Search Results (157)

Background: Despite the general interest in WPV against healthcare workers, there is evidence that this topic has comparatively fewer studies conducted in the context of community settings than in hospital settings. Given the current general transition of care from hospital to community, this study aims to analyze whether community settings present different characteristics in comparison with hospital settings on this topic in Italy. Methods: A retrospective observational study was conducted from 2020 to 2024 on aggressions reported by HCWs in hospitals and community settings belonging to a Local Health Authority of Turin in Piedmont. For physical and non-physical aggressions, a monthly time trend series was constructed. A Mantel–Haenszel fixed-effect meta-analysis was performed to obtain the odds ratio (OR) in two settings. Variables relative to aggressions included the gender of victims, their professional category (medical doctors, nurses, other HCWs), the type and gender of perpetrators (relative, patient, or unknown person), age groups of perpetrators (under 30, 30–49, ≥50), the nature of aggression (physical, non-physical), recidivism, involvement of law enforcement, and time of occurrence (morning, afternoon, or evening/night). Events within hospitals were further classified into emergency department, psychiatric ward, and other wards, while events within community settings were classified as drug addiction service units (serDs), long-term care (including specialist outpatient services, home services, and nursing homes) (LTC), mental health centres, and penitentiary assistance. Results: The results highlighted that fewer WPV incidents were reported in community settings than in hospital settings, even though reported incidents showed a more pronounced increase over time. Differences were observed in a few characteristics of WPV (age classes of aggressors, recidivism, time of aggression, profession of the assaulted worker, and specific location). Only the gender of the assaulted (female workers) (OR = 3.11, 95% CI: 1.27–7.61; p = 0.013; OR = 0.32, 95% CI: 0.13–0.79; p = 0.013 for non-physical and physical violence, respectively, compared to male workers) was identified as a specific risk factor for community settings. Conclusions: Modern health systems are experiencing a transition from hospital-centred to community-centred care settings. This study suggested that WPV is a significant concern, even outside the hospital. Community-based services often involve direct interaction with frail and chronically ill patients and their caregivers, as well as care delivery in diverse and sometimes less controlled environments, which may influence exposure to aggressive behaviours. The identification of setting-specific risk patterns in both hospital and community contexts provides valuable insights into workplace violence and may support the planning and implementation of targeted interventions aimed at mitigating the frequency and burden of WPV. Full article

This study seeks to inform emergency preparedness efforts by summarizing the pandemic’s impacts on access to opioid use disorder (OUD) recovery support as reported by women in recovery. In-depth interviews were completed with adult women in recovery from OUD. We used a primarily deductive approach to coding and analysis. Two coders analyzed transcripts; discrepancies were resolved through discussion. Seventeen women completed interviews from June to October 2020. Pandemic impacts primarily focused on engagement in care and retention at community and interpersonal levels. Community-level barriers to engagement included facilities’ halting intake of patients and fear of COVID-19 infection in treatment settings. Interpersonal barriers to engagement included loss of childcare support and the sudden transition to virtual services. Community-level retention barriers included perception of facility staff’s lack of adherence to infection prevention protocols and strict enforcement of infection prevention protocols on residents within facilities. Interpersonal barriers to retention included reduced availability of mutual aid meetings. Participants also highlighted how the pandemic worsened the addiction crisis and increased women’s caretaking burden. Leaders and administrators must be prepared to simultaneously balance responses for two public health crises: a novel infectious disease and addiction. Lessons learned from the pandemic can mitigate barriers to care and recovery when future emergencies arise. Full article

