Gender differences in physical and mental health outcomes among an aging cohort of individuals with a history of heroin dependence

Gender identity, stimulant drug use, and criminal justice history on internalized stigma among a nationally representative sample of adults who misuse opioids

PURPOSE

The rise of fatal stimulant use among adults who use opioids is a public health problem. Internalized stigma is a barrier to substance use treatment, which is greater for women and populations with criminal justice involvement.

METHODS

Using a nationally representative sample of adults in the United States from a probability-based survey on household opinions in 2021, we examined characteristics of women (n = 289) and men (n = 416) who misuse opioids. In gender-stratified multivariable linear regression, we investigated factors associated with internalized stigma, and tested for the interaction of stimulant use and criminal justice involvement.

RESULTS

Compared to men, women reported greater mental health symptom severity (3.2 vs. 2.7 on a 1 to 6 scale, p < 0.001). Internalized stigma was similar between women (2.3 ± 1.1) and men (2.2 ± 0.1). Among women and not men, however, stimulant use was positively associated with internalized stigma (0.36, 95% CI [0.07, 0.65]; p = 0.02). Interaction between stimulant use and criminal justice involvement was negatively associated with internalized stigma among women (- 0.60, 95% CI [- 1.16, -0.04]; p = 0.04); among men, the interaction was not significant. Predictive margins illustrate among women, stimulant use eliminated the gap in internalized stigma such that women with no criminal justice involvement had a similar level of internalized stigma as women with criminal justice involvement.

CONCLUSION

Internalized stigma between women and men who misuse opioids differed based on stimulant use and criminal justice involvement. Future research should assess whether internalized stigma influences treatment utilization among women with criminal justice involvement.

The health of people attending residential treatment for alcohol and other drug use: Prevalence of and risks for major lifestyle diseases

INTRODUCTION

Cardiovascular disease and cancers are the leading cause of mortality amongst people accessing treatment for alcohol and other drug use. The current study aimed to examine risk factors for chronic disease amongst people attending residential alcohol and other drug treatment services.

METHODS

Participants (N = 325) were attending residential alcohol and other drug treatment services across Australia. Diabetes and cardiovascular disease risk scores were calculated using established risk estimation algorithms. Differences in existing health conditions, risk factors for chronic diseases and risk algorithms were calculated for males and females.

RESULTS

In addition to alcohol and other drug use (including tobacco use), 95% of the sample had at least one other risk factor for chronic disease. Of participants not already diagnosed, 36% were at a high risk of developing type 2 diabetes and 11% had a high risk of developing cardiovascular disease. The heart age of participants was 11 years older than actual age (Mage = 40.63, Mheart age = 52.41). Males had a higher cardiovascular disease risk than females.

DISCUSSION AND CONCLUSIONS

A large proportion of people accessing residential alcohol and other drug treatment were at risk of chronic disease. Future research is needed that uses objective indicators of physical health. Such research will help to develop our understanding of prevention and intervention initiatives that could be adopted by treatment providers to improve the physical health of their consumers.

Estrous cycle dependent expression of oxycodone conditioned reward in rats

Oxycodone is one of the most widely prescribed and misused opioid painkillers in the United States. Evidence suggests that biological sex and hormonal status can impact drug reward in humans and rodents, but the extent to which these factors can influence the rewarding effects of oxycodone is unclear. The purpose of this study was to utilize place conditioning to determine the effects of sex and female hormonal status on the expression of oxycodone conditioned reward in rats. Gonadally intact adult Sprague-Dawley male and female rats were used to test: (1) whether both sexes express conditioned reward to oxycodone at similar doses, (2) the impact of conditioning session length on oxycodone conditioned reward expression in both sexes, and (3) the influence of female estrous cycle stage on oxycodone conditioned reward expression. Both sexes expressed conditioned reward at the same doses of oxycodone. Increasing the length of conditioning sessions did not reveal an effect of sex and resulted in lower magnitude conditioned reward expression. Importantly however, female stage of estrous cycle significantly influenced oxycodone conditioned reward expression. These results suggest that female hormonal status can impact the rewarding effects of opioids and thus have important implications for prescription opioid treatment practices.

Gender differences in physical morbidity in opioid agonist treatment patients: population-based cohort studies from the Czech Republic and Norway

BACKGROUND

Physical diseases represent a significant burden for opioid agonist treatment (OAT) patients. This study described physical morbidity in two national cohorts of OAT patients focusing on gender differences.

METHODS

This population-based cohort study linking multiple health registers investigated physical diseases (ICD-10) in patients receiving OAT in the Czech Republic (N = 4,280) and Norway (N = 11,389) during 2010-2019. Gender-stratified analysis was performed.

RESULTS

Overall, we found a large burden of physical morbidity across gender groups in OAT patients. In the Czech Republic and Norway, women in OAT had a significantly higher prevalence of physical diseases across most diagnostic chapters, notably genitourinary diseases and neoplasms. Injuries/external causes and infectious/parasitic diseases were among the most common diseases in both women and men. Viral hepatitis accounted for over half of infectious morbidity in women and men in both cohorts.

CONCLUSIONS

Our findings support the need for early screening, detection, and treatment of diseases and conditions across organ systems and the integration of health promotion activities to reduce physical morbidity in OAT patients. The gender differences underline the need for a tailored approach to address specific medical conditions.

Gender differences in clinical characteristics of emergency department patients involving illicit drugs use with analytical confirmation

BACKGROUND

To compare gender differences in socio-demographics, clinical manifestations, and laboratory test results of individuals who visited emergency departments (EDs) involving drug use.

METHODS

We retrospectively collected the data from 10 hospitals in Taiwan on drug-related ED visits from May 2017 to December 2020. We then examined the gender differences in their socio-demographics, clinical manifestations, urine toxicological results, and other laboratory tests results using chi-square or multivariable logistic regression.

RESULTS

Among individuals with drug-related ED visits, there were 546 (73.7%) men and 195 (26.3%) women. The most commonly used drugs were meth/amphetamine, followed by synthetic cathinones, and ketamine and its analogs. Compared to men, women were younger (32.03 ± 10.86 vs. 36.51 ± 10.84 years, p < 0.001) and more likely to use new psychoactive substances (NPS) (p = 0.011). Men were more likely to have human immunodeficiency virus infection (p < 0.001), whereas women were more likely to report psychiatric comorbidities (p = 0.003). Women were less likely to have aggressive behaviors (odds ratio (OR): 0.59, 95% CI: 0.39-0.88). After adjusting for socio-demographics and drug types, women were still less likely to have aggressive behaviors than men (adjusted OR: 0.59, 95% CI: 0.38-0.93). The likelihood of rhabdomyolysis and intensive care unit admission was higher in men (p < 0.001).

CONCLUSION

We found considerable gender differences in clinical characteristics among ED-visiting drug users, which could offer valuable information for the future development of more tailored gender-specific drug prevention and treatment strategies.

Ageing and older people who use illicit opioids, cocaine or methamphetamine: a scoping review and literature map

AIMS

To provide an overview of research literature on ageing and older people who use illicit opioids and stimulants by documenting the conceptual frameworks used and content areas that have been investigated.

METHODS

We conducted a scoping review of literature relating to ageing and older people who use illicit stimulants and opioids, defining 'older' as 40 years and above. Primary studies, secondary studies and editorials were included. Searches were conducted in PubMed and Embase in July 2020 and March 2021; the Cochrane library was searched in November 2021. Charted data included methodological details, any conceptual frameworks explicitly applied by authors and the content areas that were the focus of the publication. We developed a hierarchy of content areas and mapped this to provide a visual guide to the research area.

RESULTS

Of the 164 publications included in this review, only 16 explicitly applied a conceptual framework. Seven core content areas were identified, with most publications contributing to multiple content areas: acknowledgement of drug use among older people (n = 64), health status (n = 129), health services (n = 109), drug use practices and patterns (n = 84), social environments (n = 74), the criminal legal system (n = 28) and quality of life (n = 15).

