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Shrier LA, McCaskill NH, Smith MC, O'Connell MM, Gluskin BS, Parker S, Everett V, Burke PJ, Harris SK. Telehealth counseling plus mHealth intervention for cannabis use in emerging adults: Development and a remote open pilot trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 166:209472. [PMID: 39111371 DOI: 10.1016/j.josat.2024.209472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 06/27/2024] [Accepted: 07/29/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION To improve treatment access for emerging adults with cannabis use disorder (CUD), we developed a telehealth counseling-plus-mHealth intervention and remotely conducted a single-arm open pilot study to preliminarily evaluate its feasibility in primary care. METHODS A multidisciplinary team including youth developed the intervention using the structure of the MOMENT intervention: two weekly counselor-delivered Motivational Enhancement Therapy (MET) sessions, then two weeks of smartphone surveys (4 prompted/day) querying socioemotional contexts and cannabis use, with pre-programmed messages on report of personal triggers for use (Ecological Momentary Intervention; EMI). The team adapted the MET for virtual delivery; created material to enhance self-reflection, plan behavior change, and anticipate withdrawal; shortened the sessions; and tested them with five youth actors. EMI messages were created to align with the MET and programmed to minimize repetition. Patients aged 18-25 using recreational cannabis ≥3 days/week were recruited from an urban medical practice. Participants received the intervention and responded to surveys on satisfaction and burden. At baseline, post-intervention, and two months, participants reported behavior change readiness/importance/confidence and cannabis use. EMI engagement was calculated as % days with ≥1 phone survey completed. RESULTS Fourteen eligible patients enrolled; 79 % used cannabis daily/near-daily and 100 % reported use problems. All completed both MET sessions and responded to EMI surveys. All agreed/strongly agreed that they felt respected by, comfortable with, and trust for the counselor and that the activities and discussion were helpful; all rated the MET sessions as very good/excellent. Technical issues were infrequent and minor. Median EMI engagement was 100 % (≥1 report/day) in each week. Behavior change confidence was higher post-intervention and importance and confidence were higher at two months vs. baseline. By two months, 11 participants had started to change cannabis use; median percent days of use in the past 30 days declined by 27 % and average times of use per use day declined by 28 %. All rated intervention quality as good, very good, or excellent. CONCLUSIONS Emerging adults were highly satisfied and engaged with a telehealth MET counseling-plus-mHealth EMI intervention for cannabis use and reported higher motivation to change cannabis use and less use post-intervention and at 2-month follow-up.
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Affiliation(s)
- Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Nicholas H McCaskill
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Madeline C Smith
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Madison M O'Connell
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Brittany S Gluskin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Sarah Parker
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Veronica Everett
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Pamela J Burke
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Sion Kim Harris
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Kobernik EK, Ford ND, Levecke M, Galang RR, Hoots B, Roehler DR, Ko JY. Marijuana Use among Pregnant and Nonpregnant Women of Reproductive Age, 2013-2019. Subst Use Misuse 2023; 59:690-698. [PMID: 38132561 PMCID: PMC11000143 DOI: 10.1080/10826084.2023.2294974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Marijuana is the most commonly used federally illicit substance among reproductive-age women in the United States. Updated information on marijuana use in this population can inform clinical and public health interventions. METHODS Data from the 2013-2019 National Survey on Drug Use and Health was used to report weighted prevalence estimates of marijuana use in the past month, past 2-12 months, and past year among women aged 18-44 years with self-reported pregnancy status. Bivariate analyses and general linear regression models with Poisson distribution using appropriate survey procedures identified factors associated with past-year marijuana use by pregnancy status. RESULTS Among pregnant women, 4.9% (95% confidence interval [CI]: 4.1-5.6) reported marijuana use in the past month, 10.4% (95% CI: 9.3-11.5) in the past 2-12 months, and 15.2% (95% CI: 13.9-16.6) in the past year. Among nonpregnant women, 11.8% (95% CI: 11.5-12.0) reported marijuana use in the past month, 7.8% (95% CI: 7.6-8.0) in the past 2-12 months, and 19.5% (95% CI: 19.2-19.9) in the past year. After adjusting for sociodemographic characteristics, past-year marijuana use was 2.3-5.1 times more likely among pregnant, and 2.1 to 4.6 times more likely among nonpregnant women who reported past-year tobacco smoking, alcohol use, or other illicit drug use compared to those reporting no substance use. CONCLUSIONS Pregnant and nonpregnant women reporting marijuana use, alone or with other substances, can benefit from substance use screening and treatment facilitation.