Background: Mitragynine pseudoindoxyl (MP) is a semi-synthetic kratom metabolite increasingly sold online and over-the-counter, marketed misleadingly as “kratom” or “7-OH,” despite lacking FDA approval and safety data in humans. Methods: This case report describes a 44-year-old male with polysubstance use history who developed opioid withdrawal symptoms after regular MP use (400 mg daily for pain management following neck injury). Vital signs, alcohol and opioid withdrawal scores and clinical outcomes were recorded. Results: The patient presented exhibiting symptoms of moderate opioid withdrawal in the absence of other opioid use. A buprenorphine macro-induction protocol was initiated. Following pre-treatment using chlorpromazine as an anti-emetic and diazepam to treat concomitant alcohol withdrawal, 32 mg buprenorphine were provided (16 mg × 2) on day one, with subsequent maintenance dosing and adjunctive medications. The patient demonstrated significant symptomatic improvement with decreased COWS scores and expressed interest in long-acting injectable buprenorphine maintenance therapy. Discussion: This represents the first documented case of suspected MP withdrawal successfully managed with buprenorphine macro-induction, demonstrating the potential efficacy of this approach for novel semi-synthetic kratom metabolites when standard withdrawal management protocols are insufficient. Further studies should evaluate long term outcomes and validate findings. Full article

Long-Acting Buprenorphine Formulations (LAIB) have emerged as an alternative pharmacological approach for opioid use disorder, offering potential benefits extending beyond clinical stabilisation. Narrative medicine provides a unique approach to understand patients’ perspectives and experiences with sublingual buprenorphine and LAIB dispensed to fourteen patients across different Italian Addiction Services, examining how they impact the emotional, social, and motivational dimensions of recovery. Narratives were analysed by thematic content across eight domains: dependence on daily treatment regimen, emotional impact, self-perception, determination to change, quality of life, craving and withdrawal symptoms, treatment adherence, social burden, and therapeutic relationship. Statements were categorised by valence; experiential patterns were qualitatively analysed. Sublingual buprenorphine, although effective, was associated with reduced autonomy, symptom control, and difficulties in balancing treatment, work and life. These aspects were correlated with worse adherence. The stigma and burden of daily intake can reduce motivation and hinder identity reconstruction. In this setting, transitioning to LAIB resulted in improved self-autonomy, emotional balance, symptom control, self-esteem, and reduced daily and psychological burden, craving and stigma, facilitating social reintegration, and strengthening the therapeutic relationship. The results emphasise the importance of including both experiential and narrative elements in clinical care, as this helps create more tailored, recovery-focused treatment pathways. Full article

In recent years, xylazine has emerged as a cutting agent combined with illicit drugs to extend their effects. The present study aimed to discover drug use patterns associated with xylazine-positive and -negative urine toxicology drug screens and to assess whether xylazine can be used as a marker for exposure to designer drugs/new psychoactive substances in our study population. This is a retrospective analysis of urine toxicology results from two different analytical platforms: a targeted, structurally confirmatory, high-performance liquid chromatography–tandem mass spectrometry (LC-MS/MS) assay that quantifies 136 drugs and metabolites including xylazine; and a non-targeted ThermoFisher Orbitrap Tribrid mass spectrometry system (Thermo Scientific^TM, Bremen, Germany) in combination with database searches for the identification of drugs not captured by the targeted assay. All participants were patients receiving care through the Addiction Research and Treatment Services (ARTS), with documented substance misuse, undergoing routine urine drug toxicology testing at the iC42 Clinical Toxicology. Data analysis was performed using Sciex OS version 2.2.0.5738 after extraction using the targeted, structurally confirmatory and quantitative LC-MS/MS platform (SCIEX, Framingham, MA, USA). The drug patterns found in xylazine-positive and -negative urine samples were statistically significantly different (p < 0.001), indicating different consumption patterns associated with xylazine. Moreover, the overall concentrations of drugs (normalized to creatinine) were also statistically significantly different with higher concentrations in the urine samples that tested negative for xylazine. In contrast, samples that were positive for xylazine contained significantly higher concentrations of various designer drugs/new psychoactive substances as detected by the untargeted platform (p < 0.0001). The results indicated that xylazine has become increasingly common in Denver’s drug circulation and that xylazine may be used as a marker to prompt reflex testing with non-targeted high-resolution mass spectrometry assays in combination with database searches to test for the exposure to designer drugs/new psychoactive substances in our patient population. Full article

