging in treatment for alcohol use. Future research should address barriers to treatment. [ABSTRACT FROM AUTHOR]

Introduction: Substance abuse is a major public health problem. In recent years, ketamine, which is a parenteral anesthetic, has been consumed increasingly as an illicit drug together with alcohol, although little is known of how this association alters brain activity. The present study investigated the influence of progressive doses of ketamine, associated with alcohol, on electrophysiological activity. Methods: For this, 72 late-adolescent (8–10-week-old) male Wistar rats received either ketamine only, at low (10 mg/kg), intermediate (20 mg/kg) or high (30 mg/kg) doses via intraperitoneal injection, or alcohol (2 mL/100 g) via oral gavage followed by ketamine (at low, intermediate, and high doses). Electroencephalograms (EEG) and electromyographic recordings were obtained 5 min after the final application of the drug. Results: When administered alone, ketamine resulted in an increase in delta, theta, beta, and gamma brainwaves, with a more pronounced effect being detected at the highest dose (30 mg/kg) in the case of the delta, beta, and gamma waves. The amplitude of the alpha brainwaves was reduced at all doses of ketamine, but less intensively at the highest dose. When administered alone, alcohol reduced all the brainwaves, with the reduction in the alpha waves being exacerbated by ketamine at all doses, and that of the theta and beta waves being boosted at the lowest dose. The intermediate dose of ketamine (20 mg/kg) reverted the alcohol-induced reduction in the theta and gamma waves, whereas the high dose increased delta, theta, beta, and gamma bandpower. Discussion: Overall, then, while ketamine enhances the depressant effects of alcohol on the alpha brainwave at all doses, a low dose intensified this effect on the theta and beta 175 waves, whereas a high dose produces neuronal hyperexcitability in the theta and 176 gamma bandpower. [ABSTRACT FROM AUTHOR]

AbstractTramadol is a synthetic opioid with a central effect from the aminocyclohexanol group, which has two main mechanisms of action, including as a weak agonist of opioid receptors and as a norepinephrine and serotonin reuptake inhibitor. The present study presents a review based on clinical trials designed in 2023. In July 2023, six international databases, including Medline/PubMed, ProQuest, Scopus, EMBASE, Google Scholar, and ISI (Web of Science), were searched and 58 articles were included in the study. The results of most studies showed that tramadol can be used as an analgesic drug, although in some studies it was shown that tramadol is not therapeutically superior in reducing pain compared to other treatments. Also, complications related to this treatment have been reported in some studies. Physicians should consider these factors to prevent drug toxicity, poor pain relief, use disorder in patients, and unpredictable complications. It should be noted that there is not enough evidence to support the long-term effectiveness of tramadol, but this argument also extends to nonopioid and other types of opioid analgesics, and the lack of long-term trials is due to regulatory and ethical issues. Although opioids can cause addiction when used for a long time, tramadol has a reasonable safety profile. According to the patient’s condition and the clinical judgment of the medical professional, tramadol can be prescribed for patients, but the consequences of its use must be considered and a personalized treatment algorithm should be selected if the benefits outweigh the risks of the drug. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusions Women who attend alcohol and other drug (AOD) services experience higher rates of unintended pregnancy, and access less contraception, than the general population. This study aims to observe contraceptive initiation and use after contraception services were offered at metropolitan and regional AOD services.Clinical staff were provided contraception education. One hundred women aged 16–49 were recruited from two services between 2017 and 2021. Women completed a questionnaire on their obstetrics and gynaecological history, pregnancy plans and contraception use. Women were provided education on contraception options and offered referral to a contraception pathway. The primary outcome was initiation of highly reliable contraception; secondary outcomes were the types of contraception initiated, and contraception use and pregnancy at 12 months. We compared the initiation of contraception across the two study sites.At baseline, 91% of women were not planning a pregnancy within 12 months, with 21% of these using highly reliable contraception. Of all women not planning a pregnancy, 28% initiated highly reliable contraception via the pathway (2% metropolitan, 51% regional, p < 0.001), with intrauterine devices being the most frequent method initiated (15%). At 12 months, 44% were using highly reliable contraception and 15% had recorded pregnancies.Contraception pathways for women in AOD treatment can improve initiation of highly reliable methods of contraception, although pregnancy rates were still high and there were large differences between the study sites. Care navigation and clinical champions are some potential facilitators to contraception access, and understanding additional barriers to access may be useful. [ABSTRACT FROM AUTHOR]

Background: While FDA-approved treatments exist for opioid use disorder, none are available for stimulant use disorder. Kratom (Mitragyna speciosa), an unregulated plant-derived substance with known opioid- and stimulant-like effects, has been used to self-treat opioid use disorder; however, its use in relation to stimulant use disorder has not been described. Objective: To understand whether and how individuals use kratom to self-treat stimulant use disorder. Methods: Using a commercially available social listening platform, 3,820 publicly available social media posts published between January 1, 2020, and June 21, 2021, were reviewed for relevance to kratom and stimulant discontinuation. Manual qualitative thematic analysis was conducted on relevant data. Results: Among the 398 relevant posts that discussed using kratom to discontinue stimulants, motivations and methods varied considerably. Posts predominantly identified benefits but also negative outcomes of kratom use. Some justified it as necessary despite consequences, while others reported a desire to quit. Conclusions: Although there is some awareness that kratom is used to self-treat opioid use disorder, its use to treat stimulant use disorder is more novel. In the absence of approved treatments, kratom was viewed as a natural and safe way to quit stimulants. Despite some reported success, this study shows self-treatment may pose significant risks, including kratom addiction and physical dependence. Healthcare practitioners, researchers, and public health professionals may benefit from understanding motivations for kratom use, associated benefits and risks, and the importance of discussing kratom use with patients/clients who have stimulant use disorder. [ABSTRACT FROM AUTHOR]

Background: Psychoactive substance use among pregnant women has reached alarmingly high rates. Our aim was to characterize the psychiatric and clinical profiles of pregnant crack users in Brazil. Methods: This was a cross-sectional study of 24 pregnant crack users admitted to a referral hospital for psychiatric disorders in pregnant women, in Porto Alegre, Brazil, over three years. The following instruments were applied: a clinical-obstetric questionnaire; the condensed version of the Addiction Severity Index; a diagnostic interview for psychoactive substance use based on DSM-5; the Mini International Neuropsychiatric Interview for DSM-IV; and the Semi-Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Results: Most patients had severe crack dependence and used other substances, such as tobacco, cannabis, and alcohol. The median duration of crack use was three years, ranging between three and 12 years. Most women subsisted from illegal or informal activities; a fifth had previously been arrested and often had relationship problems. Twenty percent had HIV (n = 5), and 37.5% (n = 9) had syphilis. Borderline personality disorder was the most prevalent mental condition (62.5%), followed by suicidal tendencies (45.8%), hypomanic episodes due to substance use (37.5%), and past major depressive episodes (33.3%). Conclusions: An alarmingly high prevalence of consumption of other drugs, psychiatric disorders, and difficult-to-treat personality disorders was observed in our study. Investigating the psychiatric profile of women who use substances is essential to minimize the impacts on the mother and child, optimize therapeutic approaches to comorbidities, and enable more effective relapse prevention. [ABSTRACT FROM AUTHOR]

Introduction: Substance abuse is a widespread problem, with high rates of treatment dropout. Stress plays a crucial role in this problem, so innovative interventions with stressed patients can assist them in completing treatment. Methods: This study is a randomized controlled trial with 60 participants who have substance abuse disorder undergoing detoxification at a residency facility in Tehran, Iran. Participants were randomly assigned to one of three groups: watching a 360° video of nature, a 360° video of a city environment, or no virtual experience. The intervention was performed only for one session. Psychological stress was measured using the Positive and Negative Affect Schedule and Perceived Stress Scale before and after the intervention. Physiological stress was assessed through respiratory rate, skin conductance, and heart rate recordings during the virtual reality (VR) experience. Data analysis was performed using R software (version 4.2). Results: Paired t‐test results indicated significant psychological differences before and after virtual nature experiences, but not in the control and city groups. The repeated measure ANOVA showed a significant reduction in skin conductance (p < 0.01) and respiratory rate (p < 0.01) scores in the nature group. Conclusion: The findings suggest that VR relaxation could be a potentially beneficial intervention for reducing stress in patients during detoxification. [ABSTRACT FROM AUTHOR]

