Showing papers in "Substance Abuse in 2017"
TL;DR: This report summarizes the changing nature of overdose deaths in Jefferson County (home to Birmingham, Alabama) using data updated through June 30, 2016, and calls for serious reconsideration of governmental policy initiatives that continue to focus on reductions in opioid prescribing.
Abstract: The US opioid epidemic has changed profoundly in the last 3 years, in ways that require substantial recalibration of the US policy response. This report summarizes the changing nature of overdose deaths in Jefferson County (home to Birmingham, Alabama) using data updated through June 30, 2016. Heroin and fentanyl have come to dominate an escalating epidemic of lethal opioid overdose, whereas opioids commonly obtained by prescription play a minor role, accounting for no more than 15% of reported deaths in 2015. Such local data, along with similar reports from other localities, augment the insights available from the Centers for Disease Control and Prevention's current overdose summary, which lacks data from 2015–2016 and lacks information regarding fentanyl in particular. The observed changes in the opioid epidemic are particularly remarkable because they have emerged despite sustained reductions in opioid prescribing and sustained reductions in prescription opioid misuse. Among US adults, past-yea...
92 citations
TL;DR: It was showed that the use of these substances may cause minor and moderate side effects similar to those of cannabis intoxication, including tachycardia, nausea, somnolence, hallucinations, paranoia, xerostomia, and injected conjunctivae among others.
Abstract: Background: Cannabis is the most widely used illicit drug in the United States and Europe. In recent years, a range of new substances with cannabis-like effects—known as synthetic cannabinoids (SCs)—have suddenly burst on the drug scene. However, there is limited information about the clinical hazards linked to the use of these emerging substances. This review summarizes the literature to date relating the health effects of SCs. Method: A systematic literature review of original case studies was performed using PubMed and Web of Science (January 1980–July 2015). Only articles in which a drug screening was reported were included in this review. Results: Forty-six articles meeting the inclusion criteria were included in this review, reporting data on 114 patients who went to hospital emergency departments after exposure to SCs. The majority of patients were adolescent or young adult males (14–25 years; 24.5 ± 10.1 years). The most common route of administration was smoking. The SCs most involved wer...
62 citations
TL;DR: Examination of content of a Reddit community dedicated to the support of people trying to quit using cannabis highlights the potential of online communities as tools for individuals coping with addiction recovery, and future research should investigate if involvement in such communities would be a beneficial supplement to more traditional recovery practices.
Abstract: Background: Online communities can provide social support to those in need and can foster personal empowerment for individuals experiencing distress. This study examines the content of a Reddit com...
52 citations
TL;DR: To improve the informed consent process for opioid therapy, patients and PCPs need to have a shared understanding of the risks of opioids and engage in discussions that promote patient autonomy and safety.
Abstract: Background: Patients with a history of substance use are more likely than those without substance use to experience chronic noncancer pain (CNCP), to be prescribed opioids, and to experience opioid misuse or overdose. Primary care practitioners (PCPs) in safety-net settings care for low-income patients with CNCP and substance use, usually without specialist consultation. To inform communication related to opioid risk, we explored PCPs' and patients' perceptions of the risks of chronic opioid therapy. Methods: We conducted semistructured interviews with 23 PCPs and 46 of their patients, who had a history of CNCP and substance use. We recruited from 6 safety-net health care settings in the San Francisco Bay Area. We transcribed interviews verbatim and analyzed transcripts using grounded theory methodology. Results: (1) PCPs feared harming patients and the community by opioid prescribing. PCPs emphasized fear of opioid overdose. (2) Patients did not highlight concerns about the adverse health consequ...
44 citations
TL;DR: Alcohol and marijuana use intensity levels associated with the highest risk of adolescent SAM use are identified; high school seniors who consume high quantities of alcohol and marijuana are very likely to consume these substances so that their effects overlap.
