Contingency management (CM) that is delivered by peer recovery support specialists and incentivizes harm reduction goals among people not seeking treatment for stimulant use has not been tested. The Peers Expanding Engagement in Stimulant Harm Reduction with Contingency Management (PEER-CM) study compares the effectiveness of two peer-facilitated CM interventions: (1) an experimental approach incentivizing achievement of client-identified harm reduction goals and (2) an enhanced standard of care approach incentivizing peer visit attendance.

Applying a hybrid type 1 effectiveness-implementation framework and stepped-wedge design across 14 community-based peer services sites across Oregon, the PEER-CM study trains peers to conduct CM. All sites implement the standard CM approach of incentivizing peer visit attendance. Every 2 months, two sites are randomly assigned to initiate the experimental CM condition of incentives for achieving client-directed harm reduction activities. Peers monitor progress and manage incentives. In the experimental approach, peers facilitate client progress on goal-related activities (selected from a standardized list of goals) to support the primary study outcome of reducing opioid overdoses and stimulant overamping. The intended study enrollment is approximately 80 clients per site (N = 1,120). Peer specialists participate in skills-focused coaching-to-criterion coaching process to document proficient CM delivery skills. This includes a series of group coaching sessions and an individual assessment with a standardized patient, observed and rated according to core dimensions of the Contingency Management Competence Scale.

The primary study outcome is time until peer-reported fatal or first participant-reported non-fatal overdose or overamp (acute stimulant toxicity). Secondary outcomes include achievement of client-identified harm reduction goals and engagement in substance use disorder treatment. We will also demonstrate the feasibility of our coaching-to-criterion process by documenting peer proficiency in CM skills. Qualitative interviews with peers and their clients will explore the optimal context and implementation strategies for peer-facilitated CM.

PEER-CM is among the first trials to test the effectiveness of peer-facilitated CM for achieving harm reduction goals and reducing overdose in non-treatment-seeking people who use stimulants. The findings will generate evidence for peer-facilitated delivery of CM and application of CM to client-identified harm reduction goals.

This study is registered at ClinicalTrials.gov (NCT05700994).

Psychostimulant misuse and use disorders are major drivers of morbidity and fatal overdose in the United States, but little is known about how differences in psychostimulant use patterns relate to Diagnostic and Statistical Manual, Diagnostic and Statistical Manual of Mental Disorders, 4th edition and Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) stimulant substance use disorder (SUD) profiles. We used nationally representative U.S. data to assess the links between polystimulant use patterns and stimulant SUD prevalence, symptom counts, and DSM-5 stimulant SUD severity. Data were from the 2015-2019 and 2020 National Survey on Drug Use and Health. Participants (n = 282,786) were grouped by past-year psychostimulant use patterns: (a) nonmedical use of prescription stimulants (NUPS) only; (b) cocaine-only; (c) methamphetamine-only; and (d) polystimulant use. Analyses comparing groups used logistic regressions for prevalence of past-year Diagnostic and Statistical Manual of Mental Disorders, 4th edition (2015-2019 and 2020) and DSM-5 (2020 only) stimulant SUD, negative binomial regressions for stimulant SUD symptom counts, and multinomial regressions for DSM-5 stimulant SUD severity. Those with past-year methamphetamine-only or polystimulant use had significantly higher Diagnostic and Statistical Manual of Mental Disorders, 4th edition and DSM-5 prevalence rates, symptom counts, and DSM-5 severities of stimulant SUD than those with NUPS or cocaine use only. Depending on Diagnostic and Statistical Manual of Mental Disorders version, 34%-47% of those engaged in polystimulant use and 48%-54% of those with methamphetamine use only met criteria for a stimulant SUD, versus 9%-17% for NUPS-only and 16%-24% for cocaine-only. For 2020, roughly two thirds of those with methamphetamine-only use had stimulant SUD symptoms. Individuals with methamphetamine and/or polystimulant use may have different service needs than those with NUPS or cocaine use only. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Methamphetamine is increasingly co-used with opioids. This is a worrisome combination that complicates addiction disease severity, increases overdose risk, exacerbates comorbidities, and strains the national healthcare system. Growing evidence suggests that some people co-use methamphetamine and opioids to temporarily relieve painful opioid withdrawal symptoms. A national epidemiologic profile of how, and for whom, opioid withdrawal may influence increased methamphetamine use is needed to inform interventions.

We used the National Survey of Drug Use and Health to identify individuals who used both methamphetamine and opioids in the past year (pooled 2022-2023; N = 572; weighted N = 1,494,223). Our outcome was the number of days a person reported using methamphetamine in the past year (1-365), predicted by the number of past-year opioid withdrawal symptoms (0-10). We used Poisson regression to model the number of methamphetamine days and included an interaction term between opioid withdrawal and race/ethnicity. We applied survey weights to obtain unbiased US population estimates.

The mean weighted number of methamphetamine days was 160, and the mean weighted opioid withdrawal sum score was 2.9 out of 10. For every increase in opioid withdrawal sum score, the rate of methamphetamine days increased 20% faster for Black individuals compared to White individuals (interaction p < .01).

Despite reporting relatively infrequent methamphetamine use overall, our model predicted that Black individuals with high opioid withdrawal symptoms had an estimated 300 annual days using methamphetamine. We frame our findings around racial disparities and posit that access to opioid treatment may uniquely influence methamphetamine behavior for Black individuals.

The development of comprehensive strategies to understand emerging trends in substance use is necessary to design effective prevention and harm reduction strategies for people who use drugs (PWUD). Dried blood spots (DBS) can be used as a non-conventional drug testing approach that meets Food and Drug Administration (FDA) accuracy and precision guidelines.

From July 2021 to July 2022, 1,559 PWUD were enrolled at six US syringe service programs (SSP) in Sacramento, California, Ellensburg, Washington, and Missoula, Montana ("Western"), Madison, Wisconsin, New Haven, Connecticut, and Wilmington, North Carolina ("Eastern").

Participants completed a survey on demographic and behavioral characteristics and provided DBS specimens. A novel toxicology assay coupling liquid chromatography and tandem mass spectrometry was developed and used to identify the presence/absence of fentanyl, methamphetamine, xylazine, cocaine, and heroin, along with their metabolites. In this cross-sectional analysis, we describe the prevalence of each substance stratified by SSP.

Among 1,345 PWUD, methamphetamine was more prevalent in the Western versus Eastern state SSPs (95% vs. 33%). The Eastern state SSPs saw higher prevalence of cocaine, fentanyl, heroin, and xylazine than the Western state SSPs (86% vs. 24%; 41% vs. 11%; 20% vs. 17%; 20% vs. 6%, respectively). Testing positive for more than one substance was common (50%).

These results confirm existing regional differences in substance use. Further research is needed on the logistical implications of DBS and in which public health and research settings they may be useful.

