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Erinoso O, Watts T, Koning S, Lu M, Wagner KD, Pearson J. Choice of smoking cessation products among people with substance use problems in the US: Findings from the Population Assessment of Tobacco and Health (PATH) study Wave 6. Addict Behav 2024; 158:108104. [PMID: 39042998 DOI: 10.1016/j.addbeh.2024.108104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/06/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE The aim of this study was to compare past 12-month use of cigarette smoking cessation aids (e.g., Food and Drug Administration (FDA)-approved cessation products or e-cigarettes for smoking cessation) among people with substance use problems (PWSUPs) who currently smoke to people without substance use problems (SUPs) who currently smoke cigarettes in a nationally representative US sample. METHODS We used the Population Assessment of Tobacco and Health (PATH) Wave 6 Study [n = 30,516]. Our sample comprised adult (18+) established cigarette smokers (100+ lifetime-sticks with daily/non-daily use) [n = 5,895]. The independent variable was SUP status (no, moderate, and high). The dependent variables were past-year use of: nicotine replacement therapies (NRTs), cessation medications [i.e., varenicline or bupropion], or e-cigarettes [for cigarette cessation and reduction]. Weighted multivariable logistic regression models for each dependent variable examined the associations between SUP status and each cessation aid, adjusting for cigarette dependence, daily cigarette smoking, and demographic factors. RESULTS Among people who smoke, a higher proportion of respondents with high SUP severity used NRTs, cessation medications, and e-cigarettes for cigarette cessation, respectively (12.3%, 8.4%, 15.7%), compared to those with no/low SUP severity (9.8%, 6.0%, 8.9%). In the multivariable models, respondents with high SUPs had 63% (95% CI:1.16-2.29) higher odds of using e-cigarettes for cessation than those without SUPs. No significant differences were seen between high (vs. no/low SUPs) in the past-year use of NRTs and cessation medications. CONCLUSION Our findings indicate that cigarette smokers with high SUPs had higher odds of using e-cigarettes for cessation and reduction compared to smokers without SUPs.
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Affiliation(s)
- Olufemi Erinoso
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, United States.
| | - Theresa Watts
- Orvis School of Nursing, University of Nevada, Reno, United States
| | - Stephanie Koning
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Minggen Lu
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Karla D Wagner
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Jennifer Pearson
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
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Lee SW, Yu PC, Yen TT, Hsu CY, Lai LJ, Chen IC, Chang TG. Impact of the Ottawa model on opiate screening and smoking cessation in methadone-treated patients with opioid use disorder: A retrospective cohort analysis. Tob Induc Dis 2024; 22:TID-22-137. [PMID: 39076842 PMCID: PMC11284629 DOI: 10.18332/tid/191247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/17/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024] Open
Abstract
INTRODUCTION Approximately 60 million individuals worldwide used opioids in 2021, constituting 1.2% of the global adult population. This study aimed to evaluate the effectiveness of integrated treatment strategies for opioid use disorder and nicotine use disorder by assessing the impact of smoking cessation within a methadone treatment framework. METHODS In a retrospective cohort study, 53 methadone maintenance patients were divided into 16 treatment-seeking smokers (TSS) and 37 treatment-rejecting smokers (TRS) based on their participation in the Ottawa model for smoking cessation plus 16 weeks of varenicline treatment. Both groups received standard methadone treatment for 68 weeks. TSS were followed up for 44 weeks to assess smoking cessation outcomes, while TRS had none due to their lack of participation in smoking cessation treatment. RESULTS The median age of the TSS group was 48 years, while that of the TRS group was 45.5 years. Males comprised 75% of TSS and 94.6% of the TRS. TSS exhibited an 83% decrease in positive opioid screen results compared to TRS (p=0.023). In TSS, peak smoking cessation success was observed at week 20, with 57% of participants maintaining carbon monoxide levels <5 ppm. CONCLUSIONS The significant reduction in positive opioid screens and the high smoking cessation rate in the TSS group highlight the efficacy of combined treatment methods. This study underscores the advantages of integrating smoking cessation with methadone maintenance treatment, indicating that comprehensive approaches can substantially improve treatment outcomes.
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Affiliation(s)
- Shu-Wua Lee
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Po-Chung Yu
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ting-Ting Yen
- Department of Otorhinolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chiann-Yi Hsu
- Biostatistics Task Force, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Li-Jou Lai
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Chun Chen
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Ting-Gang Chang
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
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Encinosa W, Bernard D, Valdez RB. Heavy Versus Light Smoking: Its Association With Opioid Use, Chronic Pain, and Mental Health. Am J Prev Med 2024:S0749-3797(24)00249-6. [PMID: 39025246 DOI: 10.1016/j.amepre.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION There is much concern that substance use treatment programs are rarely integrated with smoking cessation programs. Here, the first national statistics are presented on the connection between heavy vs. light smoking and the opioid epidemic. METHODS Using the 2013-2021 Medical Expenditure Panel Survey linked to the National Health Interview Survey, N=81,400 adults-years, logit regressions estimate the impact of heavy vs. light smoking on opioid use, chronic pain, work limitations due to pain, and poor mental health. Analyses were conducted from October 2023 to May 2024. RESULTS Only 37 percent of the population has ever smoked, but they used 69% of the nation's annual prescription opioids. Adults who smoked more than 5 cigarettes a day composed 12% of the population but used about the same number of opioids as the 63% of the population who never smoked. Adults who formerly smoked used 16% fewer opioids than adults who currently smoke (p<0.01). The percent with chronic pain during the year varied from 12.2% for adults who never smoked to 14.2% for light smoking, to 16.5% for those smoking more than a pack a day (p<0.01). Severe work limitations due to pain varied from 7.3% for adults who never smoked to 16.9% for those smoking more than a pack a day (p<0.01). Adults smoking more than a pack a day were twice as likely to report fair or poor mental health compared to those who never smoked (29.2% vs 13.6%) (p<0.01). CONCLUSIONS As nations deal with the opioid epidemic, integrating smoking cessation programs into substance abuse treatment programs appears prudent.
