Rockefeller University.
Exp Clin Psychopharmacol. 2022 Feb;30(1):31-38. doi: 10.1037/pha0000401. Epub 2020 Oct 29.
Persons with dual severe opioid and cocaine use disorders are at risk of considerable morbidity, and the bidirectional relationship of escalation of mu-opioid agonists and cocaine use is not well understood. The aim of this study was to examine the bidirectional relationship between escalation of heroin and cocaine use in volunteers dually diagnosed with opioid and cocaine dependence (OD + CD). Volunteers from New York with OD + CD (total = 295; male = 182, female = 113; age ≥ 18 years) were interviewed with the Structured Clinical Interview for the Axis I Disorders and Kreek-McHugh-Schluger-Kellogg scales for dimensional measures of drug exposure, which also collect ages of 1st use and onset of heaviest use. Time of escalation was defined as age of onset of heaviest use minus age of 1st use in whole years. Times of escalation of heroin and cocaine were positively correlated in both men (Spearman = .34, 95% confidence interval [CI: .17, .48], < .0001) and women (Spearman = .51, [.27, .50], < .0001) volunteers. After we adjusted for demographic variables, a Cox regression showed that time of cocaine escalation was a predictor of time of heroin escalation (hazard ratio [HR] = 0.97, 95% CI [0.95, 0.99], = .003). Another Cox regression showed that this relationship is bidirectional, because time of heroin escalation was also a predictor of time of cocaine escalation (HR = 0.98, [0.96-0.99], = .016). In these adjusted models, gender was not a significant predictor of time of escalation of either heroin or cocaine. Therefore, escalation did not differ robustly by gender when adjusting for demographics and other major variables. Overall, rapid escalation of cocaine use was a predictor of rapid escalation of heroin use, and vice versa, in persons with dual severe opioid and cocaine use disorders. These findings suggest a shared vulnerability to rapid escalation of these 2 drugs in persons with dual severe opioid and cocaine use disorders. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
具有双重严重阿片类药物和可卡因使用障碍的人有相当大的发病风险，而μ-阿片激动剂和可卡因使用的双向关系尚不清楚。本研究的目的是检查双重诊断为阿片类药物和可卡因依赖（OD + CD）的志愿者中海洛因和可卡因使用升级之间的双向关系。来自纽约的 OD + CD 志愿者（共 295 名；男性 182 名，女性 113 名；年龄≥18 岁）接受了轴 I 障碍的结构临床访谈和 Kreek-McHugh-Schluger-Kellogg 量表的维度药物暴露访谈，该量表还收集了首次使用年龄和最重使用年龄。升级时间定义为最重使用年龄减去首次使用年龄的整年。男性（Spearman =.34，95%置信区间 [CI：.17，.48]， <.0001）和女性（Spearman =.51，[.27，.50]， <.0001）志愿者的海洛因和可卡因升级时间呈正相关。在调整人口统计学变量后，Cox 回归显示可卡因升级时间是海洛因升级时间的预测因子（危险比 [HR] = 0.97，95%CI [0.95，0.99]， =.003）。另一个 Cox 回归显示，这种关系是双向的，因为海洛因升级时间也是可卡因升级时间的预测因子（HR = 0.98，[0.96-0.99]， =.016）。在这些调整后的模型中，性别不是海洛因或可卡因升级时间的重要预测因子。因此，在调整人口统计学和其他主要变量后，性别并没有显著预测阿片类药物和可卡因双重严重使用障碍患者的升级速度。总之，可卡因使用的快速升级是海洛因使用快速升级的预测因子，反之亦然，这表明双重严重阿片类药物和可卡因使用障碍患者对这两种药物的快速升级具有共同的脆弱性。（PsycInfo 数据库记录（c）2022 APA，保留所有权利）。
