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Mitchell C, Stantoznik J, Fashaw-Walters S, Akosionu O, Hardeman R, Ko M. Criminal Justice, Arrests Data, and Structural Racism Measurement for Health Equity Research: Promises and Pitfalls. Health Serv Res 2025:e14449. [PMID: 39933958 DOI: 10.1111/1475-6773.14449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 12/06/2024] [Accepted: 01/18/2025] [Indexed: 02/13/2025] Open
Affiliation(s)
- Carmen Mitchell
- Department of Health Management and Systems Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, USA
| | - Julia Stantoznik
- University of Minnesota School of Public Health, Center for Antiracism Research for Health Equity, Minneapolis, Minnesota, USA
| | - Shekinah Fashaw-Walters
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Odichinma Akosionu
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Rachel Hardeman
- University of Minnesota School of Public Health, Center for Antiracism Research for Health Equity, Minneapolis, Minnesota, USA
| | - Michelle Ko
- Division of Health Policy and Management, University of California, Davis, Department of Public Health Sciences, California, USA
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2
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Hughto JMW, Kelly PJA, Vento SA, Pletta DR, Noh M, Silcox J, Rich JD, Green TC. Characterizing and responding to stimulant overdoses: Findings from a mixed methods study of people who use cocaine and other stimulants in New England. Drug Alcohol Depend 2025; 266:112501. [PMID: 39608288 DOI: 10.1016/j.drugalcdep.2024.112501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 10/04/2024] [Accepted: 11/05/2024] [Indexed: 11/30/2024]
Abstract
PURPOSE To explore people who use stimulants' (PWUS) stimulant overdose experiences and identify factors associated with calling 911 for personal and witnessed stimulant overdoses. METHODS From 2022-2023, 222 people in Massachusetts and Rhode Island with past-30-day illicit stimulant use were surveyed. Adjusted multivariable logistic regression models examined the association between sociodemographics, substance use, and stimulant overdose history and whether 911 was called for participants' last personally experienced and witnessed stimulant overdoses. RESULTS Overall, 42.2 % of PWUS witnessed- and 34.5 % personally overdosed on stimulants. Nearly half (48.7 %) of participants who overdosed used crack cocaine prior, 35.5 % reported extremely severe symptoms (e.g., heart attack, stroke, seizure, loss of consciousness), and 34.2 % said 911 was called at their last overdose. Among those who last witnessed a stimulant overdose, 41.5 % reported crack cocaine involvement, and 47.9 % said 911 was called (20.0 % personally called). Higher educational attainment and experiencing extremely severe symptoms were positively associated with 911 being called at participants' last stimulant overdose, whereas the number of overdoses witnessed and crack cocaine use by the person overdosing were negatively associated with 911 being called at participants' last witnessed stimulant overdose (all p-values<.05). CONCLUSION Stimulant overdoses were common. Most participants reported moderate-to-severe symptoms, yet 911 was called in less than half of personal or witnessed stimulant overdoses. Emergency help-seeking also varied by symptom severity, stimulant type, and the sociodemographics of the person overdosing. Research is needed to understand barriers to formal help-seeking and the practices PWUS engage in to prevent fatal stimulant overdoses.
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Affiliation(s)
- Jaclyn M W Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, 1125 North Main Street, Providence, RI 02903, USA.
| | - Patrick J A Kelly
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA.
| | - Stephanie A Vento
- Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA.
| | - David R Pletta
- Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA.
| | - Madeline Noh
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA.
| | - Joseph Silcox
- Brandeis University Opioid Policy Research Collaborative, 415 South Street, Waltham, MA, USA; University of Massachusetts - Boston, 100 Morrissey Boulevard, Boston, MA 02125, USA.
| | - Josiah D Rich
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, 1125 North Main Street, Providence, RI 02903, USA; The Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02912, USA.
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, 1125 North Main Street, Providence, RI 02903, USA; The Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02912, USA; Brandeis University Opioid Policy Research Collaborative, 415 South Street, Waltham, MA, USA.
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3
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Jiang X, Lv G, Xiong X, Li M, Yuan J, Lu ZK. Cannabis Use, Disorders, and Disparities Under the Controlled Substances Act: NSDUH 2015-2019. J Gen Intern Med 2024:10.1007/s11606-024-09138-2. [PMID: 39438384 DOI: 10.1007/s11606-024-09138-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 10/11/2024] [Indexed: 10/25/2024]
Affiliation(s)
- Xiangxiang Jiang
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Gang Lv
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaomo Xiong
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jing Yuan
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, Fudan University, Shanghai, China
| | - Z Kevin Lu
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA.
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4
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Corley C, Craig A, Sadek S, Marusich JA, Chehimi SN, White AM, Holdiness LJ, Reiner BC, Gipson CD. Enhancing translation: A need to leverage complex preclinical models of addictive drugs to accelerate substance use treatment options. Pharmacol Biochem Behav 2024; 243:173836. [PMID: 39067531 PMCID: PMC11344688 DOI: 10.1016/j.pbb.2024.173836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 07/11/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
Preclinical models of addictive drugs have been developed for decades to model aspects of the clinical experience in substance use disorders (SUDs). These include passive exposure as well as volitional intake models across addictive drugs and have been utilized to also measure withdrawal symptomatology and potential neurobehavioral mechanisms underlying relapse to drug seeking or taking. There are a number of Food and Drug Administration (FDA)-approved medications for SUDs, however, many demonstrate low clinical efficacy as well as potential sex differences, and we also note gaps in the continuum of care for certain aspects of clinical experiences in individuals who use drugs. In this review, we provide a comprehensive update on both frequently utilized and novel behavioral models of addiction with a focus on translational value to the clinical experience and highlight the need for preclinical research to follow epidemiological trends in drug use patterns to stay abreast of clinical treatment needs. We then note areas in which models could be improved to enhance the medications development pipeline through efforts to enhance translation of preclinical models. Next, we describe neuroscience efforts that can be leveraged to identify novel biological mechanisms to enhance medications development efforts for SUDs, focusing specifically on advances in brain transcriptomics approaches that can provide comprehensive screening and identification of novel targets. Together, the confluence of this review demonstrates the need for careful selection of behavioral models and methodological parameters that better approximate the clinical experience combined with cutting edge neuroscience techniques to advance the medications development pipeline for SUDs.
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Affiliation(s)
- Christa Corley
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Ashley Craig
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Safiyah Sadek
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | | | - Samar N Chehimi
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ashley M White
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Lexi J Holdiness
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Benjamin C Reiner
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cassandra D Gipson
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA.
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5
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Marineau LA, Uzzi M, Buggs SA, Ihenacho N, Campbell JC. Risk and Protective Factors for Firearm Assault Injuries Among Black Men: A Scoping Review of Research. TRAUMA, VIOLENCE & ABUSE 2024; 25:2468-2488. [PMID: 38153002 PMCID: PMC11295296 DOI: 10.1177/15248380231217042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Black men are disproportionately affected by firearm assaults in the United States, and these disparities are rooted in structural and social inequities. The objective of this scoping review of research was to identify risk and protective factors for firearm assault injuries among Black men at all levels of the social-ecological framework. The search was conducted in 2021. The initial search generated 1,122 articles. Studies were eligible if they (a) included an analysis of modifiable risk or protective factors for firearm assaults among Black men; (b) reported an estimate of correlation, association, or effect between risk or protective factors and firearm assault injuries, firearm violence, and/or firearm homicides; and (c) were published peer-reviewed articles. In all, 19 articles were identified for review. Risk factors identified at each ecological level include the following: (1) Individual: firearm possession/weapon use and criminal legal system interaction; (2) Relationships: gang membership and exposure to other people who have experienced a firearm assault; (3) Community: indicators for socioeconomic status and racial residential segregation; and (4) Societal: historical racist policy. Individual-level substance use had mixed results. Few (26%) studies examined protective factors at any ecological level, but community-level factors like neighborhood tree cover were identified. Future research needs to examine risk and protective factors at the societal level and multiple ecological levels simultaneously leading to more effective multi-level interventions that will guide policy formation. A greater diversity of study designs, research methods, and theoretical frameworks is needed to better understand factors associated with firearm assault among Black men.
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Affiliation(s)
| | - Mudia Uzzi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shani A. Buggs
- Department of Emergency Medicine, University of California, Davis, USA
- California Firearm Violence Research Center, Davis, USA
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Sung B. Effect of Social Vulnerability on Cocaine-Related Mortality Rates in U.S. Counties. J Psychoactive Drugs 2024:1-7. [PMID: 38860858 DOI: 10.1080/02791072.2024.2366192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/12/2024] [Indexed: 06/12/2024]
Abstract
Cocaine-related mortality rates have risen sharply since 2013 and social vulnerability is a crucial indicator for drug-related mortality rates. Therefore, the purpose of this study was to investigate the relationship between social vulnerability and cocaine-related mortality rates in U.S. counties. The Data were collected from the CDC WONDER, CDC's Social Vulnerability Index (CDC's SVI), and American Community Survey (ACS). The Data were analyzed by spatial autoregression models. According to present results, first, counties with social vulnerability (socioeconomic) were positively related to higher rates of cocaine overdose death (spatial lag: B = 0.323, p < .05; spatial error: B = 0.513, p < .01). Second, counties with social vulnerability (minority status & language) were negatively related to higher rates of cocaine overdose death (spatial lag: B = -0.233, p < .05). Third, counties with social vulnerability (housing type & transportation) were positively related to higher rates of cocaine overdose death (spatial lag: B = 0.413, p < .001; spatial error: B = 0.378, p < .001). In conclusion, the spread of cocaine overdose on U.S. counties with social vulnerabilities demonstrated a disproportionate burden of cocaine-related mortality.
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Affiliation(s)
- Baksun Sung
- Department of Sociology and Anthropology, Utah State University, Logan, UT, USA
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7
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Shrader CH, Duncan DT, Knox J, Chen YT, Driver R, Russell JS, Moody RL, Kanamori M, Durrell M, Hanson H, Eavou R, Goedel WC, Schneider JA. A Network Science Approach to Sex-Polydrug Use Among Black Sexually Minoritized Men and Transgender Women: The N2 Cohort Study. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:638-649. [PMID: 38372856 PMCID: PMC11588306 DOI: 10.1007/s11121-023-01639-6] [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] [Accepted: 12/28/2023] [Indexed: 02/20/2024]
Abstract
Black sexually minoritized men (SMM) and transgender women (TW) are subgroups with lower rates of substance use and comparable rates of condom use relative to White SMM and TW yet experience heightened vulnerability to HIV. This study sought to explore associations of substance use, including sex-drug use (i.e., drug or alcohol use during sex to enhance sex), and condomless sex among Black SMM and TW. Data were collected from Black SMM and TW living in Chicago, Illinois, enrolled in the Neighborhoods and Networks (N2) cohort study, from November 2018 to April 2019. We used bivariate analyses followed by a multilevel egocentric network analysis to identify factors associated with condomless sex. We conducted Spearman correlation coefficients to examine correlations between pairs of sex-drugs to enhance sex. We used a bipartite network analysis to identify correlates of sex-drug use and condomless sex. A total of 352 Black SMM and TW (egos) provided information about 933 sexual partners (alters). Of respondents, 45% reported condomless sex and 61% reported sex-drug use. In unadjusted analyses, marijuana (34%) and cocaine/crack (5%) sex-drug use were associated with condomless sex (p < 0.05). Condomless sex was positively associated with sex-polydrug use, or the use of 2+ drugs or 1 drug and alcohol (OR = 1.48; 95% CI: 1.02-2.14; p = 0.039), and negatively associated with sharing an HIV-negative serostatus with a sexual partner (OR = 0.57; 95% CI: 0.33-0.98; p = 0.041), having a different HIV serostatus with a sexual partner (OR = 0.37; 95% CI: 0.21-0.64; p < 0.001) or not knowing the HIV serostatus of a sexual partner (OR = 0.47; 95% CI: 0.26-0.84; p = 0.011). The following pairs of sex-polydrug use had Spearman correlation coefficients higher than 0.3: marijuana and alcohol, ecstasy and alcohol, cocaine/crack and ecstasy, and methamphetamine and poppers (p < 0.05). HIV prevention interventions for Black SMM and TW designed to reduce HIV transmission through egocentric sexual networks could address sex-drug use through sex-positive and pleasure-centered harm reduction strategies and provide and promote biomedical prevention and care options at supraoptimal levels.
