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Smith MD, Kromash R, Siebert S, Gratz KL, Moore KE, Tull MT. The Relation of Health Anxiety to Treatment Utilization Among Patients with Substance Use Disorders: The Moderating Role of Racial/Ethnic Background. Subst Use Misuse 2024:1-11. [PMID: 39275954 DOI: 10.1080/10826084.2024.2403122] [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] [Indexed: 09/16/2024]
Abstract
Background: Although health anxiety is broadly related to the overutilization of healthcare, limited research has examined this relation among individuals with substance use disorders (SUDs), or the extent to which racial/ethnic differences influence this relationship. Objectives: The purpose of the current study is to examine the moderating role of racial/ethnic minoritized background in the relationship between health anxiety and treatment utilization among individuals with SUDs. In the present study, patients with SUDs receiving residential treatment in Mississippi (N=118; 62% racial/ethnic minoritized status, 35.6% White) completed a measure of health anxiety and answered questions about past mental health, physical health, and substance use treatment. Regression models examined whether racial/ethnic minoritized status (White vs. racial/ethnic minoritized status) moderated the relation of health anxiety to treatment utilization among patients with SUDs. Treatment utilization was examined by asking whether participants had seen a doctor or mental health provider, engaged in substance use treatment, or alcohol treatment prior to their current treatment (dichotomous), as well as the number of times they had engaged in each treatment (physical health, mental health, substance use, and alcohol treatment) in the past year (continuous). Results: Results revealed that the facets of health anxiety involving concerns about pain and disease phobia were positively associated with treatment utilization, but only among racial/ethnic minoritized participants, with concerns about pain positively associated with self-reported physical health treatment utilization (OR=0.70, 95% CI=0.50; 0.97) and disease phobia positively associated with past mental health (B = 0.36, p = 0.023) and alcohol use treatment (B=-0.23, p=.009). Conversely, disease phobia was related to less prior alcohol use treatment among White participants (B=-0.23, p=.009). Conclusions: Overall, among patients in residential treatment for SUDs, racial/ethnic minoritized participants with SUDs reported more health anxiety compared to white participants, and certain facets of health anxiety (i.e., concerns about pain and worry about severe illness) were linked to heightened treatment utilization among racial/ethnic minoritized individuals.
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Affiliation(s)
- Madison D Smith
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
| | - Rachelle Kromash
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
| | - Shania Siebert
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
| | - Kim L Gratz
- Lyra Health, Burlingame, California, USA
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Kelly E Moore
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
| | - Matthew T Tull
- Lyra Health, Burlingame, California, USA
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
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Choi NG, Moore J, Choi BY. Cannabis use disorder and substance use treatment among U.S. adults. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 167:209486. [PMID: 39151799 DOI: 10.1016/j.josat.2024.209486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/24/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Recent expansion of cannabis legalization in multiple states calls for reexamination of the prevalence of cannabis use, cannabis use disorder (CUD), and the associations between CUD severity and substance use treatment. We used Andersen's behavioral model of healthcare use as the conceptual/analytic framework for examining treatment use. METHODS We used data from the 2022 National Survey on Drug Use and Health (NSDUH; N = 47,100, age 18+) to describe the prevalence of past-year cannabis use, CUD and CUD severity, other substance use disorders, and substance use treatment. We compared sociodemographic, mental health, healthcare use, and cannabis and other substance use characteristics by CUD severity. Finally, we used logistic regression models to examine the associations between CUD severity and substance use treatment. RESULTS Of the U.S. adult population, 23.0 % used cannabis in the past year; 7.0 % had a CUD (3.9 % mild, 1.9 % moderate, and 1.2 % severe CUD); and 4.7 % received substance use treatment. Of past-year cannabis users, 30.3 % had CUD (16.9 % mild, 8.4 % moderate, and 5.0 % severe CUD), and 9.6 % received substance use treatment. Cannabis users had 3-4 times higher rates of other substance use disorders than nonusers. Of those with CUD, 38.4 % had moderate/severe mental illness, 52.4 % had other substance use disorders, and 16.5 % received substance use treatment. Among all cannabis users, moderate (aOR [adjusted odds ratios] = 1.48, 95 % CI = 1.03-2.13) and severe (aOR = 2.57, 95 % CI = 1.60-4.11) CUDs were associated with greater odds of substance use treatment. Among cannabis users without nicotine dependence and alcohol, opioid, tranquilizer/sedative, and stimulant use disorders, only severe CUD (aOR = 6.03, 95 % CI = 3.37-10.78) was associated with greater odds of substance use treatment. CONCLUSIONS This study shows increased prevalence of cannabis use and CUD among U.S. adults, and with or without other substance use disorders, CUD was associated with greater odds of substance use treatment. However, the overall low rate of treatment use among those with CUD is concerning. Healthcare providers need to provide education for both medical and recreational users on the development of tolerance and dependence. Harm reduction strategies to minimize the negative consequences of CUD are also needed.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA.
| | - John Moore
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, USA
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Tsai RY, Gau SY, Ho YJ, Lin SY, Ku CY, Wang SI, Wei JCC. Long-COVID impacts taste and olfactory in individuals with substance use disorder: A retrospective cohort study from the TriNetX US Collaborative Networks. Psychiatry Res 2024; 337:115970. [PMID: 38810537 DOI: 10.1016/j.psychres.2024.115970] [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: 07/11/2023] [Revised: 03/03/2024] [Accepted: 03/15/2024] [Indexed: 05/31/2024]
Abstract
Substance use disorder (SUD) exacerbates the impact of Long-COVID, particularly increasing the risk of taste and olfactory disorders. Analyzing retrospective cohort data from TriNetX and over 33 million records (Jan 2020-Dec 2022), this study focused on 1,512,358 participants, revealing that SUD significantly heightens the likelihood of experiencing taste disturbances and anosmia in Long-COVID sufferers. Results indicated that individuals with SUD face a higher incidence of sensory impairments compared to controls, with older adults and women being particularly vulnerable. Smokers with SUD were found to have an increased risk of olfactory and taste dysfunctions. The findings underscore the importance of early screening, diagnosis, and interventions for Long-COVID patients with a history of SUD, suggesting a need for clinicians to monitor for depression and anxiety linked to sensory dysfunction for comprehensive care.
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Affiliation(s)
- Ru-Yin Tsai
- Department of Anatomy, School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taiwan; Department of Medical Education and Research, Kaohsiung Veterans General Hospital. Taiwan
| | - Ying-Jui Ho
- Department of Psychology, School of Medicine, Chung Shan Medical University, Taichung City, Taiwan; Clinical Psychological Room, Chung Shan Medical University Hospital, Taiwan Taichung City, Taiwan
| | - Sheng-Yi Lin
- Department of Anatomy, School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chung-Yao Ku
- School of Medicine, Chung Shan Medical University, Taiwan
| | - Shiow-Ing Wang
- Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Nursing, Chung Shan Medical University, Taichung, Taiwan.
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Kronberg G, Ceceli AO, Huang Y, Gaudreault PO, King SG, McClain N, Alia-Klein N, Goldstein RZ. Naturalistic drug cue reactivity in heroin use disorder: orbitofrontal synchronization as a marker of craving and recovery. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.11.02.23297937. [PMID: 37961156 PMCID: PMC10635268 DOI: 10.1101/2023.11.02.23297937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Movies captivate groups of individuals (the audience), especially if they contain themes of common motivational interest to the group. In drug addiction, a key mechanism is maladaptive motivational salience attribution whereby drug cues outcompete other reinforcers within the same environment or context. We predicted that while watching a drug-themed movie, where cues for drugs and other stimuli share a continuous narrative context, fMRI responses in individuals with heroin use disorder (iHUD) will preferentially synchronize during drug scenes. Results revealed such drug-biased synchronization in the orbitofrontal cortex (OFC), ventromedial and ventrolateral prefrontal cortex, and insula. After 15 weeks of inpatient treatment, there was a significant reduction in this drug-biased shared response in the OFC, which correlated with a concomitant reduction in dynamically-measured craving, suggesting synchronized OFC responses to a drug-themed movie as a neural marker of craving and recovery in iHUD.