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Liu LJ, Lin EMH, Tsao SL, Wang HY, Ho MC. Attentional Bias for Opioids in Taiwanese Heavy Smokers with Chronic Noncancer Pain. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1107. [PMID: 39064536 PMCID: PMC11279384 DOI: 10.3390/medicina60071107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Attentional bias (AB) for addictive substances is a feature of attention found in individuals with substance misuse or diagnosed with substance use disorders. When AB exists, the attention of the addicted individual may be quickly oriented to cues related to the addictive substance or be maintained on these cues for a longer time. AB toward opioids was found in Western samples of smokers with chronic noncancer pain. The level of AB was dose-responsive. However, similar studies in the Taiwanese population are lacking. This study compared the patterns of AB for opioid analgesics in Taiwanese participants with chronic noncancer pain to that of individuals without pain. This study aimed to investigate if AB toward opioids is presented in Taiwanese heavy smokers who are on long-term opioid therapy for pain control. Materials and Methods: Participants were grouped into chronic noncancer pain smokers, chronic pain nonsmokers, and smokers without pain, according to smoking habits and whether or not on long-term opioid therapy for pain control. Each participant completed demographic questionnaires, mood scales, and the opioid-related visual probe task. Differences in AB among the groups were compared using a three-way analysis of covariance controlling for daily cigarette consumption. Results: Chronic noncancer pain smokers (n = 17) and chronic pain nonsmokers (n = 16) displayed more severe levels of depression, anxiety, and pain, compared to smokers without pain (n = 28). Only did chronic pain nonsmokers show significant AB for opioid cues that were displayed for a short time. Analysis on reaction time found that smokers without pain consistently responded faster to the tasks. No difference in reaction time was found between the pain groups. Conclusions: The current study did not fully replicate findings from studies that were based in Western countries. Formulary availability and regulatory limitations might have affected patient's perception of prescription opioids in Taiwan. However, chronic pain nonsmokers exhibited initial orientation toward opioid-related cues when daily cigarette consumption was accounted for. According to previous research, this AB for shortly displayed opioid cues can be associated with the expectation of pain relief. The current finding also indicated general psychomotor retardation in individuals who were on long-term use of opioids.
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Affiliation(s)
- Ling-Jun Liu
- Department of Anesthesiology, Changhua Christian Hospital, Changhua 500, Taiwan; (L.-J.L.)
- Department of Statistics, Tunghai University, Taichung 407, Taiwan
| | | | - Shao-Lun Tsao
- Department of Anesthesiology, Changhua Christian Hospital, Changhua 500, Taiwan; (L.-J.L.)
| | - Hsin-Yu Wang
- Pharmacy Department, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Ming-Chou Ho
- Department of Psychology, Chung Shan Medical University, Taichung 402, Taiwan
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Gorrilla AA, Kaye JT, Pavlik J, Bonniot C, Vijayaraghavan M, Conner KL, Morris CD. A Call for Health Equity in Tobacco Control and Treatment for the Justice-Involved Population. Am J Prev Med 2024:S0749-3797(24)00177-6. [PMID: 38838793 DOI: 10.1016/j.amepre.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Allison A Gorrilla
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.
| | - Jesse T Kaye
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Jim Pavlik
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Catherine Bonniot
- Smoking Cessation Leadership Center, Division of General Internal Medicine, University of California, San Francisco, CL
| | - Maya Vijayaraghavan
- Smoking Cessation Leadership Center, Division of General Internal Medicine, University of California, San Francisco, CL
| | - Karen L Conner
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Chad D Morris
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Yun DH, Plymale MA, Oyler DR, Slavova SS, Davenport DL, Roth JS. Predictors of postoperative opioid use in ventral and incisional hernia repair. Surg Endosc 2024; 38:3052-3060. [PMID: 38609586 DOI: 10.1007/s00464-024-10808-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/21/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND One in two ventral and incisional hernia repair (VIHR) patients have preoperative opioid prescription within a year before procedure. The study's aim was to investigate risk factors of increased postoperative prescription filling in patients with or without preoperative opioid prescription. METHODS VIHR cases from 2013 to 2017 were reviewed. State prescription drug monitoring program data were linked to patient records. The primary endpoint was cumulative opioid dose dispensed through post-discharge day 45. Morphine milligram equivalent (MME) was used for uniform comparison. RESULTS 205 patients were included in the study (average age 53.5 years; 50.7% female). Over 35% met criteria for preoperative opioid use. Preoperative opioid tolerance, superficial wound infection, current smoking status, and any dispensed opioids within 45 days of admission were independent predictors for increased postoperative opioid utilization (p < 0.001). CONCLUSION Preoperative opioid use during 45-day pre-admission correlated strongly with postoperative prescription filling in VIHR patients, and several independent risk factors were identified.
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Affiliation(s)
- Do Hyun Yun
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Margaret A Plymale
- Division of General, Endocrine and Metabolic Surgery, Department of Surgery, University of Kentucky, 800 Rose Street, C-240, Lexington, KY, 40536, USA
| | - Douglas R Oyler
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Svetla S Slavova
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Daniel L Davenport
- Department of Surgery, Division of Healthcare Outcomes and Optimal Patient Services, University of Kentucky, Lexington, KY, USA
| | - John Scott Roth
- Division of General, Endocrine and Metabolic Surgery, Department of Surgery, University of Kentucky, 800 Rose Street, C-240, Lexington, KY, 40536, USA.
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Honeycutt S, Mukherjee A, Paladino M, Gilles-Thomas E, Loney G. Adolescent nicotine exposure promotes adulthood opioid consumption that persists despite adverse consequences and increases the density of insular perineuronal nets. ADDICTION NEUROSCIENCE 2024; 11:100150. [PMID: 38911872 PMCID: PMC11192509 DOI: 10.1016/j.addicn.2024.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Adolescence marks a sensitive period for neurodevelopment wherein exposure to drugs of abuse may disrupt maturation and induce persistent changes in neurophysiology which may exacerbate the risk for developing substance use disorders in adulthood. Adolescent nicotine exposure (ANE) enhances motivation to obtain drugs of abuse, particularly opioids, and increases vulnerability for the development of opioid use disorder (OUD). Here, we characterized ANE effects on learning about the adverse consequences of opioid consumption in adulthood in the absence of further nicotine administration. First, we show that ANE engenders punishment resistant fentanyl self-administration in a heterogenous seeking-taking chain schedule of reinforcement at least at the tested dose of fentanyl (0.75 μg/kg). We found that ANE rats consumed significantly more fentanyl and contingent foot shock punishment was less efficacious in limiting fentanyl seeking in ANE rats, relative to nicotine-naïve controls. Next, we demonstrated that ANE limits learning about the deleterious consequences of acute opioid intoxication in adulthood. In a combined conditioned taste avoidance and place preference paradigm we found that ANE resulted in significant reductions in the strength of morphine-induced CTA, and a simultaneous enhancement of CPP at a higher dose that was less capable of driving reinforcement in naïve controls. Finally, we examined the expression of perineuronal nets (PNNs) within insular cortex (IC) and found ANE rats to have increased density of PNNs across the anterior IC and significantly more parvalbumin-labeled IC cells relative to naïve controls. Together, these data lay the framework for a mechanistic explanation of the extreme comorbidity between nicotine use and development of OUDs.
