Showing papers in "Substance Abuse in 2021"
TL;DR: In this paper, a systematic review and meta-analysis was conducted to investigate the interaction between adolescents who use cannabis during adolescence and the risk of developing schizophrenia, and they reported increased risk for psychosis among individuals who use marijuana during adolescence.
Abstract: Previous research has reported increased risk for psychosis among individuals who use cannabis during adolescence. We conducted a systematic review and meta-analysis to investigate the interaction ...
39 citations
TL;DR: IPV had a significant influence on women’s substance use behaviors including their perceived risk of relapse and treatment discontinuation, demonstrating the need to integrate assessment, evaluation and management of IPV into substance use treatment settings.
Abstract: Background: Women with opioid use disorder (OUD) report high rates of intimate partner violence (IPV) and there is limited understanding of how IPV influences substance use behaviors among women wi...
37 citations
TL;DR: Analyzing Twitter content enables health professionals to identify the public’s concerns about addiction during the COVID pandemic, and findings from text mining studies addressing timely health topics can serve as preliminary analyses for building more comprehensive models, which can then be used to generate recommendations for the larger public and inform policy.
Abstract: The 2019 Novel Coronavirus (COVID-19) is responsible for thousands of deaths and hospitalizations. To curb the spread of this highly transmissible disease, governments enacted protective guidelines...
36 citations
TL;DR: Buprenorphine is one of the gold standard medication treatments for opioid use disorder (OUD), with proven effectiveness in preventing overdose, increasing abstinence, and improving quality of life as discussed by the authors.
Abstract: Buprenorphine is one of the gold standard medication treatments for opioid use disorder (OUD), with proven effectiveness in preventing overdose, increasing abstinence, and improving quality of life In the United States, buprenorphine can be legally prescribed and administered in office-based settings from clinicians who are specially credentialed to provide that care under the X-waiver We believe the X-waiver will ultimately be repealed, but there is a need for a variety of strategies to create a new treatment system after the X-waiver Building a new tier of treatment capacity will require educational outreach, systems strategies, and enhanced payments
31 citations
TL;DR: CoVID-19 has exacerbated income inequality, structural racism, and social isolation, issues that drive addiction and have previously manifested in the epidemic of opioid-associated overdose as mentioned in this paper, and the co-...
Abstract: COVID-19 has exacerbated income inequality, structural racism, and social isolation—issues that drive addiction and have previously manifested in the epidemic of opioid-associated overdose. The co-...
28 citations
TL;DR: Technological applications may not be suitable for clients with transient lifestyles, no permanent home, and lack of consistent access to a mobile device, as well as personal comfort while using drugs.
Abstract: Introduction: Rising overdose deaths are a devastating problem across the United States and Canada. Despite the availability of observed consumption sites in British Columbia (BC), data sug...
26 citations
TL;DR: Interventions to reduce substance use during societal stressors should target both risk and protective factors, particularly resilience, in relation to changes in past 30-day substance use frequency.
Abstract: Background: Given the potential for increased substance use during COVID-19, we examined (1) young adults' changes in cigarette, e-cigarette, marijuana, and alcohol use from pre- to during COVID-19; and (2) related risk/protective factors. These findings could inform intervention efforts aimed at curbing increases in substance use during periods of societal stress. Methods: We analyzed Wave 3 (W3; September-December 2019) and Wave 4 (W4; March-May 2020) from the Vape shop Advertising, Place characteristics and Effects Surveillance (VAPES), a 2-year, five-wave longitudinal study of young adults across six metropolitan areas. We examined risk/protective factors (i.e. adverse childhood experiences [ACEs], depressive symptoms, resilience) in relation to changes in past 30-day substance use frequency. Results: In this sample (N = 1084, Mage=24.76, SD = 4.70; 51.8% female; 73.6% White; 12.5% Hispanic), W3/W4 past 30-day use prevalence was: 29.1% cigarettes (19.4% increased/26.4% decreased), 36.5% e-cigarettes (23.2% increased/28.6% decreased), 49.4% marijuana (27.2% increased/21.2% decreased), and 84.8% alcohol (32.9% increased/20.7% decreased). Multivariate regressions indicated that, greater increases were predicted by: for e-cigarettes, greater ACEs; and for alcohol, greater depression. Among those with low resilience, predictors included: for e-cigarettes, greater depression; and for marijuana, greater ACEs. Conclusions: Interventions to reduce substance use during societal stressors should target both risk and protective factors, particularly resilience.