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Affiliation(s)
- Cho-Hee Shrader
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
- ICAP at Columbia University, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Dustin T Duncan
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, NY, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Yen-Tyng Chen
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA
| | - Redd Driver
- New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Jonathan S Russell
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
- ICAP at Columbia University, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Raymond L Moody
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - Mariano Kanamori
- Department of Public Health Sciences, School of Medicine, University of Miami, Miami, FL, USA
| | - Mainza Durrell
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Hillary Hanson
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Rebecca Eavou
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - William C Goedel
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA.
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.
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8
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McHugh RK, Korte FM, Bichon JA, Weiss RD. Gender differences in the prevalence of stimulant misuse in the United States: 2015-2019. Am J Addict 2024; 33:283-289. [PMID: 37924248 PMCID: PMC11032236 DOI: 10.1111/ajad.13501] [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: 07/28/2023] [Revised: 09/29/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The gender gap in prevalence of substance-use disorders has narrowed. However, gender differences in stimulant misuse have not been well-characterized in recent years. The aim of this study was to quantify gender differences in past-year stimulant misuse and stimulant-use disorder, separated by stimulant type (cocaine/crack, prescription stimulants, and methamphetamine). In an exploratory aim, we investigated whether gender differences were moderated by age or sexual orientation. METHODS We combined data from the National Survey on Drug Use and Health from 2015 to 2019 (unweighted N = 282,768) to test gender differences in the prevalence of past-year stimulant misuse. RESULTS Results indicated that stimulant misuse was significantly more prevalent in men than women for all stimulant types for both past-year use and past-year use disorder. The magnitude of this sex difference was smallest for prescription stimulants, where men had 1.37 times higher odds of past-year misuse and no gender difference was observed in the prevalence of prescription stimulant-use disorder. The magnitude of gender differences also varied based on both age and sexual orientation. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Illicit stimulant misuse continues to be more common in men than in women; however, gender differences are more modest for prescription stimulant misuse, suggesting a narrowing of this historical gender difference.
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Affiliation(s)
- R. Kathryn McHugh
- Division of Alcohol, Drugs and Addiction, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Francesca M. Korte
- Division of Alcohol, Drugs and Addiction, McLean Hospital, Belmont, MA, USA
| | - Juliette A. Bichon
- Division of Alcohol, Drugs and Addiction, McLean Hospital, Belmont, MA, USA
| | - Roger D. Weiss
- Division of Alcohol, Drugs and Addiction, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Yunusa I, Farhadi K, Karaye IM. Racial, Ethnic, and Regional Disparities in Cocaine-Involved Overdose Deaths in the US, 1999-2020. J Racial Ethn Health Disparities 2024; 11:441-450. [PMID: 36787046 DOI: 10.1007/s40615-023-01531-7] [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: 12/02/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Social inequalities among underrepresented communities may lead to higher overdose mortality involving cocaine use. We assessed the temporal trends in cocaine-involved overdose mortality rate in the US by race, ethnicity, and geographic region from 1999 to 2020. METHODS We conducted a cross-sectional study among adults in the US using data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (1999 to 2020). To identify cocaine-involved overdose decedents, we used the International Classification of Diseases Code, 10th Revision-T40.5. We used Joinpoint regression to examine the trends in age-adjusted cocaine-involved overdose mortality rates (AAMR) by race, ethnicity, and geographic region and estimated annual percentage changes (APC). RESULTS Overall, cocaine-involved overdose mortality trends increased (APC, 11.3%; 95% CI, 0.6, 23.2) from 2017 to 2020. The latest trends have remained stable among Non-Hispanic Whites since 2017 (APC, 4.3%; 95% CI, -5.7%, 15.4%) but have significantly increased among Non-Hispanic Blacks (APC, 27.2%; 95% CI, 22.1%, 32.5%), Hispanics (APC, 26.9%; 95% CI, 20.6%, 33.5%), and American Indians/Alaska Natives (APC, 24.1%; 95% CI, 16.5%, 32.2%). CONCLUSION Cocaine-related overdose deaths in the US significantly increased between 2017 and 2020, but the increase was among racial and ethnic minorities and not among Non-Hispanic Whites. These findings suggest a need to address the US' longstanding racial and ethnic healthcare inequities.
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Affiliation(s)
- Ismaeel Yunusa
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, 715 Sumter Street, Columbia, SC, 29208, USA.
| | - Kameron Farhadi
- Department of Population Health, Hofstra University, Hempstead, NY, USA
| | - Ibraheem M Karaye
- Department of Population Health, Hofstra University, Hempstead, NY, USA
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Sher KJ. The Heterogeneous Nature of Substance Use and Substance Use Disorders: Implications for Characterizing Substance-Related Stigma. Psychol Sci Public Interest 2023; 24:82-89. [PMID: 38095161 DOI: 10.1177/15291006231212385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Kenneth J Sher
- Department of Psychological Sciences, University of Missouri
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11
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Mehtani NJ, Chuku CC, Meacham MC, Vittinghoff E, Dilworth SE, Riley ED. Housing Instability Associated with Return to Stimulant Use among Previously Abstaining Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6830. [PMID: 37835100 PMCID: PMC10572661 DOI: 10.3390/ijerph20196830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023]
Abstract
Stimulant use among unstably housed individuals is associated with increased risks of psychiatric co-morbidity, violence, HIV transmission, and overdose. Due to a lack of highly effective treatments, evidence-based policies targeting the prevention of stimulant use disorder are of critical importance. However, little empirical evidence exists on risks associated with initiating or returning to stimulant use among at-risk populations. In a longitudinal cohort of unstably housed women in San Francisco (2016-2019), self-reported data on stimulant use, housing status, and mental health were collected monthly for up to 6 months, and factors associated with initiating stimulants after a period of non-use were identified through logistic regression. Among 245 participants, 42 (17.1%) started using cocaine and 46 (18.8%) started using methamphetamine. In analyses adjusting for demographics and socio-structural exposures over the preceding month, experiencing street homelessness was associated with initiating cocaine use (AOR: 2.10; 95% CI: 1.04, 4.25) and sheltered homelessness with initiating methamphetamine use (AOR: 2.57; 95% CI: 1.37, 4.79). Other factors-including race, income, unmet subsistence needs, mental health, and treatment adherence-did not reach levels of significance, suggesting the paramount importance of policies directed toward improving access to permanent supportive housing to prevent stimulant use among unstably housed women.
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Affiliation(s)
- Nicky J. Mehtani
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, CA 94143, USA;
- Whole Person Integrated Care, San Francisco Department of Public Health, San Francisco, CA 94103, USA
| | - Chika C. Chuku
- Department of Public Health Sciences, University of Miami, Coral Gables, FL 33136, USA;
| | - Meredith C. Meacham
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, CA 94143, USA;
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94143, USA;
| | - Samantha E. Dilworth
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (S.E.D.)
| | - Elise D. Riley
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (S.E.D.)
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Stiltner B, Pietrzak RH, Tylee DS, Nunez YZ, Adhikari K, Kranzler HR, Gelernter J, Polimanti R. Polysubstance addiction patterns among 7,989 individuals with cocaine use disorder. iScience 2023; 26:107336. [PMID: 37554454 PMCID: PMC10405253 DOI: 10.1016/j.isci.2023.107336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023] Open
Abstract
To characterize polysubstance addiction (PSA) patterns of cocaine use disorder (CoUD), we performed a latent class analysis (LCA) in 7,989 participants with a lifetime DSM-5 diagnosis of CoUD. This analysis identified three PSA subgroups among CoUD participants (i.e., low, 17%; intermediate, 38%; high, 45%). While these subgroups varied by age, sex, and racial-ethnic distribution (p < 0.001), there was no difference with respect to education or income (p > 0.05). After accounting for sex, age, and race-ethnicity, the CoUD subgroup with high PSA had higher odds of antisocial personality disorder (OR = 21.96 vs. 6.39, difference-p = 8.08✕10-6), agoraphobia (OR = 4.58 vs. 2.05, difference-p = 7.04✕10-4), mixed bipolar episode (OR = 10.36 vs. 2.61, difference-p = 7.04✕10-4), posttraumatic stress disorder (OR = 11.54 vs. 5.86, difference-p = 2.67✕10-4), antidepressant medication use (OR = 13.49 vs. 8.02, difference-p = 1.42✕10-4), and sexually transmitted diseases (OR = 5.92 vs. 3.38, difference-p = 1.81✕10-5) than the low-PSA CoUD subgroup. These findings underscore the importance of modeling PSA severity and comorbidities when examining the clinical, molecular, and neuroimaging correlates of CoUD.
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Affiliation(s)
- Brendan Stiltner
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Robert H. Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Daniel S. Tylee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Yaira Z. Nunez
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Keyrun Adhikari
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Henry R. Kranzler
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Mental Illness Research, Education, and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
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13
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Hussain ZS, Khan A, Loya A, Shah K, Woreta FA, Riaz KM. Early Lifetime Substance Use and Development of Visual Impairment: Analysis of the National Survey on Drug Use and Health Data. Clin Ophthalmol 2023; 17:849-860. [PMID: 36968284 PMCID: PMC10030542 DOI: 10.2147/opth.s401167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
Purpose To investigate the association between early lifetime substance use on the development of severe visual acuity impairment or blindness on a national level. Methods National Survey of Drug Use and Health data was used to identify cases of substance use before 21* years of age, within the past year, and cases of self-reported blindness or visual impairment. Univariable and multivariable binary logistic regression with time-dependency was performed to evaluate odds of visual impairment influenced by 16 substances separated into three classes: prescription, non-prescription, and illicit drugs. Adjusted variables of interest included gender, marital status, race, level of education, total family income, poverty level, population density, and history of chronic disease. Results 55,824 total responses were analyzed with 2577 (4.6%) cases of self-reported blindness or significant visual impairment. All early-use substance categories, including prescription, non-prescription, and illegal substances, were significantly associated with self-reported VI (OR 2.068, CI 1.451-2.949, p<0.001; OR 1.352, CI 1.227-1.489, p<0.001); OR 1.211, CI 1.086-1.352, p<0.001), respectively). Non-prescription substances displayed parallel significances amongst all constituents (alcohol, cigarettes, inhalants, and marijuana) (OR=1.227, CI 1.12-1.344, p<0.001; OR 1.363, CI 1.243-1.495, p<0.001; OR 1.418, CI 1.134-1.774; OR 1.388, CI 1.27-1.518, p<0.001, respectively). Univariable and multivariable analysis revealed several significant demographical and clinical adjustors. Conclusion Early lifetime use of all three classes of substances is associated with enhanced odds of subsequent visual impairment or blindness. Several readily available and commonly used substances have a greater risk. These findings may help clinicians and public health agencies in mitigation ventures including education, prevention, and rehabilitation efforts.
