The Interaction of Alcohol Use and Cannabis Use Problems in Relation to Opioid Misuse Among Adults with Chronic Pain

Michigan Marijuana Legalization: Correlations Among Cannabis Use, Mental Health, and Other Factors

Introduction: There are health implications with the statewide legalization of recreational marijuana that are still not fully understood and require further examination. This study evaluates the prevalence of marijuana use in patients being treated for a variety of conditions and whether correlations exist between marijuana use, mental health conditions, and concomitant use of psychotropic medications.

Methods: Data were collected from an electronic medical record (EMR) as part of a retrospective chart audit. A total of 500 charts were reviewed during a six-month timeframe from December 1, 2018 to May 31, 2019 with the start date approximating the timing of when marijuana became recreationally legalized in the State of Michigan.

Results: This study demonstrated a point prevalence of 15.8% since 79 of the 500 charts reviewed had marijuana use documented. Additionally, marijuana users were more likely to have a history of cocaine use, schizophrenia, antipsychotic use, and tobacco use.

Conclusion: Trends identified in this study provide a comparison point for the local prevalence of marijuana use immediately post state-wide legalization, with a projected increasing trend due to the removal of legal barriers.

[Neurotransmitter changes in the rat brain under combined intoxication induced by alcohol and morphine]

We investigated the levels of biogenic monoamines and their metabolites in the rat hypothalamus, midbrain and cerebellum in acute complex intoxication with morphine and alcohol. The distinctive features of neurotransmitter disorders in various parts of the rat brain under a single exposure to ethanol and morphine, as well as the differences between acute morphine-alcohol and alcohol-morphine intoxication were established. Complex intoxication with alcohol and morphine resulted in signs of dopamine consumption only in the hypothalamus, regardless of the order of alcohol and morphine administration. Under conditions of alcohol-morphine intoxication an increase in the level of metabolites of the serotonergic system was noted in the investigated parts of the brain. In the midbrain and cerebellum the manifestation of combined action of ethanol and morphine is mainly determined by the effect of the last of the administered substances. There are features of changes in the indices of the dopaminergic and serotonergic systems in these experimental conditions, confirmed by the processes of dopamine catabolism and a decrease in the norepinephrine and serotonin concentration in the hypothalamus, which are not observed under individual action of ethanol and morphine.

The phenomics and genetics of addictive and affective comorbidity in opioid use disorder

Opioid use disorder (OUD) creates significant public health and economic burdens worldwide. Therefore, understanding the risk factors that lead to the development of OUD is fundamental to reducing both its prevalence and its impact. Significant sources of OUD risk include co-occurring lifetime and current diagnoses of both psychiatric disorders, primarily mood disorders, and other substance use disorders, and unique and shared genetic factors. Although there appears to be pleiotropy between OUD and both mood and substance use disorders, this aspect of OUD risk is poorly understood. In this review, we describe the prevalence and clinical significance of addictive and affective comorbidities as risk factors for OUD development as a basis for rational opioid prescribing and OUD treatment and to improve efforts to prevent the disorder. We also review the genetic variants that have been associated with OUD and other addictive and affective disorders to highlight targets for future study and risk assessment protocols.

Predicting opioid overdose risk of patients with opioid prescriptions using electronic health records based on temporal deep learning

The US is experiencing an opioid epidemic, and opioid overdose is causing more than 100 deaths per day. Early identification of patients at high risk of Opioid Overdose (OD) can help to make targeted preventative interventions. We aim to build a deep learning model that can predict the patients at high risk for opioid overdose and identify most relevant features. The study included the information of 5,231,614 patients from the Health Facts database with at least one opioid prescription between January 1, 2008 and December 31, 2017. Potential predictors (n = 1185) were extracted to build a feature matrix for prediction. Long Short-Term Memory (LSTM) based models were built to predict overdose risk in the next hospital visit. Prediction performance was compared with other machine learning methods assessed using machine learning metrics. Our sequential deep learning models built upon LSTM outperformed the other methods on opioid overdose prediction. LSTM with attention mechanism achieved the highest F-1 score (F-1 score: 0.7815, AUCROC: 0.8449). The model is also able to reveal top ranked predictive features by permutation important method, including medications and vital signs. This study demonstrates that a temporal deep learning based predictive model can achieve promising results on identifying risk of opioid overdose of patients using the history of electronic health records. It provides an alternative informatics-based approach to improving clinical decision support for possible early detection and intervention to reduce opioid overdose.