Abstract: Background: Simultaneous alcohol and marijuana (SAM) use poses threats to health, particularly among adolescents. These risks would be exacerbated to the extent that high-intensity drinking (e.g., 10+ drinks in a row) and marijuana use (e.g., 1+ joints per day) are associated with a higher likelihood of SAM use. The current study examines the extent to which the intensity of alcohol use and of marijuana use are associated with adolescent SAM use prevalence, and whether associations remain after controlling for key covariates known to associate with both alcohol and marijuana use; it identifies alcohol and marijuana use intensity levels associated with the highest risk of adolescent SAM use. Methods: Data come from nationally representative samples of US 12th graders who participated in the Monitoring the Future study from 2005 to 2014 (N = 24,203 respondents; 48.4% boys, 51.6% girls). Results: SAM use during the past year was reported by 20% of 12th graders overall. SAM use prevalence was strongly...
43 citations
TL;DR: There is a need for substance use treatment programs, integrated with mental health services, which are targeted towards the needs of older homeless adults.
Abstract: Background: The median age of the single adult homeless population is 50 and rising. Although the prevalence of substance use decreases as individuals age, older adults now have a higher prevalence...
41 citations
TL;DR: The author recommends that Molly use and Molly purity be further studied to more adequately inform prevention and harm reduction.
Abstract: Molly has been the street name for powder or crystalline ecstasy (3,4-methylenedioxymethamphetamine [MDMA]) in the United States since the early 2000s; however, few studies have examined Molly use or included Molly in the definition of ecstasy/MDMA. Prevalence of self-reported ecstasy use is being underreported on surveys due to the lack of inclusion of "Molly," although Molly is often so adulterated with novel psychoactive substances such as synthetic cathinones ("bath salts") that the name "Molly" may no longer adequately represent ecstasy/MDMA. The author recommends that Molly use and Molly purity be further studied to more adequately inform prevention and harm reduction.
36 citations
TL;DR: Results indicate that patients at risk of opioid overdose might feel comfortable soliciting NRKs from a pharmacist, and participation of pharmacists in rural areas in the naloxone prescriptive authority highlight the opportunity for this novel health care delivery model in underserved areas; however, the program is clearly underutilized in these areas.
Abstract: Background: Given that opioid misuse/abuse and opioid overdose have reached epidemic proportions in the United States, expansion of naloxone access programs are desperately needed. The objective of this study was to describe emerging trends in naloxone rescue kit (NRK) prescription patterns by pharmacists in New Mexico as an example of a unique health care delivery system. Methods: The study presents cross-sectional analysis of the data on NRK prescriptions by pharmacists who received naloxone pharmacist prescriptive authority certification since 2013. Data were obtained from the Prevention of Opioid Overdose by New Mexico Pharmacists (POINt-Rx) Registry, maintained by the University of New Mexico and the New Mexico Pharmacists Association. Results: Since 2013, 133 NRKs prescribed by pharmacists have been reported to the POINt-Rx Registry. The mean age of the patients was 41.5 ± 12.0 years (range: 19–67 years), and 60.2% were female participants. Only 11.3% of the prescriptions were from pharmacis...
35 citations
TL;DR: This study adds to others in showing that law enforcement personnel are receptive to naloxone training and that the OOAS is able to capture these attitudes, by examining pre-post changes across multiple locations.
Abstract: Background: Opioid intoxication and overdoses are life-threatening emergencies requiring rapid treatment. One response to this has been to train law enforcement to detect the signs of an opioid overdose and train them to administer naloxone to reverse the effects. Although not a new concept, few studies have attempted to examine this policy. Methods: At 4 different locations in Indiana, law enforcement personnel were trained to detect the signs of an opioid-related overdose and how to administer naloxone to reverse the effects of the overdose. Pre and post surveys were administered at each location (N = 97). To examine changes in attitudes following training, the authors included items from the Opioid Overdose Attitudes Scale (OOAS), which measures respondents' competency, concerns, and readiness to administer naloxone. Results: Among the full sample, naloxone training resulted in significant increases in competency, concerns, and readiness. Examining changes in attitudes by each location revealed...
33 citations
TL;DR: The authors demonstrated the effectiveness of OOPT as an adjunct to BLS in increasing knowledge about and preparedness to respond to opioid overdoses; improving attitudes toward patients with SUDs likely requires additional intervention.
