Medications For Addiction Research Articles

Profile and healthcare utilisation patterns of adolescent frequent attenders in Singapore primary care: a retrospective study

ObjectivesFrequent attenders (FAs) visit healthcare settings at higher rates compared with the general population and use disproportionate amounts of healthcare resources. Frequent attendance (FA) has also been associated with greater...

Multiple marginalized identities: A qualitative exploration of intersectional perinatal experiences of birthing people of color with substance use disorder in Massachusetts

IntroductionRacial and ethnic inequities persist in receipt of prenatal care, mental health services, and addiction treatment for pregnant and postpartum individuals with substance use disorder (SUD). Further qualitative work is needed to understand the intersectionality of racial and ethnic discrimination, stigma related to substance use, and gender bias on perinatal SUD care from the perspectives of affected individuals. MethodsPeer interviewers conducted semi-structured qualitative interviews with recently pregnant people of color with SUD in Massachusetts to explore the impact of internalized, interpersonal, and structural racism on prenatal, birthing, and postpartum experiences. The study used a thematic analysis to generate the codebook and double coded transcripts, with an overall kappa coefficient of 0.89. Preliminary themes were triangulated with five participants to inform final theme development. ResultsThe study includes 23 participants of diverse racial/ethnic backgrounds: 39% mixed race/ethnicity (including 9% with Native American ancestry), 30% Hispanic or Latinx, 26% Black/African American, 4% Asian. While participants frequently names racial and ethnic discrimination, both interpersonal and structural, as barriers to care, some participants attributed poor experiences to other marginalized identities and experiences, such as having a SUD. Three unique themes emerged from the participants' experiences: 1) Participants of color faced increased scrutiny and mistrust from clinicians and treatment programs; 2) Greater self-advocacy was required from individuals of color to counteract stereotypes and stigma; 3) Experiences related to SUD history and pregnancy status intersected with racism and gender bias to create distinct forms of discrimination. ConclusionPregnant and postpartum people of color affected by perinatal SUD faced pervasive mistrust and unequal standards of care from mostly white healthcare staff and treatment spaces, which negatively impacted their treatment access, addiction medication receipt, postpartum pain management, and ability to retain custody of their children. Key clinical interventions and policy changes identified by participants for antiracist action include personalizing anesthetic plans for adequate peripartum pain control, minimizing reproductive injustices in contraceptive counseling, and addressing misuse of toxicology testing to mitigate inequitable Child Protective Services (CPS) involvement and custody loss.

A Prospective Observational Study in a Tertiary Care Teaching Hospital on the Trends and Outcomes of Poisoning Cases

Developing countries suffer from significant morbidity and mortality making poisoning the global health problem with thousands of deaths occurring every year. In India, 70% of the land is occupied by Agriculture making farmers the worst affected which accounts for one-third of pesticide poisoning. Organophosphorus chemicals as well as purposeful self-ingestion of poison in an effort at suicide account for the majority of the significant burden of poisoning associated with morbidity and mortality. Enforcing the law correctly when it comes to the distribution and sale of addictive medications, establishing boundaries for electronic media when it comes to exposing people to harsh facts and raising societal awareness of the importance of education are essential objectives. Not only will it save countless lives, but it will also lower health budget costs by fighting and managing diseases in line with WHO targets in poor nations.

Rural-urban disparities in the availability of hospital-based screening, medications for opioid use disorder, and addiction consult services