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Affiliation(s)
- Emily K Kobernik
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- CDC Foundation, Atlanta, GA, USA
| | - Nicole D Ford
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Madison Levecke
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, ORISE Fellow, Oak Ridge, TN, USA
| | - Romeo R Galang
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brooke Hoots
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
- U.S. Public Health Service Commissioned Corps, Atlanta, GA, USA
| | - Douglas R Roehler
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jean Y Ko
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- U.S. Public Health Service Commissioned Corps, Atlanta, GA, USA
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Lalwani K, Whitehorne-Smith P, McLeary JG, Albarus N, Abel W. Investigating the associations of age of initiation and other psychosocial factors of singular alcohol, tobacco and marijuana usage on polysubstance use: analysis of a population-based survey in Jamaica. BMJ Open 2023; 13:e076111. [PMID: 37963690 PMCID: PMC10649390 DOI: 10.1136/bmjopen-2023-076111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES This study aimed to examine concurrent polysubstance use of alcohol, tobacco and marijuana and determine correlations with access to marijuana, friend and familial drug use habits, risk perception and the age of initiation associated with the singular use of these substances. DESIGN A secondary data analysis. SETTING Used the Jamaica National Drug Prevalence Survey 2016 dataset. PARTICIPANTS Involved the entire dataset comprising 4623 randomly selected respondents between 12 and 65 years old. OUTCOME MEASURES Primary outcome: concurrent polysubstance use recorded as using two or more of alcohol, tobacco and marijuana. Predictor variables include risk perception and age of initiation of singular alcohol, tobacco and marijuana use, ease of marijuana access and family and friend alcohol and illegal drug use. RESULTS Approximately 58%-66% of respondents commenced singular alcohol, tobacco or marijuana use under 17. Participants commencing marijuana use at 11 years and under and between 12 and 17 were 3.346 and 4.560 times more likely to report past month concurrent polysubstance use (p=0.030 and p<0.001). Respondents who did not believe that smoking tobacco sometimes (p=0.049), and smoking marijuana sometimes and often was harmful, had increased odds of concurrent polysubstance use (p=0.047 and p<0.001, respectively). Respondents who indicated access to marijuana as easy were significantly more likely to report past month concurrent polysubstance use compared with those who reported access as difficult (p=0.002). Participants who indicated that friends or family members get drunk and take illegal drugs were associated with 1.722 and 1.864 increased odds of reporting past month concurrent polysubstance use (p=0.004 and p=0.017, respectively). CONCLUSIONS Decreased perceived risk, childhood and adolescent age of initiation and easy access to marijuana were significantly associated with polysubstance use among Jamaicans. The influence of friends and family members' drug and alcohol use behaviours on individuals developing polysubstance use habits further endorses the need for interventions.
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Affiliation(s)
- Kunal Lalwani
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Saint Andrew, Jamaica
| | | | - Joni-Gaye McLeary
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Saint Andrew, Jamaica
| | - Neena Albarus
- School of Social Welfare, University of California, Berkeley, California, USA
| | - Wendel Abel
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Saint Andrew, Jamaica
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Barry MJ, Nicholson WK, Silverstein M, Coker TR, Davidson KW, Davis EM, Donahue KE, Jaén CR, Li L, Ogedegbe G, Pbert L, Rao G, Ruiz JM, Stevermer J, Tsevat J, Underwood SM, Wong JB. Screening for Anxiety Disorders in Adults: US Preventive Services Task Force Recommendation Statement. JAMA 2023; 329:2163-2170. [PMID: 37338866 DOI: 10.1001/jama.2023.9301] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Importance Anxiety disorders are commonly occurring mental health conditions. They are often unrecognized in primary care settings and substantial delays in treatment initiation occur. Objective The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for anxiety disorders in asymptomatic adults. Population Asymptomatic adults 19 years or older, including pregnant and postpartum persons. Older adults are defined as those 65 years or older. Evidence Assessment The USPSTF concludes with moderate certainty that screening for anxiety disorders in adults, including pregnant and postpartum persons, has a moderate net benefit. The USPSTF concludes that the evidence is insufficient on screening for anxiety disorders in older adults. Recommendation The USPSTF recommends screening for anxiety disorders in adults, including pregnant and postpartum persons. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety disorders in older adults. (I statement).