26 citations
TL;DR: The Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) acknowledges that racism profoundly affects persons who use alcohol and other drugs and proposes an initial set of strategies to promote diversity, equity, and inclusion using a framework that speaks to four key AMERSA experiences: engagement, education, mentorship, and leadership as mentioned in this paper.
Abstract: The Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) acknowledges that racism profoundly affects persons who use alcohol and other drugs. Racism's deadly effects compounded with other social determinants of health result in a cascade of negative impacts. The AMERSA Board of Directors (BOD) proposes an initial set of strategies to promote diversity, equity, and inclusion using a framework that speaks to four key AMERSA experiences: engagement, education, mentorship, and leadership. Through these strategies, AMERSA commits to promoting equity and inclusion to dismantle the individual, institutional, and structural racism that has permeated the United States for centuries.
25 citations
TL;DR: Nicotine use is substantial among cannabis users, and associations exist between modes of delivery for both drugs, and the importance of studying cannabis and nicotine use concurrently is underscored.
Abstract: Background: Cannabis use is more common among nicotine users than non-users. This study characterized concurrent use of nicotine and cannabis (“co-use”) among 12,064 youth aged 16–19 years ...
24 citations
TL;DR: In a follow-up survey, this paper found that not all eligible OTP leaders adopted the practice of routinely allowing newly enrolled, "less stable," and "stable" patients on methadone to have increased take-home doses up to the limit allowed by federal regulations during COVID-19.
Abstract: Background: In the United States, methadone for treatment of opioid use disorder is dispensed via highly-regulated accredited opioid treatment programs (OTP). During the COVID-19 pandemic, federal regulations were loosened, allowing for greater use of take-home methadone doses. We sought to understand how OTP leaders responded to these policy changes. Methods: We distributed a multistate electronic survey from September to November 2020 of OTP leadership to members of the American Association for the Treatment of Opioid Dependence (AATOD) who self-identified as leaders of OTPs. We asked study participants about how their OTP(s) implemented COVID-19-related policy changes into their clinical practice focusing on provision of take-home methadone doses, factors used to determine patient stability, and potential concerns about increased take-home doses. We used Chi-square test to compare survey responses between characterizations of the OTPs. Results: Of 170 survey respondents (17% response rate), the majority represented leadership of for-profit OTPs (69%) and were in a Southern state (54%). Routine allowances and practices related to take-home methadone doses varied across OTPs during the COVID-19 pandemic: 80 (47%) reported 14 days for newly enrolled patients (within past 90 days), 89 (52%) reported 14 days for "less stable" patients, and 112 (66%) reported 28 days for "stable" patients. Conclusions: We found that not all eligible OTP leaders adopted the practice of routinely allowing newly enrolled, "less stable," and "stable" patients on methadone to have increased take-home doses up to the limit allowed by federal regulations during COVID-19. The pandemic provides an opportunity to critically re-evaluate long-established methadone and OTP regulations in preparation for future emergencies.
22 citations
TL;DR: In this article, the authors reviewed the evidence on use of telemedicine interventions and applicability to MOUD policy changes in the post-COVID-19 treatment landscape.
Abstract: Background: Methadone and buprenorphine are effective medications for opioid use disorder (MOUD) that are highly regulated in the United States. The on-going opioid crisis, and more recently COVID-19, has prompted reconsideration of these restrictions in order to sustain and improve treatment access, with renewed interest in telemedicine. We reviewed the evidence on use of telemedicine interventions and applicability to MOUD policy changes in the post-COVID-19 treatment landscape. Methods: Ovid MEDLINE and the Cochrane Database of Systematic Reviews databases were searched from inception to April 2021 and reference lists were reviewed to identify additional studies. Studies were eligible if they examined telemedicine interventions and reported outcomes (e.g. treatment initiation, retention in care). Randomized trials and controlled observational studies were prioritized; other studies were included when stronger evidence was unavailable. One investigator abstracted key information and a second investigator verified data. We described the results qualitatively. Results: We identified nine studies: three controlled trials (two randomized), and six observational studies. Three studies evaluated patients treated with methadone and six studies with buprenorphine, including one study of pregnant women with OUD. All studies showed telemedicine approaches associated with similar outcomes (treatment retention, positive urine toxicology) compared to treatment as usual. Trials were limited by small samples sizes, lack of reporting harms, and most were conducted prior to the COVID-19 pandemic; observational studies were limited by failure to control for confounding. Conclusions: Limited evidence suggests that telemedicine may enhance access to MOUD with similar effectiveness compared with face-to-face treatment. Few studies have been published since COVID-19, and it is unclear the potential impact of these interventions on the existing racial/ethnic disparities in treatment. The COVID-19 pandemic and need for social distancing led to temporary policy changes for prescribing of MOUD that could inform additional research in this area to support comprehensive policy reforms.
