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Showing papers in "Substance Use & Misuse in 2018"


Journal ArticleDOI
TL;DR: The toll of untreated opioid use disorder is tremendous: in 2015, 33,091 Americans died from a drug overdose involving an opioid, and in just one year, the death rate from heroin increased by 21% and the number of people dying from heroin-related injuries rose by 21%.
Abstract: The toll of untreated opioid use disorder is tremendous. In 2015, 33,091 Americans died from a drug overdose involving an opioid. In just one year, the death rate from heroin increased by 21% and f...

122 citations


Journal ArticleDOI
TL;DR: While significant use of illicit opioids during treatment with bup/nal is present, improvements in abstinence and high compliance during maintenance-assisted therapy programs may ameliorate fears of diversion in comprehensive programs.
Abstract: Background: Buprenorphine and naloxone (bup/nal), a combination partial mu receptor agonist and low-dose delta mu antagonist, is presently recommended and used to treat opioid-use disorder. However, a literature review revealed a paucity of research involving data from urine drug tests that looked at compliance and abstinence in one sample. Method: Statistical analysis of data from the Comprehensive Analysis of Reported Drugs (CARD) was used to assess compliance and abstinence during treatment in a large cohort of bup/nal patients attending chemical-dependency programs from eastern USA in 2010 and 2011. Results: Part 1: Bup/nal was present in 93.4% of first (n = 1,282; p <.0001) and 92.4% of last (n = 1,268; p <.0001) urine samples. Concomitantly, unreported illicit drugs were present in 47.7% (n = 655, p =.0261) of samples. Patients who were compliant to the bup/nal prescription were more likely than noncompliant patients to be abstinent during treatment (p =.0012; odds ratio = 1.69 with 95% conf...

56 citations


Journal ArticleDOI
TL;DR: The social control mechanisms that are imposed in MAT are strikingly similar to those reflected in criminal justice settings, namely probation, parole and community corrections more generally and how they are monitored, tracked, and controlled have major implications for recovery.
Abstract: In the United States, buprenorphine products (namely buprenorphine/naloxone combination) and methadone are the primary forms of medication-assisted treatment (MAT) that are authorized for addressing opioid addiction. Although treatment ideologies differentiate MAT programs, much of the provision in the US reflects a model of "high threshold, low tolerance." This model is discussed with a focus on structural and programmatic barriers that shape access to and retention in MAT. The critique continues with a discussion of multifaceted stigma that reinforces spoiled identities and diffuses into treatment settings. The social control mechanisms that are imposed in MAT are strikingly similar to those reflected in criminal justice settings, namely probation, parole and community corrections more generally. Parallels are drawn between the "addict" and the "felon" and how they are monitored, tracked, and controlled. These factors have major implications for recovery.

48 citations


Journal ArticleDOI
TL;DR: There was little change in adolescent marijuana use but a significant change in perception of ease of access, and public health workers and policymakers should continue to monitor these changes as essential for evaluating the impact of liberalization of marijuana policies.
Abstract: Background: As of January 1, 2017, eight states have approved laws for recreational marijuana use. While the social impacts of these changes remain under debate, the influence on adolescent marijuana use is a key policy and health issue across the U.S. Objective: To examine changes in adolescent marijuana-use behaviors in the first year after recreational marijuana implementation in Colorado, and to analyze the effect of retail marijuana store proximity on youth use and perceptions. Method: Secondary analysis of Healthy Kids Colorado Survey data from 40 schools surveyed before and after recreational marijuana sales were implemented (2013 student n = 12,240; 2014 student n = 11,931). Self-reported marijuana use, ease of access, and perceived harms were compared between years and by proximity of recreational marijuana stores to surveyed schools. Results: Adolescent marijuana use behaviors, wrongness of use, and perceptions of risk of harm were unchanged from baseline to one-year follow-up. Perceived...

48 citations


Journal ArticleDOI
TL;DR: Trends in substance use are changing over time, but not in the same ways for all sexual minority subgroups, and patterns are worsening for females.
Abstract: Background: Despite efforts to decrease substance use, rates among sexual minority youth (SMY) remain higher than among heterosexuals. Substance use is a leading contributor to morbidity and mortality in adulthood, and SMY's use of substances is related to poorer mental and emotional health. Objectives: We sought to document the trends in substance use for a large sample of youth over 14 years with special attention to SMY. In addition, we tested whether there were disparities in substance use behaviors between SMY and heterosexual youth. Last, we examined changes in disparities over time in substance use among SMY. Methods: We analyzed data from 8 waves of the Massachusetts YRBS (N = 26,002, Mage = 16), from 1999 to 2013, to investigate trends and disparities in current tobacco, alcohol, and cannabis use for heterosexual youth and SMY. We used logistic regression interaction models to test whether these disparities have widened or narrowed for SMY, as compared to heterosexuals, over the span of 1...