CONCLUSIONS

The literature regarding older people who use illicit drugs remains under-theorized. Conceptual frameworks are rarely applied and few have been purposely adapted to this population. Health status and health services access and use are among the most frequently researched topics in this area.

Race Differences in Opioid Misuse and Adolescent Suicidality

PURPOSE

The rise of the opioid epidemic coincided with the increased risk of suicide as the leading causes of death among adolescents in the United States. Past research has linked non-medical prescription opioid use (NMPOU) with adolescent suicide. Less focus has been placed on race and ethnic differences among adolescents impacted by the opioid epidemic. This study examined the relationship of adolescent NMPOU and suicidality, stratified by race.

METHOD

The 2016 National Survey on Drug Use and Health (NSDUH) was used for this study. Weighted multivariate logistic regression analyses were conducted on a sample of 11,489 adolescent respondents to examine the effect of past-year NMPOU with the odds for serious thoughts of suicide, having a suicide plan, and making a suicide attempt.

RESULTS

Findings indicated a higher prevalence of suicidality among adolescents who engaged in NMPOU compared to non-users. Adolescent opioid misuse was associated with 68% higher odds for having a suicide plan in the past year (OR = 1.68, 95% CI: [1.07, 2.63], p < 0.05). Interaction analysis found that among Asian adolescents, NMPOU was associated with higher odds for having a suicide plan compared to other race groups (OR=1.53, 95% CI: [1.04, 2.23], p < 0.05).

DISCUSSION

Results indicated that adolescent opioid misuse is a risk factor for suicide, and Asians compared to other race groups were at greater risk. Social workers can serve as a nexus point in effectively engaging at-risk adolescents in substance use and mental health prevention and recovery services.

Paying Attention to Women's Ageing Bodies in Recovery From Substance Use

BACKGROUND

Health-related research on women who use drugs (WWUD) tends to focus on reproductive and sexual health and treatment. Missing from the picture is an exploration of mid-life and older women's bodily experiences of transitioning from long-term substance use into recovery. While there are a growing number of studies that explore the intersection of drug use and ageing, the gaps in analysis lie in the intersections between drug use, recovery, ageing, gender, and the body.

METHODS

In-depth qualitative interviews were undertaken with 19 women in the UK who self-identified as "in recovery" from illicit drug use. The interviews were transcribed verbatim and analysed using Braun and Clarke's thematic analysis techniques. The study received ethical approval from the University of Glasgow.

RESULTS

Key findings from the interviews relate to the women's personal sense of power in relation to current and future health status, the challenges they endured in terms of ageing in recovery and transitioning through the reproductive life cycle, and the somatic effects of trauma on women's recovery. The findings demonstrate that health in recovery involves more than abstinence from drugs.

DISCUSSION

Moving from the body in active drug use to the body in recovery is not without its challenges for mid-life and older women. New sensations and feelings-physical and mental-must be re-interpreted in light of their ageing and drug-free bodies. This study reveals some of the substantive sex-based differences that older women in active drug use and recovery experience. This has important implications for healthcare and treatment for women in drug services and women with histories of drug use more generally.

Changes in secondary outcomes associated with brief interventions for problem gambling in methadone patients

BACKGROUND

Patients in methadone maintenance treatment (MMT) with problem gambling (PG) experience worse psychosocial outcomes than their non-PG counterparts. Interventions targeting PG in MMT may enhance psychosocial functioning beyond gambling reduction and abstinence. The present study was a secondary data analysis that examined the trajectories of non-gambling outcomes of three brief PG interventions (i.e., brief psychoeducation, brief advice, motivational enhancement therapy plus cognitive-behavioral therapy [MET + CBT]) among MMT patients.

METHODS

Participants (N = 109) were engaged in substance use disorder treatment, met criteria for PG, and had a current or lifetime history of MMT. Latent growth curve models examined outcome trajectories of psychiatric, medical, legal, employment, and social problems, as well as psychological distress and quality of life. Follow-up analyses examined clinically significant change.

RESULTS

MET + CBT patients reported lower medical problems at baseline and over time than the brief interventions. There was no evidence of differences between interventions on the other outcomes. Psychiatric problems and psychological distress decreased over time for the entire sample, regardless of the PG intervention. About 24% and 13% of the sample demonstrated clinically significant improvements in psychological distress from baseline to 5 months, and 5 months to 12 months, respectively. Nearly 21% of the sample showed clinically significant improvements in psychiatric problems from 5 months to 12 months. Among all patients, men and those with more severe opioid dependence symptoms demonstrated the greatest psychological improvements.

CONCLUSIONS

Many patients in MMT with PG experience improvements in psychological problems, including long-term improvement, regardless of the PG intervention offered.

Gender-specific associations between psychological distress and injecting risk behaviours among people who inject drugs in Montreal, Canada

BACKGROUND

Psychological distress is common among people who inject drugs (PWID) and may be associated with HCV-related risk behaviours. Previous studies have documented increased vulnerability to both psychological distress and HCV infection among female relative to male PWID. It is, however, unclear whether behavioural responses to distress differ by gender. This study estimated gender-specific associations between psychological distress and i) binge drug injection, and ii) sharing of injection materials.

METHODS

Data were drawn from HEPCO, a longitudinal cohort study involving three-monthly interviews with active PWID in Montreal, Canada. Past-month psychological distress was assessed with the Kessler (K10) scale, categorized for descriptive analyses as minimal (score 10-15), moderate (16-21), high (22-29), or severe (30-50). Binge was defined as injecting large quantities of drugs until participants could no longer continue (past 3 months). Sharing was defined as injection with previously-used needles or equipment (past 3 months). Generalized additive models were fit to estimate smooth, nonlinear associations between K10 scores and risk behaviours, by gender. Models were adjusted for known determinants of drug-related harms and included random intercepts to model within-subject correlation.

RESULTS

805 individuals (82% male) provided 8158 observations (2011-2020). High to severe levels of distress were common and more frequent among women (55% vs 37%). Among men, the odds of binge and sharing monotonically and non-linearly increased with increasing scores of psychological distress. Associations for binge among women were attenuated relative to men but nevertheless increased with distress, albeit in a linear fashion. Sharing was not associated with distress among women.

CONCLUSION

Psychological distress was differentially associated with injecting risk behaviours among men and women who inject drugs. Assessment of distress may provide novel prevention opportunities for select PWID. Further investigation into gender differences is warranted to inform development and tailoring of interventions.

A buprenorphine-validated rat model of opioid use disorder optimized to study sex differences in vulnerability to relapse

RATIONALE

Opioid use disorder (OUD) is a major epidemic in the USA. Despite evidence indicating that OUD may be particularly severe for women, preclinical models have yet to establish sex as a major factor in OUD.

OBJECTIVES

Here, we examined sex differences in vulnerability to relapse following intermittent access fentanyl self-administration and protracted abstinence and used buprenorphine, the FDA-approved treatment for OUD, to test the validity of our model.

METHODS

Following acquisition of fentanyl self-administration under one of two training conditions, male and female rats were given extended, 24-h/day access to fentanyl (0.25 μg/kg/infusion, 10 days) using an intermittent access procedure. Vulnerability to relapse was assessed using an extinction/cue-induced reinstatement procedure following 14 days of abstinence; buprenorphine (0 or 3 mg/kg/day) was administered throughout abstinence.

RESULTS

Levels of drug-seeking were high following extended-access fentanyl self-administration and abstinence; buprenorphine markedly decreased drug-seeking supporting the validity of our relapse model. Females self-administered more fentanyl and responded at higher levels during subsequent extinction testing. Buprenorphine was effective in both sexes and eliminated sex and estrous phase differences in drug-seeking. Interestingly, the inclusion of a time-out during training had a major impact on later fentanyl self-administration in females, but not males, indicating that the initial exposure conditions can persistently impact vulnerability in females.