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Kundu A, Sultana N, Felsky D, Moraes TJ, Selby P, Chaiton M. An overview of systematic reviews on predictors of smoking cessation among young people. PLoS One 2024; 19:e0299728. [PMID: 38466736 PMCID: PMC10927074 DOI: 10.1371/journal.pone.0299728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/15/2024] [Indexed: 03/13/2024] Open
Abstract
Understanding the factors that influence smoking cessation among young people is crucial for planning targeted cessation approaches. The objective of this review was to comprehensively summarize evidence for predictors of different smoking cessation related behaviors among young people from currently available systematic reviews. We searched six databases and reference lists of the included articles for studies published up to October 20, 2023. All systematic reviews summarizing predictors of intention to quit smoking, quit attempts, or smoking abstinence among people aged 10-35 years were included. We excluded reviews on effectiveness of smoking cessation intervention; smoking prevention and other smoking behaviors; cessation of other tobacco products use, dual use, and polysubstance use. We categorized the identified predictors into 5 different categories for 3 overlapping age groups. JBI critical appraisal tool and GRADE-CERqual approach were used for quality and certainty assessment respectively. A total of 11 systematic reviews were included in this study; all summarized predictors of smoking abstinence/quit attempts and two also identified predictors of intention to quit smoking. Seven reviews had satisfactory critical appraisal score and there was minimal overlapping between the reviews. We found 4 'possible' predictors of intention to quit smoking and 119 predictors of smoking abstinence/quit attempts. Most of these 119 predictors were applicable for ~10-29 years age group. We had moderate confidence on the 'probable', 'possible', 'insufficient evidence', and 'inconsistent direction' predictors and low confidence on the 'probably unrelated' factors. The 'probable' predictors include a wide variety of socio-demographic factors, nicotine dependence, mental health, attitudes, behavioral and psychological factors, peer and family related factors, and jurisdictional policies. These predictors can guide improvement of existing smoking cessation interventions or planning of new targeted intervention programs. Other predictors as well as predictors of intention to quit smoking need to be further investigated among adolescents and young adults separately.
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Affiliation(s)
- Anasua Kundu
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Nahid Sultana
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Daniel Felsky
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Theo J. Moraes
- Institute of Medical Science, University of Toronto, Toronto, Canada
- The Hospital for Sick Children (SickKids), Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Peter Selby
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Michael Chaiton
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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9
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Druckrey-Fiskaaen KT, Madebo T, Daltveit JT, Vold JH, Furulund E, Lid TG, Fadnes LT. Update of statistical analysis plan for: Integration of smoking cessation into standard treatment for patients receiving opioid agonist therapy who are smoking tobacco: protocol for a randomised controlled trial (ATLAS4LAR). Trials 2024; 25:29. [PMID: 38184633 PMCID: PMC10770886 DOI: 10.1186/s13063-023-07894-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/15/2023] [Indexed: 01/08/2024] Open
Abstract
This protocol paper presents an updated statistical analysis plan of the protocol of a randomised controlled trial. The randomised controlled trial investigates the effect of integrating smoking cessation interventions at outpatient opioid agonist therapy (OAT) clinics for persons with opioid dependency receiving OAT medication. The intervention group receives weekly follow-up including a short behavioural intervention and provision of nicotine replacement products. The control group receives standard treatment. The duration of the intervention is 16 weeks and the follow-up was completed by the end of October 2023. The primary outcome is defined as the proportion of participants reducing the number of cigarettes smoked by at least a 50% at week 16 of the intervention period. The primary outcome will be analysed according to intention-to-treat principles. Missing outcome data will be set equal to the baseline values. Development and reporting of the statistical analysis plan follow the Guidelines for the Content of Statistical Analysis Plans in Clinical Trials.Trial registration ClinicalTrials.gov NCT05290025. Registered on 22 March 2022.
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Affiliation(s)
- Karl Trygve Druckrey-Fiskaaen
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Tesfaye Madebo
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Respiratory Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jan Tore Daltveit
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
| | - Jørn Henrik Vold
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Einar Furulund
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Torgeir Gilje Lid
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
- Department of Public Health, University of Stavanger, Stavanger, Norway
| | - Lars Thore Fadnes
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Kusic DM, Heil J, Zajic S, Brangan A, Dairo O, Heil S, Feigin G, Kacinko S, Buono RJ, Ferraro TN, Rafeq R, Haroz R, Baston K, Bodofsky E, Sabia M, Salzman M, Resch A, Madzo J, Scheinfeldt LB, Issa JPJ, Jelinek J. Postmortem toxicology findings from the Camden Opioid Research Initiative. PLoS One 2023; 18:e0292674. [PMID: 37910493 PMCID: PMC10619848 DOI: 10.1371/journal.pone.0292674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023] Open
Abstract
The United States continues to be impacted by decades of an opioid misuse epidemic, worsened by the COVID-19 pandemic and by the growing prevalence of highly potent synthetic opioids (HPSO) such as fentanyl. In instances of a toxicity event, first-response administration of reversal medications such as naloxone can be insufficient to fully counteract the effects of HPSO, particularly when there is co-occurring substance use. In an effort to characterize and study this multi-faceted problem, the Camden Opioid Research Initiative (CORI) has been formed. The CORI study has collected and analyzed post-mortem toxicology data from 42 cases of decedents who expired from opioid-related toxicity in the South New Jersey region to characterize substance use profiles. Co-occurring substance use, whether by intent or through possible contamination of the illicit opioid supply, is pervasive among deaths due to opioid toxicity, and evidence of medication-assisted treatment is scarce. Nearly all (98%) of the toxicology cases show the presence of the HPSO, fentanyl, and very few (7%) results detected evidence of medication-assisted treatment for opioid use disorder, such as buprenorphine or methadone, at the time of death. The opioid toxicity reversal drug, naloxone, was detected in 19% of cases, but 100% of cases expressed one or more stimulants, and sedatives including xylazine were detected in 48% of cases. These results showing complex substance use profiles indicate that efforts at mitigating the opioid misuse epidemic must address the complications presented by co-occurring stimulant and other substance use, and reduce barriers to and stigmas of seeking effective medication-assisted treatments.
