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Worster B, Meghani SH, Leader AE, Nugent SM, Jones KF, Yeager KA, Liou K, Ashare RL. Toward reducing racialized pain care disparities: Approaching cannabis research and access through the lens of equity and inclusion. Cancer 2024; 130:497-504. [PMID: 37941524 PMCID: PMC11212108 DOI: 10.1002/cncr.35115] [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] [Indexed: 11/10/2023]
Abstract
There is growing interest in cannabis use for cancer pain. This commentary aims to discuss the evidence surrounding cannabis use for cancer pain in the context of the long-racialized landscape of cannabis policies and the disparity in pain control among cancer patients holding minoritized racial identities. Much evidence surrounding both the benefits and harms of cannabis use in cancer patients, and all patients in general, is lacking. Although drawing on the research in cancer that is available, it is also important to illustrate the broader context about how cannabis' deep roots in medical, political, and social history impact patient use and health care policies. There are lessons we can learn from the racialized disparities in opioid risk mitigation strategies, so they are not replicated in the settings of cannabis for cancer symptom management. Additionally, the authors intentionally use the term "cannabis" here rather than "marijuana.: In the early 1900s, the lay press and government popularized the use of the word "marijuana" instead of the more common "cannabis" to tie the drug to anti-Mexican prejudice.
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Affiliation(s)
- Brooke Worster
- Sidney Kimmel Cancer Center, Department of Medical Oncology, Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Salimah H Meghani
- Department of Biobehavioral Health Science, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amy E Leader
- Sidney Kimmel Cancer Center, Department of Medical Oncology, Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Shannon M Nugent
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon, USA
- Knight Cancer Institution, Oregon Health and Science University, Portland, Oregon, USA
| | - Katie Fitzgerald Jones
- Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Kevin Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rebecca L Ashare
- Department of Psychology, State University of New York at Buffalo, Buffalo, New York, USA
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Dash GF, Gizer IR, Slutske WS. Predicting first use of heroin from prescription opioid use subtypes: Insights from the Monitoring the Future longitudinal panel. Drug Alcohol Depend 2024; 255:111084. [PMID: 38232646 PMCID: PMC10842745 DOI: 10.1016/j.drugalcdep.2024.111084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/13/2023] [Accepted: 12/31/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Only a small proportion of individuals who initiate nonmedical use of prescription opioids (NUPO) transition to heroin, suggesting that more nuanced aspects of NUPO may be better indicators of risk for escalating opioid use trajectories. This study leveraged panel data to identify NUPO typologies based on NUPO characteristics associated with opioid risk trajectories (route of administration, motives) and compared rates of heroin initiation at follow-up across typologies. METHODS Latent class analyses were run among respondents with no history of heroin use from the Monitoring the Future Panel Study (base year N=10,408) at modal ages 18, 19/20, 21/22, 23/24, and 25/26. Indicators included oral NUPO, nonoral NUPO, and NUPO motives to experiment, have a good time with friends, get high, escape problems, manage pain, relax, and sleep. Heroin initiation at follow-ups through modal age 29/30 was predicted from class membership. RESULTS No NUPO, self-medication (oral, manage pain), recreational (oral, nonoral, experiment, get high, have a good time with friends), and mixed-motive (all routes, all motives) classes emerged. Heroin initiation rates did not differ across no NUPO and self-medication classes; recreational and mixed-motives classes initiated heroin at higher rates than the other classes and comparable rates to each other. Non-NUPO drug use prior to heroin initiation was prevalent in recreational and mixed-motive classes. CONCLUSIONS NUPO does not uniformly or uniquely increase risk for heroin initiation. Leveraging more nuanced indicators of risk for heroin use and targeting polysubstance use in addition to opioid-specific programming may enhance the efficacy of public health efforts.
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Affiliation(s)
- Genevieve F Dash
- Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, 320 S. 6th Street, Columbia, MO 65211, USA.
| | - Ian R Gizer
- Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, 320 S. 6th Street, Columbia, MO 65211, USA
| | - Wendy S Slutske
- Center for Tobacco Research and Intervention and Department of Family Medicine and Community Health, University of Wisconsin, 1930 Monroe St. #200, Madison, WI 53711, USA
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Dash GF, Conlin WE, Winograd RP. Causation and Common Liability in the Progression of the U.S. Opioid Crisis. J Stud Alcohol Drugs 2024; 85:12-18. [PMID: 38095266 PMCID: PMC10846605 DOI: 10.15288/jsad.23-00289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024] Open
Affiliation(s)
- Genevieve F. Dash
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - William E. Conlin
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Rachel P. Winograd
- Missouri Institute of Mental Health, University of Missouri St. Louis, St. Louis, Missouri
- Department of Psychological Sciences, University of Missouri St. Louis, St. Louis, Missouri
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Alvand S, Amin-Esmaeili M, Poustchi H, Roshandel G, Sadeghi Y, Sharifi V, Kamangar F, Dawsey SM, Freedman ND, Abnet CC, Rahimi-Movaghar A, Malekzadeh R, Etemadi A. Prevalence and determinants of opioid use disorder among long-term opiate users in Golestan Cohort Study. BMC Psychiatry 2023; 23:958. [PMID: 38129791 PMCID: PMC10734090 DOI: 10.1186/s12888-023-05436-x] [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: 07/25/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Number of opiate users worldwide has doubled over the past decade, but not all of them are diagnosed with opioid use disorder. We aimed to identify the prevalence and risk factors for OUD after ten years of follow-up. METHODS Among 8,500 chronic opiate users at Golestan Cohort Study baseline (2004-2008), we recalled a random sample of 451 subjects in 2017. We used three questionnaires: a questionnaire about current opiate use including type and route of use, the drug use disorder section of the Composite International Diagnostic Interview lifetime version, and the validated Kessler10 questionnaire. We defined opioid use disorder and its severity based on the DSM-5 criteria and used a cutoff of 12 on Kessler10 questionnaire to define psychological distress. RESULTS Mean age was 61.2 ± 6.6 years (84.7% males) and 58% were diagnosed with opioid use disorder. Starting opiate use at an early age and living in underprivileged conditions were risk factors of opioid use disorder. Individuals with opioid use disorder were twice likely to have psychological distress (OR = 2.25; 95%CI: 1.44-3.52) than the users without it. In multivariate regression, former and current opiate dose and oral use of opiates were independently associated with opioid use disorder. Each ten gram per week increase in opiate dose during the study period almost tripled the odds of opioid use disorder (OR = 3.18; 95%CI: 1.79-5.63). CONCLUSIONS Chronic opiate use led to clinical opioid use disorder in more than half of the users, and this disorder was associated with psychological distress, increasing its physical and mental burden in high-risk groups.
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Affiliation(s)
- Saba Alvand
- Liver and Pancreaticobilliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Amin-Esmaeili
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Liver and Pancreaticobilliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Yasaman Sadeghi
- Liver and Pancreaticobilliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Vandad Sharifi
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
| | - Sanford M Dawsey
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, 20892, USA
| | - Neal D Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, 20892, USA
| | - Christian C Abnet
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, 20892, USA
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Arash Etemadi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, 20892, USA.
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Paschen-Wolff MM, Kidd JD, Paine EA. The State of the Research on Opioid Outcomes Among Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexuality- and Gender-Diverse Populations: A Scoping Review. LGBT Health 2023; 10:1-17. [PMID: 36318023 PMCID: PMC10081720 DOI: 10.1089/lgbt.2022.0036] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: Research on opioid misuse, opioid use disorder (OUD), and overdose (i.e., opioid outcomes) among lesbian, gay, bisexual, transgender, queer, and other populations within the LGBTQ umbrella (LGBTQ+) remains sparse. The purpose of this scoping review was to characterize the state of the research on opioid outcomes among LGBTQ+ populations, and identify gaps in the extant literature and areas for future research. Methods: We conducted a scoping review of peer-reviewed, English language articles published between 2011 and 2020 that examined opioid outcomes among LGBTQ+ populations in the CINAHL, Embase, PubMed, and PsycINFO databases. We extracted data from articles that focused on opioid outcomes within their specific aims or purpose. We include a general summary for articles that secondarily described opioid outcomes among LGBTQ+ populations. Results: Of 113 published studies that examined opioid outcomes among LGBTQ+ populations, 10% (n = 11) were specifically designed to focus on this topic. Across studies, bisexual populations, particularly women, were at highest risk for opioid misuse and OUD. Few studies examined opioid outcomes by more than one dimension of sexual orientation (n = 3, 27%), race and/or ethnicity (n = 3, 27%), or age (n = 5, 45%). Only two included transgender or gender diverse samples; only one explicitly measured gender identity. Conclusions: Future research is needed to understand the impact of the opioid epidemic on LGBTQ+ people, particularly transgender and other gender diverse individuals, and the intersectional role of race, ethnicity, and age in opioid disparities among LGBTQ+ individuals. Additional research could contribute to the development of much-needed affirming OUD treatment and other services for LGBTQ+ people.
