Vermont Center on Behavior and Health, Burlington, VT, United States of America; Department of Psychiatry, University of Vermont, Burlington, VT, United States of America; Motivational Incentives Policy Group, United States of America.
Vermont Center on Behavior and Health, Burlington, VT, United States of America; Department of Psychiatry, University of Vermont, Burlington, VT, United States of America; Motivational Incentives Policy Group, United States of America.
Prev Med. 2023 Nov;176:107625. doi: 10.1016/j.ypmed.2023.107625. Epub 2023 Jul 17.
The current overdose and broader public health crisis involving illicit drug use is often referred to as the "opioid" or "fentanyl" crisis. Clearly there is extensive data on the profound damage done by opioids over the past 20 years and specifically by fentanyl in the past 5 years. However, there is an extensive array of data that suggests there is more to the current crisis than opioids/fentanyl. Much recent evidence indicates that methamphetamine and cocaine are playing a substantial and increasing role in the illicit drug crisis in the US-the 4th wave. This paper reviews data that illustrate the role of psychomotor stimulants in fatal overdoses, nonfatal overdoses, and emergency department visits. Despite the major detrimental role that stimulants are having on the public health in the US in 2023, there is virtually no evidence-based treatment available in practice for people with stimulant use disorder (StimUD). Although there are no medications with FDA-approval for the treatment of StimUD, there is a behavioral treatment, contingency management (CM), with over 3 decades of robust research supporting its efficacy for individuals with StimUD. Despite the overwhelming evidence supporting CM, it is not being widely used in routine treatment outside the VA healthcare system. This paper reviews some of the (a) evidence for CM, (b) CM protocol design elements that require consideration, (c) current obstacles to the widespread implementation of CM, and (d) strategies for addressing these obstacles. Overcoming these obstacles is a priority to allow routine use of CM as a treatment for StimUD.
当前涉及非法药物使用的过量用药和更广泛的公共卫生危机通常被称为“阿片类药物”或“芬太尼”危机。显然，过去 20 年有大量关于阿片类药物造成的严重损害的数据，特别是过去 5 年芬太尼造成的损害。然而，有大量数据表明，当前的危机不仅仅是阿片类药物/芬太尼造成的。最近的许多证据表明，冰毒和可卡因在美国非法药物危机（第四波）中发挥了重要且日益增加的作用。本文综述了说明精神兴奋剂在致命过量用药、非致命过量用药和急诊就诊中作用的数据。尽管兴奋剂在 2023 年对美国的公共卫生造成了重大不利影响，但实际上在实践中，对于有兴奋剂使用障碍（StimUD）的人几乎没有基于证据的治疗方法。尽管没有获得 FDA 批准用于治疗 StimUD 的药物，但有一种行为治疗方法，即条件管理（CM），已有超过 30 年的强有力研究支持其对有 StimUD 的个体的疗效。尽管有压倒性的证据支持 CM，但它并没有在退伍军人事务部医疗保健系统之外的常规治疗中广泛使用。本文综述了一些（a）CM 的证据、（b）CM 方案设计要素需要考虑的问题、（c）广泛实施 CM 的当前障碍，以及（d）解决这些障碍的策略。克服这些障碍是优先事项，以便将 CM 常规用于治疗 StimUD。