IntroductionHospitals are an ideal setting to stage opioid-related interventions with patients who are hospitalized due to overdose or other substance use–related complications. Transitional opioid programs—which initiate care and provide linkages upon discharge, such as screening, initiation of medications for opioid use disorder, and addiction consult services—have become the gold standard, but implementation has been uneven. The purpose of this study was to assess disparities in the availability of hospital-based transitional opioid programs, across rural and urban hospital settings in the United States. MethodsUsing hospital administrative data paired with county-level demographic data, we conducted bivariate and regression analyses to assess rural-urban differences in the availability of transitional opioid services including screening, addiction consult services, and MOUD in U.S general medical centers, controlling for hospital- and community-level factors. Our sample included 2846 general medical hospitals that completed the 2021 American Hospital Association (AHA) Annual Survey of Hospitals. Our primary outcomes were five self-reported measures: whether the hospital provided screening in the ED; provided screening in the inpatient setting; whether the hospital provided addiction consult services in the ED; provided addiction consult services in the inpatient setting; and whether the hospital provided medications for opioid use disorder. ResultsRural hospitals did not have lower odds of screening for OUD or other SUDs than urban hospitals, but both micropolitan rural counties and noncore rural counties had significantly lower odds of having addiction consult services in either the ED (OR: 0.74, 95 % CI: 0.58, 0.95; OR: 0.68, 95 % CI: 0.50, 0.91) or inpatient setting (OR: 0.76, 95 % CI: 0.59, 0.97; OR: 0.68, 95 % CI: 0.50, 0.93), respectively, or of offering MOUD (OR: 0.69, 95 % CI: 0.52, 0.90; OR: 0.52, 95 % CI: 0.37, 0.74). ConclusionsOur study suggests that evidence-based interventions, such as medications for opioid use disorder and addiction consult services, are less often available in rural hospitals, which may contribute to rural-urban disparities in health outcomes secondary to OUD. A priority for population health improvement should be developing implementation strategies to support rural hospital adoption of transitional opioid programs.

Accurate yet problematic: the divided sentiments regarding brain-based addiction by professionals in the Finnish service system

Background There is an ongoing debate regarding the value and applicability of brain-based understandings of addiction. This study examines how professionals in the Finnish addiction service system view this matter. Methods The study participants (n = 997) were recruited at different levels of policy-making, treatment, prevention work, education, administration and research. We created an online questionnaire containing both multiple-choice and open-ended questions. Quantitative and qualitative analyses were performed. Results There was a broad agreement among survey participants regarding the relevance and importance of brain-based understandings, per se. The support seemed to have increased a great deal in the past decades. On a closer view, a dichotomous attitude prevailed among the respondents: They expressed robust support for etiologies and ontologies of brain-based addiction, but simultaneously acknowledged some greater risks with neurocentrism and with wider implementations of neuroscientifically based interventions. New divisions of responsibility and the weakening of rights among concerned parties were presented as risk scenarios. The respondents feared that a medicalization of addiction would sideline social approaches. Conclusion The Finnish addiction service professionals were not prepared to let brain-based ideas of addiction guide the country’s addiction services but saw them as a useful supplementary hermeneutic and pedagogic tool.

Healthcare providers beliefs about the meanings and impacts of prescription drug monitoring program alerts

Background Addiction and overdose death associated with high-risk prescription medications such as benzodiazepines and opioids, are significant global issues. Prescription Drug Monitoring Programs (PDMP), which allow healthcare providers to track and monitor patients’ high-risk medication history have been implemented widely throughout North America and recently in Victoria, Australia. Australia’s PDMP uses a red alert notification to notify healthcare providers to patients at ‘high risk’ of medication related harm. Very little is known about healthcare providers beliefs about the meaning of these notifications and what impact these meanings have on the clinical encounter and patient outcome. Methods Twenty-nine interviews with Victorian healthcare providers (15 prescribers and 14 pharmacists) were thematically analyzed. Results Red alerts were understood as being both synonymous with addiction, as well as a single data point with further investigation required to draw conclusion from. The red alert both disrupted and exposed underlying addiction stigma. Healthcare providers assumptions about patient’s readiness to change influenced their decision to discuss the red alert with patients. Conclusions How healthcare providers make sense of and response to PMDP generated red alerts can impact upon the clinical encounter, including clinical decision-making and the care that patients receive. By identifying and understanding the social factors and forces driving beliefs, attitudes and behaviors toward people who use addictive prescription medications, healthcare providers may be able to pause, assess and reflect on how these factors shape their decision making in unhelpful or unethical ways.

Perceptions of Addiction Medications Within Collegiate Recovery Communities.