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Affiliation(s)
- Margaret M Paschen-Wolff
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center at New York State Psychiatric Institute, New York, New York, USA
| | - Jeremy D Kidd
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center at New York State Psychiatric Institute, New York, New York, USA
| | - Emily Allen Paine
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, New York, USA
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Hajjar ER, Lungen JM, Worster BK. Therapeutic Benefits of Medical Cannabis. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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7
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Correa-Fernández V, Barazi AM, Chandra M, Anthony JC. Similarities and Differences in Alcohol & Other Drug Dependence Among Hispanic/Latino Subgroups: A Disaggregation Approach. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100124. [PMID: 36844160 PMCID: PMC9949341 DOI: 10.1016/j.dadr.2022.100124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 11/10/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
Background Hispanic/Latino (H/L) heritage civilians out-number all other non-White ethnic groups in the United States. When studied as one group, H/L diversity is ignored, including rates of drug misuse. This study's aim was to examine H/L diversity regarding drug dependence by disaggregating how the burdens of active alcohol or other drug dependence (AODD) might change if we were to address syndromes drug by drug. Method Studying non-institutionalized H/L residents from the National Surveys on Drug Use and Health (NSDUH) 2002-2013 probability samples, we utilized online Restricted-use Data Analysis System variables to identify ethnic heritage subgroups and active AODD via computerized self-interviews. We estimated case counts of AODD with analysis-weighted cross-tabulations and variances from Taylor series. Radar plots disclose AODD variations when we simulate the reductions of drug-specific AODD one by one. Results For all H/L heritage subgroups, the most substantial AODD decline might be achieved by reducing active alcohol dependence syndromes, followed by declines of cannabis dependence. The burdens due to active syndromes attributed to cocaine and pain relievers vary somewhat across subgroups. For the Puerto Rican subgroup, our estimates reveal potentially important burden reduction if active heroin dependence can be decreased. Conclusion A sizeable reduction in the H/L population health burden attributable to AODD syndromes might be achieved via the effective decline of alcohol and cannabis dependence among all subgroups. Future research includes a systematic replication with recent NSDUH survey data, as well as various stratifications. If replicated, the need for targeted drug-specific interventions among H/L will become unequivocal.
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Affiliation(s)
- Virmarie Correa-Fernández
- Department of Psychological, Health and Learning Sciences, University of Houston, 3657 Cullen Blvd, Room 491, Farish Hall, Houston, TX 77204-5029, United States
| | - Adnan M. Barazi
- Department of Epidemiology and Biostatistics, Michigan State University; 909 Wilson Road, Room 601, East Lansing, Michigan, 48824, United States
- University of Maryland-College Park, United States
| | - Madhur Chandra
- Department of Epidemiology and Biostatistics, Michigan State University; 909 Wilson Road, Room 601, East Lansing, Michigan, 48824, United States
- Michigan Department of Health and Human Services - WIC Division, United States
| | - James C. Anthony
- Department of Epidemiology and Biostatistics, Michigan State University; 909 Wilson Road, Room 601, East Lansing, Michigan, 48824, United States
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8
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Schepis TS, McCabe SE, Ford JA. Recent trends in prescription drug misuse in the United States by age, race/ethnicity, and sex. Am J Addict 2022; 31:396-402. [PMID: 35441439 PMCID: PMC9463082 DOI: 10.1111/ajad.13289] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/07/2022] [Accepted: 03/28/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To examine changes in United States past-year opioid, stimulant, and benzodiazepine prescription drug misuse (PDM) and poly-PDM by demographics. METHODS Data were from the 2015-2019 National Survey on Drug Use and Health (N = 282,768), examining annualized PDM change by demographics. RESULTS Opioid and poly-PDM significantly declined among those under 35 years, White, and multiracial residents. DISCUSSION AND CONCLUSIONS Age and race/ethnicity are important moderators of recent PDM trends, warranting investigation of mechanisms. SCIENTIFIC SIGNIFICANCE Results highlight ongoing PDM declines in younger groups but expand the literature by showing limited changes in adults 35 and older and non-opioid PDM.
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Affiliation(s)
- Ty S. Schepis
- Department of PsychologyTexas State UniversitySan MarcosTexasUSA,School of Nursing, Center for the Study of Drugs, Alcohol, Smoking and HealthUniversity of MichiganAnn ArborMichiganUSA
| | - Sean E. McCabe
- School of Nursing, Center for the Study of Drugs, Alcohol, Smoking and HealthUniversity of MichiganAnn ArborMichiganUSA,Institute for Research on Women and GenderUniversity of MichiganAnn ArborMichiganUSA,Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborMichiganUSA,Institute for Social ResearchUniversity of MichiganAnn ArborMichiganUSA
| | - Jason A. Ford
- School of Nursing, Center for the Study of Drugs, Alcohol, Smoking and HealthUniversity of MichiganAnn ArborMichiganUSA,Department of SociologyUniversity of Central FloridaOrlandoFloridaUSA
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9
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Komro KA, Kominsky TK, Skinner JR, Livingston MD, Livingston BJ, Avance K, Lincoln AN, Barry CM, Walker AL, Pettigrew DW, Merlo LJ, Cooper HLF, Wagenaar AC. Study protocol for a cluster randomized trial of a school, family, and community intervention for preventing drug misuse among older adolescents in the Cherokee Nation. Trials 2022; 23:175. [PMID: 35197100 PMCID: PMC8864592 DOI: 10.1186/s13063-022-06096-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The national opioid crisis has disproportionately burdened rural White populations and American Indian/Alaska Native (AI/AN) populations. Therefore, Cherokee Nation and Emory University public health scientists have designed an opioid prevention trial to be conducted in rural communities in the Cherokee Nation (northeast Oklahoma) with AI and other (mostly White) adolescents and young adults. Our goal is to implement and evaluate a theory-based, integrated multi-level community intervention designed to prevent the onset and escalation of opioid and other drug misuse. Two distinct intervention approaches-community organizing, as implemented in our established Communities Mobilizing for Change and Action (CMCA) intervention protocol, and universal school-based brief intervention and referral, as implemented in our established Connect intervention protocol-will be integrated with skill-based training for adults to strengthen social support for youth and also with strategic media. Furthermore, we will test systems for sustained implementation within existing organizational structures of the Cherokee Nation and local schools and communities. This study protocol describes the cluster randomized trial, designed to measure implementation and evaluate the effectiveness on primary and secondary outcomes. METHODS Using a cluster randomized controlled design and constrained randomization, this trial will allocate 20 high schools and surrounding communities to either an intervention or delayed-intervention comparison condition. With a proposed sample of 20 high schools, all enrolled 10th grade students in fall 2021 (ages 15 to 17) will be eligible for participation. During the trial, we will (1) implement interventions through the Cherokee Nation and measure implementation processes and fidelity, (2) measure opioid and other drug use and secondary outcomes every 6 months among a cohort of high school students followed over 3 years through their transition out of high school, (3) test via a cluster randomized trial the effect of the integrated CMCA-Connect intervention, and (4) analyze implementation costs. Primary outcomes include the number of days during the past 30 days of (1) any alcohol use, (2) heavy alcohol use (defined as having at least four, among young women, or five, among young men, standard alcoholic drinks within a couple of hours), (3) any marijuana use, and (4) prescription opioid misuse (defined as "without a doctor's prescription or differently than how a doctor or medical provider told you to use it"). DISCUSSION This trial will expand upon previous research advancing the scientific evidence regarding prevention of opioid and other drug misuse during the critical developmental period of late adolescent transition to young adulthood among a sample of American Indian and other youth living within the Cherokee Nation reservation. TRIAL REGISTRATION ClinicalTrials.gov NCT04839978 . Registered on April 9, 2021. Version 4, January 26, 2022.