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Affiliation(s)
- Greg Kronberg
- Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Ahmet O Ceceli
- Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Yuefeng Huang
- Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | | | - Sarah G King
- Icahn School of Medicine at Mount Sinai, New York, NY 10029
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Phillips AZ, Wang Y, Allen NB. Patterns of health care interactions of individuals with alcohol use disorder: A latent class analysis. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209251. [PMID: 38072388 PMCID: PMC11005937 DOI: 10.1016/j.josat.2023.209251] [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: 04/20/2023] [Revised: 09/29/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Given the high rates at which individuals with alcohol use disorder (AUD) utilize health care for co-existing conditions, health systems are promising venues for interventions that will facilitate access to AUD treatment. However, how individuals with AUD interact with such systems and, thus, how systems should intervene is unclear. In this study, we seek to identify patterns in how individuals diagnosed with AUD within an academic health system interacted with the system prior to diagnosis. METHODS We use electronic health records from a single academic health system in a major US metropolitan area to create a deidentified retrospective cohort including all individuals age 18+ diagnosed with AUD 2010-2019 (n = 26,899). Latent class analysis (LCA) identified subgroups defined by aspects of previous system interaction and health status, including having an in-system primary care provider, previous utilization of primary and specialty care, diagnosis setting, payer, and presence of other chronic conditions. We then assessed subgroup differences in demographics and associations with in-system AUD treatment receipt in the year following diagnosis, adjusting for demographics. RESULTS The population was on average 38.6 years old (standard deviation = 15.4) and predominantly male (66.1 %), White (64.5 %), and not of Hispanic/Latino ethnicity (87.8 %). Only 4.7 % received in-system treatment following diagnosis. We deemed the four-class model the optimal LCA model. This model identified subgroups that can be described as 1) average utilization (20.7 % of population), 2) low utilization (54.5 %), 3) high health burden and low utilization (14.2 %), and 4) high health burden and high utilization (10.6 %). Predicted membership in the high health burden and high utilization subgroup and low utilization subgroup were associated with higher and lower odds of treatment receipt, respectively, compared with predicted membership in the average utilization subgroup (odds ratio (OR) for high/high subgroup = 1.21, 95 % confidence interval (CI) = 1.01, 1.27; OR for low subgroup = 0.29 95 % CI = 0.24, 0.34). CONCLUSION Individuals diagnosed with AUD within a health system interact with that system in markedly different ways and are unlikely to benefit uniformly from system-based interventions to facilitate treatment. Group-tailored interventions are more likely to have impact and provide returns on investments for systems.
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Affiliation(s)
- Aryn Z Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA; Department of Health Policy and Management, University of Maryland School of Public Health, 4200 Valley Drive, College Park, MD 20742, USA.
| | - Yaojie Wang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA.
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA.
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Jallo N, Kinser PA, Eglovitch M, Worcman N, Webster P, Alvanzo A, Svikis D, Meshberg-Cohen S. Giving Voice to Women with Substance Use Disorder: Findings from Expressive Writing About Trauma. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:223-230. [PMID: 38516652 PMCID: PMC10956529 DOI: 10.1089/whr.2023.0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/23/2024]
Abstract
Background Trauma exposure is a risk factor for substance use disorders (SUD) among women. This study explores written content from an expressive writing (EW) intervention conducted within a residential SUD program to examine themes across trauma experiences and characterize their deep insight into such experiences. Materials and Methods This qualitative study is a secondary data analysis of written content of the first writing session from women (n = 44) randomized to an EW condition while in residential SUD treatment. Results Nearly all participants (72.7% African American; mean age 37.3 years) reported a significant trauma event (93.2%) with an average of 3.7 types of trauma events (54.4% had a current posttraumatic stress disorder diagnosis). Four primary themes emerged: (1) trauma across the lifespan; (2) loss of safety; (3) altered self-concept; and (4) desire to move on. Most participants identified interpersonal trauma, especially at an early age, as well as parental neglect and physical and/or sexual violence. These themes indicate a pattern of interpersonal betrayal and paint a picture of trauma and the subsequent "rippling effect" such that the physical, mental, and emotional consequences were often as impactful as the event itself. However, there was also a desire to move on and gain a sense of normalcy. Conclusions Findings highlight the importance of the written word and addressing underlying trauma in addiction treatment to facilitate healing and the woman's desire to move on.
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Affiliation(s)
- Nancy Jallo
- Department of Family and Community Health Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Patricia A. Kinser
- Department of Family and Community Health Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Michelle Eglovitch
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nicola Worcman
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach, State University of Campinas, Campinas, Brazil
| | - Parker Webster
- Chinle Comprehensive Healthcare Facility, Indian Health Service, Chinle, Arizona, USA
| | - Anika Alvanzo
- Substance Use Disorders Consultation Services, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dace Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sarah Meshberg-Cohen
- Department of Psychiatry, Yale University School of Medicine, West Haven, Connecticut, USA
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Kabembo IM. Forgone healthcare for medically vulnerable groups during the pandemic era: experiences of family caregivers of young adults with substance use disorders in Zambia. Front Public Health 2024; 12:1250608. [PMID: 38525347 PMCID: PMC10959020 DOI: 10.3389/fpubh.2024.1250608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Scholars worldwide have defined the COVID-19 pandemic as a mass-disabling event of our time. The situation is grave for families experiencing financial hurdles while caring for young adults in recovery from addiction problems. Methods Using semi-structured interviews with 30 purposively selected family caregivers (FCGs) of young adults with substance use disorders (SUDs) in Lusaka, Zambia, this study reveals several factors influencing forgone healthcare for this medically vulnerable group. Results Financial challenges and huge out-of-pocket bills; caregivers' perceived far-fetched recovery of the young adult; the cost of medication and transportation; the young adult's little perceived need for healthcare service use, their runaway and treatment elusive tendencies; caregiver concerns about contracting the virus, and the stigma associated with it; and a fragmented child and adolescent mental health system influenced forgone healthcare. The young adults were often unavailable for days and months, posing challenges to the continuity of care. Despite caregivers' acknowledgment of the availability of healthcare professionals, young adults with problematic substance use had limited access to SUD recovery services, resulting in adverse health outcomes. Results also show that most family caregivers encountered challenges in accessing and purchasing psychotropic medications, which were difficult to find during the lockdowns. Some family caregivers lost their sources of income by being laid off from work due to the pandemic and skipping work to attend to caregiving responsibilities. Most of those in self-employment had to close their business and stay home to look after their youth. Several caregivers kept their youth at home because they failed to access private residential SUD recovery services. Family caregivers mostly relied on outpatient public health services, alternative medicine from traditional healers, and faith-based healing, all of which some young adults rarely accessed because of their problematic behaviors of escaping healthcare. Conclusion These identifiable risk factors, and their detrimental consequences highlight the need for interventions to improve healthcare access for this vulnerable population. Supporting FCGs of addicted young adults is crucial in ensuring the well-being of both the caregivers and care recipients. Further research is warranted to explore potential solutions, such as peer support programs, policy changes, and education initiatives for carers and recipients in the (post) pandemic era.
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Affiliation(s)
- Ireen Manase Kabembo
- Department of Sociology and Social Policy, Lingnan University, Hong Kong, Hong Kong SAR, China
- Department of Social Work and Sociology, University of Zambia, Lusaka, Zambia
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Bahji A. Navigating the Complex Intersection of Substance Use and Psychiatric Disorders: A Comprehensive Review. J Clin Med 2024; 13:999. [PMID: 38398311 PMCID: PMC10889170 DOI: 10.3390/jcm13040999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
The co-occurrence of substance use disorders (SUDs) and psychiatric conditions, often referred to as comorbidity or concurrent disorders, presents intricate challenges in both diagnosis and treatment. This comprehensive narrative review aims to synthesize and critically evaluate the existing evidence surrounding the management of individuals with comorbid SUDs and psychiatric disorders. Comorbidity in these domains carries profound implications for clinical practice, research, and policymaking, emphasizing the need for a holistic understanding of the intricate dynamics that arise when these conditions coexist. This review explores recent research findings, evidence-based guidelines, and emerging trends within the field, offering valuable insights for clinicians, researchers, and policymakers seeking to navigate the complex terrain of comorbidity in substance use and psychiatric disorders.