Addiction medications (AM) are effective in improving recovery outcomes, but many barriers still exist that reduce their implementation among young adults. While the perception of AM has been explored within clinicians and counselors in many settings, it has not yet been documented within collegiate recovery communities (CRC). The aim of this brief report is to assess the acceptability and intent to use AM among students in recovery, and to evaluate the effect of attitudes, perceived AM effectiveness, and social norms on these outcomes. Using the Theory of Planned Behavior, CRC students (N = 162; 44% female) within the United States completed an online survey. Results from a hierarchical linear model indicated that the perceived acceptance of AM use by important others was significantly related to the intent to use AM ( β = 0.47, P < 0.01) and encourage others to use AM ( β = 0.16, P < 0.05). Positive attitudes about AM predicted acceptability of AM use ( β = 0.42, P < 0.01) and encouraging other CRC students to use AM ( β = 0.38, P < 0.01). Perceived AM effectiveness was positively associated with acceptability ( β = 0.36, P < 0.01) and encouragement of others ( β = 0.27, P < 0.01). Results highlight the importance of promoting effectiveness, improving attitudes, and tapping social networks to increase AM use and acceptability among CRC students. Implications for CRC policy and programming are discussed.

Women Partners, Feeling Rules, and the Gendered Consequences of Porn Addiction

A significant portion of the research on porn addiction has focused on the construction of this social problem and the heterosexual male addicts, yet relatively little is known about women partners. Analyzing open-ended online surveys and interviews with women partners of male porn addicts, this article demonstrates how the medicalization of porn addiction has social consequences which are profoundly gendered and tangled in emotion work. Respondents’ narratives reveal how family, friends, therapists, and partners center the addict’s “recovery” and “healing” by imposing feeling rules that suppress women’s anger and sadness. These feeling rules repress partners’ discussions of the social challenges of porn addiction and lead women to seek out anonymous support online on a site explicitly designed to affirm partners. The site provides opportunities for respondents to discuss the implications of their relationships in ways not fully possible offline. This article thus expands sociological understandings of porn addiction, gender, and emotion work by (1) highlighting the social implications for women who in these partnerships, especially those which reflect and reproduce gender inequalities, and by (2) documenting how women make meaning of social support which affirms, rather than minimizes, those gendered experiences. By doing so, this article raises questions about how the medicalization of other issues related to sexuality, paired with clinical authority of therapists, results in the constraining of women’s intimate lives under the guise of treatment.

Helping patients with substance use disorder: The nurse practitioner role in access to treatment.

Over 21 million people in the United States require substance use disorder (SUD) treatment. However, less than 4 million people receive treatment. The surge of deaths due to opioid overdose requires aggressive public health interventions. This article will describe the role of the hospital emergency department (ED), not simply in emergency treatment of overdose but as a provider of care for underlying addiction and as a catalyst for change in our approach to drug use as a society. It has been found that EDs and hospitals serve as an important point for initiating treatment for SUDs. It is important to provide equitable access to care because the ED serves as an important access point for those with socioeconomic disadvantages. This article presents case studies and the nurse practitioner role in providing medication for addiction and treatment in the ED while also addressing misconceptions about treatment.

Improvement of opioid addiction medication through extended-release naltrexone: a comparative, experimental and laboratory approach

Improvement of opioid addiction medication through extended-release naltrexone: a comparative, experimental and laboratory approach

Activation of GABAB receptors in central amygdala attenuates activity of PKCδ + neurons and suppresses punishment-resistant alcohol self-administration in rats