HIV care continuum engagement is inadequate among African American/Black and Latine (AABL) young/emerging adults living with HIV in the United States. Within this population, some subgroups face barriers to research and are under-studied. Grounded in social action theory, the present study focuses on a diverse community-recruited cohort including those with non-suppressed HIV viral load. Using a sequential explanatory mixed methods design, we describe contextual self-regulatory resources (e.g., substance use, mental health), and their relationships to HIV management.

Participants (N = 271) engaged in structured baseline assessments and biomarker testing (HIV viral load, drug screening). Being well-engaged in HIV care and HIV viral suppression were the primary outcomes. We purposively sampled a subset for maximum variability for in-depth interviews (N = 41). Quantitative data were analyzed via descriptive statistics and logistic regression, and results were used to develop qualitative research questions. Then, qualitative data were analyzed via directed content analysis. The joint display method was used to integrate results.

Participants' mean age was 25 years (SD = 2). The majority (59%) were Latine/Hispanic and 41% were African American/Black. Nearly all were assigned male sex at birth (96%) and identified as gay/bisexual/queer (93%). The average HIV diagnosis was 4 years prior (SD = 3). The majority were well-engaged in HIV care (72%) and evidenced viral suppression (81%). Substance use (tobacco, marijuana, alcohol) was prevalent, mainly at low- and moderate-risk levels. Drug screening indicated marijuana, methamphetamine, and MDMA were the most common recent substances. Symptoms of depression and PTSD were associated with decreased odds of engagement in care. High-risk cannabis use was associated with decreased odds of HIV viral suppression. Qualitative results highlighted the prevalence of substance use in social networks and venues, and the importance of substances as a coping strategy, including for mental health distress. Tobacco and methamphetamine (but not marijuana) were described as problematic, and marijuana was used as harm reduction. Substance use was more common among those with non-suppressed versus suppressed HIV viral load. However, overall, substance use did not commonly interfere substantially with HIV management.

The present study advances knowledge on AABL young/emerging adults living with HIV and highlights ways to improve screening and services.

To examine epidemiological trends in drug overdose deaths for non-Hispanic American Indian/Alaska Native (AIAN) individuals compared to White individuals.

We obtained data from the CDC WONDER database to examine crude drug overdose death rates per 100,000 among AIAN and White individuals from 1999-2022. Rates were further stratified by manner of death, sex, age, urbanization, Census region, state, and specific drug types.

From 1999-2022, drug overdose death rates for AIAN individuals increased from 3.17 (95 % CI, 2.48-4.00) to 40.73 (95 % CI, 38.19-43.27), representing a 12-fold increase; in contrast, rates rose by five-fold for White individuals. In 2022, methamphetamine was the leading driver of overdose death rates for AIAN individuals, at 31.39 (95 % CI, 29.16-33.62) per 100,000, followed by fentanyl, at 22.35 (95 % CI, 20.46-24.23) per 100,000. Geographical variations were notable, with the highest rates for AIAN individuals in large central metropolitan regions (53.54 per 100,000) and the Midwest (50.31 per 100,000). Rates were higher for AIAN than White individuals in 20 of the 21 states (95.2 %) included in our analysis.

AIAN individuals are disproportionately impacted by the overdose crisis. Further efforts are needed to expand access to harm reduction-informed, culturally-competent health education, addiction treatment, and social services in the AIAN population.

Novel interventions are urgently needed to treat methamphetamine use disorder (MUD), for which there are no FDA-approved treatments. Previous studies in patients with MUD suggest transcranial magnetic stimulation (TMS) over the left dorsolateral prefrontal cortex (L. dlPFC) decreases craving for methamphetamine. Theta burst stimulation (TBS), which includes intermittent TBS and continuous TBS (cTBS), is increasingly being used for substance use disorders, including MUD. Previous reviews of TMS in MUD performed sub-group meta-analyses of studies that delivered TBS in MUD. However, these meta-analyses included studies with overlapping participant cohorts. Given the absence of prior meta-analyses or reviews examining TBS in MUD using unique participant cohorts, we reviewed randomized controlled trials (RCTs) from three databases (PubMed/Medline, EMBASE, Google Scholar) until September 1, 2024, comparing the impact of TBS versus sham TBS on cue-induced methamphetamine cravings in patients with MUD. We performed a meta-analysis with four eligible RCTs that delivered iTBS. Results suggest iTBS was more effective in reducing cue-induced methamphetamine cravings than sham iTBS (standardized mean difference [SMD] in change = 1.04; 95% CI [0.16, 1.92]). Our systematic review included two additional RCTs that did not have sham comparator arms; one of these demonstrated a significant reduction in methamphetamine craving with accelerated iTBS. Future studies should examine if iTBS can impact clinical outcome measures other than craving, such as methamphetamine use, by measuring return to drug use. It is also pertinent to explore accelerated iTBS and cTBS for MUD and study their effects on relevant biomarkers for MUD.

Ketamine's potential for treating depression has drawn increased clinical interest in recent years. However, despite growing therapeutic use, recreational use among individuals with depression remain underexplored.

We analyzed data from the 2015-2022 National Survey on Drug Use and Health focusing on adults in the US. Trends in past-year ketamine use, overall and by depression status, were estimated separately for 2015-2019 and 2021-2022 due to methodological changes in the survey. We also delineated correlates of ketamine use in each period, focusing on depression, sociodemographic characteristics, and other past-year drug use.

Overall ketamine use prevalence increased from 2015 to 2019 (from 0.11 % to 0.20 %, an 81.8 % increase, p < 0.01) and from 2021 to 2022 (from 0.20 % to 0.28 %, a 40.0 % increase, p < 0.05). From 2015 to 2019, use increased among adults with and without depression (by 139.3 % [p < 0.05] and 66.7 % [p < 0.05], respectively), while from 2021 to 2022, an increase occurred only among those without depression (by 38.9 %, p < 0.05). Multivariable models revealed that depression was associated with increased odds of ketamine use in 2015-2019 (aOR = 1.80, 95 % CI: 1.12-2.89) but not in later years. New sociodemographic correlates emerged in 2021-2022, including adults aged 26-34 and those with a college degree being at higher odds for use. Various drugs (especially ecstasy/MDMA and gamma-hydroxybutyrate) were consistently associated with higher odds of use.

We identified differential patterns and correlates of ketamine use over time. Shifts may be related to the evolving ketamine landscape and/or changing survey methodology. Monitoring of use patterns is crucial to inform prevention and harm reduction strategies.