Background and aims: Young people accessing alcohol and other drug (AOD) treatment experience high rates of treatment disengagement, contributing to poorer outcomes. To improve outcomes, it is important to identify factors associated with treatment retention. This study measured the relationships between client characteristics, treatment characteristics, clinical severity measures and completion of treatment among young people. Design, setting and participants: This study was a retrospective analysis of routinely collected data set in residential‐ and community‐based AOD services in New South Wales, Australia. Routinely collected data from the Network of Alcohol and Other Drug Agencies' (NADA) database were used. Included individuals were aged 10–24 years and accessed treatment between 2012 and 2023 (n = 17 474). Measurements: Variables included client‐related characteristics, service characteristics and baseline measures of clinical severity [Kessler‐10 (K10), EUROHIS–QoL, severity of dependence scale (SDS)]. Multivariable binary logistic regression models assessed the relationships between these characteristics and treatment completion. Findings Rates of treatment completion were highest among adolescents in community‐based treatment (57%) and lowest among young adults in residential treatment (35%). Polysubstance use was negatively associated with treatment completion among adolescents [adjusted odds ratio (adjOR) = 0.71, P < 0.001] and adults (adjOR = 0.70, P < 0.001) in community‐based treatment, and adolescents in residential treatment (adjOR = 0.62, P = 0.006), as was housing insecurity (adolescents in community treatment, adjOR = 0.61, P = 0.001; adults in community treatment, adjOR = 0.77, P = 0.002; adolescents in residential treatment, adjOR = 0.42, P = 0.005). Attending youth‐specific services was associated with higher treatment completion rates among adults in community‐based (adjOR = 1.81, P < 0.001) and residential treatment (adjOR = 1.72, P < 0.001). Varying correlates of treatment completion were identified throughout treatment groups, reflecting the differences in population and/or needs across contexts. Conclusions: In New South Wales, Australia, fewer than half of young people accessing alcohol and other drug treatment between 2012 and 2023 completed treatment, and completion rates were lower among those facing barriers such as polysubstance use and housing insecurity. [ABSTRACT FROM AUTHOR]

Objective: To examine rural–urban disparities in substance use disorder treatment access and continuation. Data Sources and Study Setting: We analyzed a 2016–2018 U.S. national secondary dataset of commercial insurance claims. Study Design: This cross‐sectional study examined individuals with a new episode of opioid, alcohol, or other drug use disorders. Treatment initiation and engagement rates, and rates of using out‐of‐network providers for these services, were compared between rural and urban patients. Data Collection: We included individuals 18–64 years old with continuous employer‐sponsored insurance. Principal Findings: Patients in rural settings experienced lower treatment initiation rates for alcohol (36.6% vs. 38.0%, p < 0.001), opioid (41.2% vs. 44.2%, p < 0.001), and other drug (37.7% vs. 40.1%, p < 0.001) use disorders, relative to those in urban areas. Similarly, rural patients had lower treatment engagement rates for alcohol (15.1% vs. 17.3%, p < 0.001), opioid (21.0% vs. 22.6%, p < 0.001), and other drug (15.5% vs. 17.5%, p < 0.001) use disorders. Rural patients had higher out‐of‐network rates for treatment initiation for other drug use disorders (20.4% vs. 17.2%, p < 0.001), and for treatment engagement for alcohol (27.6% vs. 25.2%, p = 0.006) and other drug (36.1% vs. 31.1%, p < 0.001) use disorders. Conclusions: These findings indicate that individuals with substance use disorders in rural areas have lower rates of initial and ongoing treatment, and are more likely to seek care out‐of‐network. [ABSTRACT FROM AUTHOR]

ABSTRACT Pregnant and parenting people (PPP) experience complex challenges when seeking recovery from substance use disorders (SUD). Using a community‐based participatory research approach, researchers partnered with PPP seeking recovery from SUD to explore supports needed in their communities. Findings are reported in adherence with the consolidated criteria for reporting qualitative research. Thirty PPP were recruited from a residential drug recovery facility in the Southeastern United States. Participant interviews were conducted in‐person or virtually. PPP were asked to identify existing and needed parenting and recovery supports in their communities. Interviews were transcribed, verified for accuracy and coded using NVIVO software. Thematic analysis was framed by the Substance Abuse and Mental Health Services Administration (SAMHSA) eight dimensions of wellness, which reflect wellness standards across life domains. Participants identified internal and external challenges including feelings of guilt and shame, treatment access issues, lack of recovery support, grief and loss and inadequate instrumental support. Needed supports were broadly categorised as parenting resources, childcare resources, housing supports, recovery supports, occupational training and assistance and spirituality resources, and then evaluated and sorted based on appropriate fit within the SAMHSA's eight dimensions of wellness. Highest perceived needs fit within Intellectual, Emotional, Spiritual and Environmental wellness dimensions, respectively. Healthcare providers promoting recovery for PPP should focus on support needs within SAMHSA's dimensions of wellness and develop strategies that address the full range of these critical wellness dimensions. Intellectual, emotional and tangible environmental supports including parenting and recovery skills training, accessible mental health care and residential housing with childcare availability are essential for long‐term recovery and positive parenting. [ABSTRACT FROM AUTHOR]

Objectives: Widespread health service disruptions resulting from the COVID-19 pandemic coincided with a dramatic increase in overdose deaths among people who use drugs (PWUD) in Vancouver, Canada. Those with a history of injection drug use are known to be at heightened risk of substance-associated harms. Drug use patterns and associated sociodemographic and health care utilization trends have been understudied in this population since the pandemic onset. We sought to understand patterns of drug use initiation and/or re-initiation among people with a history of injection drug use (IVDU). Methods: Data were obtained from three harmonized prospective cohort studies of PWUD in Vancouver. Participants with a lifetime history of IVDU who responded to a survey between June 2021 and May 2022 were included. The primary outcome variable was a composite of substance use initiation and re-initiation over the study period, labelled as drug (re)-initiation. A multivariable generalized linear mixed-effects model was used to examine factors associated with self-reported (re)-initiation of substance use over the past six months. Results: Among 1061 participants, the median age was 47 years at baseline and 589 (55.5%) identified as men. In total, 183 (17.2%) participants reported initiating and/or re-initiating a drug, with 44 (4.1%) reporting new drug initiation and 148 (14.0%) reporting drug re-initiation (9 participants responded 'yes' to both). Overall, unregulated stimulants (e.g., crystal methamphetamine and cocaine) were the most common drug class (re-)initiated (n = 101; 55.2%), followed by opioids (n = 74; 40.4%) and psychedelics (n = 36; 19.7%). In the multivariable analysis, (re-)initiation of drug use was independently associated with recent IVDU (adjusted odds ratio [AOR] 2.62, 95% confidence interval [CI] 1.02, 6.76), incarceration (AOR 3.36, CI 1.12, 10.14) and inability to access addiction treatment (AOR 4.91, 95% CI 1.22, 19.75). Conclusions: In an era impacted by the intersecting effects of the COVID-19 pandemic and the overdose crisis, nearly one in five PWUD with a history of IVDU began using a new drug and/or re-started use of a previous drug. Those who reported drug (re-)initiation exhibited riskier substance use behaviours and reported difficulty accessing treatment services. Our findings underscore the need to provide additional resources to support this high-risk population. [ABSTRACT FROM AUTHOR]