Alcohol use despite negative consequences is a core phenomenon of alcohol addiction. We recently used alcohol self-administration that is resistant to footshock punishment as a model of this behavior, and found that activity of PKCδ + GABAergic neurons in the central amygdala (CeA) is a determinant of individual susceptibility for punishment resistance. In the present study, we examined whether activation of GABAB receptors in CeA can attenuate the activity of PKCδ + neurons in this region, and whether this will result in suppression of punishment- resistant alcohol self-administration in the minority of rats that show this behavior. Systemic administration of the clinically approved GABAB agonist baclofen (1 and 3 mg/kg) dose- dependently reduced punishment-resistant alcohol self-administration. Bilateral microinjections of baclofen into CeA (64 ng in 0.3 µl/side) reduced the activity of PKCδ + neurons, as measured by Fos expression. This manipulation also selectively suppressed punished alcohol self-administration in punishment-resistant rats. Expression analysis indicated that virtually all CeA PKCδ + neurons express the GABAB receptor. Using in vitro electrophysiology, we found that baclofen induced hyperpolarization of CeA neurons, reducing their firing rate in response to depolarizing current injections. Together, our findings provide a potential mechanism that contributes to the clinical efficacy of baclofen in alcohol addiction. Therapeutic use of baclofen itself is limited by problems of tolerance and need for dose escalation. Our findings support a mechanistic rationale for developing novel, improved alcohol addiction medications that target GABAB receptors, and that lack these limitations, such as e.g., GABAB positive allosteric modulators (PAM:s).

Prescription of potentially addictive medications after a multilevel community intervention in general practice

Objective To evaluate the long-term effects of a multilevel community intervention to improve the quality of prescription practice of potentially addictive medications (PAMs). Design We conducted a retrospective study, using anonymized data from the Norwegian prescription registry. Setting Based on an initiative from the GPs in Molde Municipality in Norway, a multilevel community intervention was initiated by the municipal chief physician in 2018. The intervention targeted GPs, patients, and the public. Subjects We retrieved prescription data from 26 of 36 GPs. Main outcome measures By using the standardized defined daily dose (DDD), we compared prescription of three groups of PAMs from before the intervention (2017) throughout the intervention in 2018, and through 2020 to determine long-term effects. Results Three years after the intervention, the GPs in our study sample prescribed 26% less opioids, 38% less benzodiazepines, and 16% less z-hypnotics. Overall prescription of PAMs decreased by 27%. The number of individuals receiving at least 90 DDD of benzodiazepines and z-hypnotics were reduced from 9 to 7 and 34 to 24 per 1000, respectively. Also, the number of individuals receiving two and three PAMs concomitantly were reduced. Conclusion Addressing prescription practice among GPs in a community as a joint intervention, combined with addressing patients and the public may be a feasible method to obtain long-term reduction of PAM prescriptions. Key points Non-therapeutic prescriptions of potentially addictive medications (PAMs) are both a public health concern and a frequent challenge in general practice. A multilevel community intervention, targeting general practitioners, patients, and the public, led to 27% reduction in prescription of PAMs. Both the number of daily users and concomitant use of several PAMs were reduced. The reduction in prescription persisted for three years.

GIRK Channels as Candidate Targets for the Treatment of Substance Use Disorders.

Substance use disorders (SUDs) are chronic, lifelong disorders that have serious consequences. Repeated substance use alters brain function. G-protein-activated inwardly rectifying potassium (GIRK) channels are expressed widely in the brain, including the reward system, and regulate neuronal excitability. Functional GIRK channels are identified as heterotetramers of GIRK subunits (GIRK1–4). The GIRK1, GIRK2, and GIRK3 subunits are mainly expressed in rodent brain regions, and various addictive substances act on the brain through GIRK channels. Studies with animals (knockout and missense mutation animals) and humans have demonstrated the involvement of GIRK channels in the effects of addictive substances. Additionally, GIRK channel blockers affect behavioral responses to addictive substances. Thus, GIRK channels play a key role in SUDs, and GIRK channel modulators may be candidate medications. Ifenprodil is a GIRK channel blocker that does not have serious side effects. Two clinical trials were conducted to investigate the effects of ifenprodil in patients with alcohol or methamphetamine use disorder. Although the number of participants was relatively low, evidence of its safety and efficacy was found. The present review discusses the potential of GIRK channel modulators as possible medications for addiction. Therapeutic agents that target GIRK channels may be promising for the treatment of SUDs.