Methamphetamine use has increased across the US. To develop adequate interventions, understanding differences in male and female methamphetamine use is critical. Conducted in Dayton, Ohio, this study explores sex differences in attitudes and practices of methamphetamine use. Between 12/2019 and 11/2021, the study recruited 91 participants. Bivariate analyses were used to identify sex differences. Of the 91 participants, 52.7% were female, 95.6% were non-Hispanic white, and the mean age was 42.4 (SD 10.6) years. Age of methamphetamine initiation was similar for males and females (31.7 vs. 29.3). Participants reported multiple reasons for methamphetamine use, but females were more likely to report use to quit opioids (60.4% vs. 39.5%, p = .047), lose weight (35.4% vs. 14.0%, p = .019), and self-treat ADHD symptoms (43.8% vs. 16.3%, p = .005). Females were more likely to endorse increased productivity (81.3% vs. 48.8%, p = .001) as a benefit of methamphetamine use. Females were also more likely to endorse the following perceived risks of methamphetamine: depression (91.7% vs. 74.4%, p = .027), skin problems (100.0% vs. 76.2%, p = <0.001), aggression/violence (93.8% vs. 65.1%, p = <0.001), risk of HIV/AIDS (85.4% vs. 60.5%, p = .007), teeth problems (100.0% vs. 90.7%, p = .032), exposure to fentanyl contamination (81.3% vs. 55.8%, p = .009), and increased risk of an overdose (39.6% vs. 16.3%, p = .014).

Methamphetamine (Meth) use is rising in the US. Most research focuses on severe TBI, neglecting milder cases. We evaluated Meth's impact on patient outcomes and hospital resource use across all TBI severities.

This study included National Trauma Data Bank (NTDB) patients from 2017-2019, aged 18-54, with near-isolated TBI, a drug screen, and negative blood alcohol. Meth+ patients were compared to Meth- patients on demographics, injury severity, and outcomes using χ² and Wilcoxon rank-sum tests.

Of 29,416 patients with TBI patients, 337 (1%) were Meth+. Meth+ patients had significantly higher ICU admissions (61% vs. 50%, p < 0.001), mechanical ventilation (32% vs. 22%, p < 0.001), and tracheostomy (7% vs. 4%, p < 0.008). Meth+ had longer hospital stays (median 4 vs. 3 days, p < 0.001) and higher cerebral monitor use (8% vs. 5%, p < 0.05). Mortality rates were similar (5% vs. 5%, p = 0.46). Meth+ patients had more preexisting mental health/personality (20% vs. 12%, p < 0.001) and substance use disorders (44% vs. 6%, p < 0.001).

Meth use in patients with near-isolated TBI patients is linked to greater injury severity, increased resource use, and longer hospital stays but does not significantly impact mortality. Targeted interventions are needed to manage clinical challenges and optimize resource utilization.

Dopamine (DA) is a neurotransmitter that is important in the reward system and increased DA release is associated with rewarding properties of drugs. Highly addictive stimulants like methamphetamine (METH) increase DA release and block reuptake, causing the DA to stay in the synapse longer, enhancing its effects. Because the misuse of METH is increasing in the United States, it is important to investigate ways to protect against this highly addictive stimulant. Recent studies have shown that social support can be a protective factor against METH self-administration in females, but not males. Other studies using microdialysis have shown that socially housed females have lower DA release in the nucleus accumbens (NAc) compared to single housed females after treatment with METH. Additionally, researchers have shown that there are sex differences in stimulated DA release. The present study investigates whether social housing affects stimulated DA release after METH treatment. DA release in the NAc core and shell of socially housed and individually housed rats was measured using fast scan cyclic voltammetry (FSCV) with a chronic 16-channel carbon fiber electrode in the NAc. A stimulating electrode was aimed at the ventral tegmental area (VTA) to induce DA release in the NAc. The results showed that social housing enhances electrically stimulated DA release in males and that there was greater DA release in NAc core than shell in single males, but no difference in socially housed males. In females, social housing also enhanced ES DA release. In single females there was greater ES DA release in shell than in core. Additionally, in single housed females there was greater ES DA release over time, while the socially housed females had high ES DA release that remained stable over time. These results suggest that social housing protects females from sensitization, making single females more vulnerable to the addictive properties of METH.

Methamphetamine (METH) is a potent psychostimulant that disrupts cognitive and neurobiological functions in brain regions such as the prefrontal cortex (PFC) and hippocampus. Chronic METH use leads to altered synaptic plasticity, neuroinflammation, and mitochondrial dysfunction, contributing to methamphetamine use disorder (MUD). This study investigates gene expression changes following long-access intravenous METH self-administration in a rodent model. RNA sequencing (RNA-Seq) was conducted on PFC and hippocampal tissue to identify differentially expressed genes (DEGs) between METH-treated and control groups. We identified 41 DEGs in the PFC and 32 in the hippocampus, many involved in synaptic plasticity, immune response, and energy metabolism. Key findings included downregulation of mitochondrial function genes and upregulation of genes related to neural development and extracellular matrix organization, highlighting the profound transcriptional effects of METH. As a proof-of-concept, we explored individual gene expression variability in relation to economic demand for METH. Rats exhibiting higher demand showed distinct molecular profiles, including upregulation of genes linked to neural signaling and transcription regulation, such as Foxd1 and Cdh1. This preliminary analysis demonstrates that individual differences in drug-seeking correlate with unique gene expression patterns. These findings suggest that both group-level and individual molecular changes contribute to the neurobiological mechanisms of METH use. A better understanding of these individual differences could potentially inform the development of personalized therapeutic approaches for MUD.

Improving support options for people who use methamphetamine is of critical national and global importance. The role of mutual-help groups within the treatment-seeking journey of people who use methamphetamine is unclear. Self-Management and Recovery Training ('SMART Recovery') mutual-help groups are led by a trained facilitator and support participants to work on individual goals, including, but not limited to abstinence. This study examined how people who use methamphetamine came to be involved in SMART Recovery mutual-help groups and factors associated with engagement.

A sample of Australian SMART Recovery participants who self-reported using methamphetamine in the preceding 12-months (n = 18) discussed their history of substance use and experience of service provision in a semi-structured telephone interview. Interviews were audio-recorded, transcribed, and analysed using iterative categorization.

Participant initiation of SMART Recovery groups was described across two themes: i) delayed attendance and ii) use as an adjunct to other services. Factors associated with engagement were discussed in terms of: i) the 'fit' of SMART Recovery mutual-help groups; ii) coping and tolerance of discomfort; iii) the power of shared lived experience; iv) choice and autonomy; and v) short-term goal setting supports self-efficacy and the possibility of change.

SMART Recovery mutual-help groups show promise for engaging people who use methamphetamine. There is a clear need to improve awareness of mutual-help group options amongst service users, providers and the general community. Offering choice over mutual-help groups may help to engage people earlier and support improved linkage between services.

There is growing awareness of the benefits of treating patients in their own home, yet home-based detoxification of individuals with substance use disorder has received limited attention. While home-based alcohol detoxification seems to be safe and effective for patients without severe withdrawal, little is known about detoxification for illicit or polysubstance dependence. This review synthesises recent findings on home-based detoxification for alcohol and other substances.

A systematic search of published and unpublished studies from 2010 onwards was conducted. Studies describing home detoxification interventions and programs, along with qualitative, quantitative and mixed-methods research, were included. Study quality was assessed using the Mixed Methods Appraisal Tool. Findings were narratively synthesised.