CONCLUSIONS

These findings demonstrate the utility of this rat model for determining sex and hormonal influences on the development and treatment of OUD.

Increased Expression of Plasma miRNA-320a and let-7b-5p in Heroin-Dependent Patients and Its Clinical Significance

Heroin use disorder is a chronic and relapsing disease that induces persistent changes in the brain. The diagnoses of heroin use disorders are mainly based on subjective reports and no valid biomarkers available. Recent researches have revealed that circulating miRNAs are useful non-invasive biomarkers for diagnosing brain diseases such as Alzheimer's disease, multiple sclerosis, schizophrenia, and bipolar disorder. However, studies on circulating miRNAs for the diagnosis of heroin use disorders are rarely reported. In this study, we investigated the differential expression of plasma miRNAs in 57 heroin-dependent patients. Based on literature research and microarray analysis, two candidate miRNAs, miR-320a and let-7b-5p, were selected and analyzed by quantitative real-time RT-PCR. The results showed miR-320a and let-7b were significantly upregulated in plasma of the heroin-dependent patients compared to that in healthy controls. The area under curves (AUCs) of receiver operating characteristic (ROC) curves of miR-320a and let-7b-5p were 0.748 and 0.758, respectively. The sensitivities of miR-320a and let-7b-5p were 71.9 and 70.2%, while the specificities of miR-320a and let-7b-5p were 76.1 and 78.3%, respectively. The combination of these two miRNAs predicted heron dependence with an AUC of 0.782 (95% CI 0.687-0.876), with 73.7% sensitivity and 82.6% specificity. Our findings suggest a potential use for circulating miRNAs as biomarkers for the diagnosis of heroin abuse.

Gender Differences on Methadone Maintenance Treatment Outcome among Patients with Opioid use Disorder: A Systematic Review

Objectives:

The objective of this study was to review the significant differences of MMT outcomes related to drug use behavior, health status, and social behavioral functioning between genders.

Materials and Methods:

A search of publication was conducted in PubMed/MEDLINE, Embase, CINAHL, PsycINFO, and Scopus database. Two reviewers independently screened the titles, abstracts, and keyword use for the search. Inclusion of studies was based on randomized controlled trials (RCTs) or observational studies that report the difference of opioid addiction treatment outcomes between genders. Any conflict between the two reviewers was resolved through discussion and consensus. The systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO with a registration number CRD42019116261.

Results:

A total of 25 studies were evaluated as part of qualitative synthesis. The review resulted in three main themes, which are (1) improving well-being and methadone-related outcome (five subthemes), (2) impact on social and behavioral (four subthemes), and (3) illicit drug use pattern–related behavior (four subthemes).

Conclusion:

This review will highlight how men and women differ in methadone treatment outcomes for further application and improvement in the clinical setting.

Australian treatment outcome study: protocol for the 18-20-year follow-up of a prospective longitudinal cohort examining the natural history of heroin dependence and associated mortality, psychiatric and physical health, and health service use

INTRODUCTION

Opioid dependence is a global health priority, currently making the biggest contribution to drug-related deaths. The chronic, long-term persistence of heroin dependence over the life course requires investigation in prospective longitudinal studies, to better understand patterns and predictors of remission and relapse, as well as the impact of changes in substance use on a range of physical and mental health outcomes. Such knowledge is critical in order to identify modifiable risk factors that can be targeted for intervention. Crucial unanswered questions include the following: What are the long-term rates of mortality? What are the long-term patterns and predictors of heroin use, remission, psychiatric health and health service use? What are the long-term physical health consequences of heroin use?

METHODS AND ANALYSIS

The 18-20-year follow-up of the Australian Treatment Outcome Study (ATOS) cohort will examine the natural history of heroin dependence of an existing cohort of 615 people with heroin dependence, who were recruited into the study in 2001-2002. Five waves of follow-up interviews have since been completed, at 3-month, 1-year, 2-year, 3-year and 10-11-year post-baseline. At the 18-20-year follow-up, the ATOS cohort is (on average) approaching their 50s and an average of 30 years have passed since they first used heroin. The 18-20-year follow-up will consist of: (1) a structured interview; (2) physical health assessment; and (3) data linkage. The results of this follow-up will improve our understanding and management of age-related disorders in this population, which if not addressed in the immediate future, has the capacity to overwhelm treatment centres and aged care facilities.

ETHICS AND DISSEMINATION

Ethical approval has been granted for the study (Sydney Local Health District Royal Prince Alfred Zone, Human Research Ethics Committee X18-0512 & HREC/18/RPAH/733). The results of the study will be disseminated through published manuscripts, bulletins and technical reports, as well as conference, seminars, webinar and workshop presentations.

Application of the Chinese version of the addiction profile index (API) in drug users: an analysis of validity and measurement invariance across genders

Background

In China, substance use disorders represent a significant burden on public health and the economy. However, while the range of drugs and drug markets expands and diversifies, the instruments available to evaluate users’ dependence statuses from multiple dimensions have become insufficient. Accordingly, the present study presents the Chinese version of the Addiction Profile Index (API), explores its reliability and validity, and investigates the measurement invariance between males and females with substance use disorders.

Methods

The API, a self-report questionnaire, was administered to 2252 people with substance use disorders who were undergoing treatment in compulsory detoxification institutions located in five provinces in China (943 females; mean age = 33.5 years old, SD = 8.6). Additionally, to ensure the authenticity of the collected data, the study’s volunteers completed the Drug Use Disorders Identification Test (DUDIT), DUDIT-Extended (DUDIT-E), and the Health Scale for Drug Abusers (HSDA).

Results

The revised API, with its updated substance list, featured 34 items. The new four-factor model, incorporating behavioral symptoms of dependence, impact on social life, cravings, and motivations for detoxification, explained 55.30% of the total variance, indicating a good fit. Moreover, Cronbach’s α and mean item coefficient values showed good internal consistency reliability. Regarding criterion validity, the revised factors were moderately to highly correlated with their corresponding subscales in the DUDIT, DUDIT-E, and HSDA. In addition, the multigroup confirmatory factor analysis demonstrated that a measurement invariance of the revised four-factor model across genders was supported, fully assuming different degrees of invariance. The three factors of symptoms, social life, and motivation exhibited significant differences between male and female participants in the t test results (p < 0.01).

Conclusions

The Chinese version of the API shows good psychometric properties in terms of reliability and validity, and exhibits measurement equivalence across the genders. Therefore, it could be used to comprehensively assess the severity of drug dependence in people with substance use disorders.

Loneliness and depression among Chinese drug users: Mediating effect of resilience and moderating effect of gender

This study aims to explore potential correlations between gender, loneliness, resilience, and depression simultaneously among Chinese drug users; and especially to investigate the mediating effect of resilience and the moderating effect of gender on the correlation between loneliness and depression. Participants of this study included 513 drug users (399 men and 114 women) who were under treatment in two compulsory drug treatment institutions in one Eastern Chinese city. All participants completed the UCLA (University of California, Los Angeles) loneliness scale, the Zung self-rating depression scale, and the Connor-Davidson resilience scale. A correlation matrix was constructed to analyze correlations between these three characteristics. Path analyses were performed in the PROCESS for SPSS in order to test the mediating effect of resilience on the association between loneliness and depression; while a series of hierarchical multiple regressions were conducted in SPSS 22.0 to test the moderating effect of gender on the association between loneliness and depression. Compared to male drug users, female ones reported higher average scores on loneliness and depression, which indicated that female drug users suffered severer loneliness and depression. Resilience partially mediates the link between loneliness and depression and gender acts as a moderator for the relationship between loneliness and depression.