Background: In Brazil, the prevalence of mental disorders is heterogeneous, with most studies conducted in large cities with high population density. This study aimed to assess the prevalence of mental disorders and psychiatric comorbidities among young adults (22–23 years old) and adults (37–38 years old) from Ribeirão Preto, a city located in the Northeast of the São Paulo state, with approximately 700,000 inhabitants, and to explore associations with sociodemographic variables, suicide risk, and health service usage. Second, we aimed to evaluate the performance of the Self-Report Questionnaire (SRQ-20) as a screening tool for mental disorders to be applied to the local population. Methods: Participants from the 1978/1979 and 1994 Ribeirão Preto birth cohorts were evaluated using the Mini International Neuropsychiatric Interview (MINI) and the SRQ-20 at mean ages of 22–23, and 37–38 years, respectively. Results: Our sample comprised 1,769 individuals from the 1978/1979 cohort and 1,037 from the 1994 cohort. The prevalence of mental disorders ranged from 28.6% (1978/79) to 31% (1994), with frequent comorbid diagnoses (42.7% and 43.3%, respectively). Men and women had a similar prevalence of mental disorders in the younger cohort, while women had a higher prevalence in the older cohort. Low educational attainment was associated with higher rates of diagnosis. In both cohorts, alcohol and other psychoactive substance use was higher among those with a psychiatric diagnosis. Although those with a psychiatric diagnosis were less satisfied with their own health, only one-fifth had seen a mental health professional in the previous year. A psychiatric diagnosis increased the suicide risk by 5.6 to 9.1 times. Regarding the SRQ-20, the best cutoff points were 5/6 for men and 7/8 for women, with satisfactory performance. Conclusions: The prevalence and comorbidity of mental disorders were high in both cohorts and comparable to those in larger Brazilian cities. However, few individuals with a diagnosis had sought specialized care. These data suggest that the mental health gap is still significant in Brazil. [ABSTRACT FROM AUTHOR]

Background: As the demand for mental health and substance use (MHSU) services increases, there will be an even greater need for health human resources to deliver this care. This study investigates how family physicians' (FP) contact volume, and more specifically, MHSU contact volume, is shaped by demographic trends among FPs in British Columbia, Canada. Methods: We used annual physician-level administrative billing data and demographic information on FPs in British Columbia between 1996 and 2017. This study analyzes trends in primary care service provision among graduating cohorts of FPs, FPs of different ages (as measured by years since graduation), and FPs practicing during different time periods. Additionally, analyses are stratified by FP sex to account for potential differences in labour supply patterns between male and female FPs. Results: Our results show that while FPs' overall contacts with patients decreased between 1996 and 2017, their annual number of MHSU contacts increased, which was largely driven by an increase in substance use visits. Demographically, the proportion of female FPs in the labour force rose over time. Observed trends were similar, though not identical in male and female FPs, as males tended to have higher overall contact volume (both total contacts and MHSU), but also steeper declines in contact volume in later careers. The number of contacts (both total and MHSU) changed across career stage - rising steadily from start to mid-career, peaking at 20–30 years in practice, and decreasing steadily thereafter. This was evident for all cohorts and consistent over the 21-year study period but flattened in amplitude over time. Our findings also point to potential cohort effects on labour supply. The inverse U-shaped career trend extended to MHSU contacts, but its peak seems to have shifted to a later career stage (peaking at 30–40 years of practice) over time. Conclusions: Our study shows changing dynamics in MHSU service delivery among FPs over time, across the life span and between FP sexes that are likely to influence access to care beyond simply the number of FPs. Given the healthcare needs of the population, these findings point to potential future changes in provision of MHSU services. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusions Suboptimal pre‐pregnancy health, including substance use and cardiovascular risk factors, is associated with higher risks of maternal‐foetal morbidity and mortality.To determine if pre‐pregnancy substance use is associated with early pregnancy cardiovascular health (CVH). It is hypothesised that pre‐pregnancy use of substances is associated with worse CVH in the first trimester of pregnancy.This is a secondary analysis from the 2010–2015 United States nuMoM2b cohort (n = 9895). Pre‐pregnancy alcohol, tobacco, marijuana, and illicit substance use were assessed through questionnaires. Latent class analysis categorised participants based on their 3‐month pre‐pregnancy or ever(*) substance use: (1) Illicit substances*, marijuana*, and alcohol use (n = 1234); (2) marijuana* and alcohol use (n = 2066); (3) tobacco and alcohol use (n = 636); and (4) alcohol only use (n = 3194). The referent group reported no pre‐pregnancy substance use (n = 2765). First trimester CVH score from 0 (least healthy) to 100 (most healthy) was calculated using a modified American Heart Association Life's Essential 8 framework and included body mass index (BMI), blood pressure, blood glucose, non‐HDL cholesterol, diet, sleep, and physical activity. Multiple linear regression evaluated the relationship between pre‐pregnancy substance use classes and CVH scores.CVH score varied by class: No substance use (mean: 65, SD: ±1.3), illicit substances*, marijuana*, and alcohol use (68 ± 1.3), marijuana* and alcohol use (67 ± 1.3), tobacco and alcohol use (62 ± 1.4), and alcohol only use (67 ± 1.3). In adjusted models, those who used tobacco and alcohol compared to the no substance use class had a lower CVH score (−2.82); other classes had scores ranging from 1.81 to 2.44 points higher than the no substance use class. Individual CVH component scores followed similar patterns.All groups, but most markedly those who used tobacco and alcohol prior to pregnancy, began pregnancy with only moderate CVH and may benefit from CVH promotion efforts along with substance use treatment. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the form and level of daily caffeine intake recommended above 400 mg in medical students expected to consume caffeinated beverages to enhance their performance. Methods: From May to June 2023, freshman through senior medical students at a medical school in Korea were administered a seven-item questionnaire designed to measure the amount of caffeine-containing foods consumed, the weekly interval between consumption, the reason for consumption, and the level of caffeine-induced symptoms experienced. Results: Out of 443 students, 361 responded (81.5%). The most commonly consumed caffeine beverages were coffee (79.2%), followed by soda (33.2%), tea (27.4%), chocolate (25.2%), and energy drinks (20.5%). The estimated (average±standard deviation) daily intake was estimated to 274.6±276.5 mg, and they consumed caffeine on an average of 4.25±2.26 days per week. Students who consumed 400 mg or more of caffeine daily consumed 19.9%. The primary motivation for caffeine intake was “to improve academic performance” (60.9%) and “preferred food” (51.8%). Among the responders, 98% of them replied they had symptoms that could be caused by caffeine, in order of palpitations (47.4%), frequent urination (42.9%), anxiety (27.1%), indigestion (17.5%), and excitement (17.5%). A total of 45.7% reported two symptoms, and 24.7% reported three or more. Conclusion: Caffeinated beverage consumption was routine among current medical students, with 20% consuming more than the recommended daily amount. Most students experienced at least one caffeine-induced symptom, with two symptoms in half, suggesting the need for policy measures and warnings about caffeine-containing foods. [ABSTRACT FROM AUTHOR]

New psychoactive substances (NPSs) are a heterogenous group of psychotropic molecules and diverted pharmaceutical drugs sold worldwide as legal substitutes for controlled drugs. The psychiatric consequences of NPS use are relatively unknown, although evidence of related psychotic symptoms has been described in the literature. We sought to summarize the available evidence on NPS-related psychiatric disorders, to facilitate the interpretation of the molecular mechanism underlying their specific pathologies. A literature search of Scopus, PubMed and Google Scholar was conducted including studies published between 2013 and 2024, in which a correlation between NPS consumption and psychiatric symptoms was reported. Furthermore, the short- and long-term psychopathological effects were included. The literature search resulted in 109 NPS-related intoxication cases in which acute or chronic psychiatric symptoms were reported, mostly related to synthetic cannabinoids, followed by synthetic cathinones, hallucinogens, natural NPSs and stimulants. The most common acute symptoms were hallucinations, aggressiveness, and psychotic and bizarre behavior, related to the molecular disbalance of neurotransmitters in the central nervous systems, with different mechanisms. The lack of clear diagnostic criteria and toxicological analyses has resulted in crucial complications in psychiatric diagnoses related to NPS intoxication. Hence, the implementation of toxicological screening procedures in emergency rooms, including the main NPS classes, should support the diagnosis of acute intoxication and its proper therapeutic treatment. Finally, proper follow-up should be implemented to assess the chronic sequelae. [ABSTRACT FROM AUTHOR]

Issues: Self‐change from alcohol and drug use problems is increasingly acknowledged in research. Despite the growing number of published studies, the most recent broad review of this dispersed field dates back to 2010. The present review narratively synthesises key findings from empirical studies and critically identifies research gaps and directions for further research. Approach: Following the PRISMA guidelines for scoping reviews, a systematic search was conducted in multiple scientific databases, resulting in the identification of 56 relevant articles with explicit empirical results on self‐change. Key Findings: The scoping review presents findings related to: (i) methods and definitions used; (ii) the prevalence of self‐change; (iii) indicators of self‐change; (iv) the process of self‐change; and (v) population views on self‐change. Conclusion: The review highlights the significant growth in research on self‐change considering key themes as well as the need for a relational and time‐bound approach to self‐change in research and practice. [ABSTRACT FROM AUTHOR]