48 citations


Journal ArticleDOI
TL;DR: Given the potential for negative outcomes associated with alcohol misuse and transmission of risky alcohol-related behaviors from parent to child, strategies that utilize a multigenerational approach could have a large impact on population health.
Abstract: Background: Adverse childhood experiences (ACEs) have been associated with negative adult health outcomes, including alcohol misuse. The impact of ACEs on alcohol use may vary by gender, with ACEs impacting women more than men in coping with adulthood stressors. Objectives: The objective of this study is to examine the gender-specific relationships between ACEs and self-reported binge drinking and heavy drinking in adulthood among South Carolina residents. Methods: This study analyzed a sample of 8492 respondents who completed the 2014 or 2015 South Carolina Behavioral Risk Factor Surveillance System (BRFSS) survey. Logistic regression was used to examine the impact of types and the number of ACEs on binge drinking and heaving drinking in adulthood. Results: Thirty-seven percent of men and 22.8% of women survey respondents reported binge drinking and 12.2% of men and 4.1% of women reported heavy drinking. Almost all categories of ACE were associated with increased odds of reporting binge and heavy...

47 citations


Journal ArticleDOI
TL;DR: A scale assessing reasons for co-use among participants in a longitudinal cohort study of 3,418 students aged 18-25 from 7 Georgia colleges and universities demonstrated distinct associations with tobacco type used; nicotine dependence; marijuana and alcohol use frequency; tobacco and marijuana use motives; perceptions of tobacco andarijuana; and parental and friend use.
Abstract: Background: Marijuana-tobacco co-use has increased recently, particularly in young adults. Objectives: We conducted a mixed-methods study to: (1) examine reasons for co-use; and (2) develop a scale assessing reasons for co-use among participants in a longitudinal cohort study of 3,418 students aged 18-25 from 7 Georgia colleges and universities. Methods: Phone-based semi-structured interviews were conducted in Summer 2015 among 46 current (past 30-day, n = 26) or lifetime (n = 20) marijuana users. Subsequently, scale items were developed and included at Wave 3. Participants reporting past 4-month tobacco and marijuana use (n = 328) completed the Reasons for Marijuana-Tobacco Co-use section. Results: Per qualitative data, reasons for marijuana-tobacco co-use included synergistic effects, one triggering or preceding the other's use, using one to reduce the other's use, co-administration, social context, and experimentation. The survey subsample included 37.1% who used cigarettes, 30.4% LCCs, 9.4% sm...

45 citations


Journal ArticleDOI
TL;DR: The data suggest that new medical cannabis legislation might reduce the need for opioid analgesics for pain management, which could help to address adverse events associated with opioid analgesic use.
Abstract: Background: Chronic pain is common in the United States and prescribed opioid analgesics use for noncancer pain has increased dramatically in the past two decades, possibly accounting for the current opioid addiction epidemic. Co-morbid drug use in those prescribed opioid analgesics is common, but there are few data on polysubstance use patterns. Objective: We explored patterns of use of cigarette, alcohol, and illicit drugs in HIV-infected people with chronic pain who were prescribed opioid analgesics. Methods: We conducted a secondary data analysis of screening interviews conducted as part of a parent randomized trial of financial incentives to improve HIV outcomes among drug users. In a convenience sample of people with HIV and chronic pain, we collected self-report data on demographic characteristics; pain; patterns of opioid analgesic use (both prescribed and illicit); cigarette, alcohol, and illicit drug use (including cannabis, heroin, and cocaine) within the past 30 days; and current treat...

42 citations


Journal ArticleDOI
TL;DR: The present study provides a good starting point for further research to quantify through surveys how consumers understand and use edibles, and will help guide policy makers and regulators as they establish regulations for edibles.
Abstract: Background: Edible marijuana products have become extremely popular in states that have legalized marijuana for recreational use. Objectives: The goal of this research was to provide a better understanding of consumer perceptions of edible marijuana products, including why they prefer edibles relative to other forms of marijuana (e.g., smoking) and their concerns regarding the consumption of edibles. Methods: We conducted eight focus groups (four groups in Denver, Colorado, and four groups in Seattle, Washington) in February 2016 with 62 adult consumers of edibles. Focus group transcripts were coded in QSR NVivo 10.0 qualitative analysis software, and coding reports identified trends across participants. Results: Most participants preferred edibles to smoking marijuana because there is no smell from smoke and no secondhand smoke. Other reasons participants like edibles included convenience, discreetness, longer-lasting highs, less intense highs, and edibles' ability to aid in relaxation and reduce...