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Affiliation(s)
- Dara M. Kusic
- Research, Coriell Institute for Medical Research, Camden, New Jersey, United States of America
| | - Jessica Heil
- Clinical Research Office, Cooper University Health Care, Camden, New Jersey, United States of America
| | - Stefan Zajic
- Research, Coriell Institute for Medical Research, Camden, New Jersey, United States of America
| | - Andrew Brangan
- Coriell Institute for Medical Research, Camden, New Jersey, United States of America
| | - Oluseun Dairo
- Coriell Institute for Medical Research, Camden, New Jersey, United States of America
| | - Stacey Heil
- Coriell Institute for Medical Research, Camden, New Jersey, United States of America
| | - Gerald Feigin
- Office of the Medical Examiner, Gloucester County Health Department, Sewell, New Jersey, United States of America
| | - Sherri Kacinko
- Forensic Toxicology, NMS Labs, Horsham, Pennsylvania, United States of America
| | - Russell J. Buono
- Biomedical Sciences, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Thomas N. Ferraro
- Biomedical Sciences, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Rachel Rafeq
- Department of Emergency Medicine, Cooper University Health Care, Camden, New Jersey, United States of America
| | - Rachel Haroz
- Department of Emergency Medicine, Cooper University Health Care, Camden, New Jersey, United States of America
| | - Kaitlan Baston
- Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Elliot Bodofsky
- Neurological Institute, Cooper University Health Care, Camden, New Jersey, United States of America
| | - Michael Sabia
- Anesthesiology, Cooper University Health Care, Camden, New Jersey, United States of America
| | - Matthew Salzman
- Department of Emergency Medicine, Cooper University Health Care, Camden, New Jersey, United States of America
| | - Alissa Resch
- Research, Coriell Institute for Medical Research, Camden, New Jersey, United States of America
| | - Jozef Madzo
- Research, Coriell Institute for Medical Research, Camden, New Jersey, United States of America
- Biomedical Sciences, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Laura B. Scheinfeldt
- Research, Coriell Institute for Medical Research, Camden, New Jersey, United States of America
- Biomedical Sciences, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Jean-Pierre J. Issa
- Research, Coriell Institute for Medical Research, Camden, New Jersey, United States of America
- Biomedical Sciences, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Jaroslav Jelinek
- Research, Coriell Institute for Medical Research, Camden, New Jersey, United States of America
- Biomedical Sciences, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
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11
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Swartz JA, Franceschini D, Scamperle K. Mental health and substance use disorder comorbidities among Medicaid beneficiaries: Associations with opioid use disorder and prescription opioid misuse. AIMS Public Health 2023; 10:658-677. [PMID: 37842281 PMCID: PMC10567978 DOI: 10.3934/publichealth.2023046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/10/2023] [Accepted: 07/25/2023] [Indexed: 10/17/2023] Open
Abstract
Background Medicaid presently insures about one-fourth of the US population and disproportionately insures about 38 % of non-elderly adults with an opioid use disorder (OUD). Owing to Medicaid's prominent role insuring persons with an OUD and that Medicaid coverage includes pharmaceutical benefits, there has been considerable interest in studying potential prescription opioid misuse among Medicaid beneficiaries and identifying subpopulations at higher risk for misuse and possible progression to an OUD. Methods The study goals were to explore the associations among prescription opioid misuse, OUD, and co-occurring mental health and other substance use disorders (SUD). We analyzed Illinois Medicaid 2018 claims data for 1102479 adult beneficiaries 18 to 64 years of age. Using algorithms based on previous studies, we first determined either the presence or absence of nine SUDS (including OUD), nine mental health disorders and likely prescription opioid misuse. Then, we subdivided the beneficiary sample into five groups: those who were prescribed opioids and evidenced either no, possible, or probable misuse; those evidencing an OUD; and those evidencing no opioid use or misuse. Results Bivariate analyses, upset plots, and multinomial logistic regressions were used to compare the five subgroups on the prevalence of co-occurring SUDS and mental health disorders. Those with an OUD or with probable prescription opioid misuse had the highest prevalence of most co-occurring conditions with beneficiaries with an OUD the most likely to evidence co-occurring SUDS, particularly tobacco use disorder, whereas those with probable misuse had elevated prevalence rates of co-occurring mental health disorders comparable to those with an OUD. Conclusion The medical complexity of persons with an OUD or misusing prescription opioids are considered in light of recent attempts to expand buprenorphine provision as a medication for OUD among Medicaid beneficiaries. Additionally, we consider the possibility of gender, co-occurring mental health disorders, and tobacco use disorder as important risk factors for progressing to prescription opioid misuse and an OUD.
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Affiliation(s)
- James A. Swartz
- Jane Addams College of Social Work, University of Illinois Chicago
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Lavin RA, Yuspeh L, Kalia N, Tsourmas NF, Leung N, Hunt DL, Green-McKenzie J, Bernacki EJ, Tao XG. Dose Escalations Among Workers' Compensation Claimants Using Opioid Medications-An 8 Year Postinjury Follow up Study. J Occup Environ Med 2023; 65:e558-e564. [PMID: 37231640 DOI: 10.1097/jom.0000000000002893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The aim of the study is to determine the morphine equivalent dose in milligrams (MED)/day escalation trend after initial utilization. METHODS A total of 25,108 lost time claims filed between 1998 and 2007 were followed for 8 years from injury date. Claims were stratified by initial MED/day at 3 months after injury into four groups (0, 1 to < 15, 15 to < 30, and ≥30 MED/day). The slopes in MED/year of opioid dose escalation were determined for each initial MED/day group. RESULTS The slopes of MED/day escalation by initial MED categories were similar ( P ≥ 0.05) ranging from 5.38 to 7.76 MED annually. On average, MED/day increased in a liner pattern with a slope at 6.28 MED/year ( P < 0.01). CONCLUSIONS Opioid MED/day increased in a linear pattern, regardless of initial MED/day dose.
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Affiliation(s)
- Robert A Lavin
- From the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland (R.A.L., L.Y., N.K., N.F.T., N.L., E.J.B., X.G.T.); Strategy, Enterprise Risk, and Research, Louisiana Workers' Compensation Corporation, Baton Rouge, Louisiana (L.Y.); Texas Mutual, Workers' Compensation Insurance, Austin, Texas (N.F.T., N.L.); General Electric, Norwalk, Connecticut (N.K.); Corporate Administration Office, AF Group, Lansing, Michigan (D.L.H.); and University of Pennsylvania, Perelman School of Medicine, Division of Occupational Medicine, Philadelphia, Pennsylvania (J.G.-M.)