Background: Patients who undergo cardiac surgery for drug useassociated infective endocarditis (DUA-IE) have high rates of readmissions for recurrent endocarditis, substance use disorder (SUD), and septicemia. Our primary objectivewas to assesswhether exposure to an addiction consult team (ACT) was associated with reduced readmissions in this population. Methods: This single-center retrospective analysis identified patients who underwent cardiac surgery for DUA-IE between 1/2012-9/2022 using the Society for Thoracic Surgeons database, and compared the cumulative incidence of readmissions at 1, 3, 6, and 12 months among those cared for before and after the implementation of an ACT in 9/2017, accounting for competing risk of mortality and adjusted for measured confounders using inverse probability of treatment weighting. Results: The 58 patients (35 pre-ACT and 23 post-ACT) were young (36.4 +/- 7.7 years) and predominantly White (53.4%) and male (70.7%). The post-ACT cohort had a significantly lower risk of readmission at 1 month (adjusted risk difference [RD] -23.8% [95% CI -94.4%, -8.3%], P = 0.005) and 3 months (RD -34.1% [-55.1%, -13.1%], P = 0.005), but not at 6 or 12months. In a sensitivity analysis, the post-ACT cohort also had significantly lower risk of readmissions for SUD complications at 3 months. Discussion and Conclusion: ACTexposure was associated with a lower risk of short-term readmission among patients with surgically managed DUA-IE, possibly due to a reduction in SUD-related complications. Additional studies are needed to replicate these findings and to identify ways to sustain the potential benefits of ACTs over the longer term. [ABSTRACT FROM AUTHOR]

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Background: Chemsex has been defined as the deliberate use of drugs for prolonged sexual intercourse between gay and bisexual men and other men who have sex with men (MSM). Drugs associated with chemsex can trigger mental health problems such as anxiety, depression, risk of psychosis and suicidal ideation, social isolation, stigmatization, and even loss of impulse control and lack of coping strategies. Currently, the increase in illicit drugs in a sexual context is considered an outbreak of a public health emergency. Objective: The aim of this study is the construction and validation of the Chem-Sex Inventory (CSI), a new scale to assess the mental health risk of chemsex behaviors. Methods: A cross-sectional design was conducted to study 563 participants. Data were collected through an online questionnaire between January and April 2023, and the construct validity of the CSI was assessed through exploratory and confirmatory factor analysis. Results: The sample was, on average, 36 years old (SD: ±9.2). The majority of gender identity was cisgender (97.7%). A factor structure was found that can be summarized in four dimensions: emotional instability, risk of psychosis, altered body perception, and risk of suicide. The confirmatory factor analysis (CFA) presents adequate reliability values, with a Cronbach's alpha above 0.87 for all dimensions and a McDonald's omega above 0.88 with a good fit of the 42 items. Conclusions: Our study has shown that the Chem-Sex Inventory (CSI) scale has factorial validity and could be used in clinical practice and research to measure the behavioral contribution of the chemsex phenomenon in MSM. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mild traumatic brain injury (mTBI) can profoundly impact overall health, employment, and family life. Incidence of mTBI in the workplace represents an important subgroup with poorer outcomes. Mental health (MH) and substance use (SU) challenges are a primary correlate of TBI, but are rarely assessed among individuals with a work-related (wr)-mTBI, particularly at a population-level. OBJECTIVE: This study aimed to assess the association between lifetime wr-mTBI and non-wr-mTBI and the experience of MH and SU challenges. METHODS: The 2019 Centre for Addiction and Mental Health (CAMH) Monitor is a cross-sectional telephone survey of adults aged≥18 years in Ontario, Canada, employing a stratified (six regions) two-stage (telephone number, respondent) list-assisted random digit dialing probability selection procedure (N = 1792). Adjusting for sociodemographic variables, binary logistic regression was conducted to assess the association between lifetime wr-mTBI and non-wr-mTBI (relative to no TBI) and four outcomes: hazardous use of alcohol and of cannabis, psychological distress, and fair/poor mental health. RESULTS: Adjusting for sociodemographic variables, non-wr-mTBI demonstrated increased odds of hazardous alcohol (AOR = 2.12, 95% CI = 1.41, 3.19) and cannabis use (AOR = 1.61, 95% CI = 1.05, 2.45), psychological distress (AOR = 1.68, 95% CI = 1.14, 2.49), and fair/poor mental health (AOR = 1.70, 95% CI = 1.11, 2.59). Lifetime wr-mTBI demonstrated increased odds of reporting psychological distress (AOR = 3.40, 95% CI = 1.93, 5.97) and fair/poor mental health (AOR = 2.16, 95% CI = 1.12, 4.19) only. CONCLUSIONS: Non-wr-mTBI was associated with both MH and SU, whereas wr-mTBI was associated with MH only. MH outcomes were more strongly associated with wr-mTBI than non-wr-mTBI. Physicians, employers, and insurers need to consider the potential association between wr-mTBI and MH, and provide care accordingly. [ABSTRACT FROM AUTHOR]

Abstract Background Hepatitis B virus (HBV) infection is a silent epidemic among people who inject drugs (PWID). HBV testing and vaccination are important for PWID to reduce the risk of infection, prevent chronic complications and contribute to public health efforts in addressing HBV transmission. Our objective was to assess the self-reported lifetime uptake of HBV testing and vaccination among PWID in Iran and their associated factors. Method This cross-sectional study was conducted among 2,684 PWID in 11 large cities from July 2019 to March 2020 using a respondent-driven sampling method. Participants were interviewed face-to-face and asked about their lifetime experience of HBV testing and vaccination uptake as the outcome. Logistic regression models were built to identify related factors for reporting HBV testing and vaccination uptake. Results The prevalence of HBV testing and vaccination uptake among PWID was 14.2% (95% confidence intervals [CI]: 12.8–15.6) and 16.4% (95% CI: 14.9–18.1), respectively. Shared needles, syringes, or equipment in the past 12 months decreased the odds of reporting lifetime HBV testing uptake (Adjusted odds ratio [AOR]:0.46, 95% CI: 0.29–0.72). However, having an academic education (AOR: 1.89, 95% CI: 1.09–3.30) and lifetime experience of homelessness (AOR: 1.58, 95% CI: 1.21–2.06) increased the odds of reporting lifetime HBV vaccination uptake. Conclusion Our study highlighted the low prevalence of HBV testing and vaccination uptake among PWID in Iran. It is essential to understand and address the obstacles preventing PWID from getting tested and vaccinated for HBV. Addressing these barriers could significantly reduce the burden of HBV among this socio-economically marginalized population.

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

Background: Chemsex has been defined as the deliberate use of drugs for prolonged sexual intercourse between gay and bisexual men and other men who have sex with men (MSM). Drugs associated with chemsex can trigger mental health problems such as anxiety, depression, risk of psychosis and suicidal ideation, social isolation, stigmatization, and even loss of impulse control and lack of coping strategies. Currently, the increase in illicit drugs in a sexual context is considered an outbreak of a public health emergency. Objective: The aim of this study is the construction and validation of the Chem-Sex Inventory (CSI), a new scale to assess the mental health risk of chemsex behaviors. Methods: A cross-sectional design was conducted to study 563 participants. Data were collected through an online questionnaire between January and April 2023, and the construct validity of the CSI was assessed through exploratory and confirmatory factor analysis. Results: The sample was, on average, 36 years old (SD: ±9.2). The majority of gender identity was cisgender (97.7%). A factor structure was found that can be summarized in four dimensions: emotional instability, risk of psychosis, altered body perception, and risk of suicide. The confirmatory factor analysis (CFA) presents adequate reliability values, with a Cronbach’s alpha above 0.87 for all dimensions and a McDonald’s omega above 0.88 with a good fit of the 42 items. Conclusions: Our study has shown that the Chem-Sex Inventory (CSI) scale has factorial validity and could be used in clinical practice and research to measure the behavioral contribution of the chemsex phenomenon in MSM.