Abstract: Background: Opioid overdose deaths have reached epidemic proportions in the United States. This problem stems from both licit and illicit opioid use. Prescribing opioids, recognizing risky use, and initiating prevention, including opioid overdose prevention training (OOPT), are key roles physicians play. The American Heart Association (AHA) modified their basic life support (BLS) algorithms to consider naloxone in high-risk populations and when a pulse is appreciated; however, the AHA did not provide OOPT. The authors' intervention filled this training deficiency by teaching medical students opioid overdose resuscitation with a Train-the-Trainer model as part of mandatory BLS training. Methods: The authors introduced OOPT, following a Train-the-Trainer model, into the required basic life support (BLS) training for first-year medical students at a single medical school in a large urban area. The authors administered pre- and post-evaluations to assess the effects of the training on opioid overdose ...
33 citations
TL;DR: Despite efforts to address medical student wellness, students continue to report concerning levels of psychological distress, suicidal ideation, and substance use, and more work is needed to effectively address medicalStudent mental health and well-being.
Abstract: Background: Medical student wellness has emerged as an important issue in medical education. The purpose of the present study was to obtain a comprehensive assessment of substance use, psychological distress, and help-seeking among male and female medical students in order to identify targets for continued intervention efforts. Methods: Medical students from all 9 medical schools in the state of Florida were invited via e-mail and/or announcements to complete an anonymous online questionnaire assessing their well-being. Of 5053 matriculating medical students, 1137 (57.1% female) responded to the questionnaire. Descriptive statistics, t tests, and chi-square analyses were computed using SPSS 20. Results: Over 70% of students acknowledged binge drinking, with men reporting higher frequency than women (χ2 = 13.90, P = .003), and 22.7% (n = 201) reported marijuana use during medical school, with higher rates (χ2 = 9.50, P = .02) among men (27.0%, n = 99) than women (18.9%, n = 93). A significant minor...
TL;DR: Findings from this first study of variation in psychosocial stressors and alcohol use, severity, and treatment receipt across HIV status further highlight PLWH as a population that is particularly vulnerable to experiences of psychossocial stress and certain adverse alcohol-related outcomes.
Abstract: Background: Human immunodeficiency virus (HIV) is stigmatized and disproportionately impacts vulnerable populations. Thus, people living with HIV (PLWH) may have greater exposure to psychosocial stressors than those without HIV. Exposure to psychosocial stressors may increase alcohol use and serve as barriers to alcohol treatment receipt. The authors evaluate whether psychosocial stressors and alcohol use, symptom severity, and treatment receipt vary across HIV status in a general population sample of US residents and assess whether psychosocial stressors mediate identified associations. Methods: Data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were used to assess associations between HIV status and psychosocial stressors (perceived stress, alcohol-related stigma, and perceived discrimination based on race/ethnicity, sexual orientation, or sex) and alcohol-related outcomes (any use, heavy drinking, symptom severity, and treatment receipt). For each o...
TL;DR: SSTIs are common among PWID, and needle exchange programs may be good venues for SSTIs screening and treatment, and the importance of clinical and public health screening efforts to reduce S STIs is highlighted.
Abstract: Background: People who inject drugs (PWID) are at increased risk for bacterial skin and soft tissue infections (SSTIs). Although SSTIs pose significant health risks, little is known about their prevalence and characteristics in the population of PWID in the United States. This study investigates whether behavioral factors related to skin and equipment hygiene and tissue-damaging injection practices are associated with recent SSTIs among PWID. Methods: Active PWID were recruited using targeted sampling in San Francisco in 2011–2013. Interviewers collected information on behavioral risk factors of past-month self-reported SSTIs. Inferential analyses used multivariate logistic regression methods (i.e., generalized linear model) to characterize risk factors for past-month SSTIs. Results: The self-reported prevalence of lifetime, past-year, and past-month SSTI was 70%, 29%, and 11%, respectively. Several factors were significantly associated with past-month SSTIs in bivariate analysis, including injecting nonpowder drugs (odds ratio [OR] = 3.57; 95% confidence interval [CI] = 1.23, 10.35; P = .01), needle-licking before injection (OR = 3.36; 95% CI = 1.28, 8.81; P = .01), injecting with someone else's preused syringe/needle (OR = 7.97; 95% CI = 2.46, 25.83; P < .001), being injected by another person (OR = 2.63; 95% CI = 1.02, 6.78; P = .04), infrequent skin cleaning before injection (OR = 2.47; 95% CI = 1.00, 6.10; P = .04), and frequent injections (P = .02). In multivariate analysis, only syringe/needle sharing (adjusted OR = 6.38; 95% CI = 1.90, 21.46) remained statistically significant. Conclusion: SSTIs are common among PWID. These data highlight the importance of clinical and public health screening efforts to reduce SSTIs. Needle exchange programs may be good venues for SSTIs screening and treatment. (Less)
TL;DR: The SCOPE of Pain TTT program holds promise as an effective dissemination strategy to increase guideline-based safe opioid prescribing knowledge, confidence, attitudes, and self-reported practices.