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Affiliation(s)
- Kelli A Komro
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Terrence K Kominsky
- Cherokee Nation Behavioral Health, 19600 N. Ross St, Tahlequah, OK, 74464, USA
| | - Juli R Skinner
- Cherokee Nation Behavioral Health, 19600 N. Ross St, Tahlequah, OK, 74464, USA
| | - Melvin D Livingston
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Bethany J Livingston
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Kristin Avance
- Cherokee Nation Behavioral Health, 19600 N. Ross St, Tahlequah, OK, 74464, USA
| | - Ashley N Lincoln
- Cherokee Nation Behavioral Health, 19600 N. Ross St, Tahlequah, OK, 74464, USA
| | - Caroline M Barry
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Andrew L Walker
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Dallas W Pettigrew
- College of Arts and Sciences, Anne and Henry Zarrow School of Social Work, University of Oklahoma, Tulsa, USA
| | - Lisa J Merlo
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, USA
| | - Hannah L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Alexander C Wagenaar
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
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Abstract
Illicit drug use/misuse among older adults is understudied, although current trends point to older adults being the fastest-growing segment in the United States and other developed countries. There is a need for further insight into drug use patterns in older adults, who face their own set of socioeconomic, medical, and psychiatric problems. We reviewed the literature for data related to use/misuse of heroin and stimulants (cocaine, amphetamines, and methamphetamines) among people over the age of 40 years. We focused on prevalence rates of use/misuse of these substances, comorbidities, diagnostic challenges, screening tools, and treatment recommendations specific to the geriatric population.
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11
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Schepis TS, Ford JA, McCabe SE. Co-ingestion of prescription drugs and alcohol in US adults aged 50 years or older. Hum Psychopharmacol 2021; 36:e2803. [PMID: 34237180 PMCID: PMC9254454 DOI: 10.1002/hup.2803] [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: 03/25/2021] [Revised: 06/09/2021] [Accepted: 06/18/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine prevalence of past-month prescription drug misuse (PDM) and alcohol co-ingestion and its correlates in adults age 50 or older. METHODS Data were from the 2015-2018 US National Survey on Drug Use and Health (n = 35,190). PDM-alcohol co-ingestion was defined as prescription opioid, tranquilizer/sedative, or stimulant misuse while "drinking alcohol or within a couple of hours of drinking." Co-ingestion prevalence was estimated, and logistic and negative binomial regressions examined the sociodemographic, physical health, mental health, substance use, and substance use disorder (SUD) correlates of co-ingestion. RESULTS Over 344,000 adults aged 50 years or older (0.3%) engaged in past-month PDM-alcohol co-ingestion, or 27.4% of those with past-month PDM. Past-month co-ingestion was linked to greater past-month alcohol use frequency and elevated adjusted odds ratios (aORs) for all examined substance use outcomes (e.g., non-PDM SUD aOR = 21.8; 49.7% prevalence rate). The aOR for suicidal ideation was 506% higher in those with co-ingestion than those without past-year PDM. CONCLUSIONS US adults aged 50 years or older with past-month PDM-alcohol co-ingestion are at high risk for SUD and concerning mental health symptoms. Screening for mental health and substance use treatment is warranted among aging adults with signs of PDM, especially involving co-ingestion.
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Affiliation(s)
- Ty S. Schepis
- Department of Psychology, Texas State University
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan
| | - Jason A. Ford
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan
- Department of Sociology, University of Central Florida
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan
- Institute for Research on Women and Gender, University of Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan
- Institute for Social Research, University of Michigan
- Rogel Cancer Center, University of Michigan
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12
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Blanco C, Wall MM, Feng T, Olfson M. Evaluating the modified common liability hypothesis of psychiatric comorbidity. J Psychiatr Res 2021; 141:9-15. [PMID: 34171762 DOI: 10.1016/j.jpsychires.2021.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Abstract
We sought to evaluate whether the timing of co-occurrence of psychiatric disorder groups provides evidence for one disorder group predisposing individuals to subsequent onset of other disorder groups above and beyond a common liability model. Data were drawn from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 36,309). We identified statistically significant sequences of the age of onset of mood, anxiety, and substance use disorders (SUD) using a novel method distinguishing significant sequences from patterns expected only due to correlations induced by common liability among disorders. At every age, the lifetime probability of the three disorder groups was positively correlated consistent with a common liability model, but using a sequence analysis that accounts for different population level age of onset patterns and age specific correlations due to common liability, only SUD was more likely to precede mood disorders than expected (4.0% vs 3.3%, p < .001). Onsets within the same year of mood and anxiety disorders (21.5%) occurred over 6 times more commonly than expected by chance. SUD and mood disorders onsets occurred during the same year (9.0%) twice as commonly as expected, whereas SUD and anxiety disorder onsets did not occur in the same year significantly more commonly than expected. These results suggest that above and beyond common liabilities to comorbid mood, anxiety, and SUD disorders across the lifespan, SUDs predispose individuals for future onset of mood disorders, but not the reverse. Frequent simultaneous onset of psychiatric disorders further supports shared underlying vulnerabilities across disorder groups.
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Affiliation(s)
- Carlos Blanco
- National Institute on Drug Abuse, 6001 Executive Boulevard, Bethesda, MD, 20892, USA.
| | - Melanie M Wall
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Tianshu Feng
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
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Guarino H, Mateu-Gelabert P, Quinn K, Sirikantraporn S, Ruggles KV, Syckes C, Goodbody E, Jessell L, Friedman SR. Adverse Childhood Experiences Predict Early Initiation of Opioid Use Behaviors. FRONTIERS IN SOCIOLOGY 2021; 6:620395. [PMID: 34055961 PMCID: PMC8158934 DOI: 10.3389/fsoc.2021.620395] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/07/2021] [Indexed: 05/26/2023]
Abstract
Introduction: Although a substantial body of research documents a relationship between traumatic stress in childhood and the initiation of substance use later in the life course, only limited research has examined potential linkages between adverse childhood experiences (ACEs) and the initiation of non-medical prescription opioid use and other opioid use behaviors. The present study contributes to this growing body of work by investigating the association of childhood trauma with early initiation of a series of opioid use behaviors. Methods: New York City young adults (n = 539) ages 18-29 who reported non-medical use of prescription opioids or heroin use in the past 30 days were recruited using Respondent-Driven Sampling in 2014-16. Ten ACEs were assessed via self-report with the ACE Questionnaire. Associations between number of ACEs and self-reported ages of initiating seven opioid use behaviors (e.g., non-medical prescription opioid use, heroin use, heroin injection) were estimated with multivariable logistic regression. Results: Eighty nine percent of participants reported at least one ACE, and 46% reported four or more ACEs, a well-supported threshold indicating elevated risk for negative health consequences. Every increase of one trauma was associated with a 12-23% increase in odds of early initiation across the seven opioid use behaviors. Findings also document that the mean age at initiation increased with increasing risk severity across the behaviors, contributing to evidence of a trajectory from opioid pill misuse to opioid injection. Discussion: Increasing number of childhood traumas was associated with increased odds of earlier initiation of multiple opioid misuse behaviors. In light of prior research linking earlier initiation of substance use with increased substance use severity, present findings suggest the importance of ACEs as individual-level determinants of increased opioid use severity. Efforts to prevent onset and escalation of opioid use among at-risk youth may benefit from trauma prevention programs and trauma-focused screening and treatment, as well as increased attention to ameliorating upstream socio-structural drivers of childhood trauma.
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Affiliation(s)
- Honoria Guarino
- Institute for Implementation Science in Population Health, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, United States
| | - Pedro Mateu-Gelabert
- Institute for Implementation Science in Population Health, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, United States
| | - Kelly Quinn
- Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | | | - Kelly V. Ruggles
- Division of Translational Medicine, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | | | - Elizabeth Goodbody
- Institute for Implementation Science in Population Health, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, United States
| | - Lauren Jessell
- Institute for Implementation Science in Population Health, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, United States
| | - Samuel R. Friedman
- Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, United States
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14
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Friedman A, Shea M, Winter MR, Saitz R, Aschengrau A. Prenatal and early childhood exposure to tetrachloroethylene (PCE) and non-medical use of prescription drugs: A retrospective cohort study in Cape Cod, MA. ENVIRONMENTAL RESEARCH 2021; 196:110384. [PMID: 33129864 DOI: 10.1016/j.envres.2020.110384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Between 1968 and 1983, public drinking water supplies of Cape Cod, Massachusetts were contaminated with the chlorinated solvent tetrachloroethylene (PCE). We previously found an affinity for risk-taking behaviors, including the use of illicit drugs, following prenatal and early childhood exposure to PCE. Using newly collected data, we investigated the risk of non-medical use of prescription drugs (NMUPD) following prenatal and early childhood PCE exposure. METHODS Participants were identified from a retrospective cohort study ("Cape Cod Health Study") via cross-matching birth certificates and water system data. The original self-administered questionnaire gathered data on demographics, work and medical history, and alcohol and illicit drug use from 618 individuals (363 exposed and 255 unexposed). The follow-up survey added questions on non-medical use of prescription pain relievers, tranquilizers, stimulants and sedatives. A validated leaching and transport model was used to estimate exposure to PCE exposure in drinking water. RESULTS There was a wide distribution of cumulative prenatal and early childhood PCE exposure levels (range: 0.04 g-3722.2 g). PCE exposed subjects had a 1.92-fold increase in risk of any non-medical use of prescription drugs [Adjusted RR: 1.92, (95% CI: 1.31, 2.83)]. Furthermore, the association followed a dose-response relationship where the risk of NMUPD was higher for those exposed to PCE levels greater than or equal the median level versus those exposed to levels less than the median [Adjusted RR: 2.05 (95% CI: 1.34, 3.15) vs. 1.83 (95% CI: 1.20, 2.79) (p-value for trend < 0.01)]. Additionally, we found moderate increases in risk by level of non-medical use (any non-medical use, non-medical use of 1 or more categories of prescription drugs, or 2+ categories) as well as by category of drug for pain relivers, stimulants and tranquilizers. CONCLUSION We found that prenatal and early childhood exposure to PCE was associated with a moderate increase in the risk of NMUPD. Exposed subjects had dose-related increased risks of NMUPD of pain relievers, tranquilizers, and stimulants. This study has a number of limitations and is the first to report this association. Additional longitudinal studies of populations exposed to PCE during early life should be conducted to examine its long-term neurotoxic effects.