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Affiliation(s)
| | | | | | | | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | - Goutham Rao
- Case Western Reserve University, Cleveland, Ohio
| | | | | | - Joel Tsevat
- The University of Texas Health Science Center, San Antonio
| | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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AlShamlan NA. Screening and management of tobacco, alcohol, and unhealthy drug use in Saudi Arabia: uptake and practices from primary care physicians' perspective. Fam Pract 2022; 39:1031-1040. [PMID: 35616127 DOI: 10.1093/fampra/cmac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Screening and management of tobacco, alcohol, and unhealthy drug use by primary care physicians are crucial because a minority of individuals seek medical advice. However, data regarding this practice are limited. The study objective was to assess the screening practices of primary care physicians in Saudi Arabia for tobacco, alcohol, and unhealthy drug use, barriers to screening, and management of such cases. METHODS In this cross-sectional study, an online survey was sent to primary care physicians in Saudi Arabia. RESULTS A total of 952 physicians participated in the study. Most did not use validated screening tools. A significant proportion of physicians believed that the patient could not answer accurately about using alcohol or drugs and considered it socially unacceptable to ask about these substances. Family physicians screened their patients more frequently for smoking than general practitioners (P < 0.05). More years of experience and practice in the Northern Province of Saudi Arabia were predictors of frequent screening for alcohol and drug use (P < 0.05 and P < 0.01, respectively). Providing information about the risks of these behaviours and brief motivational interviews were the most reported practices. CONCLUSIONS Most physicians did not utilize validated screening tools. Addressing these barriers is a crucial step in initiating effective screening programmes. Several barriers have been reported from the physicians' perspective; further study to explore these issues from patients' perspectives is suggested. Moreover, raising physicians' awareness about using validated screening tools and locally available services is recommended.
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Affiliation(s)
- Nouf A AlShamlan
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Mangione CM, Barry MJ, Nicholson WK, Cabana M, Chelmow D, Coker TR, Davidson KW, Davis EM, Donahue KE, Jaén CR, Kubik M, Li L, Ogedegbe G, Pbert L, Ruiz JM, Silverstein M, Stevermer J, Wong JB. Screening for Depression and Suicide Risk in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA 2022; 328:1534-1542. [PMID: 36219440 DOI: 10.1001/jama.2022.16946] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Depression is a leading cause of disability in the US. Children and adolescents with depression typically have functional impairments in their performance at school or work as well as in their interactions with their families and peers. Depression can also negatively affect the developmental trajectories of affected youth. Major depressive disorder (MDD) in children and adolescents is strongly associated with recurrent depression in adulthood; other mental disorders; and increased risk for suicidal ideation, suicide attempts, and suicide completion. Suicide is the second-leading cause of death among youth aged 10 to 19 years. Psychiatric disorders and previous suicide attempts increase suicide risk. Objective To update its 2014 and 2016 recommendations, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening, accuracy of screening, and benefits and harms of treatment of MDD and suicide risk in children and adolescents that would be applicable to primary care settings. Population Children and adolescents who do not have a diagnosed mental health condition or are not showing recognized signs or symptoms of depression or suicide risk. Evidence Assessment The USPSTF concludes with moderate certainty that screening for MDD in adolescents aged 12 to 18 years has a moderate net benefit. The USPSTF concludes that the evidence is insufficient on screening for MDD in children 11 years or younger. The USPSTF concludes that the evidence is insufficient on the benefit and harms of screening for suicide risk in children and adolescents owing to a lack of evidence. Recommendation The USPSTF recommends screening for MDD in adolescents aged 12 to 18 years. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for MDD in children 11 years or younger. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for suicide risk in children and adolescents. (I statement).