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Affiliation(s)
- Anees Bahji
- Departments of Psychiatry and Community Health Sciences & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2R 1N4, Canada
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Faint N, Coleman M, Spring B, Richardson A, Thornton A, Bacon D, Kumaradevan S, Gardiner FW. Western Australia remote aeromedical substance use disorders outcomes. Intern Med J 2024; 54:86-95. [PMID: 37255269 DOI: 10.1111/imj.16140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/22/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Substance use disorders (SUDs) cause significant harm to regional Australians, who are more likely to misuse alcohol and other drugs (AODs) and encounter difficulty in accessing treatment services. The primary aims of this study were to describe the demographics of patients aeromedically retrieved from regional locations and compare hospital outcomes with a metropolitan-based cohort. AIMS Retrospective case-controlled cohort study. Participants were aeromedically retrieved within Western Australia for SUDs between 1 July 2014 and 30 June 2019. Retrieved patients were case-matched based on age and hospital discharge diagnosis. Descriptive statistics and χ2 analysis were used to summarise the findings. RESULTS One hundred thirty-six (91.3%) aeromedical retrievals were found, with the majority being male (n = 95; 69.9%). These were case-matched to 427 metropolitan patients, the majority male (n = 321; 75.2%). Retrieved patients were more likely (all P < 0.05) Indigenous (odds ratio [OR], 9.35 [95% confidence interval (CI), 5.96-14.85]), unemployed (OR, 2.9 [95% CI, 1.41-6.80]), referred to a tertiary hospital (OR, 2.18 [95% CI, 1.24-3.86]) and to stay longer in hospital (OR, 1.08 [95% CI, 1.02-1.14]). DISCUSSION Findings highlight that unmarried and/or unemployed males were overrepresented in the retrieval group, with over half identifying as Indigenous. Regional variation in retrievals was noted, while amphetamine-type stimulants featured prominently in the retrieval cohort, who experienced longer hospital stays and more restrictive treatment. CONCLUSIONS Comparing clinical outcomes for retrieved regional patients experiencing SUDs, service design and delivery should focus on offering culturally safe care for Indigenous people, catering for regional health care catchment areas, while ideally adopting collaborative and integrated approaches between AODs and mental health services.
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Affiliation(s)
- Nicholas Faint
- Great Southern Mental Health Service, Western Australia Country Health Service, Perth, Western Australia, Australia
| | - Mathew Coleman
- Great Southern Mental Health Service, Western Australia Country Health Service, Perth, Western Australia, Australia
- The Rural Clinical School of Western Australia, The University of Western Australia, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Breeanna Spring
- Public Health and Research, Royal Flying Doctor Service of Australia, Canberra, Australian Capital Territory, Australia
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Queensland, Brisbane, Australia
| | - Alice Richardson
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ashleigh Thornton
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Donna Bacon
- The Rural Clinical School of Western Australia, The University of Western Australia, Perth, Western Australia, Australia
- Geraldton Regional Aboriginal Service, Western Australia Country Health Service, Geraldton, Western Australia, Australia
| | - Santharajah Kumaradevan
- Public Health and Research, Royal Flying Doctor Service of Australia, Canberra, Australian Capital Territory, Australia
| | - Fergus W Gardiner
- The Rural Clinical School of Western Australia, The University of Western Australia, Perth, Western Australia, Australia
- Public Health and Research, Royal Flying Doctor Service of Australia, Canberra, Australian Capital Territory, Australia
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
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Pérez-Valenzuela E, Hudson R, Uzuneser T, De Felice M, Szkudlarek H, Rushlow W, Laviolette SR. Sex-Dependent Synergism of an Edible THC: CBD Formulation in Reducing Anxiety and Depressive-like Symptoms Following Chronic Stress. Curr Neuropharmacol 2024; 22:2059-2078. [PMID: 37702237 PMCID: PMC11333796 DOI: 10.2174/1570159x21666230912101441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/26/2023] [Accepted: 07/16/2023] [Indexed: 09/14/2023] Open
Abstract
Cannabis has shown therapeutic potential in mood and anxiety-related pathologies. However, the two primary constituents of cannabis, cannabidiol (CBD) and Δ-9-tetrahydrocannabinol (THC) produce distinct effects on molecular pathways in neural circuits associated with affective disorders. Moreover, it has been proposed that the combination of THC: and CBD may have unique synergistic properties. In the present study, the effects of a 1:100 THC: CBD ratio edible formulation were tested in behavioural, neuronal and molecular assays for anxiety and depressive-like endophenotypes. Adult male and female Sprague-Dawley rats were stressed for 14 days. Then, for three weeks, open field, elevated plus maze, light/dark box, social interaction, sucrose preference, and the forced swim test were performed 90 minutes after acute consumption of CBD (30 mg/kg), THC (0.3 mg/kg), or 1:100 combination of THC:CBD. After behavioural tests, in vivo, neuronal electrophysiological analyses were performed in the ventral tegmental area and prefrontal cortex (PFC). Furthermore, western-blot experiments examined the expression of biomarkers associated with mood and anxiety disorders, including protein kinase B (Akt), glycogen synthase kinase-3 (GSK-3), BDNF, mTOR, D1, and D2 receptor in nucleus accumbens (NAc) and PFC.Edible THC:CBD produces significant anxiolytic and antidepressant effects only in stressed male rats. In most cases, the combination of THC and CBD had stronger effects than either phytochemical alone. These synergistic effects are associated with alterations in Akt/GSK3 and D2-R expression in NAc and BDNF expression in PFC. Furthermore, THC:CBD reverses chronic stress-induced alterations in PFC neuronal activity. These findings demonstrate a novel synergistic potential for THC:CBD edible formulations in stress-related pathologies.
