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Risk and Protective Factors of Tramadol Abuse in the Gaza Strip: The Perspective of Tramadol Abusers and Psychiatrists. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00301-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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52
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Bunting AM, Victor G, Pike E, Staton M. The Impact of Policy Changes on Heroin and Nonmedical Prescription Opioid Use among an Incarcerated Population in Kentucky, 2008-2016. CRIMINAL JUSTICE POLICY REVIEW 2020; 31:746-762. [PMID: 33692607 PMCID: PMC7939129 DOI: 10.1177/0887403419838029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In response to the opioid epidemic, there have been several national and state-level policies enacted. Consideration of how criminal justice-involved individuals are affected by such policies has received limited attention, despite disproportionately higher use among this population. Bivariate statistics examined yearly trends and logistic regressiosns examined demographic correlates of nonmedical prescription opioid and heroin use among Kentucky inmates over an eight-year time-span of important national and local policy changes (n=34,542). Results indicate that among incarcerated individuals, prior use of heroin increased 204% from 2008 to 2016, with increases possibly linked to key policy changes associated with OxyContin reformulation and state implementation of a prescription drug monitoring program. The current incarcerated population had more severe use patterns when considering general population research. Consideration of criminal justice-involved populations is crucial to understanding and treating the opioid epidemic.
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53
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Egan KL, Gregory E, Osborne VL, Cottler LB. Power of the Peer and Parent: Gender Differences, Norms, and Nonmedical Prescription Opioid Use Among Adolescents in South Central Kentucky. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:665-673. [PMID: 30637670 DOI: 10.1007/s11121-019-0982-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study examined risk factors of nonmedical prescription opioid use (NMPOU) among adolescents and how risk factors differ by gender. In the fall of 2017, adolescents attending 6th through 12th grades across 44 schools in 10 south central Kentucky counties were invited to participate in an anonymous, school-based survey. A total of 11,761 adolescents completed the survey. Logistic regression was conducted to examine the association between NMPOU and constructs of the Theory of Reasoned Action (i.e., attitudes and subjective norms), descriptive norms (i.e., peer use), and parental control of prescription medications in the home. There were 297 (2.7%) adolescents who reported NMPOU in the past 12 months. In the adjusted multivariate logistic regression model, for both males and females, the adolescents who perceived that more of their peers engaged in NMPOU were significantly more likely to endorse NMPOU, whereas male and female adolescents who perceived their peers disapproved of use were significantly less likely to report NMPOU. Parent disapproval was significantly associated with decreased NMPOU for females only. Moderated regression analyses revealed that gender moderated the relationship between parental disapproval and NMPOU. We found that during adolescence, NMPOU is influenced by peer norms for both genders and parental norms for females. These results indicate that prevention efforts should focus on changing adolescents' peer and parental norms related to NMPOU.
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Affiliation(s)
- Kathleen L Egan
- Department of Heath Education and Promotion, East Carolina University, 3105 Carol G. Belk Building, Greenville, NC, 27858, USA.
| | - Eric Gregory
- Community Survey Solutions, LLC, Bowling Green, KY, USA
| | - Vicki L Osborne
- Drug Safety Research Unit, Southampton, UK.,Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Linda B Cottler
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
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Kokane SS, Perrotti LI. Sex Differences and the Role of Estradiol in Mesolimbic Reward Circuits and Vulnerability to Cocaine and Opiate Addiction. Front Behav Neurosci 2020; 14:74. [PMID: 32508605 PMCID: PMC7251038 DOI: 10.3389/fnbeh.2020.00074] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/22/2020] [Indexed: 12/15/2022] Open
Abstract
Although both men and women become addicted to drugs of abuse, women transition to addiction faster, experience greater difficulties remaining abstinent, and relapse more often than men. In both humans and rodents, hormonal cycles are associated with females' faster progression to addiction. Higher concentrations and fluctuating levels of ovarian hormones in females modulate the mesolimbic reward system and influence reward-directed behavior. For example, in female rodents, estradiol (E2) influences dopamine activity within the mesolimbic reward system such that drug-directed behaviors that are normally rewarding and reinforcing become enhanced when circulating levels of E2 are high. Therefore, neuroendocrine interactions, in part, explain sex differences in behaviors motivated by drug reward. Here, we review sex differences in the physiology and function of the mesolimbic reward system in order to explore the notion that sex differences in response to drugs of abuse, specifically cocaine and opiates, are the result of molecular neuroadaptations that differentially develop depending upon the hormonal state of the animal. We also reconsider the notion that ovarian hormones, specifically estrogen/estradiol, sensitize target neurons thereby increasing responsivity when under the influence of either cocaine or opiates or in response to exposure to drug-associated cues. These adaptations may ultimately serve to guide the motivational behaviors that underlie the factors that cause women to be more vulnerable to cocaine and opiate addiction than men.
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Affiliation(s)
- Saurabh S Kokane
- Department of Psychology, University of Texas at Arlington, Arlington, TX, United States
| | - Linda I Perrotti
- Department of Psychology, University of Texas at Arlington, Arlington, TX, United States
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55
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Hood LE, Leyrer-Jackson JM, Olive MF. Pharmacotherapeutic management of co-morbid alcohol and opioid use. Expert Opin Pharmacother 2020; 21:823-839. [PMID: 32103695 PMCID: PMC7239727 DOI: 10.1080/14656566.2020.1732349] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/17/2020] [Indexed: 12/12/2022]
Abstract
Opioid use disorder (OUD) and alcohol use disorder (AUD) are two highly prevalent substance-related disorders worldwide. Co-use of the substances is also quite prevalent, yet there are no pharmacological treatment approaches specifically designed to treat co-morbid OUD and AUD. Here, the authors critically summarize OUD, AUD and opioid/alcohol co-use and their current pharmacotherapies for treatment. They also review the mechanisms of action of opioids and alcohol within the brain reward circuitry and discuss potential combined mechanisms of action and resulting neuroadaptations. Pharmacotherapies that aim to treat AUD or OUD that may be beneficial in the treatment of co-use are also highlighted. Preclinical models assessing alcohol and opioid co-use remain sparse. Lasting neuroadaptations in brain reward circuits caused by co-use of alcohol and opioids remains largely understudied. In order to fully understand the neurobiological underpinnings of alcohol and opioid co-use and develop efficacious pharmacotherapies, the preclinical field must expand its current experimental paradigms of 'single drug' use to encompass polysubstance use. Such studies will provide insights on the neural alterations induced by opioid and alcohol co-use, and may help develop novel pharmacotherapies for individuals with co-occurring alcohol and opioid use disorders.
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Affiliation(s)
- Lauren E. Hood
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | | | - M. Foster Olive
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
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56
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Saraiya TC, Pavlicova M, Hu MC, Nunes EV, Hien DA, Campbell ANC. Exploring gender differences among treatment-seekers who use opioids versus alcohol and other drugs. Women Health 2020; 60:821-838. [PMID: 32233747 DOI: 10.1080/03630242.2020.1746952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Identifying clinical differences between opioid users (OU) and alcohol and other drug users (AOD) may help to tailor treatment to OU, particularly among the majority of OU who are not on opioid agonist treatments. Given the dearth of research on these differences, this study explored gender differences in demographic and clinical characteristics between OU and AOD. Participants (N = 506) were from a multisite, randomized controlled clinical trial of an Internet-delivered psychosocial intervention conducted in 2010-2011. Logistic regression models explored differences in demographic and clinical characteristics by substance use category within and between women and men. Women OU were more likely to be younger, White, employed, benzodiazepine users, and less likely to have children or use cocaine and cannabis than women AOD. Men OU, compared to men AOD, were more likely to be younger, White, younger at first abuse/dependence, benzodiazepine users, and reported greater psychological distress, but were less likely to be involved in criminal justice or use stimulants. Interactions by gender and substance use were also detected for age of first abuse/dependence, employment, and criminal justice involvement. These findings provide a nuanced understanding of gender differences within substance use groups to inform providers for OU seeking treatment.
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Affiliation(s)
- Tanya C Saraiya
- Derner School of Psychology, Adelphi University , Garden City, NY, USA.,Department of Psychology, The City College of New York , New York, NY, USA
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University , New York, NY, USA
| | - Mei-Chen Hu
- Department of Biostatistics, Mailman School of Public Health, Columbia University , New York, NY, USA
| | - Edward V Nunes
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University Medical Center , New York, NY, USA
| | - Denise A Hien
- Center of Alcohol Studies, Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey , Piscataway Township, NJ, USA
| | - Aimee N C Campbell
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University Medical Center , New York, NY, USA
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57
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Amaducci AM, Greenberg MR, Sheen AW, Warren HR, Parikh PM, Roth P, Weaver KR, Richardson DM, Burmeister DB, Stephens JL, Cannon RD. Sex-specific Outcomes in a Substance Use Intervention Program. Clin Ther 2020; 42:419-426. [PMID: 32160970 DOI: 10.1016/j.clinthera.2020.01.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE We performed an emergency department (ED)-based substance use screening, motivational interview-based intervention, and treatment referral program with the goal of determining sex-specific outcomes. Specifically, in this quality improvement project, we aimed to determine whether there was a difference among sexes in the type of substances used; the frequency of positive screening results for substance use disorder; agreeing to an intervention; the type of follow-up evaluation, participation, and referral; and attempts to change substance use after intervention. METHODS We prospectively studied a convenience sample of patients at 3 hospitals in Northeastern Pennsylvania from May 2017 through February 2018. Inclusion criteria for participation in this study were age ≥18 years; ability to answer survey questions; willingness and ability (not being too ill) to participate in intervention(s); and when screened, admitting to use of alcohol, tobacco, potentially addictive prescription drugs, or street drugs. Practitioners in the ED screened patients. For those with unhealthy substance use, a brief motivational interview was performed. Participants were each given referrals and information in accordance with the particular substance used and their assessed readiness to change. Individuals who completed the intervention were contacted by telephone for follow-up. Self-reported outcomes and the frequency of successful warm hand-off referrals were assessed. FINDINGS Of the 2209 individuals screened, 976 (44.2%) were male. Overall, 547 patients screened positive for at least 1 of the unhealthy substances for a prevalence of 24.8% (95% confidence interval, 22.9%-26.6%). In this population, a greater proportion of men screened positive than women (30.5% vs 20.2%, P = 0.01). Although the finding was not statistically significant, men (106 [35.6%]) were more likely than women (81 [32.5%]) to agree to an ED intervention. At telephone follow-up, men were more likely to report participating in a treatment or support program than women (32.9% vs 18.2%, P = 0.035). Frequencies of warm hand-off referrals were 11 of 106 (10.4%) for men and 2 of 81 (2.5%) for women. IMPLICATIONS Our small study found that unhealthy substance use rates were greater overall in men than women. Overall participation differences between men and women who agreed to take part in substance intervention and accepted a referral for follow-up treatment were not statistically significant. At telephone follow-up, more men reported participating in a treatment program than women. Direct referral (warm hand-off) rates to treatment programs were small in both sexes but greater in men than women.