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Affiliation(s)
- Zain S Hussain
- University of Medicine and Health Sciences, Basseterre, Saint Kitts and Nevis
- Department of Ophthalmology, Dean McGee Eye Institute, Oklahoma City, OK, USA
| | - Asher Khan
- Department of Ophthalmology, Dean McGee Eye Institute, Oklahoma City, OK, USA
- College of Medicine, University of Oklahoma, Oklahoma City, OK, USA
| | - Asad Loya
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Kaushal Shah
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University, Tulsa, OK, USA
| | - Fasika A Woreta
- Department of Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA
| | - Kamran M Riaz
- Department of Ophthalmology, Dean McGee Eye Institute, Oklahoma City, OK, USA
- Correspondence: Kamran M Riaz, Dean McGee Eye Institute/University of Oklahoma, 608 Stanton L Young Blvd, Suite 313, Oklahoma City, OK, 73104, USA, Tel +1-405-271-1095, Fax +1-405-271-3680, Email
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14
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Stiltner B, Pietrzak RH, Tylee DS, Nunez YZ, Adhikari K, Kranzler HR, Gelernter J, Polimanti R. Polysubstance addiction and psychiatric, somatic comorbidities among 7,989 individuals with cocaine use disorder: a latent class analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.08.23285653. [PMID: 36798273 PMCID: PMC9934788 DOI: 10.1101/2023.02.08.23285653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Aims We performed a latent class analysis (LCA) in a sample ascertained for addiction phenotypes to investigate cocaine use disorder (CoUD) subgroups related to polysubstance addiction (PSA) patterns and characterized their differences with respect to psychiatric and somatic comorbidities. Design Cross-sectional study. Setting United States. Participants Adult participants aged 18-76, 39% female, 47% African American, 36% European American with a lifetime DSM-5 diagnosis of CoUD (N=7,989) enrolled in the Yale-Penn cohort. The control group included 2,952 Yale-Penn participants who did not meet for alcohol, cannabis, cocaine, opioid, or tobacco use disorders. Measurements Psychiatric disorders and related traits were assessed via the Semi-structured Assessment for Drug Dependence and Alcoholism. These features included substance use disorders (SUD), family history of substance use, sociodemographic information, traumatic events, suicidal behaviors, psychopathology, and medical history. LCA was conducted using diagnoses and diagnostic criteria of alcohol, cannabis, opioid, and tobacco use disorders. Findings Our LCA identified three subgroups of PSA (i.e., low, 17%; intermediate, 38%; high, 45%) among 7,989 CoUD participants. While these subgroups varied by age, sex, and racial-ethnic distribution (p<0.001), there was no difference on education or income (p>0.05). After accounting for sex, age, and race-ethnicity, the CoUD subgroup with high PSA had higher odds of antisocial personality disorder (OR=21.96 vs. 6.39, difference-p=8.08×10 -6 ), agoraphobia (OR=4.58 vs. 2.05, difference-p=7.04×10 -4 ), mixed bipolar episode (OR=10.36 vs. 2.61, difference-p=7.04×10 -4 ), posttraumatic stress disorder (OR=11.54 vs. 5.86, difference-p=2.67×10 -4 ), antidepressant medication use (OR=13.49 vs. 8.02, difference-p=1.42×10 -4 ), and sexually transmitted diseases (OR=5.92 vs. 3.38, difference-p=1.81×10 -5 ) than the low-PSA CoUD subgroup. Conclusions We found different patterns of PSA in association with psychiatric and somatic comorbidities among CoUD cases within the Yale-Penn cohort. These findings underscore the importance of modeling PSA severity and comorbidities when examining the clinical, molecular, and neuroimaging correlates of CoUD.
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15
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Walsh B, Agboola I, Agboola I, Coupet E, Rozel J, Wong A. Revisiting “Excited Delirium”: Does the Diagnosis Reflect and Promote Racial Bias? West J Emerg Med 2023; 24:152-159. [PMID: 36976592 PMCID: PMC10047747 DOI: 10.5811/westjem.2022.10.56478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 10/06/2022] [Indexed: 03/20/2023] Open
Abstract
Introduction: “Excited delirium” (ExD) is purported to represent a certain type of agitated state that can lead to unexpected death. The 2009 “White Paper Report on Excited Delirium Syndrome,” authored by the American College of Emergency Medicine (ACEP) Excited Delirium Task Force, continues to play a pivotal role in defining ExD. Since that report was produced, there has been an increasing appreciation that the label has been applied more often to Black people.
Methods: Our aim was to analyze the language of the 2009 report, the role of potential stereotypes, and the mechanisms that may potentially encourage bias.
Results: Our evaluation of the diagnostic criteria for ExD proposed in the 2009 report shows that it relies on persistent racial stereotypes: eg, unusual strength, decreased sensitivity to pain, and bizarre behavior. Research indicates that use of such stereotypes could encourage biased diagnosis and treatment.
Conclusion: We suggest that the emergency medicine community avoid use of the concept ExD and that ACEP withdraw implicit or explicit support of the report.
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Affiliation(s)
- Brooks Walsh
- Bridgeport Hospital, Yale-New Haven Health System, Department of Emergency Medicine, Bridgeport, Connecticut
| | - Isaac Agboola
- University of Chicago, Northshore University Health System, Department of Emergency Medicine, Chicago, Illinois
| | - Isaac Agboola
- University of Chicago, Northshore University Health System, Department of Emergency Medicine, Chicago, Illinois
| | - Edouard Coupet
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - John Rozel
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, Pennsylvania
| | - Ambrose Wong
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
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16
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Deutsch-Link S, Belcher AM, Massey E, Cole TO, Wagner MA, Billing AS, Greenblatt AD, Weintraub E, Wish ED. Race-based differences in drug use prior to onset of opioid use disorder. J Ethn Subst Abuse 2023; 22:89-105. [PMID: 33554763 PMCID: PMC9573766 DOI: 10.1080/15332640.2021.1879702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Rates of opioid use disorder (OUD) have increased dramatically over the past two decades, a rise that has been accompanied by changing demographics of those affected. Early exposure to drugs is a known risk factor for later development of opioid use disorder; but how and whether this risk factor may differ between racial groups is unknown. Our study seeks to identify race differences in self-report of current and past substance use in OUD-diagnosed treatment-seeking individuals. Patients (n = 157) presenting for methadone maintenance treatment at a racially diverse urban opioid treatment program were approached and consented for study involvement. Participants were administered substance use history questionnaires and urine drug screening at intake. Chi-square, t-tests, and rank-sum were used to assess race differences in demographic variables. Logistic and linear regressions assessed the relationship between race and substance use for binary and continuous variables, respectively. 61% of the population identified as Black and 39% as White. Black participants were significantly older; age was thus included as a covariate. Logistic regressions demonstrated that despite similar urine toxicology at intake, White participants were significantly more likely to report having used prescription opioids and psychedelic, stimulant, and sedative substance classes prior to their first use of non-pharmaceutical opioids. Compared to Black participants, White treatment-seeking OUD-diagnosed individuals reported using a wider range of substances ever and prior to first use of non-pharmaceutical opioids. There were no differences, however, in presentation for OUD treatment, suggesting different pathways to OUD, which may carry important clinical implications.
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Affiliation(s)
| | | | | | - Thomas O. Cole
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | - Eric Weintraub
- University of Maryland School of Medicine, Baltimore, MD, USA
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17
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Cano M, Salas-Wright CP, Oh S, Noel L, Hernandez D, Vaughn MG. Socioeconomic inequalities and Black/White disparities in US cocaine-involved overdose mortality risk. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2023-2035. [PMID: 35249125 DOI: 10.1007/s00127-022-02255-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/18/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study examined whether socioeconomic inequalities account for Black/White disparities in: (a) the prevalence of potential risk factors for overdose among adults using cocaine; and (b) national mortality rates for cocaine-involved overdose. METHODS Data from 2162 Non-Hispanic (NH) Black or White adults (26 +) who reported past-year cocaine use in the 2015-2019 National Survey of Drug Use and Health were analyzed to obtain predicted probabilities of potential overdose risk factors by race and sex, using marginal effects via regression analyses, adjusting for age and socioeconomic indicators. Next, National Center for Health Statistics data (for 47,184 NH Black or White adults [26 +] who died of cocaine-involved overdose between 2015 and 2019) were used to calculate cocaine-involved overdose mortality rates by race and sex across age and educational levels. RESULTS Several potential overdose vulnerabilities were disproportionately observed among NH Black adults who reported past-year cocaine use: poor/fair overall health; cocaine use disorder; more days of cocaine use yearly; hypertension (for women); and arrests (for men). Adjusting for age and socioeconomic indicators attenuated or eliminated many of these racial differences, although predicted days of cocaine use per year (for men) and cocaine use disorder (for women) remained higher in NH Black than White adults. Cocaine-involved overdose mortality rates were highest in the lowest educational strata of both races; nonetheless, Black/White disparities were observed even at the highest level of education, especially for adults ages 50 + . CONCLUSION Age and socioeconomic characteristics may account for some, yet not all, of Black/White disparities in vulnerability to cocaine-involved overdose.
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Affiliation(s)
- Manuel Cano
- Department of Social Work, University of Texas at San Antonio, 501 W. César E. Chávez Blvd., San Antonio, TX, 78207, USA.
| | - Christopher P Salas-Wright
- School of Social Work, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
- Department of Public Health Sciences, Division of Prevention Science & Community Health, University of Miami, Miami, FL, USA
| | - Sehun Oh
- College of Social Work, The Ohio State University, 1947 College Rd, Columbus, OH, 43210, USA
| | - Lailea Noel
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA
| | - Dora Hernandez
- Department of Social Work, University of Texas at San Antonio, 501 W. César E. Chávez Blvd., San Antonio, TX, 78207, USA
| | - Michael G Vaughn
- School of Social Work, St. Louis University, 3550 Lindell Blvd, St. Louis, MO, 63103, USA
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18
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Schwartz EKC, Wolkowicz NR, De Aquino JP, MacLean RR, Sofuoglu M. Cocaine Use Disorder (CUD): Current Clinical Perspectives. Subst Abuse Rehabil 2022; 13:25-46. [PMID: 36093428 PMCID: PMC9451050 DOI: 10.2147/sar.s337338] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022] Open
Abstract
Cocaine use disorder (CUD) is a devastating disorder, impacting both individuals and society. Individuals with CUD face many barriers in accessing treatment for CUD, and most individuals with CUD never receive treatment. In this review, we provide an overview of CUD, including risk factors for CUD, common co-occurring disorders, acute and chronic effects of cocaine use, and currently available pharmacological and behavioral treatments. There are no FDA-approved pharmacological treatments for CUD. Future studies with larger sample sizes and testing treatment combinations are warranted. However, individuals with CUD and co-occurring disorders (eg, a mood or anxiety disorder) may benefit from medication treatments. There are behavioral interventions that have demonstrated efficacy in treating CUD – contingency management (CM) and cognitive-behavioral therapy for substance use disorders (CBT-SUD) in particular – however many barriers remain in delivering these treatments to patients. Following the discussion of current treatments, we highlight some promising emerging treatments, as well as offer a framework that can be used in building a treatment plan for individuals with CUD.
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Affiliation(s)
- Elizabeth K C Schwartz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
- Correspondence: Elizabeth KC Schwartz, Tel +1-203-932-5711, Fax +1-203-937-3472, Email
| | - Noah R Wolkowicz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Joao P De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - R Ross MacLean
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
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19
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Kariisa M, Davis NL, Kumar S, Seth P, Mattson CL, Chowdhury F, Jones CM. Vital Signs: Drug Overdose Deaths, by Selected Sociodemographic and Social Determinants of Health Characteristics - 25 States and the District of Columbia, 2019-2020. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:940-947. [PMID: 35862289 PMCID: PMC9310633 DOI: 10.15585/mmwr.mm7129e2] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Drug overdose deaths increased approximately 30% from 2019 to 2020 in the United States. Examining rates by demographic and social determinants of health characteristics can identify disproportionately affected populations and inform strategies to reduce drug overdose deaths. METHODS Data from the State Unintentional Drug Overdose Reporting System (SUDORS) were used to analyze overdose death rates from 2019 to 2020 in 25 states and the District of Columbia. Rates were examined by race and ethnicity and county-level social determinants of health (e.g., income inequality and treatment provider availability). RESULTS From 2019 to 2020, drug overdose death rates increased by 44% and 39% among non-Hispanic Black (Black) and non-Hispanic American Indian or Alaska Native (AI/AN) persons, respectively. Significant disparities were found across sex, age, and racial and ethnic subgroups. In particular, the rate in 2020 among Black males aged ≥65 years (52.6 per 100,000) was nearly seven times that of non-Hispanic White males aged ≥65 years (7.7). A history of substance use was frequently reported. Evidence of previous substance use treatment was lowest for Black persons (8.3%). Disparities in overdose deaths, particularly among Black persons, were larger in counties with greater income inequality. Opioid overdose rates in 2020 were higher in areas with more opioid treatment program availability compared with areas with lower opioid treatment availability, particularly among Black (34.3 versus 16.6) and AI/AN (33.4 versus 16.2) persons. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE Health disparities in overdose rates continue to worsen, particularly among Black and AI/AN persons; social determinants of health, such as income inequality, exacerbate these inequities. Implementation of available, evidence-based, culturally responsive overdose prevention and response efforts that address health disparities impacting disproportionately affected populations are urgently needed.