Abstract Objectives Widespread health service disruptions resulting from the COVID-19 pandemic coincided with a dramatic increase in overdose deaths among people who use drugs (PWUD) in Vancouver, Canada. Those with a history of injection drug use are known to be at heightened risk of substance-associated harms. Drug use patterns and associated sociodemographic and health care utilization trends have been understudied in this population since the pandemic onset. We sought to understand patterns of drug use initiation and/or re-initiation among people with a history of injection drug use (IVDU). Methods Data were obtained from three harmonized prospective cohort studies of PWUD in Vancouver. Participants with a lifetime history of IVDU who responded to a survey between June 2021 and May 2022 were included. The primary outcome variable was a composite of substance use initiation and re-initiation over the study period, labelled as drug (re)-initiation. A multivariable generalized linear mixed-effects model was used to examine factors associated with self-reported (re)-initiation of substance use over the past six months. Results Among 1061 participants, the median age was 47 years at baseline and 589 (55.5%) identified as men. In total, 183 (17.2%) participants reported initiating and/or re-initiating a drug, with 44 (4.1%) reporting new drug initiation and 148 (14.0%) reporting drug re-initiation (9 participants responded ‘yes’ to both). Overall, unregulated stimulants (e.g., crystal methamphetamine and cocaine) were the most common drug class (re-)initiated (n = 101; 55.2%), followed by opioids (n = 74; 40.4%) and psychedelics (n = 36; 19.7%). In the multivariable analysis, (re-)initiation of drug use was independently associated with recent IVDU (adjusted odds ratio [AOR] 2.62, 95% confidence interval [CI] 1.02, 6.76), incarceration (AOR 3.36, CI 1.12, 10.14) and inability to access addiction treatment (AOR 4.91, 95% CI 1.22, 19.75). Conclusions In an era impacted by the intersecting effects of the COVID-19 pandemic and the overdose crisis, nearly one in five PWUD with a history of IVDU began using a new drug and/or re-started use of a previous drug. Those who reported drug (re-)initiation exhibited riskier substance use behaviours and reported difficulty accessing treatment services. Our findings underscore the need to provide additional resources to support this high-risk population.

Abstract Background As the demand for mental health and substance use (MHSU) services increases, there will be an even greater need for health human resources to deliver this care. This study investigates how family physicians’ (FP) contact volume, and more specifically, MHSU contact volume, is shaped by demographic trends among FPs in British Columbia, Canada. Methods We used annual physician-level administrative billing data and demographic information on FPs in British Columbia between 1996 and 2017. This study analyzes trends in primary care service provision among graduating cohorts of FPs, FPs of different ages (as measured by years since graduation), and FPs practicing during different time periods. Additionally, analyses are stratified by FP sex to account for potential differences in labour supply patterns between male and female FPs. Results Our results show that while FPs’ overall contacts with patients decreased between 1996 and 2017, their annual number of MHSU contacts increased, which was largely driven by an increase in substance use visits. Demographically, the proportion of female FPs in the labour force rose over time. Observed trends were similar, though not identical in male and female FPs, as males tended to have higher overall contact volume (both total contacts and MHSU), but also steeper declines in contact volume in later careers. The number of contacts (both total and MHSU) changed across career stage - rising steadily from start to mid-career, peaking at 20–30 years in practice, and decreasing steadily thereafter. This was evident for all cohorts and consistent over the 21-year study period but flattened in amplitude over time. Our findings also point to potential cohort effects on labour supply. The inverse U-shaped career trend extended to MHSU contacts, but its peak seems to have shifted to a later career stage (peaking at 30–40 years of practice) over time. Conclusions Our study shows changing dynamics in MHSU service delivery among FPs over time, across the life span and between FP sexes that are likely to influence access to care beyond simply the number of FPs. Given the healthcare needs of the population, these findings point to potential future changes in provision of MHSU services.

Abstract Background In Brazil, the prevalence of mental disorders is heterogeneous, with most studies conducted in large cities with high population density. This study aimed to assess the prevalence of mental disorders and psychiatric comorbidities among young adults (22–23 years old) and adults (37–38 years old) from Ribeirão Preto, a city located in the Northeast of the São Paulo state, with approximately 700,000 inhabitants, and to explore associations with sociodemographic variables, suicide risk, and health service usage. Second, we aimed to evaluate the performance of the Self-Report Questionnaire (SRQ-20) as a screening tool for mental disorders to be applied to the local population. Methods Participants from the 1978/1979 and 1994 Ribeirão Preto birth cohorts were evaluated using the Mini International Neuropsychiatric Interview (MINI) and the SRQ-20 at mean ages of 22–23, and 37–38 years, respectively. Results Our sample comprised 1,769 individuals from the 1978/1979 cohort and 1,037 from the 1994 cohort. The prevalence of mental disorders ranged from 28.6% (1978/79) to 31% (1994), with frequent comorbid diagnoses (42.7% and 43.3%, respectively). Men and women had a similar prevalence of mental disorders in the younger cohort, while women had a higher prevalence in the older cohort. Low educational attainment was associated with higher rates of diagnosis. In both cohorts, alcohol and other psychoactive substance use was higher among those with a psychiatric diagnosis. Although those with a psychiatric diagnosis were less satisfied with their own health, only one-fifth had seen a mental health professional in the previous year. A psychiatric diagnosis increased the suicide risk by 5.6 to 9.1 times. Regarding the SRQ-20, the best cutoff points were 5/6 for men and 7/8 for women, with satisfactory performance. Conclusions The prevalence and comorbidity of mental disorders were high in both cohorts and comparable to those in larger Brazilian cities. However, few individuals with a diagnosis had sought specialized care. These data suggest that the mental health gap is still significant in Brazil.

Mental health challenges and substance use are common among college athletes, yet few studies have been conducted to understand substance use as a coping strategy. The pressures of collegiate athletics - including commitments to training, travel, and competition - can contribute to maladaptive coping among college athletes, including alcohol and other substance use. An online survey was completed by 188 college athletes competing across NCAA/NJCAA divisions at six institutions in the United States to examine factors associated with substance use coping and whether specific strategies of coping were associated with risk of substance use. Alcohol and drug use were assessed using the CRAFFT Screening Test, NIDA-Modified ASSIST, and Alcohol Use Disorders Identification Test. Coping was assessed with the Coping Orientation to Problems Experienced Inventory, stress was assessed using an adapted Graduate Stress Inventory, athletics-related anxiety was assessed with the Sport Anxiety Scale, and perceived control of stress was assessed using the Perceived Control Questionnaire. Older athletes, men, and those with higher stress were more likely to use substances to cope. Higher behavioral disengagement, higher substance use coping, and lower religious coping were associated with increased likelihood of binge drinking and substance-related risk behaviors. These findings point to the importance of developing targeted interventions aimed at addressing stress and facilitating healthy coping to reduce problematic drinking and substance use among college athletes. [ABSTRACT FROM AUTHOR]

Substance use is a persistent concern for adolescents in many countries due to the significant negative impact on mental, physical and social outcomes. US research indicates that while 4.1% of 12–17‐year‐olds require treatment, <10% of those who require it access it. This paper summarises the literature available on the barriers and enablers to those under 18s attending substance use treatment to inform policy and practice. Using a systematic approach, we searched six databases for studies which reported barriers and enablers to those aged 18 and under accessing substance use treatment. Thirty‐two papers met the inclusion criteria and we present the findings using a narrative synthesis. Only one paper identified explored this topic in Europe. Barriers and enablers are presented across four themes: (1) individual factors, (2) societal factors, (3) Gateway Providers and (4) treatment service factors. Mental health nurses, especially those working with young people, should be aware that adolescents are unlikely to perceive their substance use as problematic and rely on adults to access treatment. Access appears more difficult for females and socially marginalised youth. Various professionals direct young people towards treatment, but clear protocols are needed to encourage them to intervene, which could be an opportunity for nurses to be innovative and lead in this area. Services perceived as adolescent‐specific, youth‐friendly and flexible encourage attendance while the cost of treatment, including time off work and transport, function as barriers. [ABSTRACT FROM AUTHOR]