Abstract: Background: Due to the high prevalence of prescription opioid misuse, the US Food and Drug Administration (FDA) mandated a Risk Evaluation and Mitigation Strategy (REMS) requiring manufacturers of extended-release/long-acting (ER/LA) opioids to fund continuing education based on an FDA curricular Blueprint. This paper describes the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) train-the-trainer program and its impact on (1) disseminating the SCOPE of Pain curriculum and (2) knowledge, confidence, attitudes, and performance of the participants of trainer-led compared with expert-led meetings. Methods: SCOPE of Pain is a 3-hour ER/LA opioid REMS education. In addition to expert-led live statewide meetings, a 2-hour train-the-trainer (TTT) workshop was developed to increase dissemination nationally. The trainers were expected to conduct SCOPE of Pain meetings at their institutions. Participants of both the trainer-led and expert-led SCOPE of Pain programs were surveyed immediately p...
TL;DR: Many buprenorphine recipients receive overlapping prescriptions for opioids and benzodiazepines from a different health care system than the one in which their bupenorphine was filled, highlighting a previously undocumented safety risk for veterans dually enrolled in VA and Medicare.
Abstract: Background: Buprenorphine is a key tool in the management of opioid use disorder, but there are growing concerns about abuse, diversion, and safety. These concerns are amplified for the Department ...
TL;DR: This paper presents a meta-analyses of the immune system’s response to chemotherapy and shows clear patterns of decline in the immune systems of women diagnosed with central giant cell granuloma.
Abstract: In 2016, the Centers for Disease Control and Prevention (CDC) issued the first national guideline in the United States regarding opioid prescribing for pain.1 The guideline included the recommendat...
TL;DR: It is demonstrated that some providers believe they lack knowledge of opioid overdose prevention techniques and hold concerns about OEND implementation, with particular attention to concerns about harmful consequences resulting from the receipt of naloxone.
Abstract: Background: Overdose from opioids is a serious public health and clinical concern. Veterans are at increased risk for opioid overdose compared with the civilian population, suggesting the need for enhanced efforts to address overdose prevention in Department of Veterans Affairs (VA) health care settings, such as primary care clinics. Methods: Prescribing providers (N = 45) completed surveys on baseline knowledge and concerns about the VA Overdose Education and Naloxone Distribution (OEND) initiative prior to attending an OEND educational training. Results: Survey items were grouped into 4 OEND-related categories, reflecting (1) lack of knowledge/familiarity/comfort; (2) concerns about iatrogenic effects; (3) concerns about impressions of unsafe opioid prescribing; and (4) concerns about risks of naloxone prescribing. Although certain OEND-related categories were associated with each other, concerns related to iatrogenic effects of OEND (e.g., patients will use more opioids and/or be less likely to...
TL;DR: Completion of a clinical elective with a hospital-based AMCT appears to improve medical trainees' addiction-related knowledge, and further evaluation and expansion of addiction medicine education is warranted to develop the next generation of skilled addiction care providers.
