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Compton MT, Frimpong EY, Fu E, Ehntholt A, Chaudhry S, Ferdousi W, Rowan GA, Swetnam H, Radigan M, Smith TE, Rotter M. Associations Between Cumulative Social Adversities and Substance Use Comorbidity in a Statewide Sample of Individuals in Treatment for Mental Illnesses. J Nerv Ment Dis 2023; 211:814-818. [PMID: 37552046 DOI: 10.1097/nmd.0000000000001703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
ABSTRACT We sought to investigate associations of cumulative social adversities in four areas (low education, unemployment, homelessness, and criminal/legal involvement) with presence of comorbid alcohol and drug use disorders among individuals in treatment for mental illnesses. Using data from 103,416 adults in mental health treatment, generalized estimating equation modified Poisson models were used to estimate increased risk of having comorbid substance use disorders based on individual and/or cumulative number of social adversities present. Controlling for effects of sex, race/ethnicity, and region (New York City vs . the rest of the State), as well as for the other social adversities, each of four social adversities was associated with presence of substance use comorbidity. Relative to having none of the social adversities, the presence of one, two, three, or four was associated with an increased prevalence ratio (PR) of having substance use comorbidity: 1.44, 2.10, 2.66, and 2.92; all p 's < 0.0001. PRs were greater among female patients, and among Hispanics and those classified as other or multiracial compared with non-Hispanic Whites or non-Hispanic Blacks. Findings indicate substantial associations between four social adversities and presence of substance use comorbidity; the strength of association with the four social adversities is cumulative.
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Affiliation(s)
| | | | - En Fu
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | | | - Sahil Chaudhry
- New York State Office of Mental Health, Albany, New York
| | | | - Grace A Rowan
- New York State Office of Mental Health, Albany, New York
| | - Hannah Swetnam
- New York State Office of Mental Health, Albany, New York
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Ober AJ, Hunter SB, McCullough CM, Leamon I, McCreary M, Beas I, Montero A, Tarn DM, Bromley E, Hurley B, Sheehe J, Martinez J, Watkins KE. Opioid Use Disorder Among Clients of Community Mental Health Clinics: Prevalence, Characteristics, and Treatment Willingness. Psychiatr Serv 2022; 73:271-279. [PMID: 34281359 PMCID: PMC8770719 DOI: 10.1176/appi.ps.202000818] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the prevalence of co-occurring opioid use disorder and willingness to engage in treatment among clients of eight Los Angeles County Department of Mental Health outpatient clinics. METHODS Adults presenting for an appointment over a 2-week period were invited to complete a voluntary, anonymous health survey. Clients who indicated opioid use in the past year were offered a longer survey assessing probable opioid use disorder. Willingness to take medication and receive treatment also was assessed. RESULTS In total, 3,090 clients completed screening. Among these, 8% had a probable prescription (Rx) opioid use disorder and 2% a probable heroin use disorder. Of the clients with probable Rx opioid use or heroin use disorder, 49% and 25% were female, respectively. Among those with probable Rx opioid use disorder, 43% were Black, 33% were Hispanic, and 12% were White, and among those with probable heroin use disorder, 24% were Black, 22% were Hispanic, and 39% were White. Seventy-eight percent of those with Rx opioid use disorder had never received any treatment, and 82% had never taken a medication for this disorder; 39% of those with heroin use disorder had never received any treatment, and 39% had never received a medication. The strongest predictor of willingness to take a medication was believing that it would help stop opioid use (buprenorphine, β=13.54, p=0.003, and naltrexone long-acting injection, β=15.83, p<0.001). CONCLUSIONS These findings highlight the need to identify people with opioid use disorder and to educate clients in mental health settings about medications for these disorders.