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13
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Lobbe C, Bahnisch J, Lin C, Demirkol A, Murnion B. How do patients and staff in an opioid agonist treatment service view smoking cessation medications and e-cigarettes? Drug Alcohol Rev 2023. [PMID: 36877583 DOI: 10.1111/dar.13630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Tobacco use and related mortality is common in people receiving opioid agonist treatment (OAT). Smoking cessation medications are available and e-cigarettes are increasingly recommended for high risk populations. This study explores experience, knowledge and attitudes around smoking cessation medications (nicotine replacement therapy [NRT], bupropion and varenicline) and e-cigarettes in patients and clinicians in two public Australian OAT clinics. METHODS Cross-sectional surveys of patients and clinicians and a randomly sampled retrospective medical record review. Patients were recruited through an advertisement in the clinic, and clinicians through advertisement at an educational session. RESULTS Ninety-one patients and 10 clinicians completed the surveys. Most patients had at least one quit attempt and 43% were currently trying to quit. There were high levels of exposure to NRT, lower levels with varenicline and very limited exposure to bupropion. Patients considered e-cigarettes most helpful, but were more likely to consider using NRT. Few patients reported smoking cessation interventions from their clinicians. Most clinicians identified high tobacco use prevalence, considered this problematic, but reported low rates of smoking cessation intervention. NRT was the preferred medication. E-cigarettes were not considered helpful. Sixty-six percent of the 140 records reviewed documented patients as smokers. Tobacco cessation medication was rarely discussed or provided. DISCUSSION AND CONCLUSIONS Patients report high rates of tobacco cessation planning, but low rates of intervention. Experience of varenicline and bupropion is limited. E-cigarettes were preferred over varenicline and bupropion. Improving patient's and clinician's knowledge of tobacco cessation medications could improve smoking cessation interventions and uptake of approved medications.
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Affiliation(s)
- Catherine Lobbe
- Faculty of Medicine and Health, University of New England, Armidale, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Jade Bahnisch
- Faculty of Medicine and Health, University of New England, Armidale, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Chenxi Lin
- Faculty of Medicine and Health, University of New England, Armidale, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Apo Demirkol
- Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Bridin Murnion
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.,Faculty of Medicine and Public Health, The University of Sydney, Sydney, Australia
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Carter BJ, Siddiqi AD, Chen TA, Britton M, Martinez Leal I, Correa-Fernández V, Rogova A, Kyburz B, Williams T, Casey K, Reitzel LR. Educating Substance Use Treatment Center Providers on Tobacco Use Treatments Is Associated with Increased Provision of Counseling and Medication to Patients Who Use Tobacco. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4013. [PMID: 36901024 PMCID: PMC10001967 DOI: 10.3390/ijerph20054013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Tobacco use is the leading preventable cause of death in America and is elevated among patients with non-tobacco substance use disorders. Substance use treatment centers (SUTCs) do not commonly address their patients' tobacco use. Lack of knowledge on treating tobacco use with counseling and medication may be a barrier that underlies this inaction. A multi-component tobacco-free workplace program implemented in Texas SUTCs educated providers on treating tobacco use with evidence-based medication (or referral) and counseling. This study examined how center-level changes in knowledge from pre- to post-implementation (i.e., over time) affected center-level behavioral changes in providers' provision of tobacco use treatment over time. Providers from 15 SUTCs completed pre- and post-implementation surveys (pre N = 259; post N = 194) assessing (1) perceived barriers to treating tobacco use, specifically, a lack of knowledge on treating tobacco use with counseling or medication; (2) receipt of past-year education on treating tobacco use with counseling or medication; and (3) their intervention practices, specifically, the self-reported regular use of (a) counseling or (b) medication intervention or referral with patients who use tobacco. Generalized linear mixed models explored associations between provider-reported knowledge barriers, education receipt, and intervention practices over time. Overall, recent counseling education receipt was endorsed by 32.00% versus 70.21% of providers from pre- to post-implementation; the regular use of counseling to treat tobacco use was endorsed by 19.31% versus 28.87% from pre- to post-implementation. Recent medication education receipt was endorsed by 20.46% versus 71.88% of providers from pre- to post-implementation; the regular use of medication to treat tobacco use was endorsed by 31.66% versus 55.15% from pre- to post-implementation. All changes were statistically significant (ps < 0.05). High versus low reductions in the provider-reported barrier of "lack of knowledge on pharmacotherapy treatment" over time were a significant moderator of effects, such that SUTCs with high reductions in this barrier were more likely to report greater increases in both medication education receipt and medication treatment/referral for patients who use tobacco over time. In conclusion, a tobacco-free workplace program implementation strategy that included SUTC provider education improved knowledge and resulted in increased delivery of evidence-based treatment of tobacco use at SUTCs; however, treatment provision rates-in particular, offering tobacco cessation counseling-remained less than desirable, suggesting that barriers beyond lack of knowledge may be important to address to improve tobacco use care in SUTCs. Moderation results suggest (1) differences in the mechanisms underlying uptake of counseling education versus medication education and (2) that the relative difficulty of providing counseling versus providing medication persists regardless of knowledge gains.
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Affiliation(s)
- Brian J. Carter
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Ammar D. Siddiqi
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Biosciences, Rice University, 6100 Main St., Houston, TX 77005, USA
| | - Tzuan A. Chen
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Maggie Britton
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Isabel Martinez Leal
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Anastasia Rogova
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier St., Austin, TX 78704, USA
| | | | | | - Lorraine R. Reitzel
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
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Bjørnestad ED, Vederhus JK, Clausen T. High smoking and low cessation rates among patients in treatment for opioid and other substance use disorders. BMC Psychiatry 2022; 22:649. [PMID: 36261791 PMCID: PMC9583489 DOI: 10.1186/s12888-022-04283-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 09/30/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Smoking is a well-documented cause of health problems among individuals with substance use disorders. For patients in opioid maintenance treatment (OMT), the risk for somatic health problems, including preventable diseases associated with tobacco smoking, increases with age. Our aim was to describe smoking among patients entering substance use disorder (SUD) treatment, investigate changes in smoking from the start of treatment to 1-year follow-up, and explore factors related to smoking cessation. METHODS We employed data from the Norwegian Cohort of Patient in Opioid Maintenance Treatment and Other Drug Treatment Study (NorComt). Participants were 335 patients entering SUD treatment at 21 participating facilities across Norway. They were interviewed at the start of treatment and at 1-year follow-up. The main outcomes were smoking and smoking cessation by treatment modality. A logistic regression identified factors associated with smoking cessation. RESULTS High levels of smoking were reported at the start of treatment in both OMT (94%) and other SUD inpatient treatment patients (93%). At 1-year follow-up most patients in OMT were still smoking (87%), and the majority of the inpatients were still smoking (69%). Treatment as an inpatient was positively associated and higher age was negatively associated with smoking cessation. Most patients who quit smoking transitioned to smokeless tobacco or kept their existing smokeless habit. CONCLUSION As illustrated by the high smoking prevalence and relatively low cessation levels in our sample, an increased focus on smoking cessation for patients currently in OMT and other SUD treatment is warranted. Harm-reduction oriented smoking interventions may be relevant.