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20
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Nkemjika S, Singh J, Oladeji O, Dzakuma S, Olatunji O, Zaman A, West B. Commentary on disparity bias in opioid use disorder treatment: policy change perspective. J Addict Dis 2022:1-6. [PMID: 35757973 DOI: 10.1080/10550887.2022.2091397] [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: 10/17/2022]
Abstract
Disparities in the healthcare system are a topic of continuous discussion in public health. Despite decades of conversations with regards to health inequities, disparities still plague substance use disorder treatment. Opioid use disorder treatment is no exception as disparities has been attributed to the ingrained and deeply flawed mindset of discrimination. Hence, this review highlights the role of policy with regards to discrimination.
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Affiliation(s)
- Stanley Nkemjika
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA.,Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Jasmine Singh
- School of Medicine, St. Matthew's University, Caymans Island, United Kingdom
| | | | - Sena Dzakuma
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Olubusola Olatunji
- College of Health & Human Services, Northern Kentucky University, KY, USA
| | - Afrina Zaman
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA
| | - Bernadette West
- School of Public Health, Rutgers University, New Brunswick, NJ, USA
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21
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Santos RRD, Hacker MDAVB, Mota JCD, Bastos FI. Housing characteristics of crack cocaine users in Northeast Brazil, 2011-2013. CIENCIA & SAUDE COLETIVA 2022; 27:2407-2416. [PMID: 35649027 DOI: 10.1590/1413-81232022276.16522021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 12/03/2021] [Indexed: 11/22/2022] Open
Abstract
We compared sociodemographic characteristics, substance use patterns, sexual behavior, use of health services, and criminal records of homeless vs. domiciled users. Data are from the Brazilian National Survey on Crack Use. A discriminant model and correspondence analysis cross-compared characteristics of users according to their housing status. The logistic model revealed associations between "living in the streets" and female gender and intermittent work. "Homelessness" was also associated with the use of tobacco and "oxi" in the previous 30 days, reliance on soup kitchens, low access to public mental health services, and arrests in the previous year. Correspondence analysis highlighted the spatial proximity of the variables as follows: "having traded sex for drugs", "informal work", "age 31 years or older", "access to public mental health services", "problems with law enforcement", and female gender with homeless crack users. People who smoke crack cocaine in Northeast Brazil are seldom studied. Their profiles, stratified according to their housing conditions, show subgroups with specific characteristics. While domiciled users have access to specialized clinics, homeless users basically reported access to free food and harm reduction services.
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Affiliation(s)
- Raquel Rodrigues Dos Santos
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz (Fiocruz). R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | | | - Jurema Corrêa da Mota
- Laboratório de Informações em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fiocruz. Rio de Janeiro RJ Brasil
| | - Francisco Inácio Bastos
- Laboratório de Informações em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fiocruz. Rio de Janeiro RJ Brasil
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22
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Nason SL, Lin E, Eitzer B, Koelmel J, Peccia J. Changes in Sewage Sludge Chemical Signatures During a COVID-19 Community Lockdown, Part 1: Traffic, Drugs, Mental Health, and Disinfectants. ENVIRONMENTAL TOXICOLOGY AND CHEMISTRY 2022; 41:1179-1192. [PMID: 34668219 DOI: 10.26434/chemrxiv.13562525.v1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/04/2021] [Accepted: 09/14/2021] [Indexed: 05/21/2023]
Abstract
The early months of the COVID-19 pandemic and the associated shutdowns disrupted many aspects of daily life and thus caused changes in the use and disposal of many types of chemicals. While records of sales, prescriptions, drug overdoses, and so forth provide data about specific chemical uses during this time, wastewater and sewage sludge analysis can provide a more comprehensive overview of chemical changes within a region. We analyzed primary sludge from a wastewater-treatment plant in Connecticut, USA, collected March 19 to June 30, 2020. This time period encompassed the first wave of the pandemic, the initial statewide stay at home order, and the first phase of reopening. We used liquid chromatography-high-resolution mass spectrometry and targeted and suspect screening strategies to identify 78 chemicals of interest, which included pharmaceuticals, illicit drugs, disinfectants, ultraviolet (UV) filters, and others. We analyzed trends over time for the identified chemicals using linear trend analyses and multivariate comparisons (p < 0.05). We found trends related directly to the pandemic (e.g., hydroxychloroquine, a drug publicized for its potential to treat COVID-19, had elevated concentrations in the week following the implementation of the US Emergency Use Authorization), as well as evidence for seasonal changes in chemical use (e.g., increases for three UV-filter compounds). Though wastewater surveillance during the pandemic has largely focused on measuring severe acute respiratory syndrome-coronavirus-2 RNA concentrations, chemical analysis can also show trends that are important for revealing the public and environmental health effects of the pandemic. Environ Toxicol Chem 2022;41:1179-1192. © 2021 SETAC.
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Affiliation(s)
- Sara L Nason
- Connecticut Agricultural Experiment Station, New Haven, Connecticut, USA
| | - Elizabeth Lin
- Department of Environmental Health, Yale School of Public Health, New Haven, Connecticut, USA
| | - Brian Eitzer
- Connecticut Agricultural Experiment Station, New Haven, Connecticut, USA
| | - Jeremy Koelmel
- Department of Environmental Health, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jordan Peccia
- Department of Chemical and Environmental Engineering, Yale University, New Haven, Connecticut, USA
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23
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Nason SL, Lin E, Eitzer B, Koelmel J, Peccia J. Changes in Sewage Sludge Chemical Signatures During a COVID-19 Community Lockdown, Part 1: Traffic, Drugs, Mental Health, and Disinfectants. ENVIRONMENTAL TOXICOLOGY AND CHEMISTRY 2022; 41:1179-1192. [PMID: 34668219 PMCID: PMC8653241 DOI: 10.1002/etc.5217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/04/2021] [Accepted: 09/14/2021] [Indexed: 05/05/2023]
Abstract
The early months of the COVID-19 pandemic and the associated shutdowns disrupted many aspects of daily life and thus caused changes in the use and disposal of many types of chemicals. While records of sales, prescriptions, drug overdoses, and so forth provide data about specific chemical uses during this time, wastewater and sewage sludge analysis can provide a more comprehensive overview of chemical changes within a region. We analyzed primary sludge from a wastewater-treatment plant in Connecticut, USA, collected March 19 to June 30, 2020. This time period encompassed the first wave of the pandemic, the initial statewide stay at home order, and the first phase of reopening. We used liquid chromatography-high-resolution mass spectrometry and targeted and suspect screening strategies to identify 78 chemicals of interest, which included pharmaceuticals, illicit drugs, disinfectants, ultraviolet (UV) filters, and others. We analyzed trends over time for the identified chemicals using linear trend analyses and multivariate comparisons (p < 0.05). We found trends related directly to the pandemic (e.g., hydroxychloroquine, a drug publicized for its potential to treat COVID-19, had elevated concentrations in the week following the implementation of the US Emergency Use Authorization), as well as evidence for seasonal changes in chemical use (e.g., increases for three UV-filter compounds). Though wastewater surveillance during the pandemic has largely focused on measuring severe acute respiratory syndrome-coronavirus-2 RNA concentrations, chemical analysis can also show trends that are important for revealing the public and environmental health effects of the pandemic. Environ Toxicol Chem 2022;41:1179-1192. © 2021 SETAC.
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Affiliation(s)
- Sara L. Nason
- Connecticut Agricultural Experiment StationNew HavenConnecticutUSA
| | - Elizabeth Lin
- Department of Environmental HealthYale School of Public HealthNew HavenConnecticutUSA
| | - Brian Eitzer
- Connecticut Agricultural Experiment StationNew HavenConnecticutUSA
| | - Jeremy Koelmel
- Department of Environmental HealthYale School of Public HealthNew HavenConnecticutUSA
| | - Jordan Peccia
- Department of Chemical and Environmental EngineeringYale UniversityNew HavenConnecticutUSA
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24
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McCormack M, Measham F, Measham M, Wignall L. Kink in an English Field: The Drinking, Drug use and Sexual Practices of English Festival-Goers Who Engage in Kink. SEXUALITY & CULTURE 2022; 26:1750-1765. [PMID: 35496643 PMCID: PMC9043504 DOI: 10.1007/s12119-022-09968-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
Little is known about the other leisure activities of people who engage in kink, including sexual practices and the use of alcohol and other drugs. This article examines the drinking, illicit drug use and sexual practices of people who engage in kink from a novel sample of attendees at an English festival. Of 966 respondents, 64 reported having engaged in kink within the past 12 months. We provide evidence of these respondents' self-reported demographic characteristics, alcohol and other drug use in their lifetime and within the past 12 months, as well as other sexual practices they engaged in. This study illustrates the value of accessing participants through in situ festival fieldwork to understand kink practices, and helps us move beyond notions of clustered risky activities toward a leisure studies approach to understanding the practices of people who engage in kink.
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Affiliation(s)
- Mark McCormack
- School of Humanities and Social Sciences, University of Roehampton, Roehampton Lane, London, SW15 5PU UK
| | - Fiona Measham
- School of Law and Social Justice, University of Liverpool, Liverpool, UK
| | | | - Liam Wignall
- Department of Psychology, University of Bournemouth, Poole, UK
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Coughlin LN, Zhang L, Bohnert ASB, Maust DT, Goldstick J, Lin LA. Patient characteristics and treatment utilization in fatal stimulant-involved overdoses in the United States Veterans Health Administration. Addiction 2022; 117:998-1008. [PMID: 34648209 DOI: 10.1111/add.15714] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/19/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND AIMS This study aimed to (1) describe trends in stimulant-alone and stimulant and other substance use overdose deaths from 2012 to 2018 and (2) measure patient and service use characteristics across stimulant-related overdose death profiles. DESIGN Retrospective cohort study of patients who died from stimulant-involved overdose between annual years 2012 and 2018. SETTING United States Veterans Health Administration (VHA). A total of 3631 patients died from stimulant-involved overdose, as identified through the National Death Index. MEASUREMENTS Stimulant-involved overdose deaths were categorized by stimulant type (cocaine or methamphetamine/other) and other substance co-involvement. Cause of death data were linked to patient characteristics, including demographic and treatment use preceding overdose from VHA administrative data. We examined trends over time and compared treatment use factors between the following mutually exclusive overdose profiles: cocaine alone, methamphetamine alone, cocaine + opioid, methamphetamine + opioid, any stimulant + other substance and cocaine + methamphetamine. FINDINGS The rate of overdose death was 3.06 times higher in 2018 than 2012, with increases across all toxicology profiles. Compared with cocaine-involved overdoses, methamphetamine-involved overdoses were less likely in people who were older [adjusted odds ratio (aOR) = 0.22, 95% confidence interval (CI) = 0.06-0.87 aged 65+ versus 18-29] and more likely among those who lived in rural areas (aOR = 2.73, 95% CI = 1.43-5.23). People who died from stimulant + opioid overdoses had lower odds of a stimulant use disorder diagnosis compared with stimulant alone deaths (cocaine: aOR = 0.55, 95% CI = 0.41-0.75, methamphetamine: aOR = 0.44, 95% CI = 0.29-0.68). CONCLUSIONS The rate of deaths among US Veterans from stimulant-related overdose was three times higher in 2018 than 2012. Key differences in characteristics of patients across overdose toxicology profiles, such as geographic location and health-care use, point to distinct treatment needs based on stimulant use type.