Stepped implementation-to-target: a study protocol of an adaptive trial to expand access to addiction medications

BackgroundIn response to the US opioid epidemic, significant national campaigns have been launched to expand access to `opioid use disorder (MOUD). While adoption has increased in general medical care settings, specialty addiction programs have lagged in both reach and adoption. Elevating the quality of implementation strategy, research requires more precise methods in tailoring strategies rather than a one-size-fits-all-approach, documenting participant engagement and fidelity to the delivery of the strategy, and conducting an economic analysis to inform decision making and policy. Research has yet to incorporate all three of these recommendations to address the challenges of implementing and sustaining MOUD in specialty addiction programs.MethodsThis project seeks to recruit 72 specialty addiction programs in partnership with the Washington State Health Care Authority and employs a measurement-based stepped implementation-to-target approach within an adaptive trial design. Programs will be exposed to a sequence of implementation strategies of increasing intensity and cost: (1) enhanced monitoring and feedback (EMF), (2) 2-day workshop, and then, if outcome targets are not achieved, randomization to either internal facilitation or external facilitation. The study has three aims: (1) evaluate the sequential impact of implementation strategies on target outcomes, (2) examine contextual moderators and mediators of outcomes in response to the strategies, and (3) document and model costs per implementation strategy. Target outcomes are organized by the RE-AIM framework and the Addiction Care Cascade.DiscussionThis implementation project includes elements of a sequential multiple assignment randomized trial (SMART) design and a criterion-based design. An innovative and efficient approach, participating programs only receive the implementation strategies they need to achieve target outcomes. Findings have the potential to inform implementation research and provide key decision-makers with evidence on how to address the opioid epidemic at a systems level.Trial registrationThis trial was registered at ClinicalTrials.gov (NCT05343793) on April 25, 2022.

The impact of clinical experience on working tasks and job-related stress: a survey among 1032 Norwegian GPs

BackgroundGeneral practice is a generalist discipline fraught with complexity. For inexperienced physicians, it may be demanding to get to grips with the clinical challenges. The purpose of this article is to describe possible differences in the range of tasks between inexperienced and experienced general practitioners (GPs), and the extent to which clinical experience affects the way in which GPs perceive their daily work.MethodsAn online questionnaire was sent to all regular GPs in Norway (N = 4784) in 2018. The study sought to document the tasks performed during a typical working day and how the GPs perceived their working situation. In this study, we compare the tasks, working situation and occurrence of potentially conflictual consultations among ‘less experienced physicians’ (≤ 5 years of experience in general practice) versus ‘more experienced physicians’ (> 5 years of experience). The findings are discussed in light of theories on development of expertise.ResultsWe received responses from 1032 GPs; 296 (29%) were less experienced and 735 (71%) more experienced. The two groups reported virtually the same number of consultations (19.2 vs. 20.5) and clinical problems handled (40.4 vs. 44.2) during the study day. The less experienced physicians reported a higher proportion of challenging and/or conflictual consultations, involving prescriptions for potentially addictive medication (5.7% vs. 3.1%), sickness certification (4.1% vs. 2.4%) and referral for medical investigations on weak clinical indication (8.1% vs. 5.6%). For other clinical issues there were minor or no differences. Both GP groups reported high levels of work-related stress with negative effect on self-perceived health (61.6% vs 64.6%). GPs who felt that high job demands harmed their health tended to handle a slightly higher number of medical issues per consultation and more consultations with elements of conflict.Conclusions and implicationsInexperienced GPs in Norway handle a workload comparable to that of experienced GPs, but they perceive more conflictual consultations. These findings have relevance for training and guidance of future GP specialists. Irrespective of experience, the GPs report such high levels of negative work-related stress as to indicate an acute need for organisational changes that imply a reduced workload.

Providing Low-barrier Addiction Treatment Via a Telemedicine Consultation Service During the COVID-19 Pandemic in Los Angeles, County: An Assessment 1 Year Later.