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Affiliation(s)
- Enzo Pérez-Valenzuela
- Addiction Research Group, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Roger Hudson
- Addiction Research Group, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Taygun Uzuneser
- Addiction Research Group, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Marta De Felice
- Addiction Research Group, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Hanna Szkudlarek
- Addiction Research Group, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Walter Rushlow
- Addiction Research Group, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Steven R. Laviolette
- Addiction Research Group, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
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Abrams MP, Merchant RM, Meisel ZF, Pelullo AP, Chandra Guntuku S, Agarwal AK. Association Between Online Reviews of Substance Use Disorder Treatment Facilities and Drug-Induced Mortality Rates: Cross-Sectional Analysis. JMIR AI 2023; 2:e46317. [PMID: 38875553 PMCID: PMC11041514 DOI: 10.2196/46317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 06/16/2024]
Abstract
BACKGROUND Drug-induced mortality across the United States has continued to rise. To date, there are limited measures to evaluate patient preferences and priorities regarding substance use disorder (SUD) treatment, and many patients do not have access to evidence-based treatment options. Patients and their families seeking SUD treatment may begin their search for an SUD treatment facility online, where they can find information about individual facilities, as well as a summary of patient-generated web-based reviews via popular platforms such as Google or Yelp. Web-based reviews of health care facilities may reflect information about factors associated with positive or negative patient satisfaction. The association between patient satisfaction with SUD treatment and drug-induced mortality is not well understood. OBJECTIVE The objective of this study was to examine the association between online review content of SUD treatment facilities and drug-induced state mortality. METHODS A cross-sectional analysis of online reviews and ratings of Substance Abuse and Mental Health Services Administration (SAMHSA)-designated SUD treatment facilities listed between September 2005 and October 2021 was conducted. The primary outcomes were (1) mean online rating of SUD treatment facilities from 1 star (worst) to 5 stars (best) and (2) average drug-induced mortality rates from the Centers for Disease Control and Prevention (CDC) WONDER Database (2006-2019). Clusters of words with differential frequencies within reviews were identified. A 3-level linear model was used to estimate the association between online review ratings and drug-induced mortality. RESULTS A total of 589 SAMHSA-designated facilities (n=9597 reviews) were included in this study. Drug-induced mortality was compared with the average. Approximately half (24/47, 51%) of states had below average ("low") mortality rates (mean 13.40, SD 2.45 deaths per 100,000 people), and half (23/47, 49%) had above average ("high") drug-induced mortality rates (mean 21.92, SD 3.69 deaths per 100,000 people). The top 5 themes associated with low drug-induced mortality included detoxification and addiction rehabilitation services (r=0.26), gratitude for recovery (r=-0.25), thankful for treatment (r=-0.32), caring staff and amazing experience (r=-0.23), and individualized recovery programs (r=-0.20). The top 5 themes associated with high mortality were care from doctors or providers (r=0.24), rude and insensitive care (r=0.23), medication and prescriptions (r=0.22), front desk and reception experience (r=0.22), and dissatisfaction with communication (r=0.21). In the multilevel linear model, a state with a 10 deaths per 100,000 people increase in mortality was associated with a 0.30 lower average Yelp rating (P=.005). CONCLUSIONS Lower online ratings of SUD treatment facilities were associated with higher drug-induced mortality at the state level. Elements of patient experience may be associated with state-level mortality. Identified themes from online, organically derived patient content can inform efforts to improve high-quality and patient-centered SUD care.
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Affiliation(s)
- Matthew P Abrams
- Center for Digital Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Center for Emergency Care Policy and Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Raina M Merchant
- Center for Digital Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Center for Emergency Care Policy and Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Zachary F Meisel
- Center for Emergency Care Policy and Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Arthur P Pelullo
- Center for Digital Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Sharath Chandra Guntuku
- Center for Digital Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Anish K Agarwal
- Center for Digital Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Center for Emergency Care Policy and Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
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Pobee R, Cable T, Chan D, Herrick J, Durkalski-Mauldin V, Korley F, Callaway C, Del Rios M. Association of substance use with outcomes in mildly ill COVID-19 outpatients. Am J Emerg Med 2023; 74:27-31. [PMID: 37748266 PMCID: PMC10841661 DOI: 10.1016/j.ajem.2023.09.017] [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: 04/26/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Smoking, alcohol use, and non-prescription drug use are associated with worsened COVID-19 outcomes in hospitalized patients. Whether there is an association between substance use and outcomes in patients with COVID-19 who visited the Emergency Department (ED) but did not require hospitalization has not been well established. We investigated whether smoking, alcohol, and non-prescription drug use were associated with worsened COVID-19 outcomes among such patients presenting to the ED. METHODS We conducted a secondary analysis of a clinical trial which sought to determine the effect of early convalescent plasma administration in patients presenting to the ED within 7 days of onset of mild COVID-19 symptoms. The study recruited 511 participants who were aged 50 years or older or had one or more risk factors for severe COVID-19. The primary outcome was disease progression within 15 days after randomization, which was defined as a composite of hospital admission for any reason, seeking emergency or urgent care, or death without hospitalization. Secondary outcomes included: no hospitalization within 30 days post-randomization, symptom worsening on the 5-category COVID-19 outpatient ordinal scale within 15 days post-randomization, and all-cause mortality. Substance use was categorized into either use or never use based on participant self-report. Logistic regression models were used to determine the association between substance use and outcomes. RESULTS The mean age of the 511 patients enrolled was 52 years and the majority were females (274, 54%). Approximately 213 (42%) were non-Hispanic Whites, 156 (30%) Hispanics, 100 (20%) non-Hispanic Blacks, 18 (4%) non-Hispanic Asian, 8 (1%) American Indian Alaskan, and 16 (3%) unknown race. Tobacco 152 (30%) was the most common substance use reported. Alcohol use 36 (7%) and non-prescription drug use 33 (6%) were less common. Tobacco use and non-prescription drug use were associated with an increased risk for meeting the primary outcome ((tobacco: adjusted odds ratio [aOR] =2.08; 95% confidence interval [CI]: 1.37-3.15) and (drug: aOR =2.41; 95%CI: 1.17-5.00)) and increased risk for symptom worsening on the 5-category COVID-19 outpatient scale ((tobacco: aOR = 1.62; 95%CI: 1.09-2.42) and (drug: aOR = 2.32 95% CI: 1.10-4.87)) compared to non-use after adjusting for age, sex, plasma administration, and comorbidity. CONCLUSION Tobacco and non-prescription drug use but not alcohol use were associated with worsened COVID-19 outcomes in patients who did not require hospitalization on their initial presentation. Future studies should determine the quantity, duration, and type of drug/tobacco use that may worsen COVID-19.
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Affiliation(s)
- Ruth Pobee
- UI Health/University of Illinois Chicago College of Medicine, Departments of Emergency Medicine, 808 S. Woods St., Chicago, IL 60612, USA.
| | - Tracy Cable
- University of Cincinnati Medical Center, Infectious Disease, 234, Goodman St Cincinnati, OH 45219, USA
| | - David Chan
- University of Illinois Chicago, Department of Pharmacy Practice, 833 S Wood St, Chicago, IL 60612, USA.
| | - Jesica Herrick
- UI Health/University of Illinois Chicago College of Medicine, Medicine Infectious Disease, 1740 W Taylor St, Chicago, IL 60612, USA.
| | - Valerie Durkalski-Mauldin
- Medical University of South Carolina, Department of Public Health Sciences, 135 Cannon St, Ste 303, Charleston, SC 29425, USA.
| | - Frederick Korley
- University of Michigan, Departments of Emergency Medicine, 1500 E Medical Center Dr Spc 5301, Ann Arbor, MI 48109, USA.
| | - Clifton Callaway
- University of Pittsburgh, Departments of Emergency Medicine, 400A Iroquois, 3600 Forbes Avenue, Pittsburgh, PA 15260, USA.
| | - Marina Del Rios
- UI Health/University of Illinois Chicago College of Medicine, Departments of Emergency Medicine, 808 S. Woods St., Chicago, IL 60612, USA; University of Iowa Hospitals and Clinics, Department of Emergency Medicine, Iowa, USA.
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13
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Matson TE, Williams EC, Lapham GT, Oliver M, Hallgren KA, Bradley KA. Association between cannabis use disorder symptom severity and probability of clinically-documented diagnosis and treatment in a primary care sample. Drug Alcohol Depend 2023; 251:110946. [PMID: 37688980 PMCID: PMC10655701 DOI: 10.1016/j.drugalcdep.2023.110946] [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: 03/01/2023] [Revised: 08/01/2023] [Accepted: 08/13/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Brief cannabis screening followed by standardized assessment of symptoms may support diagnosis and treatment of cannabis use disorder (CUD). This study tested whether the probability of a medical provider diagnosing and treating CUD increased with the number of substance use disorder (SUD) symptoms documented in patients' EHRs. METHODS This observational study used EHR and claims data from an integrated healthcare system. Adult patients were included who reported daily cannabis use and completed the Substance Use Symptom Checklist, a scaled measure of DSM-5 SUD symptoms (0-11), during routine care 3/1/2015-3/1/2021. Logistic regression estimated associations between SUD symptom counts and: 1) CUD diagnosis; 2) CUD treatment initiation; and 3) CUD treatment engagement, defined based on Healthcare Effectiveness Data and Information Set (HEDIS) ICD-codes and timelines. We tested moderation across age, gender, race, and ethnicity. RESULTS Patients (N=13,947) were predominantly middle-age, male, White, and non-Hispanic. Among patients reporting daily cannabis use without other drug use (N=12,568), the probability of CUD diagnosis, treatment initiation, and engagement increased with each 1-unit increase in Symptom Checklist score (p's<0.001). However, probabilities of diagnosis, treatment, and engagement were low, even among those reporting ≥2 symptoms consistent with SUD: 14.0% diagnosed (95% CI: 11.7-21.6), 16.6% initiated treatment among diagnosed (11.7-21.6), and 24.3% engaged in treatment among initiated (15.8-32.7). Only gender moderated associations between Symptom Checklist and diagnosis (p=0.047) and treatment initiation (p=0.012). Findings were similar for patients reporting daily cannabis use with other drug use (N=1379). CONCLUSION Despite documented symptoms, CUD was underdiagnosed and undertreated in medical settings.