Research on men’s mental health points out gender differences in help-seeking and access to care. Traditional masculine norms (i.e., emotional repression, self-reliance, “being strong”) and gender bias might conceal distress, delay treatment, and help to explain higher burdens of addiction, violence, and suicide alongside lower recorded affective/anxiety diagnoses. An exploratory narrative review was conducted. PubMed, Scopus, and Web of Science were searched for 2015–2025 studies using MeSH and terms on men’s mental health, masculinities, and stigma. Eleven studies identified attitudinal barriers (i.e., self-stigma, shame, symptom minimization, mistrust, etc.) and structural barriers (i.e., limited tailored services, navigation difficulties, costs, bureaucracy, etc.) that delay identification of psychological distress symptoms, weaken therapeutic alliance, and increase dropout, especially when therapy is perceived as impersonal or ineffective. Intersectional factors (i.e., class, age, ethnicity) further contribute to access and they need to be included in the field of men’s mental health. Gender-sensitive approaches and alternative masculinity role models have the potential to enhance engagement and legitimize emotional experience. To sum up, hegemonic masculinity-related gender norms, acquired through gender-differentiated socialization, are associated with adverse mental health outcomes among men. A lack of gender-sensitive awareness campaigns to reduce stigma around men’s mental health may hinder prevention, delaying early identification and timely intervention. Therefore, men’s mental health care should integrate gender and intersectionality transversally to improve prevention, access, diagnosis, treatment, adherence, and outcomes, supported by professional training and tailored therapeutic tools in clinical routine practice. These findings underscore the need to promote healthier, more egalitarian masculinities and to deconstruct stigmas associated with help-seeking and mental health service. Full article

Background: Adults with attention-deficit/hyperactivity disorder (ADHD) often have comorbid substance use disorders (SUDs). In Italy, individuals with both ADHD and heroin use disorder (HUD) are usually treated in addiction services with opioid agonist therapy (OAT), but stimulant medications are rarely prescribed. This may create a treatment gap for core ADHD symptoms. Aim: This study examined the clinical and behavioural profiles of ADHD patients with HUD who receive OAT but no stimulant treatment, compared to ADHD patients without opioid use disorder (ADHD/NoHUD) on standard pharmacotherapy. All participants were considered treatment responders in their respective services. Methods: Data were collected from two outpatient clinics and included 103 adult ADHD patients assessed using validated tools for symptom severity, emotional dysregulation, and global functioning. Differences between groups were analysed using univariate tests and logistic regression. Results: The ADHD+HUD group was significantly older and showed higher levels of emotional dysregulation, impulsivity, and current cocaine use. Despite clinical stability, these individuals presented a more severe psychopathological profile than their ADHD/NoHUD counterparts, who received stimulant-based treatment. Conclusions: Although limited by its cross-sectional nature and setting-related confounders, the study indicates that OAT alone may not be sufficient to manage neurodevelopmental symptoms in ADHD+HUD patients. Further research is necessary to assess the safety and efficacy of integrated stimulant-based treatments, ideally within dual disorder services combining psychiatric and addiction expertise. Full article

Problematic smartphone use (PSU) is increasingly recognized as a behavioral concern among university students, with consequences for well-being, risky behaviors, and academic outcomes. However, evidence from Greece remains limited. This study assessed the prevalence and correlates of PSU among students at the University of Piraeus and interpreted findings through Griffiths’ components model of addiction. A cross-sectional survey was conducted between March and June 2023 with 1743 participants, who provided socio-demographic, lifestyle, and health information and completed the Smartphone Addiction Scale–Short Version (SAS-SV). Nearly half of the students (49.2%) exceeded the proposed SAS-SV thresholds for PSU (50.5% men; 48% women). Regression analysis showed that alcohol consumption (p < 0.001), weekly screen time (p < 0.001), younger age (p < 0.001), female sex (p < 0.001), size of household (p < 0.033), and anxiety/depression (p = 0.019) were significant predictors of higher SAS-SV scores, while smoking, BMI, exercise, and academic performance were not associated. For the independent statistical tests, the Benjamini–Hochberg correction was applied to control the false discovery rate. Group comparisons confirmed greater alcohol use (p < 0.001), screen exposure (p < 0.001), and anxiety/depression (p = 0.004) among PSU students. Item-level responses reflected components of tolerance, salience, withdrawal, and conflict. These findings place Greek students at the higher end of international prevalence estimates and highlight the importance of integrating digital-well-being initiatives within student health services in universities. Full article