Eleven publications were included. Many studies are descriptive, explorative or use a small sample, but four studies are of high quality. Five publications focused exclusively on alcohol detoxification. The outcomes in reducing or abstaining from substance use seem acceptable, except for opioids. Patients and families reported high satisfaction, viewing it as less stressful than inpatient care. However, no conclusions can be drawn regarding the effectiveness compared to other detoxification settings.

The limited evidence base illustrates a great need for further investigation and controlled trials of home-based detoxification and comparison between detoxification settings. Investigating the broader applicability across substances is crucial.

Home-based detoxification shows potential as a safe and patient-preferred intervention, though more research is required to assess its broader effectiveness and feasibility across various substances. It could play a valuable role within established care models.

Neuropsychologists can expect to meet with increasing rates of patients who use methamphetamine (MA), as MA use is on the rise, often comorbid with other substance use disorders, and frequently accompanied by changes in cognitive functioning. To detect impairment, neuropsychologists must apply the appropriate normative data according to important demographic factors such as age, sex, and education. This study involved 241 adults with and without MA dependence who were administered the Neuropsychological Assessment Battery. Given the high rates of polysubstance use among adults who use MA, we included adults with mono-dependence and poly-dependence on MA and at least one other substance. We compared the rates of adults with and without previous MA dependence classified as impaired on neurocognitive testing when using norms corrected for age, education, and sex versus norms corrected only for age. Norms corrected for age, education, and sex resulted in less frequent identification of impairment compared to norms corrected only for age, but both sets of norms appeared sufficient and similar enough to warrant their use with this population. It may be appropriate to explore the possible implications of discrepancies between education-corrected and non-education corrected sets of scores when assessing impairment in individuals who use MA.

Methamphetamine use disorder has emerged as a significant public health concern globally. This study endeavors to elucidate the alterations in expression changes of miRNAs in the plasma of methamphetamine use disorder and elucidate the alterations in miRNA expression in the plasma of individuals with methamphetamine use disorder and investigate the relationship between these differentially expressed miRNAs and the disorder itself, cravings for methamphetamine, and associated mental disorders. Furthermore, the study seeks to clarify the expression of downstream target molecules of specific miRNAs in the plasma of methamphetamine use disorder, assess the diagnostic utility of these miRNAs and their target molecules, explore their potential as biomarkers, and identify potential targets for the diagnosis and treatment of methamphetamine use disorder. The research subjects included 112 individuals with methamphetamine use disorder and 112 healthy controls. A questionnaire was utilized to gather baseline information on methamphetamine use disorder, assess craving for methamphetamine using a Visual Analog Scale (VAS), and evaluate anxiety (SAS) and depression (SDS) states. Employing qRT-PCR technology, we measured the expression levels of miR-9-3p and let-7b-3p in the plasma of those with the disorder. Bioinformatics tools were then used to predict downstream target molecules. Western blot analysis was conducted to quantify the levels of these target molecules in the plasma. Receiver operating characteristic (ROC) curves were utilized to evaluate the diagnostic accuracy of miRNAs and their target molecules. Additionally, we analyzed the correlation between the miRNA expression levels and the psychiatric symptoms of methamphetamine use disorder. The qRT-PCR results revealed that the expression levels of miR-9-3p and let-7b-3p were significantly elevated in the plasma of individuals with methamphetamine use disorder compared to healthy controls (P < 0.05). Furthermore, qRT-PCR and Western blot analyses demonstrated that transfection with miR-9-3p mimic led to overexpression of miR-9-3p, while transfection with let-7-3p mimic promoted overexpression of let-7-3p, concurrently inhibiting the protein levels of BDNF and GSK3B in cells (P < 0.05); ROC curve analysis indicated that the AUC for miR-9-3p was 0.782 (95% CI 0.716-0.848) and for let-7b-3p was 0.720 (95% CI 0.650-0.789). However, Spearman correlation analysis showed no significant association between the expression levels of target miRNAs and proteins and the psychiatric symptoms of methamphetamine use disorder. Notably, the combination of miR-9-3p, let-7b-3p, and BDNF exhibited high diagnostic accuracy for methamphetamine use disorder, suggesting their potential as biomarkers for its diagnosis.

Aptamers are oligonucleotide-based affinity reagents that are increasingly being used in various applications. Systematic evolution of ligands by exponential enrichment (SELEX) has been widely used to isolate aptamers for small-molecule targets, but it remains challenging to generate aptamers with high affinity and specificity for targets with few functional groups. To address this challenge, we have systematically evaluated strategies for optimizing the isolation of aptamers for (+)-methamphetamine, a target for which previously reported aptamers have weak or no binding affinity. We perform four trials of library-immobilized SELEX against (+)-methamphetamine and demonstrate that N30 libraries do not yield high-quality aptamers. However, by using a more complex N40 library design, stringent counter-SELEX, and fine-tuned selection conditions, we identify aptamers with high affinity for (+)-methamphetamine and better selectivity relative to existing antibodies. Bioinformatic analysis from our selections reveals that high-quality aptamers contain long conserved motifs and are more informationally dense. Finally, we demonstrate that our best aptamer can rapidly detect (+)-methamphetamine at toxicologically relevant concentrations in saliva in a colorimetric dye-displacement assay. The insights provided here demonstrate the challenges in generating high-quality aptamers for low complexity small-molecule targets and will help guide the design of more efficient future selection efforts.

We define criteria for methamphetamine-induced psychotic disorder (MIPD) to aid in accurate and reliable diagnosis.

An expert panel was recruited and engaged in an iterative consensus process. A literature search supported this work. The a priori level for consensus was considered ≥80% of voting panellists.

The final expert panel included 22 physicians from different backgrounds and practice environments. The panel produced two consensus diagnoses: (1) acute MIPD and (2) persisting MIPD, which is further separated into subacute and chronic timeframes. Although certain characteristics differentiate methamphetamine-induced psychosis shortly after use, identification of persisting MIPD depends largely on a history of symptom onset. All respondents voted in the final round, and both criteria were fully endorsed by 91% (20/22) of respondents. Panellists further recommended next steps in validation and research on this topic.

These diagnostic criteria aid clinicians in differentiating methamphetamine-induced psychotic symptoms from psychosis because of other psychiatric disorders and can guide future studies. Future research might examine these criteria's prognostic significance, interrater reliability and acceptability including among persons in recovery. This work is a necessary and vital step in advancing the science of methamphetamine addiction treatment.

Fentanyl and its analogs contribute substantially to drug overdose deaths in the United States. There is concern that people using drugs are being unknowingly exposed to fentanyl, increasing their risk of overdose death. This study examines temporal trends and spatial variations in the co-occurrence of fentanyl with other seized drugs.