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Affiliation(s)
- Alexandra M Amaducci
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Marna Rayl Greenberg
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA.
| | - Andrew W Sheen
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Hanna R Warren
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Pratik M Parikh
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Paige Roth
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Kevin R Weaver
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - David M Richardson
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - David B Burmeister
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Jennifer L Stephens
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Robert D Cannon
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
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58
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Zuckermann AME, Qian W, Battista K, Jiang Y, de Groh M, Leatherdale ST. Factors influencing the non-medical use of prescription opioids among youth: results from the COMPASS study. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1736669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Alexandra M. E. Zuckermann
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
- Applied Research Division, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Wei Qian
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Katelyn Battista
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Ying Jiang
- Applied Research Division, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Margaret de Groh
- Applied Research Division, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Scott T. Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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59
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Silver ER, Hur C. Gender differences in prescription opioid use and misuse: Implications for men's health and the opioid epidemic. Prev Med 2020; 131:105946. [PMID: 31816359 DOI: 10.1016/j.ypmed.2019.105946] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/18/2019] [Accepted: 11/30/2019] [Indexed: 11/16/2022]
Abstract
The majority of research on gender and the opioid epidemic focuses on women as patients, caregivers, or expectant mothers. However, little research approaches men as gendered subjects, despite their dramatically increased risk of opioid overdose. Accordingly, we examined gender differences in prescription opioid use and misuse with specific attention to implications for men using data from the 2017 National Survey on Drug Use and Health. We used design-adjusted, weighted Wald tests and multivariate logistic regression to compare gender differences in rates of prescription opioid use and misuse, prescription opioid sources, primary motivation for misuse, and prescription opioid dependence. We found that although men were significantly less likely than women to report opioid use, they were significantly more likely to report opioid misuse and to misuse prescription opioids primarily to feel good or get high. Among past-year opioid users, men were significantly more likely than women to meet DSM-IV criteria for opioid dependence. Results are consistent with past work on the intersection of masculinity norms and health behaviors. Although gender-specific interventions are typically synonymous with interventions tailored to women, our results suggest that such interventions could alleviate the burden of the opioid epidemic for men as well. Further research studying possible mechanisms that explain men's increased vulnerability to the opioid epidemic is urgently needed to address this growing public health crisis.
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Affiliation(s)
- Elisabeth R Silver
- Department of Medicine, Division of General Medicine, New York Presbyterian Columbia University Medical Center, New York, NY, USA
| | - Chin Hur
- Department of Medicine, Division of General Medicine, New York Presbyterian Columbia University Medical Center, New York, NY, USA.
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60
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Prescription opioid misuse among heterosexual versus lesbian, gay, and bisexual military veterans: Evidence from the 2015-2017 national survey of drug use and health. Drug Alcohol Depend 2020; 207:107794. [PMID: 31864165 DOI: 10.1016/j.drugalcdep.2019.107794] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Little research examines risks of opioid misuse among military veterans, particularly among minority military veterans. The present study examines lifetime and past 12-month prescription opioid misuse among heterosexual versus non-heterosexual military veterans in the United States. METHOD Participants comprised 9729 U.S. military veterans aged 18 and older who completed the 2015-2017 National Survey on Drug Use and Health (NSDUH). Sample weights were applied to yield nationally representative estimates in the target population. Design-based multivariable logistic regression analysis was used to examine associations between sociodemographic characteristics and risk of prescription opioid misuse. RESULTS Bisexual veterans reported greater lifetime odds of having misused prescription opioids in their lives compared to their heterosexual peers (AOR: 4.04, 95% CI: 1.72-5.38). However, only bisexual women veterans reported elevated risk past 12-month misuse (AOR: 3.47, 95% CI: 1.28, 9.41). Although veterans aged 50 and older reported lower risk of lifetime prescription opioid misuse relative to 18-34 year olds (AOR: 0.33, 95% CI: 0.25-0.44), older veterans showed greater risk of past 12-month misuse (AOR: 1.23, 95% CI: 1.02-1.49). DISCUSSION To our knowledge, this study is the first to systematically examine differential risk factors of prescription opioid misuse between heterosexual and non-heterosexual military veterans. Results from this study suggest a critical need for greater investigations into the specific risks of opioid-related substance use for military veterans. This study highlights areas of research and practice that can improve health outcomes for military veterans and their communities.
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61
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Pro G, Utter J, Cram J, Baldwin J. Racial/Ethnic and Gender Differences in Associations of Medication-Assisted Therapy and Reduced Opioid Use between Outpatient Treatment Admission and Discharge. J Psychoactive Drugs 2020; 52:186-194. [PMID: 32005084 DOI: 10.1080/02791072.2020.1717685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Medication-assisted therapy (MAT) for opioid use disorders is an effective treatment strategy. Racial/ethnic and gender disparities in MAT utilization have been documented, but less is known about disparities in MAT outcomes. We used the Treatment Episodes Dataset-Discharges (TEDS-D; 2015- 2017) to identify outpatient treatment episodes with heroin or illicit opioids indicated at admission (n = 232,547). We used multivariate logistic regression to model the association between MAT and a reduction in opioid use between treatment admission and discharge. We explored moderation by race/ethnicity and gender by including an interaction term. We identified a strong moderating effect of race/ethnicity and gender. American Indian/Alaska Native (AI/AN) women demonstrated the strongest association between MAT (versus no MAT) and a reduction in opioid use (aOR = 6.05, 95% CI = 4.81- 7.61), while White men demonstrated the weakest association (aOR = 2.78, CI = 2.70- 2.87). Our findings could inform changes in clinical MAT settings that are based on harm reduction and the incremental transition from illicit opioids to medication-assistance among a diverse opioid use disorder population.
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Affiliation(s)
- George Pro
- Center for Health Equity Research, Northern Arizona University , Flagstaff, AZ, USA
| | - Jeff Utter
- Department of Family Medicine, University of Colorado , Denver, CO, USA
| | - Jessica Cram
- Department of Counseling Supervising and Education, Capella University , Minneapolis, MN, USA
| | - Julie Baldwin
- Center for Health Equity Research, Northern Arizona University , Flagstaff, AZ, USA.,Department of Health Sciences, Northern Arizona University , Flagstaff, AZ, USA
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Friedman S, Patel K, Liu Y, Hartzell S, Keller MS. Urine Drug Testing among Opioid-Naïve and Long-Term Opioid Nevada Medicaid Beneficiaries. Subst Use Misuse 2020; 55:2314-2320. [PMID: 32835582 DOI: 10.1080/10826084.2020.1805467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Current guidelines recommend that, when prescribing opioids, providers use urine drug testing (UDT) for harm reduction. Objective: To identify whether Medicaid beneficiaries in Nevada at increased risk for opioid misuse received UDT. Methods: We used Nevada Medicaid claims data (2017-2018) to describe UDT among three samples: opioid naïve patients (N = 11,326), opioid naïve patients with a second follow-up prescription (N = 8,910), and long-term opioid patients (N = 19,173). Predictors of opioid misuse include past diagnoses of mental health and substance use, demographic characteristics and potentially risky behaviors. Outcomes include receiving UDT prior to opioid prescription among the two naïve samples and within six months for the long-term sample. We report predicted probabilities (PP) from logistic regressions and hazard ratios (HR) and Kaplan-Meier curves. Results: A small percentage of patients received UDT (naïve sample: 2.5%; naïve with a second follow-up prescription sample: 3.5%; long-term sample: 9.9%). Adults with alcohol disorders and other substance use disorders had the highest PP of UDT, among both the naïve (alcohol related disorder: 3.1%; other substance use disorder: 7.7%) and the naïve with a second follow-up prescription (alcohol related disorder: 4.1%; other substance use disorder: 11.7%) samples. Among the long-term sample, similar predictors were significant. Conclusions: Although there was an association between having risk factors for opioid misuse (e.g. past alchohol disorders and other substance use disorder diagnoses) and receiving UDT, the percentage of patients who received UDT was unexpectedly low, pointing to the need to increase guideline adherence and implementation among providers who prescribe opioids.
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Affiliation(s)
- Sarah Friedman
- School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada, USA
| | | | - Yan Liu
- School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada, USA
| | - Sarah Hartzell
- School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada, USA
| | - Michelle S Keller
- Department of Medicine, Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
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63
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Romberg AR, Miller Lo EJ, Barton AA, Xiao H, Vallone DM, Hair EC. Cigarette smoking, prescription opioid use and misuse among young adults: An exploratory analysis. Prev Med 2019; 129:105845. [PMID: 31518628 DOI: 10.1016/j.ypmed.2019.105845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/06/2019] [Accepted: 09/09/2019] [Indexed: 11/20/2022]
Abstract
Young adults have the highest prevalence of misuse of prescription opioids. In 2016, 7.1% of 18- to 25-year-olds reported misuse, meaning use other than as prescribed. While smoking is known to be associated with opioid use, to our knowledge no study has examined the relationships between smoking, prescribed use of opioids, and opioid misuse in young adults at the population level. Online survey data were collected in spring 2018 from a nationally representative sample of 18-25-year-olds from the Truth Longitudinal Cohort (N = 10,502). Respondents self-reported cigarette smoking, and both lifetime and recent (past 6-month) prescribed use and misuse of opioids. Generalized ordered logistic regression modeling was used to determine associations between cigarette smoking and recent prescribed use and misuse while controlling for demographic characteristics, other substance use, sensation seeking, and mental health status. Overall, 61.0% of respondents reported lifetime prescribed use of opioids and 16% reported recent prescribed use. Lifetime misuse was reported by 19.4%, with 7.8% reporting recent misuse. Together, the models revealed a graded relationship, with current smokers having higher odds of both prescribed use and misuse, never smokers having lowest odds of use or misuse, and ever smokers, those who had smoked but not in the past 30 days, falling between current and never smokers. Findings indicate a clear association between smoking and use of opioids even after accounting for a strong association between prescribed use and misuse among young adults.
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Affiliation(s)
- Alexa R Romberg
- Schroeder Institute at Truth Initiative, 900 G St. NW, Washington, DC, USA.
| | - Erin J Miller Lo
- Schroeder Institute at Truth Initiative, 900 G St. NW, Washington, DC, USA.
| | - Alexis A Barton
- Schroeder Institute at Truth Initiative, 900 G St. NW, Washington, DC, USA.
| | - Haijun Xiao
- Schroeder Institute at Truth Initiative, 900 G St. NW, Washington, DC, USA.
| | - Donna M Vallone
- Schroeder Institute at Truth Initiative, 900 G St. NW, Washington, DC, USA.
| | - Elizabeth C Hair
- Schroeder Institute at Truth Initiative, 900 G St. NW, Washington, DC, USA.