40 citations


Journal ArticleDOI
TL;DR: This is the first open trial to show improved alcohol-related behavior and emotional regulation in alcohol-dependent patients treated with DBT-ST and to posit a partial but significant relation between improved emotional regulation and alcohol use outcomes.
Abstract: Background: Dialectical behavior therapy (DBT) has demonstrated efficacy in treating disorders such as alcohol dependence that are characterized by emotional dysregulation. Preliminary evidence has...

40 citations


Journal ArticleDOI
TL;DR: The positive association between past-year smoking reduction and cessation and current NTM flavored e-cigarettes use may be explained by young adults' escalated e-cigarette use with NTM flavors.
Abstract: Background: E-cigarette use prevalence has increased drastically among young adult cigarette smokers in recent years. Objectives: This study seeks to understand which e-cigarette flavors—sweet and ...

Journal ArticleDOI
TL;DR: Heroin use decreased and PO misuse increased among Latino respondents during the late 2000s, but these trends largely reversed in more recent years and among OTP entrants, racially/ethnically disparate rates of heroin use and to a lesser extent of PO misuse have become more similar over time.
Abstract: Recent data suggest an increase in use of heroin and non-medical use of prescription opioids (POs) in the United States, but it is unclear if these trends are consistent across racial/ethnic groups. In a nationwide prevalence study, 69,140 patients newly admitted to an opioid treatment program (OTP) completed a brief self-administered survey of past month heroin use and PO misuse from January 2005 through September 2016. We calculated heroin use and PO misuse prevalence rates, and prevalence rate ratios of Black and Latino OTP entrants compared to White entrants over time. Initially, Black and Latino respondents reported much higher prevalence of heroin use and much lower prevalence of PO misuse than White respondents. Heroin use increased among White respondents, while it decreased among Black respondents, resulting in rates that were no longer significantly different. PO misuse prevalence decreased among White respondents while it increased among Black respondents, but remained significantly higher among White respondents. Heroin use decreased and PO misuse increased among Latino respondents during the late 2000s, but these trends largely reversed in more recent years. Among OTP entrants, racially/ethnically disparate rates of heroin use, and to a lesser extent, of PO misuse have become more similar over time. These trends were stronger when analysis was restricted to OTP entrants who either had no previous OTP history or were younger. To understand potential impacts of interventions to deter PO misuse and to maximize the effectiveness of OTPs it is important to consider potential changes in opioid use across racial/ethnic groups.

Journal ArticleDOI
TL;DR: Alternative constructions of MMT cannot be understood outside of the structural context of criminalization and the War on Drugs which shape illegal drug use as a difficult and dangerous activity, and consequently position MMT as a way to moderate or escape from those harms.
Abstract: Background: Methadone Maintenance Treatment (MMT) in the United States (U.S.) has been undergoing a shift towards conceptualizing the program as recovery-based treatment. Although recovery is seen ...

Journal ArticleDOI
TL;DR: This study provides additional data that enrich the discussion on whether the ‘food addiction’ phenotype should be included or not in the “substance-related and addictive disorder” category.
Abstract: Background: The “food addiction” phenotype identifies a subpopulation of individuals experiencing substance-dependence symptoms toward specific foods. In the current debate on whether the “food add...

Journal ArticleDOI
TL;DR: It is argued that without attention to the multiple oppressions and survival needs of addiction patients who are further stigmatized by race and class, buprenorphine treatment can become a form of clinical abandonment.
Abstract: Background/Objective: Office-based buprenorphine maintenance has been legalized and promoted as a treatment approach that not only expands access to care, but also reduces the stigma of addiction t...

Journal ArticleDOI
TL;DR: IAs moderated associations of both abuse and household dysfunction with early initiation of marijuana and alcohol for females but not for males, and special attention should be paid to improving IAs among girls who have already experienced ACEs.
Abstract: Introduction: Early adolescence is a critical risk period for initiation of substance use. Internal assets (IAs), which are individual qualities guiding positive choices, and adverse childhood expe...