Los Angeles County Department of Health Services provides medical care to a diverse group of patients residing in underresourced communities. To improve patients' access to addiction medications during the COVID-19 pandemic, Los Angeles County Department of Health Services established a low-barrier telephone service for DHS providers in March 2020, staffed by DATA-2000-waivered providers experienced with prescribing addiction medications. This study describes the patient population and medications prescribed through this service during its initial 12 months. We performed a retrospective evaluation of a provider-entered call registry for the telephone consult line. Information was collected between March 31, 2020, and March 30, 2021. The registry includes information related to patient demographics, the reason for visit, and which addiction medications were prescribed. We conducted descriptive statistics in each of these domains. During the study period, 11 providers on the MAT telephone service logged 713 calls. These calls represented a total of 557 unique patients (mean age of 40 years, 75% male, 41% Latino, 49% experiencing homelessness). Most patients either had Medicaid insurance (77%) or were uninsured (20%). The most prescribed addiction medication was buprenorphine-naloxone (90%), followed by nicotine replacement therapy (5.3%), naltrexone (4.2%), and buprenorphine monotherapy (1.8%). A telephone addiction medication service is feasible to deliver low-barrier medications to treat addiction in underresourced communities, especially to individuals experiencing homelessness. This can mitigate but does not eliminate disparities in access to addiction medications for communities of color.

Drug Addiction and its Ayurveda and Yoga Management: Case Study

Addiction is defined as a psychological or physiological dependence on a drug or behaviour that is beyond voluntary control. It's a long-term brain disorder that leads to obsessive substance usage despite negative effects. Addiction has a wide-ranging negative impact on people, as well as society consequences. Sudden withdrawal from any addictive medication might result in psychosomatic illness. Material and method- The material for this article is taken from personal clinical experiences and from various clinical researches on drug addiction, withdrawal, and management those are published in index and non-index journals. To gather pertinent material, Ayurvedic Samhitas with commentaries and textbooks of Ayurveda and Modern medicine are referred. Case report- A 45 year male resident in Tamil Nadu, India visited OPD of Shatkarma Department, Patanjali Ayurvedic Hospital in Haridwar, September 2020 with complaints of drug addiction and other multiple drugs taken, breathlessness while walking since 12 years. Patient had no systemic abnormalities detected during examination. Patient was then advised Shodhana by Shatkarmas followed by Shamana medicines. Patient was followed upto 1 month and he got significant relief in the symptoms caused due to addiction. Result- Shatkarmas along with internal medicines have good results in management of addictive, in management of systemic as well as associated ailments. Conclusion- Withdrawal of addicted drug by Padanshik Karma, symptomatic withdrawal treatment, Shatkarmas, psychological counselling, Yoga and meditation are very helpful in de-addiction of drugs.

Effects of Cannabinoid Agonists and Antagonists in Rats Discriminating Fentanyl

Extensive evidence suggests the existence of a functional interaction between endogenous cannabinoids and opioid systems. Targeting cannabinoid CB1 receptors might be a promising approach for developing new medications for opioid addiction. The present studies were undertaken to evaluate the effects of CB1 agonists and antagonists in rats (n=8) trained to discriminate, i.p., injections of 0.032 mg/kg fentanyl from saline on a 10‐response fixed‐ratio (FR‐10) schedule of food reinforcement. Results show that the µ‐opioid agonists (fentanyl, morphine, and oxycodone) substituted fully for fentanyl, whereas the muscarinic antagonist atropine did not substitute for fentanyl. The CB1 agonists Δ9‐THC, AM2201, and AM8936 all partially substituted for fentanyl’s discriminative‐stimulus effects suggesting some overlap in the discriminative‐stimulus effects of cannabinoid agonists and fentanyl. Pretreatment studies with a µ‐opioid receptor antagonist show that naltrexone antagonized fentanyl’s effects. Interestingly, pretreatment studies with CB1 antagonists show that rimonabant (inverse agonist) produced some attenuation of fentanyl’s discriminative‐stimulus effects at doses that significantly decreased response rates, whereas the neutral CB1 antagonist AM4113 blocked fentanyl discrimination at doses that did not modify rates of responding. Our findings are consistent with our recent work showing that AM4113 attenuates heroin self‐administration in rats, without producing depressive‐like effects. Collectively, these data suggests that CB1 neutral antagonists that block CB1 receptors with rimonabant‐like potency, devoid of unwanted side‐effects, may be therapeutically advantageous for countering the abuse‐related behavioral effects of opioids.