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Affiliation(s)
| | | | | | | | | | | | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Chan Medical School, Worcester
| | | | | | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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7
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Mangione CM, Barry MJ, Nicholson WK, Cabana M, Coker TR, Davidson KW, Davis EM, Donahue KE, Jaén CR, Kubik M, Li L, Ogedegbe G, Pbert L, Ruiz JM, Silverstein M, Stevermer J, Wong JB. Screening for Anxiety in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA 2022; 328:1438-1444. [PMID: 36219403 DOI: 10.1001/jama.2022.16936] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
IMPORTANCE Anxiety disorder, a common mental health condition in the US, comprises a group of related conditions characterized by excessive fear or worry that present as emotional and physical symptoms. The 2018-2019 National Survey of Children's Health found that 7.8% of children and adolescents aged 3 to 17 years had a current anxiety disorder. Anxiety disorders in childhood and adolescence are associated with an increased likelihood of a future anxiety disorder or depression. OBJECTIVE The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for anxiety disorders in children and adolescents. This is a new recommendation. POPULATION Children and adolescents 18 years or younger who do not have a diagnosed anxiety disorder or are not showing recognized signs or symptoms of anxiety. EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that screening for anxiety in children and adolescents aged 8 to 18 years has a moderate net benefit. The USPSTF concludes that the evidence is insufficient on screening for anxiety in children 7 years or younger. RECOMMENDATION The USPSTF recommends screening for anxiety in children and adolescents aged 8 to 18 years. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety in children 7 years or younger. (I statement).
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Affiliation(s)
| | | | | | | | | | | | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Chan Medical School, Worcester
| | | | | | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Calcaterra SL, Bottner R, Martin M, Englander H, Weinstein ZM, Weimer MB, Lambert E, Ronan MV, Huerta S, Zaman T, Ullal M, Peterkin AF, Torres-Lockhart K, Buresh M, O’Brien MT, Snyder H, Herzig SJ. Management of opioid use disorder, opioid withdrawal, and opioid overdose prevention in hospitalized adults: A systematic review of existing guidelines. J Hosp Med 2022; 17:679-692. [PMID: 35880821 PMCID: PMC9474657 DOI: 10.1002/jhm.12908] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/11/2022] [Accepted: 05/22/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hospitalizations related to the consequences of opioid use are rising. National guidelines directing in-hospital opioid use disorder (OUD) management do not exist. OUD treatment guidelines intended for other treatment settings could inform in-hospital OUD management. OBJECTIVE Evaluate the quality and content of existing guidelines for OUD treatment and management. DATA SOURCES OVID MEDLINE, PubMed, Ovid PsychINFO, EBSCOhost CINHAL, ERCI Guidelines Trust, websites of relevant societies and advocacy organizations, and selected international search engines. STUDY SELECTION Guidelines published between January 2010 to June 2020 addressing OUD treatment, opioid withdrawal management, opioid overdose prevention, and care transitions among adults. DATA EXTRACTION We assessed quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. DATA SYNTHESIS Nineteen guidelines met the selection criteria. Most recommendations were based on observational studies or expert consensus. Guidelines recommended the use of nonstigmatizing language among patients with OUD; to assess patients with unhealthy opioid use for OUD using the Diagnostic Statistical Manual of Diseases-5th Edition criteria; use of methadone or buprenorphine to treat OUD and opioid withdrawal; use of multimodal, nonopioid therapy, and when needed, short-acting opioid analgesics in addition to buprenorphine or methadone, for acute pain management; ensuring linkage to ongoing methadone or buprenorphine treatment; referring patients to psychosocial treatment; and ensuring access to naloxone for opioid overdose reversal. CONCLUSIONS Included guidelines were informed by studies with various levels of rigor and quality. Future research should systematically study buprenorphine and methadone initiation and titration among people using fentanyl and people with pain, especially during hospitalization.