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Xiao D, Guo L, Zhao M, Zhang S, Li W, Zhang WH, Lu C. Effect of Sex on the Association Between Nonmedical Use of Opioids and Sleep Disturbance Among Chinese Adolescents: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4339. [PMID: 31703294 PMCID: PMC6888280 DOI: 10.3390/ijerph16224339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 11/16/2022]
Abstract
Sleep disturbance and non-medical prescription opioid use (NMPOU) are currently growing public health concerns, and sex differences may result in differential exposure to frequency of NMPOU or sleep disturbance. This study aimed to explore the association between the frequency of lifetime or past-year NMPOU and sleep disturbance and to evaluate whether there was any sex difference in this association among Chinese adolescents. A cross-sectional study was performed in seven randomly selected Chinese provinces through the 2015 School-Based Chinese Adolescents Health Survey. A total of 159,640 adolescents were invited to participate and among them, 148,687 adolescents' questionnaires were completed and qualified for this study (response rate: 93.14%). All analyses were performed for boys and girls separately. There were significant sex differences in the prevalence of lifetime or past-year opioid misuse and sleep disturbance (p < 0.05). Among girls, frequent lifetime NMPOU (adjusted odds ratio [aOR] = 2.09, 95% CI = 1.80-2.44) and past-year NMPOU (aOR = 2.16, 95% CI = 1.68-2.77) were positively associated with sleep disturbance. Among boys, these associations were also statistically significant, while the magnitudes of associations between frequent lifetime NMPOU or past-year NMPOU and sleep disturbance were greater in girls than those in boys. There is a significant sex difference in the prevalence of lifetime or past-year NMPOU and sleep disturbance. Furthermore, exposure to more frequent lifetime or past-year NMPOU is associated with a greater risk of sleep disturbance, especially among girls. Taking into account the sex difference for lifetime or past-year NMPOU may help to decrease the risk of sleep disturbance.
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Affiliation(s)
- Di Xiao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (D.X.); (L.G.); (M.Z.); (S.Z.); (W.L.)
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Ghent University, 9000 Gent, Belgium
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (D.X.); (L.G.); (M.Z.); (S.Z.); (W.L.)
| | - Meijun Zhao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (D.X.); (L.G.); (M.Z.); (S.Z.); (W.L.)
| | - Sheng Zhang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (D.X.); (L.G.); (M.Z.); (S.Z.); (W.L.)
| | - Wenyan Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (D.X.); (L.G.); (M.Z.); (S.Z.); (W.L.)
| | - Wei-Hong Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Ghent University, 9000 Gent, Belgium
- Research Laboratory for Human Reproduction, Faculty of Medicine, Université Libre de Bruxelles (ULB), 1050 Bruxelles, Belgium
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (D.X.); (L.G.); (M.Z.); (S.Z.); (W.L.)
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
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Risk Factors for Misuse of Prescribed Opioids: A Systematic Review and Meta-Analysis. Ann Emerg Med 2019; 74:634-646. [DOI: 10.1016/j.annemergmed.2019.04.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/02/2019] [Accepted: 04/17/2019] [Indexed: 01/24/2023]
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Fenton JJ, Agnoli AL, Xing G, Hang L, Altan AE, Tancredi DJ, Jerant A, Magnan E. Trends and Rapidity of Dose Tapering Among Patients Prescribed Long-term Opioid Therapy, 2008-2017. JAMA Netw Open 2019; 2:e1916271. [PMID: 31730189 PMCID: PMC6902834 DOI: 10.1001/jamanetworkopen.2019.16271] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/08/2019] [Indexed: 12/12/2022] Open
Abstract
Importance A 2016 Centers for Disease Control and Prevention prescribing guideline cautioned against higher-dose long-term opioid therapy and recommended tapering daily opioid doses by approximately 10% per week if the risks outweigh the benefits. Warnings have since appeared regarding potential hazards of rapid opioid tapering. Objectives To characterize US trends in opioid dose tapering among patients prescribed long-term opioids from 2008 to 2017 and identify patient-level variables associated with tapering and a more rapid rate of tapering. Design, Setting, and Participants This retrospective cohort study used deidentified medical and pharmacy claims and enrollment records for 100 031 commercial insurance and Medicare Advantage enrollees, representing a diverse mixture of ages, races/ethnicities, and geographical regions across the United States. Adults with stable, higher-dosage (mean, ≥50 morphine milligram equivalents [MMEs]/d) opioid prescriptions for a 12-month baseline period and 2 or more months of follow-up from January 1, 2008, to December 31, 2017, were included in the study. Main Outcomes and Measures Tapering was defined as 15% or more relative reduction in mean daily MME during any of 6 overlapping 60-day windows within a 7-month follow-up period. The rate of tapering was computed as the maximum monthly percentage dose reduction. Results Among the 100 031 participants (53 452 [53.4%] women; mean [SD] age, 57.6 [11.8] years), from 2008 to 2015, the age- and sex-standardized percentage of patients tapering daily opioid doses increased from 10.5% to 13.7% (adjusted incidence rate ratio [aIRR] per year, 1.05 [95% CI, 1.05-1.06]) before increasing to 16.2% in 2016 and 22.4% in 2017 (aIRR in 2016-2017 vs 2008-2015, 1.20 [95% CI, 1.16-1.25]). Patient-level covariates associated with tapering included female sex (aIRR, 1.13 [95% CI, 1.10-1.15]) and higher baseline dose (aIRR for ≥300 MMEs/d vs 50-89 MMEs/d, 2.57 [95% CI, 2.48-2.65]). Among patients tapering daily opioid doses, the mean (SD) maximum dose reduction was 27.6% (17.0%) per month, and 18.8% of patients had a maximum tapering rate exceeding 40% per month (ie, faster than 10% per week). More rapid dose reduction was associated with 2016-2017 vs 2008-2015 (adjusted difference, 1.4% [95% CI, 0.8%-2.1%]) and higher baseline dose (adjusted difference, 2.7% [95% CI, 2.2%-3.3%] for 90-149 vs 50-89 MMEs/d). Conclusions and Relevance Patients using long-term opioid therapy are increasingly undergoing dose tapering, particularly women and those prescribed higher doses; in addition, dose tapering has become more common since 2016. Many patients undergoing tapering reduce daily doses at a rapid maximum rate.
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Affiliation(s)
- Joshua J. Fenton
- Department of Family and Community Medicine, University of California, Davis, Sacramento
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
| | - Alicia L. Agnoli
- Department of Family and Community Medicine, University of California, Davis, Sacramento
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
| | - Guibo Xing
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
| | | | | | - Daniel J. Tancredi
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
- Department of Pediatrics, University of California, Davis, Sacramento
| | - Anthony Jerant
- Department of Family and Community Medicine, University of California, Davis, Sacramento
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
| | - Elizabeth Magnan
- Department of Family and Community Medicine, University of California, Davis, Sacramento
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
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You DS, Hah JM, Collins S, Ziadni MS, Domingue BW, Cook KF, Mackey SC. Evaluation of the Preliminary Validity of Misuse of Prescription Pain Medication Items from the Patient-Reported Outcomes Measurement Information System (PROMIS)®. PAIN MEDICINE (MALDEN, MASS.) 2019; 20:1925-1933. [PMID: 30856659 PMCID: PMC6784744 DOI: 10.1093/pm/pnz001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The National Institutes of Health's Patient-Reported Outcomes Measurement Information System (PROMIS)® includes an item bank for measuring misuse of prescription pain medication (PROMIS-Rx Misuse). The bank was developed and its validity evaluated in samples of community-dwelling adults and patients in addiction treatment programs. The goal of the current study was to investigate the validity of the item bank among patients with mixed-etiology chronic pain conditions. METHOD A consecutive sample of 288 patients who presented for initial medical evaluations at a tertiary pain clinic completed questionnaires using the open-source Collaborative Health Outcomes Information Registry. Participants were predominantly middle-aged (M [SD] = 51.6 [15.5] years), female (62.2%), and white/non-Hispanic (51.7%). Validity was evaluated by estimating the association between PROMIS-Rx Misuse scores and scores on other measures and testing the ability of scores to distinguish among risk factor subgroups expected to have different levels of prescription pain medicine misuse (known groups analyses). RESULTS Overall, score associations with other measures were as expected and scores effectively distinguished among patients with and without relevant risk factors. CONCLUSION The study results supported the preliminary validity of PROMIS-Rx Misuse item bank scores for the assessment of prescription opioid misuse in patients visiting an outpatient pain clinic.
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Affiliation(s)
- Dokyoung Sophia You
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Jennifer M Hah
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Sophie Collins
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Maisa S Ziadni
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Ben W Domingue
- Stanford University Graduate School of Education, Palo Alto, California
| | - Karon F Cook
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sean C Mackey
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
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Huhn AS, Tompkins DA, Campbell CM, Dunn KE. Individuals with Chronic Pain Who Misuse Prescription Opioids Report Sex-Based Differences in Pain and Opioid Withdrawal. PAIN MEDICINE (MALDEN, MASS.) 2019; 20:1942-1947. [PMID: 30690594 PMCID: PMC6784741 DOI: 10.1093/pm/pny295] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Individuals with chronic pain who misuse prescription opioids are at high risk for developing opioid use disorder and/or succumbing to opioid overdose. The current study conducted a survey to evaluate sex-based differences in pain catastrophizing, opioid withdrawal, and current pain in persons with co-occurring chronic pain and opioid misuse. We hypothesized that women with chronic pain who misused prescription opioids would self-report higher pain ratings compared with men and that the relationship between pain catastrophizing and self-reported current pain would be moderated by symptoms of opioid withdrawal in women only. Design Survey assessment of the relationship between pain and opioid misuse. Setting Online via Amazon Mechanical Turk. Participants Persons with ongoing chronic pain who also misused prescription opioids on one or more days in the last 30 days were eligible (N = 181). Methods Participants completed demographic and standardized assessments including the Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), and Subjective Opiate Withdrawal Scale (SOWS). Results Women reported higher levels of current (P < 0.001), average (P < 0.001), and worst (P = .002) pain in the last 24 hours compared with men. Women also endorsed higher scores on the PCS (P = 0.006) and marginally higher past-30-day SOWS ratings (P = 0.068) compared with men. SOWS ratings moderated the relationship between PCS and BPI Worst Pain in women (ΔR2 < 0.127, ΔF(1, 78) = 12.39, P = 0.001), but not in men (ΔR2 < 0.000, ΔF(1, 98) = 0.003, P = 0.954). Conclusions These data suggest a strong relationship between opioid withdrawal, pain catastrophizing, and the experience of pain in women with chronic pain who misuse opioids.