Facilitators and Barriers to Nurse Practitioners Prescribing Methadone for Opioid Use Disorder in Nova Scotia: A Qualitative Study

Background

Opioid use has escalated dramatically resulting in an increase in deaths. Access to treatment for opioid use disorder (OUD) is poor. The addition of nurse practitioners (NPs) as prescribers of methadone for OUD offers potential for improving access. Little is known about what support NPs will require as they prescribe methadone.

Purpose

This paper identifies facilitators and barriers to NPs prescribing methadone.

Methods

In this qualitative study, in-person and phone semi-structured interviews were conducted with 18 participants. Participants included NPs (n=5), physicians (n=5), and stakeholders including members of professional regulatory bodies and government, academics and other clinicians (n=8). Interviews were recorded, transcribed, and analyzed using thematic analysis and software (NVivo 12.4.0) for data management.

Results

Four themes emerged: 1) Pervasive Barrier of Stigma; 2) Perceived Complexity of Patients Living with OUD; 3) NP Education and Practice Supports and; 4) Health Care Context and NP Role Implementation.

Conclusions

Barriers and facilitators to NP prescribing are similar to those encountered by physicians. Factors unique to NPs include the identification of role clarity as a facilitator and navigation of physician networks as a barrier. Research conducted with current NP methadone prescribers is required to evaluate implementation of this service.

Pain-induced alterations in the dynorphinergic system within the mesocorticolimbic pathway: Implication for alcohol addiction

Latest studies have revealed that pain negatively impacts on reward processing and motivation leading to negative affective states and stress. These states not only reduce quality of life of patients by increasing the appearance of psychiatric comorbidities, but also have an important impact on vulnerability to drug abuse, including alcohol. In fact, clinical, epidemiological but also preclinical studies have revealed that the presence of pain is closely related to alcohol use disorders (AUDs). All this evidence suggests that pain is a factor that increases the risk of suffering AUD, predicting heavy drinking behavior and relapse drinking in those patients with a previous history of AUD. The negative consequences of chronic pain and its impact on stress and AUD are likely mediated by alterations in the central nervous system, especially in the stress and reward systems. Therefore, pain and stress impact on dopaminergic mesolimbic pathway can lead to an increase in drug abuse liability. In this mini review we analyze the interaction between pain, stress, and alcohol addiction, and how dynamic changes in the kappa opioid system might play a crucial role in the development of compulsive alcohol drinking in chronic pain patients.

The influence of neuroticism in terms of E-cigarette dependence and beliefs about use and quitting among dual users of combustible and electronic cigarettes

OBJECTIVE

Dual use of combustible and electronic cigarettes (e-cigarettes) is increasing in prevalence and may be related to an increased risk for health problems. Accordingly, dual users represent a particularly vulnerable group. Neuroticism is an individual difference factor that demonstrates robust relations to combustible cigarette use. Yet, no work has examined neuroticism in relation to e-cigarette dependence or cognitions among dual users.

METHODS

To address this limitation, the present study examined neuroticism in relation to e-cigarette dependence, expectancies about the negative effects of e-cigarettes, and perceived barriers for quitting e-cigarettes. The present study analyzed data collected from a cross-sectional survey of 437 dual combustible cigarette and e-cigarette users (49.9% female, M_age = 35.12 years, SD = 10.04).

RESULTS

Results indicated that neuroticism was significantly, positively related to e-cigarette dependence (ΔR² = 0.02, p < .001), expectancies about the negative effects of e-cigarettes (ΔR² = 0.03, p < .001), and perceived barriers for quitting e-cigarettes (ΔR² = 0.10, p < .001).

CONCLUSIONS

These novel findings suggest there may be merit in further exploring the role of neuroticism in the maintenance of concurrent combustible cigarette and e-cigarette use.