Abstract: Background: Implementation of evidence-based approaches to the treatment of various substance use disorders is needed to tackle the existing epidemic of substance use and related harms. Most clinicians, however, lack knowledge and practical experience with these approaches. Given this deficit, the authors examined the impact of an inpatient elective in addiction medicine amongst medical trainees on addiction-related knowledge and medical management. Methods: Trainees who completed an elective with a hospital-based Addiction Medicine Consult Team (AMCT) in Vancouver, Canada, from May 2015 to May 2016, completed a 9-item self-evaluation scale before and immediately after the elective. Results: A total of 48 participants completed both pre and post AMCT elective surveys. On average, participants were 28 years old (interquartile range [IQR] = 27–29) and contributed 20 days (IQR = 13–27) of clinical service. Knowledge of addiction medicine increased significantly post elective (mean difference [MD] = 8...
TL;DR: Earlier NMUPO initiation is associated with increased odds of OUD, although those with early initiation had a slower progression to OUD and only having an alcohol use disorder was associated with shorter time to Oud.
Abstract: Background: Nonmedical use of prescription opioids (NMUPO) is an ongoing public health challenge, as NMUPO is associated with psychopathology, other drug use, and fatal overdose. These concomitant risks are greatest in those with opioid use disorder (OUD), but the development of NMUPO-related use disorder is poorly understood. The primary aim of this study was to establish factors associated with the development of and time to OUD among persons engaged in NMUPO. Methods: Data were from wave 1 of the National Epidemiologic Study on Alcohol and Related Conditions, with 1755 participants endorsing lifetime NMUPO. Analyses used sequential design-based logistic regression for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) opioid dependence correlates, followed by Cox regression of proportional hazards for correlates (e.g., sociodemographics, age of NMUPO initiation, and psychopathology) of time to dependence in those who developed DSM-IV dependence. Results: Earlier age ...
TL;DR: A smartphone application for unhealthy alcohol use appears acceptable and useful (although there is room for improvement), although without prompting, its use is infrequent.
Abstract: Background: Technology-delivered interventions are useful tools for addressing unhealthy alcohol use. Smartphones in particular offer opportunities to deliver interventions at the user's convenience. A smartphone application with 5 modules (personal feedback, self-monitoring of drinking, designated driver tool, blood alcohol content [BAC] calculator, information) was developed. Its acceptability and associations between use and drinking outcomes were assessed. Methods: One hundred thirty adults with unhealthy alcohol use (>14 [men]/>7 [women] drinks/week or ≥1 episode/month with 6 or more drinks) recruited in Switzerland (n = 70) and Canada (n = 60) were offered to use the application. Follow-up occurred after 3 months. Appreciation, usefulness, and self-reported frequency of use of the modules, and drinking outcomes (drinks/week, binge drinking) were assessed. Associations between application use and drinking at 3 months were evaluated with negative binomial and logistic regression models, adjust...
TL;DR: The studies included in this systematic review demonstrate that teaching pharmacy students about SUDs produces a positive impact in their attitudes and knowledge on this subject.
Abstract: Background: The authors sought to systematically review the quantity and quality of literature describing substance use disorders (SUDs) education in US schools of pharmacy and determine the effect...
TL;DR: Although it is unclear whether a global curriculum is needed, a consensus on a core set of principles for progression of knowledge, attitudes, and skills in addiction medicine to be developed at each educational level amongst medical graduates would likely have substantial value.
Abstract: Background: Despite the high prevalence of substance use disorders, associated comorbidities and the evidence-base upon which to base clinical practice, most health systems have not invested in standardised training of healthcare providers in addiction medicine. As a result, people with substance use disorders often receive inadequate care, at the cost of quality of life and enormous direct health care costs and indirect societal costs. Therefore, we undertook this study to assess the views of international scholars, representing different countries, on the core set of addiction medicine competencies that need to be covered in medical education. Methods: We interviewed 13 members of the International Society of Addiction Medicine (ISAM), from 12 different countries (37% response rate), over Skype, email survey or in-person - at the annual conference. We content-analysed the interview transcripts, using constant comparison methodology. Results: We identified recommendations related to the core set ...
TL;DR: Implementing and sustaining SBI as a standard of integrated care is essential to reduce the burden of substance use.