Modeling Body-Mind-Spirit Well-Being and the Possibility of Relapse Intention in Adults Who Have a History of Substance Use in Taiwan

BACKGROUND: Substance use is a global mental health issue. There has been limited research exploring the relationships among body, mind, and spirit well-being and the possibility of relapse across different categories of substance users. AIMS: The purpose of the current path analysis was to examine the relationship between body-mind-spirit well-being and the possibility of relapse intention as well as other relevant predictors in people who had a history of substance use. METHODS: A cross-sectional survey was used. Participants were recruited in Southern Taiwan between December 2015 and June 2016. Data were collected from 467 participants who had a history of using controlled substances. RESULTS: Path analysis results revealed that body-mind-spirit well-being was negatively predictive of the possibility of relapse intention. Out of several predictors, stress influence and duration of substance use had direct effects on body-mind-spirit well-being and the possibility of relapse intention, respectively. Stress influence and duration of substance use were associated with decreased body-mind-spirit well-being and increased relapse intention scores. In addition, no history of health problems and male gender were associated with increased body-mind-spirit well-being. CONCLUSIONS: Stress management and the duration of substance use play an important role in body-mind-spirit well-being and relapse intention in people with a history of substance use. Health care professionals could teach substance users coping strategies to address their stress and problems, which may improve their health and reduce the possibility of relapse intention.

Longitudinal analysis of HIV-risk behaviors of participants in a randomized trial of prison-initiated buprenorphine

Background

It has been estimated that approximately 15% of people who are incarcerated in the US have histories of opioid use disorder. Relapse to opioid use after release from prison poses a serious risk of HIV infection. Prison-initiated buprenorphine may help to reduce HIV infection given the association between opioid use and HIV-risk behaviors.

Methods

The present study is a secondary analysis of longitudinal data gathered from a randomized controlled trial of buprenorphine-naloxone for people who were incarcerated (N = 211) between 2008 and 2012. It compares the impact of assignment to initiate buprenorphine in prison (N = 106 randomized, N = 104 analyzed) versus in the community (N = 107 randomized, N = 107 analyzed) and whether or not participants entered community treatment on the frequency of HIV-risk behaviors in the 12 months following release from prison. Data were analyzed hierarchically and for each outcome variable, a multilevel, over-dispersed Poisson model was fit to the data. Outcome variables were the number of times the following behaviors occurred in the last 30 days: (1) having sex without a condom (2) injecting drugs (3) using unsterilized needles, and (4) sharing injection paraphernalia.

Results

Participants assigned to begin buprenorphine in the community experienced a greater decrease in injection drug use over time compared to participants assigned to begin buprenorphine in prison. There were no significant associations between treatment assignment or community treatment entry and instances of having sex without a condom, sharing injection paraphernalia, or using unsterilized needles.

Conclusions

Overall, the present study did not find support for the initiation of buprenorphine in prison (as opposed to the community) as a means to reduce incidences of HIV-risk behaviors. Avenues for future research in the nexus of HIV-risk reduction, criminal justice, and pharmacotherapy are discussed.

Trial registration This study was supported by the National Institute on Drug Abuse (NIDA), Buprenorphine for Prisoners (PI: Kinlock; R01DA021579). ClinicalTrials.gov identifier: NCT 00574067

Social inclusion of clients treated for substance abuse in Sweden in the 1980s: A 27-year follow-up

AIM

To investigate social inclusion/exclusion in terms of criminality, substance abuse and participation in the labour market in clients treated for substance abuse in Sweden in the 1980s during a follow-up period of 27 years.

METHOD

SWEDATE data are used for background information on the clients. The data were collected through interviews with clients registered for treatment in 31 in-patient treatment units in 1982 and 1983. Data on labour market status, education and medication related to drugs were collected from public registers. The study population consisted of 1132 individuals, who were followed from the year after exiting from treatment (Year 1) until the end of the follow-up (December 2013).

RESULTS

Among those who survived, the women seem to have succeeded better in terms of social inclusion both at an aggregated level and when the individual pathways were followed during the follow-up period. When comparing pathways between adverse and non-adverse groups during the follow-up period the results show movements from being adverse to non-adverse but also the opposite. In the last follow-up in 2013, the majority of the clients defined as non-adverse for the last nine years were in some way established in the labour market (including studies). In total, about two fifths of the group were in some way established in the labour market.

CONCLUSIONS

The fairly high proportion of clients moving between being adverse and non-adverse during the follow-up might support the perspective suggesting that dependence should not be considered as chronic.

Review: Sex-Based Differences in Treatment Outcomes for Persons With Opioid Use Disorder

BACKGROUND AND OBJECTIVES

In order to address the current opioid crisis, research on treatment outcomes for persons with opioid use disorder (OUD) should account for biological factors that could influence individual treatment response. Women and men might have clinically meaningful differences in their experience in OUD treatment and might also have unique challenges in achieving successful, long-term recovery. This review summarizes and synthesizes the current literature on sex-based differences in OUD treatment outcomes.

METHODS

Relevant literature was identified via automated and manual searches using the terms "opioid treatment outcome sex [or gender] differences" and "opiate treatment outcome sex [or gender] differences." Search methodology was consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and were conducted within the PubMed electronic database during March and April of 2018.

RESULTS

The initial PubMed search yielded 241 manuscripts and 31 original research articles that met inclusion/exclusion criteria were synthesized in this review. Several important trends emerged, including findings that women are more likely than men to present to treatment with co-occurring mental health conditions such as depression, and that women might respond particularly well to buprenorphine maintenance.

DISCUSSION AND CONCLUSIONS

While much of the literature on this topic is subject to potential cohort effects, interventions that address co-occurring mental health conditions and psychosocial stress might improve treatment outcomes for women with OUD.

SCIENTIFIC SIGNIFICANCE

Funding agencies and researchers should focus attention toward human laboratory studies and clinical trials that are prospectively designed to assess sex-based differences in OUD recovery. (Am J Addict 2019;28:246-261).

Substance misuse in later life: challenges for primary care: a review of policy and evidence

BACKGROUND

Substance misuse in older people represents a growing clinical and public health problem within primary care.

AIM

The aim of article is to explore policy and research evidence for informing best practice in the assessment, treatment effectiveness, treatment implementation and approaches to recovery for older people with substance misuse in primary care.

METHODS

Relevant search terms were used to examine the databases MEDLINE, EMBASE, CINAHL and PsychINFO up to January 2016.

RESULTS

An age-sensitive approach is required to overcome barriers to assessment. Training is essential for developing relevant knowledge, skills and attitudes. Clinical audit be used to develop care pathways, particularly for older people with dual diagnosis. There is also a need to develop closer links between primary care and the secondary care specialties, as well as added value in working with carers and voluntary agencies.

DISCUSSION

Further research is needed to inform more effective approaches to treatment. Adequate funding for workforce development and quality improvement in service development are also essential to improve health outcomes and quality of life in older people with substance misuse.

Gender differences in acute recreational drug toxicity: a case series from Oslo, Norway

Background

Female drug users report poorer physical and mental health than male drug users. We describe female and male patients treated for acute recreational drug toxicity, and look for gender differences in clinical state, treatment, and toxic agents taken.

Methods

Retrospective case series from a primary care emergency outpatient clinic and a hospital emergency department in Oslo, Norway. All patients treated for acute recreational drug toxicity from October 2013 through March 2015 were included, except patients with lone alcohol intoxication. Patients were grouped according to whether they had taken opioids or not, as a proxy differentiation between heavy drug users and party drug users. Data from the two clinical settings were analysed separately.

Results

In total, 2495 cases were included, 567 (22.7%) were women. Female patients were younger than males, median 31 vs 34 years (p < 0.001). On most comparisons of clinical variables there were no significant differences between genders. A larger proportion of females in the outpatient opioid group were hypotensive, 10.9% vs 3.9% (p < 0.001). Fewer females were intubated, none vs 21.1% (p = 0.019) in the hospital opioid group, and 6.4% vs 21.0% (p = 0.039) in the hospital non-opioid group. The proportion of gamma-hydroxybutyrate (GHB) poisoning was larger among females both at the outpatient clinic (14.4% vs 8.6%, p < 0.001) and at the hospital (60.3% vs 36.4%, p = 0.001), while the proportion of heroin poisoning was smaller among females at the outpatient clinic (37.1% vs 47.0%, p < 0.001).