Gambling and substance use disorders (SUDs) are prevalent among U.S. military veterans and often co-occur. However, little is known about the clinical and behavioral correlates and suicidal risk of SUDs and gambling among veterans that can help inform targeted interventions for their co-occurrence. In the current study, we analyzed data from a nationally representative sample of 4069 veterans who participated in the National Health and Resilience in Veterans Study. Self-reported measures of lifetime SUDs and past-year gambling (Brief Problem Gambling Screen) were administered. A multinomial logistic regression analysis was conducted to examine differences between four groups: non-SUD/non-gambling, 40.3%; SUD-only 27.3%; Gambling-only 16.3%; and SUD + Gambling, 16.1%. The Gambling-only, SUD-only, and SUD + Gambling groups reported more adverse childhood experiences relative to the non-SUD/non-gambling group. The SUD-only and SUD + Gambling groups had higher odds for all lifetime and current clinical and trauma variables relative to the non-SUD/non-gambling group. The SUD + Gambling group had higher odds of suicidality, non-suicidal self-injury, nicotine dependence and mental health treatment relative to the SUD-only group and all assessed clinical measures relative to the Gambling-only group. Results suggest that SUDs and gambling are associated with substantial trauma and mental health burden among U.S. veterans, with co-occurring SUDs and gambling linked particularly to suicidality/self-harm and mental health treatment. The findings underscore the importance of multicomponent assessments and interventions targeting SUDs, gambling, and related concerns, such as trauma-related mental health difficulties, in this population. [ABSTRACT FROM AUTHOR]

Abstract Background Prisons often serve as high-risk environments for drug use, and incarcerated people are at a high risk for substance use-related mental and physical harms. This study aimed to determine the prevalence of non-injection drug use inside the prison and its related factors among incarcerated people in Iran. Methods We utilized data from three national bio-behavioral surveillance surveys conducted among incarcerated people in Iran in 2009, 2013, and 2017. Eligibility criteria were being ≥ 18 years old, providing informed consent, and being incarcerated for over a week. Overall, 17,228 participants across all surveys were recruited through a multi-stage random sampling approach. Each participant underwent a face-to-face interview and HIV test. The primary objective of the study was to assess self-reported non-injection drug use within the prison environment within the last month. A multivariable logistic regression model was built to determine associated covariates with drug use inside prison and an adjusted odds ratio (aOR) with 95% confidence intervals (CI) were reported. Result The prevalence of non-injection drug use inside the prison was 24.1% (95% CI 23.5, 24.7) with a significant decreasing trend (39.7% in 2009, 17.8% in 2013, 14.0% in 2017; p-value

Abstract Background Although clinical substance use disorder (SUD) care is multidisciplinary there are few opportunities to collaborate for quality improvement or systems change. In Oregon, the Project ECHO (Extension for Community Healthcare Outcomes) model was adapted to create a novel multidisciplinary SUD Leadership ECHO. The objective of this study was to understand the unique effects of the adapted ECHO model, determine if the SUD Leadership ECHO could promote systems change, and identify elements that enabled participant-leaders to make changes. Methods Four focus groups were conducted between August and September of 2022 with a purposive sample of participants from the second cohort of the Oregon ECHO Network’s SUD Leadership ECHO that ran January to June 2022. Focus group domains addressed the benefits of the adapted ECHO model, whether and why participants were able to make systems change following participation in the ECHO, and recommendations for improvement. Thematic analysis developed emergent themes. Results 16 of the 53 ECHO participants participated in the focus groups. We found that the SUD Leadership ECHO built a multi-disciplinary community of practice among leaders and reduced isolation and burnout. Three participants reported making organizational changes following participation in the ECHO. Those who successfully made changes heard best practices and how other organizations approached problems. Barriers to initiating practice and policy changes included lack of formal leadership authority, time constraints, and higher-level systemic issues. Participants desired for future iterations of the ECHO more focused presentations on a singular topic, and asked for a greater focus on solutions, advocacy, and next steps. Conclusions The adapted ECHO model was well received by focus group participants, with mixed reports on whether participation equipped them to initiate organizational or policy changes. Our findings suggest that the SUD Leadership ECHO model, with fine-tuning, is a promising avenue to support SUD leaders in promoting systems change and reducing isolation among SUD leaders.

Abstract Introduction The hepatitis C virus (HCV) causes chronic and curable disease with a substantial burden of morbidity and mortality across the globe. In the United States (US) and other developed countries, incidence of HCV is increasing and people who inject drugs are disproportionately affected. However, HCV treatment rates amongst patients with substance use disorders (SUD) are suboptimal. In this study, we aimed to understand the perspectives of subspecialist physicians who care for substantial numbers of patients with HCV, including addiction medicine, infectious diseases, and hepatology physicians, to better understand barriers and facilitators of HCV treatment. Methods We recruited subspecialty physicians via purposive and snowball sampling and conducted semi-structured interviews with 20 physicians at 12 institutions across the US. We used a mixed deductive and inductive approach to perform qualitative content analysis with a rapid matrix technique. Results Three major themes emerged: (1) Perceptions of patient complexity; (2) Systemic barriers to care, and (3) Importance of multidisciplinary teams. Within these themes, we elicited subthemes on the effects of patient-level factors, provider-level factors, and insurance-based requirements. Conclusion Our results suggest that additional strategies are needed to reach the “last mile” untreated patients for HCV care, including decentralization and leverage of telehealth-based interventions to integrate treatment within primary care clinics, SUD treatment facilities, and community harm reduction sites. Such programs are likely to be more successful when multidisciplinary teams including pharmacists and/or peer navigators are involved. However, burdensome regulatory requirements continue to hinder this expansion in care and should be eliminated.

Abstract Background Substance misuse poses a significant public health challenge, characterized by premature morbidity and mortality, and heightened healthcare utilization. While studies have demonstrated that previous hospitalizations and emergency department visits are associated with increased mortality in patients with substance misuse, it is unknown whether prior utilization of emergency medical service (EMS) is similarly associated with poor outcomes among this population. The objective of this study is to determine the association between EMS utilization in the 30 days before a hospitalization or emergency department visit and in-hospital outcomes among patients with substance misuse. Methods We conducted a retrospective analysis of adult emergency department visits and hospitalizations (referred to as a hospital encounter) between 2017 and 2021 within the Substance Misuse Data Commons, which maintains electronic health records from substance misuse patients seen at two University of Wisconsin hospitals, linked with state agency, claims, and socioeconomic datasets. Using regression models, we examined the association between EMS use and the outcomes of in-hospital death, hospital length of stay, intensive care unit (ICU) admission, and critical illness events, defined by invasive mechanical ventilation or vasoactive drug administration. Models were adjusted for age, comorbidities, initial severity of illness, substance misuse type, and socioeconomic status. Results Among 19,402 encounters, individuals with substance misuse who had at least one EMS incident within 30 days of a hospital encounter experienced a higher likelihood of in-hospital mortality (OR 1.52, 95% CI [1.05 – 2.14]) compared to those without prior EMS use, after adjusting for confounders. Using EMS in the 30 days prior to an encounter was associated with a small increase in hospital length of stay but was not associated with ICU admission or critical illness events. Conclusions Individuals with substance misuse who have used EMS in the month preceding a hospital encounter are at an increased risk of in-hospital mortality. Enhanced monitoring of EMS users in this population could improve overall patient outcomes.

