1
|
Rudolph JE, Cepeda JA, Astemborski J, Kirk GD, Mehta SH, German D, Genberg BL. Longitudinal patterns of use of stimulants and opioids in the AIDS linked to the IntraVenous experience cohort, 2005-2019. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104364. [PMID: 38408416 PMCID: PMC11056308 DOI: 10.1016/j.drugpo.2024.104364] [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: 12/05/2023] [Revised: 01/30/2024] [Accepted: 02/16/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Overdoses involving opioids and stimulants are on the rise, yet few studies have examined longitudinal trends in use of both substances. We sought to describe use and co-use of opioids and stimulants, 2005-2019, in the AIDS Linked to the Intravenous Experience (ALIVE) cohort - a community-based cohort of people with a history of injection drug use living in or near Baltimore, MD. METHODS We included 2083 ALIVE participants, who had at least two visits during the study period. Our outcome was based on self-reported use of opioids and stimulants in the prior 6 months. We estimated prevalence of 4 categories of use (neither stimulants nor opioids, only stimulants, only opioids, stimulants and opioids), using a non-parametric multi-state model, accounting for the competing event of death and weighting for informative loss to follow-up. All analyses were stratified by enrollment cohort, with the main analysis including participants who enrolled prior to 2015 and a sub-analysis including participants who enrolled 2015-2018. RESULTS In the main analysis, prevalence of using stimulants and opioids decreased from 38 % in 2005 to 12 % 2013 but stabilized from 2014 onwards (13-19 %). The prevalence of using only stimulants (7-11 %) and only opioids (5-10 %) was stable across time. Participants who reported using both were more likely to report homelessness, depression, and other substance use (e.g., marijuana and heavy alcohol use) than participants in the other use categories. On average, 65 % of visits with use of both were followed by a subsequent visit with use of both; of participants transitioning out of using both, 13% transitioned to using neither. CONCLUSIONS While use of stimulants and opioids declined in the cohort through 2013, a meaningful proportion of participants persistently used both. More research is needed to understand and develop strategies to mitigate harms associated with persistent use of both stimulants and opioids.
Collapse
Affiliation(s)
- Jacqueline E Rudolph
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Javier A Cepeda
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jacquie Astemborski
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Gregory D Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle German
- Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Becky L Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
2
|
Tummala HP, Bies RR, Ramanathan M. Modelling the progression of illicit substance use patterns from real-world evidence. Br J Clin Pharmacol 2024; 90:700-712. [PMID: 37997480 DOI: 10.1111/bcp.15965] [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: 10/01/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
AIMS To investigate an innovative pharmacometrics approach that addresses the challenges of using real-world evidence to model the progression of illicit substance use. METHODS The modelling strategy analysed real-world data from the National Longitudinal Study of Adolescent to Adult Health (AddHealth) survey using survival analyses and differential equations. Respondents were categorized into drug-naïve, active users and nonusers. The transitions between categories were modelled using interval-censored parametric survival analysis. The resulting hazard rate functions were used as time-dependent rate constants in a differential equation system. Covariate models for sex and depression status were assessed. RESULTS AddHealth enrolled 6504 American teenagers (median age 16 years, range 11-21 years); this cohort was followed with five interviews over a 22-year period; the median age at the last interview was 38 years (range 34-45 years). The percentages of illicit drug users at Interviews 1-5 were 7.7%, 5.9%, 15.8%, 21.4% and 0.98%, respectively. The generalized gamma distribution emerged as the preferred model for the survival functions for transitions between categories. Age-dependent prevalence was obtained from the differential equation system. Active drug use was more prevalent in males, increased in adolescence and college years, peaked at 24 years, and decreased to low levels by 35 years. Depression, which was more frequent in females, increased the drug-naïve-active user transition rates but not the active user-nonuser and nonuser-active user transition rates. The evidence did not support an interaction between sex and depression. CONCLUSIONS The model provided a satisfactory approximation for the age-dependent progression of illicit substance use from preadolescence to early middle age.
Collapse
Affiliation(s)
- Hari Prabhath Tummala
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Robert R Bies
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Murali Ramanathan
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
| |
Collapse
|
3
|
Zarchev M, Kamperman AM, El Marroun H, Bloemendaal A, Mulder CL, Hoogendijk WJG, Grootendorst-van Mil NH. Timing and type of adverse life events: Impact on substance use among high-risk adolescents. Dev Psychopathol 2023:1-10. [PMID: 37519039 DOI: 10.1017/s095457942300086x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
A robust association has been reported between childhood adverse life events (ALEs) and risky substance use in adolescence. It remains unclear, however, what the impact of type and timing of these ALEs is. We investigated the association between ALEs and substance use in adolescents. ALEs were operationalized as broad (e.g., moving, parental divorce, family sickness) or physically threatening (physical and/or sexual abuse). First, we examined lifetime ALEs, followed by an investigation into their timing. The sample consisted of 909 adolescents (aged 12-18 years) from a cohort oversampled on high levels of emotional and behavioral problems. The primary caregiver indicated which ALEs each adolescent experienced across their lifetime. Adolescents self-reported on number and frequency of substances used. Poisson and ordinal regression models were used to model the associations. The associations between lifetime ALEs and a substance used were observed only for physical ALEs (incidence rate ratio 1.18 [1.03, 1.35], p = 0.02). When investigating timing, physical ALEs after the age of 12 predicted number of substances used (IRR 1.36 [1.13, 1.63], p < .001). Recent ALEs (occurring after age 12) seem to have considerable impact on substance use. Alcohol and drugs as a coping mechanism were considered a plausible explanation for the results.
Collapse
Affiliation(s)
- Milan Zarchev
- Department of Psychiatry, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Astrid M Kamperman
- Department of Psychiatry, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute (ESPRi), Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hanan El Marroun
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Anthony Bloemendaal
- Department of Psychiatry, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Dual Disorder Treatment Centre, Fivoor, The Hague, The Netherlands
| | - Cornelis L Mulder
- Department of Psychiatry, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute (ESPRi), Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Parnassia Psychiatric Institute, Rotterdam, The Netherlands
| | - Witte J G Hoogendijk
- Department of Psychiatry, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nina H Grootendorst-van Mil
- Department of Psychiatry, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute (ESPRi), Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
4
|
Ku YC, Chung HP, Hsu CY, Cheng YH, Hsu FIC, Tsai YC, Chao E, Lee TSH. Recidivism of Individuals Who Completed Schedule I Drugs Deferred Prosecution Treatment: A Population-Based Follow-Up Study from 2008 to 2020 in Taiwan. Int J Ment Health Addict 2023. [DOI: 10.1007/s11469-023-01034-w] [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] [Indexed: 03/17/2023] Open
Abstract
AbstractDeferred Prosecution with Condition to Complete the Addiction Treatment (DPCCAT) is a judicial diversion program in Taiwan that shifts people who use drugs away from the label drug offender and toward the label patient. However, little is known about the effectiveness of completing a DPCCAT program on people who use drugs. Using a nationwide population-based retrospective panel data from 2008 to 2020, recidivism is defined as a person was caught urine positive and charged by a prosecutor after their completion of DPCCAT. After controlled gender, age, and region, comparisons of recidivism rates and time to relapse between Schedule I drug use only, Schedule I & II drug use, and heterogeneous group were examined. Of 24,248 participants with DPCCAT, 11,141 (46%) completed the one-year treatment program. Of completers, the five-year recidivism rates are significantly lower for the Schedule I drug use only (26%) than Schedule I & II drugs use (52%) and heterogeneous group (47%). Results from Cox regression indicated that the duration of recidivate to drug use is significantly longer for the Schedule I drug only than the other two groups after controlling for demographics. The main findings support that completion of a DPCCAT program only reduces the risk of recidivism for people who use Schedule I drug only and is less effective for polydrug users and heterogeneous group. We suggest that characteristics of people who use drugs and other criminal offenses should be taken into consideration for triage when DPCCAT is offered.
Collapse
|
5
|
Splice-Site Variants in the Gene Encoding GABA-A Receptor Delta Subunit Are Associated with Amphetamine Use in Patients under Methadone Maintenance Treatment. Int J Mol Sci 2022; 24:ijms24010721. [PMID: 36614162 PMCID: PMC9820820 DOI: 10.3390/ijms24010721] [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: 10/05/2022] [Revised: 12/13/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023] Open
Abstract
Chronic opioid use disorder patients often also use other substances such as amphetamines. The gene-based analysis method was applied in the genomic database obtained from our previous study with 343 methadone maintenance treatment (MMT) patients. We found that the gene encoding gamma-aminobutyric acid type A receptors (GABA-A receptor) delta subunit isoforms (GABRD) was associated with amphetamine use in heroin dependent patients under MMT in Taiwan. A total of 15% of the 343 MMT patients tested positive for amphetamine in the urine toxicology test. Two genetic variants in the GABRD, rs2889475 and rs2376805, were found to be associated with the positive urine amphetamine test. They are located in the exon 1 of the splice variant and altered amino acid compositions (T126I, C/T, for rs2889475, and R252Q, G/A, for rs2376805). The CC genotype carriers of rs2889475 showed a four times higher risk of amphetamine use than those with TT genotype. The GG genotype carriers of rs2376805 showed a three times higher risk of amphetamine use than the AA genotype carriers. To our knowledge, this is the first report that demonstrated an association of the delta splice variant isoform in the GABA-A receptor with an increased risk of amphetamine use in MMT patients. Our results suggest that rs2889475 and rs2376805 may be indicators for the functional role and risk of amphetamine use in MMT patients.
Collapse
|
6
|
Smith KE, Rogers JM, Strickland JC. Associations of Lifetime Nonmedical Opioid, Methamphetamine, and Kratom Use within a Nationally Representative US Sample. J Psychoactive Drugs 2022; 54:429-439. [PMID: 34842079 PMCID: PMC9148372 DOI: 10.1080/02791072.2021.2006374] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/23/2021] [Accepted: 09/07/2021] [Indexed: 12/31/2022]
Abstract
Co-use of non-medical opioids (NMO) and methamphetamine is increasing. So too is the use of the psychoactive botanical "kratom," including among people with NMO and methamphetamine use histories. We assessed characteristics associated with respondent groups who reported lifetime methamphetamine and/or kratom use within a nationally representative US sample using 2019 National Survey on Drug Use and Health data from respondents reporting lifetime NMO use (diverted prescription opioids, heroin). Weighted prevalence estimates for demographic, mental health, and substance use outcomes were determined. Logistic regression examined associations between group membership and outcomes. Among this sample of respondents with lifetime NMO use, 67.6% (95% CI = 65.6-69.4%) reported only NMO use; 4.6% (3.9-5.4%) reported NMO+Kratom; 24.7% (22.7-26.7%) reported NMO+Methamphetamine; and 3.2% (2.5-3.9%) reported NMO+Methamphetamine+Kratom. Compared to those in the NMO-only group, the NMO+Kratom group was more likely to report past-year serious mental illness (SMI; OR = 2.27), suicidality (OR = 1.89), and past-month psychological distress (OR = 1.88). The NMO+Methamphetamine+Kratom group was more likely to report past-year SMI (OR = 2.65), past-month psychological distress (OR = 2.06), and unmet mental health needs (OR = 2.03); increased odds for drug injection, opioid withdrawal, and perceived treatment need also emerged. Risk factors were observed for all groups but were greatest among those reporting use of all three substances.
Collapse
Affiliation(s)
- Kirsten E. Smith
- National Institute on Drug Abuse Intramural Research Program, 251 Bayview Blvd. Baltimore, Maryland 21224, USA
| | - Jeffrey M. Rogers
- National Institute on Drug Abuse Intramural Research Program, 251 Bayview Blvd. Baltimore, Maryland 21224, USA
| | - Justin C. Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| |
Collapse
|
7
|
Stafford AM, Yamamoto BK, Phillips TJ. Combined and sequential effects of alcohol and methamphetamine in animal models. Neurosci Biobehav Rev 2021; 131:248-269. [PMID: 34543650 PMCID: PMC8642292 DOI: 10.1016/j.neubiorev.2021.09.019] [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: 09/25/2020] [Revised: 09/11/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022]
Abstract
Comorbid drug use, often alcohol with other drugs, poses significant health and societal concerns. Methamphetamine is among the illicit drugs most often co-used with alcohol. The current review examines the animal literature for impacts of comorbid alcohol and methamphetamine exposure. We found evidence for additive or synergistic effects of combined or sequential exposure on behavior and physiology. Dopaminergic, serotonergic, and glutamatergic systems are all impacted by combined exposure to alcohol and methamphetamine and cyclooxygenase-2 activity plays an important role in their combined neurotoxic effects. Adverse consequences of comorbid exposure include altered brain development with prenatal exposure, impaired learning and memory, motor deficits, gastrotoxicity, hepatotoxicity, and augmented intake under some conditions. Given high susceptibility to drug experimentation in adolescence, studies of co-exposure during the adolescent period and of how adolescent exposure to one drug impacts later use or sensitivity to the other drug should be a priority. Further, to gain traction on prevention and treatment, additional research to identify motivational and neurobiological drivers and consequences of comorbid use is needed.