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Affiliation(s)
- Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.,University of Michigan Injury Prevention Center, Ann Arbor, MI, USA
| | - Lan Zhang
- Department of Veteran Affairs Healthcare System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA
| | - Amy S B Bohnert
- Department of Veteran Affairs Healthcare System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA.,Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Donovan T Maust
- Department of Veteran Affairs Healthcare System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA.,University of Michigan Injury Prevention Center, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jason Goldstick
- University of Michigan Injury Prevention Center, Ann Arbor, MI, USA
| | - Lewei Allison Lin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.,Department of Veteran Affairs Healthcare System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA.,University of Michigan Injury Prevention Center, Ann Arbor, MI, USA
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Exploring protective associations between the use of classic psychedelics and cocaine use disorder: a population-based survey study. Sci Rep 2022; 12:2574. [PMID: 35173246 PMCID: PMC8850431 DOI: 10.1038/s41598-022-06580-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/01/2022] [Indexed: 12/14/2022] Open
Abstract
Cocaine Use Disorder (CUD) is a significant public health problem associated with elevated morbidity and mortality within the United States. Current behavioral treatments have limited efficacy and there are currently no FDA approved pharmacological treatments for CUD. Classic psychedelics might be associated with lowered odds of substance misuse and may effectively treat various forms of addiction. Thus, the goal of this study is to assess protective associations that lifetime use of classic psychedelics may share with CUD within a nationally representative sample of the U.S. We used data from The National Survey on Drug Use and Health (NSDUH) (2015–2019) and conducted survey-weighted multivariable logistic regression to test whether each of four classic psychedelics (peyote, mescaline, psilocybin, LSD) conferred lowered odds of CUD and its related 11 sub-criteria. Participants were 214,505 adults in the NSDUH (2015–2019) aged 18 and older. Peyote conferred lowered odds of CUD, reducing the odds of CUD by over 50% (aOR: 0.47). All other substances (including other classic psychedelics) either shared no association to CUD or conferred increased odds of CUD. Furthermore, sensitivity analyses revealed peyote to confer sharply lowered odds of the majority (seven of 11) of CUD criteria as well (aOR range: 0.26–0.47). Peyote use is associated with lowered odds of CUD. Future inquiries into third variable factors (i.e., demographic/personality profiles of individuals who use peyote, motivational/contextual factors surrounding peyote use) that may underlie our observed associations may reveal protective factors that can inform treatment development for CUD. Additionally, future longitudinal studies can shed further light on whether there is a temporal link between peyote use and lowered odds of CUD.
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Liu Y, Richards VL, Gebru NM, Spencer EC, Cook RL. Associations amongst form of cocaine used (powder vs crack vs both) and HIV-related outcomes. Addict Behav Rep 2021; 14:100374. [PMID: 34938835 PMCID: PMC8664776 DOI: 10.1016/j.abrep.2021.100374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/20/2021] [Accepted: 09/01/2021] [Indexed: 11/06/2022] Open
Abstract
Among PWH, cocaine use vs no-use was associated with worse HIV treatment outcomes. Powder cocaine only users were more likely to be younger, Hispanic, and employed. Users of powder + crack cocaine had lower viral suppression than users of either alone. Harm reduction efforts addressing substance use should be a key component of HIV care.
Introduction Cocaine (including powder and crack) use is common among people with HIV (PWH). We identified socio-demographic and behavioral factors associated with cocaine use (overall and various forms) among PWH; we also examined differences in HIV treatment outcomes across cocaine exposure groups. Methods The study sample (N = 1166) was derived from two cohorts of PWH in Florida between 2014 and 2020. Baseline data were linked to the Enhanced HIV/AIDS Reporting System (eHARS) which tracks HIV viral load. Socio-demographics and polysubstance use were compared by cocaine use and the three cocaine use groups (powder only n = 101, crack only n = 91, or both n = 65). The association between the three cocaine use groups, ART adherence, and HIV viral suppression (<200 copies/mL) in the following year was assessed by multivariate logistic regression. Results People who used cocaine had lower HIV treatment adherence and viral suppression than those who did not use. People who used powder cocaine only were more likely to be younger, Hispanic/Latinx, and employed than those who used crack only or both. Compared to people who used both powder and crack cocaine, those who used one form of cocaine had 3 + odds of having durable viral suppression in the following year. Conclusion The dual use of both powder and crack cocaine was associated with significantly worse HIV outcomes compared to use of only one form of cocaine. Screening for powder and crack cocaine use and timely intervention are needed to improve HIV treatment outcomes among this high-risk population.
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Affiliation(s)
- Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Veronica L Richards
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Nioud Mulugeta Gebru
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Emma C Spencer
- Florida Department of Health, Bureau of Communicable Diseases, Tallahassee, FL, USA
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
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28
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Volkow ND. Addiction should be treated, not penalized. Neuropsychopharmacology 2021; 46:2048-2050. [PMID: 34404909 PMCID: PMC8369862 DOI: 10.1038/s41386-021-01087-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Nora D Volkow
- National Institute on Drug Abuse, Three White Flint North, North Bethesda, MD, USA.
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Amin-Esmaeili M, Susukida R, Johnson RM, Farokhnia M, Crum RM, Thrul J, Mojtabai R. Patterns of reduced use and abstinence in multi-site randomized controlled trials of pharmacotherapies for cocaine and methamphetamine use disorders. Drug Alcohol Depend 2021; 226:108904. [PMID: 34304121 DOI: 10.1016/j.drugalcdep.2021.108904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many individuals with cocaine or methamphetamine use disorders who enter treatment do not achieve abstinence but reduce their use of the target drug. We aimed to compare change in pattern of drug use (i.e., achieving "abstinence", "reduced use" or no reduction in use) among participants in randomized controlled trials (RCTs) of treatment of cocaine and methamphetamine use disorder, irrespective of the type of treatment. METHODS The data were drawn from 10 multi-site pharmacotherapy RCTs of cocaine (n = 1,134) and methamphetamine (n = 555) use disorders. The outcome patterns and their sociodemographic and clinical correlates were compared in cocaine and methamphetamine RCTs, using multinomial logistic regression models. Analyses were adjusted for missing data, clustering within RCTs, socio-demographic and baseline clinical characteristics, and treatment arms. RESULTS Those in cocaine RCTs were more likely to experience reduced use compared to participants in methamphetamine RCTs (20.6% vs. 13.2%, respectively), but less likely to experience "abstinence" (7.6% vs. 20.3%; Chi-squared = 14.20, df = 2, P < 0.001). Differences in "abstinence" persisted after adjustment for baseline covariates. Association of sociodemographic and clinical correlates with outcomes differed in cocaine and methamphetamine RCTs. CONCLUSION A sizeable proportion of individuals in RCTs of pharmacological treatment for stimulant use disorder who do not attain "abstinence" nevertheless reduce their use. The outcome patterns of drug use are different for cocaine and methamphetamine use disorders and reliance on abstinence as the sole outcome may obscure these differences.
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Affiliation(s)
- Masoumeh Amin-Esmaeili
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, 1336616357, Iran.
| | - Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, 21205, USA.
| | - Mehdi Farokhnia
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore, Bethesda, MD, USA.
| | - Rosa M Crum
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, 21205, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St. Baltimore, MD, 21287, USA.
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St. Baltimore, MD, 21287, USA.
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Dennermalm N, Scarlett J, Thomsen S, Persson KI, Alvesson HM. Sex, drugs and techno - a qualitative study on finding the balance between risk, safety and pleasure among men who have sex with men engaging in recreational and sexualised drug use. BMC Public Health 2021; 21:863. [PMID: 33952247 PMCID: PMC8097859 DOI: 10.1186/s12889-021-10906-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 04/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recreational and sexual drug use among men who have sex with men may result in increased risk of poor health. The aim of this study was to better understand drug use and harm reduction techniques among Swedish men who have sex with men traveling to Berlin in order to improve the health of this population and inform public health strategies. METHODS A qualitative study based on semi-structured interviews with 15 Swedish men aged 23-44 with experience of drug use were recruited through network sampling. Interviews were conducted in Stockholm and Berlin and analysed using content analysis. The interview guide included questions on drug use, context, health and safety. RESULTS The participants engaged in drug use in both settings and in various contexts. Participants saw themselves as capable of finding a balance between pleasure, safety and risk with the aim to maximize positive effects while minimizing negative ones. The different risks of drug use were known, and participants relied on knowledge, harm reduction strategies and self-defined rules of intake to stay safe and healthy in a broad sense, both short term (i.e. during each session) and long term. Choice of drug and, frequency of intake, multi-use, risk of overdose, risk of HIV, purpose and context of use, how often, etc. were all part of the overall strategy. Knowledge of these methods was spread within the community and on-line rather than from counsellors or other health care providers. However, it did not always translate perfectly into practice and some had experienced overdoses and problematic use. CONCLUSIONS The findings of this study point to the need for increased adoption of harm reduction techniques in this population focusing on mitigating harm and prevention of risk of problematic use or starting injection drugs. Existing traditional services require adaptations to become more accessible and acceptable to sub-groups of drug users, including low-threshold services providing non-judgemental, evidence-based information. This will require funding of alternative providers such as STI/HIV clinics, among others, and health care providers to increase adoption of prevention strategies, specifically pre-exposure prophylaxis for HIV.
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Affiliation(s)
- Nicklas Dennermalm
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Social Work, Stockholm University, Sveavägen 160, 113 46, Stockholm, Sweden.
| | - Julia Scarlett
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Sarah Thomsen
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
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Antoine J, Berndt N, Astudillo M, Cairns D, Jahr S, Jones A, Kuijpers W, Llorens N, Lyons S, Maffli E, Magliocchetti N, Molina Olivas M, Palle C, Schwarzkopf L, Wisselink J, Montanari L. Cocaine treatment demands in 10 western European countries: observed trends between 2011 and 2018. Addiction 2021; 116:1131-1143. [PMID: 32860458 PMCID: PMC8247055 DOI: 10.1111/add.15237] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/15/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023]
Abstract
AIMS To describe cocaine treatment demand in 10 western European countries and to examine the size, direction and temporality of recent trends in the proportion of cocaine users among all clients entering treatment. DESIGN Aggregated data collected through the European Union standardized treatment demand monitoring system (TDI) between 2011 and 2018 were used. SETTING Belgium, England, France, Germany, Ireland, Italy, Luxembourg, Spain, Switzerland and the Netherlands. PARTICIPANTS In total, more than 700 000 cocaine treatment records were analysed. Clients in treatment for cocaine as primary drug were predominantly male (85%), with an average age of 35 years. MEASUREMENTS Number of treatment episodes for substance use and for cocaine as primary or secondary drug were collected year- and country-wise. When available, powder cocaine and crack and patients with and without previous treatment were differentiated. FINDINGS Among the participating countries the share of cocaine as primary drug in treatment demand ranged between 4.7% [95% confidence interval (CI) = 4.6-4.9%] in Germany and 43.1% in Spain (95% CI = 42.6-43.5%). The general trend analysis showed a decreasing proportion of cocaine-related treatment entrants between 2011 and 2014 among all subgroups followed by a strong increase in 2015. The increase appeared stronger than for powder cocaine. Seven of 10 countries observed a recent significant increase in the proportion of treatment entrants reporting cocaine as the primary substance: Belgium [annual percentage change (APC) = 9.6%, P < 0.01], England (APC = 14.9%, P < 0.05), France (APC = 21.8%, P < 0.01), Ireland (APC = 28.2%, P < 0.01), Italy (APC = 7.8%, P < 0.01), Spain (APC = 7.0%, P < 0.05) and Switzerland (APC = 12.0%, P < 0.05). Trends were similar when looking at cocaine reported as primary or adjunctive substance. CONCLUSIONS Despite substantial country-specific variation regarding cocaine prevalence and treatment demand, there has been an overall significant increase since 2015 in the share of cocaine-related treatment demand in western Europe.