Background: Inequities in pain management are well documented in chronic pain and outpatient settings, yet little is known about disparities in inpatient Acute Pain Service (APS) care. This study evaluated demographic, clinical, and social factors associated with APS utilization and outcomes in an urban safety-net hospital, with a subgroup analysis of trauma patients who presented with at least three rib fractures. Methods: We performed a retrospective cohort study of two patient populations from our institution: (1) all patients receiving APS consultation from 1 January 2020 to 1 November 2022 (n = 1445) and (2) all patients with traumatic rib fractures during this time, stratified by APS consult status (n = 650). Demographics, insurance, comorbidities, opioid prescribing, and discharge outcomes were analyzed using descriptive statistics, multivariable logistic regression, and log-linear models. As APS consultation criteria were not standardized during the study period, referral patterns reflected routine clinical practice rather than predefined eligibility criteria. Results: Across the full APS cohort, patients were disproportionately represented from vulnerable groups: 30.5% were Black, 81.0% had public insurance, and 32.9% had a substance use disorder (SUD). Methadone use was a strong predictor of non-home discharge, including discharges to a medical facility, hospice, or against medical advice (AMA). In the rib fracture cohort, patients receiving APS consults had significantly higher injury severity scores (Injury Severity Score 17.1 vs. 13.0, p < 0.001). Black patients were less likely to receive APS consult (17.3% vs. 28.8%, p = 0.024). However, this association appeared to be attributable to the younger age and male predominance within this subgroup, as both factors were identified as significant predictors of APS consultation. Conclusions: APS utilization at a high-volume safety-net hospital highlights the intersection of medical vulnerability and structural inequities, with greater involvement among patients who were members of racial and ethnic minorities, publicly insured, or diagnosed with SUD. In trauma populations, younger Black men were over-represented, reinforcing the heightened injury risks Black men may face and the downstream effects on patient care. Taken together, these results highlight how APS involvement acts not only as a marker of increased injury severity but also as an intervention to improve care for vulnerable patient populations. As APS teams regularly serve these populations, they are well-positioned to bridge broader gaps through the integration of addiction and social support services, individualized pain management, and seamless coordination of care across specialties. These findings underscore the need for standardized consultation criteria and integration of social and addiction medicine resources into APS care models. Full article

Background/Objectives: Integrating behavioral health and primary care services is a national public health priority in the US, especially in underserved settings like northern Arizona. This healthcare delivery model is crucial to meet the mental and physical health needs of people with SU/SUDs, particularly those belonging to culturally diverse populations. In collaboration with a behavioral health center in northern Arizona, the current study aimed to assess the perspectives of providers and administrative staff on the implementation of integrated primary care (IPC) services for people with SU/SUDs. Methods: In February 2023, twelve healthcare providers and administrative staff from diverse educational backgrounds were recruited using purposive sampling to capture a range of perspectives on IPC implementation at the behavioral health center. Participants completed individual, semi-structured interviews conducted via Zoom, which were audio recorded and lasted approximately 30 min. The interview recordings were transcribed verbatim using Trint Software, and analyzed on Google Docs using applied thematic analysis. Two researchers coded the transcripts, iteratively developing and refining themes through multiple cycles of review and team discussions. Additional team members provided feedback and verified the themes, with consensus reached through collaborative meetings. This rigorous, iterative approach ensured the reliability and validity of the final thematic framework. Results: We found that IPC supports SU/SUDs recovery by providing holistic care that integrates medical, mental health, and addiction services while addressing social and co-occurring needs. It fosters an empathetic environment where clients do not need to repeatedly disclose their SU/SUDs, improves access to preventive care, and offers continuous support and education. Implementation barriers included workforce shortages, limited internal communication, and insufficient interdisciplinary training. Gaps in culturally centered care were identified, including reliance on Western models, limited representation of Native American and sexual and gender minority staff, and inconsistent use of inclusive practices such as pronouns, traditional healing, and trauma-informed approaches. Additionally, community partnerships with multisectoral organizations help clients access supportive resources beyond the facility, including vision care, clothing, and dental services. Conclusions: The implementation of IPC was seen as important to support the behavioral health center in northern Arizona to foster an empathetic environment where clients with SU/SUDs can have their mental, physical, and social needs addressed, either within the facility or through community partnerships, thereby supporting their recovery. However, progress is hindered by barriers such as workforce shortages, limited internal communication, and insufficient interdisciplinary care training. Additionally, despite regular cultural competency training, gaps remain in culturally centered care for underserved populations, particularly Native American and sexual and gender minority clients. Full article