Abstract: The US Surgeon General recently issued a comprehensive report indicating that substance use is a major public health concern that must be addressed using a number of strategies. Screening, brief intervention, and referral to treatment (SBIRT) is one such strategy. SBIRT Colorado, funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), has implemented a statewide initiative for the past 10 years that has provided ample opportunities to identify key components for successful implementation. Successful implementation requires (1) strong clinical and management advocates; (2) full integration of services into practices' workflow utilizing technology whenever possible; (3) interprofessional team approaches; (4) appropriate options for the small proportion of patients screening positive for a possible substance use disorder; (5) cannabis screening that accounts for legalization, and interventions that acknowledge differences between alcohol and cannabis use; (6) incorporating SBIRT into standard health care professionals' training; and (7) addressing the significant issues regarding reimbursement through private and public payers for SBIRT services. Implementing and sustaining SBI as a standard of integrated care is essential to reduce the burden of substance use. Interdisciplinary approaches, technology, and training to increase practitioner confidence and skill are fundamental.
TL;DR: Less pain was associated with greater likelihood of 24-hour and 7-day point prevalence abstinence, and the effectiveness of more comprehensive smoking cessation treatment that incorporates aspects of pain management for PLWHA who smoke and have high pain and symptom burden was examined.
Abstract: Background: Smoking rates among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS; PLWHA) are at least twice as high as rates in the general population. Consistent with the reciprocal model of pain and smoking, PLWHA with pain who smoke may use smoking as a means of coping with pain, thus presenting a potential barrier to quitting. The aim of this study is to better understand how pain relates to smoking cessation among 474 HIV-positive adults enrolled in a cell phone–delivered smoking cessation trial. Methods: Participants were randomly assigned to usual care (cessation advice and self-help materials) or 11 sessions of cell phone–delivered smoking cessation treatment. Pain, as assessed by the Medical Outcomes Study-HIV Health Survey (MOS-HIV), and point prevalence abstinence were collected at the 3-month treatment end and at 6- and 12-month follow-ups. Self-reported abstinence was biochemically verified by expired carbon monoxide (CO) level of <7 ppm. Re...
TL;DR: In a patient population with complex social and mental health histories, buprenorphine treatment via a shared medical appointment had high retention rates.
Abstract: Background: Opioid misuse and dependence are prevalent and rising problems in the United States. Treatment with buprenorphine is a successful treatment option for individuals with opioid dependence. This study describes and preliminarily evaluates a unique delivery system that provides buprenorphine treatment via a shared medical appointment. Methods: A retrospective medical record review on all 77 opioid-dependent patients referred for a buprenorphine shared medical appointment in a homeless clinic from 2010 to 2012. Results: Most patients were currently homeless (61%), unemployed (92%), had an Axis I psychiatric diagnosis (81%), and had recent polysubstance use (53%). Of the 77 patients, 95% attended at least 1 shared medical appointment. Treatment retention at 12 and 24 weeks was 86% and 70%, respectively. Conclusions: In a patient population with complex social and mental health histories, buprenorphine treatment via a shared medical appointment had high retention rates. Findings can help guid...
TL;DR: Trainees may benefit from educational interventions focused on developing a 2-generational model of trauma-informed care to improve attitudes and ultimately the care of substance-exposed infants and their families.
Abstract: Background: As rates of substance use disorder during pregnancy rise, pediatric trainees are increasingly caring for infants with neonatal abstinence syndrome (NAS). This study evaluated the knowledge, attitudes, and practices of trainees caring for substance-exposed newborns and their families, comparing differences by level and type of training, and personal experience with addiction or trauma. Methods: A cross-sectional survey of medical students and pediatric, medicine/pediatric, and family medicine residents in 2015–2106. Measures included knowledge about NAS, attitudes towards mothers who use drugs, and practices around discussing addiction and trauma with families. Descriptive and bivariate analyses were conducted. Results: The overall response rate was 70%, with 229 trainees included in the final sample (99 students, 130 residents). Fifty percent of trainees endorsed personal experience with addiction, 50% with trauma, and 35% with both addiction and trauma. Increasing years of pediatric t...