Collapse
Affiliation(s)
- Alexandra M Stafford
- Department of Behavioral Neuroscience, Portland Alcohol Abuse Research Center and Methamphetamine Abuse Research Center, Oregon Health & Science University, Portland, OR, USA.
| | - Bryan K Yamamoto
- Department of Pharmacology & Toxicology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tamara J Phillips
- Department of Behavioral Neuroscience, Portland Alcohol Abuse Research Center and Methamphetamine Abuse Research Center, Oregon Health & Science University, Portland, OR, USA; Veterans Affairs Portland Health Care System, Portland, OR, USA
| |
Collapse
|
8
|
|
9
|
Des Jarlais DC, Feelemyer J, Arasteh K, Huong DT, Oanh KTH, Khue PM, Giang HT, Thanh NTT, Moles JP, Vinh VH, Vallo R, Quillet C, Rapoud D, Michel L, Laureillard D, Nagot N. The methamphetamine epidemic among persons who inject heroin in Hai Phong, Vietnam. J Subst Abuse Treat 2021; 126:108320. [PMID: 34116818 PMCID: PMC8197775 DOI: 10.1016/j.jsat.2021.108320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 11/11/2020] [Accepted: 01/31/2021] [Indexed: 11/21/2022]
Abstract
AIMS To describe the current methamphetamine (MA) use epidemic among persons who inject heroin (PWID) in Hai Phong, Vietnam, and consider possibilities for mitigating adverse effects of methamphetamine use. METHODS This study conducted surveys of PWID in 2016, 2017, and 2018 (N = 1383, 1451, and 1445, respectively). Trained interviewers administered structured interviews covering drug use histories, current drug use, and related risk behaviors. The study used urinalysis to confirm current drug use, and conducted HIV and HCV testing. RESULTS Participants were predominantly male (95%), mean age of 40, and all reported injecting heroin. Respondents' reports of initiating MA use were rare up through early 2000s but increased exponentially through the mid-2010s. MA use was predominantly "smoking," heating the drug and inhaling the vapor using a pipe; injecting MA was rare. Current (past 30 day) MA use appears to have plateaued in 2016-2018 with 53-58% of participants reporting no use in the last 30 days, 37-41% reporting low to moderate use (1 to 19 days in last 30 days), and 5-7% reporting very frequent use (20 or more days in last 30 days). This plateau reflects a rough balance between new users and individuals ceasing use. CONCLUSIONS MA use has become a substantial public health problem among PWID in Hai Phong. Initiation into MA use rose exponentially from 2005 to about 2015. Use of MA will likely continue for a substantial number of PWID. Currently, no medication is approved for treating MA disorders in Vietnam. Current psychosocial treatment requires highly trained counselors and months of treatment, so that psychosocial treatment for all PWID with MA disorders is likely beyond the resources available in a middle-income country such as Vietnam. Harm reduction programs implemented by community-based organization staff may provide a way to rapidly address aspects of the current MA epidemic. Such programs could emphasize social support for reducing use where possible and for avoiding escalation of use among persons continuing to use.
Collapse
Affiliation(s)
- Don C Des Jarlais
- New York University School of Global Public Health, New York, NY, USA.
| | | | - Kamyar Arasteh
- New York University School of Global Public Health, New York, NY, USA
| | - Duong Thi Huong
- Haiphong University of Medicine and Pharmacy, Haiphong, Viet Nam
| | | | - Pham Minh Khue
- Haiphong University of Medicine and Pharmacy, Haiphong, Viet Nam
| | - Hoang Thi Giang
- Haiphong University of Medicine and Pharmacy, Haiphong, Viet Nam
| | | | - Jean Pierre Moles
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Vu Hai Vinh
- Dept of Infectious and Tropical Diseases, Viet Tiep Hospital, Haiphong, Viet Nam
| | - Roselyne Vallo
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Catherine Quillet
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Delphine Rapoud
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Laurent Michel
- Pierre Nicole Center, French Red Cross, CESP/Inserrm 1018, Paris, France
| | - Didier Laureillard
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France; Infectious Diseases Department, Caremeau University Hospital, Nîmes, France
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| |
Collapse
|
10
|
Gender Differences in Methamphetamine Use Initiation and Trajectory of Use Among People Who Use Methamphetamine in a Mexico-US Border City. ADDICTIVE DISORDERS & THEIR TREATMENT 2021; 20:288-302. [DOI: 10.1097/adt.0000000000000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Drug addiction co-morbidity with alcohol: Neurobiological insights. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 157:409-472. [PMID: 33648675 DOI: 10.1016/bs.irn.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Addiction is a chronic disorder that consists of a three-stage cycle of binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation. These stages involve, respectively, neuroadaptations in brain circuits involved in incentive salience and habit formation, stress surfeit and reward deficit, and executive function. Much research on addiction focuses on the neurobiology underlying single drug use. However, alcohol use disorder (AUD) can be co-morbid with substance use disorder (SUD), called dual dependence. The limited epidemiological data on dual dependence indicates that there is a large population of individuals suffering from addiction who are dependent on more than one drug and/or alcohol, yet dual dependence remains understudied in addiction research. Here, we review neurobiological data on neurotransmitter and neuropeptide systems that are known to contribute to addiction pathology and how the involvement of these systems is consistent or divergent across drug classes. In particular, we highlight the dopamine, opioid, corticotropin-releasing factor, norepinephrine, hypocretin/orexin, glucocorticoid, neuroimmune signaling, endocannabinoid, glutamate, and GABA systems. We also discuss the limited research on these systems in dual dependence. Collectively, these studies demonstrate that the use of multiple drugs can produce neuroadaptations that are distinct from single drug use. Further investigation into the neurobiology of dual dependence is necessary to develop effective treatments for addiction to multiple drugs.
Collapse
|
12
|
Sadeh N, Miglin R, Bounoua N, Beckford E, Estrada S, Baskin-Sommers A. Profiles of lifetime substance use are differentiated by substance of choice, affective motivations for use, and childhood maltreatment. Addict Behav 2021; 113:106710. [PMID: 33091716 PMCID: PMC8312989 DOI: 10.1016/j.addbeh.2020.106710] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/27/2020] [Accepted: 10/11/2020] [Indexed: 01/03/2023]
Abstract
To develop personalized interventions and improve outcomes in substance-using populations, research is needed on the heterogeneity in substance use patterns and motivations that exists among adult substance users. This study took a person-centered approach to identify profiles of lifetime substance use and discern the psychosocial differences among them. To survey a spectrum of drug use severity, 1106 adults (43.4% women) were recruited from forensic and community samples. Participants reported on the frequency of lifetime substance use across multiple drug categories (sedatives, stimulants, marijuana, heroin, hallucinogens, misuse of prescription drugs) and alcohol use. Latent profile analysis was used to identify distinct profiles of substance use that were then compared on potential risk and maintenance factors for substance use. Four profiles of lifetime substance use emerged that diverged on severity of use and degree of mono vs. polysubstance use (Recreational Marijuana Use, Heavy Multidrug Intoxication, Heavy Marijuana Use, and Heavy Opioid and Polysubstance Use). The profiles differed on affective motivations for substance use (e.g., using to cope vs. using to seek a thrill), age of use onset, drug-related functional impairment, and experiences of childhood maltreatment. Cognitive functioning did not differentiate the heavy substance use profiles. Results provide compelling initial evidence that lifetime patterns of use can be used to identify groups of substance users with distinct risk and maintenance factors. Results highlight affective motivations for substance use and maltreatment history as potential treatment targets and underscore the importance of studying polysubstance use in the context of the opioid epidemic.
Collapse
Affiliation(s)
- Naomi Sadeh
- University of Delaware, Department of Psychological and Brain Sciences, 105 The Green, Newark, DE 19716, United States.
| | - Rickie Miglin
- University of Delaware, Department of Psychological and Brain Sciences, 105 The Green, Newark, DE 19716, United States.
| | - Nadia Bounoua
- University of Delaware, Department of Psychological and Brain Sciences, 105 The Green, Newark, DE 19716, United States.
| | - Emil Beckford
- Yale University, Department of Psychology, P.O. Box 208205, New Haven, CT 06520, United States.
| | - Suzanne Estrada
- Yale University, Department of Psychology, P.O. Box 208205, New Haven, CT 06520, United States.
| | - Arielle Baskin-Sommers
- Yale University, Department of Psychology, P.O. Box 208205, New Haven, CT 06520, United States.
| |
Collapse
|
13
|
Stafford AM, Reed C, Phillips TJ. Non-genetic factors that influence methamphetamine intake in a genetic model of differential methamphetamine consumption. Psychopharmacology (Berl) 2020; 237:3315-3336. [PMID: 32833064 PMCID: PMC7572688 DOI: 10.1007/s00213-020-05614-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/17/2020] [Indexed: 12/20/2022]
Abstract
RATIONALE Genetic and non-genetic factors influence substance use disorders. Our previous work in genetic mouse models focused on genetic factors that influence methamphetamine (MA) intake. The current research examined several non-genetic factors for their potential influence on this trait. OBJECTIVES We examined the impact on MA intake of several non-genetic factors, including MA access schedule, prior forced MA exposure, concomitant ethanol (EtOH) access, and gamma-aminobutyric acid type B (GABAB) receptor activation. Selectively bred MA high drinking (MAHDR) and low drinking (MALDR) mice participated in this research. RESULTS MAHDR, but not MALDR, mice increased MA intake when given intermittent access, compared with continuous access, with a water choice under both schedules. MA intake was not altered by previous exposure to forced MA consumption. Male MAHDR mice given simultaneous access to MA, EtOH, and an EtOH+MA mixture exhibited a strong preference for MA over EtOH and EtOH+MA; MA intake was not affected by EtOH in female MAHDR mice. When independent MAHDR groups were given access to MA, EtOH, or EtOH+MA vs. water in each case, MA intake was reduced in the water vs. EtOH+MA group, compared with the water vs. MA group. The GABAB receptor agonist R(+)-baclofen (BAC) not only reduced MA intake but also reduced water intake and locomotor activity in MAHDR mice. There was a residual effect of BAC, such that MA intake was increased after termination of BAC treatment. CONCLUSIONS These findings demonstrate that voluntary MA intake in MAHDR mice is influenced by non-genetic factors related to MA access schedule and co-morbid EtOH exposure.
Collapse
Affiliation(s)
- A M Stafford
- Department of Behavioral Neuroscience and Methamphetamine Abuse Research Center, Oregon Health & Science University, Portland, OR, USA
| | - C Reed
- Department of Behavioral Neuroscience and Methamphetamine Abuse Research Center, Oregon Health & Science University, Portland, OR, USA
| | - T J Phillips
- Department of Behavioral Neuroscience and Methamphetamine Abuse Research Center, Oregon Health & Science University, Portland, OR, USA.
- Veterans Affairs Portland Health Care System, Portland, OR, USA.
| |
Collapse
|
14
|
Shapira B, Rosca P, Berkovitz R, Gorjaltsan I, Neumark Y. The switch from one substance-of-abuse to another: illicit drug substitution behaviors in a sample of high-risk drug users. PeerJ 2020; 8:e9461. [PMID: 32742781 PMCID: PMC7370931 DOI: 10.7717/peerj.9461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/10/2020] [Indexed: 01/07/2023] Open
Abstract
Background Substitution can be defined as the consciously motivated choice to use one drug, either licit or illicit, instead of another, due to perceptions of cost, availability, safety, legality, substance characteristics, and substance attributions. Substitution represents a potential risk to drug users, mainly when substitutes are of higher potency and toxicity. This study offers a basic conceptualization of illicit substitution behavior and describes substitution patterns among users of two highly prevalent drugs of abuse-heroin and cannabis. Methods Here, 592 high-risk drug users undergoing pharmacological and psycho-social treatment were interviewed. Patients were asked questions about current drug use, lifetime substitution, and substitution patterns. Descriptive statistics, chi-square tests of independence, and multinomial logistic regressions were used to identify and test correlates of substitution patterns for heroin and cannabis. Results Of the 592 drug users interviewed, 448 subjects (75.7%) reported having substituted their preferred drug for another illicit substance. Interviews yielded a total of 275 substitution events reported by users of cannabis, and 351 substitution events reported by users of heroin. The most frequently reported substitution substances for responders who preferred heroin were illicit non-prescribed "street" methadone (35.9%), followed by oral and transdermal prescription opioids (17.7%). For responders who preferred cannabis, substitution for synthetic cannabinoid receptor agonists (33.5%) followed by alcohol (16.0%) were the most commonly reported. Age at onset-of-use (p < 0.005), population group (p = 0.008), and attending treatment for the first time (p = 0.026) were significantly associated with reported lifetime substitution. Past-year use of stimulants, heroin, hallucinogens, methylenedioxymethamphetamine (MDMA), and novel psychoactive substances were-at the 95% confidence level-also significantly associated with reported lifetime substitution. In multivariate analysis, the odds for methadone substitution among heroin users were significantly affected by age at onset-of-use, type of treatment center, and education. Odds for substitution for synthetic cannabinoid receptor agonists among cannabis users were significantly affected by age, population group, type of treatment center, and education. Conclusion Self-substitution behavior should be considered by clinicians and policymakers as a common practice among most drugusers. Substitution for street methadone provides evidence for the ongoing diversion of this substance from Opioid Maintenance Treatment Centers, while the prominence of substitution of synthetic cannabinoids among dual-diagnosis patients should be regarded as an ongoing risk to patients that needs to be addressed by clinicians. Analysis of additional substitution patterns should provide further valuable insights into the behavior of drugusers.