Background/Objectives: The growing intersection between nyaope use and HIV infection constitutes a critical public health problem that undermines efforts to achieve universal access to HIV treatment in South Africa. Nyaope use is strongly associated with the increased risk of HIV of transmission. A significant amount of new HIV infections was linked to substance use through sharing of injectable needles. Despite significant progress made to increase public awareness and increase accessibility to HIV services, little is known about how addiction, stigma, and discrimination influence access to HIV treatment among homeless individuals who nyaope. This study explored the hurdles of accessing HIV treatment among people who use nyaope and are homeless in Mogale City, Gauteng Province. Methods: An exploratory descriptive qualitative research approach was employed among people who are homeless, living with HIV and using nyaope (PHHIVN) in Mogale City, between May and August 2024. Data were collected utilizing in- depth interviews in English, isiZulu and Setswana languages. Purposive sampling technique was followed to select participants, and a sample size of 25 participants was reached with a mean age of 32.28 and SD = ±5.54 years, of whom 21 (84%) were male, 3 (12%) were female and 1 (4%) identified as other. Audio recordings were transcribed, translated, and analyzed following inductive thematic analysis. Results: Social exclusion and fractured support system, prioritization of drug use, nyaope dependency, withdrawal symptoms, negative peer influence, socioeconomic factors and misconception about the interaction between nyaope and HIV treatment were reported as some of the main hurdles of accessing HIV treatment among PHHIVN in Mogale City, Gauteng Province. Conclusions: It is therefore concluded that access to HIV treatment among PHHIVN in Mogale City, Gauteng Province, remains a serious public health concern influenced by various hurdles. The development of tailored interventions to improve access and adherence to HIV treatment among this population group has potential to enhance the uptake of HIV treatment. Full article

Medetomidine, a potent central acting α2 agonist, has emerged as a fentanyl adulterant in the non-medical opioid supply. Its use has been linked to a novel withdrawal syndrome that is often resistant to conventional treatment protocols. Four cases are presented exemplifying extreme, but increasingly common forms of this withdrawal syndrome. A literature review is provided demonstrating both the paucity of available literature as well as potential avenues for treatment and future research. As adulterants continue to proliferate in the illicit drug supply, clinicians should anticipate atypical withdrawal phenotypes and consider early intervention. Full article