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Affiliation(s)
- Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - D Andrew Tompkins
- Department of Psychiatry, UCSF School of Medicine, San Francisco, California, USA
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Cheng T, Nosova E, Small W, Hogg RS, Hayashi K, DeBeck K. A gender-based analysis of nonmedical prescription opioid use among people who use illicit drugs. Addict Behav 2019; 97:42-48. [PMID: 31146150 DOI: 10.1016/j.addbeh.2019.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 03/09/2019] [Accepted: 05/20/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Research investigating the unique impacts associated with engaging in nonmedical prescription opioid use (NMPOU) among males and females who also use illicit drugs is needed. METHODS Data were collected between 2013 and 2017 from two linked prospective cohort studies in Vancouver: the At-Risk Youth Study and Vancouver Injection Drug Users Study. Generalized estimating equations were used to identify factors associated with engaging in NMPOU among females and males separately. RESULTS Among 1459 participants, 534 were female (37%). Similar proportions of females (46%) and males (48%) engaged in NMPOU at their first visit during the study period. In multivariable analyses, factors associated with NMPOU among both males and females included heroin use, overdose, drug dealing, and difficulty accessing health and social services. Among females, those who engaged in NMPOU were more likely to report Caucasian or white ethnicity, cocaine use, crystal methamphetamine use, and sex work; among males, those who engaged in NMPOU were older, reported crack use and engaged in binge drug use (all p < 0.05). CONCLUSION The prevalence of NMPOU was similar among males and females who use illicit drugs in Vancouver, and NMPOU was independently associated with markers of vulnerability among both genders. Findings highlight the need for a comprehensive public health approach to address NMPOU that integrates overdose prevention and reversal services, employment opportunities, and better access to services for both women and men.
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Bolshakova M, Bluthenthal R, Sussman S. Opioid use and misuse: health impact, prevalence, correlates and interventions. Psychol Health 2019; 34:1105-1139. [PMID: 31177850 PMCID: PMC7456364 DOI: 10.1080/08870446.2019.1622013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 05/09/2019] [Accepted: 05/16/2019] [Indexed: 12/30/2022]
Abstract
Objective: To provide a broad overview of the state of drug misuse research, particularly focusing on opioid drug use in the U.S.A. Design: An overview of published reviews of the literature. Results: Prescription opioid use has increased globally from 2008 to 2013, while use of opiates such as heroin and opium have remained stable in many countries, although, decreases have been observed in parts of Europe. Opioid misuse is highest in the United States; approximately 11.8 million Americans misused opioids in 2016. Demographic, genetic, psychosocial and structural/environmental factors all play a role in determining who will become an opioid misuser. Strategies such as increased prescribing of non-opioid derived pain relievers, expansion of medication treatment, distribution of naloxone for overdose reversal and supervised consumption sites are some of the solutions posed to reduce the spread and consequences of opioid misuse. Conclusion: Research focused on understanding of opioid neurobiology, as well as empirically based, effective alternatives to pain management and implementation studies on combined prevention and treatment approaches are needed. It will take the combined effort of community members, healthcare professionals, policymakers and researchers in order to prevent and treat opioid misuse.
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Affiliation(s)
- Maria Bolshakova
- Department of Preventive Medicine, University of Southern California , Los Angeles , CA , USA
| | - Ricky Bluthenthal
- Department of Preventive Medicine, University of Southern California , Los Angeles , CA , USA
| | - Steve Sussman
- Department of Preventive Medicine, University of Southern California , Los Angeles , CA , USA
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Griffioen C, Husebo BS, Flo E, Caljouw MAA, Achterberg WP. Opioid Prescription Use in Nursing Home Residents with Advanced Dementia. PAIN MEDICINE 2019; 20:50-57. [PMID: 29136228 DOI: 10.1093/pm/pnx268] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 10/04/2017] [Indexed: 11/14/2022]
Abstract
Background Although proper pain treatment may require opioids, discussion continues about possible undertreatment or overtreatment in persons with advanced dementia. Objective To investigate the prevalence of pain, frequency of opioid prescription use, and factors associated with strong opioid prescription use in nursing homes. Design Cross-sectional study. Setting and Subjects Eighteen Norwegian nursing homes; 327 persons with advanced dementia and behavioral disturbances participated. Methods Potential factors associated with strong opioid prescription use were assessed: demographics (age, gender), medical conditions (comorbidity, number of medications), pain (Mobilization-Observation-Behaviour-Intensity-Dementia-2 Pain Scale ≥ 3, pain-related diagnoses, analgesic prescription use), functioning (activities of daily living, Mini-Mental State Examination) and behavior (Neuropsychiatric Inventory-Nursing Home version, Cohen-Mansfield Agitation Inventory). Factors with P < 0.10, age, and gender were included in multivariate regression analysis. Results The prevalence of moderate to severe pain was 62.1%. Of all participants, 19.3% (N = 63) were prescribed opioids, and of these, 79.4% (N = 50) were still in pain; 66.7% of the opioid prescriptions were less than or equal to the lowest dosage of fentanyl patches (12 mcg/h) or buprenorphine (5 or 10 mcg/h). Pain (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.12-1.42), total number of pain-related diagnoses (OR = 1.47, 95% CI = 1.14-1.90), and depression and anxiety (OR = 1.05, 95% CI = 1.01-1.11) were positively associated with an opioid prescription. Stroke was negatively associated (OR = 0.43, 95% CI = 0.19-0.99). Conclusions Strong opioid prescription use was mainly associated with pain. However, in this population, despite the relatively prevalent use of strong prescription opioids, pain was still prevalent. This emphasizes the challenge of proper pain treatment and need for regular evaluation of pain and pain management.
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Affiliation(s)
- Charlotte Griffioen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.,Novicare, Elderly Care, Best, the Netherlands
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Elisabeth Flo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Monique A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Esser MB, Guy GP, Zhang K, Brewer RD. Binge Drinking and Prescription Opioid Misuse in the U.S., 2012-2014. Am J Prev Med 2019; 57:197-208. [PMID: 31200998 PMCID: PMC6642832 DOI: 10.1016/j.amepre.2019.02.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Prescription opioids were responsible for approximately 17,000 deaths in the U.S. in 2016. One in five prescription opioid deaths also involve alcohol. Drinkers who misuse prescription opioids (i.e., use without a prescription or use only for the experience or feeling it causes) are at a heightened risk of overdose. However, little is known about the relationship between drinking patterns and prescription opioid misuse. METHODS Data were analyzed from 160,812 individuals (aged ≥12 years) who responded to questions about prescription opioid misuse and alcohol consumption in the 2012, 2013, or 2014 National Survey on Drug Use and Health (analyzed in 2017-2018). The prevalence of self-reported past-30-days prescription opioid misuse was assessed by sociodemographic characteristics, other substance use (i.e., cigarettes, marijuana), and drinking patterns. Multiple logistic regression analyses were used to calculate AORs. RESULTS From 2012 to 2014, 1.6% (95% CI=1.5, 1.7) of all individuals aged ≥12 years (estimated 4.2 million) and 3.5% (95% CI=3.3, 3.8) of binge drinkers (estimated 2.2 million) reported prescription opioid misuse. Prescription opioid misuse was more common among binge drinkers than among nondrinkers (AOR=1.7, 95% CI=1.5, 1.9). Overall, the prevalence of prescription opioid misuse increased significantly with binge drinking frequency (p-value<0.001). CONCLUSIONS More than half of the 4.2 million people who misused prescription opioids during 2012-2014 were binge drinkers, and binge drinkers had nearly twice the odds of misusing prescription opioids, compared with nondrinkers. Widespread use of evidence-based strategies for preventing binge drinking might reduce opioid misuse and overdoses involving alcohol.
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Affiliation(s)
- Marissa B Esser
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Gery P Guy
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kun Zhang
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert D Brewer
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Prescription opioid misuse and the need to promote medication safety among adolescents. Res Social Adm Pharm 2019; 15:841-844. [DOI: 10.1016/j.sapharm.2019.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/26/2018] [Accepted: 01/07/2019] [Indexed: 01/19/2023]
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Ombach HJ, Scholl LS, Bakian AV, Renshaw KT, Sung YH, Renshaw PF, Kanekar S. Association between altitude, prescription opioid misuse, and fatal overdoses. Addict Behav Rep 2019; 9:100167. [PMID: 31193784 PMCID: PMC6542744 DOI: 10.1016/j.abrep.2019.100167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/10/2019] [Accepted: 02/01/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Prescription opioid misuse and fatal overdoses have increased significantly over the last two decades. Living at altitude has been linked to greater reward benefits of other drugs of abuse, and living at altitude may also exacerbate the respiratory depression linked to opioid use. Therefore, we examined the relationships between living at altitude, and prescription opioid misuse and fatal overdoses. METHOD State-level past year rates of prescription opioid misuse were retrieved from the Substance Abuse and Mental Health Services Administration. County-level overdose data were extracted from the Centers for Disease Control and Prevention. Multiple linear regression models were fit to determine the relationship between average state elevation and state rates of opioid misuse. Logistic regression models were fit to determine the relationship between county elevation and county-level fatal opioid overdose prevalence. RESULTS After controlling for state opioid prescribing rates and other confounders, we identified a significant positive association between mean state altitude and state-level opioid misuse rates for women, but not men. We also found a significant positive association between county-level altitude and prevalence of fatal opioid overdose. CONCLUSIONS Living at altitude is thus demographically associated with increasing rates of misuse of prescription opioids, as well as of cocaine and methamphetamine. Animal studies suggest that the hypobaric hypoxia exposure involved with living at altitude may disrupt brain neurochemistry, to increase reward benefits of drugs of abuse. This increased misuse of both stimulants and opioids may increase likelihood of overdose at altitude, with overdoses by opioid use also potentially facilitated by altitude-related hypoxia.
