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Frohe T, Janssen T, Garner BR, Becker SJ. Examining changes in pain interference via pandemic-induced isolation among patients receiving medication for opioid use disorder: a secondary data analysis. BMC Public Health 2024; 24:2581. [PMID: 39334184 PMCID: PMC11428855 DOI: 10.1186/s12889-024-20077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/13/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Early in the pandemic, the United States population experienced a sharp rise in the prevalence rates of opioid use, social isolation, and pain interference. Given the high rates of pain reported by patients on medication for opioid use disorder (MOUD), the pandemic presented a unique opportunity to disentangle the relationship between opioid use, pain, and social isolation in this high-risk population. We tested the hypothesis that pandemic-induced isolation would partially mediate change in pain interference levels experienced by patients on MOUD, even when controlling for baseline opioid use. Such work can inform the development of targeted interventions for a vulnerable, underserved population. METHODS Analyses used data from a cluster randomized trial (N = 188) of patients on MOUD across eight opioid treatment programs. As part of the parent trial, participants provided pre-pandemic data on pain interference, opioid use, and socio-demographic variables. Research staff re-contacted participants between May and June 2020 and 133 participants (71% response rate) consented to complete a supplemental survey that assessed pandemic-induced isolation. Participants then completed a follow-up interview during the pandemic that again assessed pain interference and opioid use. A path model assessed whether pre-pandemic pain interference had an indirect effect on pain interference during the pandemic via pandemic-induced isolation. RESULTS Consistent with hypotheses, we found evidence that pandemic-induced isolation partially mediated change in pain interference levels among MOUD patients during the pandemic. Higher levels of pre-pandemic pain interference and opioid use were both significantly associated with higher levels of pandemic-induced isolation. In addition, pre-pandemic pain interference was significantly related to levels of pain interference during the pandemic, and these pain levels were partially explained by the level of pandemic-induced isolation reported. CONCLUSIONS Patients on MOUD with higher use of opioids and higher rates of pain pre-pandemic were more likely to report feeling isolated during COVID-related social distancing and this, in turn, partially explained changes in levels of pain interference. These results highlight social isolation as a key risk factor for patients on MOUD and suggest that interventions promoting social connection could be associated with reduced pain interference, which in turn could improve patient quality of life. TRIAL REGISTRATION NCT03931174 (Registered 04/30/2019).
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Affiliation(s)
- Tessa Frohe
- Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, 1959 NE Pacific ST, Box 357238, Seattle, WA, 98195-7238, USA
| | - Tim Janssen
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Bryan R Garner
- Department of Internal Medicine, Ohio State University, The Ohio State University College of Medicine, 2050 Kenny Road, Columbus, 43221, USA
| | - Sara J Becker
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, 633 North St Clair, Suite 2000, Chicago, IL, USA.
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Sorkhou M, Dent EL, George TP. Cannabis use and mood disorders: a systematic review. Front Public Health 2024; 12:1346207. [PMID: 38655516 PMCID: PMC11035759 DOI: 10.3389/fpubh.2024.1346207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Background Problematic cannabis use is highly prevalent among people with mood disorders. This underscores the need to understand the effects of cannabis and cannabinoids in this population, especially considering legalization of recreational cannabis use. Objectives We aimed to (1) systematically evaluate cross-sectional and longitudinal studies investigating the interplay between cannabis use, cannabis use disorder (CUD), and the occurrence of mood disorders and symptoms, with a focus on major depressive disorder (MDD) and bipolar disorder (BD) and; (2) examine the effects of cannabis on the prognosis and treatment outcomes of MDD and BD. Methods Following PRISMA guidelines, we conducted an extensive search for English-language studies investigating the potential impact of cannabis on the development and prognosis of mood disorders published from inception through November 2023, using EMBASE, PsycINFO, PubMed, and MEDLINE databases. Results Our literature search identified 3,262 studies, with 78 meeting inclusion criteria. We found that cannabis use is associated with increased depressive and manic symptoms in the general population in addition to an elevated likelihood of developing MDD and BD. Furthermore, we observed that cannabis use is linked to an unfavorable prognosis in both MDD or BD. Discussion Our findings suggest that cannabis use may negatively influence the development, course, and prognosis of MDD and BD. Future well-designed studies, considering type, amount, and frequency of cannabis use while addressing confounding factors, are imperative for a comprehensive understanding of this relationship. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023481634.
