Outpatient Direct Initiation of Injectable Buprenorphine in a Harm Reduction Agency and Primary Care Clinic: A Retrospective Case Series

Journal of Addiction Medicine

Initiating weekly long-acting injectable buprenorphine (LAIB) without prior sublingual buprenorphine (“direct-to-inject” or DTI) may reduce buprenorphine initiation barriers. In this case series, outpatient DTI outcomes are described. Of the 23 patients with available data, 83% had no withdrawal symptoms pre-DTI. Of the 20 patients with documented post-DTI withdrawal symptoms, 15% had no withdrawal, 60% had mild, 20% had moderate, and 5% had severe withdrawal. Thirty days post-DTI, 58% of patients were retained on any buprenorphine formulation, and 46% were retained at 90 days. The median number of post-DTI buprenorphine treatment days was 77 (range: 9–90). The majority of patients had no pre-DTI withdrawal symptoms, no or mild withdrawal symptoms post-DTI, and were retained on buprenorphine at 30 days post-DTI, with nearly half retained at 90 days. DTI is a promising buprenorphine initiation strategy, but further research is warranted.

Association between state-level kratom regulations and poison center-reported severe medical outcomes and healthcare use: A United States national analysis 🔓

Addiction

Kratom use has significantly increased in the United States and is not regulated at the federal level. Researchers conducted a retrospective study to assess the association between state regulations and medical outcomes from kratom use. Regulation categories assessed included none (no regulations), local-level Kratom Consumer Protection Acts (KCPAs) (age restrictions, labeling requirements), state-level KCPAs, and total bans. Between 2010 and 2023, kratom-related poison center cases increased 65.4-fold, and severe medical outcomes, including death, increased significantly. The only state regulations associated with a statistically significant lower incidence of severe medical outcomes, hospitalizations, and healthcare utilization were complete kratom bans.

Effects of cannabis edible advertising messages and warnings on product perceptions among US young adults

Drug and Alcohol Dependence

The use of cannabis, including edibles, has increased significantly among young adults. Researchers conducted an online survey to evaluate the effects of advertising messages and warnings on young adult perceptions of cannabis edibles. The researchers assessed advertising focused on the taste of edibles or the psychological effects, in combination with various warnings (no warnings, for adults only, intoxication effects, and edible-specific warnings). Psychological effects of advertising were associated with higher interest in use among those with past-month use, but not among those who did not use cannabis. Among those who did not use cannabis, edible-specific warnings were associated with a higher perceived risk of addiction, and intoxication warnings were associated with a lower interest in use. Of note, for-adult-use-only warnings had no effects.

A population-based study exploring racial and gender inequities in polysubstance-related deaths across the United States from 2004 to 2022

Addiction

This study aimed to measure gender-specific racial disparities in opioid-related polysubstance use drug mortality in the United States from 2004 to 2022. The final analytic sample included 627,793 opioid-only deaths, 196,001 opioid-stimulant deaths, and 117,322 opioid-benzodiazepine overdose deaths. Opioid-involved deaths increased across all groups, with the highest absolute rate change experienced by non-Hispanic Black men. Opioid-stimulant polysubstance use deaths had the largest increases among non-Hispanic Black men and women. Among Hispanic men, the rates accelerated 33.8% per year. For opioid-benzodiazepine polysubstance use deaths, non-Hispanic White men and women experienced the highest absolute rate change.

A systematic review and meta-analysis of the association between e-cigarette use and cigarette abstinence or changes in continued cigarette smoking among individuals who smoke cigarettes 🔓

Harm Reduction Journal

This systematic review and meta-analysis concerned the effect of e-cigarette use on combustible cigarette smoking. The literature search resulted in 214 studies meeting the inclusion criteria; of these, 22 were randomized controlled trials and were included in the meta-analysis. Studies comparing nicotine-containing e-cigarettes to behavioral support alone found e-cigarettes to be significantly superior for combustible cigarette abstinence at 6 months (RR=2.70, 95% CI 1.15–6.50). Studies of the effect of e-cigarette use on the number of combustible cigarettes smoked per day found a significant mean reduction of 4.7 combustible cigarettes at 6 months (95% CI 3.34–6.07). The authors conclude that e-cigarettes are effective for smoking cessation and reduction in the number of cigarettes smoked.

Prenatal exposure to buprenorphine or methadone and adverse neurodevelopmental outcomes: population based cohort study 🔓

The BMJ

This study compared neurodevelopmental disorders in offspring exposed to buprenorphine (n=12,635) or methadone (n=5,390) during pregnancy. Data for pregnancy and offspring (up to 8 years of age) came from Medicaid records from 2000 to 2018. The risk of any neurodevelopmental disorder due to exposure to prenatal buprenorphine compared to prenatal methadone was RR=0.81 (95% CI 0.7–0.9). The most common disorders were ADHD and developmental speech and language disorders. Hazard ratios for individual disorders were not statistically significant due to small numbers. The risk for any developmental disorder for patients already receiving medication at the time of pregnancy was even less compared to those who initiated medication during pregnancy (aHR=0.61, CI 0.5–0.8). Risks were similar for exposure during each of the 3 trimesters. The authors conclude that the risks associated with buprenorphine and methadone are similar.