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Affiliation(s)
- Hendrik J. Ombach
- Department of Psychiatry, University of Utah School of Medicine, 383 Colorow Drive, Salt Lake City, UT, 84108, United States
| | - Lindsay S. Scholl
- Department of Psychiatry, University of Utah School of Medicine, 383 Colorow Drive, Salt Lake City, UT, 84108, United States
| | - Amanda V. Bakian
- Department of Psychiatry, University of Utah School of Medicine, 383 Colorow Drive, Salt Lake City, UT, 84108, United States
| | - Kai T. Renshaw
- Department of Psychiatry, University of Utah School of Medicine, 383 Colorow Drive, Salt Lake City, UT, 84108, United States
| | - Young-Hoon Sung
- Department of Psychiatry, University of Utah School of Medicine, 383 Colorow Drive, Salt Lake City, UT, 84108, United States
| | - Perry F. Renshaw
- Department of Psychiatry, University of Utah School of Medicine, 383 Colorow Drive, Salt Lake City, UT, 84108, United States
- Utah Science Technology and Research (USTAR) Initiative, Salt Lake City, UT, 84108, United States
- Rocky Mountain VISN19 Mental Illness Research, Education, and Clinical Centers (MIRECC), 500 Foothill Drive, Salt Lake City, UT, 84148, United States
- Salt Lake City Veterans Affairs Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, United States
| | - Shami Kanekar
- Department of Psychiatry, University of Utah School of Medicine, 383 Colorow Drive, Salt Lake City, UT, 84108, United States
- Rocky Mountain VISN19 Mental Illness Research, Education, and Clinical Centers (MIRECC), 500 Foothill Drive, Salt Lake City, UT, 84148, United States
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Gilmore AK, Guille C, Baker NL, Brady KT, Hahn CK, Davis CM, McCauley JL, Back SE. Gender differences in subjective stress and neuroendocrine response to a stress task among individuals with opioid dependence: A pilot study. Addict Behav 2019; 92:148-154. [PMID: 30640146 PMCID: PMC6499664 DOI: 10.1016/j.addbeh.2018.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Opioid dependence is a significant public health problem in the United States and the number of opioid overdose deaths among women has increased dramatically in comparison to men in the last few years. In this context, understanding the biological mechanisms underlying gender differences in vulnerability to opioid dependence is essential. METHODS The current pilot study examined gender differences in subjective stress, heart rate (HR), and cortisol/dephydroepiandrosterone (DHEA) response to a laboratory stressor (Trier Social Stress Test; TSST) or a no-stress condition, and drug cue paradigm among men (n = 21) and women (n = 18) with opioid dependence. RESULTS Significant group (TSST vs. no stress) differences emerged in self-reported stress [F(1,35) = 23.8, p < .001], HR [F(1,31) = 12.3; p = .001] and cortisol (F1,34 = 5.0; p = .032) response, such that the TSST group was more reactive than the no-stress group. Women reported greater subjective stress [F(1,35) = 6.5, p <= .015] in response to the TSST compared to men. However, men evidenced marginally greater cortisol and DHEA responses to the TSST compared to women [F(1,34) = 2.7; p = .113 and F(1,31) = 3.4; p = .073, respectively]. CONCLUSIONS Although women with opioid dependence reported greater subjective stress when exposed to a laboratory stress paradigm as compared to men, the neuroendocrine response was more robust in men. This pattern was similar to gender findings in men and women with cocaine and tobacco use disorders. The blunted cortisol combined with an increased subjective response among women may be a sign of HPA axis dysregulation which could increase vulnerability to relapse in women.
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Affiliation(s)
- Amanda K Gilmore
- College of Nursing, Medical University of South Carolina, United States; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States.
| | - Constance Guille
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, United States
| | - Kathleen T Brady
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States
| | - Christine K Hahn
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States
| | - Callah M Davis
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States
| | - Jenna L McCauley
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States
| | - Sudie E Back
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States
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Zin CS, Alias NE, Taufek NH, Ahmad MM. Sex differences in high opioid dose escalation among Malaysian patients with long term opioid therapy. J Pain Res 2019; 12:1251-1257. [PMID: 31118748 PMCID: PMC6499483 DOI: 10.2147/jpr.s199243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/26/2019] [Indexed: 01/16/2023] Open
Abstract
Purpose: This study evaluated the risk of opioid dose escalation as it relates to sex differences among patients receiving opioids for long-term therapy. Patients and methods: This retrospective cohort study was conducted in tertiary hospital settings in Malaysia using electronic prescription records. Opioid naïve patients, aged ≥18 years, who were undergoing long-term opioid therapy of ≥90 days, with at least one opioid prescription (buprenorphine, morphine, oxycodone, fentanyl, dihydrocodeine or tramadol) between 1st January 2011 and 31st December 2016, were included in the study. They were followed until (i) the end of the study period, (ii) death from any cause or (iii) discontinuation of therapy from their first opioid prescription without any intervals of ≥120 days between successive prescriptions. The risk of high opioid dose escalation to ≥100 mg/day and ≥200 mg/day relative to men and women was measured. Results: A total of 4688 patients (58.8% women, 41.3% men) on long-term opioid therapy were identified. Among these patients, 248 (5.29%) were escalated to high opioid doses of ≥100 mg/day and 69 (1.47%) were escalated to ≥200 mg/day. The escalation to high-dose opioid therapy was more likely to occur in men than in women, even after adjustment for age (dose ≥100 mg/day [adjusted hazard ratio 2.32; 95% confidence interval (CI), 1.79 to 3.00; p<0.0001] and ≥200 mg/day [adjusted hazard ratio 6.10; 95% CI, 3.39 to 10.98; p<0.0001]). Conclusion: The risk of opioid dose escalation differed between men and women, as men were at higher risk than women for high opioid dose escalation.
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Affiliation(s)
- Che Suraya Zin
- Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan Campus, 25200 Kuantan, Pahang, Malaysia
| | - Nor Elina Alias
- Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan Campus, 25200 Kuantan, Pahang, Malaysia
| | - Nor Hidayah Taufek
- Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan Campus, 25200 Kuantan, Pahang, Malaysia
| | - Mazlila Meor Ahmad
- Hospital Selayang, Lebuhraya Selayang-Kepong, 68100 Batu Caves, Selangor Darul Ehsan, Malaysia
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Abstract
BACKGROUND Prescription opioid misuse (POM) is a significant problem among U.S. adults, including Blacks, as indicated by past research. Despite potential gender differences in POM among Black adults, previous research has yet to examine this possibility. OBJECTIVES This study identified the prevalence and unique correlates of POM among both Black men and Black women. Results were compared to those of Whites. METHODS We used data from 2015-2016 National Survey on Drug Use and Health (N = 60,133). Weighted logistic regression models stratified by race and gender were estimated. One model was stratified by gender only, with race serving as the primary predictor. RESULTS Findings revealed 3.4% of Black women, 4.9% of Black men, 4.1% of White women, and 5.4% of White men reported past-year POM; although, no significant differences were found. Among Black women only, lower socioeconomic status increased odds of POM. Higher educational attainment, residence in rural areas and older age lowered odds of POM. Encounters with drug dealers, illicit drug, marijuana, and tobacco use, other prescription drug misuse, and poor health were associated with increased odds of POM among Black men. In the gender stratified models, White men were more likely to report POM than Black men. However, White women were not more likely to report POM compared to Black women. CONCLUSIONS Clear gender differences exist in the prevalence and correlates of POM among Black adults. Prevention and intervention strategies must be cognizant of these differences when developing programs to decrease POM.
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Affiliation(s)
- Harvey L Nicholson
- a Department of Sociology , University of Central Florida , Orlando , Florida , USA
| | - Jolene Vincent
- b Department of Sociology , College of William and Mary , Williamsburg , Virginia , USA
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Moningka H, Lichenstein S, Worhunsky PD, DeVito EE, Scheinost D, Yip SW. Can neuroimaging help combat the opioid epidemic? A systematic review of clinical and pharmacological challenge fMRI studies with recommendations for future research. Neuropsychopharmacology 2019; 44:259-273. [PMID: 30283002 PMCID: PMC6300537 DOI: 10.1038/s41386-018-0232-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/11/2018] [Accepted: 09/18/2018] [Indexed: 02/04/2023]
Abstract
The current opioid epidemic is an urgent public health problem, with enormous individual, societal, and healthcare costs. Despite effective, evidence-based treatments, there is significant individual variability in treatment responses and relapse rates are high. In addition, the neurobiology of opioid-use disorder (OUD) and its treatment is not well understood. This review synthesizes published fMRI literature relevant to OUD, with an emphasis on findings related to opioid medications and treatment, and proposes areas for further research. We conducted a systematic literature review of Medline and Psychinfo to identify (i) fMRI studies comparing OUD and control participants; (ii) studies related to medication, treatment, abstinence or withdrawal effects in OUD; and (iii) studies involving manipulation of the opioid system in healthy individuals. Following application of exclusionary criteria (e.g., insufficient sample size), 45 studies were retained comprising data from ~1400 individuals. We found convergent evidence that individuals with OUD display widespread heightened neural activation to heroin cues. This pattern is potentiated by heroin, attenuated by medication-assisted treatments for opioids, predicts treatment response, and is reduced following extended abstinence. Nonetheless, there is a paucity of literature examining neural characteristics of OUD and its treatment. We discuss limitations of extant research and identify critical areas for future neuroimaging studies, including the urgent need for studies examining prescription opioid users, assessing sex differences and utilizing a wider range of clinically relevant task-based fMRI paradigms across different stages of addiction.
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Affiliation(s)
- Hestia Moningka
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Sarah Lichenstein
- Yale School of Medicine, Radiology and Bioimaging Sciences, New Haven, CT, 06510, USA
| | - Patrick D Worhunsky
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Elise E DeVito
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Dustin Scheinost
- Yale School of Medicine, Radiology and Bioimaging Sciences, New Haven, CT, 06510, USA
| | - Sarah W Yip
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA.
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Transnational trends in prescription drug misuse among women: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 63:56-73. [DOI: 10.1016/j.drugpo.2018.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 09/14/2018] [Accepted: 10/09/2018] [Indexed: 12/21/2022]
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Lichenstein SD, Zakiniaeiz Y, Yip SW, Garrison KA. Mechanisms and Clinical Features of Co-occurring Opioid and Nicotine Use. CURRENT ADDICTION REPORTS 2019; 6:114-125. [PMID: 32864292 DOI: 10.1007/s40429-019-00245-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purpose of review To review the literature addressing shared pathophysiological and clinical features of opioid and nicotine use to inform etiology and treatment, and highlight areas for future research. Recent findings Opioid and nicotine use co-occur at an alarmingly high rate, and this may be driven in part by interactions between the opioid and cholinergic systems underlying drug reward and the transition to dependence. Pain, among other shared risk factors, is strongly implicated in both opioid and nicotine use and appears to play an important role in their co-occurrence. Additionally, there are important sex/gender considerations that require further study. Regarding treatment, smoking cessation can improve treatment outcomes in opioid use disorder, and pharmacological approaches that target the opioid and cholinergic systems may be effective for treating both classes of substance use disorders. Summary Understanding overlapping etiological and pathophysiological mechanisms of opioid and nicotine use can aid in understanding their co-occurrence and guiding their treatment.
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Affiliation(s)
| | - Yasmin Zakiniaeiz
- Department of Radiology & Biomedical Imaging, Yale School of Medicine
| | - Sarah W Yip
- Department of Psychiatry, Yale School of Medicine
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DiMarco LA, Ramger BC, Howell GP, Serrani AM, Givens DL, Rhon DI, Cook CE. Differences in Characteristics and Downstream Drug Use Among Opioid-Naïve and Prior Opioid Users with Low Back Pain. Pain Pract 2018; 19:149-157. [PMID: 30269416 DOI: 10.1111/papr.12728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/30/2018] [Accepted: 09/15/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Recent clinical practice guidelines have suggested conservative treatment approaches, including physical therapy, are indicated as first-line treatment for patients with low back pain (LBP); however, LBP continues to be managed with opioids, despite decreases in function, morbidity, and insignificant improvements in pain. OBJECTIVE The primary purpose was to compare characteristics and downstream medication use between patients with LBP with prior opioid exposure vs. those who were opioid-naïve. The secondary purpose was to explore the role of prior opioid use by LBP disability. METHODS Seven hundred and nine participants in a LBP self-management class were evaluated utilizing self-report data at baseline and longitudinal claims data from the Military Health System Data Repository. Participants were dichotomized into opioid-naïve and prior opioid use groups and then further divided into low and high disability groups based on Oswestry Disability Index (ODI) scores. Patient characteristics, comorbidities, and medication use were compared between groups. RESULTS Prior opioid users had significantly higher baseline ODI and Fear Avoidance Beliefs Questionnaire physical activity subscale and work subscale scores as well as pre-index instances of mental health disorders, chronic pain, and insomnia than opioid-naïve individuals. Prior opioid users filled significantly more pain medication prescriptions in the year after the index date than did opioid-naïve individuals. Prior opioid users were significantly more likely to be taking opioids at 1 year after the index date, regardless of disability level. CONCLUSION In patients presenting with LBP, prior opioid exposure appears to be related to increased analgesic use (opioid and non-opioid) and longitudinal analgesic utilization at 1 year after the index date.