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Affiliation(s)
- Susan L. Calcaterra
- Department of Medicine, Division of General Internal Medicine and Division of Hospital Medicine, University of Colorado, Aurora, CO, USA
| | - Richard Bottner
- Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, TX, USA
| | - Marlene Martin
- Department of Medicine, Division of Hospital Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, CA, USA
| | - Honora Englander
- Section of Addiction Medicine and Division of Hospital Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Zoe M. Weinstein
- Boston University School of Medicine, Boston Medical Center, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | | | - Eugene Lambert
- Harvard Medical School, Boston, MA and Massachusetts General Hospital, Medicine, Charlestown, MA, USA
| | - Matthew V. Ronan
- Harvard Medical School, Boston, MA and Massachusetts General Hospital, Medicine, Charlestown, MA, USA
- Department of Medicine, VA Boston Healthcare System, West Roxbury, MA, USA
| | - Sergio Huerta
- Department of Internal Medicine, Division of Hospital Medicine, University of New Mexico School of Medicine, NM, USA
| | - Tauheed Zaman
- San Francisco VA Medical Center, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Monish Ullal
- Department of Internal Medicine at Highland Hospital, Alameda Health System, Oakland, CA, USA
| | - Alyssa F. Peterkin
- Boston University School of Medicine, Boston Medical Center, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | | | - Megan Buresh
- Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Meghan T. O’Brien
- Department of Medicine, Division of Hospital Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, CA, USA
| | - Hannah Snyder
- Family Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Shoshana J. Herzig
- Harvard Medical School, Boston, MA and Massachusetts General Hospital, Medicine, Charlestown, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Davidson KW, Mangione CM, Krist AH, Curry SJ. Preventing opioid use disorder and misuse in asymptomatic primary care patients: A call for relevant primary prevention intervention research. Prev Med 2022; 154:106898. [PMID: 34861337 DOI: 10.1016/j.ypmed.2021.106898] [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] [Received: 07/27/2021] [Revised: 11/17/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
Abstract
To contribute to the national effort to combat the opioid crisis, the United States Preventive Services Task Force (USPSTF) commissioned a scoping review to describe the state of evidence for the primary prevention of opioid misuse or use disorder in persons not yet prescribed opioids or not yet misusing opioids. (Patnode et al., 2021) As found by the scoping review, sparse direct evidence focusing on primary care-relevant prevention interventions exists. The purpose of the current commentary is to describe the relevant research needed to effectively inform primary care providers and patients about how to reduce the risk for future opioid use disorder and opioid misuse and improve health outcomes in those not yet exposed to or misusing opioid medications.
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Affiliation(s)
- Karina W Davidson
- Institute for Health System Science, Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr., Manhasset, NY 11030, USA; Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd., Hempstead, NY 11549, USA.
| | - Carol M Mangione
- Department of Medicine, David Geffen School of Medicine at UCLA, University of California, 10833, Le Conte Ave, Los Angeles, CA 90095, USA
| | - Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, One Capitol Square, 830 E. Main St., Richmond, VA 23219, USA
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10
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Wagner NM, Binswanger IA, Shetterly SM, Rinehart DJ, Wain KF, Hopfer C, Glanz JM. Development and validation of a prediction model for opioid use disorder among youth. Drug Alcohol Depend 2021; 227:108980. [PMID: 34482048 PMCID: PMC8464513 DOI: 10.1016/j.drugalcdep.2021.108980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Youth are vulnerable to opioid use initiation and its complications. With growing rates of opioid overdose, strategies to identify youth at risk of opioid use disorder (OUD) to efficiently focus prevention interventions are needed. This study developed and validated a prediction model of OUD in youth aged 14-18 years. METHODS The model was developed in a Colorado healthcare system (derivation site) using Cox proportional hazards regression analysis. Model predictors and outcomes were identified using electronic health record data. The model was externally validated in a separate Denver safety net health system (validation site). Youth were followed for up to 3.5 years. We evaluated internal and external validity using discrimination and calibration. RESULTS The derivation cohort included 76,603 youth, of whom 108 developed an OUD diagnosis. The model contained 3 predictors (smoking status, mental health diagnosis, and non-opioid substance use or disorder) and demonstrated good calibration (p = 0.90) and discrimination (bootstrap-corrected C-statistic = 0.76: 95 % CI = 0.70, 0.82). Sensitivity and specificity were 57 % and 84 % respectively with a positive predictive value (PPV) of 0.49 %. The validation cohort included 45,790 youth of whom, 74 developed an OUD diagnoses. The model demonstrated poorer calibration (p < 0.001) but good discrimination (C-statistic = 0.89; 95 % CI = 0.84, 0.95), sensitivity of 87.8 % specificity of 68.6 %, and PPV of 0.45 %. CONCLUSIONS In two Colorado healthcare systems, the prediction model identified 57-88 % of subsequent OUD diagnoses in youth. However, PPV < 1% suggests universal prevention strategies for opioid use in youth may be the best health system approach.