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Affiliation(s)
- Alexa Friedman
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
| | - Margaret Shea
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA.
| | - Michael R Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA.
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
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15
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Deputy NP, Lowry R, Clayton HB, Demissie Z, Bohm MK, Conklin S. Initiation of nonmedical use of prescription opioids among high school students. Subst Abus 2021; 42:460-465. [PMID: 33684025 DOI: 10.1080/08897077.2021.1892013] [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: 10/22/2022]
Abstract
Background: Nonmedical use of prescription opioids (NUPO) is associated with heroin use and other adverse outcomes among adolescents. To inform the timing of substance use prevention activities and which substances to target, we examined age at NUPO initiation, associations between substance use initiation and current (past 30-day) NUPO, and order of NUPO initiation relative to other substances. Methods: Data from 2,834 students aged 15 or older participating in the 2017 Virginia Youth Survey, the first Youth Risk Behavior Surveillance System survey to assess age at NUPO initiation and current NUPO, were analyzed in 2019. Students reported current NUPO and ages at initiation for cigarettes, alcohol, marijuana, and NUPO (categorized as 12 or younger, 13 or 14, 15 or older, or never). Associations between age at substance use initiation and current NUPO were examined using adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Results: Overall, 12% of students reported lifetime NUPO, with 2.4%, 4.0%, and 5.6% initiating at 12 or younger, 13 or 14, and 15 or older, respectively; 5.3% reported current NUPO. Initiating cigarettes, alcohol, and marijuana at each age category (compared with never) was associated with an increased prevalence of current NUPO after adjusting for demographics and initiation of other substances. Among students initiating NUPO, initiating NUPO at 12 or younger (compared with 15 or older) was associated with an increased prevalence of current NUPO after adjusting for demographics (aPR = 1.54, 95% CI: 1.10-2.16), but not after further adjustment for initiation of other substances (aPR = 1.38, 95% CI = 0.97-1.97). Among students initiating NUPO, 45.4% initiated NUPO before or during the same age as other substances. Conclusions: More than 6% of students initiated NUPO at 14 or younger. Younger substance use initiation was associated with current NUPO, suggesting that some students may benefit from prevention activities during early adolescence that address multiple substances.
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Affiliation(s)
- Nicholas P Deputy
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,US Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Richard Lowry
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heather B Clayton
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zewditu Demissie
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,US Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Michele K Bohm
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Conklin
- Division of Population Health Data, Virginia Department of Health, Richmond, Virginia, USA
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16
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Shanahan L, Hill SN, Bechtiger L, Steinhoff A, Godwin J, Gaydosh LM, Harris KM, Dodge KA, Copeland WE. Prevalence and Childhood Precursors of Opioid Use in the Early Decades of Life. JAMA Pediatr 2021; 175:276-285. [PMID: 33369615 PMCID: PMC7770613 DOI: 10.1001/jamapediatrics.2020.5205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Opioid use disorder and opioid deaths have increased dramatically in young adults in the US, but the age-related course or precursors to opioid use among young people are not fully understood. OBJECTIVE To document age-related changes in opioid use and study the childhood antecedents of opioid use by age 30 years in 6 domains of childhood risk: sociodemographic characteristics; school or peer problems; parental mental illness, drug problems, or legal involvement; substance use; psychiatric illness; and physical health. DESIGN, SETTING, AND PARTICIPANTS This community-representative prospective longitudinal cohort study assessed 1252 non-Hispanic White individuals and American Indian individuals in rural counties in the central Appalachia region of North Carolina from January 1993 to December 2015. Data were analyzed from January 2019 to January 2020. EXPOSURES Between ages 9 and 16 years, participants and their parents were interviewed up to 7 times using the Child and Adolescent Psychiatric Assessment and reported risk factors in 6 risk domains. MAIN OUTCOMES AND MEASURES Participants were assessed again at ages 19, 21, 25, and 30 years for nonheroin opioid use (any and weekly) and heroin use using the structured Young Adult Psychiatric Assessment. RESULTS Of 1252 participants, 342 (27%) were American Indian. By age 30 years, 322 participants had used a nonheroin opioid (24.2%; 95% CI, 21.8-26.5), 155 had used a nonheroin opioid weekly (8.8%; 95% CI, 7.2-10.3), and 95 had used heroin (6.6%; 95% CI, 5.2-7.9). Childhood risk markers for later opioid use included male sex, tobacco use, depression, conduct disorder, cannabis use, having peers exhibiting social deviance, parents with legal involvement, and elevated systemic inflammation. In final models, childhood tobacco use, depression, and cannabis use were most robustly associated with opioid use in young adulthood (ages 19 to 30 years). Chronic depression and dysthymia were strongly associated with any nonheroin opioid use (OR. 5.43; 95% CI, 2.35-12.55 and OR, 7.13; 95% CI, 1.99-25.60, respectively) and with weekly nonheroin opioid use (OR, 8.89; 95% CI, 3.61-21.93 and OR, 11.51; 95% CI, 3.05-42.72, respectively). Among young adults with opioid use, those with heroin use had the highest rates of childhood psychiatric disorders and comorbidities. CONCLUSIONS AND RELEVANCE Childhood tobacco use and chronic depression may be associated with impaired reward system functioning, which may increase young adults' vulnerability to opioid-associated euphoria. Preventing and treating early substance use and childhood mental illness may help prevent later opioid use.
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Affiliation(s)
- Lilly Shanahan
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland,Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Sherika N. Hill
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Laura Bechtiger
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Annekatrin Steinhoff
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Jennifer Godwin
- Center for Child and Family Policy, Duke University, Durham, North Carolina
| | - Lauren M. Gaydosh
- Center for Medicine, Health, and Society, Public Policy Studies, Vanderbilt University, Nashville, Tennessee
| | - Kathleen Mullan Harris
- Carolina Population Center, Department of Sociology, University of North Carolina at Chapel Hill
| | - Kenneth A. Dodge
- Center for Child and Family Policy, Duke University, Durham, North Carolina,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - William E. Copeland
- Vermont Center for Children, Youth, and Families, Department of Psychiatry, University of Vermont, Burlington
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17
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Jordan A, Mathis M, Haeny A, Funaro M, Paltin D, Ransome Y. An Evaluation of Opioid Use in Black Communities: A Rapid Review of the Literature. Harv Rev Psychiatry 2021; 29:108-130. [PMID: 33666395 PMCID: PMC8335706 DOI: 10.1097/hrp.0000000000000285] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND There are multiple aspects of the opioid crisis among Black people, who have been left out of the broader conversation. Despite evidence of increased opioid overdose deaths, less is known about opioid use among Black people. This review synthesizes research on Black people who use opioids; the goals are to advance knowledge, highlight research gaps, and inform clinical practice. METHODS This rapid review investigating opioid use among Black people utilized systematic review methods and was conducted according to a predefined protocol with clear inclusion criteria (PROSPERO ID: 177071). A comprehensive search strategy was used, including published and gray-literature sources (i.e., literature that has not been formally published). A narrative summary of the results is presented. RESULTS A total of 76 works were selected for inclusion and full text review. Sex, age, geographic location, and involvement in the carceral system were associated with the use of opioids among Black individuals. Non-epidemiologic factors included treatment-seeking patterns, disparate clinician prescribing, and social determinants. CONCLUSIONS Through this rapid review we suggest three main areas of focus: (1) including culturally informed collection methods in epidemiologic surveys to accurately reflect prevalences, (2) funding research that specifically addresses the importance of culture in accessing treatment, and (3) directly studying how social determinants can improve or exacerbate health outcomes. Focusing on the unique needs of Black people who use opioids is warranted to increase treatment initiation and adherence among a population less likely to engage with the traditional health care system.