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Affiliation(s)
| | | | | | - Isabel Leamon
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407
| | | | - Ivan Beas
- David Geffen School of Medicine at UCLA
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Association of co-occurring opioid or other substance use disorders with increased healthcare utilization in patients with depression. Transl Psychiatry 2021; 11:265. [PMID: 33941761 PMCID: PMC8093211 DOI: 10.1038/s41398-021-01372-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 02/03/2023] Open
Abstract
Substance use disorders (SUDs) commonly co-occur with mental illness. However, the ongoing addiction crisis raises the question of how opioid use disorder (OUD) impacts healthcare utilization relative to other SUDs. This study examines the utilization patterns of patients with major depressive disorder (MDD) and: (1) co-occurring OUD (MDD-OUD); (2) a co-occurring SUD other than OUD (MDD-NOUD); and (3) no co-occurring SUD (MDD-NSUD). We analyzed electronic health records (EHRs) derived from multiple health systems across the New York City (NYC) metropolitan area between January 2008 and December 2017. 11,275 patients aged ≥18 years with a gap of 30-180 days between 2 consecutive MDD diagnoses and an antidepressant prescribed 0-180 days after any MDD diagnosis were selected, and prevalence of any SUD was 24%. Individuals were stratified into comparison groups and matched on age, gender, and select underlying comorbidities. Prevalence rates and encounter frequencies were measured and compared across outpatient, inpatient, and emergency department (ED) settings. Our key findings showed that relative to other co-occurring SUDs, OUD was associated with larger increases in the rates and odds of using substance-use-related services in all settings, as well as services that integrate mental health and substance abuse treatments in inpatient and ED settings. OUD was also associated with larger increases in total encounters across all settings. These findings and our proposed policy recommendations could inform efforts towards targeted OUD interventions, particularly for individuals with underlying mental illness whose treatment and recovery are often more challenging.
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Polimanti R, Levey DF, Pathak GA, Wendt FR, Nunez YZ, Ursano RJ, Kessler RC, Kranzler HR, Stein MB, Gelernter J. Multi-environment gene interactions linked to the interplay between polysubstance dependence and suicidality. Transl Psychiatry 2021; 11:34. [PMID: 33431810 PMCID: PMC7801457 DOI: 10.1038/s41398-020-01153-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 12/19/2022] Open
Abstract
Substance dependence diagnoses (SDs) are important risk factors for suicidality. We investigated the associations of multiple SDs with different suicidality outcomes, testing how genetic background moderates these associations. The Yale-Penn cohort (N = 15,557) was recruited to investigate the genetics of SDs. The Army STARRS (Study to Assess Risk and Resilience in Servicemembers) cohort (N = 11,236) was recruited to evaluate mental health risk and resilience among Army personnel. We applied multivariate logistic regression to investigate the associations of SDs with suicidality and, in the Yale-Penn cohort, we used the structured linear mixed model (StructLMM) to study multivariate gene-environment interactions. In Yale-Penn, lifetime polysubstance dependence was strongly associated with lifetime suicidality: having five SDs showed an association with suicidality, from odds ratio (OR) = 6.77 (95% confidence interval, CI = 5.74-7.99) for suicidal ideation (SI) to OR = 3.61 (95% CI = 2.7-4.86) for suicide attempt (SA). In Army STARRS, having multiple substance use disorders for alcohol and/or drugs was associated with increased suicidality ranging from OR = 2.88 (95% CI = 2.6-3.19) for SI to OR = 3.92 (95% CI = 3.19-4.81) for SA. In Yale-Penn, we identified multivariate gene-environment interactions (Bayes factors, BF > 0) of SI with respect to a gene cluster on chromosome 16 (LCAT, p = 1.82 × 10-7; TSNAXIP1, p = 2.13 × 10-7; CENPT, p = 2.32 × 10-7; PARD6A, p = 5.57 × 10-7) for opioid dependence (BF = 12.2), cocaine dependence (BF = 12.1), nicotine dependence (BF = 9.2), and polysubstance dependence (BF = 2.1). Comorbidity of multiple SDs is a significant associated with suicidality and heritability of suicidality is partially moderated by multivariate gene interactions.