Conclusion

One in four patients treated for acute recreational drug toxicity were women. Female patients were younger, had more frequently taken GHB and were less frequently intubated. Otherwise, the gender differences regarding clinical state and treatment were small. Although female drug users are known to report poorer health than males, we did not find that women had a more severe clinical course than men when presenting with overdose.

Gender-specific predictors of methadone treatment outcomes among African Americans at an urban clinic

Background: African American patients with opioid use disorder (OUD) have demonstrated poorer methadone maintenance treatment (MMT) outcomes compared with white patients. This issue is further complicated in urban settings, where African Americans experience high rates of poverty and publicly funded treatment. Despite interrelated factors that disadvantage African Americans, the literature focusing on this population is scant. To address this shortcoming, we conducted the first investigation of gender differences and gender-specific MMT outcome predictors among African Americans (or any racial minority population). This study provides gender-specific findings to improve African American MMT outcomes. Methods: We studied 211 African American patients (male: n = 137, 64.9%) at an urban, university-affiliated MMT clinic. We used existing intake data to assess baseline demographic, substance use, mental health, and interpersonal factors. Primary outcomes were 3-month drug⁺ (positive) urine drug screen (UDS) results and treatment retention. Results: Women were more likely (than men) to endorse histories of interpersonal violence, substance abuse in their social network, and mental health problems. Men reported a greater likelihood (than women) for early opioid-use onset and a lack of prior MMT. There were no gender differences in 3-month drug⁺ UDS or treatment retention. In multivariable analyses among women, no baseline factors predicted 3-month opioid⁺ UDS and physical abuse history predicted a higher proportion of 3-month cocaine⁺ UDS. Among men, primary injection opioid use and older age best predicted a higher proportion of 3-month cocaine⁺ UDS and parent substance abuse predicted shorter retention. In both gender-stratified analyses, higher proportions of 3-month opioid⁺ UDS and cocaine⁺ UDS predicted shorter retention. Conclusions: This study offers an analysis of gender differences in risk factors, MMT outcomes, and gender-specific predictors among African American patients. MMT clinics should tailor assessment and treatment protocols to address gender-specific needs.

Value of perceived support on depressive symptoms and hazardous drinking among underserved HIV+ adults 50 and older

The current study examined the association between perceived social support, depressive symptoms and alcohol use among people living with HIV (PLWH) 50 and older who identified as Black. Participants included 96 men and women ages 50 and older. Participants completed an interviewer-administered assessment examining mental and behavioral health functioning. Mediation analyses examined whether perceived support mediated the association between depressive symptoms and hazardous drinking. Depressive symptoms were significantly associated with hazardous drinking (B = .068, SE = .035, t = 1.92, p = 0.05) and negatively associated with having the desired amount of contact with a primary supporter (B = -.072, SE = .018, z = -3.96, p < 0.001). In addition, having the desired amount of contact with a confidant was negatively associated with hazardous drinking (B = -.543, SE = .208, t = -2.61, p 0 < .01). The effect of depressive symptoms on hazardous drinking when controlling for having adequate contact with a primary supporter was not significant (B = .033, SE = .04, t = .829, p = 0.41). Having a valued confidant mediated the association between depressive symptoms and hazardous drinking. Thus, social support interventions may be an effective method of reducing hazardous drinking among older PLWH.

Chinese Drug Users’ Abstinence Intentions: The Role of Perceived Social Support

This study investigated the relationship between Chinese drug users’ perceived social support and their intentions for choosing abstinence. Both bivariate and multivariate analyses were performed with 3,239 drug users, especially heroin (427) and methamphetamine (890) users. All participants were from multiple Chinese compulsory drug treatment institutions. Perceived support from friends was the factor that showed a strongest positive relationship with Chinese drug users’ abstinence intentions. The positive influence from family support on the willingness to seek and choose abstinence was not as great as scholars have suggested, which challenges previous research findings. Methamphetamine users had a significantly lower chance of pursuing abstinence, but their abstinence intentions were positively related to perceived support from friends. Comparatively, all types of perceived social support had no significant influence on heroin users’ abstinence intentions. This study highlights that, as China’s methamphetamine-addicted population rapidly expands, tailored treatment, especially facilitating positive peer support, is urgently needed.

Violent and Non-Violent Criminal Behavior among Young Chinese Drug Users: A Mixed Methods Study

Young drug users are found to be increasingly involved in criminal justice issues. This exploratory and descriptive study aims to analyze the criminal behaviors among young Chinese drug users through a mixed methods research design. Quantitative analysis indicates that young drug users with and without a history of criminality show significant differences in terms of several features. Male drug users, particularly, those who are older, with religious beliefs, and initiated into drug use at younger age were most likely to commit crimes. Among drug users with criminal experiences, those who committed crimes prior to drug initiation have a greater likelihood of committing violent crimes. Furthermore, young drug users with severe depression are more likely to commit crimes, especially violent ones. Qualitative analysis further illustrates that young male drug users often get involved in criminal conduct of the youth gang nature with propensity for engaging in violent crimes as compared to their female counterparts who are more likely to turn into drug dealers and traffickers, in addition to engaging in larceny. The research findings are consistent with developmental theories and "victim to offender cycle". Integrated mental health and substance use services are suggested for crime prevention among young Chinese drug users.

Trajectories of heroin use: 10-11-year findings from the Australian Treatment Outcome Study

AIMS

To identify trajectories of heroin use in Australia, predictors of trajectory group membership and subsequent outcomes among people with heroin dependence over 10-11 years.

DESIGN

Longitudinal cohort study.

SETTING

Sydney, Australia.

PARTICIPANTS

A total of 615 participants were recruited between 2001 and 2002 as part of the Australian Treatment Outcome Study (66.2% male; mean age 29 years). The predominance of the cohort (87.0%) was recruited upon entry to treatment (maintenance therapies, detoxification and residential rehabilitation), and the remainder from non-treatment settings (e.g. needle and syringe programmes). This analysis focused upon 428 participants for whom data on heroin use were available over 10-11 years following study entry.

MEASUREMENTS

Structured interviews assessed demographics, treatment history, heroin and other drug use, overdose, criminal involvement, physical health and psychopathology. Group-based trajectory modelling was used to: (i) identify trajectory groups based on use of heroin in each year, (ii) examine predictors of group membership and (iii) examine associations between trajectory group membership and 10-11-year outcomes.

FINDINGS

Six trajectory groups were identified [Bayesian Information Criterion (BIC) = -1927.44 (n = 4708); -1901.07 (n = 428)]. One in five (22.1%) were classified as having 'no decrease' in heroin use, with the probability of using remaining high during the 10-11 years (> 0.98 probability of use in each year). One in six (16.1%) were classified as demonstrating a 'rapid decrease to maintained abstinence'. The probability of heroin use among this group declined steeply in the first 2-3 years and continued to be low (< 0.01). The remaining trajectories represented other fluctuating patterns of use. Few baseline variables were found to predict trajectory group membership, but group membership was predictive of demographic, substance use and physical and mental health outcomes at 10-11 years.

CONCLUSIONS

Long-term trajectories of heroin use in Australia appear to show considerable heterogeneity during a decade of follow-up, with few risk factors predicting group membership. Just more than a fifth continued to use at high levels, while fewer than a fifth become abstinent early on and remained abstinent. The remainder showed fluctuating patterns.

Men's and women's response to treatment and perceptions of outcomes in a randomized controlled trial of injectable opioid assisted treatment for severe opioid use disorder

Background

To test whether there are gender differences in treatment outcomes among patients receiving injectable opioids for the treatment of long-term opioid-dependence. The study additionally explores whether men and women have different perceptions of treatment effectiveness.