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Affiliation(s)
- Lindsay A DiMarco
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina, U.S.A
| | - Benjamin C Ramger
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina, U.S.A
| | - Gregory P Howell
- Doctor of Physical Therapy Division, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Ali M Serrani
- Doctor of Physical Therapy Division, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Deborah L Givens
- Doctor of Physical Therapy Division, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Daniel I Rhon
- Doctoral Programs in Physical Therapy, Baylor University, San Antonio, Texas, U.S.A
| | - Chad E Cook
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina, U.S.A
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Coloma-Carmona A, Carballo JL, Rodríguez-Marín J, Pérez-Carbonell A, Alonso-Garrido C. Medical and psychological predictors of prescription opioids dependence during chronic pain treatment. EUROPEAN REVIEW OF APPLIED PSYCHOLOGY-REVUE EUROPEENNE DE PSYCHOLOGIE APPLIQUEE 2018. [DOI: 10.1016/j.erap.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Vest NA, Murphy KT, Tragesser SL. Borderline personality disorder features and drinking, cannabis, and prescription opioid motives: Differential associations across substance and sex. Addict Behav 2018; 87:46-54. [PMID: 29945027 DOI: 10.1016/j.addbeh.2018.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Drinking motives have shown meaningful associations with borderline personality disorder (BPD) features. However, it is unknown whether other common substances of abuse (namely cannabis and prescription opioids) have the same associations with BPD features. In the present study, we tested associations between BPD features and motives across three substances: alcohol, cannabis, and prescription opioids. The purpose of the study was to determine whether BPD showed similar patterns of associations across drugs, or whether some substances serve particular functions for individuals with BPD features, and whether this also varies by sex in a college student sample. METHOD Five-hundred ninety-four college students completed online questionnaires measuring demographics, borderline personality disorder features, substance use, and substance specific motives for alcohol, cannabis, and prescription opioid use. RESULTS BPD was most strongly associated with coping motives across all substances. For both alcohol and cannabis, this was true for both males and females, along with conformity motives. For prescription opioids, coping, social, enhancement, and pain motives were only significantly related to BPD features for females. When compared statistically, it was found that the associations with coping drinking motives and opioid pain motives were higher among females. CONCLUSIONS This pattern of results suggests that negatively reinforcing motives (coping and conformity) play a similar functional role in borderline personality and substance use disorder pathology for alcohol and cannabis, but for prescription opioids the negative reinforcement motives (coping and pain) were only evident in females.
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Nahata R, Mancino MJ, Thostenson J, Oliveto AH. Survey of Treatment Preferences for Opioid Use Disorder. JACOBS JOURNAL OF ADDICTION AND THERAPY 2018; 5:30. [PMID: 31131330 PMCID: PMC6530927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES This study gathered preliminary information on the initial feasibility of using injection Naltrexone (NTX) therapy in opioid users. METHODS One hundred opioid users (36% female, 8% minorities, mean age 34.5±11.4 yrs.) undergoing a health screen to determine initial eligibility for an ongoing study completed the survey. RESULTS Of the 100 respondents, 26, 16, 16, 1 and 0 reported prior treatment episodes of opioid detoxification, buprenorphine (BUP), methadone (MTD), oral NTX and injection NTX, respectively. Ninety and 71% were interested in participating in a study involving oral and/or injection NTX treatment, respectively. Reasons for not wanting to try injection NTX included fear of needles (n=13), side effects (n=7), lack of pain relief (n=12) and cost (n=3). A significantly higher percentage of those interested in injection NTX had episodes of prior opioid agonist maintenance treatment relative to those uninterested (32.4% vs 10.3%; Chi2=5.2, p<0.03). Those preferring injection NTX therapy showed a higher level of interest in this therapy (3.08±1.01 vs 1.62±1.35; Rank Sum p<0.0001) and a lower degree of interest in BUP treatment (2.96±0.93 vs 3.38±0.90; Rank Sum p< 0.03) than those not preferring injection NTX. CONCLUSIONS These preliminary results suggest that those with prior, failed experience with opioid agonist maintenance treatment are more likely to consider injection NTX therapy, suggesting it may be optimal as a second-line treatment for OUD.
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Affiliation(s)
- Ravi Nahata
- Division of Mental Health Service, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, Bldg. 170, Rm. 3L 105, North Little Rock, AR 72114
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR 72205, USA
| | - Michael J. Mancino
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR 72205, USA
| | - Jeff Thostenson
- Department of Biostatistics, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR 72205, USA
| | - Alison H. Oliveto
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR 72205, USA
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Cheng T, Small W, Dong H, Nosova E, Hayashi K, DeBeck K. An age-based analysis of nonmedical prescription opioid use among people who use illegal drugs in Vancouver, Canada. Subst Abuse Treat Prev Policy 2018; 13:41. [PMID: 30482215 PMCID: PMC6260714 DOI: 10.1186/s13011-018-0180-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 11/13/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Nonmedical prescription opioid use (NMPOU) is a serious public health problem in North America. At a population-level, previous research has identified differences in the prevalence and correlates of NMPOU among younger versus older age groups; however, less is known about age-related differences in NMPOU among people who use illegal drugs. METHODS Data were collected between 2013 and 2015 from two linked prospective cohort studies in Vancouver, Canada: the At-Risk Youth Study (ARYS) and the Vancouver Injection Drug Users Study (VIDUS). Factors independently associated with NMPOU among younger (ARYS) and older (VIDUS) participants were examined separately using bivariate and multivariate generalized estimating equations. RESULTS A total of 1162 participants were included. Among 405 eligible younger participants (Median age = 25; Inter-Quartile Range [IQR]: 22-28), 40% (n = 160) reported engaging in NMPOU at baseline; among 757 older participants (Median age = 48, IQR: 40-55), 35% (n = 262) reported engaging in NMPOU at baseline. In separate multivariate analyses of younger and older participants, NMPOU was positively and independently associated with heroin use (younger: Adjusted Odds Ratio [AOR] = 3.12, 95% Confidence Interval [CI]: 2.08-4.68; older: AOR = 2.79, 95% CI: 2.08-3.74), drug dealing (younger: AOR = 2.22, 95% CI: 1.58-3.13; older: AOR = 1.87, 95% CI: 1.40-2.49), and difficulty accessing services (younger: AOR = 1.47, 95% CI: 1.04-2.09; older: AOR = 1.74, 95% CI: 1.32-2.29). Among the youth cohort only, NMPOU was associated with younger age (AOR = 1.12, 95% CI: 1.05-1.19), crack use (AOR = 1.56, 95% CI: 1.06-2.30), and binge drug use (AOR = 1.41, 95% CI: 1.00-1.97); older participants who engaged in NMPOU were more likely to report crystal methamphetamine use (AOR = 1.97, 95% CI: 1.46-2.66), non-fatal overdose (AOR = 1.76, 95% CI: 1.20-2.60) and sex work (AOR = 1.49, 95% CI: 1.00-2.22). DISCUSSION The prevalence of NMPOU is similar among younger and older people who use drugs, and independently associated with markers of vulnerability among both age groups. Adults who engage in NMPOU are at risk for non-fatal overdose, which highlights the need for youth and adult-specific strategies to address NMPOU that include better access to health and social services, as well as a range of addiction treatment options for opioid use. Findings also underscore the importance of improving pain treatment strategies tailored for PWUD.
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Affiliation(s)
- Tessa Cheng
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
| | - Will Small
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
- Centre for Applied Research in Mental Health and Addiction, SFU Faculty of Health Sciences, 515 W. Hastings Street, Vancouver, BC V6B 5K3 Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Ekaterina Nosova
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
| | - Kanna Hayashi
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
- School of Public Policy, Simon Fraser University, 515 West Hastings Street, Suite 3271, Vancouver, BC V6B 5K3 Canada
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Enman NM, Reyes BAS, Shi Y, Valentino RJ, Van Bockstaele EJ. Sex differences in morphine-induced trafficking of mu-opioid and corticotropin-releasing factor receptors in locus coeruleus neurons. Brain Res 2018; 1706:75-85. [PMID: 30391476 DOI: 10.1016/j.brainres.2018.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/24/2018] [Accepted: 11/01/2018] [Indexed: 01/18/2023]
Abstract
The locus coeruleus (LC)-norepinephrine (NE) system is a key nucleus in which endogenous opioid and stress systems intersect to regulate the stress response. LC neurons of male rats become sensitized to stress following chronic morphine administration. Whether sex dictates this pattern of opioid-induced plasticity has not been demonstrated. Delineating the neurobiological adaptations produced by chronic opioids will enhance our understanding of stress vulnerability in opioid-dependent individuals, and may reveal how stress negatively impacts addiction recovery. In the present study, the effect of chronic morphine on the subcellular distribution of mu-opioid (MOR) and CRF receptors (CRFR) was investigated in the LC of male and female rats using immunoelectron microscopy. Results showed that placebo-treated females exhibited higher MOR and CRFR cytoplasmic distribution ratio when compared to placebo-treated males. Chronic morphine exposure induced a shift in the distribution of MOR immunogold-silver particles from the plasma membrane to the cytoplasm selectively in male LC neurons. Interestingly, chronic morphine exposure induced CRFR recruitment to the plasma membrane of both male and female LC neurons. These findings provide a potential mechanism by which chronic opioid administration increases stress vulnerability in males and females via an increase in surface availability of CRFR in LC neurons. However, our results also support the notion that cellular adaptations to chronic opioids differ across the sexes as redistribution of MOR following morphine exposure was only observed in male LC neurons.
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Affiliation(s)
- Nicole M Enman
- Department of Pharmacology and Physiology, College of Medicine, Drexel University, Philadelphia, PA 19102, USA.
| | - Beverly A S Reyes
- Department of Pharmacology and Physiology, College of Medicine, Drexel University, Philadelphia, PA 19102, USA.
| | - Yufan Shi
- Department of Pharmacology and Physiology, College of Medicine, Drexel University, Philadelphia, PA 19102, USA
| | - Rita J Valentino
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Elisabeth J Van Bockstaele
- Department of Pharmacology and Physiology, College of Medicine, Drexel University, Philadelphia, PA 19102, USA.