TL;DR: A brief training can improve residents' self-reported knowledge and confidence in managing patients with chronic pain and safe opioid prescribing practices and how this change in confidence affects patient care requires further study.
Abstract: Background: Residents feel unprepared to care for patients with chronic pain on long-term opioids who exhibit signs of prescription opioid misuse. Objective: Describe an educational intervention for internal medicine residents to improve confidence, practices, attitudes, and self-reported knowledge of resources for chronic pain and opioid misuse. Methods: The intervention included 2 sessions. Session 1 (3 hours): a lecture on chronic pain, prescription opioid misuse, and opioid use disorders and communication skills practice. The residents were asked to use one of these skills during the following week. Session 2 (1.5 hours): debriefing of patient encounters and overview of: prescription opioid monitoring strategies, discontinuation of prescription opioids when appropriate, and treatment for opioid use disorders. Pre- and post-assessments evaluated change in residents' safe opioid prescribing confidence, self-reported practices, attitudes, and self-reported knowledge of available patient resources...
TL;DR: Examination of changes in adolescent alcohol use in New Zealand between 2007 and 2012 explored variations across sociodemographic strata and revealed a shift towards increasing typical drinking-occasion quantities among those of low household and neighborhood SEP.
Abstract: Background: Many Western countries have reported declines in adolescent alcohol use This study examined changes in adolescent alcohol use in New Zealand between 2007 and 2012 and explored variations across sociodemographic strata Methods: Data from 2 nationally representative, cross-sectional high school surveys conducted in 2007 (n = 7709) and 2012 (n = 7266) were examined Changes in the prevalence of drinking in the past 4 weeks were examined among the total sample, as well as the frequency of drinking in the past 4 weeks and typical drinking-occasion quantity among drinkers Only students residing in urban areas were included Variation in changes was investigated across 4 demographic groups characterized by age (<16 years, ≥16 years) and sex Interactions with household- and neighborhood-level socioeconomic position (SEP) identified any differential changes between socioeconomic strata Results: From 2007 to 2012, significantly fewer students consumed alcohol in the past 4 weeks Interactio
TL;DR: This study assesses baseline knowledge, attitudes, and practices of the New Mexico SBHC provider workforce regarding adolescent substance use and provision of services to suggest that SBIRT training for New MexicoSBHC providers is timely.
Abstract: Background: Recent attention has focused on the potential for school-based health centers (SBHCs) to provide access points for adolescent substance use care. In 2015, the University of New Mexico began screening, brief intervention, and referral to treatment (SBIRT) training for providers at New Mexico Department of Health (NMDOH)-funded SBHCs across the state. This study assesses baseline knowledge, attitudes, and practices of the New Mexico SBHC provider workforce regarding adolescent substance use and provision of services. Methods: In early 2015, the NMDOH administered an SBHC provider workforce survey (N = 118) and achieved a 44.9% response rate. This descriptive analysis includes all survey respondents who self-identified as a primary care or behavioral health provider in an SBHC serving middle or high school students (n = 52). Results: Among respondents, the majority (57.7%) were primary care providers, including nurse practitioners, physicians, and physician assistants. The remaining 42.3%...
TL;DR: Even though only a small number of patients were identified to have spiked their urine samples, quantitative testing may help identify urine spiking during office-based opioid treatment with buprenorphine.
Abstract: Background: Patients may spike urine samples with buprenorphine during office-based opioid treatment to simulate adherence to prescribed buprenorphine, potentially to conceal diversion of medications. However, routine immunoassay screens do not detect instances of spiking, as these would simply result in a positive result. The aim of this study was to report on the experience of using quantitative urine testing for buprenorphine and norbuprenorphine to facilitate the identification of urine spiking. Methods: This is a retrospective chart review of 168 consecutive patients enrolled in outpatient buprenorphine treatment at an urban academic medical setting between May 2013 and August 2014. All urine samples submitted were subjected to quantitative urine toxicology testing for buprenorphine and norbuprenorphine. Norbuprenorphine-to-buprenorphine ratio of less than 0.02 were further examined for possible spiking. Demographic and clinical variables were also extracted from medical records. Clinical and...