Collapse
Affiliation(s)
- Barak Shapira
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Division of Enforcement and Inspection, Israel Ministry of Health, Jerusalem, Israel
| | - Paola Rosca
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel
| | - Ronny Berkovitz
- Division of Enforcement and Inspection, Israel Ministry of Health, Jerusalem, Israel
| | | | - Yehuda Neumark
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
15
|
Shapira B, Berkovitz R, Rosca P, Neumark Y. Recent Use of Synthetic Cannabinoids, Synthetic Opioids, and Other Psychoactive Drug Groups among High-risk Drug Users. J Psychoactive Drugs 2020; 52:334-343. [DOI: 10.1080/02791072.2020.1754534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Barak Shapira
- Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Ronny Berkovitz
- Division of Enforcement and Inspection, Israel Ministry of Health, Jerusalem, Israel
| | - Paola Rosca
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel
| | - Yehuda Neumark
- Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem, Israel
| |
Collapse
|
16
|
Liu L, Luo T, Dong H, Zhang C, Liu T, Zhang X, Hao W. Genome-Wide DNA Methylation Analysis in Male Methamphetamine Users With Different Addiction Qualities. Front Psychiatry 2020; 11:588229. [PMID: 33192735 PMCID: PMC7645035 DOI: 10.3389/fpsyt.2020.588229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/24/2020] [Indexed: 12/20/2022] Open
Abstract
This paper aimed to explore the genome-wide DNA methylation status of methamphetamine (MA) abusers with different qualities to addiction and to identify differentially methylated candidate genes. A total of 207 male MA abusers with an MA abuse frequency of ≥10 times and an MA abuse duration of ≥1 year were assigned to the high MA addiction quality group (HMAQ group; 168 subjects who met the diagnostic criteria for MA dependence according to the DSM-IV) or to the low MA addictive quality group (LMAQ group; 39 subjects who did not meet the criteria for MA dependence). In addition 105 healthy controls were recruited. Eight HMAQ subjects, eight LMAQ subjects, and eight healthy controls underwent genome-wide DNA methylation scans with an Infinium Human Methylation 450 array (Illumina). The differentially methylated region (DMR) data were entered into pathway analysis, and the differentially methylated position (DMP) data were screened for candidate genes and verified by MethyLight qPCR with all samples. Seven specific pathways with an abnormal methylation status were identified, including the circadian entrainment, cholinergic synapse, glutamatergic synapse, retrograde endocannabinoid signaling, GABAergic synapse, morphine addiction and PI3K-Akt signaling pathways. SLC1A6, BHLHB9, LYNX1, CAV2, and PCSK9 showed differences in their methylation levels in the three groups. Only the number of methylated copies of CAV2 was significantly higher in the LMAQ group than in the HMAQ group. Our findings suggest that the circadian entrainment pathway and the caveolin-2 gene may play key roles in MA addiction quality. Further studies on their functions and mechanisms will help us to better understand the pathogenesis of MA addiction and to explore new targets for drug intervention.
Collapse
Affiliation(s)
- Liang Liu
- Department of Geriatric Psychiatry, Wuxi Mental Health Center, Nanjing Medical University, Wuxi, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, National Clinical Research Center on Mental Disorders, National Technology Institute on Mental Disorders, Central South University, Changsha, China
| | - Tao Luo
- Hunan Key Laboratory of Psychiatry and Mental Health, Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, National Clinical Research Center on Mental Disorders, National Technology Institute on Mental Disorders, Central South University, Changsha, China.,Department of Clinic Psychiatry, Jiangxi Mental Hospital, Nanchang University, Nanchang, China
| | - Huixi Dong
- Hunan Key Laboratory of Psychiatry and Mental Health, Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, National Clinical Research Center on Mental Disorders, National Technology Institute on Mental Disorders, Central South University, Changsha, China
| | - Chenxi Zhang
- Hunan Key Laboratory of Psychiatry and Mental Health, Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, National Clinical Research Center on Mental Disorders, National Technology Institute on Mental Disorders, Central South University, Changsha, China
| | - Tieqiao Liu
- Hunan Key Laboratory of Psychiatry and Mental Health, Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, National Clinical Research Center on Mental Disorders, National Technology Institute on Mental Disorders, Central South University, Changsha, China
| | - Xiangyang Zhang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Wei Hao
- Hunan Key Laboratory of Psychiatry and Mental Health, Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, National Clinical Research Center on Mental Disorders, National Technology Institute on Mental Disorders, Central South University, Changsha, China
| |
Collapse
|
17
|
Degenhardt L, Grebely J, Stone J, Hickman M, Vickerman P, Marshall BDL, Bruneau J, Altice FL, Henderson G, Rahimi-Movaghar A, Larney S. Global patterns of opioid use and dependence: harms to populations, interventions, and future action. Lancet 2019; 394:1560-1579. [PMID: 31657732 PMCID: PMC7068135 DOI: 10.1016/s0140-6736(19)32229-9] [Citation(s) in RCA: 397] [Impact Index Per Article: 79.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 08/15/2019] [Accepted: 09/06/2019] [Indexed: 12/15/2022]
Abstract
We summarise the evidence for medicinal uses of opioids, harms related to the extramedical use of, and dependence on, these drugs, and a wide range of interventions used to address these harms. The Global Burden of Diseases, Injuries, and Risk Factors Study estimated that in 2017, 40·5 million people were dependent on opioids (95% uncertainty interval 34·3-47·9 million) and 109 500 people (105 800-113 600) died from opioid overdose. Opioid agonist treatment (OAT) can be highly effective in reducing illicit opioid use and improving multiple health and social outcomes-eg, by reducing overall mortality and key causes of death, including overdose, suicide, HIV, hepatitis C virus, and other injuries. Mathematical modelling suggests that scaling up the use of OAT and retaining people in treatment, including in prison, could avert a median of 7·7% of deaths in Kentucky, 10·7% in Kiev, and 25·9% in Tehran over 20 years (compared with no OAT), with the greater effects in Tehran and Kiev being due to reductions in HIV mortality, given the higher prevalence of HIV among people who inject drugs in those settings. Other interventions have varied evidence for effectiveness and patient acceptability, and typically affect a narrower set of outcomes than OAT does. Other effective interventions focus on preventing harm related to opioids. Despite strong evidence for the effectiveness of a range of interventions to improve the health and wellbeing of people who are dependent on opioids, coverage is low, even in high-income countries. Treatment quality might be less than desirable, and considerable harm might be caused to individuals, society, and the economy by the criminalisation of extramedical opioid use and dependence. Alternative policy frameworks are recommended that adopt an approach based on human rights and public health, do not make drug use a criminal behaviour, and seek to reduce drug-related harm at the population level.
Collapse
Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia.
| | - Jason Grebely
- Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Julie Bruneau
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Succursale Centre-Ville, Montreal, QC, Canada
| | | | | | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| |
Collapse
|
18
|
Timko C, Han X, Woodhead E, Shelley A, Cucciare MA. Polysubstance Use by Stimulant Users: Health Outcomes Over Three Years. J Stud Alcohol Drugs 2019. [PMID: 30422794 DOI: 10.15288/jsad.2018.79.799] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Studies show that stimulant users have varied substance use patterns and that polysubstance use is associated with poorer past or concurrent medical, mental health, and substance use outcomes. This study examined outcomes of substance use patterns prospectively. METHOD A latent class analysis was conducted to examine substance use patterns among adults using stimulants (n = 710; 38.6% women) at baseline, and the health and treatment utilization outcomes of different use patterns over the subsequent 3 years. To examine associations between latent class membership and outcomes, generalized estimating equation modeling was conducted. RESULTS Four classes of substance use patterns at baseline were identified, involving high use of (a) methamphetamine and marijuana (23%); (b) crack cocaine and alcohol (25%); (c) powder cocaine, alcohol, and marijuana (23%); and (d) nonprescribed opioids, alcohol, marijuana, crack cocaine, and powder cocaine (i.e., polysubstance [29%]). Polysubstance class members had poorer physical health and mental health status, and more severe substance use, over the subsequent 3-year period, than other class members. Regarding treatment utilization, polysubstance class members had more medical care utilization than crack cocaine class members, and more substance use treatment utilization than powder cocaine class members. The methamphetamine, crack cocaine, and powder cocaine classes did not differ from each other on any health or treatment utilization outcome. CONCLUSIONS People using stimulants commonly use other substances, and those whose polysubstance use includes nonprescribed opioids have especially poor health outcomes.
Collapse
Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, Menlo Park, California.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Xiaotong Han
- Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.,VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas
| | - Erin Woodhead
- Department of Psychology, San Jose State University, San Jose, California
| | - Alexandra Shelley
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, Menlo Park, California
| | - Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.,VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| |
Collapse
|
19
|
Marel C, Mills KL, Slade T, Darke S, Ross J, Teesson M. Modelling Long-Term Joint Trajectories of Heroin Use and Treatment Utilisation: Findings from the Australian Treatment Outcome Study. EClinicalMedicine 2019; 14:71-79. [PMID: 31709404 PMCID: PMC6833348 DOI: 10.1016/j.eclinm.2019.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/09/2019] [Accepted: 07/23/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Heroin is currently contributing to the worst drug addiction epidemic in United States history; recent rates of use, dependence and death have also increased dramatically in parts of Europe. An improved understanding of the long-term relationship between heroin use and treatment utilisation is essential to inform both clinical and public health responses. We aimed to identify i) joint trajectories of heroin use and treatment utilisation, ii) predictors of joint group membership, and iii) outcomes associated with joint group membership; over 10-11 years among a cohort of Australians with heroin dependence. METHODS A total of 615 people with heroin dependence were recruited as part of a prospective longitudinal cohort study between 2001 and 02. This analysis focuses on 428 participants (70.1% of the original cohort) for whom complete data were available over 10-11 years. FINDINGS Five joint trajectory groups were identified: i) 'long-term stable' (17%: decrease in probability of heroin use alongside high treatment utilisation); ii) 'long-term success' (13%: decrease in heroin use alongside decreased treatment utilisation, until there was maintained abstinence from heroin with no treatment utilisation); iii) 'treatment failure' (12%: no decrease in heroin use alongside high treatment utilisation); iv) 'late success' (9%: gradual decrease in heroin use alongside increased treatment utilisation); and v) 'relapsed' (9%: relapse in heroin use alongside an increase and decrease in treatment utilisation). Few variables were found to predict joint group membership, but group membership was predictive of demographic, substance use and physical and mental health outcomes at 10-11 years. INTERPRETATION The role of treatment in recovery from heroin dependence is undeniable; however, a considerable proportion of people are able achieve and maintain abstinence without the need for ongoing treatment. An equally significant proportion will continue to use heroin despite being in long-term treatment. FUNDING Australian National Health and Medical Research Council.
Collapse
Affiliation(s)
- Christina Marel
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
- Corresponding author at: The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building (G02), The University of Sydney, NSW 2006, Australia.
| | - Katherine L. Mills
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Tim Slade
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Australia
| | - Joanne Ross
- National Drug and Alcohol Research Centre, University of New South Wales, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| |
Collapse
|
20
|
Acute and long-term cannabis use among stimulant users: Results from CTN-0037 Stimulant Reduction Intervention using Dosed Exercise (STRIDE) Randomized Control Trial. Drug Alcohol Depend 2019; 200:139-144. [PMID: 31129484 PMCID: PMC6863445 DOI: 10.1016/j.drugalcdep.2019.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 02/04/2019] [Accepted: 02/09/2019] [Indexed: 11/22/2022]
Abstract
AIMS The aim of this study was to examine the impact of vigorous intensity, high dose exercise (DEI) on cannabis use among stimulant users compared to a health education intervention (HEI) using data from the Stimulant Reduction Intervention using Dosed Exercise, National Institute of Drug Abuse National Drug Treatment Clinical Trials Network Protocol Number 0037 (STRIDE). METHODS Adults (N = 302) enrolled in the STRIDE randomized clinical trial were randomized to either the DEI or the HEI. Interventions included supervised sessions three times a week during the Acute phase (12 weeks) and once a week during the Follow-up phase (6 months). Cannabis use was measured at each assessment via Timeline Follow Back and urine drug screens. Cannabis use was compared between the groups during the Acute and Follow-up phases using both the intent-to-treat sample and a complier average causal effects (CACE) analysis. FINDINGS Approximately 43% of the sample reported cannabis use at baseline. The difference in cannabis use between the DEI and HEI groups during the Acute phase was not significant. During the Follow-up phase, the days of cannabis use was significantly lower among those in the DEI group (1.20 days) compared to the HEI group (2.15 days; p = 0.04). CONCLUSIONS For those who adhered to the exercise intervention, vigorous intensity, high dose exercise resulted in less cannabis use. Results suggest that there were no significant short-term differences in cannabis use between the groups. Further study on the long-term impact of exercise as a treatment to reduce cannabis use should be considered.
Collapse
|
21
|
De Luca MT, Montanari C, Meringolo M, Contu L, Celentano M, Badiani A. Heroin versus cocaine: opposite choice as a function of context but not of drug history in the rat. Psychopharmacology (Berl) 2019; 236:787-798. [PMID: 30443795 PMCID: PMC6469678 DOI: 10.1007/s00213-018-5115-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/06/2018] [Indexed: 12/26/2022]
Abstract
RATIONALE Previous studies have shown that rats trained to self-administer heroin and cocaine exhibit opposite preferences, as a function of setting, when tested in a choice paradigm. Rats tested at home prefer heroin to cocaine, whereas rats tested outside the home prefer cocaine to heroin. Here, we investigated whether drug history would influence subsequent drug preference in distinct settings. Based on a theoretical model of drug-setting interaction, we predicted that regardless of drug history rats would prefer heroin at home and cocaine outside the home. METHODS Rats with double-lumen catheters were first trained to self-administer either heroin (25 μg/kg) or cocaine (400 μg/kg) for 12 consecutive sessions. Twenty-six rats were housed in the self-administration chambers (thus, they were tested at home), whereas 30 rats lived in distinct home cages and were transferred to self-administration chambers only for the self-administration session (thus, they were tested outside the home). The rats were then allowed to choose repeatedly between heroin and cocaine within the same session for seven sessions. RESULTS Regardless of the training drug, the rats tested outside the home preferred cocaine to heroin, whereas the rats tested at home preferred heroin to cocaine. There was no correlation between drug preference and drug intake during the training phase. CONCLUSION Drug preferences were powerfully influenced by the setting but, quite surprisingly, not by drug history. This suggests that, under certain conditions, associative learning processes and drug-induced neuroplastic adaptations play a minor role in shaping individual preferences for one drug or the other.