Journal ArticleDOI
TL;DR: High prevalence of smoking and nicotine dependence in subjects with ADHD is probably best explained by a combination of imitation, peer pressure and typical traits of ADHD, and self-medication is supported by ample evidence.
Abstract: Background: ADHD is a highly prevalent disorder and poses a risk for a variety of mental disorders and functional impairments into adulthood. One of the most striking comorbidities of ADHD is nicotine dependence. Youth diagnosed with ADHD are 2–3 times more likely to smoke than their peers without ADHD, initiate smoking earlier in life and progress more quickly and more frequently to regular use and dependence. Possible explanations for these increased risks are: (a) self-medication of ADHD symptoms with the stimulant nicotine; (b) ADHD symptoms like inattention and hyperactivity/impulsivity predispose for smoking initiation and impede smoking cessation; (c) peer pressure; and/or (d) common genetic or environmental determinants for ADHD and smoking. Objective: Identify the most probable causes of the high prevalence of smoking and nicotine dependence in subjects with ADHD. Methods: A systematic literature review was performed and the causality of the observed relations was ranked using the Bradfor...

Journal ArticleDOI
TL;DR: Findings suggest that students with more depressive symptoms would benefit from clinical interventions tailored to address negative reinforcement drinking motives and, by extension, increase student utilization of PBS related to minimizing harm.
Abstract: Background: College students with depressive symptoms tend to engage in more hazardous drinking and experience more alcohol-related consequences to cope with their symptoms. Given the perceived ten...

Journal ArticleDOI
TL;DR: As high-intensity drinking does not appear to be a drinking pattern unique to college-attenders and non-college-attending young adults are less likely to mature out of heavy drinking patterns, intervention efforts are needed for this at-risk age group.
Abstract: Background: Young adults report the heaviest drinking of any age group, and many are at risk for experiencing an alcohol use disorder. Most research investigating young adult drinking has focused o...

Journal ArticleDOI
TL;DR: Factors that should be addressed to attract, support, and retain primary care physicians in prescribing methadone to treat opioid use disorder are identified.
Abstract: Background: Methadone maintenance treatment is an effective way to reduce harms associated with opioid use disorder and, in several countries, is delivered in community-based primary care settings. Expanding methadone into primary care depends, in part, on physicians' willingness and readiness to integrate it into their practices. Objectives: This qualitative study explores factors that primary care physicians consider important when contemplating prescribing methadone to treat opioid use disorder. Methods: In-depth interviews were conducted during 2015 with 20 primary care physicians in various sized communities throughout Nova Scotia, Canada. Participants shared their views and experiences related to prescribing methadone to treat opioid use disorder. Data were analyzed inductively using thematic analysis to identify predominant themes. Results: Participants discussed an interplay of factors as they contemplated prescribing methadone to treat opioid use disorder in primary care. Physician-relate...

Journal ArticleDOI
TL;DR: Study findings suggest that the drug/crime relationship among rural Appalachian women is associated with their high-risk home environment, partner relationships, and mental health, and factors such as family and child relationships, anxiety, victimization, and relationships with partners should also be considered in the trajectory of criminal careers among Rural Appalachian women.
Abstract: Background/Objective: The purpose of this paper is to examine drug use and incarceration history among rural Appalachian women. Methods: This study involved random selection, screening, and intervi...

Journal ArticleDOI
TL;DR: Characteristics of state-wide ED presentations in a cohort of people who inject drugs (PWID) are described, and presentation rates to the general population are compared, to suggest referrals to drug treatment, mental health, and social support services can improve patient care and reduce the burden on EDs.
Abstract: Background: Although people who inject drugs (PWID) have been described as frequent users of emergency services, the majority of research is cross-sectional and involves records from a single emerg...

Journal ArticleDOI
Carla J. Berg1, Carmen N. Daniel1, Milkie Vu1, Jingjing Li1, Kathleen Martin1, Lana Le1 
TL;DR: Interventions and campaigns should address social norms and risk perceptions regarding marijuana use, particularly as it relates to DUI.
Abstract: Background: Given increases in marijuana use and driving under the influence (DUI), it is critical to identify those at risk in order to inform intervention efforts. Objectives: We used a socioecological framework to examine correlates of level of marijuana use and DUI in the past month among young adult marijuana users. Methods: We recruited 1567 participants aged 18–34 years via Facebook ads targeting tobacco and marijuana users in August 2014 to complete an online survey assessing marijuana use and DUI, as well as related multilevel factors. Analyses focused on 649 participants reporting past 30-day marijuana use. Results: The sample was an average age of 24.48 (SD = 5.10), 43.9% female, and 76.4% White and used marijuana an average of 17.86 (SD = 11.29) days in the past month. Notably, 48.4% reported driving after marijuana use at least once in the past month, and 74.0% were passengers. Multivariable regression indicated that greater use was associated with: being older; being male; greater sy...