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Affiliation(s)
- Theresa E Matson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Health Services Research & Development (HSR&D) Center for Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98101, USA.
| | - Emily C Williams
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Health Services Research & Development (HSR&D) Center for Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98101, USA
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA
| | - Malia Oliver
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA
| | - Kevin A Hallgren
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
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Antwi I, Watkins D, Pedawi A, Ghrayeb A, Van de Vuurst C, Cory TJ. Substances of abuse and their effect on SAR-CoV-2 pathogenesis. NEUROIMMUNE PHARMACOLOGY AND THERAPEUTICS 2023; 2:301-316. [PMID: 38013836 PMCID: PMC10474379 DOI: 10.1515/nipt-2023-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/19/2023] [Indexed: 11/29/2023]
Abstract
Following the emergence of SARS-CoV-2, various reports suggest that there has been a significant increase in substance abuse due to social distancing and related issues. Several reports have suggested the impact of chronic substance use on individuals' physiological and psychological health. Therefore, there is a need to know the impact of SARS-CoV-2 on persons with substance use disorders. Individuals with substance use disorders are the most vulnerable groups and are at a high risk of SARS-CoV-2 infection due to their already existing health issues associated with substance use. This review discusses some of the molecular and systemic/organic effects chronic substance use such as alcohol, nicotine, marijuana (cannabis), opioids, methamphetamine, and cocaine have on SARS-CoV-2 infectivity and its potential cause for worsened disease outcomes in persons with substance use disorder. This will provide healthcare providers, public health policies, and researchers with the needed knowledge to address some of the many challenges faced during the Covid-19 pandemic to facilitate treatment strategies for persons with substance use disorders.
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Affiliation(s)
- Ivy Antwi
- Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Destiny Watkins
- Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alahn Pedawi
- Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Atheel Ghrayeb
- Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Christine Van de Vuurst
- Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Theodore J. Cory
- Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
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Carpenedo Mun C, Schuler H, Baker R, Byrne F, Bresani E, Meyers K. Rural communities face more than an opioid crisis: Reimagining funding assistance to address polysubstance use, associated health problems, and limited rural service capacity. J Rural Health 2023; 39:795-803. [PMID: 36775905 DOI: 10.1111/jrh.12743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PURPOSE Rural communities in the United States face unique challenges related to the opioid epidemic. This paper explores the substances and substance-related health problems that pose the greatest concern to rural communities that received funding to address the opioid epidemic and examines their reported capacity to address these challenges. METHODS This paper analyzed data collected as part of quarterly progress reporting from multisector consortiums across 2 cohorts of grantees funded to reduce the morbidity and mortality of opioids. Consortium project directors ranked the top 3 issues in their community in each of the following categories: (1) drugs of concern; (2) drugs with the least capacity to address; (3) related problem areas of concern (eg, neonatal abstinence syndrome [NAS]); and (4) related problem areas with the least capacity to address. FINDINGS Methamphetamines, fentanyl, and alcohol were the substances rated as most problematic in rural communities funded to address the opioid epidemic across all reporting periods. Over 40% of respondents ranked methamphetamine as a top concern and the substance they had the least capacity to address. This was nearly double the percentage of the next highest-ranked substance (fentanyl). Overdoses, NAS, and viral hepatitis constituted the top-ranking related concerns, with limited capacity to address them. CONCLUSIONS Multiple drug and concomitant problems coalesced on rural communities during the opioid epidemic. Funding communities to address substance use disorders and related problems of concern, rather than targeting funding toward a specific type of drug, may result in better health outcomes throughout the entire community.
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Affiliation(s)
| | | | - Robin Baker
- Oregon Health and Science University, Portland, Oregon, USA
| | - Fraser Byrne
- Health Resources and Services Administration (HRSA), Rockville, Maryland, USA
| | - Elena Bresani
- JBS International, Inc., North Bethesda, Maryland, USA
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Lana-Lander I, Muñoz-Galán R, Palacio-Vieira J, Majo-Roca X, Martínez-Carbonell E, Muga R, Colom J. Incidence and Determinants of COVID-19 in Patients Seeking Treatment for Substance Use Disorder: A Patient-Based Linkage Study. Eur Addict Res 2023; 29:333-343. [PMID: 37586329 PMCID: PMC10614235 DOI: 10.1159/000528647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/05/2022] [Indexed: 08/18/2023]
Abstract
INTRODUCTION People with substance use disorder (SUD) may be at increased risk of COVID-19 infection. However, there is little evidence regarding the incidence of and determinants associated with infection in this group. The aims of the study were to determine the cumulative incidence of COVID-19 among people who sought treatment for heroin, cocaine, cannabis, and alcohol use disorder in Catalonia; to identify sociodemographic, substance, and clinical determinants associated with COVID-19 infection among SUD patients; and to compare the cumulative incidence of COVID-19 infection in the population with SUD with that of the general population. METHODS A patient-based retrospective observational study was conducted. The study population comprised people who sought treatment for heroin, cocaine, cannabis, or alcohol use disorder in Catalonia in 2018 and 2019. We analysed cumulative incidence of COVID-19 (confirmed by PCR test) from 25 February to 31 December 2020. Additionally, we used a log-link binomial generalized linear model for COVID-19 infection, using the substance as the exposition, adjusting for sociodemographic and clinical variables. RESULTS Of the 23,092 individuals who sought treatment for SUD, 38.15% were considered suspected cases of COVID-19, and 2.60% (95% CI = 2.41-2.82) were confirmed positive for COVID-19 by PCR test during the study period. Those who sought treatment for alcohol use (cumulative incidence of COVID-19 of 3% [95% CI = 2.70-3.34]) had a higher risk ratio than, those who sought treatment for heroin use (cumulative incidence of 1.94% [95% CI = 1.47-2.56]). Being born outside of Spain, living in an institutionalized residence, having HIV, and being in a high morbidity group were associated with higher risk of COVID-19 infection. Meanwhile, the cumulative incidence of COVID-19 in the general population, according to public COVID-19 test data, was 3.86% (95% CI = 3.85-3.87). CONCLUSION This study did not find higher cumulative incidence of COVID-19 infection among people with SUD in Catalonia in 2020, despite the clinical vulnerability of this population and their social disadvantage. However, differences were seen in the cumulative incidence of COVID-19 according to the substance for which treatment was sought. For example, those with alcohol dependence had a higher rate than those dependent on heroin. Further studies are needed to determine the factors contributing to these differences.