Collapse
Affiliation(s)
- Maria Teresa De Luca
- Department of Physiology and Pharmacology Vittorio Erspamer, Sapienza University of Rome, Rome, Italy
| | - Christian Montanari
- Department of Physiology and Pharmacology Vittorio Erspamer, Sapienza University of Rome, Rome, Italy
| | - Maria Meringolo
- Department of Physiology and Pharmacology Vittorio Erspamer, Sapienza University of Rome, Rome, Italy
| | - Laura Contu
- Department of Physiology and Pharmacology Vittorio Erspamer, Sapienza University of Rome, Rome, Italy
| | - Michele Celentano
- Department of Physiology and Pharmacology Vittorio Erspamer, Sapienza University of Rome, Rome, Italy
| | - Aldo Badiani
- Department of Physiology and Pharmacology Vittorio Erspamer, Sapienza University of Rome, Rome, Italy.
- Sussex Addiction Research and Intervention Centre (SARIC), School of Psychology, University of Sussex, Sussex, UK.
- Sussex Neuroscience, University of Sussex, Sussex, UK.
| |
Collapse
|
22
|
Eastwood B, Strang J, Marsden J. Change in alcohol and other drug use during five years of continuous opioid substitution treatment. Drug Alcohol Depend 2019; 194:438-446. [PMID: 30502545 DOI: 10.1016/j.drugalcdep.2018.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND English national prospective, observational cohort study of patients continuously enrolled for five years in opioid substitution treatment (OST) with oral methadone and sublingual buprenorphine. This is a secondary outcome analysis of change in use of alcohol and other drug use (AOD) following identification of heroin use trajectories during OST. METHODS All adults admitted to community OST in 2008/09 and enrolled to 2013/14 (n = 7717). Data from 11 sequential, six-monthly clinical reviews were used to identify heroin and AOD use trajectories by multi-level Latent Class Growth Analysis. OST outcome in the sixth and seventh year was 'successful completion and no re-presentation' (SCNR) to structured treatment and was assessed using multi-level logistic regression. RESULTS With 'rapid decreasing' heroin use trajectory as referent, 'continued high-level' heroin use predicted 'continued high-level' crack cocaine use (relative risk ratio [RRR] 58.7; 95% confidence interval [CI] 34.2-100.5),'continued high-level' alcohol use (RRR 1.2; 95% CI 1.0-1.5), 'increasing' unspecified drug use (RRR 1.7; 95% CI 1.4-2.1) and less 'high and increasing' cannabis use (RRR 0.5; 95% CI 0.4-0.6). 'Increasing' crack use was negatively associated with SCNR outcome for the 'decreasing then increasing' and 'gradual decreasing' heroin use groups (adjusted odds ratio [AOR] 0.5; 95% CI 0.3-0.9 and AOR 0.2; 95% CI 0.1-0.7, respectively). CONCLUSIONS Continued high-level heroin use non-response during long-term OST is associated with high-level crack cocaine and alcohol use, increasing unspecified drug use, but less high and increasing cannabis use. Increasing use of crack cocaine is negatively associated with the likelihood that long-term OST is completed successfully.
Collapse
Affiliation(s)
- Brian Eastwood
- King's College London, Addictions Department, Box 48, Institute of Psychiatry, Psychology and Neuroscience, DeCrespigny Park, Denmark Hill, London SE5 8AF, United Kingdom; Alcohol, Drugs, Tobacco and Justice Division, Health Improvement Directorate, Public Health England, 7th Floor Wellington House, 133-155 Waterloo Road, London SE1 8UG, United Kingdom.
| | - John Strang
- King's College London, Addictions Department, Box 48, Institute of Psychiatry, Psychology and Neuroscience, DeCrespigny Park, Denmark Hill, London SE5 8AF, United Kingdom.
| | - John Marsden
- King's College London, Addictions Department, Box 48, Institute of Psychiatry, Psychology and Neuroscience, DeCrespigny Park, Denmark Hill, London SE5 8AF, United Kingdom; Alcohol, Drugs, Tobacco and Justice Division, Health Improvement Directorate, Public Health England, 7th Floor Wellington House, 133-155 Waterloo Road, London SE1 8UG, United Kingdom.
| |
Collapse
|
23
|
Curtin K, Fleckenstein AE, Keeshin BR, Yurgelun-Todd DA, Renshaw PF, Smith KR, Hanson GR. Increased risk of diseases of the basal ganglia and cerebellum in patients with a history of attention-deficit/hyperactivity disorder. Neuropsychopharmacology 2018; 43:2548-2555. [PMID: 30209407 PMCID: PMC6224615 DOI: 10.1038/s41386-018-0207-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/10/2018] [Accepted: 08/28/2018] [Indexed: 12/13/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity and involves dysregulated dopaminergic pathways. Dopaminergic agents (i.e., amphetamine and methylphenidate) are thus prescribed to treat ADHD. As little is known regarding long-term consequences of either ADHD or its treatment, the objective of this study was to determine if either alters the risk of diseases of the basal ganglia and cerebellum, including Parkinson's disease. Statewide medical records from 1996 to 2016 were retrieved from the Utah Population Database to conduct a retrospective cohort study. Participants included ADHD patients (International Classification of Diseases, 9th revision (ICD-9) diagnosis codes 314.0-314.2, 314.8, 314.9) and 5:1 random sex-matched and age-matched subjects with no ADHD diagnosis history. Both patients and non-ADHD subjects met the following eligibility criteria: (1) no prior diagnosis of Parkinson's disease, secondary parkinsonism, basal ganglia disease, or essential tremor (ICD-9 codes 332.0, 332.1, 333.0, 333.1), (2) born in 1950 or later and age ≥20 years at last follow-up, and (3) no history of substance abuse (illicit drugs or alcohol). Outcomes were measured as time to diagnosis of diseases of the basal ganglia and cerebellum, death, or study-end. A Cox model incorporating a competing risk of death was used to provide hazard ratio estimates. Patients with ADHD (N = 31,769) had a 2.4-fold increased risk of basal ganglia and cerebellum diseases (95% confidence interval (CI): 2.0-3.0; P < 0.0001) compared with 158,790 non-ADHD persons, after controlling for sex and age and adjusting for tobacco use and psychotic conditions. In 4960 ADHD patients prescribed psychostimulants, risk of basal ganglia and cerebellum diseases between ages 21 and 49 years was especially pronounced, at 8.6-fold (95% CI: 4.8-15.6; P < 0001). The association of ADHD patients prescribed psychostimulants with higher risk of diseases of the basal ganglia and cerebellum may reflect a more severe ADHD phenotype rather than a direct association between prescribed stimulant use and basal ganglia or cerebellum disorders. Future studies to assess and stratify patient risk so as to inform treatment are warranted.
Collapse
Affiliation(s)
- Karen Curtin
- 0000 0001 2193 0096grid.223827.eDepartment of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Annette E. Fleckenstein
- 0000 0001 2193 0096grid.223827.eUniversity of Utah School of Dentistry, Salt Lake City, UT USA
| | - Brooks R. Keeshin
- 0000 0001 2193 0096grid.223827.eDepartment of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT USA ,0000 0004 0442 6404grid.415178.eDepartment of Pediatric Psychiatry, Intermountain Healthcare Primary Children’s Hospital, Salt Lake City, UT USA
| | - Deborah A. Yurgelun-Todd
- 0000 0001 2193 0096grid.223827.eDepartment of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Perry F. Renshaw
- 0000 0001 2193 0096grid.223827.eDepartment of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Ken R. Smith
- 0000 0001 2193 0096grid.223827.eHuman Development and Family Studies, University of Utah, Salt Lake City, UT USA
| | - Glen R. Hanson
- 0000 0001 2193 0096grid.223827.eUniversity of Utah School of Dentistry, Salt Lake City, UT USA
| |
Collapse
|
24
|
Timko C, Han X, Woodhead E, Shelley A, Cucciare MA. Polysubstance Use by Stimulant Users: Health Outcomes Over Three Years. J Stud Alcohol Drugs 2018; 79:799-807. [PMID: 30422794 PMCID: PMC6240007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/10/2018] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVE Studies show that stimulant users have varied substance use patterns and that polysubstance use is associated with poorer past or concurrent medical, mental health, and substance use outcomes. This study examined outcomes of substance use patterns prospectively. METHOD A latent class analysis was conducted to examine substance use patterns among adults using stimulants (n = 710; 38.6% women) at baseline, and the health and treatment utilization outcomes of different use patterns over the subsequent 3 years. To examine associations between latent class membership and outcomes, generalized estimating equation modeling was conducted. RESULTS Four classes of substance use patterns at baseline were identified, involving high use of (a) methamphetamine and marijuana (23%); (b) crack cocaine and alcohol (25%); (c) powder cocaine, alcohol, and marijuana (23%); and (d) nonprescribed opioids, alcohol, marijuana, crack cocaine, and powder cocaine (i.e., polysubstance [29%]). Polysubstance class members had poorer physical health and mental health status, and more severe substance use, over the subsequent 3-year period, than other class members. Regarding treatment utilization, polysubstance class members had more medical care utilization than crack cocaine class members, and more substance use treatment utilization than powder cocaine class members. The methamphetamine, crack cocaine, and powder cocaine classes did not differ from each other on any health or treatment utilization outcome. CONCLUSIONS People using stimulants commonly use other substances, and those whose polysubstance use includes nonprescribed opioids have especially poor health outcomes.
Collapse
Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, Menlo Park, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Xiaotong Han
- Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas
- VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas
| | - Erin Woodhead
- Department of Psychology, San Jose State University, San Jose, California
| | - Alexandra Shelley
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, Menlo Park, California
| | - Michael A. Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas
- VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| |
Collapse
|
25
|
Palamar JJ, Le A, Mateu-Gelabert P. Not just heroin: Extensive polysubstance use among US high school seniors who currently use heroin. Drug Alcohol Depend 2018; 188:377-384. [PMID: 29880271 PMCID: PMC6198323 DOI: 10.1016/j.drugalcdep.2018.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Heroin-related deaths are on the rise in the US and a large portion of heroin overdoses involve co-use of other drugs such as benzodiazepines. A better understanding of heroin polysubstance use patterns could help discern better prevention measures. METHODS Data were examined from past-month ("current") heroin users from a nationally representative sample of high school seniors in the Monitoring the Future study (2010-2016, n = 327). We examined how past-month use and frequency of use of various drugs relate to frequency of current heroin use using chi-square and multivariable ordinal logistic regression. RESULTS Prevalence of any past-month use of various other drugs (and past-month use 10+ times) tends to increase as the frequency of heroin use increases; however, other drug use tends to decline among those reporting the use of heroin 40+ times in the past month. In multivariable models controlling for demographic characteristics, most levels of alcohol use were associated with decreased odds of higher-frequency heroin use (ps<.05). Nonmedical opioid (aOR = 5.84, p = .037) and tranquilizer (aOR = 14.63, p = .045) use 40+ times in the past month were associated with increased odds of higher-frequency heroin use. CONCLUSIONS High school seniors who use heroin also use multiple other drugs. Increases in the frequency of heroin use are associated with shifts in the nature and frequency of polysubstance use, with a higher frequency of heroin use associated with the highest percentage and frequency of use of depressants (nonmedical opioid and benzodiazepine use), compounding the risk of overdose. Prevention measures should consider polysubstance use patterns among heroin-using adolescents.
Collapse
Affiliation(s)
- Joseph J Palamar
- Department of Population Health, New York University Langone Medical Center, 227 E. 30th Street, 7th Floor, New York, NY, 10016, USA; Center for Drug Use and HIV/HCV Research, New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, USA.
| | - Austin Le
- Department of Population Health, New York University Langone Medical Center, 227 E. 30th Street, 7th Floor, New York, NY, 10016, USA; New York University College of Dentistry, 345 E. 24th Street, New York, NY, 10010, USA
| | - Pedro Mateu-Gelabert
- Center for Drug Use and HIV/HCV Research, New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, USA; National Development and Research Institutes, 71 West 23rd Street, 4th Floor, New York, NY, 10010, USA
| |
Collapse
|
26
|
Clark CB, Swails JA, Akao KA, Pontinen HM, Cropsey KL. Gaging the impact of multiple substance use on community corrections involvement. Addict Behav 2018; 81:55-59. [PMID: 29428813 PMCID: PMC5845843 DOI: 10.1016/j.addbeh.2018.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 01/31/2023]
Abstract
Historically, research has demonstrated that multiple substance use, compared to single substance use, poses additional challenges for treatment throughout the continuum of care including referrals, interventions, and relapse prevention. However, it appears that this pattern cannot be easily generalized to all criminal justice settings as evidenced by mixed findings across criminal justice samples. The purpose of the current study is to investigate possible differences in legal and substance-related outcomes between multiple substance users and single substance users within a community corrections sample. Structured clinical interviews were conducted to divide 531 individuals under community corrections supervision into three groups including multiple substance users, single substance users, and non-substance users. Results indicated that while multiple substance users were arrested more frequently and had more problems with family members, there were no differences compared to their single substance using counterparts in terms of depressive disorders, anxiety disorders, or types of offense. These findings contrast with previous research on samples outside of community corrections suggesting that multiple substance use requires tailored interventions with consideration to context of their use. Discussion includes limitations to generalizability and assessment of substance use as well as implications for treatment and future research.
