Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Psychiatr Res. 2023 Aug;164:15-22. doi: 10.1016/j.jpsychires.2023.05.018. Epub 2023 May 17.
The twin opioid-stimulant epidemics have led to increased overdose deaths and present unique challenges for individuals entering treatment with opioid-stimulant polysubstance use. This study examined tonic and cue-induced craving as a primary outcome among persons in substance use treatment who reported primary substances of opioids, methamphetamine, or cocaine. The sample consisted of 1974 individuals in 55 residential substance-use treatment centers in the United States in 2021. Weekly surveys were delivered via a third-party outcomes tracking system, including measures of tonic and cue-induced craving. Initial comparisons on tonic and cue-induced craving were made among those who primarily used opioids, cocaine, or methamphetamine. Further, the effect of opioid/stimulant polysubstance use on tonic and cue-induced craving was evaluated using marginal effect regression models. Primary methamphetamine use was associated with decreased tonic craving compared to primary opioid use (β = -5.63, p < 0.001) and primary cocaine use was also associate with decreased tonic craving compared to primary opioid use (β = -6.14, p < 0.001). Primary cocaine use was also associated with lower cue-induced cravings compared to primary opioid use (β = -0.53, p = 0.037). Opioid-methamphetamine polysubstance use was associated with higher tonic craving (β = 3.81, p = <0.001) and higher cue-induced craving (β = 1.55, p = 0.001); however, this was not the case for opioid-cocaine polysubstance use. The results of this study indicate that individuals who primarily use opioids and have secondary methamphetamine use experience higher cue-induced and tonic-induced craving, suggesting that these individuals may benefit from additional interventions that target craving and mitigate relapse risk and other negative sequelae.
双重阿片类药物和兴奋剂流行导致过量死亡增加，并给同时使用阿片类药物和兴奋剂的多种物质使用者进入治疗带来了独特的挑战。本研究以接受物质使用治疗的个体为研究对象，考察了他们的持续和线索诱导的渴望，作为他们的主要物质为阿片类药物、甲基苯丙胺或可卡因的主要结果。该样本包括 2021 年美国 55 个住宅物质使用治疗中心的 1974 名个体。每周通过第三方结果跟踪系统进行调查，包括持续和线索诱导的渴望测量。在主要使用阿片类药物、可卡因或甲基苯丙胺的个体之间进行了持续和线索诱导的渴望的初步比较。此外，使用边缘效应回归模型评估了阿片类药物/兴奋剂多种物质使用对持续和线索诱导的渴望的影响。与主要使用阿片类药物相比，主要使用甲基苯丙胺与较低的持续渴望相关（β=-5.63，p<0.001），主要使用可卡因也与较低的持续渴望相关（β=-6.14，p<0.001）。与主要使用阿片类药物相比，主要使用可卡因也与较低的线索诱导渴望相关（β=-0.53，p=0.037）。阿片类药物-甲基苯丙胺多种物质使用与较高的持续渴望（β=3.81，p=0.001）和较高的线索诱导渴望（β=1.55，p=0.001）相关；然而，阿片类药物-可卡因多种物质使用并非如此。本研究的结果表明，主要使用阿片类药物且有继发性甲基苯丙胺使用的个体经历更高的线索诱导和持续渴望，这表明这些个体可能受益于额外的干预措施，这些干预措施针对渴望并减轻复发风险和其他负面后果。