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Affiliation(s)
- Irene Lana-Lander
- Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Programme on Substance Abuse, Barcelona, Spain
| | - Regina Muñoz-Galán
- Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Programme on Substance Abuse, Barcelona, Spain
| | - Jorge Palacio-Vieira
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Badalona, Spain
| | - Xavier Majo-Roca
- Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Programme on Substance Abuse, Barcelona, Spain
| | | | - Robert Muga
- Servei de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Joan Colom
- Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Programme on Substance Abuse, Barcelona, Spain
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Sevcik B, Lobay K, Luu H, Martins KJB, Vu K, Nguyen PU, Bohlouli S, Eurich DT, Lester ELW, Williamson T, Richer L, Klarenbach SW. Analgesic Use Among Adults with a Trauma-Related Emergency Department Visit: A Retrospective Cohort Study from Alberta, Canada. Pain Ther 2023; 12:1039-1053. [PMID: 37269501 PMCID: PMC10289951 DOI: 10.1007/s40122-023-00521-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/25/2023] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION A better understanding of current acute pain-driven analgesic practices within the emergency department (ED) and upon discharge will provide foundational information in this area, as few studies have been conducted in Canada. METHODS Administrative data were used to identify adults with a trauma-related ED visit in the Edmonton area in 2017/2018. Characteristics of the ED visit included time from initial contact to analgesic administration, type of analgesics dispensed during and upon being discharged home directly from the ED (≤ 7 days after), and patient characteristics. RESULTS A total of 50,950 ED visits by 40,505 adults with trauma were included. Analgesics were administered in 24.2% of visits, of which non-opioids were dispensed in 77.0% and opioids were dispensed in 49.0%. Time to analgesic initiation occurred more than 2 h after first contact. Upon discharge, 11.5% received a non-opioid and 15.2% received an opioid analgesic, among whom 18.5% received a daily dose ≥ 50 morphine milligram equivalents (MME) and 30.2% received > 7 days of supply. Three hundred and seventeen adults newly met criteria for chronic opioid use after the ED visit, among whom 43.5% received an opioid dispensation upon discharge; of these individuals, 26.8% had a daily dose ≥ 50 MME and 65.9% received > 7 days of supply. CONCLUSIONS Findings can be used to inform optimization of analgesic pharmacotherapy practices for the treatment of acute pain, which may include reducing the time to initiation of analgesics in the ED, as well as close consideration of recommendations for acute pain management upon discharge to provide ideal patient-centered, evidence-informed care.
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Affiliation(s)
- Bill Sevcik
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kevin Lobay
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Huong Luu
- Real World Evidence Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Karen J B Martins
- Real World Evidence Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Khanh Vu
- Real World Evidence Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Phuong Uyen Nguyen
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Solmaz Bohlouli
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Erica L W Lester
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lawrence Richer
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Scott W Klarenbach
- Department of Medicine and Real World Evidence Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
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Ali F, Kaura A, Russell C, Bonn M, Bruneau J, Dasgupta N, Imtiaz S, Martel-Laferrière V, Rehm J, Shahin R, Elton-Marshall T. Identifying barriers and facilitators to COVID-19 vaccination uptake among People Who Use Drugs in Canada: a National Qualitative Study. Harm Reduct J 2023; 20:99. [PMID: 37516836 PMCID: PMC10387201 DOI: 10.1186/s12954-023-00826-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND People Who Use Drugs (PWUD) have lower vaccination uptake than the general population, and disproportionately experience the burden of harms from vaccine-preventable diseases. We conducted a national qualitative study to: (1) identify the barriers and facilitators to receiving COVID-19 vaccinations among PWUD; and (2) identify interventions to support PWUD in their decision-making. METHODS Between March and October 2022, semi-structured interviews with PWUD across Canada were conducted. Fully vaccinated (2 or more doses) and partially or unvaccinated (1 dose or less) participants were recruited from a convenience sample to participate in telephone interviews to discuss facilitators, barriers, and concerns about receiving COVID-19 vaccines and subsequent boosters, and ways to address concerns. A total of 78 PWUD participated in the study, with 50 participants being fully vaccinated and 28 participants partially or unvaccinated. Using thematic analysis, interviews were coded based on the capability, opportunity, and motivation-behavior (COM-B) framework. RESULTS Many partially or unvaccinated participants reported lacking knowledge about the COVID-19 vaccine, particularly in terms of its usefulness and benefits. Some participants reported lacking knowledge around potential long-term side effects of the vaccine, and the differences of the various vaccine brands. Distrust toward government and healthcare agencies, the unprecedented rapidity of vaccine development and skepticism of vaccine effectiveness were also noted as barriers. Facilitators for vaccination included a desire to protect oneself or others and compliance with government mandates which required individuals to get vaccinated in order to access services, attend work or travel. To improve vaccination uptake, the most trusted and appropriate avenues for vaccination information sharing were identified by participants to be people with lived and living experience with drug use (PWLLE), harm reduction workers, or healthcare providers working within settings commonly visited by PWUD. CONCLUSION PWLLE should be supported to design tailored information to reduce barriers and address mistrust. Resources addressing knowledge gaps should be disseminated in areas and through organizations where PWUD frequently access, such as harm reduction services and social media platforms.
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Affiliation(s)
- Farihah Ali
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada.
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada.
| | - Ashima Kaura
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Cayley Russell
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montreal, QC, H2X 0A9, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 Boul, Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Nabarun Dasgupta
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Sameer Imtiaz
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Valérie Martel-Laferrière
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, Canada
| | - Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
- Department of Psychiatry, Dalla Lana School of Public Health, & Institute of Medical Science (IMS), Toronto, Canada
- 1 King's College Circle, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 1001 Queen St. West, Toronto, ON, M6J 1H4, Canada
- Institut Für Klinische Psychologie Und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | | | - Tara Elton-Marshall
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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19
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Brick LA, Benca-Bachman CE, Johnson EC, Gustavson DE, Carper M, Palmer RHC. Genetic associations among internalizing and externalizing traits with polysubstance use among young adults. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.04.23287779. [PMID: 37066212 PMCID: PMC10104191 DOI: 10.1101/2023.04.04.23287779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Though most genetic studies of substance use focus on specific substances in isolation or generalized vulnerability across multiple substances, few studies to date focus on the concurrent use of two or more substances within a specified time frame (i.e., polysubstance use; PSU). We evaluated whether distinct genetic factors underlying internalizing and externalizing traits were associated with past 30-day PSU above variance shared across general psychopathology and substance use (SU). Using Genomic Structural Equation Modeling, we constructed theory-driven, multivariate genetic factors of 16 internalizing, externalizing, and SU traits using genome-wide association studies (GWAS) summary statistics. Next, we fit a model with a higher order SU-related psychopathology factor as well as genetic variance specific to externalizing and internalizing (i.e., residual genetic variance not explained by SU or general psychopathology). GWAS-by-subtraction was used to obtain single nucleotide polymorphism effects on each of these factors. Polygenic scores (PGS) were then created in an independent target sample with data on PSU, the National Longitudinal Study of Adolescent to Adult Health. To evaluate the effect of genetic variance due to internalizing and externalizing traits independent of variance related to SU, we regressed PSU on the PGSs, controlling for sex, age, and genetic principal components. PGSs for SU-related psychopathology and non-SU externalizing traits were associated with higher PSU factor scores, while the non-SU internalizing PGS was not significantly associated with PSU. In total, the three PGSs accounted for an additional 4% of the variance in PSU above and beyond a null model with only age, sex, and genetic principal components as predictors. These findings suggest that there may be unique genetic variance in externalizing traits contributing to liability for PSU that is independent of the genetic variance shared with SU.
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Affiliation(s)
- Leslie A Brick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Providence VA Medical Center, Providence, Rhode Island, USA
- Behavioral Genetics of Addiction Laboratory, Department of Psychology at Emory University, Atlanta, Georgia, USA
| | - Chelsie E Benca-Bachman
- Providence VA Medical Center, Providence, Rhode Island, USA
- Behavioral Genetics of Addiction Laboratory, Department of Psychology at Emory University, Atlanta, Georgia, USA
| | - Emma C Johnson
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Daniel E. Gustavson
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, Colorado, USA
| | - Matthew Carper
- Department of Clinical Psychology, William James College, Newton, Massachusetts, USA
| | - Rohan HC Palmer
- Providence VA Medical Center, Providence, Rhode Island, USA
- Behavioral Genetics of Addiction Laboratory, Department of Psychology at Emory University, Atlanta, Georgia, USA
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20
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Watanabe JH. The Critical Role of Pharmacists in Treating Older People in the Opioid Crisis. Sr Care Pharm 2023; 38:47-49. [PMID: 36751937 DOI: 10.4140/tcp.n.2023.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Pharmacy-based Opioid Use Disorder (OUD) treatment has been identified as a central pillar in curbing the spiraling opioid epidemic that claimed more than 100,000 lives in the United States in a one year period for the first time. This epidemic is also partially responsible for the plummeting US life expectancy that began prior to the COVID-19 pandemic and has now claimed more than 500,000 lives since 1999 with more than 70% of the 70,630 overdose deaths in 2019 involved with an opioid. Older people are at increased risk of both OUD and OUD-related complications. Recent studies have demonstrated that people older than 65 years of age were more likely to die of OUD-related complications, and - because of an increased likelihood of polypharmacy - are more likely to experience a drug interaction that magnifies the risk of an opioid-related misadventure.