Collapse
Affiliation(s)
- C Brendan Clark
- Wichita State University, Department of Psychology, United States.
| | - Jeffrey A Swails
- Wichita State University, Department of Psychology, United States
| | - Karen A Akao
- Wichita State University, Department of Psychology, United States
| | - Heidi M Pontinen
- Wichita State University, Department of Psychology, United States
| | - Karen L Cropsey
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, United States
| |
Collapse
|
27
|
Hill R, Dewey WL, Kelly E, Henderson G. Oxycodone-induced tolerance to respiratory depression: reversal by ethanol, pregabalin and protein kinase C inhibition. Br J Pharmacol 2018; 175:2492-2503. [PMID: 29574756 PMCID: PMC5980627 DOI: 10.1111/bph.14219] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/08/2018] [Accepted: 03/13/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Oxycodone, a prescription opioid, is a major drug of abuse, especially in the USA, and contributes significantly to opioid overdose deaths each year. Overdose deaths result primarily from respiratory depression. We have studied respiratory depression by oxycodone and have characterized how tolerance develops on prolonged exposure to the drug. We have investigated the role of PKC in maintaining tolerance and have examined whether ethanol or pregabalin reverses oxycodone-induced tolerance. EXPERIMENTAL APPROACH Respiration was measured in male CD-1 mice by whole-body plethysmography. Mice were preinjected with oxycodone then implanted with mini-pumps (s.c.) delivering 20, 45 or 120 mg·kg-1 ·day-1 oxycodone for 6 days and subsequently challenged with oxycodone (3 mg·kg-1 , i.p.) or morphine (10 mg·kg-1 , i.p.) to assess the level of tolerance. KEY RESULTS Oxycodone-treated mice developed tolerance to oxycodone and cross tolerance to morphine-induced respiratory depression. Tolerance was less with 20 mg·kg-1 ·day-1 than with 45 or 120 mg·kg-1 ·day-1 oxycodone treatment. At doses that do not depress respiration, ethanol (0.3 g·kg-1 ), pregabalin (20 mg·kg-1 ) and calphostin C (45 μg·kg-1 ) all reversed oxycodone-induced tolerance resulting in significant respiratory depression. Reversal of tolerance was less in mice treated with oxycodone (120 mg·kg-1 ·day-1 ). In mice receiving ethanol and calphostin C or ethanol and pregabalin, there was no greater reversal of tolerance than seen with either drug alone. CONCLUSION AND IMPLICATIONS These data suggest that oxycodone-induced tolerance is mediated by PKC and that reversal of tolerance by ethanol or pregabalin may be a contributory factor in oxycodone overdose deaths.
Collapse
Affiliation(s)
- Rob Hill
- School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolBS8 1TDUK
| | - William L Dewey
- Department of Pharmacology and ToxicologyVirginia Commonwealth UniversityRichmondVA23298‐0613USA
| | - Eamonn Kelly
- School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolBS8 1TDUK
| | - Graeme Henderson
- School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolBS8 1TDUK
| |
Collapse
|
28
|
Tavitian-Exley I, Boily MC, Heimer R, Uusküla A, Levina O, Maheu-Giroux M. Polydrug Use and Heterogeneity in HIV Risk Among People Who Inject Drugs in Estonia and Russia: A Latent Class Analysis. AIDS Behav 2018; 22:1329-1340. [PMID: 28699018 PMCID: PMC5878835 DOI: 10.1007/s10461-017-1836-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Non-medical drug injection is a major risk factor for HIV infection in Russia and Estonia. Multiple drug use (polydrug) has further been associated with increased harms. We compared HIV, injecting and sexual risk associated with polydrug use among people who injected drugs (PWID) in 2012–2013 in Kohtla-Järve (Estonia, n = 591) and St Petersburg (Russia, n = 811). Using latent class analysis, we identified five (poly)drug classes, the largest consisting of single-drug injectors among whom an opioid was the sole drug injected (56% of PWID). The four remaining polydrug classes included polydrug-polyroute injectors who injected and used opiates and stimulants (9%), opiate-stimulant poly-injectors who injected amphetamine-type-stimulants with a primary opiate (7%) and opiate-opioid poly-injectors who injected opioids and opiates (16%). Non-injection stimulant co-users were injectors who also used non-injection stimulants (12%). In multivariable multinomial regressions, all four polydrug classes were associated with greater injection risks than single-drug injection, while opiate-stimulant and opiate-opioid poly-injection were also associated with having multiple sex partners. Riskier behaviours among polydrug-injectors suggest increased potential for transmission of blood-borne and sexually-transmitted infections. In addition to needles/syringes provision, services tailored to PWID drug and risk profiles, could consider drug-appropriate treatment and sexual risk reduction strategies to curb HIV transmission.
Collapse
Affiliation(s)
- Isabel Tavitian-Exley
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk place, London, W21PG, UK.
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk place, London, W21PG, UK.
| | - Robert Heimer
- Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, USA
| | - Anneli Uusküla
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Olga Levina
- NGO Stellit, St Petersburg, Russian Federation
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| |
Collapse
|
29
|
Lauritzen G, Nordfjærn T. Changes in opiate and stimulant use through 10 years: The role of contextual factors, mental health disorders and psychosocial factors in a prospective SUD treatment cohort study. PLoS One 2018; 13:e0190381. [PMID: 29370197 PMCID: PMC5784893 DOI: 10.1371/journal.pone.0190381] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 12/13/2017] [Indexed: 12/01/2022] Open
Abstract
AIM To examine temporal changes in opiate and stimulant use among patients in substance abuse treatment over a ten-year observation period and to explore the role of contextual factors, mental health disorders and psychosocial factors on these changes. METHODS A cohort of 481 patients was prospectively interviewed at admission to treatment and after 1, 2, 7 and 10 years. The sample was recruited from 20 facilities in the Greater Oslo region, Norway. RESULTS The majority of patients were poly-drug users and 80% had used both opiates and stimulants the last 30 days prior to treatment admission. Last-month use of heroin, other opiates, cocaine and amphetamines declined from 80% to 34% at the end of the observation period. The most substantial reduction was observed between baseline and one-year follow-up. Use of heroin decreased the most from 62% to 16% after 10 years (a reduction of 74%), and the reduction continued from one-year follow-up throughout the observation period. The most important multivariate risk factors for sustained use of these drugs were male gender, having one or both biological parents with severe alcohol or drug problems, having an antisocial personality disorder, and living together with a person who abuses alcohol or drugs. Employment was associated with reduced risk of drug use at 7-year follow-up. CONCLUSIONS There was a substantial reduction in opiate and stimulant use from baseline to all follow-up assessments, most greatly for heroin. Findings regarding sustained use could suggest familial transmission and the challenges of preventive strategies and treatment efforts in an intergenerational context. Co-occurrence between drug abuse and mental health problems highlights the need of highly specialized competence in SUD treatment.
Collapse
Affiliation(s)
- Grethe Lauritzen
- Department of Drug Policy, Norwegian Institute of Public Health, Oslo, Norway
| | - Trond Nordfjærn
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
| |
Collapse
|
30
|
Tavitian-Exley I, Maheu-Giroux M, Platt L, Heimer R, Uusküla A, Levina O, Vickerman P, Boily MC. Differences in risk behaviours and HIV status between primary amphetamines and opioid injectors in Estonia and Russia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 53:96-105. [PMID: 29306786 DOI: 10.1016/j.drugpo.2017.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 11/14/2017] [Accepted: 11/20/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE People who inject drugs (PWID) account for over half of new HIV infections in Eastern Europe and central Asia, where opioids continue to be the dominant illicit drugs injected. Stimulants including amphetamines (ATS) have been associated with HIV infection risk in several settings. We sought to examine whether primary ATS injection was associated with greater HIV risk, compared to opioid injection in two European locales with significant HIV epidemics. METHODS PWID in Kohtla-Järve and St. Petersburg were recruited using respondent-driven sampling in 2012-2013. Survey data on demographic characteristics, service use, injecting and sexual risk behaviours and HIV-status (and HCV in Kohtla-Järve) were compared between primary opioid and ATS injectors using logistic regression models. RESULTS Of 591 injectors recruited in Kohtla-Järve and 811 in St. Petersburg, 195 (33%) and 27 (4%) primarily injected ATS in each city. In both cities, ATS injectors were younger than opioid injectors, initiated injection later, injected less frequently and were more likely to have been paid for sex. In both cities, PWID had high levels of multiple sex partners. In Kohtla-Järve, ATS-injectors had lower odds of back-loading and greater odds of polydrug use than opioid-injectors. In St. Petersburg, where over half of PWID reported unsafe sharing practices, ATS-injectors were less likely to report these practices. ATS-injection was negatively associated with being HIV positive in Kohtla-Järve (aOR = 0.6; 95%CI: 0.5-0.8) and St. Petersburg (aOR = 0.3; 95%CI: 0.1-0.7). ATS-injection was negatively associated with HCV-reactivity in Kohtla-Järve (aOR = 0.5; 95%CI: 0.3-0.6). CONCLUSIONS In both locations, primary ATS injection was associated with lower injecting risk behaviours, lower odds of HIV and being paid for sex compared to opioid injection. Interventions targeting the characteristics and needs of ATS injectors are needed to increase contact with services and reduce sexual and injecting risk. Harm reduction services, including sexual risk reduction, need to be expanded for all PWID in St. Petersburg.
Collapse
Affiliation(s)
- Isabel Tavitian-Exley
- Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom.
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
| | - Lucy Platt
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Robert Heimer
- Epidemiology of Microbial Diseases, School of Public Health, Yale University, United States
| | - Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Olga Levina
- NGO Stellit, St Petersburg, Russian Federation
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom.
| |
Collapse
|
31
|
Winkler MC, Greager EM, Stafford J, Bachtell RK. Methamphetamine self-administration reduces alcohol consumption and preference in alcohol-preferring P rats. Addict Biol 2018; 23:90-101. [PMID: 27860181 PMCID: PMC5811924 DOI: 10.1111/adb.12476] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Subclinical levels of polysubstance use are a prevalent and understudied phenomenon. Alcohol is a substance commonly co‐used with other substances of other drug classes. These studies sought to determine the consumption effects of combining alcohol drinking and methamphetamine (MA) self‐administration. Male alcohol‐preferring P rats had continuous access to a two‐bottle alcohol drinking procedure in the home cage. Control rats remained alcohol naïve. Rats were also surgically implanted with intra‐jugular catheters and trained to self‐administer saline (control) or MA in daily 2‐hour sessions. We first measured the acquisition and maintenance of MA intake in alcohol‐consuming or control rats. MA intake was initially enhanced by alcohol consumption on a fixed ratio 1 schedule of reinforcement, but this effect did not prevail as the difficulty of the schedule (FR5 and progressive ratio) was increased. We next measured both alcohol consumption and preference before, during and after MA (or saline) self‐administration. MA self‐administration significantly reduced alcohol intake and preference ratios, a robust effect that persisted across several experimental variations. Interestingly, alcohol consumption rebounded following the cessation of MA self‐administration. The effects of MA self‐administration were specific to alcohol intake because it did not alter total fluid consumption or consumption of sucrose. MA self‐administration did not impact blood‐alcohol concentrations or alcohol‐induced loss of righting reflex suggesting no effect of MA intake on the alcohol metabolism or sensitivity. Together, the results suggest that MA intake disrupts alcohol consumption and preferences but not the reverse in alcohol‐preferring P rats.
Collapse
Affiliation(s)
- Madeline C. Winkler
- Department of Psychology and Neuroscience and Center for Neuroscience; University of Colorado Boulder; Boulder CO USA
| | - Emilee M. Greager
- Department of Psychology and Neuroscience and Center for Neuroscience; University of Colorado Boulder; Boulder CO USA
| | - Jacob Stafford
- Department of Psychology and Neuroscience and Center for Neuroscience; University of Colorado Boulder; Boulder CO USA
| | - Ryan K. Bachtell
- Department of Psychology and Neuroscience and Center for Neuroscience; University of Colorado Boulder; Boulder CO USA
| |
Collapse
|
32
|
Bahorik AL, Campbell CI, Sterling SA, Leibowitz A, Travis A, Weisner CM, Satre DD. Adverse impact of marijuana use on clinical outcomes among psychiatry patients with depression and alcohol use disorder. Psychiatry Res 2018; 259:316-322. [PMID: 29100135 PMCID: PMC5742048 DOI: 10.1016/j.psychres.2017.10.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/14/2017] [Accepted: 10/16/2017] [Indexed: 02/01/2023]
Abstract
This study examined whether marijuana use was associated with clinically problematic outcomes for patients with depression and alcohol use disorder (AUD). The sample consisted of 307 psychiatry outpatients with mild to severe depression and past 30-day hazardous drinking/drug use, who participated in a trial of substance use treatment. Participants were assessed for AUD based on DSM-IV criteria. Measures of marijuana use, depression symptoms, and functional status related to mental health were collected at baseline, 3, and 6 months. Differences in these outcomes were analyzed among patients with and without AUD using growth models, adjusting for treatment effects. Marijuana was examined as both an outcome (patterns of use) and a predictor (impact on depression and functioning). Forty percent used marijuana and about half the sample met AUD criteria. Fewer patients with AUD used marijuana than those without AUD at baseline. Over 6 months, the proportion of patients with AUD using marijuana increased compared to those without AUD. Patients with AUD using marijuana had greater depressive symptoms and worse functioning than those without AUD. These findings indicate that marijuana use is clinically problematic for psychiatry outpatients with depression and AUD. Addressing marijuana in the context of psychiatry treatment may help improve outcomes.