Methods

This study is a secondary analysis from SALOME, a double-blind, phase III, randomized controlled trial testing the non-inferiorirty of injectable hydromorphone to injectable diacetylmorphine among 202 long-term street opioid injectors in Vancouver (Canada). Given this was a secondary analysis, no a priori power calaculation was conducted. Differences in baseline characteristics and six-month treatment outcomes (illicit heroin use, opioid use, crack cocaine use, non-legal activities, physical and psychological health scores, urine positive for street heroin markers, and retention) were analysed by gender using fitted models. Responses to an open ended question on reasons for treatment effectiveness were explored with a thematic analysis.

Results

Men and women differed significantly on a number of characteristics at baseline. For example, women were significantly younger, presented to treatment with significantly higher rates of prior month sex work (31.5% vs. 0%), and used significantly more crack cocaine (14.71 vs. 8.38 days). After six-months of treatment there were no significant differences in treatment outcomes by gender, after adjusting for baseline values. For both men and women, improved health and quality of life were the most common reasons provided for treatment effectiveness, however women were more specific in the types of health improvements.

Conclusions

Despite presenting to treatment with vulnerabilities not faced to the same extent by men, at six-months women did not differ significantly from men in tested trial efficacy outcomes. While the primary outcome in the trial was the reduction of illicit opioid use, in the open-ended responses both men and women focused their comments on improvement in health and quality of life as reasons for treatment effectiveness. The supervised model of care with injectable medications provides a particularly suitable framework for providing care to opioid-dependent men and women not attracted or retained by other treatments. The absence of statistical differences reported in this secondary analysis may be due to lack of adequate statistical power to detect meaningful effects.

Trial registration

This trial is registered with ClinicalTrials.gov (NCT01447212) Registered: October 4, 2011 at the following link: https://clinicaltrials.gov/ct2/show/NCT01447212.

Perceived need for depression treatment among persons entering inpatient opioid detoxification

BACKGROUND AND OBJECTIVES

Depression is common among persons with opioid use disorder. We examined the perceived need for depression treatment (PNDT) among opioid-dependent patients and the relationship of PNDT to depression screening result.

METHODS

Between May and December 2015, we surveyed consecutive persons (n = 440) seeking inpatient opioid detoxification. We used the Patient Health Questionnaire-2 (PHQ-2) to screen for depression. To assess perceived need for depression services, participants were asked, "Do you believe you should be treated for depression?" Response options were recorded into four categories: "Not Depressed (ND)," "Perceive Need for Depression Treatment (PNDT)," "Depressed/Don't Want Treatment," and "Currently Treated."

RESULTS

Participants' mean age was 32.3 (±8.7) years; 70.7% were male. Nearly two out of three persons screened positive for depression yet only 8.2% were being treated for depression prior to admission. Screening positive for depression was associated with a 2.95 (95%CI 1.82-4.81, p < .005) fold increase in the expected odds of PNDT. But nearly half of those depressed (48%) did not perceive the need for treatment. Approximately 40% of the participants (n = 177) perceived that they were not depressed; of these persons, 52% screened positive for depression.

DISCUSSION AND CONCLUSIONS

Detoxification program staff should screen patients for depression, and if a clinical diagnosis is confirmed, discuss treatment options, exploring the level of interest in mental health treatment for depression.

SCIENTIFIC SIGNIFICANCE

Screening for and addressing depression, including patients' interest in treatment, should be central to post-detoxification aftercare planning. (Am J Addict 2017;26:395-399).

Double whammy: Adverse childhood events and pain reflect symptomology and quality of life in women in substance abuse treatment

BACKGROUND

This study examined the profiles of symptoms and health-related quality of life (QOL) of women in substance abuse treatment, comparing those with higher versus lower histories of adverse childhood events (ACE), and those with versus without current pain.

METHODS

Adult women in outpatient substance abuse treatment (n = 30) completed questionnaires (cross-sectional study) on topics including drug use, adverse childhood events (ACE), QOL, functional ability, current pain, and depression.

RESULTS

Women with pain indicated significant differences in emotional (p < 0.05), and functional ability (p < 0.01); but no significant differences were found between women with high versus low levels of ACE. Yet, radar plots of women with both current pain and high levels of ACE, versus those without, portrayed a distinctive profile indicating high levels of anxiety and depression.

CONCLUSIONS

Rather than a checklist, visual composites of symptoms experienced by women in substance abuse treatment illustrates areas of concern in the overall status of women in substance abuse treatment.

Overview of Substance Use and Mental Health Among the "Baby Boomers" Generation

As the population ages, risk factors commonly shared by chronic degenerative disease can be exacerbated by behaviours and lifestyle choices. There is increasing evidence that those affected by chronic disease (and associated symptoms such as pain), depression and adverse behavioural and lifestyle patterns are at risk of substance misuse. This paper overviews substance use in Baby Boomers, which are defined as people aged between 52-70 years old, and the implications this may have on their mental health and well-being. We provide an overview of the characteristics of the Baby Boomer generation, their health status and what is currently known about their substance use and misuse. A strengthening of older adult mental health outpatient services is recommended to prevent and address substance use among older adults. Further research examining factors that influence substance use among this group could better inform health promotion programs targeting Baby Boomers.

Heart Rate Variability and the Efficacy of Biofeedback in Heroin Users with Depressive Symptoms

Objective

Low heart rate variability (HRV) has been confirmed in heroin users, but the effects of heart-rate-variability–biofeedback in heroin users remain unknown. This study examined (1) correlations between depression and HRV indices; (2) group differences in HRV indices among a heroin-user group, a group with major depressive disorder but no heroin use, and healthy controls; and (3) the effects of heart-rate-variability–biofeedback on depressive symptoms, HRV indices, and respiratory rates within the heroin group.

Methods

All participants completed a depression questionnaire and underwent electrocardiogram measurements, and group differences in baseline HRV indices were examined. The heroin group underwent electrocardiogram and respiration rate measurements at baseline, during a depressive condition, and during a happiness condition, before and after which they took part in the heart-rate-variability–biofeedback program. The effects of heart-rate-variability–biofeedback on depressive symptoms, HRV indices, and respiration rates were examined.

Results

There was a negative correlation between depression and high frequency of HRV, and a positive correlation between depression and low frequency to high frequency ratio of HRV. The heroin group had a lower overall and high frequency of HRV, and a higher low frequency/high frequency ratio than healthy controls. The heart-rate-variability–biofeedback intervention increased HRV indices and decreased respiratory rates from pre-intervention to post-intervention.

Conclusion

Reduced parasympathetic and increased sympathetic activations were found in heroin users. Heart-rate-variability–biofeedback was an effective non-pharmacological intervention to restore autonomic balance.

Sex differences in outcomes of methadone maintenance treatment for opioid use disorder: a systematic review and meta-analysis

BACKGROUND

Opioid use disorder is a serious international concern with limited treatment success. Men and women differ in their susceptibility to opioid use disorder and response to methadone treatment and can therefore benefit from sex-specific treatment. We performed a systematic review of the literature on outcomes of methadone maintenance treatment for opioid use disorder in men and women related to drug use, health status and social functioning.

METHODS

We searched PubMed, Embase, PsycINFO and CINAHL for observational or randomized controlled studies involving adults 18 years of age or older undergoing methadone treatment for opioid use disorder. Studies were included if they investigated sex differences in methadone treatment outcomes. Two authors independently reviewed and extracted data. Meta-analyses were performed when possible; risk of bias and quality of evidence were also assessed.

RESULTS

Twenty studies with 9732 participants were included, of which 18 were observational and 2 were randomized controlled trials. Men and women differed significantly in alcohol use (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.31 to 0.86), amphetamine use (OR 1.47, 95% CI 1.12 to 1.94), legal involvement (OR 0.63, 95% CI 0.47 to 0.84) and employment during treatment (OR 0.39, 95% CI 0.21 to 0.73). Opioid use patterns were similar among men and women. Risk of bias was moderate, and quality of evidence was generally low.