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Affiliation(s)
| | - Nadine Berndt
- Ministry of Health, Directorate of Health, Department of Epidemiology and StatisticsLuxembourg
| | | | | | | | | | - Wil Kuijpers
- Stichting Informatievoorziening Zorg (IVZ), Houtenthe Netherlands
| | - Noelia Llorens
- Ministry of Health, Spanish National Plan on DrugsMadridSpain
| | | | | | | | | | - Christophe Palle
- French Monitoring Center on Drugs and Drugs AddictionParisFrance
| | | | - Jeroen Wisselink
- Stichting Informatievoorziening Zorg (IVZ), Houtenthe Netherlands
| | - Linda Montanari
- European Monitoring Center for Drugs and Drug AddictionLisbonPortugal
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McCormack M, Measham F, Wignall L. The Normalization of Leisure Sex and Recreational Drugs: Exploring Associations Between Polydrug Use and Sexual Practices by English Festival-Goers. ACTA ACUST UNITED AC 2021. [DOI: 10.1177/00914509211009901] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The relationship between drug use and sexual practice is complex. Significant focus has been placed on risky practices, yet the broader associations between drug use and sexual activities remain elusive outside such contexts. This is despite similar trends of liberalizing attitudes and practices being identified in each area, theorized as the normalization of recreational drug use and the liberalization of consensual sexual practice. In this article, we draw on convenience sample surveys of 966 festival-goers at an English music festival in 2016 and 2019 to assess prevalence of polydrug use and to examine whether people who consume illicit drugs are more likely to engage in sexual behaviors considered more liberal than the traditional norm. We show that people who reported polydrug use in the last 12 months were significantly more likely to engage in non-traditional sexual behaviors, including sex with a friend and anal sex, in that same time period. In combining and comparing two usually distinct discourses, this exploratory study suggests that the normalization of drugs and the liberalization of consensual sexual practices are related and can be conceptualized as part of a broader societal acceptance and cultural accommodation of illicit drug use and particular sexual practices as leisure activities, despite markedly different policy and legal contexts for each activity. We conclude that the concept of “normalization” may be more appropriate to understanding changes in sexuality than “liberalization” in the context of “leisure sex” and call for further cross-disciplinary research on drugs and sex using this approach.
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Affiliation(s)
- Mark McCormack
- Department of Social Sciences, University of Roehampton, London, United Kingdom
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Peacock A, Tran LT, Larney S, Stockings E, Santo T, Jones H, Santomauro D, Degenhardt L. All-cause and cause-specific mortality among people with regular or problematic cocaine use: a systematic review and meta-analysis. Addiction 2021; 116:725-742. [PMID: 32857457 PMCID: PMC7914269 DOI: 10.1111/add.15239] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/02/2020] [Accepted: 08/24/2020] [Indexed: 12/29/2022]
Abstract
AIMS To estimate pooled all-cause and cause-specific mortality risk for people with regular or problematic cocaine use. METHODS Systematic review and meta-analysis of prospective or retrospective cohort studies or clinical trials (n ≥30) of people with regular or problematic cocaine use with data on all-cause or cause-specific mortality. Of 2808 papers, 28 were eligible and reported on 21 cohorts, with a total 170 019 individuals. Cohorts identified based on acute care for drug poisoning or other severe health presentation were excluded. Title/abstract screening was conducted by one reviewer; a second reviewer independently checked 10% of excluded studies. Two reviewers conducted full-text screening. Data were extracted by one reviewer and checked by a second. A customized review-specific study reporting quality/risk of bias tool was used. Data on crude mortality rates (CMR) and standardized mortality ratios were extracted for both all-cause and cause-specific mortality. Standardized mortality ratios were imputed where not provided by the author using extracted data and information from the Global Burden of Disease Study 2017. Data were pooled using a random-effects model. RESULTS The pooled all-cause crude mortality rate was 1.24 per 100 person-years [95% confidence interval (CI) = 0.86, 1.78; n = 16 cohorts], but with considerable heterogeneity (I2 = 98.8%). The pooled all-cause standardized mortality ratio (SMR) was 6.13 (95% CI = 4.15, 9.05; n = 16 cohorts). Suicide (SMR = 6.26, 95% CI = 2.84, 13.80), accidental injury (SMR = 6.36, 95% CI = 4.18, 9.68), homicide (SMR = 9.38, 95% CI 3.45-25.48) and AIDS-related mortality (SMR = 23.12, 95% CI = 11.30, 47.31) were all elevated compared with age and sex peers in the general population. CONCLUSIONS There are elevated rates of mortality among people with regular or problematic cocaine use for traumatic deaths and deaths attributable to infectious disease.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia,School of Psychology, University of Tasmania, Hobart, Australia
| | - Lucy Thi Tran
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - Thomas Santo
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - Hayley Jones
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Damian Santomauro
- Queensland Centre for Mental Health Research and School of Public Health, University of Queensland, Brisbane, Australia,Institute for Health metrics and Evaluation, University of Washington, Washington, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
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Fine DR, Herzberg D, Wakeman SE. Societal Biases, Institutional Discrimination, and Trends in Opioid Use in the USA. J Gen Intern Med 2021; 36:797-801. [PMID: 32556873 PMCID: PMC7947135 DOI: 10.1007/s11606-020-05974-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
History has demonstrated cyclical trends in opioid use in the USA, alternating between high rates of prescribing driven by compassion and marketing and restrictive prescribing driven by stigma and fear of precipitating addiction and other harms. Two under-recognized yet powerful forces driving these trends are societal biases against individuals who use and are addicted to drugs, as well as a recognized social determinant of health, institutional discrimination. In the context of these influential forces, which are often based on racist and classist ideologies, we examine the history of opioid use in the USA from the 1800s when the vast majority of those addicted to opioids were middle- to upper-class women to the present-day white-washed narrative of the opioid crisis. As the demographics of those affected by opioid use and addiction has started to shift from white communities to communities of color, we cannot allow the preliminary success observed in white communities to obscure rising mortality rates from opioids in black and Latinx communities. To do so, we highlight ways to prevent racist and classist ideologies from further shaping responses towards opioid use. It is important to acknowledge the long history that has influenced responses to opioid use in the USA and take active steps towards promoting a sense of compassion towards all individuals who use and those who are addicted to drugs.
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Affiliation(s)
- Danielle R Fine
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital , Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - David Herzberg
- Department of History, University at Buffalo College of Arts and Sciences, Buffalo, NY, USA
| | - Sarah E Wakeman
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital , Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Dogan J, Stevens-Watkins D, Knighton JS, Wheeler P, Hargons C. Perceived need for drug treatment among African American male drug-using prisoners. J Subst Abuse Treat 2021; 120:108166. [PMID: 33298302 PMCID: PMC7733029 DOI: 10.1016/j.jsat.2020.108166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/30/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
Since 2016, African Americans have experienced the largest increase in cocaine-related drug overdose deaths compared to other racial/ethnic groups. African American male prisoners who used drugs prior to incarceration are at an increased risk for relapse and overdose upon community re-entry. Using the Theory of Planned Behavior as a guiding framework, this study examined correlates of perceived need for treatment among 193 drug-using incarcerated African American men nearing release. Linear regression analyses revealed that the number of lifetime drug overdoses, severity of legal problems, and previous drug treatment significantly predicted a need for treatment. Further, more frequent drug use, specifically crack cocaine, in the month prior to incarceration predicted a higher perceived need for drug treatment. Implications suggest this population demonstrates a need for treatment, which may be exacerbated by re-entry stressors. Preventative measures, including culturally tailored treatment and transitional care from prison to community-based services, are necessary to reduce risk of relapse and overdose among this group.
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Affiliation(s)
- Jardin Dogan
- University of Kentucky, Department of Educational, School, and Counseling Psychology, , 36 Dickey Hall, 251 Scott Street, Lexington, KY 40503, United States of America.
| | - Danelle Stevens-Watkins
- University of Kentucky, Department of Educational, School, and Counseling Psychology, 235 Dickey Hall, 251 Scott Street, Lexington, KY 40503, United States of America.
| | - Joi-Sheree Knighton
- Center for Forensic Psychiatry, Michigan Department of Health and Human Services (MDHHS), P.O. Box 2060, Ann Arbor, MI 48160, United States of America.
| | - Paris Wheeler
- University of Kentucky, Department of Educational, School, and Counseling Psychology, 235 Dickey Hall, 251 Scott Street, Lexington, KY 40503, United States of America.
| | - Candice Hargons
- University of Kentucky, Department of Educational, School, and Counseling Psychology, 239 Dickey Hall, 251 Scott Street, Lexington, KY 40503, United States of America.
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Cano M, Oh S, Salas-Wright CP, Vaughn MG. Cocaine use and overdose mortality in the United States: Evidence from two national data sources, 2002-2018. Drug Alcohol Depend 2020; 214:108148. [PMID: 32702620 PMCID: PMC7423708 DOI: 10.1016/j.drugalcdep.2020.108148] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/24/2020] [Accepted: 06/27/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cocaine-involved overdose mortality has recently risen in the United States (US), yet it is unclear to what extent patterns in cocaine-involved overdose mortality parallel patterns in cocaine use. This study: examined time trends (2002-2018) in past-year cocaine use and cocaine-involved overdose mortality in the US; and compared demographics and drug involvement of adults who reported past-year cocaine use versus adults who died of a cocaine-involved overdose. METHODS Data from two sources were utilized: (1) the National Survey on Drug Use and Health (n = 1,334 adults self-reporting cocaine use in 2018); and (2) the Multiple Cause of Death dataset of the National Center for Health Statistics (N = 14,630 adults who died of a cocaine-involved overdose in 2018). The study examined prevalence of past-year cocaine use, mortality rates for cocaine-involved overdose, 2002-2018 trends, demographic characteristics, and involvement of other drugs. RESULTS Results of Joinpoint Regression indicated that the prevalence of past-year cocaine use increased after 2011, with an annual percent change of 5.13, while age-adjusted cocaine-involved overdose mortality rates escalated after 2012, with an annual percent change of 26.54. In 2018, prevalence of past-year cocaine use did not significantly differ (p = 0.09) by racial/ethnic group, yet Non-Hispanic Blacks had an age-adjusted cocaine-involved overdose mortality rate more than double the rate in Non-Hispanic Whites and significantly higher (p < 0.001) than in any other group. CONCLUSIONS While the prevalence of cocaine use has increased modestly, cocaine-involved overdose mortality has risen dramatically. Cocaine-involved overdose mortality is disproportionately affecting individuals who are Black, older, or with lower educational attainment.
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Affiliation(s)
- Manuel Cano
- Department of Social Work, University of Texas at San Antonio, 501 W. César E. Chávez Blvd., San Antonio, TX, 78207, USA.
| | - Sehun Oh
- College of Social Work, The Ohio State University, 1947 College Rd., Columbus, OH 43210, USA
| | - Christopher P. Salas-Wright
- School of Social Work, Boston University, 264 Bay State Rd, Boston, MA 02215, USA,Department of Public Health Sciences, Division of Prevention Science & Community Health, University of Miami, Miami, FL, USA
| | - Michael G. Vaughn
- School of Social Work, St. Louis University, 3550 Lindell Blvd., St. Louis, MO 63103, USA,Graduate School of Social Welfare and College of Social Science, Yonsei University, Republic of Korea
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Eiden C, Vincent M, Serrand C, Serre A, Richard N, Picot MC, Frauger E, Fouilhé N, Daveluy A, Peyrière H. Health consequences of cocaine use in France: data from the French Addictovigilance Network. Fundam Clin Pharmacol 2020; 35:455-465. [PMID: 32854152 DOI: 10.1111/fcp.12603] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/06/2020] [Accepted: 08/17/2020] [Indexed: 12/20/2022]
Abstract
As the number and severity of complications related to cocaine use reported to the French Addictovigilance Network have increased, the French health authorities requested a national epidemiologic study of the data collected by this network from 2010 to 2016. For this purpose, the spontaneous reports (SRs) linked to cocaine notified by health professionals were analyzed as well as the data from the pharmacoepidemiological surveys OPPIDUM (observation of illegal drugs and misuse of psychotropic medications) and DRAMES (deaths related to the abuse of licit and illicit psychoactive substances). In total, 1 265 SRs were analyzed (510% increase from 2010 to 2016). Users were mainly men (952/1 261; 75%), with a median age of 35.0 years [IQ25-75 : 28-42]. Cocaine was consumed through the intranasal route by 52% of users (416/797), followed by intravenous administration (32%, 253/797) and inhalation (24%, 190/797). The use of cocaine powder and crack cocaine was reported in 70% (475/674) and 23% (154/674) of SRs, respectively. Cocaine was consumed with other psychoactive substances and alcohol in 47% (603/1265) and 60% (387/649) of cases, respectively. The main cocaine-related complications were psychiatric complications (29%), neurologic complications (24%) and cardiovascular complications (23%). Analysis of the OPPIDUM survey data showed that in 2016, 15.9 and 2.4% of the included subjects consumed cocaine or crack cocaine the week preceding the survey, the highest rate for the 2006-2016 period. The DRAMES survey indicated that cocaine-related deaths increased by threefold from 2014 to 2016. These data confirm that cocaine use in France is worrying with an increase in the number of severe complications and deaths.