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Affiliation(s)
- Endre Dahlen Bjørnestad
- Addiction Unit, Sørlandet Hospital HF, Po. box 416, N-4604, Kristiansand, Norway. .,Norwegian Centre for Addiction Research (SERAF), University of Oslo, Kirkeveien 166, N-0407, Oslo, Norway.
| | - John-Kåre Vederhus
- grid.417290.90000 0004 0627 3712Addiction Unit, Sørlandet Hospital HF, Po. box 416, N-4604 Kristiansand, Norway
| | - Thomas Clausen
- grid.5510.10000 0004 1936 8921Norwegian Centre for Addiction Research (SERAF), University of Oslo, Kirkeveien 166, N-0407 Oslo, Norway ,grid.417290.90000 0004 0627 3712Addiction Unit, Sørlandet Hospital HF, Po. box 416, N-4604 Kristiansand, Norway
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Rzeszutek MJ, Gipson-Reichardt CD, Kaplan BA, Koffarnus MN. Using crowdsourcing to study the differential effects of cross-drug withdrawal for cigarettes and opioids in a behavioral economic demand framework. Exp Clin Psychopharmacol 2022; 30:452-465. [PMID: 35201826 PMCID: PMC9308700 DOI: 10.1037/pha0000558] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Smoking rates among those who use prescribed or recreational opioids are significantly higher than the general population. Hypothesized neuropharmacological interactions between opioids and nicotine may contribute to this pattern of polysubstance use, especially during withdrawal. However, little research has examined how the withdrawal of one substance may affect the consumption of the other (i.e., cross-drug withdrawal effects). Behavioral economic demand tasks (e.g., hypothetical purchase tasks) can be used to quickly assess the value of a drug. Crowdsourcing can be a convenient tool to gain preliminary insight into different processes in substance valuation that may otherwise be impossible or prohibitively difficult to study. The purpose of the present study was to provide a preliminary examination of the effects of hypothetical withdrawal of cigarettes and opioids on the consumption of those drugs among polysubstance users. Amazon Mechanical Turk workers who reported daily smoking and at least monthly opioid use completed a series of hypothetical purchase tasks for doses of opioids and cigarettes under various withdrawal conditions. Sensitivity to the price of both drugs decreased when under withdrawal for either, indicating a higher drug value of cigarettes and opioids due to effects of cross-drug withdrawal. Nicotine and opioid dependence severity, impulsive choice, and riskiness were also positively related to drug purchasing. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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17
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Rates of substance and polysubstance use through universal maternal testing at the time of delivery. J Perinatol 2022; 42:1026-1031. [PMID: 35177791 PMCID: PMC9356969 DOI: 10.1038/s41372-022-01335-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To report substance and polysubstance use at the time of delivery. STUDY DESIGN A cross-sectional study was performed on mothers consented for universal drug testing (99%) during hospital admission at six delivery hospitals in Cincinnati, Ohio. Mass spectrometry urinalysis detected positivity rates of 46 substances. Rates of positive drug tests for individual and common co-occurring substances measured were reported. RESULTS 2531 maternal samples were tested (88%) and 33% contained cotinine, 11.3% THC, 7.2% opioids, 3.8% cocaine, and 1.9% methamphetamines. Polysubstance use prevalence was as high as 15%. Among mothers testing positive for methadone or buprenorphine, 93% also tested positive for cotinine and 39% tested positive for a third substance in addition to cotinine. CONCLUSIONS Substance use at delivery is more prevalent than previously reported. Many mothers testing positive for opioids also test positive for other substances, which may increase overdose risk and exacerbate neonatal opioid withdrawal syndrome (NOWS).
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18
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Giordano NA, Seilern Und Aspang J, Baker J, Medline A, Rice CW, Barrell B, Kirk L, Ortega E, Wallace M, Steck A, Schenker ML. Integration of Life Care Specialists Into Orthopaedic Trauma Care to Improve Postoperative Outcomes: A Pilot Study. Pain Manag Nurs 2022; 23:608-615. [PMID: 35477669 DOI: 10.1016/j.pmn.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AIM: This pilot study assessed the feasibility and impact of integrating a Life Care Specialist (LCS) into orthopaedic trauma care. DESIGN This was a prospective feasibility single group pilot study at a level 1 trauma center. METHOD The LCS is a paraprofessional behavior-based "pain coach" and delivered patient-centered opioid safety education, trained participants on nonpharmacologic pain management approaches, conducted opioid risk assessments, and coordinated care. Numeric Rating Scale pain scores were assessed on admission, at discharge, and at 2-week follow-up. Daily morphine milligram equivalents (MME) during hospitalization, opioid medication use at 2-weeks, and patient satisfaction were recorded. T test compared mean morphine milligram equivalents (MME) to historical orthopaedic trauma patient population's mean dosage at discharge from the study site. Generalized linear models assessed pain scores over time. RESULTS Twenty-two percent of 121 total participants met criteria for moderate to severe risk of opioid misuse at initial hospitalization. On average, 2.8 LCS pain management interventions were utilized, most frequently progressive muscle relaxation (80%) and sound therapy (48%). Mean inpatient MME/day was 40.5, which was significantly lower than mean historical MME/day of 49.7 (p < .001). Pain scores improved over time from admission to 2-weeks postoperatively (p < .001). Nearly all participants agreed that the LCS was helpful in managing pain (99%). CONCLUSIONS The findings indicate feasibility to integrate LCS into orthopaedic trauma care, evident by participant engagement and satisfaction, and that LCS serve as valuable resources to assist with pain management and opioid education.
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Affiliation(s)
| | | | - J'Lynn Baker
- Emory University Orthopaedic Surgery, Grady Memorial Hospital, Atlanta, Georgia
| | - Alexandra Medline
- Emory University Orthopaedic Surgery, Grady Memorial Hospital, Atlanta, Georgia
| | | | | | | | - Erika Ortega
- Emory University Orthopaedic Surgery, Grady Memorial Hospital, Atlanta, Georgia
| | | | - Alaina Steck
- Emory University Department of Emergency Medicine, Grady Memorial Hospital, Atlanta, Georgia
| | - Mara L Schenker
- Emory University Orthopaedic Surgery, Grady Memorial Hospital, Atlanta, Georgia; Grady Memorial Hospital, Atlanta, Georgia.