Abstract Background Poor adherence to health behaviors is one of the considerable challenges among drug users. This issue is especially noticeable among people who use injection methods for consumption, which increases the possibility of contracting HIV and hepatitis B and C. Therefore, it seems that adopting appropriate intervention approaches focusing on all dimensions of health-related behaviors to promote health behaviors is considered. As a result, in the present study, the effectiveness of a comprehensive educational program on promoting health behaviors and awareness of HIV, hepatitis B, and hepatitis C in drug users was investigated. Methods This pretest–posttest quasi-experimental study was performed. The participants were 81 men with substance use disorders residing in a rehabilitation center. The participants took part in four training workshops. The workshops focused on mental health, awareness of HIV, and hepatitis B and C with learner-centered approaches. Results According to the results, the mean score of the health behavior scale in the participants after receiving the intervention of the comprehensive program increased significantly (P

Background: Although clinical substance use disorder (SUD) care is multidisciplinary there are few opportunities to collaborate for quality improvement or systems change. In Oregon, the Project ECHO (Extension for Community Healthcare Outcomes) model was adapted to create a novel multidisciplinary SUD Leadership ECHO. The objective of this study was to understand the unique effects of the adapted ECHO model, determine if the SUD Leadership ECHO could promote systems change, and identify elements that enabled participant-leaders to make changes. Methods: Four focus groups were conducted between August and September of 2022 with a purposive sample of participants from the second cohort of the Oregon ECHO Network's SUD Leadership ECHO that ran January to June 2022. Focus group domains addressed the benefits of the adapted ECHO model, whether and why participants were able to make systems change following participation in the ECHO, and recommendations for improvement. Thematic analysis developed emergent themes. Results: 16 of the 53 ECHO participants participated in the focus groups. We found that the SUD Leadership ECHO built a multi-disciplinary community of practice among leaders and reduced isolation and burnout. Three participants reported making organizational changes following participation in the ECHO. Those who successfully made changes heard best practices and how other organizations approached problems. Barriers to initiating practice and policy changes included lack of formal leadership authority, time constraints, and higher-level systemic issues. Participants desired for future iterations of the ECHO more focused presentations on a singular topic, and asked for a greater focus on solutions, advocacy, and next steps. Conclusions: The adapted ECHO model was well received by focus group participants, with mixed reports on whether participation equipped them to initiate organizational or policy changes. Our findings suggest that the SUD Leadership ECHO model, with fine-tuning, is a promising avenue to support SUD leaders in promoting systems change and reducing isolation among SUD leaders. [ABSTRACT FROM AUTHOR]

Background: Prisons often serve as high-risk environments for drug use, and incarcerated people are at a high risk for substance use-related mental and physical harms. This study aimed to determine the prevalence of non-injection drug use inside the prison and its related factors among incarcerated people in Iran. Methods: We utilized data from three national bio-behavioral surveillance surveys conducted among incarcerated people in Iran in 2009, 2013, and 2017. Eligibility criteria were being ≥ 18 years old, providing informed consent, and being incarcerated for over a week. Overall, 17,228 participants across all surveys were recruited through a multi-stage random sampling approach. Each participant underwent a face-to-face interview and HIV test. The primary objective of the study was to assess self-reported non-injection drug use within the prison environment within the last month. A multivariable logistic regression model was built to determine associated covariates with drug use inside prison and an adjusted odds ratio (aOR) with 95% confidence intervals (CI) were reported. Result: The prevalence of non-injection drug use inside the prison was 24.1% (95% CI 23.5, 24.7) with a significant decreasing trend (39.7% in 2009, 17.8% in 2013, 14.0% in 2017; p-value < 0.001). Overall, 44.0% of those who used drugs were also receiving opioid agonist therapy (OAT) and we noted that in 2017, 75.1% of those on OAT used stimulants. In the multivariable logistic regression model, the year of interview (2013: aOR = 1.43 and 2009: aOR = 5.60), younger age (19–29: aOR = 1.14 and 30–40: aOR = 1.37), male sex (aOR = 3.35), < high school education (aOR = 1.31), having a history of previous incarceration (aOR = 1.26), and having a history of lifetime HIV testing (aOR = 1.76) were significantly and positively associated with recent non-injection drug use inside the prison. Conclusions: Approximately one in four incarcerated people in Iran reported drug use within the last month inside prisons. While a declining trend in non-injection drug use was noted, substantial gaps persist in harm reduction programs within Iranian prisons. In particular, there is a pressing need for improvements in drug treatment programs, focusing on the integration of initiatives specifically designed for people who use stimulants. [ABSTRACT FROM AUTHOR]

Purpose Substance use disorders (SUDs) increase the risk and severity of infectious diseases, including coronavirus disease 2019 (COVID-19). Adults with a co-occurring SUD and psychiatric disorder were studied to elucidate the association between SUD severity and (1) COVID-19 vaccination status, (2) receptivity to a one-session intervention with a pharmacist advocating the benefits of vaccination, and (3) acceptance of referral for vaccination following the intervention. Methods COVID-19 vaccination status was recorded in 460 adults with SUD (324 males and 136 females) upon entry into inpatient treatment. A 2-parameter item response theory (IRT) model quantified SUD severity. Pharmacist-delivered intervention, modeled after the screening, brief intervention, and referral to treatment (SBIRT) protocol, was offered to unvaccinated participants. Results Higher SUD severity was associated with a lower vaccination rate. Nicotine, opioid, and sedative use disorders were most frequently associated with unvaccinated status. SUD severity was not associated with receptivity to intervention advocating vaccination or subsequent acceptance of a referral for vaccination. The portion of the sample that received the intervention was over 7 times more likely to accept a referral for vaccination when compared to participants who rejected the intervention (20.8% vs 2.8%). Conclusion Pharmacist-administered intervention produced motivation for vaccination in a number of recipients; however, receptivity to the intervention was not related to SUD severity. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence and demographic, social and health characteristics associated with co-occurring psychological distress symptoms, risky alcohol and/or substance use among a national sample of Aboriginal and Torres Strait Islander people aged 15 years or older. Methods: This study uses secondary cross-sectional data from the 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS). Data were collected via face-to-face interviews with those living in private dwellings across Australia. Participants were Aboriginal and Torres Strait Islander people (n = 10,579) aged 15 years or older. Data pertaining to psychological distress, alcohol and substance use were obtained and weighted to represent the total population of Aboriginal and Torres Strait Islander people in Australia. Results: A total of 20.3% participants were found to have co-occurring psychological distress, risky alcohol use and/or substance use, and 4.0% reported co-occurrence of all three conditions. Female participants in a registered marriage and fully engaged in study or employment had lower rates of co-occurring conditions. Poorer self-rated health, one or more chronic conditions and increased experiences of unfair treatment and physical harm in the past 12 months were associated with increased rates of co-occurring conditions. Conclusion: A range of potential risk and protective factors were identified for co-occurring psychological distress, risky alcohol and/or substance use among Aboriginal and Torres Strait Islander people. This information is critical for planning effective holistic strategies to decrease the burden of suffering imposed upon the individual, family and community members impacted by co-occurring conditions. [ABSTRACT FROM AUTHOR]

Introduction: The hepatitis C virus (HCV) causes chronic and curable disease with a substantial burden of morbidity and mortality across the globe. In the United States (US) and other developed countries, incidence of HCV is increasing and people who inject drugs are disproportionately affected. However, HCV treatment rates amongst patients with substance use disorders (SUD) are suboptimal. In this study, we aimed to understand the perspectives of subspecialist physicians who care for substantial numbers of patients with HCV, including addiction medicine, infectious diseases, and hepatology physicians, to better understand barriers and facilitators of HCV treatment. Methods: We recruited subspecialty physicians via purposive and snowball sampling and conducted semi-structured interviews with 20 physicians at 12 institutions across the US. We used a mixed deductive and inductive approach to perform qualitative content analysis with a rapid matrix technique. Results: Three major themes emerged: (1) Perceptions of patient complexity; (2) Systemic barriers to care, and (3) Importance of multidisciplinary teams. Within these themes, we elicited subthemes on the effects of patient-level factors, provider-level factors, and insurance-based requirements. Conclusion: Our results suggest that additional strategies are needed to reach the "last mile" untreated patients for HCV care, including decentralization and leverage of telehealth-based interventions to integrate treatment within primary care clinics, SUD treatment facilities, and community harm reduction sites. Such programs are likely to be more successful when multidisciplinary teams including pharmacists and/or peer navigators are involved. However, burdensome regulatory requirements continue to hinder this expansion in care and should be eliminated. [ABSTRACT FROM AUTHOR]

This report seeks to discuss sequelae of chronic cellulitis that is commonly treated in the ambulatory setting, as exacerbated by the conditions of living outside. Further we hope to identify etiologic factors that contribute to complication development. Additionally, this article will touch on unique treatment plan considerations for unhoused patients with the intention to educate providers and reduce mortality and morbidity relating to pedal skin and soft tissue infections in this population. This piece examines the case of a 52-year-old man with a history of chronic diseases, substance use disorder, and recurrent cellulitis. We highlight systemic issues in healthcare delivery for unhoused patients, including inadequate discharge planning, limited access to medication, and challenges in shelter placement. The discussion section emphasizes the importance of accurate diagnosis and tailored treatment plans for cellulitis in houseless individuals, the importance of a multidisciplinary approach incorporating social work services, and addressing chronic illnesses, substance use disorder, and housing issues. The report advocates for heightened awareness of bilateral cellulitis in unhoused populations, emphasizing the need for comprehensive, individualized treatment plans. [ABSTRACT FROM AUTHOR]