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Affiliation(s)
- Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, Yale University, West Haven, CT, USA. .,Veteran Affairs CT Healthcare System, West Haven, CT, USA.
| | - Daniel F. Levey
- grid.47100.320000000419368710Department of Psychiatry, Yale School of Medicine, Yale University, West Haven, CT USA ,Veteran Affairs CT Healthcare System, West Haven, CT USA
| | - Gita A. Pathak
- grid.47100.320000000419368710Department of Psychiatry, Yale School of Medicine, Yale University, West Haven, CT USA ,Veteran Affairs CT Healthcare System, West Haven, CT USA
| | - Frank R. Wendt
- grid.47100.320000000419368710Department of Psychiatry, Yale School of Medicine, Yale University, West Haven, CT USA ,Veteran Affairs CT Healthcare System, West Haven, CT USA
| | - Yaira Z. Nunez
- grid.47100.320000000419368710Department of Psychiatry, Yale School of Medicine, Yale University, West Haven, CT USA ,Veteran Affairs CT Healthcare System, West Haven, CT USA
| | - Robert J. Ursano
- grid.265436.00000 0001 0421 5525Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Ronald C. Kessler
- grid.38142.3c000000041936754XDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Henry R. Kranzler
- grid.25879.310000 0004 1936 8972University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA ,grid.410355.60000 0004 0420 350XCrescenz Veterans Affairs Medical Center, Philadelphia, PA USA
| | - Murray B. Stein
- grid.266100.30000 0001 2107 4242Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA USA ,grid.410371.00000 0004 0419 2708Psychiatry Service, Veterans Affairs San Diego Healthcare System, San Diego, CA USA
| | - Joel Gelernter
- grid.47100.320000000419368710Department of Psychiatry, Yale School of Medicine, Yale University, West Haven, CT USA ,Veteran Affairs CT Healthcare System, West Haven, CT USA ,grid.47100.320000000419368710Departments of Genetics and Neuroscience, Yale University School of Medicine, New Haven, CT 06510 USA
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Montiel Ishino FA, McNab PR, Gilreath T, Salmeron B, Williams F. A comprehensive multivariate model of biopsychosocial factors associated with opioid misuse and use disorder in a 2017-2018 United States national survey. BMC Public Health 2020; 20:1740. [PMID: 33208132 PMCID: PMC7672927 DOI: 10.1186/s12889-020-09856-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have comprehensively and contextually examined the relationship of variables associated with opioid use. Our purpose was to fill a critical gap in comprehensive risk models of opioid misuse and use disorder in the United States by identifying the most salient predictors. METHODS A multivariate logistic regression was used on the 2017 and 2018 National Survey on Drug Use and Health, which included all 50 states and the District of Columbia of the United States. The sample included all noninstitutionalized civilian adults aged 18 and older (N = 85,580; weighted N = 248,008,986). The outcome of opioid misuse and/or use disorder was based on reported prescription pain reliever and/or heroin use dependence, abuse, or misuse. Biopsychosocial predictors of opioid misuse and use disorder in addition to sociodemographic characteristics and other substance dependence or abuse were examined in our comprehensive model. Biopsychosocial characteristics included socioecological and health indicators. Criminality was the socioecological indicator. Health indicators included self-reported health, private health insurance, psychological distress, and suicidality. Sociodemographic variables included age, sex/gender, race/ethnicity, sexual identity, education, residence, income, and employment status. Substance dependence or abuse included both licit and illicit substances (i.e., nicotine, alcohol, marijuana, cocaine, inhalants, methamphetamine, tranquilizers, stimulants, sedatives). RESULTS The comprehensive model found that criminality (adjusted odds ratio [AOR] = 2.58, 95% confidence interval [CI] = 1.98-3.37, p < 0.001), self-reported health (i.e., excellent compared to fair/poor [AOR = 3.71, 95% CI = 2.19-6.29, p < 0.001], good [AOR = 3.43, 95% CI = 2.20-5.34, p < 0.001], and very good [AOR = 2.75, 95% CI = 1.90-3.98, p < 0.001]), no private health insurance (AOR = 2.12, 95% CI = 1.55-2.89, p < 0.001), serious psychological distress (AOR = 2.12, 95% CI = 1.55-2.89, p < 0.001), suicidality (AOR = 1.58, 95% CI = 1.17-2.14, p = 0.004), and other substance dependence or abuse were significant predictors of opioid misuse and/or use disorder. Substances associated were nicotine (AOR = 3.01, 95% CI = 2.30-3.93, p < 0.001), alcohol (AOR = 1.40, 95% CI = 1.02-1.92, p = 0.038), marijuana (AOR = 2.24, 95% CI = 1.40-3.58, p = 0.001), cocaine (AOR = 3.92, 95% CI = 2.14-7.17, p < 0.001), methamphetamine (AOR = 3.32, 95% CI = 1.96-5.64, p < 0.001), tranquilizers (AOR = 16.72, 95% CI = 9.75-28.65, p < 0.001), and stimulants (AOR = 2.45, 95% CI = 1.03-5.87, p = 0.044). CONCLUSIONS Biopsychosocial characteristics such as socioecological and health indicators, as well as other substance dependence or abuse were stronger predictors of opioid misuse and use disorder than sociodemographic characteristics.