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Affiliation(s)
- Nicole M Wagner
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, 13199 E Montview Blvd, Suite 300, Aurora, CO, 80045, USA; Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Road, Suite 200, Aurora, CO, 80014, USA.
| | - Ingrid A Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Road, Suite 200, Aurora, CO, 80014, USA; Colorado Permanente Medical Group, P.C., 10350 E. Dakota Ave., Denver, CO, 80247, USA; Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E 17thAve., Aurora, CO, 80045, USA.
| | - Susan M Shetterly
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Road, Suite 200, Aurora, CO, 80014, USA.
| | - Deborah J Rinehart
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E 17thAve., Aurora, CO, 80045, USA; Center for Health Systems Research, Denver Health Hospital and Authority, 777 Bannock St., M.C 6551, Denver, CO, 80204, USA.
| | - Kris F Wain
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Road, Suite 200, Aurora, CO, 80014, USA.
| | - Christian Hopfer
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz, 13001 East 17thPlace, Q20-C2000, Aurora, CO, 80045, USA.
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Road, Suite 200, Aurora, CO, 80014, USA; Department of Epidemiology, University of Colorado School of Public Health, 13001 East 17thPlace, 3rd Floor, Aurora, CO, 80045, USA.
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Kistin CJ, Silverstein M. Substance Use in Youth: What Could an Ounce of Prevention Be Worth? Pediatrics 2021; 147:S265-S267. [PMID: 33386330 DOI: 10.1542/peds.2020-023523k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Caroline J Kistin
- Division of General Pediatrics, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Michael Silverstein
- Division of General Pediatrics, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
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Salmanzadeh H, Ahmadi-Soleimani SM, Azadi M, Halliwell RF, Azizi H. Adolescent Substance Abuse, Transgenerational Consequences and Epigenetics. Curr Neuropharmacol 2021; 19:1560-1569. [PMID: 33655865 PMCID: PMC8762180 DOI: 10.2174/1570159x19666210303121519] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/13/2021] [Accepted: 02/12/2021] [Indexed: 11/22/2022] Open
Abstract
Adolescence is the transitional period between childhood and adulthood and a critical period in brain development. Adolescence in humans is also associated with increased expression of risk-taking behaviors. Epidemiological and clinical studies, for example, show a surge of drug abuse and raise the hypothesis that the adolescent brain undergoes critical changes resulting in diminished control. Determining how substance abuse during this critical period might cause longterm neurobiological changes in cognition and behavior is therefore critically important. The present work aims to provide an evaluation of the transgenerational and multi-generational phenotypes derived from parent animals exposed to drugs of abuse only during their adolescence. Specifically, we will consider changes found following the administration of cannabinoids, nicotine, alcohol and opiates. In addition, epigenetic modifications of the genome following drug exposure will be discussed as emerging evidence of the underlying adverse transgenerational effects. Notwithstanding, much of the new data discussed here is from animal models, indicating that future clinical studies are much needed to better understand the neurobiological consequences and mechanisms of drug actions on the human brains' development and maturation.