Collapse
Affiliation(s)
- Amber L. Bahorik
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, USA,Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, USA,Send correspondence to: Amber L. Bahorik, PhD, Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143; Fax: 501.891.3606, Phone: 510.891.5980.
| | - Cynthia I. Campbell
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, USA,Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, USA
| | - Stacy A. Sterling
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, USA
| | - Amy Leibowitz
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, USA
| | - Adam Travis
- Kaiser Permanente Southern Alameda Department of Psychiatry, USA
| | - Constance M. Weisner
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, USA,Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, USA
| | - Derek D. Satre
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, USA,Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, USA
| |
Collapse
|
33
|
Wang L, Min JE, Krebs E, Evans E, Huang D, Liu L, Hser YI, Nosyk B. Polydrug use and its association with drug treatment outcomes among primary heroin, methamphetamine, and cocaine users. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 49:32-40. [PMID: 28888099 PMCID: PMC5681890 DOI: 10.1016/j.drugpo.2017.07.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/17/2017] [Accepted: 07/10/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Polydrug use may challenge effective treatment for substance use disorders. We evaluate whether secondary substance use modifies the association between treatment and primary drug use among primary heroin, cocaine and methamphetamine (MA) users. METHODS Data were obtained from prospective cohort studies on people who use illicit drugs (PWUD) in California, USA. Using repeated monthly data on self-reported secondary substance use (heroin, cocaine, MA, alcohol or marijuana; ≥1day in a month), primary drug use (≥1day in a month), and treatment participation, collected via timeline follow-back, we fitted generalized linear mixed multiple regression models controlling for potential confounders to examine the interactions between treatment and secondary substance use on the odds of primary heroin, cocaine and MA use, respectively. RESULTS Included in our study were 587 primary heroin, 444 primary MA, and 501 primary cocaine users, with a median of 32.4, 13.3 and 18.9 years of follow-up, respectively. In the absence of secondary substance use, treatment was strongly associated with decreased odds of primary drug use (adjusted odds ratios (aORs): 0.25, 95% CI: 0.24, 0.27, 0.07 (0.06, 0.08), and 0.07 (0.07, 0.09)) for primary heroin, MA, and cocaine users, respectively. Secondary substance use of any kind moderated these associations (0.82 (0.78, 0.87), 0.25 (0.21, 0.30) and 0.53 (0.45, 0.61), respectively), and these findings were consistent for each type of secondary substance considered. Moreover, we observed different associations in terms of direction and magnitude between secondary substance use and primary drug use during off-treatment periods across substance types. CONCLUSION This study demonstrates secondary substance use moderates the temporal associations between treatment and primary drug use among primary heroin, MA and cocaine users. Disparate patterns of polydrug use require careful measurement and analysis to inform targeted treatment for polydrug users.
Collapse
Affiliation(s)
- Linwei Wang
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
| | - Jeong Eun Min
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
| | - Emanuel Krebs
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
| | - Elizabeth Evans
- UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Ste. 200, Los Angeles, CA 90025, USA; Centre for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Health Service Research & Development, Greater Los Angeles Healthcare System, 1301 Wilshire Blvd (111G), Los Angeles, CA 90073, USA.
| | - David Huang
- UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Ste. 200, Los Angeles, CA 90025, USA.
| | - Lei Liu
- Feinberg School of Medicine, Northwestern University, 303 E Chicago Ave, Chicago, IL 60611, USA.
| | - Yih-Ing Hser
- UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Ste. 200, Los Angeles, CA 90025, USA.
| | - Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| |
Collapse
|
34
|
Meacham MC, Roesch SC, Strathdee SA, Gaines TL. Perceived Treatment Need and Latent Transitions in Heroin and Methamphetamine Polydrug Use among People who Inject Drugs in Tijuana, Mexico. J Psychoactive Drugs 2017; 50:62-71. [PMID: 28960166 DOI: 10.1080/02791072.2017.1370747] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
People who inject drugs (PWID) in Tijuana, Mexico, use heroin and/or methamphetamine. While polydrug use is associated with HIV risk behavior, less is known about the stability of polydrug use patterns over time and how polydrug use is related to perceived treatment need. Within a cohort of PWID in Tijuana (N = 735) we sought to (1) characterize subgroups of polydrug and polyroute use from baseline to six months; (2) determine the probabilities of transitioning between subgroups; and (3) examine whether self-reported need for help for drug use modified these transition probabilities. Latent transition analysis (LTA) identified four latent statuses: heroin-only injection (38% at both baseline and follow-up); co-injection of heroin with methamphetamine (3% baseline, 15% follow-up); injection of heroin and methamphetamine (37% baseline, 32% follow-up); and polydrug and polyroute users who injected heroin and both smoked and injected methamphetamine (22% baseline, 14% follow-up). Heroin-only injectors had the highest probability of remaining in the same latent status at follow-up. The majority reported great or urgent need for treatment (51%) and these PWID had greater odds of transitioning to a higher-risk status at follow-up, emphasizing the need for evidence-based drug treatment options for PWID.
Collapse
Affiliation(s)
- Meredith C Meacham
- a Postdoctoral Fellow, Department of Psychiatry , University of California, San Francisco , San Francisco , CA , USA.,b Doctoral Student, School of Public Health , San Diego State University , San Diego , CA , USA.,c Doctoral Student, Division of Global Public Health , Department of Medicine, University of California , San Diego, La Jolla , CA , USA
| | - Scott C Roesch
- d Professor, Department of Psychology , San Diego State University , San Diego , CA , USA
| | - Steffanie A Strathdee
- e Professor, Division of Global Public Health, Department of Medicine , University of California , San Diego, La Jolla , CA , USA
| | - Tommi L Gaines
- f Assistant Professor, Division of Global Public Health, Department of Medicine , University of California , San Diego, La Jolla , CA , USA
| |
Collapse
|
35
|
Lyndon A, Audrey S, Wells C, Burnell ES, Ingle S, Hill R, Hickman M, Henderson G. Risk to heroin users of polydrug use of pregabalin or gabapentin. Addiction 2017; 112:1580-1589. [PMID: 28493329 PMCID: PMC5635829 DOI: 10.1111/add.13843] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 02/20/2017] [Accepted: 04/05/2017] [Indexed: 12/13/2022]
Abstract
AIM To examine the risk to heroin users of also using gabapentin or pregabalin (gabapentoids). DESIGN Multi-disciplinary study: we (a) examined trends in drug-related deaths and gabapentoid prescription data in England and Wales to test for evidence that any increase in deaths mentioning gabapentin or pregabalin is associated with trends in gabapentoid prescribing and is concomitant with opioid use; (b) interviewed people with a history of heroin use about their polydrug use involving gabapentin and pregabalin; and (c) studied the respiratory depressant effects of pregabalin in the absence and presence of morphine in mice to determine whether concomitant exposure increased the degree of respiratory depression observed. SETTING England and Wales. PARTICIPANTS Interviews were conducted with 30 participants (19 males, 11 female). MEASUREMENTS (a) Office of National Statistics drug-related deaths from 1 January 2004 to 31 December 2015 that mention both an opioid and pregabalin or gabapentin; (b) subjective views on the availability, use, interactions and effects of polydrug use involving pregabalin and gabapentin; and (c) rate and depth of respiration. RESULTS Pregabalin and gabapentin prescriptions increased approximately 24% per year from 1 million in 2004 to 10.5 million in 2015. The number of deaths involving gabapentoids increased from fewer than one per year prior to 2009 to 137 in 2015; 79% of these deaths also involved opioids. The increase in deaths was correlated highly with the increase in prescribing (correlation coefficient 0.94; 5% increase in deaths per 100 000 increase in prescriptions). Heroin users described pregabalin as easy to obtain. They suggested that the combination of heroin and pregabalin reinforced the effects of heroin but were concerned it induced 'blackouts' and increased the risk of overdose. In mice, a low dose of S-pregabalin (20 mg/kg) that did not itself depress respiration reversed tolerance to morphine depression of respiration (resulting in 35% depression of respiration, P < 0.05), whereas a high dose of S-pregabalin (200 mg/kg) alone depressed respiration and this effect summated with that of morphine. CONCLUSIONS For heroin users, the combination of opioids with gabapentin or pregabalin potentially increases the risk of acute overdose death through either reversal of tolerance or an additive effect of the drugs to depress respiration.
Collapse
Affiliation(s)
- Abigail Lyndon
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol BS8 1TD, UK
| | - Suzanne Audrey
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Claudia Wells
- Mortality Analysis, Office for National Statistics, Newport NP10 8XG, UK
| | - Erica S Burnell
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol BS8 1TD, UK
| | - Suzanne Ingle
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Rob Hill
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol BS8 1TD, UK
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Graeme Henderson
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol BS8 1TD, UK
| |
Collapse
|
36
|
Krebs E, Urada D, Evans E, Huang D, Hser YI, Nosyk B. The costs of crime during and after publicly funded treatment for opioid use disorders: a population-level study for the state of California. Addiction 2017; 112:838-851. [PMID: 27981691 PMCID: PMC5382102 DOI: 10.1111/add.13729] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/19/2016] [Accepted: 12/12/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS Treatment for opioid use disorders (OUD) reduces the risk of mortality and infectious disease transmission; however, opportunities to quantify the potential economic benefits of associated decreases in drug-related crime are scarce. This paper aimed to estimate the costs of crime during and after periods of engagement in publicly funded treatment for OUD to compare total costs of crime during a hypothetical 6-month period following initiation of opioid agonist treatment (OAT) versus detoxification. DESIGN Retrospective, administrative data-based cohort study with comprehensive information on drug treatment and criminal justice systems interactions. SETTING Publicly funded drug treatment facilities in California, USA (2006-10). PARTICIPANTS A total of 31 659 individuals admitted for the first time to treatment for OUD, and who were linked with criminal justice and mortality data, were followed during a median 2.3 years. Median age at first treatment admission was 32, 35.8% were women and 37.1% primarily used prescription opioids. MEASUREMENTS Daily costs of crime (US$2014) were calculated from a societal perspective and were composed of the costs of policing, court, corrections and criminal victimization. We estimated the average marginal effect of treatment engagement in OAT or detoxification adjusting for potential fixed and time-varying confounders, including drug use and criminal justice system involvement prior to treatment initiation. FINDINGS Daily costs of crime during treatment compared with after treatment were $126 lower for OAT [95% confidence interval (CI) = $116, $136] and $144 lower for detoxification (95% CI = $135, $154). Summing the costs of crime during and after treatment over a hypothetical 6-month period using the observed median durations of OAT (161 days) and detoxification (19 days), we estimated that enrolling an individual in OAT as opposed to detoxification would save $17 550 ($16 840, $18 383). CONCLUSIONS In publicly funded drug treatment facilities in California, USA, engagement in treatment for opioid use disorders is associated with lower costs of crime in the 6 months following initiation of treatment, and the economic benefits were far greater for individuals receiving time-unlimited treatment.
Collapse
Affiliation(s)
| | | | | | | | | | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS
- UCLA Integrated Substance Abuse Programs
- Faculty of Health Sciences, Simon Fraser University
| |
Collapse
|
37
|
Evans EA, Grella CE, Washington DL, Upchurch DM. Gender and race/ethnic differences in the persistence of alcohol, drug, and poly-substance use disorders. Drug Alcohol Depend 2017; 174:128-136. [PMID: 28324815 DOI: 10.1016/j.drugalcdep.2017.01.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/09/2017] [Accepted: 01/14/2017] [Indexed: 12/13/2022]
Abstract
AIMS To examine gender and racial/ethnic differences in the effect of substance use disorder (SUD) type on SUD persistence. METHODS Data were provided by 1025 women and 1835 men from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to examine whether gender and race/ethnicity (Non-Hispanic White, Black, Hispanic) moderate the effects of DSM-IV defined past-12 month SUD type (alcohol, drug, poly-substance) on SUD persistence at 3-year follow-up, controlling for covariates. Using gender-stratified weighted binary logistic regression, we examined predictors of SUD persistence, tested an SUD type by race/ethnicity interaction term, and calculated and conducted Bonferroni corrected pairwise comparisons of predicted probabilities. RESULTS SUD persistence rates at 3-year follow-up differed for SUD type by gender by race/ethnicity sub-group, and ranged from 31% to 81%. SUD persistence rates were consistently higher among poly-substance users; patterns were mixed in relation to gender and race/ethnicity. Among women, alcohol disordered Hispanics were less likely to persist than Whites. Among men, drug disordered Hispanics were less likely to persist than Whites. Also, Black men with an alcohol or drug use disorder were less likely to persist than Whites, but Black men with a poly-substance use disorder were more likely to persist than Hispanics. CONCLUSIONS The effect of SUD type on SUD persistence varies by race/ethnicity, and the nature of these relationships is different by gender. Such knowledge could inform tailoring of SUD screening and treatment programs, potentially increasing their impact.