We identified fentanyl co-occurrence (the proportion of samples of non-fentanyl substances that also contain fentanyl) among 9 substances or substance classes of interest: methamphetamine, cannabis, cocaine, heroin, club drugs, hallucinogens, and prescription opioids, stimulants, and benzodiazepines. We used serial cross-sectional data on drug reports across 50 states and the District of Columbia from the National Forensic Laboratory Information System, the largest available database on the U.S. illicit drug supply, from January 2013 to December 2023.

We analyzed data from 11,940,207 samples. Fentanyl co-occurrence with all examined substances increased monotonically over time (Mann-Kendall p < 0.0001). Nationally, fentanyl co-occurrence was highest among heroin samples (approx. 50%), but relatively low among methamphetamine (≤1%), cocaine (≤4%), and other drug samples. However, co-occurrence rates have grown to over 10% for cocaine and methamphetamine in several Northeast states in 2017-2023.

Fentanyl co-occurs most commonly with heroin, but its presence in stimulant supplies is increasing in some areas, where it may pose a disproportionately high risk of overdose.

This work was partly supported by FDA grant U01FD00745501. This article reflects the views of the authors and does not represent the views or policies of the FDA or US Department of Health and Human Services.

Amphetamine-type stimulants (ATSs) are related to significant harm worldwide, with limited effective pharmacological treatments for ATS use disorder (ATSUD). Modafinil has been explored as a potential treatment for ATSUD. This systematic review and meta-analysis (PROSPERO ID: CRD42023388487) aimed to evaluate the efficacy and safety of modafinil for the treatment of ATSUD.

A comprehensive search of major indexing sources and trial registries, from inception to search date, was conducted on February 15, 2023, and updated on October 31, 2023. Eligible studies were randomized placebo-controlled trials (RCTs) of modafinil in individuals meeting the criteria for the Diagnostic and Statistical Manual of Mental Disorders, fourth and fifth editions, diagnoses of ATSUD. Eligible studies were assessed for risk of bias, using the Cochrane Risk of Bias tool. The primary outcome included the effect of modafinil on ATS use. Secondary outcomes included retention in treatment, ATS craving, treatment discontinuation due to adverse events (AEs), and serious AEs. Subgroup analysis by modafinil dose was conducted where appropriate. Risk ratio (RR) or Peto's odds ratio (OR) was calculated for the meta-analysis of dichotomous variables and standardized mean difference (SMD) was calculated for the random-effect meta-analysis of continuous variables.

Five RCTs (N = 451 participants) were included. Modafinil did not significantly impact ATS use (RR = 0.99; 95% CI, 0.97 to 1.02; p = 0.655), retention in treatment (RR = 1.02; 95% CI, 0.91 to 1.14; p = 0.799), ATS craving (SMD = -0.36; 95% CI, -1.19 to 0.47; p = 0.398), or treatment discontinuation due to AEs (Peto's OR = 0.48; 95% CI, 0.20 to 1.14; p = 0.100). These results were consistent across subgroup analyses. More episodes of serious AEs were reported in the modafinil group than in the placebo group, at higher doses (Peto's OR = 4.80; 95% CI, 1.18 to 19.56, p = 0.029).

There is currently no evidence suggesting that modafinil has a statistically significant effect on efficacy outcomes in populations with ATSUD. Continued research into effective treatments and harm reduction strategies for ATSUD is essential.

Methamphetamine addiction is a serious and difficult-to-treat disorder. Existing treatment options are limited, and patient perspectives on effective strategies are lacking. Emergency departments (EDs) may be a critical entry point for individuals with methamphetamine use disorder (MUD) to be identified and linked to treatment. We aimed to understand patients' perspectives regarding their methamphetamine use and related ED experiences and how to improve linkage to substance treatment.

Between July and November 2022, semistructured qualitative interviews were conducted with adult patients with MUD in an urban safety-net healthcare setting in Denver, Colorado. Interviews were recorded, summarized, and analyzed using the Rapid Assessment Process.

During the interviews, 18 patients shared their experiences. Participants described feeling stigmatized and experiencing a lack of communication from ED staff during their visit. Additionally, participants shared the perception that ED staff often did not take their health concerns seriously once substance use was identified. Participants were uncertain about overdose risk and felt that their psychiatric symptoms complicated treatment. Referrals to treatment were lacking, and participants supported a care navigation intervention that incorporates elements of contingency management. Participants also shared the importance of ED staff recognizing their social needs and being empathetic, trauma-informed, and flexible to meet patients where they are regardless of their readiness to seek treatment.

Treatment options and entry points for individuals with MUD are currently limited. The patient perspectives described here are helpful in developing services to support, engage, and link individuals to MUD services after discharge from ED services.

Pulmonary arterial hypertension (PAH) is a rare, chronic, progressive form of pulmonary hypertension in which increased arterial pressure causes remodeling of the arterial system and is associated with heart failure. Methamphetamine is a stimulant that has recently become a focus in PAH research, but the recent trends and demographics of this cohort of patients are not known. The study aimed to analyze the overall trends and demographics of PAH patients with and without concurrent methamphetamine usage.

The study used the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), and Agency for Healthcare Research and Quality (AHRQ) from 2008 to 2020 to calculate nationally weighted estimates for both conditions by ICD-9 and ICD-10 diagnosis codes. We used several statistical measures, including descriptive statistics with design-based chi-square and t-tests, trend analysis with Cochran-Armitage test, generalized linear models, and other data preprocessing measures.

A significant increase was evident in patients with pulmonary arterial hypertension (PAH) and concurrent methamphetamine use (9.2-fold). Most of the hospitalized patients were males (59.16%), aged 41-64 (45.77%), White (68.64%), from the West (53.09%), with Medicaid (50.48%), and with median income <$25,000. The rate of increase over the period was higher for males (11.8-fold), race (not sure which race; please check and modify), aged 41-64 (11.3-fold), and in the South (15.1-fold). An overall adjusted prevalence ratio (PR) for PAH hospitalizations among concurrent methamphetamine users was 32.19 (CI = 31.19-33.22) compared to non-users. With respective reference categories, the significantly higher PR was evident for males, patients aged 41-64, White, with Medicare, median income <$25,000, all regions compared to Northeast, length of hospital stays, and conditions, including chronic pulmonary disease, diabetes, hypertension, obesity, and peripheral vascular disorders.

This study reveals a national overall and demographic-specific trend of increasing PAH with concurrent methamphetamine usage and associated factors. The findings may help to understand the current patterns and identify the vulnerable sociodemographic cohorts for further research and to take appropriate policy measures.

The increasing incidence of opioid use disorder (OUD) among pregnant women in the United States constitutes a significant public health concern, jeopardizing both maternal and fetal health. Proposed solutions include opioid maintenance therapy, telemedicine, and integrated prenatal care centers. These strategies seek to mitigate harm and enhance therapeutic accessibility, yet encounter obstacles, including stigma, technological access, and ethical problems. While opioid maintenance therapy stabilizes addiction, telemedicine expands access, and integrated centers streamline care, each strategy requires policy support, community acceptance, and further evaluation to optimize outcomes for pregnant women with OUD.