INTERPRETATION

Sex differences were evident in polysubstance use, legal involvement and employment status among men and women receiving methadone treatment for opioid use disorders. Although the quality of evidence was low, our review highlights the need for improved implementation of sex-specific treatment strategies.

Long-term mortality, remission, criminality and psychiatric comorbidity of heroin dependence: 11-year findings from the Australian Treatment Outcome Study

AIMS

To determine the long-term mortality, remission, criminality and psychiatric comorbidity during 11 years among heroin-dependent Australians.

DESIGN

Longitudinal cohort study.

SETTING

Sydney, Australia.

PARTICIPANTS

A total of 615 participants were recruited and completed baseline interviews between 2001 and 2002. Participants completed follow-up interviews at 3, 12, 24 and 36 months post-baseline, and again at 11 years post-baseline; 431 (70.1%) of the original 615 participants completed the 11-year follow-up.

MEASUREMENTS

Participants were administered the Australian Treatment Outcome Study (ATOS) structured interview, addressing demographics, treatment history, drug use, heroin overdose, criminality, health and mental health at all interviews. Overall, 96.1% of the cohort completed at least one follow-up interview.

FINDINGS

At 11 years, 63 participants (10.2%) were deceased. The proportion of participants who reported using heroin in the preceding month decreased significantly from baseline (98.7%) to 36-month follow-up (34.0%; odds ratio = 0.01; 95% confidence interval = 0.00, 0.01) with further reductions evident between 36 months and 11 years (24.8%). However, one in four continued to use heroin at 11 years, and close to one-half (46.6%) were in current treatment. The reduction in current heroin use was accompanied by reductions in risk-taking, crime and injection-related health problems, and improvements in general physical and mental health. The relationship with treatment exposure was varied. Major depression was associated consistently with poorer outcome.

CONCLUSIONS

In an 11-year follow-up of patients undergoing treatment for heroin dependence, 10.2% had died and almost half were still in treatment; the proportion still using heroin fell to a quarter, with major depression being a significant predictor of continued use.

Long-term course of opioid addiction

Opioid addiction is associated with excess mortality, morbidities, and other adverse conditions. Guided by a life-course framework, we review the literature on the long-term course of opioid addiction in terms of use trajectories, transitions, and turning points, as well as other factors that facilitate recovery from addiction. Most long-term follow-up studies are based on heroin addicts recruited from treatment settings (mostly methadone maintenance treatment), many of whom are referred by the criminal justice system. Cumulative evidence indicates that opioid addiction is a chronic disorder with frequent relapses. Longer treatment retention is associated with a greater likelihood of abstinence, whereas incarceration is negatively related to subsequent abstinence. Over the long term, the mortality rate of opioid addicts (overdose being the most common cause) is about 6 to 20 times greater than that of the general population; among those who remain alive, the prevalence of stable abstinence from opioid use is low (less than 30% after 10-30 years of observation), and many continue to use alcohol and other drugs after ceasing to use opioids. Histories of sexual or physical abuse and comorbid mental disorders are associated with the persistence of opioid use, whereas family and social support, as well as employment, facilitates recovery. Maintaining opioid abstinence for at least five years substantially increases the likelihood of future stable abstinence. Recent advances in pharmacological treatment options (buprenorphine and naltrexone) include depot formulations offering longer duration of medication; their impact on the long-term course of opioid addiction remains to be assessed.

Mortality among older adults with opioid use disorders in the Veteran's Health Administration, 2000-2011

BACKGROUND

The population of people with opioid use disorders (OUD) is aging. There has been little research on the effects of aging on mortality rates and causes of death in this group. We aimed to compare mortality in older (≥ 50 years of age) adults with OUD to that in younger (<50 years) adults with OUD and older adults with no history of OUD. We also examined risk factors for specific causes of death in older adults with OUD.

METHODS

Using data from the Veteran's Health Administration National Patient Care Database (2000-2011), we compared all-cause and cause-specific mortality rates in older adults with OUD to those in younger adults with OUD and older adults without OUD. We then generated a Cox regression model with specific causes of death treated as competing risks.

RESULTS

Older adults with OUD were more likely to die from any cause than younger adults with OUD. The drug-related mortality rate did not decline with age. HIV-related and liver-related deaths were higher among older OUD compared to same-age peers without OUD. There were very few clinically important predictors of specific causes of death.

CONCLUSION

Considerable drug-related mortality in people with OUD suggests a need for greater access to overdose prevention and opioid substitution therapy across the lifespan. Elevated risk of liver-related death in older adults may be addressed through antiviral therapy for hepatitis C virus infection. There is an urgent need to explore models of care that address the complex health needs of older adults with OUD.

Gender-specific predictors of retention and opioid abstinence during methadone maintenance treatment

AIMS

Retention in methadone maintenance treatment (MMT) for 1 year is associated with positive outcomes including opioid abstinence, however, most studies have not investigated gender differences. We hypothesized that predictors of retention and opioid abstinence would differ between men and women, and aimed to determine which factors best predict retention and abstinence for each gender.

METHODS

Data were available for 290 patients (173 M, 117 F) admitted to outpatient MMT. Regression analyses, stratified by gender, were conducted to identify unique predictors of MMT retention (<1 vs. >1 year) and opioid abstinence rate (proportion of opioid-free urine samples up to 1 year retention).

RESULTS

Gender did not significantly predict treatment retention (mean = 231 days, 39% retained > 1 year) or opioid abstinence (49% overall). For males, significant predictors of > 1-year retention were urine samples negative for opioids (odds ratio [OR] = 6.67) and cannabinoids (OR = 5.00) during the first month, and not cocaine dependent (OR = 2.70). Significant predictors of higher long-term opioid abstinence were first-month urine samples negative for opioids and cocaine metabolites. For females, significant predictors of >1-year retention were first-month urine samples negative for cocaine metabolites (OR = 4.00) and cannabinoids (OR = 9.26), and no history of sexual victimization (OR = 3.03). The only significant predictor of higher opioid abstinence rate was first-month opioid-free urine samples.

CONCLUSIONS

These findings indicate gender-specific predictors of MMT retention and opioid abstinence. Future studies on MMT outcomes should examine each gender separately, and consider unique pathways by which females and males adhere to, and benefit from MMT.

First-time admissions for opioid treatment: cross-sectional and descriptive study of new opioid users seeking treatment

BACKGROUND

The purpose of this study was to gain an understanding of the profiles of the new treatment demands posed by opioid addicts between 2005 and 2010 at the addictive disorders assistance units in Galicia, Spain.

METHODS

A cluster analysis was performed using data from 1,655 treatment entrants. Clusters were constructed using sociodemographic and medicolegal variables. A cluster analysis was also conducted according to age. Once clusters were defined, their association with the following variables was analyzed: age at first use of opioids, years of use, frequency of opioid use in the previous month, psychiatric treatment, cocaine use, existence of a drug-dependent partner, and source of referral.

RESULTS

Four clusters were obtained in the main analysis. Cluster 1 (34.01%) consisted of young males, cluster 2 (16.19%) consisted of not-so-young males, cluster 3 (32.62%) consisted mainly of older males and a small group of females, and cluster 4 (17.18%) was made up entirely of women. With regard to age-related clusters, two clusters were obtained in those under the age of 30 years: cluster 1 (73%) without medicolegal complications and cluster 2 (27%) with medicolegal complications. For those over the age of 30 years, two clusters were obtained: cluster 1 (53.92%) with hardly any medicolegal complications and cluster 2 (46.08%) with medicolegal complications.

CONCLUSION

Cluster analysis suggests that there have been no substantial changes in variables indicating greater severity in this new group of patients. Women are likely to seek help earlier, which reduces their duration of opioid use. The younger the patient, the shorter the duration of opioid use and the greater the likelihood of cessation of intravenous use. Public health systems should use a two-pronged treatment strategy of short but intense cessation therapies for women and younger treatment entrants and longer maintenance and replacement therapies for older treatment entrants with more psychosocial and medical complications.