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Affiliation(s)
- Ayana Jordan
- Yale University School of Medicine, Department of Psychiatry, 300 George Street, New Haven, CT 06511
| | - Myra Mathis
- University of Rochester, Department of Psychiatry, 601 Elmwood Avenue, Rochester, NY 14642
| | - Angela Haeny
- Yale School of Medicine, Department of Psychiatry, Division of Prevention and Community Research, and The Consultation Center 389 Whitney Avenue, New Haven, CT 06511
| | - Melissa Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, 333 Cedar Street, New Haven, CT 06520-8014
| | - Dafna Paltin
- Yale University, Department of Psychiatry, 300 George Street, New Haven, CT 06511
| | - Yusuf Ransome
- Yale School of Public Health, Department of Social and Behavioral Sciences, Studies of Religion Ethnicity Technology and Contextual Influences on Health (STRETCH)-Lab, 60 College Street, New Haven, CT 06510
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18
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D'Amico EJ, Davis JP, Tucker JS, Seelam R, Stein BD. Opioid misuse during late adolescence and its effects on risk behaviors, social functioning, health, and emerging adult roles. Addict Behav 2021; 113:106696. [PMID: 33264695 DOI: 10.1016/j.addbeh.2020.106696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/04/2020] [Accepted: 10/02/2020] [Indexed: 12/22/2022]
Abstract
Opioid misuse has emerged in recent years as a major public health concern in the United States, particularly for adolescents and emerging young adults. We examined the association of opioid misuse from ages 18 to 20 with four domains at age 21-22: risk behaviors and consequences; health; social functioning; and emerging adult roles. Participants were surveyed annually from 2008 through 2019. The sample includes N = 2880 youth from waves 8-11. The sample was approximately 18 years old at wave 8; 54% female, 46% Hispanic, 20% white, 20% Asian, 2% Black, and 11% multiracial. Opioid misuse was low in this general sample of young adults, with about 4% reporting misuse from age 18-20. We used latent growth curve modeling to examine how misuse from ages 18-20 was associated with functioning at age 21-22. Adolescents who reported opioid misuse at age 18 also reported more negative consequences from alcohol and cannabis use and greater odds of other prescription drug misuse at age 21-22 than those with no misuse. Those reporting opioid misuse at age 18 were also more likely to engage in sexual risk behaviors, report delinquent behavior, and have a higher likelihood of experiencing sexual victimization and engaging in sexual perpetration at age 21-22 than those with no misuse. Neither the intercept nor slope of opioid misuse was associated with depression, anxiety, physical health or ailments, satisfaction with friends, romantic relationship functioning, or emerging adult roles at wave 11. Findings highlight the importance of screening and brief intervention for adolescents reporting opioid misuse.
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Affiliation(s)
- Elizabeth J D'Amico
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA.
| | - Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, USC Institute for Addiction Science, 669 W 34th St, Los Angeles, CA 90089, USA
| | - Joan S Tucker
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA
| | - Rachana Seelam
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA
| | - Bradley D Stein
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA
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19
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Griesler PC, Hu MC, Wall MM, Kandel DB. Assessment of Prescription Opioid Medical Use and Misuse Among Parents and Their Adolescent Offspring in the US. JAMA Netw Open 2021; 4:e2031073. [PMID: 33410876 PMCID: PMC7791357 DOI: 10.1001/jamanetworkopen.2020.31073] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/03/2020] [Indexed: 11/14/2022] Open
Abstract
Importance Limited information is available regarding the association between parental and adolescent medical prescription opioid use and misuse in the US. Objective To examine the associations between parental and adolescent prescription opioid medical use and misuse. Design, Setting, and Participants This cross-sectional, nationally representative study included 15 200 parent-adolescent dyads from the annual 2015-2017 National Survey on Drug Use and Health. Data were collected from January 6, 2015, to December 20, 2017, and analyzed from October 4, 2019, to October 15, 2020. Exposures Parental past 12-month exclusive medical prescription opioid use and any misuse (ie, using without a prescription or in any way not directed by a physician). Main Outcomes and Measures Adolescent past 12-month medical prescription opioid use or misuse. Multivariable regressions estimated associations between parental and offspring medical prescription opioid use or misuse, controlling for sociodemographic and psychosocial variables. Results Respondents included 9400 mother-child and 5800 father-child dyads in the same household; children were aged 12 to 17 years (52.8% male; mean [SD] age, 14.5 [1.7] years). Controlling for other factors, parental medical prescription opioid use was associated with adolescent prescription opioid medical use (adjusted odds ratio [aOR], 1.28; 95% CI, 1.06-1.53) and misuse (aOR, 1.53; 95% CI, 1.07-2.25), whereas parental misuse was not. Parental medical prescription stimulant use was associated with adolescent medical prescription opioid use (aOR, 1.40; 95% CI, 1.02-1.91). Parental marijuana use (aOR, 1.84; 95% CI, 1.13-2.99), parent-adolescent conflict (aOR, 1.26; 95% CI, 1.05-1.52), and adolescent depression (aOR, 1.75; 95% CI, 1.26-2.44) were associated with adolescent prescription opioid misuse. Adolescent delinquency (aOR, 1.55; 95% CI, 1.38-1.74) and perceived schoolmates' drug use (aOR, 2.87; 95% CI, 1.95-4.23) were also associated with adolescent misuse and more weakly with medical use (aORs, 1.13 [95% CI, 1.05-1.22] and 1.61 [95% CI, 1.32-1.96], respectively). Conclusions and Relevance Youth use of prescription opioids is in part a structural/environmental issue. The findings of this study suggest that parental medical prescription opioid use is associated with offspring prescription opioid use, whereas parental misuse is not. Restricting physicians' opioid prescribing to parents is a crucial public health goal. In addition, parents could be educated on the risks of their prescription opioid use for offspring and on practices to mitigate risk, including safe medication storage and disposal. Screening for parental prescription opioid use could be part of pediatric practice. Addressing adolescent mental health could also reduce adolescent prescription opioid misuse.
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Affiliation(s)
- Pamela C. Griesler
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- New York State Psychiatric Institute, New York, New York
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Melanie M. Wall
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- New York State Psychiatric Institute, New York, New York
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
- Research Foundation for Mental Hygiene, New York, New York
| | - Denise B. Kandel
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- New York State Psychiatric Institute, New York, New York
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
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20
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Stevens-Watkins D. Opioid-related overdose deaths among African Americans: Implications for research, practice and policy. Drug Alcohol Rev 2020; 39:857-861. [PMID: 32281200 PMCID: PMC7554142 DOI: 10.1111/dar.13058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 03/03/2020] [Indexed: 01/22/2023]
Abstract
Opioid-related overdose deaths among African Americans have only recently received national attention despite evidence of increase in death rates among this population spanning the past decade. Numerous authors have highlighted how the 'opioid epidemic' has largely been portrayed as a problem mostly affecting White America. The purpose of this commentary is to provide a synthesis spotlighting the unique structural and cultural considerations involved in research, practice and policy related to opioid use and treatment for opioid use disorders among African Americans. The commentary concludes with considerations for future research and practice intended to reduce deaths among this group.
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Affiliation(s)
- Danelle Stevens-Watkins
- Department of Educational, School, and Counseling Psychology, University of Kentucky, Lexington, USA
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21
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Lagisetty P, Zhang K, Haffajee RL, Lin LA, Goldstick J, Brownlee R, Bohnert A, Larochelle MR. Opioid prescribing history prior to heroin overdose among commercially insured adults. Drug Alcohol Depend 2020; 212:108061. [PMID: 32428788 PMCID: PMC7768819 DOI: 10.1016/j.drugalcdep.2020.108061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Since 2010, heroin-related overdoses have risen sharply, coinciding with policies to restrict access to prescription opioids. It is unknown if patients tapered or discontinued off prescription opioids transitioned to riskier heroin use. This study examined opioid prescribing, including long-term opioid therapy (LTOT) and discontinuation, prior to heroin overdose. METHODS We used retrospective longitudinal data from a national claims database to identify adults with an emergency or inpatient claim for heroin overdose between January 2010 and June 2017. Receipt of opioid prescription, LTOT episodes, and discontinuation of LTOT were measured for the period of one year prior to heroin overdose. RESULTS We identified 3183 individuals (53.2% age 18-25; 70.0% male) with a heroin overdose (incidence rate 4.20 per 100k person years). Nearly half (42.3%) received an opioid prescription in the prior 12 months, and 10.9% had an active opioid prescription in the week prior to overdose. LTOT at any time in the 12 months prior to overdose was uncommon (12.8%) among those with heroin overdoses, especially among individuals 18-25 years old (3.5%, P < 0.001). LTOT discontinuation prior to overdose was also relatively uncommon, experienced by 6.7% of individuals aged 46 and over and 2.5% of individuals aged 18-25 years (P < 0.001). CONCLUSIONS Prior to heroin overdose, prescription opioid use was common, but LTOT discontinuation was uncommon and observed primarily in older individuals with the lowest heroin overdose rates. Further study is needed to determine if these prescribing patterns are associated with increased heroin overdose.