Methamphetamine (METH) is a highly addictive psychostimulant that causes physical and psychological damage and immune system disorder, especially in the liver which contains a significant number of immune cells. Dopamine, a key neurotransmitter in METH addiction and immune regulation, plays a crucial role in this process. Here, we developed a chronic METH administration model and conducted single-cell RNA sequencing (scRNA-seq) to investigate the effect of METH on liver immune cells and the involvement of dopamine receptor D1 (DRD1). Our findings reveal that chronic exposure to METH induces immune cell identity shifts from IFITM3+ macrophage (Mac) and CCL5+ Mac to CD14+ Mac, as well as from FYN+CD4+ T effector (Teff), CD8+ T, and natural killer T (NKT) to FOS+CD4+ T and RORα+ group 2 innate lymphoid cell (ILC2), along with the suppression of multiple functional immune pathways. DRD1 is implicated in regulating certain pathways and identity shifts among the hepatic immune cells. Our results provide valuable insights into the development of targeted therapies to mitigate METH-induced immune impairment.

Sleep problems and impulsivity frequently occur in methamphetamine (MA) abstainers and are linked to aberrant brain function. However, the interplay between these factors remains poorly understood. This study aimed to investigate the relationship between sleep, impulsivity, and regional homogeneity (ReHo) through mediation analysis in MA abstainers. 46 MA abstainers and 44 healthy controls were included. Impulsivity and sleep problems were evaluated using the Barratt Impulsivity Scale and the Pittsburgh Sleep Quality Scale, respectively. ReHo, indicative of local brain spontaneous neural activity, was assessed using resting-state functional magnetic resonance imaging. Results unveiled correlations between different dimensions of impulsivity and ReHo values in specific brain regions. Motor impulsivity correlated with ReHo values in the left postcentral gyrus and left precentral gyrus, while non-planning impulsivity was only associated with ReHo values in the left precentral gyrus. Additionally, the need for sleep medications correlated with ReHo values in the left precentral gyrus and bilateral postcentral gyrus. Also, the need for sleep medications was positively correlated with cognitive impulsivity and motor impulsivity. Mediation analysis indicated that reduced ReHo values in the left precentral gyrus mediated the association between impulsivity and the need for sleep medications. These findings imply that addressing sleep problems, especially the need for sleep medications, might augment spontaneous neural activity in specific brain regions linked to impulsivity among MA abstainers. This underscores the importance of integrating sleep interventions into comprehensive treatment strategies for MA abstainers.

Previous research has demonstrated therapeutic potential for VMAT2 inhibitors in rat models of methamphetamine use disorder. Here, we report on the neurochemical and behavioral effects of 1-(2-methoxyphenethyl)-4-phenethypiperazine (JPC-141), a novel analog of lobelane. JPC-141 potently inhibited (Ki = 52 nM) [3H]dopamine uptake by VMAT2 in striatal vesicles with 50 to 250-fold greater selectivity for VMAT2 over dopamine, norepinephrine and serotonin plasmalemma transporters. Also, JPC-141 was 57-fold more selective for inhibiting VMAT2 over [3H]dofetilide binding to hERG channels expressed by HEK293, suggesting relatively low potential for cardiotoxicity. When administered in vivo to rats, JPC-141 prevented the METH-induced reduction in striatal dopamine content when given either prior to or after a high dose of METH, suggesting a reduction in METH-induced dopaminergic neurotoxicity. In behavioral assays, JPC-141 decreased METH-stimulated locomotor activity in METH-sensitized rats at doses of JPC-141 which did not alter locomotor activity in the saline control group. Moreover, JPC-141 specifically decreased iv METH self-administration at doses that had no effect on food-maintained responding. These findings support the further development of VMAT2 inhibitors as pharmacotherapies for individuals with methamphetamine use disorder.

Anxiety and substance use disorders are highly comorbid and represent two of the leading causes of disease burden globally. Psychosocial interventions are important treatment options for people with co-occurring anxiety and substance use (A-SUD). To date, few reviews have assessed the efficacy of psychosocial treatments for patients with A-SUD. This systematic review and meta-analysis aims to synthesize this literature and assess the efficacy of psychosocial interventions among patients with A-SUD.

We searched all relevant records published until March 2023 in Medline, EMBASE, PsycINFO, CINAHL and Google Scholar. Two authors extracted and reconciled relevant data and assessed risk of bias. Random effects models were used to calculate effect sizes using Hedges' g for post treatment and follow-up time points. Main outcomes of the review were anxiety, alcohol use, and use of other substances. We examined effects on depression as a secondary outcome since it commonly co-occurs with A-SUD.

Psychosocial interventions for co-occurring A-SUD showed moderate effects on anxiety (g = 0.44), alcohol (Hedges' g = 0.29), and other substance use (g = 0.38) at post intervention. Large effects were observed on depression (g = 0.88) at post intervention with high heterogeneity. These effects were maintained at follow-up for anxiety (Hedges' g = 0.38), other substances (g = 0.44), and depression (g = 0.50). Moderation analyses for demographic factors, intervention characteristics, community level factors, anxiety reduction, and alcohol use reduction, were non-significant.

The current meta-analysis investigated the effects of psychosocial interventions on patients with anxiety and co-occurring SUD. The analyses indicated promising moderate-sized effects of treatment on anxiety, alcohol, all other drug use, and depression. The findings point to important avenues for psychosocial treatment while highlighting critical gaps in knowledge to be addressed in future research.

The United States is in the midst of an evolving overdose crisis, driven by the proliferation of potent synthetic opioids (e.g., illicitly made fentanyl), the resurgence of stimulants (e.g., methamphetamine), and the introduction of adulterants (e.g., xylazine) into the illicit drug supply. These substance use challenges are happening against the backdrop of rising mental health challenges that are closely linked to substance use and overdose. As overdose deaths have increased, the demographic profile of those dying has shifted and now disproportionately affects certain racial and ethnic minority populations. Social determinants of health (SDOH) are an underexplored component of the prevention response but are particularly salient in addressing substance use and overdose. Many SDOH have been linked to an increased risk for substance use and overdose, either directly or indirectly. The author examines the connection between SDOH and substance use and overdose, with a particular focus on young adults.

The HEALing Communities Study (HCS) evaluated the effectiveness of the Communities That HEAL (CTH) intervention in preventing fatal overdoses amidst the US opioid epidemic.

To evaluate the impact of the CTH intervention on total drug overdose deaths and overdose deaths involving combinations of opioids with psychostimulants or benzodiazepines.

This randomized clinical trial was a parallel-arm, multisite, community-randomized, open, and waitlisted controlled comparison trial of communities in 4 US states between 2020 and 2023. Eligible communities were those reporting high opioid overdose fatality rates in Kentucky, Massachusetts, New York, and Ohio. Covariate constrained randomization stratified by state allocated communities to the intervention or control group. Trial groups were balanced by urban or rural classification, 2016-2017 fatal opioid overdose rate, and community population. Data analysis was completed by December 2023.