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Ford JA, Hinojosa MS, Nicholson HL. Disability status and prescription drug misuse among U.S. adults. Addict Behav 2018; 85:64-69. [PMID: 29852357 DOI: 10.1016/j.addbeh.2018.05.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/24/2018] [Accepted: 05/23/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The U.S. is in the midst of a public health crisis related to drug overdose deaths. Largely responsible for the dramatic increase in overdose deaths is the misuse of prescription drugs such as opioids and benzodiazepines. While much research attention has focused on correlates of prescription drug misuse in recent years, notable gaps in the literature remain. The current research addresses one of these gaps by examining the relationship between disability status and prescription drug misuse. METHOD We examine data from the 2015 National Survey on Drug use and Health, a leading source of epidemiological data on drug use in the United States that added questions related to disability status to the 2015 survey. The current research assessed the relationship between disability status (i.e. activities of daily living and instrumental activities of daily living) and prescription drug misuse (i.e. opioids and benzodiazepines) among adults. RESULTS Findings from multinomial logistic regression analysis showed that a disability related to activities of daily living was correlated with opioid misuse, while a disability associated with instrumental activities of daily living was associated with benzodiazepine misuse and misuse of both. In addition, health related measures had a greater impact on the relationship between disability status and prescription drug misuse than did the social engagement/isolation measures. CONCLUSION Findings indicated that disability status is a significant correlate of prescription drug misuse. However, this relationship was largely mediated by measures associated with poor health and social engagement/isolation.
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Affiliation(s)
- Jason A Ford
- Department of Sociology, University of Central Florida, Orlando, FL 32816, United States.
| | | | - Harvey L Nicholson
- Department of Sociology, University of Central Florida, Orlando, FL 32816, United States
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Bilsker D, Fogarty AS, Wakefield MA. Critical Issues in Men's Mental Health. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:590-596. [PMID: 29673272 PMCID: PMC6109879 DOI: 10.1177/0706743718766052] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This narrative review highlights key issues in men's mental health and identifies approaches to research, policy and practice that respond to men's styles of coping. Issues discussed are: 1) the high incidence of male suicide (80% of suicide deaths in Canada, with a peak in the mid-50 s age group) accompanied by low public awareness; 2) the perplexing nature of male depression, manifesting in forms that are poorly recognised by current diagnostic approaches and thus poorly treated; 3) the risky use of alcohol among men, again common and taking a huge toll on mental and physical health; 4) the characteristic ways in which men manage psychological suffering, the coping strengths to be recognised, and the gaps to be addressed; 5) the underutilization of mental health services by men, and the implication for clinical outcomes; and 6) male-specific approaches to service provision designed to improve men's accessing of care, with an emphasis on Canadian programs. The main conclusion is that a high proportion of men in Western society have acquired psychological coping strategies that are often dysfunctional. There is a need for men to learn more adaptive coping approaches long before they reach a crisis point. Recommendations are made to address men's mental health through: healthcare policy that facilitates access; research on tailoring interventions to men; population-level initiatives to improve the capacity of men to cope with psychological distress; and clinical practice that is sensitive to the expression of mental health problems in men and that responds in a relevant manner.
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Affiliation(s)
- Dan Bilsker
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Andrea S. Fogarty
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Matthew A. Wakefield
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
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Prescription opioid dispensing in New South Wales, Australia: spatial and temporal variation. BMC Pharmacol Toxicol 2018; 19:30. [PMID: 29914572 PMCID: PMC6006696 DOI: 10.1186/s40360-018-0219-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/30/2018] [Indexed: 11/12/2022] Open
Abstract
Background Patterns of opioid dispensing often exhibit substantial temporal and geographical variability, which has implications for public health policy decisions and interventions. The study examined recent trends in prescription opioid dispensing and identified high dispensing areas and factors associated with the doses dispensed. Methods Three years (1 January 2013–31 December 2015) of dispensing data of prescription opioids in local government areas (LGAs) for New South Wales (NSW), Australia’s most populous state, were analyzed. The proportion of individuals who were dispensed opioids was computed for four age-groups. A Chi-square test was used to examine trends over time in proportions of the population who were dispensed opioids in four age-groups. The number of prescriptions over time and quantities in daily defined dose/1000 people/day (denoted DDD) were also examined. LGAs with relatively high levels of dispensing were identified and mapped. A multivariate regression model was used to identify factors associated with DDD. Results Overall, codeine, oxycodone and tramadol were the main opioids in terms of DDD, number of prescriptions and number of individuals who were dispensed these medications. Quantity (in DDD), and population dispensed to were consistently higher for women than men over time. Proportions of individuals who were dispensed opioids increased significantly over time in all four age-groups. In the multivariate model, age, urbanization, sex and socio-economic indexes for areas were significantly associated with doses dispensed among opioid users. All areas with very high dispensing were outside major metropolitan areas. Conclusions Given that over-use of opioids is a major public health problem and that long-term use has substantial side effects including dependence, it is important to understand spatial patterns of opioid prescribing to enable targeted interventions. Nationwide implementation of real-time drug-monitoring programs and access to monitoring databases from both doctor and pharmacy point-of-care sources may potentially reduce excessive and undue use of opioid.
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91
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Radell ML, Allen MT, Favaloro B, Myers CE, Haber P, Morley K, Moustafa AA. Intolerance of uncertainty and conditioned place preference in opioid addiction. PeerJ 2018; 6:e4775. [PMID: 29844956 PMCID: PMC5967368 DOI: 10.7717/peerj.4775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/25/2018] [Indexed: 11/20/2022] Open
Abstract
Several personality factors have been implicated in vulnerability to addiction by impacting learning and decision making. One such factor is intolerance of uncertainty (IU), the tendency to perceive uncertain situations negatively and avoid them. Conditioned place preference (CPP), which compares preference for contexts paired with reward, has been used to examine the motivation for both drug and non-drug rewards. However, preference for locations associated with non-drug reward, as well as the potential influence of IU, has not been thoroughly studied in individuals with addiction. In the current study, we examined CPP using a computer-based task in a sample of addicted individuals undergoing opioid maintenance treatment and never-addicted controls. Patients were confirmed to have higher IU than controls. In the CPP task, the two groups did not differ in overall time spent in the previously-rewarded context. However, controls were more likely than patients to immediately return to this context. Contrary to our predictions, IU was not a significant predictor of preference for the previously-rewarded context, although higher IU in controls was associated with a higher number of rewards obtained in the task. No such relationship was found in patients.
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Affiliation(s)
- Milen L Radell
- Department of Psychology, Niagara University, Lewiston, NY, United States of America
| | - Michael Todd Allen
- School of Psychological Sciences, University of Northern Colorado, Greeley, CO, United States of America
| | - Belinda Favaloro
- School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Catherine E Myers
- Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America.,Department of Pharmacology, Physiology & Neuroscience, New Jersey Medical School, Rutgers University, Newark, NJ, United States of America
| | - Paul Haber
- Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten Morley
- Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ahmed A Moustafa
- School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia.,Marcs Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, New South Wales, Australia
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92
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Barbosa-Leiker C, McPherson S, Layton ME, Burduli E, Roll JM, Ling W. Sex differences in opioid use and medical issues during buprenorphine/naloxone treatment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 44:488-496. [PMID: 29672167 DOI: 10.1080/00952990.2018.1458234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND There are sex differences in buprenorphine/naloxone clinical trials for opioid use. While women have fewer opioid-positive urine samples, relative to men, a significant decrease in opioid-positive samples was found during treatment for men, but not women. In order to inform sex-based approaches to improve treatment outcomes, research is needed to determine if opioid use, and predictors of opioid use, differs between men and women during treatment. OBJECTIVES To test for sex differences in opioid use during a buprenorphine/naloxone clinical trial and determine if sex differences exist in the associations between addiction-related problem areas and opioid use over the course of the trial. METHOD This secondary data analysis of the National Drug Abuse Treatment Clinical Trials Network (CTN) 0003 examined sex differences (men = 347, women = 169) in opioid-positive samples in a randomized clinical trial comparing 7-day vs. 28-day buprenorphine/naloxone tapering strategies. Addiction-related problem areas were defined by Addiction Severity-Lite (ASI-L) domain composite scores. RESULTS Women were more likely than men to use opioids during the course of the buprenorphine/naloxone clinical trial (B = .33, p = .01) and medical issues were positively related to submitting an opioid-positive sample during treatment for women (B = 1.67, p = .01). No ASI-L domain composite score was associated with opioid-positive samples during treatment for men. CONCLUSION Women were more likely than men to use opioids during the course of the buprenorphine/naloxone clinical trial, and medical issues predicted opioid use during treatment for women but not men. Complementary treatment for medical problems during opioid replacement therapy may benefit women.
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Affiliation(s)
- Celestina Barbosa-Leiker
- a College of Nursing , Washington State University , Spokane , WA , USA.,b Program of Excellence in Addictions Research , Washington State University , Spokane , WA , USA.,c Translational Addictions Research Center , Washington State University , Spokane , WA , USA
| | - Sterling McPherson
- b Program of Excellence in Addictions Research , Washington State University , Spokane , WA , USA.,c Translational Addictions Research Center , Washington State University , Spokane , WA , USA.,d Elson S. Floyd College of Medicine , Washington State University , Spokane , WA , USA
| | - Matthew E Layton
- b Program of Excellence in Addictions Research , Washington State University , Spokane , WA , USA.,c Translational Addictions Research Center , Washington State University , Spokane , WA , USA.,d Elson S. Floyd College of Medicine , Washington State University , Spokane , WA , USA
| | - Ekaterina Burduli
- b Program of Excellence in Addictions Research , Washington State University , Spokane , WA , USA.,c Translational Addictions Research Center , Washington State University , Spokane , WA , USA.,d Elson S. Floyd College of Medicine , Washington State University , Spokane , WA , USA
| | - John M Roll
- b Program of Excellence in Addictions Research , Washington State University , Spokane , WA , USA.,c Translational Addictions Research Center , Washington State University , Spokane , WA , USA.,d Elson S. Floyd College of Medicine , Washington State University , Spokane , WA , USA
| | - Walter Ling
- e Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine , University of California , Los Angeles , CA , USA.,f Integrated Substance Abuse Programs , University of California , Los Angeles , CA , USA
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93
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Gender differences in trends for heroin use and nonmedical prescription opioid use, 2007–2014. J Subst Abuse Treat 2018; 87:79-85. [DOI: 10.1016/j.jsat.2018.01.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/17/2017] [Accepted: 01/02/2018] [Indexed: 02/08/2023]
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94
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Rogers AH, Bakhshaie J, Lam H, Langdon KJ, Ditre JW, Zvolensky MJ. Pain-related anxiety and opioid misuse in a racially/ethnically diverse young adult sample with moderate/severe pain. Cogn Behav Ther 2018; 47:372-382. [PMID: 29482460 DOI: 10.1080/16506073.2018.1436085] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Pain problems are of significant public health concern, and with opioid-related problems and death due to overdose at an all-time high, there is significant public health importance to identify risk factors that link instances of pain to opioid misuse among persons with pain whether or not they have been prescribed opioids for pain management. Severe pain and pain-related problems have been associated with increased risk for opioid misuse, and recent research indicates that pain-related anxiety (worry about the negative consequences of pain) may contribute to a more debilitating pain experience. Additionally, pain-related anxiety has previously been linked to substance use motives and dependence for cannabis and tobacco. However, little research has examined pain-related anxiety as a transdiagnostic risk factor for opioid misuse. The current study examined the relationship between pain-related anxiety and self-reported opioid misuse (addiction, prescription denial, family concerns, detox) in a racially/ethnically diverse sample of young adults (N = 256, M age = 22.84) reporting moderate to severe bodily pain over the previous four weeks. Results indicated that pain-related anxiety was significantly related to several indicators of opioid misuse as well as an increased number of opioid-related problems. Findings from the current study suggest that targeting pain-related anxiety may be one therapeutic strategy to reduce opioid misuse.