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Affiliation(s)
- Céline Eiden
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
| | - Marc Vincent
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
| | - Chris Serrand
- Unité de Recherche Clinique et d'Epidémiologie, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
| | - Anais Serre
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
| | - Nathalie Richard
- ANSM Agence Nationale de Sécurité du Médicament et des Produits de Santé, Saint-Denis, 93285, France
| | - Marie-Christine Picot
- Unité de Recherche Clinique et d'Epidémiologie, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
| | - Elisabeth Frauger
- Service de Pharmacologie Clinique et Pharmacovigilance, Centre d'Evaluation et d'Information sur la Pharmacodependance Paca Corse, Hôpital de la Timone, Marseille, 13005, France
| | - Nathalie Fouilhé
- Centre d'Addictovigilance, CHU de Grenoble, Grenoble cedex 9, 38043, France
| | - Amélie Daveluy
- Centre d'Addictovigilance, Service de Pharmacologie Médicale, CHU de Bordeaux, INSERM U657, Place Amélie Raba-Léon, Bordeaux, 33000, France
| | - Hélène Peyrière
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
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Montgomery L, Friedmann P, Abraham A, Evans E, Glass J, Ilgen M. Editorial: Health equity in substance use disorder treatment. J Subst Abuse Treat 2020; 118:108101. [PMID: 32807568 DOI: 10.1016/j.jsat.2020.108101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- LaTrice Montgomery
- University of Cincinnati College of Medicine, Cincinnati, OH, United States of America.
| | - Peter Friedmann
- University of Massachusetts Medical School-Baystate, Baystate Health, Springfield, MA, United States of America
| | - Amanda Abraham
- University of Georgia, Augusta, GA, United States of America
| | - Elizabeth Evans
- University of Massachusetts-Amherst, Amherst, MA, United States of America
| | - Joseph Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Mark Ilgen
- University of Michigan, Center for Clinical Management Research, Ann Arbor VA Healthcare System, Ann Arbor, MI, United States of America
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Longitudinal patterns of illicit drug use, antiretroviral therapy exposure and plasma HIV-1 RNA viral load among HIV-positive people who use illicit drugs. AIDS 2020; 34:1389-1396. [PMID: 32590435 DOI: 10.1097/qad.0000000000002551] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES HIV-positive people who use illicit drugs (PWUD) experience elevated rates of HIV-associated morbidity and mortality compared with members of other key affected populations. Although suboptimal levels of access and adherence to antiretroviral therapy (ART) are common among HIV-positive PWUD, there is a need for studies investigating the possible biological impacts of noninjection illicit drug use among people living with HIV in real-world settings. METHODS We accessed data from the ACCESS study, an ongoing prospective cohort of illicit drug users with systematic HIV viral load monitoring in a setting with universal care and ART dispensation records. We used multivariable generalized linear mixed models to estimate the longitudinal associations between noninjection use of crack cocaine, powder cocaine, opioids, methamphetamine, cannabis and alcohol on plasma HIV-1 RNA viral load, adjusted for ART exposure and relevant confounders. RESULTS Between 2005 and 2018, 843 individuals from the ACCESS cohort were included and contributed to 8698 interviews. At baseline, the mean age was 43 years, 566 (67%) reported male sex and 659 (78%) used crack cocaine in the previous 6 months. In multivariable models adjusted for ART exposure, only crack cocaine use in the last 6 months was found to be significantly associated with higher HIV viral load. CONCLUSION We observed significantly higher HIV viral load during periods of crack cocaine use independent of ART exposure. Our findings support further research to investigate the possible biological mechanisms of this effect.
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The association between quantity, frequency and duration of cocaine use during the heaviest use period and DSM-5 cocaine use disorder. Drug Alcohol Depend 2020; 213:108114. [PMID: 32563848 DOI: 10.1016/j.drugalcdep.2020.108114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/02/2020] [Accepted: 06/06/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Quantity (Q), frequency (F), and duration (D) of cocaine use during a person's heaviest use period are important aspects of cocaine use patterns that associated with cocaine use disorder (CocUD). METHODS A total 2988 lifetime cocaine users who met CocUD after the onset of cocaine heaviest use were identified from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). QFD were each categorized into four levels. Hierarchical regressions were used to examine the association between QFD of cocaine use and CocUD. Two-way interactions between QFD were also examined. RESULTS As the level of cocaine use increased from low to very high, the prevalence of CocUD increased. Compared to people with low F, cocaine users with very high F were 12.09 times (95 %CI 6.33, 23.07) as likely to meet criteria for CocUD. Similarly, Q was associated with 4.84 (95 %CI 2.55, 9.18) times the risk of CocUD. D was not significantly associated with the risk of CocUD. Significant additive interaction was identified between Q*F on CocUD prevalence. Approximately one-third of the excess risk associated with having high Q & high F was due to the interactive effect. CONCLUSION Of these three cocaine use patterns, F had the strongest association with CocUD, followed by the Q. High Q and high F was a very dangerous pattern of cocaine use as the combination had as a synergistic effect on the risk of CocUD. It is important for intervention programs to focus on the reduction of both Q and F.
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Montgomery L, Burlew AK, Haeny AM, Jones CA. A systematic scoping review of research on Black participants in the National Drug Abuse Treatment Clinical Trials Network. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:117-127. [PMID: 31246072 PMCID: PMC6933111 DOI: 10.1037/adb0000483] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Black individuals experience a disproportionate burden of substance-related disabilities and premature death relative to other racial/ethnic groups, highlighting the need for additional research. The National Drug Abuse Treatment Clinical Trials Network (CTN), a research platform for multisite behavioral, pharmacological, and integrated trials designed to evaluate the effectiveness of substance use treatments in community settings with diversified patient populations, provides a wealth of research knowledge on substance use. Although CTN trials have enrolled over 5,000 Black individuals since its inception in 2000, there has been no synthesis of the findings, discussion of the implications, or suggestions for future research for Black individuals. Members of the Minority Interest Group of the CTN conducted a scoping review of published research on Black participants in CTN trials. Studies were included if the sample was more than 75% Black and/or specific findings pertaining to Black participants were reported. The review yielded 50 articles, with studies that mostly focused on baseline characteristics, followed by substance use treatment outcomes, HIV/risky sex behaviors, retention, comorbid conditions and measurement issues. This review highlighted the importance of several issues that are critical to understanding and treating substance misuse among Black people, such as the characteristics of Black people entering treatment, measurement equivalence, and engaging/retaining adolescents and young adults in treatment. There is still a continued need to identify the most effective treatments for Black individuals who use substances. The CTN offers several untapped opportunities to further advance research on Black individuals who use substances (e.g., secondary analyses of publicly available data). (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Nesoff ED, Branas CC, Martins SS. The Geographic Distribution of Fentanyl-Involved Overdose Deaths in Cook County, Illinois. Am J Public Health 2020; 110:98-105. [PMID: 31725315 PMCID: PMC6893352 DOI: 10.2105/ajph.2019.305368] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2019] [Indexed: 11/04/2022]
Abstract
Objectives. To contrast the geographic distribution of fentanyl-involved and non-fentanyl-involved fatal overdoses between 2014 and 2018 in Cook County, Illinois.Methods. We conducted a spatial analysis using locations of fentanyl-involved fatal overdoses (n = 1433) compared with nonfentanyl opioid and polydrug fatal overdoses (n = 1838) collected through the Cook County Medical Examiner's Office from 2014 to 2018. We also used logistic regression to test significant individual- and neighborhood-level covariates.Results. Fentanyl overdoses geographically clustered more than nonfentanyl overdoses, and this difference was statistically significant. One area in particular showed significantly elevated risk for fentanyl overdoses (P < .05) located in 2 specific neighborhoods of Chicago. The odds of a fentanyl-involved overdose were significantly increased for men, Blacks, Latinos/as, and younger individuals. Neighborhood deprivation score was the only significant neighborhood-level predictor (odds ratio = 1.11; 95% confidence interval = 1.07, 1.17).Conclusions. Fentanyl-involved fatal overdoses follow a distinct geographic distribution associated with resource deprivation in neighborhoods where they occur. This suggests an evolving bifurcated drug market, with drug markets in resource-deprived neighborhoods disproportionately likely to include fentanyl.
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Affiliation(s)
- Elizabeth D Nesoff
- The authors are with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Charles C Branas
- The authors are with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Silvia S Martins
- The authors are with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
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Mezaache S, Briand-Madrid L, Laporte V, Mora M, Moudachirou K, Rojas Castro D, Carrieri P, Roux P. Correlates of Self-Reported Cotton Fever Experience among People Who Inject Opioids. Subst Use Misuse 2020; 55:1021-1027. [PMID: 32009485 DOI: 10.1080/10826084.2020.1720247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Cotton fever is a febrile syndrome occurring after intravenous drug injection. Although its clinical presentation is well described in the literature, data regarding prevention is lacking. We aimed to assess proportion and correlates of cotton fever experience among people who inject opioids. Methods: We performed a cross-sectional study using data from the community-based survey PrebupIV conducted in France in 2015 among 557 people who regularly injected opioids. Self-reported sociodemographic data, together with data on substance use, injecting practices and occurrence of cotton fever were all collected through face-to-face (n = 398) or online (n = 159) questionnaires. Factors associated with cotton fever experience were assessed using logistic regression model. Results: Over half of the participants (54%) reported cotton fever experience. In the multivariable logistic regression, crack cocaine injection (adjusted Odds Ratio (aOR) = 1.96, 95% Confidence Interval (CI) = 1.03-3.63), longer duration of opioid use (for 1 year of use: aOR = 1.05, 95%CI = 1.02-1.09), and filtering mainly with cotton filters (compared with membrane filters, aOR = 1.86, 95%CI = 1.24-2.78) were all associated with cotton fever experience. Conclusions: Our findings highlight that cotton fever is a frequent complication of injecting drug use. Avoiding the use and reuse of cotton balls to filter injected solutions, and promoting membrane filters use could reduce the risk of the condition occurring.