Increased overdose education and naloxone distribution, treatment with medications for opioid use disorder, safer opioid prescribing practices, and communication campaigns to mitigate stigma and drive demand for evidence-based interventions.

The primary outcome was the number of drug overdose deaths among adults (aged 18 years or older), with secondary outcomes of overdose deaths involving specific opioid-involved drug combinations from death certificates. Rates of overdose deaths per 100 000 adult community residents in intervention and control communities from July 2021 to June 2022 were compared with analyses performed in 2023.

In 67 participating communities (34 in the intervention group, 33 in the control group) and including 8 211 506 participants (4 251 903 female [51.8%]; 1 273 394 Black [15.5%], 603 983 Hispanic [7.4%], 5 979 602 White [72.8%], 354 527 other [4.3%]), the average rate of overdose deaths involving all substances was 57.6 per 100 000 population in the intervention group and 61.2 per 100 000 population in the control group. This was not a statistically significant difference (adjusted rate ratio [aRR], 0.92; 95% CI, 0.78-1.07; P = .26). There was a statistically significant 37% reduction (aRR, 0.63; 95% CI, 0.44-0.91; P = .02) in death rates involving an opioid and psychostimulants (other than cocaine), and nonsignificant reductions in overdose deaths for an opioid with cocaine (6%) and an opioid with benzodiazepine (1%).

In this clinical trial of the CTH intervention, death rates involving an opioid and noncocaine psychostimulant were reduced; total deaths did not differ statistically. Community-focused data-driven interventions that scale up evidence-based practices with communications campaigns may effectively reduce some opioid-involved polysubstance overdose deaths.

ClinicalTrials.gov Identifier: NCT04111939.

While much attention has been given to methamphetamine's wake-promoting properties and the concept of using methamphetamine to increase energy, little is known about the ways people who use methamphetamine manage their use to pursue their functional goals or the challenges they encounter doing so. This qualitative study explores the experiences of people who used methamphetamine to manage wakefulness and reduce sleep as a means to achieve functional goals. We conducted a grounded theory analysis of 202 anonymous letters submitted to an online forum. Five themes emerged from this process: (1) Using methamphetamine to extend wakefulness and reduce the need for sleep; (2) Losing control over wakefulness and the need for sleep; (3) Managing wakefulness and the need for sleep while on methamphetamine; (4) Getting caught in a cycle of wakefulness and sleep; and (5) Sleep disruptions even after ceasing methamphetamine use. Participants believed methamphetamine was critical to meeting their functional goals, and they went to great lengths to try to manage the substance's ill effects. Thus, clients in treatment for methamphetamine use disorder may benefit from interventions addressing their underlying motivations and perceived associations between methamphetamine and meeting functional goals.

Treatment for methamphetamine and other stimulants can be effective but treatment attrition and continued use are very high. Abstinence is the conventional outcome used to evaluate treatment success, but defining treatment success in this way misses opportunities to promote improved health even when abstinence is not achieved. Reducing methamphetamine and stimulant use without abstinence is associated with many positive outcomes. However, little is known about drug use patterns during treatment or trends in use over time.

We used the Treatment Episode Dataset-Discharges (TEDS-D) to identify treatment episodes that had a stimulant drug indicated as the primary substance of use (2017-2021; N=251,841; methamphetamine, cocaine, other amphetamines, or other stimulants). Our outcome was the change in the frequency of drug use between admission and discharge (decreased use with abstinence, decreased use without abstinence, increased use). We used multiple logistic regression to model a change in drug use frequency, predicted by year, stimulant type, and their interaction.

Nearly two-thirds of the sample (60 %) had methamphetamine indicated as the primary stimulant of use. There was a decrease in the predicted rate of abstinence over time and worsening trends were strongest among those using methamphetamine. Daily and periodic drug use at both admission and discharge (no change in use) became worse over time, particularly for those using methamphetamine.

Treatment outcomes worsened over time and declined fastest among those reporting methamphetamine. Abstinence was rare and most treatment clients did not change their drug use behavior. We recommend a renewed focus on evidence-based harm reduction while the nation's treatment systems continue grappling with the stimulant crises.

Although methamphetamine use has been increasing in recent years and occurring within new populations and in broader geographical areas, there is limited research on its use and effect in pregnancy.

This study aimed to examine the association between prenatal methamphetamine use and maternal and neonatal outcomes in a large, contemporary birth cohort.

This was a retrospective cohort study using California-linked vital statistics and hospital discharge data from 2008 to 2019. Methamphetamine use was identified using the International Classification of Disease, Ninth Revision and Tenth Revision, codes. Chi-square tests and multivariable Poisson regression models were used to evaluate the associations between methamphetamine use and maternal and neonatal outcomes.

A total of 4,775,463 pregnancies met the inclusion criteria, of which 18,473 (0.39%) had methamphetamine use. Compared with individuals without methamphetamine use, individuals with methamphetamine use had an increased risk of nonsevere hypertensive disorders (adjusted risk ratio, 1.81; 95% confidence interval, 1.71-1.90), preeclampsia with severe features (adjusted risk ratio, 3.38; 95% confidence interval, 3.14-3.63), placental abruption (adjusted risk ratio, 3.77; 95% confidence interval, 3.51-4.05), cardiovascular morbidity (adjusted risk ratio, 4.30; 95% confidence interval, 3.79-4.88), and severe maternal morbidity (adjusted risk ratio, 3.53; 95% confidence interval, 3.29-3.77). In addition, adverse neonatal outcomes were increased, including preterm birth at <37 weeks of gestation (adjusted risk ratio, 2.85; 95% confidence interval, 2.77-2.94), neonatal intensive care unit admission (adjusted risk ratio, 2.46; 95% confidence interval, 2.39-2.53), and infant death (adjusted risk ratio, 2.73; 95% confidence interval, 2.35-3.16).

Methamphetamine use in pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes that persists after adjustment for confounding variables and sociodemographic factors. Our results can inform prenatal and postpartum care for this high-risk, socioeconomically vulnerable population.

Methamphetamine use disorder (MUD) is a global health problem. Studies have shown Tai Chi is a potential treatment for MUD. We aimed to explore the effectiveness of Tai Chi in improving drug cravings, attention bias, and physical fitness in men with MUD compared with aerobic exercise.

A total of forty-eight participants (mean age 39.1 ± 8.7 years) were randomly assigned to either the Tai Chi group (TC) or the running group (RG). The TC performed 60 min of moderate-intensity (65-75% HRmax) Tai Chi exercise three times a week. The RG performed 60 min of moderate-intensity (65-75% HRmax) running on a treadmill three times a week. Before and after the intervention, drug cravings, attention bias, and physical fitness were evaluated.