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Affiliation(s)
- Maryam Sorkhou
- Institute for Mental Health Policy and Research at CAMH, Toronto, ON, Canada
- Department of Psychiatry, Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Eliza L. Dent
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Tony P. George
- Institute for Mental Health Policy and Research at CAMH, Toronto, ON, Canada
- Department of Psychiatry, Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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Berey BL, Frohe TM, Pritschmann RK, Yurasek AM. An examination of the acquired preparedness model among college student marijuana users. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:2050-2060. [PMID: 33529130 PMCID: PMC8326293 DOI: 10.1080/07448481.2020.1842419] [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: 02/05/2020] [Revised: 09/11/2020] [Accepted: 10/18/2020] [Indexed: 06/12/2023]
Abstract
ObjectiveTo examine the Acquired Preparedness Model using a behavioral impulsivity facet and positive marijuana expectancies to examine direct and indirect effects on marijuana use and related problems. Participants: 250 college students (61.7% female, 54% white) recruited from a southeastern university. Methods: Participants completed an online survey of delay reward discounting, marijuana expectancies, consideration of future consequences, and marijuana-related outcomes. Results: Delay reward discounting and consideration of future consequences related to marijuana-related problems, but not marijuana use. However, positive marijuana expectancies did not mediate the relation between impulsivity and marijuana outcomes. Conclusions: These results emphasize delay reward discounting and consideration of future consequences as important factors associated with marijuana-related problems. Interventions aimed at decreasing delay reward discounting and augmenting future orientation may be effective in college students who report light to moderate marijuana use. Future studies would benefit from longitudinal study designs using multiple impulsivity measures among light and heavy users.
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Affiliation(s)
- Benjamin L Berey
- Department of Health Education & Behavior, University of Florida, Gainesville, Florida, USA
- Center for Addiction Research and Education, University of Florida, Gainesville, Florida, USA
- Center for Behavioral Economic Health Research, University of Florida, Gainesville, Florida, USA
- Department of Epidemiology Southern HIV & Alcohol Research Consortium, University of Florida, Gainesville, Florida, USA
| | - Tessa M Frohe
- Department of Health Education & Behavior, University of Florida, Gainesville, Florida, USA
- Center for Addiction Research and Education, University of Florida, Gainesville, Florida, USA
- Center for Behavioral Economic Health Research, University of Florida, Gainesville, Florida, USA
- Department of Epidemiology Southern HIV & Alcohol Research Consortium, University of Florida, Gainesville, Florida, USA
| | - Ricarda K Pritschmann
- Department of Health Education & Behavior, University of Florida, Gainesville, Florida, USA
- Center for Addiction Research and Education, University of Florida, Gainesville, Florida, USA
- Center for Behavioral Economic Health Research, University of Florida, Gainesville, Florida, USA
| | - Ali M Yurasek
- Department of Health Education & Behavior, University of Florida, Gainesville, Florida, USA
- Center for Addiction Research and Education, University of Florida, Gainesville, Florida, USA
- Center for Behavioral Economic Health Research, University of Florida, Gainesville, Florida, USA
- Department of Epidemiology Southern HIV & Alcohol Research Consortium, University of Florida, Gainesville, Florida, USA
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Butelman ER, Chen CY, Brown KG, Lake KJ, Kreek MJ. Age of onset of heaviest use of cannabis or alcohol in persons with severe opioid or cocaine use disorders. Drug Alcohol Depend 2021; 226:108834. [PMID: 34216857 DOI: 10.1016/j.drugalcdep.2021.108834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Persons with severe opioid or cocaine use disorders are particularly vulnerable to morbidity and mortality. Heaviest use of mu-opioid receptor agonists and cocaine typically commences in early adulthood and is preceded by substantial adolescent exposure to cannabis and/or alcohol. Little information exists on the age trajectories of exposure to cannabis or alcohol in persons diagnosed with severe opioid or cocaine use disorders, compared to persons diagnosed with other substance use disorders (unrelated to opioids or cocaine). METHOD This observational study had n = 854 volunteers (male = 581, female = 273; ≥18 years of age at the time of interview) and examined the ages of onset of heaviest use of cannabis and alcohol in persons diagnosed by DSM-IV criteria with opioid dependence (OD), both opioid and cocaine dependence (OD + CD) and cocaine dependence (CD). These age trajectory measures were compared to persons with other substance use disorders (primarily cannabis and alcohol use disorders, termed "Any Other Diagnoses"). RESULTS Unadjusted survival analyses showed persons diagnosed with either OD + CD or CD had earlier onset of heaviest use of cannabis (mean ages of 16.2 and 17.8, respectively) compared to the "Any Other Diagnoses" reference group (mean age = 19.5). A multivariate logistic regression showed that later onset of heaviest use of cannabis was associated with lower odds of being in the OD + CD or CD groups, when compared to the reference group. CONCLUSIONS Persons diagnosed with severe cocaine use disorders or dual opioid and cocaine use disorders exhibit a pattern of heavy and especially early adolescent exposure to cannabis, compared to persons with other substance use disorders.