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Affiliation(s)
- Jonathan H Watanabe
- Professor of Clinical Pharmacy Associate Dean of Pharmacy Assessment and Quality Member Forum on Drug Discovery, Development, and Translation of the National Academies of Sciences, Engineering, and Medicine University of California, Irvine School of Pharmacy & Pharmaceutical Sciences
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21
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Nagamatsu ST, Rompala G, Hurd YL, Núñez-Rios DL, Montalvo-Ortiz JL. CpH methylome analysis in human cortical neurons identifies novel gene pathways and drug targets for opioid use disorder. Front Psychiatry 2023; 13:1078894. [PMID: 36745154 PMCID: PMC9892724 DOI: 10.3389/fpsyt.2022.1078894] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/19/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction DNA methylation (DNAm), an epigenetic mechanism, has been associated with opioid use disorder (OUD) in preclinical and human studies. However, most of the studies have focused on DNAm at CpG sites. DNAm at non-CpG sites (mCpHs, where H indicates A, T, or C) has been recently shown to have a role in gene regulation and to be highly abundant in neurons. However, its role in OUD is unknown. This work aims to evaluate mCpHs in the human postmortem orbital frontal cortex (OFC) in the context of OUD. Methods A total of 38 Postmortem OFC samples were obtained from the VA Brain Bank (OUD = 12; Control = 26). mCpHs were assessed using reduced representation oxidative bisulfite sequencing in neuronal nuclei. Differential analysis was performed using the "methylkit" R package. Age, ancestry, postmortem interval, PTSD, and smoking status were included as covariates. Significant mCpHs were set at q-value < 0.05. Gene Ontology (GO) and KEGG enrichment analyses were performed for the annotated genes of all differential mCpH loci using String, ShinyGO, and amiGO software. Further, all annotated genes were analyzed using the Drug gene interaction database (DGIdb). Results A total of 2,352 differentially methylated genome-wide significant mCpHs were identified in OUD, mapping to 2,081 genes. GO analysis of genes with differential mCpH loci showed enrichment for nervous system development (p-value = 2.32E-19). KEGG enrichment analysis identified axon guidance and glutamatergic synapse (FDR 9E-4-2.1E-2). Drug interaction analysis found 3,420 interactions between the annotated genes and drugs, identifying interactions with 15 opioid-related drugs, including lofexidine and tizanidine, both previously used for the treatment of OUD-related symptoms. Conclusion Our findings suggest a role of mCpHs for OUD in cortical neurons and reveal important biological pathways and drug targets associated with the disorder.
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Affiliation(s)
- Sheila T. Nagamatsu
- Division of Human Genetics, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
- VA Connecticut (VA CT) Healthcare Center, West Haven, CT, United States
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center of Posttraumatic Stress Disorder, West Haven, CT, United States
| | - Gregory Rompala
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Yasmin L. Hurd
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Diana L. Núñez-Rios
- Division of Human Genetics, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
- VA Connecticut (VA CT) Healthcare Center, West Haven, CT, United States
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center of Posttraumatic Stress Disorder, West Haven, CT, United States
| | - Janitza L. Montalvo-Ortiz
- Division of Human Genetics, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
- VA Connecticut (VA CT) Healthcare Center, West Haven, CT, United States
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center of Posttraumatic Stress Disorder, West Haven, CT, United States
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22
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Reilly J, Meurk C, Heffernan E, Sara G. Substance use disorder screening and brief intervention in routine clinical practice in specialist adult mental health services: A systematic review. Aust N Z J Psychiatry 2023; 57:793-810. [PMID: 36632829 DOI: 10.1177/00048674221148394] [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] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Substance use disorders co-occurring with other mental health disorders are common and harmful. Clinical guidelines often recommend substance use screening and brief intervention though evidence about screening practice in mental health services is limited. This systematic review of routine clinical practice in adult mental health services aims to identify (a) proportions of screening and brief intervention, (b) how they are practised and (c) their outcomes. METHODS We searched MEDLINE, PsycINFO and Embase and relevant Cochrane databases for articles until 31 July 2021 reporting on adults in English, regardless of geographical location. Backward snowball methods were used to locate additional articles. Screening, brief intervention and mental health services were defined. Data were extracted and variables compared related to setting, period, patient cohort, substances routine substance use disorder care pathways, and study quality was assessed. RESULTS We identified 17 articles reporting routine screening within adult mental health services. Studies in community settings mainly reported on screening for alcohol and other substance use disorders, while studies from inpatient settings reported mainly on tobacco. There was marked variation in methods and screening proportions. Only two studies reported on brief intervention. CONCLUSION This systematic review shows marked variation in mental health services routine screening practices with early focus on alcohol but more recently tobacco screening. We suggest approaches to enhancing implementation of screening and brief intervention in routine care, particularly using electronic health records.
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Affiliation(s)
- John Reilly
- Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Queensland Health, Brisbane, QLD, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Carla Meurk
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Brisbane, QLD, Australia
| | - Ed Heffernan
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Brisbane, QLD, Australia.,Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Grant Sara
- NSW Ministry of Health, St Leonards, NSW, Australia
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23
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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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24
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SEROPREVALENCE OF HBsAg, Anti-HBs, Anti-HCV, and Anti-HIV IN PATIENTS WITH ALCOHOL AND SUBSTANCE ABUSE IN AN AMATEM CLINIC IN EASTERN TURKIYE: A SIX-YEAR RETROSPECTIVE EVALUATION. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1189072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aim
Substance abuse and concomitant infections are important causes of morbidity and mortality. Yet, the number of epidemiological studies regarding infectious diseases in people with substance abuse are limited in our country. In this study, the aim was to investigate the frequency of illegal alcohol and substance use in an Alcohol and Drug Research, Treatment and Training Centres (AMATEM) clinic in Turkey as well as the HBsAg, anti-HBs, anti-HCV, and anti-HIV parameters between the years of 2016-2021.
Material and Method
HBsAg, anti-HBs, anti-HCV, and anti-HIV tests were conducted using the ELISA technique in 6881 alcohol and substance use disorder (ASUD). Urine samples from ASUD’s were analyzed for alcohol, cannabis, and cocaine metabolites. The results were evaluated retrospectively.
Results
All of the 6881 ASUD’s were male with a mean age of 32.18±9.66 years. Of the 6881 ASUD’s included in the study, 4107 (59.7%) were opioid addicts; 1479 (21.5%) were mixed drug addicts; 897 (13%) were alcohol addicts; and the rest were addicts with other types of substance use. The mean age of the alcohol users was 45.33±13.03 and the mean age of opioid users was 29.90±7.13. The percentage of opioid addiction in 2016 was 71.2% which dropped to 28.7% in 2021. Meanwhile, the percentage of alcohol addiction was 13.6% in 2016 and increased to 21.4% in 2021; and the percentage of mixed drug use was 8.7% in 2016 and increased to 36.8% in 2021. HBsAg-positivity in opioid users (56.7%) was higher compared to cannabis users (2.6%) and mixed drug users (22.3%). Anti-HCV positivity of opioid users (69.4%) was found to be higher compared to alcohol (9.4%), cannabis (2%), and mixed drug (16.2%) users, and this finding was statistically significant (p=0.0001). Anti-HBs positivity of opioid users (63.1%) was found to be higher compared to alcohol (9.9%), cannabis (3%), and mixed drug (21%) users, and this finding was statistically significant (p=0.0001). Anti-HIV was determined negative in all ASUD’s. The highest rates of HBsAg, anti-HCV and anti-HBs positivity were found in the 26-30 years of age.