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Affiliation(s)
| | | | | | - Robert F. Halliwell
- Address correspondence to this author at the TJ Long School of Pharmacy, University of the Pacific, Stockton, California, USA; Tel: +1 (209) 946 2074; E-mail: and Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; Tel: +98-21-82884587; Fax: +98-21-82884528; E-mail:
| | - Hossein Azizi
- Address correspondence to this author at the TJ Long School of Pharmacy, University of the Pacific, Stockton, California, USA; Tel: +1 (209) 946 2074; E-mail: and Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; Tel: +98-21-82884587; Fax: +98-21-82884528; E-mail:
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Impulsivity traits and neurocognitive mechanisms conferring vulnerability to substance use disorders. Neuropharmacology 2020; 183:108402. [PMID: 33189766 DOI: 10.1016/j.neuropharm.2020.108402] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/30/2020] [Accepted: 11/10/2020] [Indexed: 01/11/2023]
Abstract
Impulsivity - the tendency to act without sufficient consideration of potential consequences in pursuit of short-term rewards - is a vulnerability marker for substance use disorders (SUD). Since impulsivity is a multifaceted construct, which encompasses trait-related characteristics and neurocognitive mechanisms, it is important to ascertain which of these aspects are significant contributors to SUD susceptibility. In this review, we discuss how different trait facets, cognitive processes and neuroimaging indices underpinning impulsivity contribute to the vulnerability to SUD. We reviewed studies that applied three different approaches that can shed light on the role of impulsivity as a precursor of substance use related problems (versus a consequence of drug effects): (1) longitudinal studies, (2) endophenotype studies including non-affected relatives of people with SUD, and (3) clinical reference groups-based comparisons, i.e., between substance use and behavioural addictive disorders. We found that, across different methodologies, the traits of non-planning impulsivity and affect-based impulsivity and the cognitive processes involved in reward-related valuation are consistent predictors of SUD vulnerability. These aspects are associated with the structure and function of the medial orbitofrontal-striatal system and hyperexcitability of dopamine receptors in this network. The field still needs more theory-driven, comprehensive studies that simultaneously assess the different aspects of impulsivity in relation to harmonised SUD-related outcomes. Furthermore, future studies should investigate the impact of impulsivity-related vulnerabilities on novel patterns of substance use such as new tobacco and cannabinoid products, and the moderating impact of changes in social norms and lifestyles on the link between impulsivity and SUD. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.
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Francis E, Shifler Bowers K, Buchberger G, Ryan S, Milchak W, Kraschnewski J. Reducing Alcohol and Opioid Use Among Youth in Rural Counties: An Innovative Training Protocol for Primary Health Care Providers and School Personnel. JMIR Res Protoc 2020; 9:e21015. [PMID: 33155572 PMCID: PMC7679207 DOI: 10.2196/21015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 01/03/2023] Open
Abstract
Background Given that youth alcohol use is more common in rural communities, such communities can play a key role in preventing alcohol use among adolescents. Guidelines recommend primary care providers incorporate screening, brief intervention, and referral to treatment (SBIRT) into routine care. Objective The aim is to train primary care providers and school nurses within a rural 10-county catchment area in Pennsylvania to use SBIRT and facilitate collaboration with community organizations to better coordinate substance use prevention efforts. Methods To build capacity to address underage drinking and opioid use among youth aged 9-20 years, this project uses telehealth, specifically Project ECHO (Extension for Community Healthcare Outcomes), to train primary care providers and school nurses to address substance use with SBIRT. Our project will provide 120 primary care providers and allied health professionals as well as 20 school nurses with SBIRT training. Community-based providers will participate in weekly virtual ECHO sessions with a multidisciplinary team from Penn State College of Medicine that will provide SBIRT training and facilitate case discussions among participants. Results To date, we have launched one SBIRT ECHO project with school personnel, enrolling 34 participants. ECHO participants are from both rural (n=17) and urban (n=17) counties and include school nurses (n=15), school counselors (n=8), teachers (n=5), administrators (n=3), and social workers (n=3). Before the study began, only 2/13 (15.5%) of schools were screening for alcohol use. Conclusions This project teaches primary care clinics and schools to use SBIRT to prevent the onset and reduce the progression of substance use disorders, reduce problems associated with substance use disorders, and strengthen communities’ prevention capacity. Ours is an innovative model to improve rural adolescent health by reducing alcohol and opioid use. International Registered Report Identifier (IRRID) DERR1-10.2196/21015
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Affiliation(s)
- Erica Francis
- College of Medicine, Penn State University, Hershey, PA, United States
| | | | | | - Sheryl Ryan
- Penn State Health, Hershey, PA, United States
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