Collapse
Affiliation(s)
- Elizabeth A Evans
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA; Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, USA; Department of Veterans Affairs (VA) Health Service Research and Development (HSR and D) Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, USA; Department of Health Policy and Promotion, School of Public Health and Health Sciences, University of Massachusetts Amherst, USA.
| | - Christine E Grella
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
| | - Donna L Washington
- Department of Veterans Affairs (VA) Health Service Research and Development (HSR and D) Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, USA; Department of Medicine, Geffen School of Medicine, University of California, Los Angeles, USA
| | - Dawn M Upchurch
- Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, USA
| |
Collapse
|
38
|
Savulich G, Riccelli R, Passamonti L, Correia M, Deakin JFW, Elliott R, Flechais RSA, Lingford-Hughes AR, McGonigle J, Murphy A, Nutt DJ, Orban C, Paterson LM, Reed LJ, Smith DG, Suckling J, Tait R, Taylor EM, Sahakian BJ, Robbins TW, Ersche KD. Effects of naltrexone are influenced by childhood adversity during negative emotional processing in addiction recovery. Transl Psychiatry 2017; 7:e1054. [PMID: 28267152 PMCID: PMC5416677 DOI: 10.1038/tp.2017.34] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 12/12/2022] Open
Abstract
Naltrexone is an opioid receptor antagonist used in the management of alcohol dependence. Although the endogenous opioid system has been implicated in emotion regulation, the effects of mu-opioid receptor blockade on brain systems underlying negative emotional processing are not clear in addiction. Individuals meeting criteria for alcohol dependence alone (n=18, alcohol) and in combination with cocaine and/or opioid dependence (n=21, alcohol/drugs) and healthy individuals without a history of alcohol or drug dependence (n=21) were recruited. Participants were alcohol and drug abstinent before entered into this double-blind, placebo-controlled, randomized, crossover study. Functional magnetic resonance imaging was used to investigate brain response while viewing aversive and neutral images relative to baseline on 50 mg of naltrexone and placebo. We found that naltrexone modulated task-related activation in the medial prefrontal cortex and functional connectivity between the anterior cingulate cortex and the hippocampus as a function of childhood adversity (for aversive versus neutral images) in all groups. Furthermore, there was a group-by-treatment-by-condition interaction in the right amygdala, which was mainly driven by a normalization of response for aversive relative to neutral images under naltrexone in the alcohol/drugs group. We conclude that early childhood adversity is one environmental factor that influences pharmacological response to naltrexone. Pharmacotherapy with naltrexone may also have some ameliorative effects on negative emotional processing in combined alcohol and drug dependence, possibly due to alterations in endogenous opioid transmission or the kappa-opioid receptor antagonist actions of naltrexone.
Collapse
Affiliation(s)
- G Savulich
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - R Riccelli
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK,Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - L Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - M Correia
- Cognition and Brain Sciences Unit, Medical Research Council, Cambridge, UK
| | - J F W Deakin
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - R Elliott
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - R S A Flechais
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | | | - J McGonigle
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - A Murphy
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - D J Nutt
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - C Orban
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - L M Paterson
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - L J Reed
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - D G Smith
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - J Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - R Tait
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - E M Taylor
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - B J Sahakian
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - T W Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK,Department of Psychology, University of Cambridge, Cambridge, UK
| | - K D Ersche
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK,Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK. E-mail:
| | | |
Collapse
|
39
|
Baggio S, Gainsbury SM, Berchtold A, Iglesias K. Co-morbidity of gambling and Internet use among Internet and land-based gamblers: classic and network approaches. INTERNATIONAL GAMBLING STUDIES 2016. [DOI: 10.1080/14459795.2016.1242148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
40
|
Hayashi K, Wood E, Kerr T, Dong H, Nguyen P, Puskas CM, Guillemi S, Montaner JSG, Milloy MJ. Factors associated with optimal pharmacy refill adherence for antiretroviral medications and plasma HIV RNA non-detectability among HIV-positive crack cocaine users: a prospective cohort study. BMC Infect Dis 2016; 16:455. [PMID: 27568002 PMCID: PMC5002322 DOI: 10.1186/s12879-016-1749-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 08/03/2016] [Indexed: 01/18/2023] Open
Abstract
Background Crack cocaine use is known to contribute to poor adherence to antiretroviral medications; however, little is known about facilitators of or barriers to effective HIV treatment use among HIV-infected crack cocaine users. We sought to identify correlates of optimal pharmacy refill adherence for antiretroviral medications and plasma HIV RNA viral load (pVL) suppression among this population. Methods Data from a prospective cohort of HIV-positive people who use illicit drugs in Vancouver, Canada, were linked to comprehensive HIV clinical monitoring and pharmacy dispensation records. We used multivariable generalized linear mixed-effects modelling to longitudinally identify factors associated with ≥95 % adherence to pharmacy refills for antiretroviral medications and pVL <50 copies/mL among crack cocaine users exposed to highly-active antiretroviral therapy (HAART). Results Among 438 HAART-exposed crack cocaine users between 2005 and 2013, 240 (54.8 %) had ≥95 % pharmacy refill adherence in the previous 6 months at baseline. In multivariable analyses, homelessness (adjusted odds ratio [AOR]: 0.58), ≥daily crack cocaine smoking (AOR: 0.64), and ≥ daily heroin use (AOR: 0.43) were independently associated with optimal pharmacy refill adherence (all p < 0.05). The results for pVL non-detectability were consistent with those of medication adherence, except that longer history of HAART (AOR: 1.06), receiving a single tablet-per-day regimen (AOR: 3.02) and participation in opioid substitution therapies was independently associated with pVL non-detectability (AOR: 1.55) (all p < 0.05). Conclusions Homelessness, and daily crack cocaine and/or heroin use were independently and negatively associated with optimal HAART-related outcomes. With the exception of opioid substitution therapies, no addiction treatment modalities assessed appeared to facilitate medication adherence or viral suppression. Evidence-based treatment options for crack cocaine use that also confer benefits to HAART need to be developed.
Collapse
Affiliation(s)
- Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Paul Nguyen
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Cathy M Puskas
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Silvia Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Michael-John Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Division of AIDS, Department of Medicine, University of British Columbia, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| |
Collapse
|
41
|
Moeeni M, Razaghi EM, Ponnet K, Torabi F, Shafiee SA, Pashaei T. Predictors of time to relapse in amphetamine-type substance users in the matrix treatment program in Iran: a Cox proportional hazard model application. BMC Psychiatry 2016; 16:265. [PMID: 27455958 PMCID: PMC4960917 DOI: 10.1186/s12888-016-0973-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 06/14/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The aim of this study was to determine which predictors influence the risk of relapse among a cohort of amphetamine-type substance (ATS) users in Iran. METHODS A Cox proportional hazards model was conducted to determine factors associated with the relapse time in the Matrix treatment program provided by the Iranian National Center of Addiction Studies (INCAS) between March 2010 and October 2011. RESULTS Participating in more treatment sessions was associated with a lower probability of relapse. On the other hand, patients with less family support, longer dependence on ATS, and those with an experience of casual sex and a history of criminal offenses were more likely to relapse. CONCLUSION This study broadens our understanding of factors influencing the risk of relapse in ATS use among an Iranian sample. The findings can guide practitioners during the treatment program.
Collapse
Affiliation(s)
- Maryam Moeeni
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Science (TUMS), Tehran, Iran
| | - Emran M. Razaghi
- Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Koen Ponnet
- Department of Communication Studies, Media, ICT/Interpersonal Relations in Organizations and Society (MIOS), University of Antwerp, Sint-Jacobsstraat 2, 2000 Antwerp, Belgium
- Department of Communication Studies, Research Group for Media & ICT (MICT), Ghent University, Korte Meer 11, 9000 Ghent, Belgium
- Higher Institute for Family Sciences, Odisee, Huart Hamoirlaan 136, 1030 Brussels, Belgium
- Antwerp Maritime Academy, Noordkasteel Oost 6, Antwerp, 2030 Belgium
| | - Fatemeh Torabi
- Department of Demography, Faculty of Social Sciences, University of Tehran, Tehran, Iran
| | - Seyed Ali Shafiee
- Department of Neurosciences and Addiction Studies,School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Pashaei
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Department of public health, School of Health, Kurdistan University of Medical Sciences, Sanandaj, Iran
| |
Collapse
|
42
|
Wittenberg E, Bray JW, Aden B, Gebremariam A, Nosyk B, Schackman BR. Measuring benefits of opioid misuse treatment for economic evaluation: health-related quality of life of opioid-dependent individuals and their spouses as assessed by a sample of the US population. Addiction 2016; 111:675-84. [PMID: 26498740 PMCID: PMC5034732 DOI: 10.1111/add.13219] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/16/2015] [Accepted: 09/28/2015] [Indexed: 11/28/2022]
Abstract
AIMS To understand how the general public views the quality of life effects of opioid misuse and opioid use disorder on an individual and his/her spouse, measured in terms used in economic evaluations. DESIGN Cross-sectional internet survey of a US population-representative respondent panel conducted December 2013-January 2014. SETTING United States. PARTICIPANTS A total of 2054 randomly selected adults; 51.1% male (before weighting). MEASUREMENTS Mean (95% confidence interval) and median health 'utility' for six opioid misuse and treatment outcomes: active injection misuse; active prescription misuse; methadone maintenance therapy at initiation and when stabilized in treatment; and buprenorphine therapy at initiation and when stabilized. Utility is a numerical representation of health-related quality of life used in economic evaluations to 'adjust' estimated survival to include peoples' preferences for health states. Utilities are determined by surveying the general population to estimate the value they assign to particular health states on a scale where 0 = the value of being dead and 1.0 = the value of being in perfect health. Spouse spillover utility is assigned to a spouse of an individual who is in a particular health state. FINDINGS Mean individual utility ranged from 0.574 [95% confidence interval (CI) = 0.538, 0.611] for active injection opioid misuse to 0.766 for stabilized buprenorphine therapy (95% CI = 0.738, 0.795), with other states in between. Female respondents assigned higher utility to the active prescription misuse and buprenorphine therapy at initiation states than did males (P < 0.05); all other states did not differ by respondent gender. Mean spousal utilities were significantly lower than 1.0 but mostly higher than individual utility, and were similar between male and female respondents. CONCLUSIONS In the opinion of the US public, injection opioid misuse results in worse health-related quality of life than prescription misuse, and methadone therapy results in worse health-related quality of life than buprenorphine therapy. Spouses are negatively affected by their partner's opioid misuse and early treatment.
Collapse
Affiliation(s)
- Eve Wittenberg
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jeremy W. Bray
- Department of Economics, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Brandon Aden
- Department of Healthcare Policy and Research and Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | | | - Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada,Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Bruce R. Schackman
- Department of Healthcare Policy and Research and Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
43
|
Moss HB, Goldstein RB, Chen CM, Yi HY. Patterns of use of other drugs among those with alcohol dependence: Associations with drinking behavior and psychopathology. Addict Behav 2015; 50:192-8. [PMID: 26151585 PMCID: PMC4515391 DOI: 10.1016/j.addbeh.2015.06.041] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/28/2015] [Accepted: 06/21/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Alcohol dependence (AD) presents with substantial clinical heterogeneity, including concurrent use of non-alcohol drugs. Here, we examine specific patterns of concurrent non-alcohol substance use during the previous year among a nationally representative sample of adults with DSM-IV AD, and estimate their population prevalence in the U.S. We then evaluate alcohol use behavior and comorbid psychopathology among respondents with AD according to their patterns of concurrent non-alcohol substance use. METHODS These analyses utilized data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Latent class analyses classified respondents with AD into four clinically meaningful patterns of concurrent substance use: (1) use of alcohol only; (2) use of alcohol and tobacco only; (3) use of alcohol, tobacco and cannabis; and (4) use of alcohol, tobacco, cannabis, cocaine, and other illicit drug(s). RESULTS Among AD respondents, the most prevalent pattern was the use of alcohol and tobacco only (weighted percentage, 32.4%), followed by the use of alcohol only (weighted percentage, 27.5%). AD respondents who used alcohol, tobacco, cannabis, cocaine, and other illicit drug(s) (weighted percentage, 25.3%) manifested the most severe pattern of alcohol consumption, and had significant overrepresentations of major depression, panic, and other anxiety disorders as well as paranoid, schizotypal, borderline, antisocial, and histrionic personality disorders compared with those who used alcohol alone. CONCLUSIONS Specific patterns of concurrent substance use convey important information regarding the clinical presentation and prognosis for AD. In particular, concurrent use of illicit drugs over the past year by AD individuals was associated with greater severity and comorbid psychopathology. These data suggest the need for pragmatic trials of AD interventions that take into account patterns of substance use behavior in addition to an AD diagnosis.
Collapse
Affiliation(s)
- Howard B Moss
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Risë B Goldstein
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Chiung M Chen
- Alcohol Epidemiologic Data System, CSR Incorporated, Arlington, VA 22201, USA
| | - Hsiao-Ye Yi
- Alcohol Epidemiologic Data System, CSR Incorporated, Arlington, VA 22201, USA
| |
Collapse
|
44
|
Rawson RA, Chudzynski J, Mooney L, Gonzales R, Ang A, Dickerson D, Penate J, Salem BA, Dolezal B, Cooper CB. Impact of an exercise intervention on methamphetamine use outcomes post-residential treatment care. Drug Alcohol Depend 2015; 156:21-28. [PMID: 26371404 PMCID: PMC4633370 DOI: 10.1016/j.drugalcdep.2015.08.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/31/2015] [Accepted: 08/17/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND We examined the efficacy of an 8-week exercise intervention on posttreatment methamphetamine (MA) use among MA-dependent individuals following residential treatment. METHODS 135 individuals newly enrolled in treatment were randomly assigned to a structured 8-week exercise intervention or health education control group. Approximately 1 week after completion of the intervention, participants were discharged to the community. Interview data and urine samples were collected at 1-, 3-, and 6-months post-residential care. Of the sample, 54.8% were classified as higher severity users (using MA more than 18 days in the month before admission) and 45.2% as lower severity users (using MA for up to 18 days in the month before admission). Group differences in MA use outcomes were examined over the 3 timepoints using mixed-multivariate modeling. RESULTS While fewer exercise participants returned to MA use compared to education participants at 1-, 3- and 6-months post-discharge, differences were not statistically significant. A significant interaction for self-reported MA use and MA urine drug test results by condition and MA severity was found: lower severity users in the exercise group reported using MA significantly fewer days at the three post-discharge timepoints than lower severity users in the education group. Lower severity users in the exercise group also had a lower percentage of positive urine results at the three timepoints than lower severity users in the education group. These relationships were not present in the comparison of the higher severity conditions. CONCLUSION Results support the value of exercise as a treatment component for individuals using MA 18 or fewer days/month.