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Affiliation(s)
- Pooja Lagisetty
- Department of Internal Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA; Center for Clinical Management and Research, Ann Arbor VA Hospital, 2215 Fuller Road, MS 152, Ann Arbor, MI 48105, USA.
| | - Kun Zhang
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC, 4770 Buford Highway, MS F62, Atlanta, GA 30341, USA
| | - Rebecca L Haffajee
- Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; RAND Corporation
| | - Lewei Allison Lin
- Center for Clinical Management and Research, Ann Arbor VA Hospital, 2215 Fuller Road, MS 152, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Jason Goldstick
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Rebecca Brownlee
- Department of Psychiatry, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Amy Bohnert
- Center for Clinical Management and Research, Ann Arbor VA Hospital, 2215 Fuller Road, MS 152, Ann Arbor, MI 48105, USA; Department of Anesthesiology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Marc R Larochelle
- Clinical Addiction Research and Education Unit at Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA 02118, USA
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22
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Blanco C, Wiley TRA, Lloyd JJ, Lopez MF, Volkow ND. America's opioid crisis: the need for an integrated public health approach. Transl Psychiatry 2020; 10:167. [PMID: 32522999 PMCID: PMC7286889 DOI: 10.1038/s41398-020-0847-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 02/28/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
Continued increases in overdose deaths and recent declines in life expectancy call for need to adopt comprehensive public health approaches to the United States opioid crisis and to establish an infrastructure to avert future crises. Successfully addressing the challenges posed by the crisis requires a translational, integrated approach that combines the contribution of neuroscience, pharmacology, epidemiology, treatment services and prevention. It also is critical to integrate interventions across settings, including healthcare, justice, education and social service systems. This review highlights four interconnected themes: (1) social determinants of health and disease; (2) person-centered approaches for prevention and treatment; (3) bridging the gap between implementation science and practice; and (4) using data to build learning systems of care, relevant to public health approaches to address the opioid crisis. We discuss how across these four themes taking into account the influence of developmental factors on brain function and sensitivity to environmental stimuli including drugs, addressing the complex interactions between biological and social factors, and promoting an ongoing dialogue across disciplines and settings will help accelerate public health advances that are evidenced based and sustainable to address the current opioid crisis and avert future ones.
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Affiliation(s)
- Carlos Blanco
- National Institute on Drug Abuse, Bethesda, MD, 20892, USA.
| | | | | | - Marsha F Lopez
- National Institute on Drug Abuse, Bethesda, MD, 20892, USA
| | - Nora D Volkow
- National Institute on Drug Abuse, Bethesda, MD, 20892, USA
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Schepis TS, Klare DL, Ford JA, McCabe SE. Prescription Drug Misuse: Taking a Lifespan Perspective. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221820909352. [PMID: 32214819 PMCID: PMC7065295 DOI: 10.1177/1178221820909352] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/16/2022]
Abstract
Prescription drug misuse (PDM), or medication use without a prescription or in ways not intended by the prescriber, is a notable public health concern, especially in the United States. Accumulating research has characterized PDM prevalence and processes, but age-based or lifespan changes in PDM are understudied. Given age-based differences in the medical or developmental concerns that often underlie PDM, it is likely that PDM varies by age. This review summarizes the literature on PDM across the lifespan, examining lifespan changes in prevalence, sources, motives and correlates for opioid, stimulant, and tranquilizer/sedative (or benzodiazepine) PDM. In all, prevalence rates, sources and motives vary considerably by age group, with fewer age-based differences in correlates or risk factors. PDM prevalence rates tend to decline with aging, with greater use of physician sources and greater endorsement of self-treatment motives in older groups. Recreational motives (such as to get high) tend to peak in young adulthood, with greater use of peer sources or purchases to obtain medication for PDM in younger groups. PDM co-occurs with other substance use and psychopathology, including suicidality, across age groups. The evidence for lifespan variation in PDM is strongest for opioid PDM, with a need for more research on tranquilizer/sedative and stimulant PDM. The current literature is limited by the few studies of lifespan changes in PDM within a single sample, a lack of longitudinal research, little research addressing PDM in the context of polysubstance use, and little research on minority groups, such as sexual and gender minorities.
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Affiliation(s)
- Ty S Schepis
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Dalton L Klare
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Jason A Ford
- Department of Sociology, University of Central Florida, Orlando, FL, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of MI, Ann Arbor, Michigan, USA.,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA.,Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan, USA.,Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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Schuler MS, Dick AW, Stein BD. Heterogeneity in Prescription Opioid Pain Reliever Misuse Across Age Groups: 2015-2017 National Survey on Drug Use and Health. J Gen Intern Med 2020; 35:792-799. [PMID: 31792871 PMCID: PMC7080910 DOI: 10.1007/s11606-019-05559-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/22/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prescription opioid misuse among older adults has received little attention to date. Potential age variation in characteristics of and motivations for prescription opioid misuse has not been fully characterized yet has important implications for preventing diversion and misuse. OBJECTIVE To examine (1) age-specific patterns of source of misused prescription opioid pain relievers and motives for misuse and (2) age-specific and source-specific associations with opioid use disorder (OUD), heroin use, benzodiazepine misuse, and OUD treatment utilization. DESIGN Cross-sectional study using 3 waves (2015-2017) of the National Survey on Drug Use and Health (68% average response rate) PARTICIPANTS: Respondents aged 12 and older with past-year prescription opioid pain reliever misuse (n = 8228) MAIN MEASURES: Source for the most-recently misused prescription pain reliever (categorized as medical, social, or illicit/other), motive for last episode of misuse, OUD, heroin use, benzodiazepine misuse, and OUD treatment. KEY RESULTS Adults 50 and older comprised approximately 25% of all individuals reporting past-year prescription opioid misuse. A social source was most common for individuals under age 50 while a medical source was most common for individuals 50 and older. The most commonly reported motive for misuse was to "relieve physical pain"; the frequency of this response increased across age groups (47% aged 12-17 to 87% aged 65+). Among adults age 50 and older with prescription opioid misuse, 17% met criteria for OUD, 15% reported past-year benzodiazepine misuse, and 3% reported past-year heroin use. CONCLUSIONS Physicians continue to be a direct source of prescription opioids for misuse, particularly for older adults. Ongoing clinical initiatives regarding optimal opioid prescribing practices are needed in addition to effective non-opioid strategies for pain management. Clinical initiatives should also include screening adult and adolescent patients for non-medical use of prescription opioids as well as improving access to OUD treatment for individuals of all ages.