TL;DR: Assessment of interventions for reducing barriers to delivery of M-OUD by rural primary care providers in North Carolina found perceived usefulness of the UNC ECHO for MAT intervention was generally satisfied, but barriers may prevent consistent participation.
Abstract: Background: Medication treatment for opioid use disorder (M-OUD) is underutilized, despite research demonstrating its effectiveness in treating opioid use disorder (OUD). The UNC Extension ...
TL;DR: While prescribing rates have decreased in Texas, overdose deaths from both legal and illicit opioids are rising, suggesting that changing physician prescribing behavior alone may not be sufficient to curb the epidemic.
Abstract: Background: Opioid use disorder has recently been declared a public health emergency, yet it is unknown whether opioid prescribing patterns have changed over time. Our objective is to exami...
TL;DR: Comprehensive assessment of sexual orientation and gender may improve understanding of substance use and increase equity within support and treatment services for SGM populations.
Abstract: Background: Profiles of substance use among less commonly described subgroups of sexual and gender minority (SGM) people (e.g., queer, genderqueer) remain largely unknown. Objective(s): To identify...
TL;DR: In this article, the Project for Extension for Community Health Outcomes (ECHO) tele-education model was used as an implementation strategy to increase the number of primary care clinicians who waivered to prescribe buprenorphine for treatment of opioid use disorder (OUD).
Abstract: Background: Our rural health system sought to (1) increase the number of primary care clinicians waivered to prescribe buprenorphine for treatment of opioid use disorder (OUD) and (2) consequently increase the number of our patients receiving this treatment. Methods: We used the Project for Extension for Community Health Outcomes (ECHO) tele-education model as an implementation strategy. We examined the number of clinicians newly waivered, the number of patients treated with buprenorphine, the relationship between clinician engagement with ECHO training and rates of buprenorphine prescribing, and treatment retention at 180 days. Results: The number of clinicians with a waiver and number of patients treated increased during and after ECHO training. There was a moderate correlation between the number of ECHO sessions attended by a clinician and number of their buprenorphine prescriptions (r = 0.50, p = 0.01). The 180-day retention rate was 80.7%. Conclusions: Project ECHO was highly effective for increasing access to this evidence-based treatment. The high retention rate in this rural context indicates that most patients are increasing their likelihood of favorable outcomes.
TL;DR: For example, this article found that more than 59% of respondents had an SDS score >15, indicating overall lack of willingness to interact with the vignette patient, and that patients with OUD require excessive time and effort, and strongly agreed that some people lack self-discipline to use prescription pain medication without becoming addicted.
Abstract: Health professionals may stigmatize and prefer social distance from patients with opioid misuse, leading to poorer quality of care provided. The degree to which pharmacists prefer social distance from patients with opioid misuse and opioid use disorder (OUD) is not known. Methods: Pharmacists (n = 187) completed a survey comprised of demographics, attitudinal, and Social Distance Scale (SDS) questions based on a vignette patient who displayed opioid misuse. SDS question responses and total scores (maximum of 30; higher scores representing great preference for social distance) were tallied and associations with attitudes and demographics were examined. Results: Mean SDS total score was 16.32 (range 9-23). More than 59% of respondents had an SDS score >15, indicating overall lack of willingness to interact with the vignette patient. Females had a higher mean SDS score vs male pharmacists (16.58 vs. 15.36, respectively; p = 0.023). Pharmacists were more likely to prefer social distance from the vignette patient in personal situations (i.e. renting a room) than work-related interactions (i.e. providing patient education). Pharmacists with >10 years of experience, those without personal experience with a substance use disorder, those who strongly agreed that patients with OUD require excessive time and effort, and those who agreed that some people lack self-discipline to use prescription pain medication without becoming addicted had significantly higher SDS scores than pharmacists without these characteristics. Conclusions: Pharmacists expressed significant preference for social distance indicating stigmatization of patients with opioid misuse. Pharmacists were comfortable performing pharmacy tasks with patients with opioid misuse, but were less comfortable forming therapeutic relationships, an important tenet of patient-centered care. Efforts are needed to examine contributions to social distance preferences and implement measures to reduce them. Targeting of pharmacists with >10 years' experience and without personal experience with OUD may also be most beneficial.