Collapse
Affiliation(s)
- Richard A. Rawson
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Joy Chudzynski
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Larissa Mooney
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Rachel Gonzales
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Alfonso Ang
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Daniel Dickerson
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jose Penate
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Bilal A. Salem
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Brett Dolezal
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, 10833 Le Conte 37-131 CHS, University of California, Los Angeles, Los Angeles, CA, USA
| | - Christopher B. Cooper
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, 10833 Le Conte 37-131 CHS, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
45
|
Schmidt TD, Haddox JD, Nielsen AE, Wakeland W, Fitzgerald J. Key Data Gaps Regarding the Public Health Issues Associated with Opioid Analgesics. J Behav Health Serv Res 2015; 42:540-53. [PMID: 24554390 PMCID: PMC4139477 DOI: 10.1007/s11414-014-9396-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Most pharmaceutical opioids are used to treat pain, and they have been demonstrated to be effective medications for many. Their abuse and misuse pose significant public health concerns in the USA. Research has provided much insight into the prevalence, scope, and drivers of opioid abuse, but a holistic understanding is limited by a lack of available data regarding key aspects of this public health problem. Twelve data gaps were revealed during the creation of a systems-level computer model of medical use, diversion, nonmedical use, and the adverse outcomes associated with opioid analgesics in the USA. Data specific to these gaps would enhance the validity and real-world applications of systems-level models of this public health problem and would increase understanding of the complex system in which use and abuse occur. This paper provides an overview of these gaps, argues for the importance of closing them, and provides specific recommendations for future data collection efforts.
Collapse
Affiliation(s)
- Teresa D Schmidt
- Systems Science Graduate Program, Portland State University, Portland, OR, USA.
| | - J David Haddox
- Health Policy, Purdue Pharma L.P., Stamford, CT, USA.
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - Alexandra E Nielsen
- Systems Science Graduate Program, Portland State University, Portland, OR, USA.
| | - Wayne Wakeland
- Systems Science Graduate Program, Portland State University, Portland, OR, USA.
| | | |
Collapse
|
46
|
Rade CB, Desmarais SL, Van Dorn RA, Lutnick A, Kral AH, Lorvick J. Mental health correlates of drug treatment among women who use methamphetamine. Am J Addict 2015; 24:646-53. [DOI: 10.1111/ajad.12279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 07/24/2015] [Accepted: 08/08/2015] [Indexed: 12/01/2022] Open
Affiliation(s)
- Candalyn B. Rade
- Department of Psychology; North Carolina State University; Raleigh 27695 North Carolina
| | - Sarah L. Desmarais
- Department of Psychology; North Carolina State University; Raleigh 27695 North Carolina
| | - Richard A. Van Dorn
- Behavioral Health Epidemiology Program; RTI International; Research Triangle Park 27709 North Carolina
| | - Alexandra Lutnick
- Urban Health Program; RTI International; San Francisco 94104 California
| | - Alex H. Kral
- Urban Health Program; RTI International; San Francisco 94104 California
| | - Jennifer Lorvick
- Urban Health Program; RTI International; San Francisco 94104 California
| |
Collapse
|
47
|
Evans E, Li L, Min J, Huang D, Urada D, Liu L, Hser YI, Nosyk B. Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006-10. Addiction 2015; 110:996-1005. [PMID: 25644938 PMCID: PMC4452110 DOI: 10.1111/add.12863] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/13/2014] [Accepted: 01/22/2015] [Indexed: 11/29/2022]
Abstract
AIMS To estimate mortality rates among treated opioid-dependent individuals by cause and in relation to the general population, and to estimate the instantaneous effects of opioid detoxification and maintenance treatment (MMT) on the hazard of all-cause and cause-specific mortality. DESIGN Population-based treatment cohort study. SETTING Linked mortality data on all individuals first enrolled in publicly funded pharmacological treatment for opioid dependence in California, USA from 2006 to 2010. PARTICIPANTS A total of 32 322 individuals, among whom there were 1031 deaths (3.2%) over a median follow-up of 2.6 years (interquartile range = 1.4-3.7). MEASUREMENTS The primary outcome was mortality, indicated by time to death, crude mortality rates (CMR) and standardized mortality ratios (SMR). FINDINGS Individuals being treated for opioid dependence had a more than fourfold increase of mortality risk compared with the general population [SMR = 4.5, 95% confidence interval (CI) = 4.2, 4.8]. Mortality risk was higher (1) when individuals were out-of-treatment (SMR = 6.1, 95% CI = 5.7, 6.5) than in-treatment (SMR = 1.8, 95% CI = 1.6, 2.1) and (2) during detoxification (SMR = 2.4, 95% CI = 1.5, 3.8) than during MMT (SMR = 1.8, 95% CI = 1.5, 2.1), especially in the 2 weeks post-treatment entry (SMR = 5.5, 95% CI = 2.7, 9.8 versus SMR = 2.5, 95% CI = 1.7, 4.9). Detoxification and MMT both independently reduced the instantaneous hazard of all-cause and drug-related mortality. MMT preceded by detoxification was associated with lower all-cause and other cause-specific mortality than MMT alone. CONCLUSIONS In people with opiate dependence, detoxification and methadone maintenance treatment both independently reduce the instantaneous hazard of all-cause and drug-related mortality.
Collapse
Affiliation(s)
| | - Libo Li
- UCLA Integrated Substance Abuse Programs
| | - Jeong Min
- British Columbia Centre for Excellence in HIV/AIDS
| | | | | | - Lei Liu
- Northwestern University Feinberg School of Medicine
| | | | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS,Simon Fraser University, Faculty of Health Sciences
| |
Collapse
|
48
|
Tavitian-Exley I, Vickerman P, Bastos FI, Boily MC. Influence of different drugs on HIV risk in people who inject: systematic review and meta-analysis. Addiction 2015; 110:572-84. [PMID: 25582153 DOI: 10.1111/add.12846] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 09/10/2014] [Accepted: 01/05/2015] [Indexed: 11/29/2022]
Abstract
AIMS To assess systematically the risk of HIV acquisition by type of drug injected across different settings. METHODS A systematic review and meta-analysis were conducted. Databases were searched for studies of HIV incidence in people who inject different drugs (PWID). Pooled HIV incidence rate ratio (IRR) was used to compare HIV risk between injecting and not-injecting a given drug, when possible, or otherwise with those reported not to have injected the substance. Pooled estimates of crude IRR were derived using random-effects models. Variations in IRR were assessed in subgroup analyses, by drug and geographical region. RESULTS Of 5779 studies screened, 15 were included. HIV incidence was reported for people injecting cocaine (eight: North America, Europe), amphetamine-type stimulants (ATS) (four: Western and Eastern Europe, Asia), heroin (11: all settings), opiate-stimulants (four: North America, Western and Eastern Europe) and opiates-sedatives (five: Europe, Asia). HIV risk in cocaine injectors was 3.6 times 95% confidence interval (CI) = 2.8-4.7, I(2) = 0%; n = 4) that of non-injectors and 3.0 for ATS injectors (95% CI = 2.2-4.1, I(2) = 0%; n = 2). Higher sexual risk was reported in cohorts injecting stimulants. Compared to not-injecting, HIV IRR was 2.8 (95% CI = 1.7-4.7, I(2) = 77%; n=6) for all heroin injectors and 3.5 (95% CI = 2.3-5.2, I(2) = 40%; n=5) for heroin injectors in Asia and Europe. CONCLUSION The risk of HIV acquisition in people who inject drugs appears to vary by drug type but differences are not statistically significant, precluding conclusive grading of risk.
Collapse
|
49
|
Meacham MC, Rudolph AE, Strathdee SA, Rusch ML, Brouwer KC, Patterson TL, Vera A, Rangel G, Roesch SC. Polydrug Use and HIV Risk Among People Who Inject Heroin in Tijuana, Mexico: A Latent Class Analysis. Subst Use Misuse 2015; 50:1351-9. [PMID: 26444185 PMCID: PMC4786000 DOI: 10.3109/10826084.2015.1013132] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although most people who inject drugs (PWID) in Tijuana, Mexico, primarily inject heroin, injection and non-injection use of methamphetamine and cocaine is common. We examined patterns of polydrug use among heroin injectors to inform prevention and treatment of drug use and its health and social consequences. METHODS Participants were PWID residing in Tijuana, aged ≥18 years who reported heroin injection in the past six months and were recruited through respondent-driven sampling (n = 1,025). Latent class analysis was conducted to assign individuals to classes on a probabilistic basis, using four indicators of past six-month polydrug and polyroute use: cocaine injecting, cocaine smoking or snorting, methamphetamine injecting, and methamphetamine smoking or snorting. Latent class membership was regressed onto covariates in a multinomial logistic regression. RESULTS Latent class analyses testing 1, 2, 3, and 4 classes were fit, with the 3-class solution fitting best. Class 1 was defined by predominantly heroin use (50.2%, n = 515); class 2 by methamphetamine and heroin use (43.7%, n = 448), and class 3 by methamphetamine, cocaine, and heroin use (6.0%, n = 62). Bivariate and multivariate analyses indicated a group of methamphetamine and cocaine users that exhibited higher-risk sexual practices and lower heroin injecting frequency, and a group of methamphetamine users who were younger and more likely to be female. CONCLUSIONS Discrete subtypes of heroin PWID were identified based on methamphetamine and cocaine use patterns. These findings have identified subtypes of heroin injectors who require more tailored interventions to reduce the health and social harms of injecting drug use.
Collapse
Affiliation(s)
- Meredith C Meacham
- a Division of Global Public Health, University of California, San Diego School of Medicine , La Jolla , California , USA.,b Graduate School of Public Health, San Diego State University , San Diego , California , USA
| | - Abby E Rudolph
- c Pacific Institute for Research and Evaluation , Calverton , Maryland , USA
| | - Steffanie A Strathdee
- a Division of Global Public Health, University of California, San Diego School of Medicine , La Jolla , California , USA
| | - Melanie L Rusch
- d Vancouver Island Health Authority , Victoria , British Columbia , Canada
| | - Kimberly C Brouwer
- a Division of Global Public Health, University of California, San Diego School of Medicine , La Jolla , California , USA
| | - Thomas L Patterson
- e Department of Psychiatry, University of California , San Diego, La Jolla , California , USA
| | - Alicia Vera
- a Division of Global Public Health, University of California, San Diego School of Medicine , La Jolla , California , USA
| | | | - Scott C Roesch
- g Department of Psychology, San Diego State University , San Diego , California , USA
| |
Collapse
|
50
|
Kaag AM, Crunelle CL, van Wingen G, Homberg J, van den Brink W, Reneman L. Relationship between trait impulsivity and cortical volume, thickness and surface area in male cocaine users and non-drug using controls. Drug Alcohol Depend 2014; 144:210-7. [PMID: 25278147 DOI: 10.1016/j.drugalcdep.2014.09.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/03/2014] [Accepted: 09/12/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND Trait impulsivity is commonly associated with cocaine dependence. The few studies that have investigated the relation between trait impulsivity and cortical morphometry, have shown a distinct relation between impulsivity and cortical volume (CV) of temporal, frontal and insula cortex. As CV is the function of cortical surface area (SA) and cortical thickness (CT) impulsivity may be differently associated to SA than to CT. METHOD Fifty-three cocaine users (CU) and thirty-five controls (HC) (males aged 18-55 years) completed the Barrat impulsiveness scale and a structural scan was made on a 3T MRI scanner. CV, SA and CT were measured using Freesurfer. Multivariate analysis was used to test for group differences and group by impulsivity interaction effects in CV, SA and ST across nine regions of interest in the temporal, frontal and insular cortices. Possible confounding effects of drug- and alcohol exposure were explored. RESULTS Compared to HC, CU had a smaller SA of the superior temporal cortex but a larger SA of the insula. There were divergent relations between trait impulsivity and SA of the superior temporal cortex and insula (positive in HC, negative in CU) and CT of the anterior cingulate cortex (negative in HC, positive in CU). Within CU, there was a negative association between monthly cocaine use and CT of the insula and superior temporal cortex. DISCUSSION The distinct relation between trait impulsivity and cortical morphometry in CU and HC might underlie inefficient control over behavior resulting in maladaptive impulsive behaviour such as cocaine abuse.
Collapse
Affiliation(s)
- Anne Marije Kaag
- Departement of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Brain Imaging Center, Academic Medical Center, Amsterdam, The Netherlands.
| | - Cleo L Crunelle
- Toxicological Center, University of Antwerp, Antwerp, Belgium
| | - Guido van Wingen
- Brain Imaging Center, Academic Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Judith Homberg
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Medical Centre, Nijmegen, The Netherlands
| | - Wim van den Brink
- Brain Imaging Center, Academic Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Liesbeth Reneman
- Departement of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Brain Imaging Center, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|