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Affiliation(s)
- Eduardo R Butelman
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, 1230 York Ave, New York, NY, 10065, USA.
| | - Carina Y Chen
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, 1230 York Ave, New York, NY, 10065, USA
| | - Kate G Brown
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, 1230 York Ave, New York, NY, 10065, USA
| | - Kimberly J Lake
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, 1230 York Ave, New York, NY, 10065, USA
| | - Mary Jeanne Kreek
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, 1230 York Ave, New York, NY, 10065, USA
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Dodge T, Joshi D, Alharbi M, Moore B. Effect of physical activity goals on aerobic physical activity: testing the mediating role of external and internal motivation. PSYCHOL HEALTH MED 2021; 27:1296-1310. [PMID: 33486976 DOI: 10.1080/13548506.2021.1874430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Prior work has shown that primary care patients endorse one or more of the following PA goals, weight maintenance, overall benefits, stress reduction, weight loss, tone/body shape, overall well-being, cardiovascular fitness, and increased energy. Using self-determination theory as a guide, the present study tested whether these eight goals had indirect effects on likelihood of meeting aerobic PA guidelines through internal motivation, external motivation or both. Patients (N = 642; 60.7% female; 44.5% Black; Mage = 50.26 years) were recruited from the waiting room of a primary care clinic to complete a questionnaire. Results showed that PA goals of tone/shape, weight maintenance, and stress reduction had dual, opposing influences on likelihood of meeting aerobic PA guidelines via internal and external motivation. The goal of weight loss had a negative indirect effect on likelihood of meeting guidelines via external motivation. The PA goals of overall health benefits and cardiovascular health had singular, positive indirect effects on PA via internal motivation. Well-being had a direct positive effect on PA and a negative indirect effect via external motivation. Finally, the goal of improved energy had a direct positive effect on likelihood to meet PA guidelines. Implications for clinical practice and theory development are discussed.
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Affiliation(s)
- Tonya Dodge
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Deepti Joshi
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
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Abstract
Objectives: To examine rates and correlates of dual cannabis and prescription pain reliever (PPNR) use and misuse among U.S. individuals aged 50+ who reported past-year cannabis use. Methods: Using the 2015-2018 National Survey of Drug Use and Health, we examined cannabis nonuse/use and PPNR nonuse/use/misuse among all 35,229 respondents, and then focused on 2,632 past-year cannabis users to examine the risk of PPNR use but no misuse and the risk of PPNR misuse, compared to PPNR nonuse. Results: More than one-half of older cannabis users used PPNR in the past year. Multinomial logistic regression results show that the risks of PPNR use/no misuse and PPNR misuse were higher among those who had more chronic medical conditions and a major depressive episode. The risk of PPNR use/no misuse was also associated with high frequency and medical cannabis use. The risk of PPNR misuse was also associated with younger cannabis initiation age and cannabis and other illicit drug use disorders. Conclusions: Correlates of dual cannabis and PPNR use/misuse among older adults are poor physical and mental health problems and problematic cannabis use. Clinical Implications: Older adults with cannabis and PPNR misuse need access to evidence-based treatment, including medication-assisted treatment when needed.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin , Austin, TX, USA
| | - Diana M DiNitto
- Steve Hicks School of Social Work, University of Texas at Austin , Austin, TX, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Brown University Warren Alpert Medical School , Providence, RI, USA
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Matzopoulos R, Morlock R, Morlock A, Lerer B, Lerer L. Psychedelic Mushrooms in the USA: Knowledge, Patterns of Use, and Association With Health Outcomes. Front Psychiatry 2021; 12:780696. [PMID: 35046855 PMCID: PMC8761614 DOI: 10.3389/fpsyt.2021.780696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/30/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: Popular media coverage of psychedelics use, growing research into this class of compounds for psychiatry and decriminalization initiatives, are transforming the public perception of psychedelics. However, little is known about levels of knowledge and psychedelic mushroom (PM) use among American adults. Methods: We examined PM use and various measures of health status, quality of life, and self-reported mental health outcome measures obtained through a national on-line, cross-sectional survey of adults with a demographic composition representative of the US adult population by region, gender, age, and race (weighted N = 251,297,495) from November 2020-March 2021. Results: General mental health and well-being were popular reasons for PM use (63.6%), although use for medically-diagnosed (31.8%) and self-diagnosed (19.0%) conditions was also common. PM users reported more depression and anxiety as reflected in higher GAD-7 and PHQ-9 scores. Factors predictive of PM use included being male [OR 1.54 95%CI 1.09-2.15] and having higher Charlson Comorbidity Index scores [OR 1.42; 95%CI 1.22-1.65]. Self-reported PM use was less likely among participants with health insurance [OR = 0.50 (0.35-0.72)], increased age [OR = 0.92 (0.90-0.93)] and, relative to those living in the west US census region, living in the northeast [OR = 0.27 (0.15-0.50)], midwest [OR = 0.34 (0.20-0.56)], and south [OR = 0.38 (0.26-0.55)]. Discussion and Conclusions: A significant number of Americans are already "self-medicating" with PM and as growing positive media coverage of psychedelics drives public interest in the health benefits of PM, this number will increase. The association between PM use and poor mental health requires further research to inform policy.
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Affiliation(s)
- Richard Matzopoulos
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.,School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Amy Morlock
- Acumen Health Research Institute, Ann Arbor, MI, United States
| | - Bernard Lerer
- Biological Psychiatry Laboratory and Hadassah BrainLabs, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Leonard Lerer
- Back of the Yards Algae Sciences - Parow Entheobiosciences, Chicago, IL, United States
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