Yale University1, Johns Hopkins University2, Medical College of Wisconsin3, University of Utah4, Pennsylvania State University5, University of Pittsburgh6, Columbia University7, Oregon Health & Science University8, University of Miami9, University of Texas Southwestern Medical Center10, University of Washington11, Duke University12
TL;DR: The National Institute on Drug Abuse Center for Clinical Trials Network convened the Methadone Access Research Task Force to develop a research agenda to expand and create more equitable access to methadone treatment for OUD as discussed by the authors.
Abstract: In the US, methadone treatment can only be provided to patients with opioid use disorder (OUD) through federal and state-regulated opioid treatment programs (OTPs). There is a shortage of OTPs, and racial and geographic inequities exist in access to methadone treatment. The National Institute on Drug Abuse Center for Clinical Trials Network convened the Methadone Access Research Task Force to develop a research agenda to expand and create more equitable access to methadone treatment for OUD. This research agenda included mechanisms that are available within and outside the current regulations. The task force identified 6 areas where research is needed: (1) access to methadone in general medical and other outpatient settings; (2) the impact of methadone treatment setting on patient outcomes; (3) impact of treatment structure on outcomes in patients receiving methadone; (4) comparative effectiveness of different medications to treat OUD; (5) optimal educational and support structure for provision of methadone by medical providers; and (6) benefits and harms of expanded methadone access. In addition to outlining these research priorities, the task force identified important cross-cutting issues, including the impact of patient characteristics, treatment, and treatment system characteristics such as methadone formulation and dose, concurrent behavioral treatment, frequency of dispensing, urine or oral fluid testing, and methods of measuring clinical outcomes. Together, the research priorities and cross-cutting issues represent a compelling research agenda to expand access to methadone in the US.
TL;DR: The need for further study is highlighted about how public libraries can act as part of comprehensive, community-based strategies to address the opioid epidemic, and how they can further address these issues.
Abstract: Background: The overdose crisis is affecting public libraries. In a 2017 survey of public librarians, half reported providing patrons support regarding substance use and mental health in th...
TL;DR: This study supports the theory that more stringent state PDMPs are associated with higher rates of heroin-related deaths, potentially due to decreases in prescription opioid availability.
Abstract: Background: Prescription drug monitoring programs (PDMPs) are tools that states can use to fight prescription opioid misuse within their jurisdiction. However, because PDMPs make prescripti...
TL;DR: Findings highlight that differences in patterns of substance use by sexual identity persist and underscore the need for screening, prevention, and intervention, particularly for sexual minority women.
Abstract: Background: Population-based surveys document disparities in substance use among sexual minorities compared to heterosexuals, but few studies examine changes over time. This study compared ...
TL;DR: In this article, treatment of opioid use disorder (OUDUD) is highly effective, but access is limited and care is often fragmented, and treatment in primary care can improve access to treatment and address psy...
Abstract: Background: Treatment of opioid use disorder (OUD) is highly effective, but access is limited and care is often fragmented. Treatment in primary care can improve access to treatment and address psy...
TL;DR: Clinicians caring for opioid-involved patients should consider screening for concurrent use of other substances and discussing the risks of this practice, which is common and driven by diverse motives.
Abstract: Recent evidence suggests that the practice of combining opioid use with non-opioid substances is common, though little is known about this phenomenon and how best to address it. Methods: We recruit...
TL;DR: The limited evidence is in stark contrast to the presumably high prevalence and relevance of comorbid mental disorders in adolescents with MUD, and suggests for future research topics, informed by adult findings, include genetic vulnerabilities, biological changes, and consequences of different use patterns.
Abstract: Methamphetamine use disorder (MUD) frequently begins in adolescence, often accompanied by other psychiatric or mental disorders. Up to now, no comprehensive review about MUD and comorbid disorders ...
TL;DR: Findings suggest that the videogame intervention, smokeSCREEN, has a promising effect on participants’ beliefs and knowledge about tobacco product use, including electronic cigarettes and vaping, and is well accepted by adolescents.
Abstract: Background: Preventing tobacco product initiation in youth is a critical need. While cigarette smoking among youth has been on the decline, tobacco use in other forms, such as e-cigarettes ...