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19
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Shankar D, Borrelli B, Cobb V, Quintiliani LM, Palfai T, Weinstein Z, Bulekova K, Kathuria H. Text-messaging to promote smoking cessation among individuals with opioid use disorder: quantitative and qualitative evaluation. BMC Public Health 2022; 22:668. [PMID: 35387648 PMCID: PMC8988312 DOI: 10.1186/s12889-022-13008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Individuals with opioid use disorder (OUD) who smoke cigarettes have high tobacco-related comorbidities, lack of access to tobacco treatment, lack of inclusion in smoking cessation trials, and remain understudied in the mobile health field. The purpose of this study was to understand patients' with OUD perceptions of 1) text message programs to promote smoking cessation, 2) content and features to include in such a program, and 3) how message content should be framed. METHODS From December 2018 to February 2019, we recruited 20 hospitalized individuals with a concurrent diagnosis of OUD and tobacco dependence at Boston Medical Center (BMC), the largest safety-net hospital in New England. We surveyed participants' cell phone use, their interest in a text message program to promote smoking cessation, and their reactions to and ratings of a series of 26 prototype texts. We then conducted open-ended interviews to elicit content and suggestions on how text message interventions can improve motivation to increase smoking cessation among individuals with OUD. The interviews also included open-ended inquiries exploring message ratings and message content, inquiries about preferences for message duration, frequency, and personalization. RESULTS Quantitative analysis of questionnaire data indicated that the majority of participants owned a cell phone (95%, 19/20). Most participants (60%, 12/20) reported that they would be interested or very interested in receiving text messages about smoking cessation. Text messages about the health benefits of quitting were rated the highest among various categories of text messages. Qualitative analysis showed that almost every participant felt that text messages would help motivate smoking cessation given the support it would provide. CONCLUSIONS This study demonstrates that individuals with OUD who smoke cigarettes perceive that a text message program designed to promote smoking cessation would motivate and support smoking cessation efforts. Our findings demonstrate that such a program is feasible as participants own cell phones, frequently send and receive text messages, and have unlimited text message plans. Findings from this study provide valuable insight into content and features to include when developing text message programs to address barriers to smoking cessation in individuals who have OUD and smoke cigarettes.
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Affiliation(s)
- Divya Shankar
- Pulmonary Center, Department of Medicine, Boston University Medical Center, 72 East Concord Street, R304, Boston, MA, USA.
| | - Belinda Borrelli
- Boston University, Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Vinson Cobb
- Pulmonary Center, Department of Medicine, Boston University Medical Center, 72 East Concord Street, R304, Boston, MA, USA
| | - Lisa M Quintiliani
- Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Tibor Palfai
- Psychological and Brain Science, Boston University, Boston, MA, USA
| | - Zoe Weinstein
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Katia Bulekova
- Research Computing Services (RCS) group, Information Services & Technology, Boston University, Boston, MA, USA
| | - Hasmeena Kathuria
- Pulmonary Center, Department of Medicine, Boston University Medical Center, 72 East Concord Street, R304, Boston, MA, USA
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Avelar AJ, Cooper SY, Wright TD, Wright SK, Richardson MR, Henderson BJ. Morphine Exposure Reduces Nicotine-Induced Upregulation of Nicotinic Receptors and Decreases Volitional Nicotine Intake in a Mouse Model. Nicotine Tob Res 2022; 24:1161-1168. [PMID: 34999827 PMCID: PMC9278828 DOI: 10.1093/ntr/ntac002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/18/2021] [Accepted: 01/04/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Nicotine addiction remains a primary health concern as tobacco smoking remains the number one cause of preventable death in America. At the same time, America is still facing the threat of the opioid epidemic. While the prevalence of smoking combustible cigarettes or electronic nicotine delivery systems in the United States varies between 12% and 35%, the smoking rates among the opioid use dependent (OUD) population is 74%-97%. We examined changes in brain reward mechanisms in which co-use of nicotine and opioids may result in enhanced reward and reinforcement. AIMS AND METHODS Adult male and female α4-mCherryα6-GFP mice (C57BL/6J) were used in conditioned place preference (CPP) and microscopy assays to examine reward-related behavior and nicotinic acetylcholine receptor (nAChR) upregulation following treatments with saline, nicotine, morphine, or nicotine plus morphine. Following this, separate mice were trained in e-Vape self-administration assays to examine morphine's impact on nicotine reinforcement. RESULTS We observed that nicotine and morphine coexposure in a CPP assay did not produce enhanced reward-related behavior when compared with nicotine or morphine alone. In parallel we observed coexposure reduced nicotine-induced upregulation of nAChRs on ventral tegmental area dopamine and GABA neurons. Additionally, we observed that concurrent morphine exposure reduced nicotine (plus menthol) vapor self-administration in male and female mice. CONCLUSIONS While nicotine use is high among OUD individuals, our CPP assays suggest coexposure not only fails to enhance reward-related behavior but also reduces nicotine-induced changes in ventral tegmental area neurobiology. Our self-administration assays suggest that morphine exposure during nicotine acquisition reduces nicotine reinforcement-related behavior. IMPLICATIONS While some may postulate that the co-use of opioids and nicotine may be driven by reward-related mechanisms, our data indicate that opioid exposure may hinder nicotine intake due to reduced upregulation of nAChRs critical for nicotine reward and reinforcement. Thus, the high co-use in OUD individuals may be a result of other mechanisms and this warrants further investigations into nicotine and opioid co-use.