After 12 weeks, we found the TC significantly improved in attention bias (F (1, 43) = 6.023, p = 0.019, d = -0.42) and reaction time (F (1, 43) = 6.181, p = 0.017, d = -0.72). No significant improvement was found in other variables in the TC, compared to the RG (p > 0.05).

The 12-week Tai Chi intervention improved attention bias and reaction time, compared to RG. Tai Chi exercise might be a potential auxiliary method for the rehabilitation for men with MUD.

Methamphetamine is a growing health problem, as is mental health illness. However, no studies have investigated the combinatory effects of both diseases or characterized national trends over a period of time greater than 10 years. We evaluated US trends in mental health disorder-related hospital admissions (MHD-HAs) and compared them with those with concurrent methamphetamine use (MHD-HA-MUs), comparing the demographic characteristics from 2008 to 2020. Our findings reveal a significant increase in MHD-HA-MUs, increasing 10.5-fold, compared with a 1.4-fold increase in MHD-HAs. We also found a 1.53 times higher adjusted prevalence ratio of MHD-HA-MUs compared with MHD-HAs, even when adjusted for confounding factors. MHD-HA-MUs increased significantly among male patients (13-fold), non-Hispanic Black patients (39-fold), those aged 41-64 years (16-fold), and the South (24-fold). Overall, the data suggest that there are synergistic effects with methamphetamine use and mental health disorder, highlighting this patient group's unique needs, requiring distinct action.

Unintentional and undetermined intent drug overdose fatality records from the State Unintentional Drug Overdose Reporting System (SUDORS) for Hawai'i from July 1, 2020, to December 31, 2021 revealed that 58.2% of decedents were aged 50-75. The main substance associated with cause of death for those aged 50-75 years was methamphetamine, followed by a combination of mixed drugs. Of those aged 50 and older, 25.5% died from cardiovascular or neurological complications which were likely to be associated with chronic, long-term methamphetamine use. Based on death investigator narrative reports, 76.5% of the older decedents had a history of substance abuse, suggesting possible long-term substance use starting at a young age. The trajectory of substance use over the life course is often influenced by life events and transitions, which can be stressors. Hawai'i kūpuna (older adults) should be screened for substance use and dependence to ensure that there is treatment if needed, for the entirety of this use trajectory.Also, barriers to kūpuna seeking treatment, such as stigma towards drug use should be addressed.

Deaths related to opioid overdoses continue to climb, and there remains a need for innovative strategies to address this ongoing crisis. Harm reduction (HR), a nonjudgmental philosophy aimed at reducing consequences associated with drug use and other potentially unsafe behavior, has emerged as a compassionate and effective approach. Harm reduction further emphasizes overdose prevention and fosters a shift in perspective that recognizes substance use disorder as a disease and not a moral failing. The tenets of HR collectively advocate for the well-being of individuals who use substances and support any positive change as defined by the individual. Given the high rate of morbidity and mortality associated with substance misuse and barriers or ambivalence to receiving treatment, awareness of and advocacy for HR practice is essential. This manuscript aims to describe evidence-based HR interventions, provide a foundation for the implementation of services, and further promote the importance of providing humanistic care without judgment. As valued members of the multidisciplinary treatment team, Board-Certified Psychiatric Pharmacists should implement and engage in HR services in the settings where people with substance use disorders receive care.

Manitoba saw the highest number of new HIV diagnoses in the province's history in 2021 and is the only Canadian province not meeting any of the previous UNAIDS 90-90-90 targets. Our goal was to describe sex differences and syndemic conditions within an incident HIV cohort in Manitoba, and the HIV treatment initiation and undetectable viral load outcomes.

This was a retrospective cohort study of all people 18 years and older newly diagnosed with HIV in Manitoba, Canada between January 1st, 2018 and December 31st, 2021. Data was collected as follows: before HIV diagnosis: chlamydia, gonorrhoea, syphilis, and/or hepatitis C antibodies. At the time of HIV diagnosis: age, sex, gender, race/ethnicity, sexual orientation. During follow-up: CD4 counts, viral load, HIV treatment, hospitalizations, and number of visits to HIV care. Main exposures evaluated: methamphetamine use, injection drug use, houselessness, and mental health conditions. Outcomes: started antiretroviral treatment and achieved an undetectable viral load. A descriptive statistical analysis was used.

There were 404 new HIV diagnoses in Manitoba from 2018 to 2021; 44.8% were female, 55.2% male; 76.% self-identified as Indigenous, 13.4% white/European, 4.7% African/black; 86.6% cis-gender; 60.9% heterosexual, 13.4% gay, bisexual and men who have sex with men, and 1.7% lesbian. Injection drug use was reported by 71.8% and 43.5% of females and males respectively. Methamphetamine was the most frequently injected drug (62.4%). Amongst females, 81.8% experienced at least one of the following: houselessness (43.1%), mental health comorbidities (46.4%), and injection drug use (71.8%). Only 64.9% of all individuals had an undetectable viral load (61.1% females and 67.9% males), 56.5% among people experiencing houselessness, 59% among young people (≤29 years), and 60.1% among people who inject drugs.

People newly diagnosed with HIV in Manitoba are disproportionately experiencing houselessness, mental illness, and injection drug use (mostly methamphetamine). This pattern is more pronounced for female individuals. These findings highlight the need for syndemic and gender-specific approaches, simultaneously addressing social and health conditions, to treat HIV.

This work was supported by the Canadian Institutes of Health Research, The Manitoba Medical Service Foundation, The James Farley Memorial Fund and the Canada Research Chairs Program.

Methamphetamine is associated with increased HIV risk and suboptimal adherence to pre-exposure prophylaxis (PrEP). Interventions to support PrEP adherence for people who use methamphetamine are needed.

We evaluated peer navigation to support adherence among people initiating PrEP who use methamphetamine. The HIV Prevention in Methamphetamine Users (HMU!) study enrolled participants from May 2018-January 2022 in Seattle, WA, and followed them for 6 months. Surveys collected sociodemographic, drug use, and sexual behavior data at enrollment, month 3, and month 6. Dried blood spots (DBS) were collected at months 1, 3, and 6 to measure PrEP adherence.

We enrolled 21 participants of a target sample of 40, of whom 20 were prescribed PrEP. Nine participants (43%) received peer navigation and 12 (57%) received standard of care or text messaging. At baseline, most participants reported at least weekly methamphetamine use (17, 81%) and condomless receptive anal intercourse (CRAI) (16, 76%). One-third reported CRAI with a partner with HIV. Among those who provided a DBS, 78% and 50% had results commensurate with ≥4 pills/week at the month 3 and 6 visit, respectively. More than half of those prescribed PrEP completed a month 6 visit (11, 55%). Retention was not associated with peer support compared to standard of care or text messaging (p = .20).

We enrolled half our target sample size despite extensive recruitment efforts. As expected, participants had challenges with PrEP adherence and persistence. While peer navigation interventions should be studied further, additional interventions are likely needed to support PrEP uptake, adherence, and persistence among people who use methamphetamine.