TL;DR: An adjunctive aerobic exercise program during SUD treatment was associated with similar reductions in perceived stress and drug craving as standard care, and exercise produced the additional benefit of increases in vigor and circulating anandamide.
Abstract: Background: Exercise has been examined as an adjunctive treatment for substance use disorders (SUDs), yet few exercise interventions have been conducted among patients undergoing intensive ...
TL;DR: Self-Monitoring (SM) has been used in substance use treatment because SM may bring conscious awareness to automatized substance use behaviors as discussed by the authors, and it has been shown that self-monitoring may bring awareness to automated substance use behaviours.
Abstract: Self-Monitoring (SM), the act of observing ones’ own behavior, has been used in substance use treatment because SM may bring conscious awareness to automatized substance use behaviors. Empirical fi...
TL;DR: Inaccurate self-reporting of alcohol drinking behavior does exist in trauma patients and a composite of objective alcohol screening modalities, in addition to AUDIT, is needed to screen for alcohol use in this population.
Abstract: Background: This study assessed the inconsistencies between self-reported alcohol consumption and blood alcohol content (BAC) in trauma patients. We aimed to identify the incidence of positive BAC ...
TL;DR: Exposure to a single diagnosed concussion is associated with a modest increase in the risk of substance use and this association increases with the accumulation of multiple diagnosed concussions, which holds when controlling for sensation-seeking.
Abstract: Background: No large-scale epidemiological survey of adolescents in the US has assessed the association between lifetime history of concussion, propensity toward sensation-seeking, and recent substance use. Methods: This study assesses the association between lifetime history of diagnosed concussions, sensation-seeking, and recent substance use (i.e., cigarette use, binge drinking, marijuana use, illicit drug use, and nonmedical prescription drug use) using the 2016 and 2017 Monitoring the Future study of 25,408 8th, 10th, and 12th graders. Results: Lifetime diagnosis of concussion was associated with greater odds of past 30-day/2-week substance use. Adolescents who indicated multiple diagnosed concussions (versus none) had two times greater odds of all types of recent substance use, after adjusting for potential confounding factors. Adolescents indicating multiple diagnosed concussions also had higher adjusted odds of cigarette use, binge drinking, and marijuana use) when compared to adolescents who only indicated one diagnosed concussion. Accounting for adolescents' propensity toward sensation-seeking did not significantly change the association between substance use and multiple diagnosed concussions. Conclusions: This study provides needed epidemiological data regarding concussion and substance use among US adolescents. Exposure to a single diagnosed concussion is associated with a modest increase in the risk of substance use and this association increases with the accumulation of multiple diagnosed concussions. These associations hold when controlling for sensation-seeking. Substance use prevention efforts should be directed toward adolescents who have a history of multiple concussions.
TL;DR: The authors found consistent negative associations between heavy drinking and drug use and adherence to social distancing and personal hygiene guidelines for preventing the spread of COVID-19 early in the US pandemic.
Abstract: Background: We sought to understand the association between heavy alcohol and frequent drug use and non-adherence to recommended social distancing and personal hygiene guidelines for preventing the spread of COVID-19 early in the US pandemic. Methods: A survey was offered on the crowdsourcing platform, Amazon Mechanical Turk (MTurk) during April 2020 (the early days of strict, social distancing restrictions). The study included 1,521 adults ages 18 years and older who resided in the US and were enrolled as MTurk workers, i.e., workers who are qualified by Amazon to complete a range of human interaction tasks, including surveys through the MTurk worker platform. Main predictors included measures of heavy drinking, marijuana, and polysubstance use. The dependent measures were measures of social distancing and personal hygiene, based on guidelines recommended at the time of the survey by the US Centers for Disease Control to prevent the spread of COVID-19. Results: We found consistent negative associations between heavy drinking and drug use and adherence to social distancing and personal hygiene. Additionally, three control variables, age, gender, and race/ethnicity, were significant correlates of adherence to these measures. Conclusions: The findings here are consistent with previous research exploring links between substance use and other adverse health behaviors. Further, the negative association between heavy drinking (five or more drinks in one sitting) and adherence underscore the public health risks entailed with the unrestricted reopening of public drinking establishments.
TL;DR: Program evaluation findings suggest that large-scale training in and implementation of EBPs for SUDs is associated with improvements in substance use and other functional outcomes.
Abstract: Background: As part of the nation’s largest dissemination and implementation of evidence-based psychotherapies (EBPs) and the promotion of EBPs for substance use disorders (SUDs), the Veter...