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Affiliation(s)
- Alicia J Avelar
- Department of Biomedical Sciences, Joan C Edwards School of Medicine at Marshall University, Huntington, WV, USA
| | - Skylar Y Cooper
- Department of Biomedical Sciences, Joan C Edwards School of Medicine at Marshall University, Huntington, WV, USA
| | - Thomas Douglas Wright
- Department of Biomedical Sciences, Joan C Edwards School of Medicine at Marshall University, Huntington, WV, USA
| | - Sheavonnie K Wright
- Department of Biomedical Sciences, Joan C Edwards School of Medicine at Marshall University, Huntington, WV, USA
| | - Montana R Richardson
- Department of Biomedical Sciences, Joan C Edwards School of Medicine at Marshall University, Huntington, WV, USA
| | - Brandon J Henderson
- Corresponding Author: Brandon J. Henderson, PhD, Department of Biomedical Sciences, Joan C Edwards School of Medicine at Marshall University, 1700 3rd Ave, 410 BBSC, Huntington, WV 25703, USA. Telephone: 304-696-7316; Fax: 304-696-7391; E-mail:
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Giordano NA, Seilern Und Aspang J, Baker J, Rice CW, Barrell B, Kirk L, Ortega E, Wallace M, Steck A, Schenker ML. The effect of a Life Care Specialist on pain management and opioid-related outcomes among patients with orthopedic trauma: study protocol for a randomized controlled trial. Trials 2021; 22:858. [PMID: 34838101 PMCID: PMC8626911 DOI: 10.1186/s13063-021-05841-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Orthopedic trauma patients face complex pain management needs and are frequently prescribed opioids, leaving them at-risk for prolonged opioid use. To date, post-trauma pain management research has placed little emphasis on individualized risk assessments for misuse and systematically implementing non-pharmacologic pain management strategies. Therefore, a community-academic partnership was formed to design a novel position in the healthcare field (Life Care Specialist (LCS)), who will educate patients on the risks of opioids, tapering usage, safe disposal practices, and harm reduction strategies. In addition, the LCS teaches patients behavior-based strategies for pain management, utilizing well-described techniques for coping and resilience. This study aims to determine the effects of LCS intervention on opioid utilization, pain control, and patient satisfaction in the aftermath of orthopedic trauma. METHODS In total, 200 orthopedic trauma patients will be randomized to receive an intervention (LCS) or a standard-of-care control at an urban level 1 trauma center. All patients will be assessed with comprehensive social determinants of health and substance use surveys immediately after surgery (baseline). Follow-up assessments will be performed at 2, 6, and 12 weeks postoperatively, and will include pain medication utilization (morphine milligram equivalents), pain scores, and other substance use. In addition, overall patient wellness will be evaluated with objective actigraphy measures and patient-reported outcomes. Finally, a survey of patient understanding of risks of opioid use and misuse will be collected, to assess the influence of LCS opioid education. DISCUSSION There is limited data on the role of individualized, multimodal, non-pharmacologic, behavioral-based pain management intervention in opioid-related risk-mitigation in high-risk populations, including the orthopedic trauma patients. The findings from this randomized controlled trial will provide scientific and clinical evidence on the efficacy and feasibility of the LCS intervention. Moreover, the final aim will provide early evidence into which patients benefit most from LCS intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT04154384 . Registered on 11/6/2019 (last updated on 6/10/2021).
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Affiliation(s)
- Nicholas A Giordano
- Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA, 30322, USA
| | - Jesse Seilern Und Aspang
- Emory University Orthopaedic Surgery, Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA
| | - J'Lynn Baker
- Emory University Orthopaedic Surgery, Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA
| | | | | | | | - Erika Ortega
- Emory University Orthopaedic Surgery, Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA
| | | | - Alaina Steck
- Emory University Department of Emergency Medicine, Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA
| | - Mara L Schenker
- Emory University Orthopaedic Surgery, Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA. .,Grady Memorial Hospital, Atlanta, GA, USA.
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22
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Gonzalez M, Sanders-Jackson A. Traditional Cigarette and Poly-Tobacco Use Are Associated with Medical Opioid Use in Rural Areas of the US. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211864. [PMID: 34831619 PMCID: PMC8619274 DOI: 10.3390/ijerph182211864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 11/16/2022]
Abstract
Introduction: Medical prescriptions for opioids are higher in rural areas of the US as compared to urban areas. Tobacco use may also play a role in this process. This analysis examines the association between differing types of tobacco use and medical opioid use. Methods: We analyze the relationship between tobacco product use and medical opioid use among the US general population living in rural (non-metropolitan) areas using the publicly available sample adult file 2019 National Health Interview Survey (NHIS) (n = 5028). Tobacco use was classified into the following categories: only using cigarettes, only using e-cigarettes/vapes, only using cigars, only using smokeless tobacco, or using two or more of the following products. We used a binary logistic regression, controlling for individual differences. Results: Individuals who reported using only traditional cigarettes (and no other tobacco product, OR = 1.62, 95% CI: 1.31, 2.01), or who reported being a poly-tobacco users (OR = 2.13, 95% CI: 1.40, 3.22) had higher odds of medical opioid use in the last twelve months. Conclusion: Results suggest a link between tobacco use, particularly cigarette use and poly-tobacco use, and medical opioid use in rural communities. Clinical and structural level interventions need to be implemented in rural communities to reduce comorbid tobacco and opioid use.
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Affiliation(s)
- Mariaelena Gonzalez
- Department of Public Health, School of Social Sciences Humanities and the Arts, University of California Merced, Merced, CA 95343, USA
- Nicotine and Cannabis Policy Center, University of California Merced, Merced, CA 95343, USA
- Correspondence:
| | - Ashley Sanders-Jackson
- Department of Advertising and Public Relations, College of Communications Arts and Sciences, Michigan State University, East Lansing, MI 48824, USA;
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23
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Smith BL. Improving translational relevance: The need for combined exposure models for studying prenatal adversity. Brain Behav Immun Health 2021; 16:100294. [PMID: 34589787 PMCID: PMC8474200 DOI: 10.1016/j.bbih.2021.100294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022] Open
Abstract
Prenatal environmental adversity is a risk factor for neurodevelopmental disorders (NDDs), with the neuroimmune environment proposed to play a role in this risk. Adverse maternal exposures are associated with cognitive consequences in the offspring that are characteristics of NDDs and simultaneous neuroimmune changes that may underlie NDD risk. In both animal models and human studies the association between prenatal environmental exposure and NDD risk has been shown to be complex. Maternal overnutrition/obesity and opioid use are two different examples of complex exposure epidemics, each with their own unique comorbidities. This review will examine maternal obesity and maternal opioid use separately, illustrating the pervasive comorbidities with each exposure to argue a need for animal models of compound prenatal exposures. Many of these comorbidities can impact neuroimmune function, warranting systematic investigation of combined exposures to begin to understand this complexity. While traditional approaches in animal models have focused on modeling a single prenatal exposure or second exposure later in life, a translational approach would begin to incorporate the most prevalent co-occurring prenatal exposures. Long term follow-up in humans is extremely challenging, so animal models can provide timely insight into neurodevelopmental consequences of complex prenatal exposures. Animal models that represent this translational context of comorbid exposures behind maternal obesity or comorbid exposures behind maternal opioid use may reveal potential synergistic neuroimmune interactions that contribute to cognitive consequences and NDD risk. Finally, translational co-exposure models can identify concerning exposure combinations to guide treatment in complex cases, and identify high risk children starting in the prenatal period where early interventions improve prognosis.
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Affiliation(s)
- Brittany L. Smith
- Department of Pharmacology & Systems Physiology, University of Cincinnati, Cincinnati, OH, USA
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