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Capistrant BD, Nakash O. Lesbian, Gay, and Bisexual Adults have Higher Prevalence of Illicit Opioid Use than Heterosexual Adults: Evidence from the National Survey on Drug Use and Health, 2015–2017. LGBT Health 2019; 6:326-330. [DOI: 10.1089/lgbt.2019.0060] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Ora Nakash
- School of Social Work, Smith College, Northampton, Massachusetts
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Canizares M, Power JD, Rampersaud YR, Badley EM. Patterns of opioid use (codeine, morphine or meperidine) in the Canadian population over time: analysis of the Longitudinal National Population Health Survey 1994-2011. BMJ Open 2019; 9:e029613. [PMID: 31345978 PMCID: PMC6661673 DOI: 10.1136/bmjopen-2019-029613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE This study aimed to investigate cohort effects in selected opioids use and determine whether cohort differences were associated with changes in risk factors for use over time. DESIGN This study presents secondary analyses of a longitudinal survey panel of the general population that collected data biannually. SETTING Data from the Canadian Longitudinal National Population Health Survey 1994-2011. POPULATION This study included 12 542 participants from the following birth cohorts: post-World War I (born 1915-1924), pre-World War II (born 1925-1934), World War II (born 1935-1944), Older Baby Boom (born 1945-1954), Younger Baby Boom (born 1955-1964), Older Generation X (born 1965-1974) and Younger Generation X (born 1975-1984). MAIN OUTCOME Responses to a single question asking about the use of codeine, morphine or meperidine in the past month (yes/no) were examined. RESULTS Over and above age and period effects, there were significant cohort differences in selected opioids use: each succeeding recent cohort had greater use than their predecessors (eg, Gen Xers had greater use than younger baby boomers). Selected opioids use increased significantly from 1994 to 2002, plateauing between 2002 and 2006 and then declining until 2011. After accounting for cohort and period effects, there was a decline in use of these opioids with increasing age. Although pain was significantly associated with greater selected opioids use (OR=3.63, 95% CI 3.39 to 3.94), pain did not explain cohort differences. Cohort and period effects were no longer significant after adjusting for the number of chronic conditions. Cohort differences in selected opioids use mirrored cohort differences in multimorbidity. Use of these opioids was significantly associated with taking antidepressants or tranquillisers (OR=2.52, 95% CI 2.27 to 2.81 and OR=1.60, 95% CI 1.46 to 1.75, respectively). CONCLUSIONS The findings underscore the need to consider multimorbidity including possible psychological disorders and associated medications when prescribing opioids (codeine, morphine, meperidine), particularly for recent birth cohorts. Continued efforts to monitor prescription patterns and develop specific opioid use guidelines for multimorbidity appear warranted.
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Affiliation(s)
- Mayilee Canizares
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - J Denise Power
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Y Raja Rampersaud
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Elizabeth M Badley
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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Kapadia SN, Bao Y. Prescription painkiller misuse and the perceived risk of harm from using heroin. Addict Behav 2019; 93:141-145. [PMID: 30711666 DOI: 10.1016/j.addbeh.2019.01.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/30/2018] [Accepted: 01/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prescription opioid pain reliever misuse is associated with initiation of heroin use. The perceived risk of harm from substance use is a key factor in initiation. We hypothesized that prescription pain reliever misuse is associated with a lower perceived risk of harm from trying heroin and from regular use. METHODS Using the 2015-6 National Survey on Drug Use and Health (NSDUH), we evaluated the perceived risk of trying and regularly using heroin among heroin never-users. We estimated logistic regressions to assess the association between past-year prescription pain reliever misuse with the perceived risk of heroin initiation and regular use, adjusting for potential confounders. RESULTS The sample contained 84,312 adults and 27,814 adolescents. Four percent of adults and 3.7% of adolescents reported past-year prescription pain reliever misuse. 87.9% of adults and 65.9% of adolescents perceived trying heroin as a great risk. Pain reliever misuse was associated with a significantly lower odds of perceiving great risk of harm from trying heroin (adults: AOR = 0.760, 95%CI 0.614-0.941, p = 0.013; adolescents: AOR = 0.817, 95%CI 0.672-0.993, p = 0.042). Both age groups were more likely to report perceiving regular heroin use as a great risk of harm compared to trying heroin once or twice, but only adults showed significant association with of pain reliever misuse. (AOR = 0.539 95%CI 0.390-0.744, p < 0.001). CONCLUSIONS Past-year prescription pain reliever misuse was associated with lower perceived risk of harm from heroin initiation and regular use. Further understanding of risk perception and the association with heroin initiation might inform development of primary prevention interventions.
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Affiliation(s)
- Shashi N Kapadia
- Departments of Medicine and Healthcare Policy and Research, Weill Cornell Medicine, 1300 York Ave, Rm A-421, New York, NY 10065, USA.
| | - Yuhua Bao
- Department of Healthcare Policy and Research, Weill Cornell Medicine, 425 E 61st Street, New York, NY 10065, USA.
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Association between tobacco smoking and opioid use: A meta-analysis. Addict Behav 2019; 92:225-235. [PMID: 30685521 DOI: 10.1016/j.addbeh.2018.11.043] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 11/24/2018] [Accepted: 11/27/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Tobacco smoking has been shown to be a major risk factor for opioid use and opioid use disorders in several observational studies; however, the results are inconsistent. Thus, this systematic review and meta-analysis of observational studies was conducted to investigate the association between smoking behavior and opioid use and opioid use disorders. METHODS A systematic literature search of relevant keywords was done in Medline, Embase, Scopus, Web of Science, and Google Scholar up to October 2017. The reference lists of retrieved articles were also examined for inclusion. While random effects meta-analysis was used, pooled odds ratio (OR) and 95% confidence intervals were calculated using Der-Simonian and Laird method, taking into account conceptual heterogeneity. Subgroup analyses were performed using participants and studies' characteristics to assess the sources of heterogeneity. RESULTS Ten eligible observational studies (6 cohorts and 4 population-based cross sectional studies), with 175,063 participants, were identified. The pooled OR of opioid use disorders was 8.23 (95% CI: 3.07-22.09) for current smokers compared to nonsmokers; pooled OR for opioid use was 2.51 (95% CI: 1.91-3.28). Opioid use or opioid use disorders were positively associated with earlier age at onset of smoking (pooled OR = 1.66; 95% CI: 1.28-2.16). CONCLUSIONS The results of this meta-analysis confirmed that tobacco smoking is associated with opioid use and opioid use disorders development. This conclusion has an important public health message for areas with high smoking prevalence and high opioid use and opioid use disorders incidence.
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Sexual Orientation Disparities in Prescription Opioid Misuse Among U.S. Adults. Am J Prev Med 2019; 56:17-26. [PMID: 30467089 PMCID: PMC6385586 DOI: 10.1016/j.amepre.2018.07.032] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/24/2018] [Accepted: 07/24/2018] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The opioid epidemic in the U.S. continues to increase in severity, and misuse of prescription opioids is of particular concern since it commonly precedes heroin use. This study examined whether sexual orientation (i.e., sexual identity and sexual attraction) is a risk factor for prescription opioid misuse and use disorder among a nationally representative sample of adults in the U.S. METHODS This study used data from adult participants (ages ≥18 years) in the 2015 National Survey on Drug Use and Health. Chi-square tests and logistic regression examined how sexual identity and sexual attraction relate to past-year and past-month prescription opioid misuse and past-year prescription opioid use disorder. Multivariable models examined associations controlling for demographic characteristics and other drug use. Gender-stratified analyses were also conducted. Data were analyzed in 2018. RESULTS In multivariable analyses, compared with those identifying as heterosexual, bisexual individuals were at 1.53 (95% CI=1.20, 1.97) and 1.66 (95% CI=1.14, 2.42) higher odds of reporting past-year and past-month misuse, respectively. In stratified analyses, female bisexuals remained at high risk. Regarding sexual attraction, compared with being attracted to only the opposite sex, being attracted to mostly the opposite sex (AOR=2.15, 95% CI=1.77, 2.63) or being equally attracted to both sexes (AOR=1.78, 95% CI=1.38, 2.30) were associated with higher odds for past-year opioid misuse. In stratified analyses, these associations were limited to females. CONCLUSIONS Sexual orientation disparities in opioid misuse and use disorder among a nationally representative sample of U.S. adults was found.
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Keyes KM, Rutherford C, Miech R. Historical trends in the grade of onset and sequence of cigarette, alcohol, and marijuana use among adolescents from 1976-2016: Implications for "Gateway" patterns in adolescence. Drug Alcohol Depend 2019; 194:51-58. [PMID: 30399500 PMCID: PMC6390293 DOI: 10.1016/j.drugalcdep.2018.09.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/15/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION In the past decade, marijuana use prevalence among adolescents has remained relatively steady while cigarette and alcohol prevalence has declined. We examined historical trends in: average grade of onset of marijuana, alcohol, and cigarette use by 12th grade; proportion who try alcohol/cigarettes before first marijuana use, among those who use by 12th grade; and conditional probability of marijuana use by 12th grade after trying alcohol/cigarettes. METHODS Data were drawn from 40 yearly, cross-sectional surveys of 12th grade US adolescents. A subset of students (N = 246,050) were asked when they first used each substance. We reconstructed cohorts of substance use from grade-of-onset to determine sequence of drug use, as well as probability of marijuana use in the same or later grade. RESULTS Average grade of first alcohol and cigarette use by 12th grade increased across time; e.g., first cigarette increased from grade 7.9 in 1986 to 9.0 by 2016 (β=0.04, SE = 0.001, p < 0.01). The proportion of 12th grade adolescents who smoke cigarettes before marijuana fell below 50% in 2006. Each one-year increase was associated with 1.11 times increased odds of first cigarette in a grade after first marijuana (95% C.I. 1.11-1.12). Among those who initiate alcohol/cigarettes prior to marijuana by 12th grade, the probability of subsequent marijuana use is increasing. CONCLUSION Marijuana is increasingly the first substance in the sequence of adolescent drug use. Reducing adolescent smoking has been a remarkable achievement of the past 20 years; those who continue to smoke are at higher risk for progression to marijuana use.