Journal ArticleDOI
TL;DR: The findings suggest that the web-based intervention to reduce substance abuse is feasible, although it is not more effective than other intervention modalities; its effectiveness must be evaluated in a larger sample.
Abstract: Background: Web-based cognitive-behavioral interventions to reduce substance use can be a useful low-cost treatment for a large number of people, and an attractive option in countries where a great...

Journal ArticleDOI
TL;DR: The balance between treating the patient's symptoms and causing potential harm is a challenge, but the potential harm of opioid therapy is not taken lightly, as the public health concern of prescription drug abuse in rural Appalachia continues to spread.
Abstract: Background: Rural Tennessee, especially rural East Tennessee has seen a dramatic increase in rates of controlled drug prescriptions and controlled drug overdose deaths in recent years. However, little is known about the individual decisions to prescribe or continue prescriptions with relation to addiction concerns. Objectives: The purpose of this study was to learn more about what factors lead to physicians’ prescribing control drugs for non-cancer pain through the use of focus groups. Methods: A qualitative study, using focus groups, in five family medicine clinics in East Tennessee and Southwest Virginia. The investigators used a semi-structured interview guide designed to facilitate group discussions about prescription drug abuse and misuse. Results: There were four main themes identified by the focus groups: (1) prescribers’ changing prescribing patterns over time; (2) factors that influence controlled drug prescribing; (3) use and barriers to using state prescription drug monitoring programs ...

Journal ArticleDOI
TL;DR: Assessment of cannabis normalization as differentiated by social location predictors shows that normalization components of recent use, acceptability, and accessibility are differentiated by gender, nativity, and peer network cannabis use prevalence.
Abstract: Background/Objectives: The drug normalization framework investigates the social integration of substance use. This article contributes a quantitative assessment of cannabis normalization as differe...

Journal ArticleDOI
TL;DR: Examining the context in which college students use ENDS, co-occurring health risks beyond traditional tobacco use, and the role of ethnicity indicated that a large proportion of college students have tried ENDS irrespective of ethnicity or sex.
Abstract: Background: Prevalence rates of electronic nicotine delivery systems (ENDS; i.e., e-cigarette/vape) use has grown exponentially in the past few years. College students present a particularly vulner...

Journal ArticleDOI
TL;DR: Initial support is provided for the role of stigma as a contributor to maladaptive coping responses, such as substance use, among people living with depression and the potential utility of targeting emotion dysregulation in stigma coping and substance abuse prevention intervention efforts is underscored.
Abstract: The comorbidity between depression and substance use problems is well-documented, yet little research has investigated how stigma associated with one's depression might relate to alcohol and drug use. The current study examined the association between depression-related stigma and substance use coping and considered the role of emotion dysregulation (i.e., difficulty in monitoring, evaluating, and modulating one's emotional reactions) as a mechanism underlying this association. A sample of individuals who self-identified as having current or remitted depression (N = 218) completed self-report measures of depression-related stigma, emotion dysregulation, and tendency to rely on alcohol or drugs to cope with psychological distress. Depression-related stigma was positively associated with emotion dysregulation, which was in turn associated with a greater tendency to engage in substance use coping. These findings provide initial support for the role of stigma as a contributor to maladaptive coping responses, such as substance use, among people living with depression. Further, they underscored the potential utility of targeting emotion dysregulation in stigma coping and substance abuse prevention intervention efforts.

Journal ArticleDOI
TL;DR: The MMT program was found to be successful; hence, it should be expanded and lower methadone dosage was significantly associated with improvements in the physical, psychological, social, and environmental domains.
Abstract: Background: Opioid misuse and dependence is a global issue with a huge negative impact. In Malaysia, heroin is still the main illicit drug used, and methadone maintenance treatment (MMT) has been u...

Journal ArticleDOI
TL;DR: A preference for group smoking and product sharing, and the belief that cigarillos extend the high of marijuana were found to promote the co-use of these products.
Abstract: Background: The use of cigarillos for smoking as a tobacco product and for making marijuana blunts is increasing among adolescents. Previous research has documented the co-use of these prod...