Background: Borderline Personality Disorder (BPD) often emerges during adolescence and young adulthood, a period marked by heightened vulnerability to impulsivity and affective dysregulation. While impulsivity is a core feature of BPD, its multidimensional expression in this age group remains insufficiently documented. This study examined impulsivity traits in young adults with BPD, their associations with depressive and anxiety symptoms, and their links to risk behaviors. Methods: A total of 160 participants aged 16–25 were recruited in Belgium between 2021 and 2023: 44 with BPD from inpatient and outpatient psychiatric services and 116 healthy controls from schools and universities. Assessments included the short UPPS-P, Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory (STAI-T), and the Diagnostic Interview for Borderlines–Revised (DIB-R). Logistic regressions with robust errors and Kendall’s tau-b correlations were used. Results: Compared with controls, individuals with BPD scored higher on all UPPS-p subscales except Sensation Seeking (e.g., Negative Urgency: 14 vs. 10, p < 0.001). Logistic regression identified Negative Urgency (OR = 5.31, 95% CI: 2.07–13.62, p = 0.001) and Positive Urgency (OR = 3.26, 95% CI: 1.37–7.75, p = 0.007) as independent predictors of BPD. Within the BPD group, depressive and anxiety symptoms correlated with several UPPS-P dimensions, notably Negative Urgency and Lack of Perseverance. Suicide attempts were associated with the DIB-R total score, BDI-II, and STAI-T, while substance use was linked to the DIB-R impulsivity subscale and STAI-T. Conclusions: Emotional impulsivity—particularly Negative Urgency—emerges as a central feature of BPD in emerging adulthood. Its interplay with depressive and anxiety symptoms, and its associations with suicidal and addictive behaviors, support a dual-level conceptualization of impulsivity as both a dispositional trait and a state-dependent clinical risk factor. Full article

Background and Objectives: This study aimed to evaluate the treatment outcomes of adults with pulmonary drug-susceptible tuberculosis (DS-TB) in Lithuania over 22 years, and to examine associations between treatment outcomes, various risk factors, and temporal trends. Materials and Methods: A retrospective cohort analysis was conducted using data from the National Tuberculosis Information System from 2000 to 2021. A total of 18,697 adult patients with DS-TB were included. Patients were grouped into three time periods: Period I (2000–2007), Period II (2008–2015), and Period III (2016–2021). Treatment outcomes were categorized as successful (treatment completed with recovery) or unsuccessful (patients who encountered treatment failure, died during treatment, or converted to drug-resistant tuberculosis). Associations with individual risk factors, including smoking, alcohol use, comorbidities, and sociodemographic variables, were analyzed. Results: Treatment success rates improved steadily across the study periods: 82.3% in Period I, 84.4% in Period II, and 87.6% in Period III. Mortality rates declined over time but remained substantial: 17.1%, 15.2%, and 12.0% in Periods I, II, and III, respectively. Non-lethal treatment failures decreased slightly (0.6%, 0.4%, and 0.4%). Multivariate analysis identified significant associations between treatment failure and multiple risk factors, including low BMI, male gender, unemployment, homelessness, smoking, alcohol and substance use, and comorbid conditions such as cancer, cardiovascular disease, chronic lung disease, diabetes mellitus, HIV, and renal failure. Conclusions: Treatment outcomes for DS-TB in Lithuania have improved over the past two decades; however, certain modifiable risk factors—such as low BMI, homelessness, substance use, and comorbidities—remain strongly linked to treatment failure. To further improve outcomes, targeted interventions such as nutritional support, housing programs, and integrated addiction services should be prioritized for high-risk groups within national TB control efforts. Full article

(1) Background: The COVID-19 pandemic exacerbated existing health inequities for Native American communities, intensifying the challenges faced in accessing addiction and recovery services. As part of a tribal-university collaborative effort in Arizona, our team explored the impacts of the COVID-19 pandemic on mental well-being and resilience among the Indigenous substance use recovery community. (2) Methods: We conducted qualitative analysis of transcribed individual interviews (n = 19) to understand the factors of resilience and mental well-being for providers of Western addiction treatment services and Indigenous community members who were in addiction recovery or engaged in addiction treatment during the pandemic. (3) Results: Four major themes that impacted mental well-being among the Indigenous recovery group during the pandemic were identified: (1) healthcare barriers; (2) culture in recovery; (3) the impact of colonization/historical trauma; and (4) the importance of relationships. (4) Conclusions: This work provides insight into the disproportionate impact of the COVID-19 pandemic on Indigenous communities and vulnerable populations such as the recovery community. Findings from this study highlight the need for Indigenous-grounded and culturally informed recovery interventions. Full article