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Affiliation(s)
- Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA,Center for Research on Society and Health, Universidad Mayor, Santiago, Chile
| | - Caroline Rutherford
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Richard Miech
- Institute for Social Research, University of Michigan, Ann Arbor, MI
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Dudovitz RN, Chung PJ, Reber S, Kennedy D, Tucker JS, Shoptaw S, Dosanjh KK, Wong MD. Assessment of Exposure to High-Performing Schools and Risk of Adolescent Substance Use: A Natural Experiment. JAMA Pediatr 2018; 172:1135-1144. [PMID: 30383092 PMCID: PMC6350909 DOI: 10.1001/jamapediatrics.2018.3074] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE Although school environments are thought to influence health behaviors, experimental data assessing causality are lacking, and which aspects of school environments may be most important for adolescent health are unknown. OBJECTIVE To test whether exposure to high-performing schools is associated with risky adolescent health behaviors. DESIGN, SETTING, AND PARTICIPANTS This natural experiment used admission lotteries, which mimic random assignment, to estimate the association of school environments and adolescent health. A survey of 1270 students who applied to at least 1 of 5 high-performing public charter schools in low-income minority communities in Los Angeles, California. Schools had an academic performance ranked in the top tertile of Los Angeles County public high schools, applicants outnumbered available seats by at least 50, and an admissions lottery was used. Participants included lottery winners (intervention group [n = 694]) and lottery losers (control group [n = 576]) from the end of 8th grade and beginning of 9th grade through the end of 11th grade. Intention-to-treat (ITT) and instrumental variable techniques estimated the association of winning the lottery and attending high-performing schools with health behaviors and whether the association varied by sex. Data were collected from March 11, 2013, through February 22, 2017, and analyzed from October 1, 2017, through July 1, 2018. EXPOSURES Schools were considered high performing if they placed in the top tercile of public high schools in LA County on 2012 state standardized tests. Most students attended that same school for 3 years (9th-11th grades). MAIN OUTCOMES AND MEASURES Primary self-reported outcomes were 30-day and high-risk self-reported marijuana use. Additional health outcomes included 30-day alcohol use, alcohol misuse, ever being in a fight, ever having sex, and past-year delinquency. Potential intermediate factors (time studying, truancy, school mobility, school culture, school order, teacher support for college, and proportion of substance-using peers in students' social networks) were also examined. RESULTS Among the 1270 participating students (52.6% female; mean [SD] age at enrollment, 14.3 [0.5] years), ITT analysis showed that the intervention group reported less marijuana misuse than the control group (mean marijuana misuse score, 0.46 vs 0.71), as well as fewer substance-using peers (9.6% vs 12.7%), more time studying (mean, 2.63 vs 2.49 hours), less truancy (84.3% vs 77.3% with no truancy), greater teacher support for college (mean scores, 7.20 vs 7.02), more orderly schools (mean order score, 7.06 vs 6.83), and less school mobility (21.4% vs 28.4%) (all P < .05). Stratified analyses suggest that among boys, intervention participants had significantly lower marijuana use (mean misuse score, 0.43 vs 0.88; difference, -0.45; 95% CI, -0.78 to -0.13) and alcohol misuse (mean misuse score, 0.52 vs 0.97; difference, -0.44; 95% CI, -0.80 to -0.09) scores compared with control participants, whereas no significant health outcomes were noted for girls. CONCLUSIONS AND RELEVANCE This natural experiment provides evidence that school environments can improve risky behaviors for low-income minority adolescents.
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Affiliation(s)
- Rebecca N. Dudovitz
- Department of Pediatrics and Children’s Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital
| | - Paul J. Chung
- Department of Pediatrics and Children’s Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital,Department of Health Policy & Management, UCLA Fielding School of Public Health,RAND Health, RAND Corporation
| | - Sarah Reber
- Department of Public Policy, UCLA Luskin School of Public Affairs and National Bureau of Economic Research
| | | | | | - Steve Shoptaw
- Department of Family Medicine and Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine at UCLA, Department of Psychiatry, University of Cape Town
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Generational trends and patterns in readmission within a statewide cohort of clients receiving heroin use disorder treatment in Maryland, 2007-2013. J Subst Abuse Treat 2018; 96:82-91. [PMID: 30466553 DOI: 10.1016/j.jsat.2018.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 11/24/2022]
Abstract
The recent rise in opioid-related overdose deaths stresses the importance of understanding how heroin use disorders persist and what interventions are best suited for treating these illnesses. Trends show that there are diverse pathways leading to heroin use disorder that span multiple generations, but little is known about how different generations utilize and respond to treatment. This study provides insight into treatment utilization for young, middle-aged, and older adults by examination of an unusually rich longitudinal dataset of substance use disorder clients in Maryland who were treated for heroin use. Results show that clear patterns of treatment readmission emerge across generations in treatment-naïve clients with regard to gender, ethnicity, employment, geographical region, and treatment type/intensity. In particular, Millennials comprise the majority of the clients receiving heroin use disorder treatment and are the largest contributor to these readmission patterns. Millennials are also given opioid maintenance therapy (OMT) more frequently than other generations, while exhibiting a strong avoidance to treatment. Generational differences in treatment decisions and outcomes over the course of a treatment career are important for understanding the nature of the current opioid epidemic, and can play an important role in directing heroin use disorder treatment efforts and improving models of care.
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Butelman ER, Chen CY, Fry RS, Kimani R, Levran O, Ott J, Correa da Rosa J, Kreek MJ. Re-evaluation of the KMSK scales, rapid dimensional measures of self-exposure to specific drugs: Gender-specific features. Drug Alcohol Depend 2018; 190:179-187. [PMID: 30041093 DOI: 10.1016/j.drugalcdep.2018.05.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/14/2018] [Accepted: 05/30/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND The Kreek-McHugh-Schluger-Kellogg (KMSK) scales provide a rapid assessment of maximal self-exposure to specific drugs and can be used as a dimensional instrument. This study provides a re-evaluation of the KMSK scales for cannabis, alcohol, cocaine, and heroin in a relatively large multi-ethnic cohort, and also the first systematic comparison of gender-specific profiles of drug exposure with this scale. METHODS This was an observational study of n = 1,133 consecutively ascertained adult volunteers. The main instruments used were the SCID-I interview (DSM-IV criteria) and KMSK scales for cannabis, alcohol, cocaine, and heroin. RESULTS Participants were 852 volunteers (297 female) with specific DSM-IV abuse or dependence diagnoses, and 281 volunteers without any drug diagnoses (154 female). Receiver operating characteristic (ROC) curves were calculated for concurrent validity of KMSK scores with the respective DSM-IV dependence diagnoses. The areas under the ROC curves for men and women combined were 99.5% for heroin, 97% for cocaine, 93% for alcohol, and 85% for cannabis. Newly determined optimal KMSK "cutpoint" scores were identical for men and women for cocaine and heroin dependence diagnoses, but were higher in men than in women, for cannabis and alcohol dependence diagnoses. CONCLUSIONS This study confirms the scales' effectiveness in performing rapid dimensional analyses for cannabis, alcohol, cocaine, and heroin exposure, in a cohort larger than previously reported, with "cutpoints" changed from initial determinations, based on this larger sample. The KMSK scales also detected gender differences in self-exposure to alcohol and cannabis that are associated with the respective dependence diagnoses.
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Affiliation(s)
- Eduardo R Butelman
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, 1230 York Avenue, New York, NY, 10065, USA.
| | - Carina Y Chen
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, 1230 York Avenue, New York, NY, 10065, USA
| | - Rebecca S Fry
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, 1230 York Avenue, New York, NY, 10065, USA
| | - Rachel Kimani
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, 1230 York Avenue, New York, NY, 10065, USA
| | - Orna Levran
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, 1230 York Avenue, New York, NY, 10065, USA
| | - Jürg Ott
- Laboratory of Statistical Genetics, The Rockefeller University, 1230 York Avenue, New York, NY, 10065, USA
| | - Joel Correa da Rosa
- Center for Clinical and Translational Science, The Rockefeller University Hospital, 1230 York Avenue, New York, NY, 10065, USA
| | - Mary Jeanne Kreek
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, 1230 York Avenue, New York, NY, 10065, USA
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