Background: Substance misuse poses a significant public health challenge, characterized by premature morbidity and mortality, and heightened healthcare utilization. While studies have demonstrated that previous hospitalizations and emergency department visits are associated with increased mortality in patients with substance misuse, it is unknown whether prior utilization of emergency medical service (EMS) is similarly associated with poor outcomes among this population. The objective of this study is to determine the association between EMS utilization in the 30 days before a hospitalization or emergency department visit and in-hospital outcomes among patients with substance misuse. Methods: We conducted a retrospective analysis of adult emergency department visits and hospitalizations (referred to as a hospital encounter) between 2017 and 2021 within the Substance Misuse Data Commons, which maintains electronic health records from substance misuse patients seen at two University of Wisconsin hospitals, linked with state agency, claims, and socioeconomic datasets. Using regression models, we examined the association between EMS use and the outcomes of in-hospital death, hospital length of stay, intensive care unit (ICU) admission, and critical illness events, defined by invasive mechanical ventilation or vasoactive drug administration. Models were adjusted for age, comorbidities, initial severity of illness, substance misuse type, and socioeconomic status. Results: Among 19,402 encounters, individuals with substance misuse who had at least one EMS incident within 30 days of a hospital encounter experienced a higher likelihood of in-hospital mortality (OR 1.52, 95% CI [1.05 – 2.14]) compared to those without prior EMS use, after adjusting for confounders. Using EMS in the 30 days prior to an encounter was associated with a small increase in hospital length of stay but was not associated with ICU admission or critical illness events. Conclusions: Individuals with substance misuse who have used EMS in the month preceding a hospital encounter are at an increased risk of in-hospital mortality. Enhanced monitoring of EMS users in this population could improve overall patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Although suicide bereavement is associated with suicide and self-harm, evidence regarding mechanisms is lacking. We investigated whether depression and substance use (alcohol and/or other drugs) explain the association between partner suicide bereavement and suicide. Methods: Linkage of nationwide, longitudinal data from Denmark for the period 1980–2016 facilitated a comparison of 22 668 individuals exposed to bereavement by a partner's suicide with 913 402 individuals bereaved by a partner's death due to other causes. Using causal mediation models, we estimated the degree to which depression and substance use (considered separately) mediated the association between suicide bereavement and suicide. Results: Suicide-bereaved partners were found to have a higher risk of suicide (HRadj = 1.59, 95% CI 1.36–1.86) and of depression (ORadj 1.16, 95% CI 1.09–1.25) when compared to other-bereaved partners, but a lower risk of substance use (ORadj 0.83; 95% CI 0.78–0.88). An increased risk of suicide was found among any bereaved individuals with a depression diagnosis recorded post-bereavement (ORadj 3.92, 95% CI 3.55–4.34). Mediation analysis revealed that depression mediated 2% (1.68%; 95% CI 0.23%–3.14%; p = 0.024) of the association between suicide bereavement and suicide in partners when using bereaved controls. Conclusions: Depression is a partial mediator of the association between suicide bereavement and suicide. Efforts to prevent and optimize the treatment of depression in suicide-bereaved people could reduce their suicide risk. Our findings might be conservative because we did not include cases of depression diagnosed in primary care. Further work is needed to understand this and other mediators. [ABSTRACT FROM AUTHOR]

Introduction: Over the past decade, frequent use of large quantities of nitrous oxide (N2O) has become more common in the Netherlands. Although N2O poses several negative health consequences for a subgroup of problematic N2O users, there is a lack of knowledge on what characterizes these intensive users. This study therefore aims to provide the demographic and substance use characteristics and experiences during treatment of treatment seeking problematic N2O users and to compare this with a matched group of treatment-seeking problematic cocaine users. Methods: A retrospective chart review was performed of patients who were referred for treatment of problematic N2O use at a large Dutch addiction care facility from January 2020 to September 2022, extracting demographics, pattern of use and follow-up data. Additionally, a subgroup of N2O users was propensity-score matched (1:1) with a subgroup of treatment seeking problematic cocaine users, both groups excluding users with substance use disorders or frequent use of substances other than N2O and cocaine, respectively. Results: 128 patients with a N2O use disorder were included in the total sample and a subgroup of 77 N2O-only users was propensity-score matched on age and sex to 77 cocaine-only users. N2O users were typically young (mean age 26.2 years), male (66.4%), unmarried (82.9%), with a low education level (59.0%) and born in the Netherlands (88.2%), with parents born in Morocco (45.3%). N2O was used intermittently (median 10 days/month, IQR 4.0–17.5 days) and often in very large quantities (median 5 kg [ca. 750 balloons] per average using day, IQR 2–10 kg). Compared to the patients with a cocaine use disorder, matched N2O users were lower educated, more often from Moroccan descent, and less likely to be alcohol or polysubstance users. Despite receiving similar treatments, N2O users were twice as likely to discontinue treatment before completion compared to cocaine users (63 vs. 35%, p = 0.004). Conclusion: Treatment-seeking problematic N2O users are demographically different from treatment-seeking problematic cocaine users and are much more likely to dropout from psychological treatment. Further research is needed into the needs and other factors of problematic N2O users that relate to poor treatment adherence in problematic N2O users. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to identify sociodemographic and substance-related factors associated with being screened, receiving advice or treatment information from healthcare providers, among individuals who met the criteria for the past 12-month alcohol use disorder (AUD). Methods: The 2015–2019 National Survey on Drug Use and Health data were analyzed to identify factors associated with being (1) asked about alcohol used among adults with AUD, who visited a healthcare provider within the past 12 months, and were not receiving AUD treatment (sample 1, n = 13,321); (2) asked about problematic use; (3) advised to reduce consumption; and (4) offered alcohol treatment information, among those in sample 1 who were asked about their use (n = 6,905). Results: About half (52.9%) in sample 1 were asked about their alcohol use. Among them, 21.6% were asked about problematic use, 17.7% were advised to reduce alcohol consumption, and 7.6% were offered information. The odds of being asked about alcohol use among male participants were 0.72 times the odds of female participants; however once asked, male participants showed greater odds of being asked about problematic use (adjusted odds ratio [aOR] = 1.53, 95% confidence interval [CI] = 1.29–1.82), advised to reduce consumption (aOR = 1.64, 95% CI = 1.24–2.16), and offered treatment information (aOR = 1.77, 95% CI = 1.34–2.35). As compared with non-Hispanic White participants, other racial/ethnic groups were less likely to be asked about alcohol use; however, once asked, no differences were observed for other outcomes. Conclusions: Significant gaps in the screening and provision of advice or treatment information were identified, particularly for racial/ethnic and sex subgroups. Reducing barriers for effective screening could help address AUD-related disparities. [ABSTRACT FROM AUTHOR]

Introduction: Multiple Canadian jurisdictions have reported a pattern of chronic pain among people who died from substance-related acute toxicity. This study examined the prevalence and characteristics of those with chronic pain using data from a national study of people who died of accidental acute toxicity. Methods: A cross-sectional analysis of accidental substance-related acute toxicity deaths that occurred in Canada between 1 January 2016 and 31 December 2017 was conducted. The prevalence of pain and pain-related conditions were summarized as counts and percentages of the overall sample. Subgroups of people with and without a documented history of chronic pain were compared across sociodemographic characteristics, health history, contextual factors and substances involved. Results: From the overall sample (n = 7902), 1056 (13%) people had a history of chronic pain while 6366 (81%) had no documented history. Those with chronic pain tended to be older (40 years and older), unemployed, retired and/or receiving disability supports around the time of death. History of mental health conditions, trauma and surgery or injury was significantly more prevalent among people with chronic pain. Of the substances that most frequently contributed to death, opioids typically prescribed for pain (hydromorphone and oxycodone) were detected in toxicology more often among those with chronic pain than those without. Conclusion: Findings underscore the cross-cutting role of multiple comorbidities and unmanaged pain, which could compound the risk of acute toxicity death. Continued prioritization of harm reduction and regular patient engagement to assess ongoing needs are among the various opportunities for intervention. [ABSTRACT FROM AUTHOR]