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Affiliation(s)
- Salim Mezaache
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.,Observatoire régional de la santé Provence-Alpes-Côte d'Azur, ORS PACA, Marseille, France
| | - Laélia Briand-Madrid
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.,Observatoire régional de la santé Provence-Alpes-Côte d'Azur, ORS PACA, Marseille, France
| | | | - Marion Mora
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.,Observatoire régional de la santé Provence-Alpes-Côte d'Azur, ORS PACA, Marseille, France
| | | | - Daniela Rojas Castro
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.,Observatoire régional de la santé Provence-Alpes-Côte d'Azur, ORS PACA, Marseille, France.,Coalition Plus, Pantin, France.,Groupe de Recherche en Psychologie Sociale (EA 4163), Université Lyon 2, Bron, France
| | - Patrizia Carrieri
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.,Observatoire régional de la santé Provence-Alpes-Côte d'Azur, ORS PACA, Marseille, France
| | - Perrine Roux
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.,Observatoire régional de la santé Provence-Alpes-Côte d'Azur, ORS PACA, Marseille, France
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Janssen E, Cadet-Taïrou A, Gérome C, Vuolo M. Estimating the size of crack cocaine users in France: Methods for an elusive population with high heterogeneity. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 76:102637. [PMID: 31881370 DOI: 10.1016/j.drugpo.2019.102637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/21/2019] [Accepted: 12/14/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite several sources corroborating an expanding market and increased visibility and greater diversity in users' profiles, very little is known about the number of crack cocaine users in France. METHOD The estimates rely on a single data source capture-recapture method. Annual data are extracted from treatment centres nationwide. To account for heterogeneity, we use an innovative zero-truncated geometric, regression-based estimator controlling for individual and centre characteristics. We use the well-known Zelterman estimator as a benchmark. RESULTS The number of crack cocaine users received in treatment centres increased dramatically, from 3388 in 2010 to 5143 in 2017 (+52%). The estimated number of crack cocaine users is believed to have tripled over the course of the same period (from 9775, 95% CI [8288-11530] to 28983 [24876-33766], respectively), with prevalences below 1‰, similar to other European countries. The coverage rate (observed number/estimated number of users) decreased in a similar fashion, indicating lower utilization. In particular, females and younger users are underestimated by data from treatment centres. CONCLUSION The prevalence of crack cocaine use is fairly low but steadily increasing. The diversity in users' profiles is a challenge to prevention and public health policies that should expand their scope to a more inclusive perspective of what defines crack cocaine users. Our method overcomes several methodological issues (data sources, data linkage, heterogeneity) and can be easily applied to a wide range of settings.
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Affiliation(s)
- Eric Janssen
- French Monitoring Centre on Drugs and Drug Addiction (Observatoire Français des Drogues et Toxicomanies - OFDT), 69 rue de Varenne, 75007 Paris, France.
| | - Agnès Cadet-Taïrou
- French Monitoring Centre on Drugs and Drug Addiction (Observatoire Français des Drogues et Toxicomanies - OFDT), 69 rue de Varenne, 75007 Paris, France
| | - Clément Gérome
- French Monitoring Centre on Drugs and Drug Addiction (Observatoire Français des Drogues et Toxicomanies - OFDT), 69 rue de Varenne, 75007 Paris, France
| | - Michael Vuolo
- Department of Sociology, Ohio State University, 238 Townsend Ave, 1885 Neil Avenue Mall, Columbus, OH 43210, USA
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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: 48] [Impact Index Per Article: 8.0] [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.
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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
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George JR, Michaels TI, Sevelius J, Williams MT. The psychedelic renaissance and the limitations of a White-dominant medical framework: A call for indigenous and ethnic minority inclusion. JOURNAL OF PSYCHEDELIC STUDIES 2019. [DOI: 10.1556/2054.2019.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In recent years, the study of psychedelic science has resurfaced as scientists and therapists are again exploring its potential to treat an array of psychiatric conditions, such as depression, post-traumatic stress disorder, and addiction. The scientific progress and clinical promise of this movement owes much of its success to the history of indigenous healing practices; yet the work of indigenous people, ethnic and racial minorities, women, and other disenfranchised groups is often not supported or highlighted in the mainstream narrative of psychedelic medicine. This review addresses this issue directly: first, by highlighting the traditional role of psychedelic plants and briefly summarizing the history of psychedelic medicine; second, through exploring the historical and sociocultural factors that have contributed to unequal research participation and treatment, thereby limiting the opportunities for minorities who ought to be acknowledged for their contributions. Finally, this review provides recommendations for broadening the Western medical framework of healing to include a cultural focus and additional considerations for an inclusive approach to treatment development and dissemination for future studies.
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Affiliation(s)
- Jamilah R. George
- 1 Department of Psychiatry, Yale University, New Haven, CT, USA
- 2 Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Timothy I. Michaels
- 2 Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Jae Sevelius
- 3 Department of Medicine, University of California, San Francisco, CA, USA
| | - Monnica T. Williams
- 2 Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
- 4 School of Psychology, University of Ottawa, Ottawa, ON, Canada
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Moore KE, Oberleitner L, Pittman BP, Roberts W, Verplaetse TL, Hacker RL, Peltier MR, McKee SA. The Prevalence of Substance Use Disorders among Community-based Adults with Legal Problems in the U.S. ADDICTION RESEARCH & THEORY 2019; 28:165-172. [PMID: 32952490 PMCID: PMC7500665 DOI: 10.1080/16066359.2019.1613524] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 05/29/2023]
Abstract
BACKGROUND Current national prevalence estimates of DSM-5 diagnosed substance use disorders (SUDs) among adults with justice system involvement are lacking. METHODS This study drew from NESARC-III data (n = 36,309; 2012-2013), a nationally representative U.S. sample, to examine current and lifetime alcohol use disorder (AUD) and drug use disorder (DUD) diagnoses among adults reporting current or prior drug-related, alcohol-related, and general legal problems. RESULTS Adults reporting current alcohol-related legal problems were 22 times more likely to have a current AUD diagnosis (AOR = 22.0, 95% CI = 12.1; 40.1) and 15 times more likely to have had a lifetime AUD diagnosis (AOR = 15.2, 95% CI = 7.5; 30.9) than adults without alcohol-related legal problems. Adults with lifetime drug-related legal problems were 3-5 times more likely to have a current (AOR = 2.6, 95% CI = 2.1; 3.2) and lifetime (AOR = 5.1, 95% CI = 4.3; 6.1) DUD diagnosis, with stimulant use disorder being the most prevalent (AOR = 5.4, 95% CI = 4.5; 6.5). Adults with general legal problems were around 3 times more likely to have a current AUD (AOR = 3.2, 95% CI = 2.6; 4.0) or DUD (AOR = 3.5, 95% CI = 2.8; 4.4). Women with any type of legal problem were more likely to have SUD diagnoses than men. CONCLUSIONS SUD diagnoses are prevalent among adults reporting legal problems, particularly those involving alcohol. There is a continued need for community-based addiction prevention and intervention efforts, especially for women with justice system involvement.
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Affiliation(s)
- Kelly E. Moore
- East Tennessee State University, Department of Psychology, 420 Rogers-Stout Hall, P.O. Box 70649, Johnson City, TN 37614
| | - Lindsay Oberleitner
- Yale University School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven, CT 06519
| | - Brian P. Pittman
- Yale University School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven, CT 06519
| | - Walter Roberts
- Yale University School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven, CT 06519
| | - Terril L. Verplaetse
- Yale University School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven, CT 06519
| | - Robyn L. Hacker
- Center for Dependency, Addiction, and Rehabilitation, University of Colorado Boulder, 1693 N. Quentin St., Aurora, CO 80045
| | - MacKenzie R. Peltier
- Yale University School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven, CT 06519
| | - Sherry A. McKee
- Yale University School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven, CT 06519
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Schwartz RP, Kelly SM, Mitchell SG, Gryczynski J, O'Grady KE, Jaffe JH. Initiating methadone in jail and in the community: Patient differences and implications of methadone treatment for reducing arrests. J Subst Abuse Treat 2019; 97:7-13. [PMID: 30577902 PMCID: PMC6310067 DOI: 10.1016/j.jsat.2018.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/16/2018] [Accepted: 11/18/2018] [Indexed: 10/27/2022]
Abstract
The extent to which patient characteristics differ between individuals entering methadone treatment through community programs and jail-based programs is not known. Such differences could impact the likelihood of relapse and recidivism in these two populations and inform efforts at targeting interventions. We compared treatment-entry characteristics of participants enrolling in methadone treatment in two studies conducted in Baltimore, one conducted in community programs (N = 295) and the other in a jail-based program (N = 225). Controlling for age, race, and gender, individuals starting methadone treatment in jail compared to the community, had more severe drug use and criminal justice profiles. These different characteristics suggest that patients initiating methadone in a jail-based program could have greater likelihood of future arrest compared to patients entering community-based treatment. CLINICAL TRIALS REGISTRATION: Clinicaltrials.gov NCT 02334215 and NCT 01442493.
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Affiliation(s)
| | | | | | | | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
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Nicholson HL, Ford JA. Sociodemographic, neighborhood, psychosocial, and substance use correlates of cocaine use among Black adults: Findings from a pooled analysis of national data. Addict Behav 2019; 88:182-186. [PMID: 30218941 DOI: 10.1016/j.addbeh.2018.08.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 08/31/2018] [Accepted: 08/31/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Cocaine use (CU) is serious a public health issue affecting U.S. adults, including Blacks. Cocaine-related overdose deaths have also trended upwards among this population. However, there remains a lack of research on correlates of CU among a nationally representative sample of Black adults. METHODS The current study examines the prevalence and correlates of past-year CU among Black adults aged 18 and older (N = 9,821). Data from the National Survey on Drug Use and Health (2015-2016) were used and a weighted logistic regression model was estimated. RESULTS Findings showed 2.4% of Black adults reported past-year CU-significantly higher than rates of CU among other assessed racial groups. Opioid use/misuse, encounters with drug dealers, easier access to cocaine, unemployment, and being 35 or older were associated with increased odds of CU. Greater risk perception of CU and religiosity were associated decreased odds of CU. CONCLUSION Results identified several correlates associated with past-year CU among Black adults. Findings suggest addressing CU among this population will likely require the development of multilevel prevention and intervention strategies and an increased focus on opioid use/misuse as opioids have been recently implicated in cocaine-related overdose deaths.
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Affiliation(s)
| | - Jason A Ford
- University of Central Florida, Department of Sociology, United States
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50
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Walker LS, Mezuk B. Mandatory minimum sentencing policies and cocaine use in the U.S., 1985-2013. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:43. [PMID: 30497476 PMCID: PMC6267913 DOI: 10.1186/s12914-018-0182-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/16/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND As of May 2017, the United States federal government renewed its prioritization for the enforcement of mandatory minimum sentences for illicit drug offenses. While the effect of such policies on racial disparities in incarceration is well-documented, less is known about the extent to which these laws are associated with decreased drug use. This study aims to identify changes in cocaine use associated with mandatory minimum sentencing policies by examining differential sentences for powder and crack cocaine set by the Anti-Drug Abuse Act (ADAA) (100:1) and the Fair Sentencing Act (FSA), which reduced the disparate sentencing to 18:1. METHODS Using data from National Survey on Drug Use and Health, we examined past-year cocaine use before and after implementation of the ADAA (1985-1990, N = 21,296) and FSA (2009-2013, N = 130,574). We used weighted logistic regressions and Z-tests across models to identify differential change in use between crack and powder cocaine. Prescription drug misuse, or use outside prescribed indication or dose, was modeled as a negative control to identify underlying drug trends not related to sentencing policies. RESULTS Despite harsher ADAA penalties for crack compared to powder cocaine, there was no decrease in crack use following implementation of sentencing policies (odds ratio (OR): 0.72, p = 0.13), although both powder cocaine use and misuse of prescription drugs (the negative control) decreased (OR: 0.59, p < 0.01; OR: 0.42, p < 0.01 respectively). Furthermore, there was no change in crack use following the FSA, but powder cocaine use decreased, despite no changes to powder cocaine sentences (OR: 0.81, p = 0.02), suggesting that drug use is driven by factors not associated with sentencing policy. CONCLUSIONS Despite harsher penalties for crack versus powder cocaine, crack use declined less than powder cocaine and even less than drugs not included in sentencing policies. These findings suggest that mandatory minimum sentencing may not be an effective method of deterring cocaine use.
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Affiliation(s)
- Lauryn Saxe Walker
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 E. Main St, Richmond, VA USA
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI USA
- Institute for Social Research, University of Michigan, 426 Thompson St, Ann Arbor, MI USA
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, 830 E. Main St, Richmond, VA USA
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