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The aim of this study is to determine if extended‐release, bioabsorbable, subcutaneous naltrexone (NTX) implants can mitigate respiratory depression after an intravenous injection (IV) of fentanyl. Six different BIOabsorbable Polymeric Implant Naltrexone (BIOPIN) formulations, comprising combinations of Poly‐d,l‐Lactic Acid (PDLLA) and/or Polycaprolactone (PCL‐1 or PCL‐2), were used to create subcutaneous implants. Both placebo and naltrexone implants were implanted subcutaneously in male dogs. The active naltrexone implants consisted of two doses, 644 mg and 1288 mg. A challenge with IV fentanyl was performed in 33 male dogs at 97–100 days after implantation. Following the administration of a 30 μg/kg intravenous fentanyl dose, the placebo cohort manifested a swift and profound respiratory depression with a ~50% reduction in their pre‐dose respiratory rate (RR). The BIOPIN NTX‐implanted dogs were exposed to escalating doses of intravenous fentanyl (30 μg/kg, 60 μg/kg, 90 μg/kg, and 120 μg/kg). In contrast, the dogs implanted with the BIOPIN naltrexone implants tolerated doses up to 60 μg/kg without significant respiratory depression (<50%) but had severe respiratory depression with fentanyl doses of 90 μg/kg and especially at 120 μg/kg. Bioabsorbable, extended‐release BIOPIN naltrexone implants are effective in mitigating fentanyl‐induced respiratory depression in male canines at about 3 months after implantation. This technology may also have potential for mitigating fentanyl‐induced respiratory depression in humans. [ABSTRACT FROM AUTHOR]

Adolescent cannabis use is associated with working memory impairment. The present randomized controlled trial assigned adolescents ages 14 to 21 enrolled in cannabis use treatment to receive either working memory training (experimental group) or a control training (control group) as an adjunctive treatment. Cognitive function, drug use, and other outcomes were assessed before and after training. We observed few differences in cognitive, functional, or self-reported drug use outcomes as a function of training group, although tetrahydrocannabinol (THC) urinalysis results favored the experimental group. These findings are similar to previous studies in substance users, which have shown limited transfer effects for working memory training.

This study evaluated the association between medication for opioid use disorder (MOUD) and health care utilization over time among a sample of treatment-seeking individuals with opioid use disorder. In contrast to previous studies, this study used a novel measure of MOUD adherence, more comprehensive utilization data, and analyses that controlled for detailed individual and social determinants of health. This study was a secondary analysis of a comparative effectiveness trial (N=570) of extended-release naltrexone versus buprenorphine-naloxone. The outcome of interest was usage of nonstudy acute care, inpatient and outpatient addiction services, and other outpatient services across 36 weeks of assessment. Adherence (percentage of days taking MOUD) was defined as low (<20%), medium (≥20% but <80%), or high (≥80%). A two-part model evaluated the probability of utilizing a resource and the quantity (utilization days) of the resource consumed. A time-varying approach was used to examine the effect of adherence in a given month on utilization in the same month, with analyses controlling for a wide range of person-level characteristics. Participants with high adherence (vs. low) were significantly less likely to use inpatient addiction (p<0.001) and acute care (p<0.001) services and significantly more likely to engage in outpatient addiction (p=0.045) and other outpatient (p=0.042) services. These findings reinforce the understanding that greater MOUD adherence is associated with reduced usage of high-cost health services and increased usage of outpatient care. The results further suggest the need for enhanced access to MOUD and for interventions that improve adherence. [ABSTRACT FROM AUTHOR]

Background and Objectives: Posttraumatic stress disorder (PTSD) is highly comorbid with substance use disorders (SUD) and can impede SUD recovery. Residential SUD treatment is a crucial opportunity to address PTSD. However, PTSD treatment is lacking in residential SUD care. Methods: We conducted a nonrandomized feasibility study of Written Exposure Therapy (WET), a brief, evidence‐based treatment for PTSD, with patients in residential SUD treatment. We assessed attitudes towards treatment (Credibility and Expectancy Questionnaire, Barriers to Treatment Participation Scale) and mental health indicators (PTSD Checklist for DSM‐5, Trauma Coping Self‐Efficacy, Difficulties in Emotion Regulation‐Short Form, and Brief Assessment of Recovery Capital). Results: Thirty of 49 eligible participants completed WET (61%) and 92% (n = 45) attended at least one WET session. Paired sample t‐tests revealed significant posttreatment improvement across all mental health indicators, with medium to large effect sizes. Discussion and Conclusions: Attendance and completion rates compared favorably to prior exposure‐based treatment for PTSD in SUD settings. Although causality cannot be inferred without a randomized controlled trial, mental health indicators, including PTSD, improved significantly following WET. Scientific Significance: These findings provide evidence that PTSD can be successfully treated in short‐term residential care using brief exposure‐based interventions, which is a crucial clinical need that has been minimally studied in the past. [ABSTRACT FROM AUTHOR]

This study examined posttreatment patterns of polysubstance use and heroin relapse in a sample of 43 adolescents (ages 14-20) entering short-term residential treatment for primary heroin use. At 12-month follow-up, youths that achieved heroin abstinence (N = 19) were significantly less likely than youths that relapsed to heroin (N = 24) to endorse polysubstance use and cannabis, cocaine, or benzodiazepine use. Furthermore, heroin-abstinent youths significantly reduced their cannabis and cocaine use across the study period while youths that relapsed made initial reductions before returning to their pretreatment levels of use for these drugs. Clinical implications for heroin-using youths and areas for future research are discussed. (Contains 2 figures, 2 tables and 2 notes.)

The purpose of this study is to identify factors associated with adolescent alcohol or drug (AOD) abuse/dependence, mental health and co-occurring problems, as well as factors associated with access to treatment. This is a secondary analysis of data from the National Survey on Drug Use and Health (NSDUH) 2000. The 12-month prevalence rate of adolescents with only mental health problems was 10.8%, 5.1% had AOD abuse/dependence only, and 2.7% had co-occurring problems. Approximately 15% of youths reported receiving behavioral health treatment in the past 12 months. Several factors associated with having behavioral health problems and receiving treatment are presented. (Contains 3 tables.)

Objective: To characterize baseline depressive symptoms among substance-abusing adolescents and determine their association with post residential treatment substance use outcomes. Method: In total, 153 adolescents (mean age 6.6 years, plus or minus 0.11) entering residential treatment were assessed at intake and at 3, 6, 9, and 12 months. Beck Depression Inventory (BDI) and Global Appraisal of Individual Needs were administered to assess depression, other risk factors, and substance use. A regression model was developed with 10 risk factors including BDI scores of greater than or equal to 11 versus less than 11 to predict the outcome measure mean percentage of days in the past 90 days with any (nonnicotine) substance use. Results: At intake, 55% had BDI scores of greater than or equal to 11. A baseline BDI score of greater than or equal to 11 was significantly associated with greater mean percentage of days of substance use (27.5 plus or minus 3.8% versus 15.4 plus or minus 4.0% days, p less than 0.01) across 1-year follow-up. Two other factors were significant: length of drug career greater than 2 years and having an opioid use disorder. Conclusions: Results from this prospective study, although preliminary, suggest the association of depressive symptoms with poorer substance outcomes and the utility of the BDI as a prognostic tool. They highlight the need for interventions targeting co-occurring depressive symptoms that may improve adolescent substance treatment outcomes. (Contains 2 tables and 1 figure.)