Wait No Longer: Reducing Medication Wait-Times for Individuals with Co-Occurring Disorders*

Objective: Community addiction treatment agencies have utilized Network for the Improvement of Addiction Treatment (NIATx), a proven implementation strategy, to reduce appointment wait-times. However, its effectiveness at reducing medication access wait-times has not been explored. Thus, we conducted an exploratory analysis to evaluate the impact of the NIATx implementation strategies on reduced wait-times to addiction, psychotropic or both medications for individuals with co-occurring disorders (COD). Methods: In a cluster-randomized waitlist control group design, community addiction treatment agencies (n = 49) were randomized to receive the NIATx strategy (Cohort 1, n = 25) or to a Waitlist control (Cohort 2, n = 24). All agencies had a 12-month active intervention period. The primary outcome was the medication encounter wait-time. A univariate general linear model analysis utilizing a logarithmic (log10) transformation examined medication wait-times improvements. Results: The intent-to-treat analysis for psychotropic medications and both medications (reflecting integrated treatment) showed significant main effects for intervention and time, especially comparing Baseline and Year 1 to Year 2. Conversely, only the main effect for time was significant for addiction medications. Wait-time reductions in Cohort 1 agencies was delayed and occurred in the sustainment phase. Wait-times to a psychotropic, addiction, or both medications encounter declined by 3 days, 4.9 days, and 6.8 days, respectively. For Cohort 2 agencies, reduced wait-times were seen for psychotropic (3.4 days), addiction (6 days), and both medications (4.9 days) during their active implementation period. Same- or next-day medication access also improved. Conclusions: NIATx implementation strategies reduced medication encounter wait-times but timing of agency improvements varied. Despite a significant improvement, a three-week wait-time to receive integrated pharmacological interventions is clinically suboptimal for individuals with a COD in need of immediate intervention. Community addiction treatment agencies should identify barriers and implement changes to improve medication access so that their patients “wait no longer” to receive integrated treatment and medications for their COD.

Misuse of prescribed psychotropic medication and drug crime offending: A follow-up case-control study of former adolescent psychiatric inpatients.

BackgroundVarious psychotropic prescription drugs are known to have potential for misuse. Among teenagers, non‐medical use of prescription drugs may predate illicit drug use or occur concomitantly.AimsOur aim was to examine prescriptions of psychotropic medications among drug crime offenders and non‐criminal controls in a psychiatric inpatient cohort of 13–17‐year‐olds. Our research question was: were prescribed psychotropic and potentially addictive drugs associated with later drug crime offending.MethodsOur sample was of all 60 adolescents who had been convicted of a drug crime by young adulthood with a twice‐sized control group, matched for gender, age and family‐type, from a cohort of 508 adolescents consecutively admitted to a psychiatric inpatient care in Finland between April 2001 and March 2006. Adolescence‐related information on substance use and psychiatric disorders was obtained by semi‐structured interviews. Follow‐up information on crimes and medication purchases was obtained from Finnish nationwide registers. The association of studied factors to drug crime offending was examined using stepwise binary logistic regression analysis.Results75% of drug crime offenders and 47% of non‐criminal controls had used addictive psychotropic medications during the follow‐up period (p < 0.001). 74% of all drug crime offenders' purchases of prescribed addictive drugs occurred within the year preceding drug crimes. Of addictive drugs, the use of clonazepam and gabapentinoids was most likely to associate with drug crime offending (AOR 7.77, p < 0.001). Conduct and substance use disorders diagnosed in adolescence (AOR 3.49, p = 0.010; AOR 2.34, p = 0.050) were predictors for drug crime offending.ConclusionsOur findings suggest that, when treating young adults with conduct disorder and a history of substance use, physicians should prescribe addictive medications with caution, favouring instead non‐addictive medications complemented by psychosocial interventions.