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Affiliation(s)
- Andrew H Rogers
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Jafar Bakhshaie
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Hantin Lam
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Kirsten J Langdon
- b Department of Psychiatry , Rhode Island Hospital , Providence , RI , USA.,c Department of Psychiatry and Human Behavior , Alpert Medical School of Brown University , Providence , RI , USA
| | - Joseph W Ditre
- d Department of Psychology , Syracuse University , Syracuse , NY , USA
| | - Michael J Zvolensky
- a Department of Psychology , University of Houston , Houston , TX , USA.,e Department of Behavioral Sciences , University of Texas MD Anderson Cancer Center , Houston , TX , USA
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95
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Koons AL, Rayl Greenberg M, Cannon RD, Beauchamp GA. Women and the Experience of Pain and Opioid Use Disorder: A Literature-based Commentary. Clin Ther 2018; 40:190-196. [DOI: 10.1016/j.clinthera.2017.12.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 01/08/2023]
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96
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Al Achkar M, Grannis S, Revere D, MacKie P, Howard M, Gupta S. The effects of state rules on opioid prescribing in Indiana. BMC Health Serv Res 2018; 18:29. [PMID: 29347984 PMCID: PMC5774127 DOI: 10.1186/s12913-018-2830-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 01/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prescription opioids have been linked to over half of the 28,000 opioid overdose deaths in 2014. High rates of prescription opioid non-medical use have continued despite nearly all states implementing large-scale prescription drug monitoring programs (PDMP), which points to the need to examine the impact of state PDMP's on curbing inappropriate opioid prescribing. In the short-term, PDMPs have been associated with short-term prescribing declines. Yet little is known about how such policies differentially impact patient subgroups or are interpreted by prescribing providers. Our objective was to compare volumes of prescribed opioids before and after Indiana implemented opioid prescribing emergency rules and stratify the changes in opioid prescribing by patient and provider subgroups. METHODS An interrupted time series analysis was conducted using data obtained from the Indiana PDMP. Prescription level data was merged with census data to characterize patient socioeconomic status. Analyses were stratified by patients' gender, age, opioid dosage, and payer. The primary outcome indicator was the total morphine equivalent dose (MED) of dispensed opioids per day in the state of Indiana. Also considered were number of unique patients, unique providers, and prescriptions; MED per transaction and per day; and number of days supplied. RESULTS After controlling for time trends, we found that total MED for opioids decreased after implementing the new emergency rules, differing by patient gender, age, and payer. The effect was larger for males than females and almost 10 times larger for 0-20 year olds as compared to the 60+ age range. Medicare and Medicaid patients experienced more decline in prescribing than patients with private insurance. Patients with prescriptions paid for by workers' comp experienced the most significant decline. The emergency rules were associated with decline in both the number of prescribers and the number of day supply. CONCLUSIONS Although the Indiana opioid prescribing emergency rules impacted statewide prescribing behavior across all individual patient and provider characteristics, the emergency rules' effect was not consistent across patient characteristics. Further studies are needed to assess how individual patient characteristics influence the interpretation and application of state policies on opioid prescribing.
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Affiliation(s)
| | - Shaun Grannis
- Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Indianapolis, IN, USA
| | - Debra Revere
- University of Washington School of Public Health, Seattle, WA, USA
| | - Palmer MacKie
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Meredith Howard
- University of North Texas System College of Pharmacy, Fort Worth, TX, USA
| | - Sumedha Gupta
- Indiana University-Purdue University School of Liberal Art, Indianapolis, IN, USA
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Plank-Bazinet JL, Sampson A, Kornstein SG, Germino GG, Robert-Guroff M, Gilman SE, Wetherington CL, Cook N, Cornelison TL, Begg L, Clayton JA. A Report of the 24th Annual Congress on Women's Health-Workshop on Transforming Women's Health: From Research to Practice. J Womens Health (Larchmt) 2018; 27:115-120. [PMID: 29341869 DOI: 10.1089/jwh.2017.29016.orwh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sex and gender are critical contributors to overall health and disease, and considering both in research informs the development of prevention strategies and treatment interventions for both men and women. The National Institutes of Health (NIH) Office of Research on Women's Health sponsored a preconference workshop on this topic at the 24th Annual Women's Health Congress, which was held in Crystal City, VA, in April 2016. The workshop featured presentations by NIH intramural and extramural scientists who presented data on a variety of topics including polycystic kidney disease, vaccine protection, depression, drug addiction, and cardiovascular disease. In this publication, we discuss the major points of each presentation and demonstrate the importance of considering sex and gender in biomedical research.
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Affiliation(s)
| | - Annie Sampson
- 1 Office of Research on Women's Health, National Institutes of Health , Bethesda, Maryland
| | - Susan G Kornstein
- 2 Department of Psychiatry, Institute for Women's Health , Virginia Commonwealth University, Richmond, Virginia
| | - Gregory G Germino
- 3 Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases , National Institutes of Health, Bethesda, Maryland
| | - Marjorie Robert-Guroff
- 4 Immune Biology of Retroviral Infection Section, Vaccine Branch, National Cancer Institute , National Institutes of Health, Bethesda, Maryland
| | - Stephen E Gilman
- 5 Health Behavior Branch, Division of Intramural Population Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development , National Institutes of Health, Bethesda, Maryland
| | - Cora Lee Wetherington
- 6 Behavioral and Cognitive Neuroscience Branch, Division of Neuroscience and Behavior, National Institute on Drug Abuse , National Institutes of Health, Bethesda, Maryland
| | - Nakela Cook
- 7 Office of the Director, National Heart, Lung, and Blood Institute, National Institutes of Health , Bethesda, Maryland
| | - Terri L Cornelison
- 1 Office of Research on Women's Health, National Institutes of Health , Bethesda, Maryland
| | - Lisa Begg
- 1 Office of Research on Women's Health, National Institutes of Health , Bethesda, Maryland
| | - Janine Austin Clayton
- 1 Office of Research on Women's Health, National Institutes of Health , Bethesda, Maryland
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Affective dysregulation predicts incident nonmedical prescription analgesic use among college students. Addict Behav 2018; 76:328-334. [PMID: 28889062 DOI: 10.1016/j.addbeh.2017.08.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/25/2017] [Accepted: 08/29/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION This study investigated the relationship between four suspected risk factors-affective dysregulation, conduct problems, depressive symptoms, and psychological distress-and incident nonmedical prescription analgesic (NPA) use among college students. METHODS The sample was derived from 929 college students from a large, mid-Atlantic university who completed the third annual College Life Study assessment (Y3) and were NPA use naïve at baseline (Y1). A series of logistic regression analyses were conducted to evaluate the predictors of incident NPA use by Y3. Separate models were developed to evaluate the association between the suspected risk factors and (a) NPA use relative to non-use of other drugs, including nonmedical use of other drug classes, (b) NPA use relative to other drug use, and (c) other drug use relative to non-use. All models included gender, parental education level, and race/ethnicity. RESULTS Affective dysregulation was significantly associated with becoming an incident NPA user relative to both drug users without NPA use as well as non-users, after statistically controlling for demographic characteristics and other factors. Conduct problems in early childhood were positively related to both incident NPA use and other drug use without NPA use relative to non-users, after statistically controlling for demographic characteristics and other factors. Depressive symptoms were associated with NPA incidence at the bivariate level only. CONCLUSIONS These findings extend previous research suggesting that NPA use might be related to deficits in regulating negative emotional states, and highlight possible markers for screening and intervention to prevent NPA use.
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Marks KR, Leukefeld CG. Recovering to Recovery Among Adolescent Youth. ADOLESCENT SUBSTANCE ABUSE 2018. [DOI: 10.1007/978-3-319-90611-9_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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100
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Al Achkar M, Revere D, Dennis B, MacKie P, Gupta S, Grannis S. Exploring perceptions and experiences of patients who have chronic pain as state prescription opioid policies change: a qualitative study in Indiana. BMJ Open 2017; 7:e015083. [PMID: 29133312 PMCID: PMC5695446 DOI: 10.1136/bmjopen-2016-015083] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The misuse and abuse of prescription opioids (POs) is an epidemic in the USA today. Many states have implemented legislation to curb the use of POs resulting from inappropriate prescribing. Indiana legislated opioid prescribing rules that went into effect in December 2013. The rules changed how chronic pain is managed by healthcare providers. This qualitative study aims to evaluate the impact of Indiana's opioid prescription legislation on the patient experiences around pain management. SETTING This is a qualitative study using interviews of patient and primary care providers to obtain triangulated data sources. The patients were recruited from an integrated pain clinic to which chronic pain patients were referred from federally qualified health clinics (FQHCs). The primacy care providers were recruited from the same FQHCs. The study used inductive, emergent thematic analysis. PARTICIPANTS Nine patient participants and five primary care providers were included in the study. RESULTS Living with chronic pain is disruptive to patients' lives on multiple dimensions. The established pain management practices were disrupted by the change in prescription rules. Patient-provider relationships, which involve power dynamics and decision making, shifted significantly in parallel to the rule change. CONCLUSIONS As a result of the changes in pain management practice, some patients experienced significant challenges. Further studies into the magnitude of this change are necessary. In addition, exploring methods for regulating prescribing while assuring adequate access to pain management is crucial.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Debra Revere
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Barbara Dennis
- School of Education, Indiana University, Bloomington, Indiana, USA
| | - Palmer MacKie
- Department of Clinical Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Sumedha Gupta
- School of Liberal Arts, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - Shaun Grannis
- Department of Family Medicine, Indiana University, Indianapolis, Indiana, USA
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