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Affiliation(s)
- Francisco A Montiel Ishino
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 7201 Wisconsin Ave Ste. 533, Bethesda, MD, 20814, USA. .,Transdisciplinary Center for Health Equity Research, College of Education and Human Development, Texas A&M University, 4243 TAMU, 311 Blocker, College Station, TX, 77843, USA.
| | - Philip R McNab
- Center for a Livable Future, Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, 111 Market Place, Suite 840, Baltimore, MD, 21202, USA
| | - Tamika Gilreath
- Transdisciplinary Center for Health Equity Research, College of Education and Human Development, Texas A&M University, 4243 TAMU, 311 Blocker, College Station, TX, 77843, USA
| | - Bonita Salmeron
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 7201 Wisconsin Ave Ste. 533, Bethesda, MD, 20814, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 7201 Wisconsin Ave Ste. 533, Bethesda, MD, 20814, USA
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Cheatle MD, Falcone M, Dhingra L, Lerman C. Independent association of tobacco use with opioid use disorder in patients of European ancestry with chronic non-cancer pain. Drug Alcohol Depend 2020; 209:107901. [PMID: 32126454 PMCID: PMC7219106 DOI: 10.1016/j.drugalcdep.2020.107901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The harms associated with prescription opioid abuse have become a public health crisis. There is a need for evidence-based objective markers of the risk of opioid use disorder (OUD) in patients with pain receiving opioid treatment. The objective of this study was to evaluate the independent association of tobacco use and OUD in patients with chronic non-cancer pain. METHODS This cross-sectional naturalistic study evaluated 798 adults ≥ 18 years with chronic non-cancer pain treated with long-term opioid therapy (≥ 6 months) who either developed an OUD (cases, n = 216) or displayed no evidence of an OUD (controls, n = 582). The primary outcome was presence of OUD. In addition to current self-reported tobacco use (primary predictor), covariates included demographics, pain severity, and psychiatric history. Data were collected between November 2012 and September 2018. RESULTS Current tobacco use independently was strongly associated with OUD [odds ratio (OR) 14.0, 95 % confidence interval (CI) 9.5-20.6, p < 0.001], and this association remained significant after adjusting for other risk factors [adjusted odds ratio (aOR) 7.6, 95 % CI 4.8-12.2, p < 0.001]. Other factors associated independently with development of OUD included age, marital status, financial status, education and pain severity. CONCLUSIONS AND RELEVANCE Current tobacco use is significantly associated with OUD in patients with chronic pain receiving long-term opioid therapy.
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Affiliation(s)
- Martin D Cheatle
- Department of Psychiatry, Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Mary Falcone
- Keck School of Medicine, University of Southern California, Los Angeles, CA, 99003, USA
| | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY, USA; Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Caryn Lerman
- Keck School of Medicine, University of Southern California, Los Angeles, CA, 99003, USA
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