Self-care and risk reduction habits in older injection drug users with chronic wounds: a cross-sectional study

Background

We surveyed a population of injection drug users (IDUs) frequenting the mobile Baltimore City Needle Exchange Program (BNEP) to investigate self-care factors associated with chronic wounds, a significant cause of morbidity especially among older IDUs.

Methods

Participants ≥18 years old completed a survey regarding chronic wounds (duration ≥8 weeks), injection and hygiene practices. Study staff visually verified the presence of wounds. Participants were categorized into four groups by age and wound status. Factors associated with the presence of chronic wounds in participants ≥45 years were analyzed using logistic regression.

Results

Of the 152 participants, 19.7% had a chronic wound. Of those with chronic wounds, 18 were ≥45 years old (60.0%). Individuals ≥45 years old with chronic wounds were more likely to be enrolled in a drug treatment program (Odds ratio (OR) 3.4, 95% Confidence interval (CI) 1.0–10.8) and less likely to use cigarette filters when drawing up prepared drug (OR 0.2, 95% CI 0.03–0.7) compared to the same age group without chronic wounds. Compared to individuals <45 years old without chronic wounds, individuals ≥45 with a chronic wound were more likely to report cleaning reused needles with bleach (OR 10.7, 95% CI 1.2–93.9) and to use the clinic, rather than an emergency room, as a primary source of medical care (OR 3.4, 95% CI 1.1–10.4).

Conclusions

Older IDUs with chronic wounds have different, and perhaps less risky, injection and hygiene behaviors than their peers and younger IDUs without wounds in Baltimore City. Because of these differences, older IDUs with wounds may be more receptive to community-based healthcare and substance abuse treatment messages.

Predictors of healthcare service utilization for mental health reasons

This study was designed to identify: (1) predictors of 12-month healthcare service utilization for mental health reasons, framed by the Andersen model, among a population cohort in an epidemiological catchment area; and (2) correlates associated with healthcare service utilization for mental health reasons among individuals with and without mental disorders respectively. Analyses comprised univariate, bivariate, and multiple regression analyses. Being male, having poor quality of life, possessing better self-perception of physical health, and suffering from major depressive episodes, panic disorder, social phobia, and emotional problems predicted healthcare service utilization for mental health reasons. Among individuals with mental disorders, needs factors (psychological distress, impulsiveness, emotional problems, victim of violence, and aggressive behavior) and visits to healthcare professionals were associated with healthcare service utilization for mental health reasons. Among individuals without mental disorders, healthcare service utilization for mental health reasons is strongly associated with enabling factors such as social support, income, environmental variables, and self-perception of the neighborhood. Interventions facilitating social cohesion and social solidarity in neighborhood settings may reduce the need to seek help among individuals without mental disorders. Furthermore, in their capacity as frontline professionals, general practitioners should be more sensitive in preventing, detecting, and treating mental disorders in routine primary care.

Comparing the life concerns of prescription opioid and heroin users

This study explored life concerns of prescription opioid (PO) and heroin users. Persons entering opioid detoxification rated their level of concern about 43 health and welfare items. Using exploratory factor analysis and conceptual rationale, we identified ten areas of concern. Participants (N=529) were 69.9% male, 87.5% non-Hispanic Caucasian, and 24.2% PO users. Concern about drug problems was perceived as the most serious concern, followed by money problems, relationship problems, mental health, and cigarette smoking. PO users expressed significantly lower concern about drug problems (p=.017) and transmissible diseases (p<.001), but were more concerned about alcohol use (p<.001) than heroin users. There were no significant differences with regard to the other 7 areas of concern. Recognition of the daily worries of opioid dependent persons could allow providers to better tailor their services to the context of their patients' lives.

Sex, age, and progression of drug use in adolescents admitted for substance use disorder treatment in the northeastern United States: comparison with a national survey

BACKGROUND

National adolescent drug use surveys are distributed in United States schools. Survey results determine trends in drug use and inform research and prevention efforts; however, students who have dropped out of school or were truant the day of the survey are excluded. Examining drug trends in a high-risk population (adolescents admitted for drug treatment) may better characterize drug users and their use patterns.

METHODS

The current study examined questionnaires completed by 939 adolescents admitted for substance abuse treatment between 1995 and 2010.

RESULTS

Age of first use (ranging from 13.2 years for alcohol to 15.1 years for cocaine) was significantly younger for cigarettes, alcohol, and cannabis than for "harder" drugs such as cocaine and heroin, and adolescents increased their use of almost every substance (except inhalants) with increasing age. This was not true of national data. Additionally, in the national data, less than 1.5% of participants reported using any of the harder drugs more than 5 times, but in the McLean data, even for harder drugs, >10% of adolescents used >50 times.

CONCLUSIONS

In the high-risk sample examined here, progression to harder drugs is accelerated and increases with age regardless of sex. These data underscore the importance of prevention and immediate treatment when adolescent substance use is identified.

A comparative study of opioid substitution therapy utilisation among opioid-dependent men and women

INTRODUCTION AND AIMS

Few population-based studies have examined differences in opioid substitution therapy (OST) treatment utilisation between men and women. Using a population of opioid-dependent people in New South Wales, Australia, first-episode and long-term OST treatment utilisation profiles were compared between men and women, differentiating between treatment initiation in the community and in custody.

DESIGN AND METHODS

Retrospective data linkage study using records of new OST entrants (2001-2010) and custody episodes (2000-2012). First OST treatment episode and overall treatment utilisation characteristics were compared between men and women initiating treatment in the community or in custody. Treatment retention was evaluated at 3, 6, 9 and 12 months after first commencing OST and overall, as the median proportion of follow-up time spent in treatment.

RESULTS

There were 15,600 new OST entrants in the cohort--10,930 were men (70.1%) and 4670 women (29.9%); 12,584 (80.7%) initiated treatment in the community and 3016 (19.3%) in custody. More men initiated OST in custody (24.0% vs. 8.3%, P < 0.001) and only received OST in custody (57.5% vs. 41.8%, P < 0.001). Women were retained longer in their first OST treatment episode at all four time points in both treatment settings and in treatment overall (community: 46.6% vs. 39.1%, P < 0.001; custody: 41.3% vs. 30.8%, P < 0.001).

DISCUSSION AND CONCLUSIONS

There are a number of key differences in OST treatment utilisation profiles between men and women. Whereas men commonly initiate and only receive OST in custody, treatment retention is higher among women, independent of the setting treatment is initiated.

Sex differences in outcomes of methadone maintenance treatment for opioid addiction: a systematic review protocol

BACKGROUND

Use of methadone for the treatment of opioid addiction is an effective harm-reduction approach, although variability in treatment outcomes among individuals has been reported. Men and women with opioid addiction have been known to differ in factors such as opioid use patterns and characteristics at treatment entry; however, little has been reported about differences in methadone treatment outcomes between men and women. Therefore, we present a protocol for a systematic review which aims to provide a summary of existing literature on sex differences in outcomes of methadone treatment for opioid addiction.

METHODS/DESIGN

Electronic search of PubMed/MEDLINE, EMBASE, PsycINFO, and CINAHL databases will be conducted using a priori defined search strategy. Two authors (MB and BBD) will independently screen potential articles for eligibility using pre-determined inclusion and exclusion criteria and extract key information using a data extraction form designed for this study. Discrepancies will be resolved using a third party (ZS). The primary outcome will be sex differences in response to treatment defined as abstinence from illicit opioid use. We will also assess sex differences in treatment outcomes including treatment retention, remission status post-treatment, polysubstance abuse, methadone dose, drug-related adverse events, health status, psychological status, mortality, criminal activity, high risk sexual behavior, social support/relations, and employment. A meta-analysis will be conducted if possible; risk of bias and overall quality of evidence will be assessed to determine confidence in the estimates.

DISCUSSION

We anticipate that this review will highlight how men and women differ in methadone treatment outcomes and allow us to generate conclusions that can be applied to treatment in a clinical setting.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42013006549.