Conclusion
These findings indicate a high prevalence of intravenous substance abuse in the 26-30 years age group in our region as well as the high HBV and HCV rates in this patient group.
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25
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Lambdin-Pattavina C, Pyatak E. Occupational Therapy's Role in Chronic Conditions. Am J Occup Ther 2022; 76:24002. [PMID: 36706303 DOI: 10.5014/ajot.2022.76s3003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
It is the position of the American Occupational Therapy Association (AOTA) that occupational therapy practitioners are distinctly qualified to address the impact of chronic conditions on occupational performance and participation across the life span. The purpose of this position statement is twofold. First, it defines chronic conditions and describes the multiple factors associated with the development of one or more chronic conditions. Second, it provides an overview of how the field of occupational therapy has a distinct impact on improving the health and wellness of persons, groups, and populations with or at risk for chronic conditions through health promotion, disease prevention, and intervention.
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26
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Annis IE, Jordan R, Thomas KC. Quickly identifying people at risk of opioid use disorder in emergency departments: trade-offs between a machine learning approach and a simple EHR flag strategy. BMJ Open 2022; 12:e059414. [PMID: 36104124 PMCID: PMC9476155 DOI: 10.1136/bmjopen-2021-059414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Emergency departments (EDs) are an important point of contact for people with opioid use disorder (OUD). Universal screening for OUD is costly and often infeasible. Evidence on effective, selective screening is needed. We assessed the feasibility of using a risk factor-based machine learning model to identify OUD quickly among patients presenting in EDs. DESIGN/SETTINGS/PARTICIPANTS In this cohort study, all ED visits between January 2016 and March 2018 for patients aged 12 years and older were identified from electronic health records (EHRs) data from a large university health system. First, logistic regression modelling was used to describe and elucidate the associations between patient demographic and clinical characteristics and diagnosis of OUD. Second, a Gradient Boosting Classifier was applied to develop a predictive model to identify patients at risk of OUD. The predictive performance of the Gradient Boosting algorithm was assessed using F1 scores and area under the curve (AUC). OUTCOME The primary outcome was the diagnosis of OUD. RESULTS Among 345 728 patient ED visits (mean (SD) patient age, 49.4 (21.0) years; 210 045 (60.8%) female), 1.16% had a diagnosis of OUD. Bivariate analyses indicated that history of OUD was the strongest predictor of current OUD (OR=13.4, CI: 11.8 to 15.1). When history of OUD was excluded in multivariate models, baseline use of medications for OUD (OR=3.4, CI: 2.9 to 4.0) and white race (OR=2.9, CI: 2.6 to 3.3) were the strongest predictors. The best Gradient Boosting model achieved an AUC of 0.71, accuracy of 0.96 but only 0.45 sensitivity. CONCLUSIONS Patients who present at the ED with OUD are high-need patients who are typically smokers with psychiatric, chronic pain and substance use disorders. A machine learning model did not improve predictive ability. A quick review of a patient's EHR for history of OUD is an efficient strategy to identify those who are currently at greatest risk of OUD.
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Affiliation(s)
- Izabela E Annis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Robyn Jordan
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Kathleen C Thomas
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
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Walters JE, Jones AE, Brown AR, Wallis D. Impacts of the COVID-19 Pandemic on a Rural Opioid Support Services Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11164. [PMID: 36141436 PMCID: PMC9517684 DOI: 10.3390/ijerph191811164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Abstract
During 2020, Kentucky saw the third highest increase in overdose deaths in the U.S. Employment issues, inadequate housing, transportation problems, and childcare needs present barriers to accessing treatment in rural areas. These barriers and others (e.g., technology) arose during the pandemic negatively affecting individuals in recovery and service providers as they adjusted services to provide primarily telehealth and remote services. This study examines the impact of COVID-19 in its early stages on an opioid use disorder (OUD) support services program in a nonprofit located in rural eastern Kentucky, part of the central Appalachia region. A qualitative design was applied, employing semi-structured interviews in early fall 2020. Participants were associated with one OUD support services program, including service recipients, program coordinators, and business vendors. Guided by the Social Determinants of Health framework, two-cycle coding-descriptive coding and pattern coding-was utilized. Codes were sorted into three patterns: changes to daily life; financial impacts; and service access and provision. Overall, early stages of COVID-19 brought increased stress for individuals in recovery, as they were taking on more responsibility and navigating a changing environment. Coordinators were under pressure to provide services in a safe, timely manner. Vendors vocalized their struggles and successes related to finances. These findings can help organizations make realistic adjustments and policymakers set reasonable expectations and consider additional financial support.
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Affiliation(s)
- Jayme E. Walters
- Department of Social Work, Utah State University, 0730 Old Main Hill, Logan, UT 84322, USA
| | - Aubrey E. Jones
- College of Social Work, University of Kentucky, 619 Patterson Office Tower, Lexington, KY 40506, USA
| | - Aaron R. Brown
- College of Social Work, University of Kentucky, 619 Patterson Office Tower, Lexington, KY 40506, USA
| | - Dorothy Wallis
- Department of Social Work, Utah State University, 0730 Old Main Hill, Logan, UT 84322, USA
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Ober AJ, Murray-Krezan C, Page K, Friedmann PD, Chan Osilla K, Ryzewicz S, Huerta S, Mazer MW, Leamon I, Messineo G, Watkins KE, Nuckols T, Danovitch I. The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder. Addict Sci Clin Pract 2022; 17:39. [PMID: 35902888 PMCID: PMC9331017 DOI: 10.1186/s13722-022-00320-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with opioid use disorder experience high burden of disease from medical comorbidities and are increasingly hospitalized with medical complications. Medications for opioid use disorder are an effective, life-saving treatment, but patients with an opioid use disorder admitted to the hospital seldom initiate medication for their disorder while in the hospital, nor are they linked with outpatient treatment after discharge. The inpatient stay, when patients may be more receptive to improving their health and reducing substance use, offers an opportunity to discuss opioid use disorder and facilitate medication initiation and linkage to treatment after discharge. An addiction-focus consultative team that uses evidence-based tools and resources could address barriers, such as the need for the primary medical team to focus on the primary health problem and lack of time and expertise, that prevent primary medical teams from addressing substance use. METHODS This study is a pragmatic randomized controlled trial that will evaluate whether a consultative team, called the Substance Use Treatment and Recovery Team (START), increases initiation of any US Food and Drug Administration approved medication for opioid use disorder (buprenorphine, methadone, naltrexone) during the hospital stay and increases linkage to treatment after discharge compared to patients receiving usual care. The study is being conducted at three geographically distinct academic hospitals. Patients are randomly assigned within each hospital to receive the START intervention or usual care. Primary study outcomes are initiation of medication for opioid use disorder in the hospital and linkage to medication or other opioid use disorder treatment after discharge. Outcomes are assessed through participant interviews at baseline and 1 month after discharge and data from hospital and outpatient medical records. DISCUSSION The START intervention offers a compelling model to improve care for hospitalized patients with opioid use disorder. The study could also advance translational science by identifying an effective and generalizable approach to treating not only opioid use disorder, but also other substance use disorders and behavioral health conditions. TRIAL REGISTRATION Clinicaltrials.gov: NCT05086796, Registered on 10/21/2021. https://www. CLINICALTRIALS gov/ct2/results?recrs=ab&cond=&term=NCT05086796&cntry=&state=&city=&dist = .
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Affiliation(s)
- Allison J Ober
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90407-2138, USA.
| | | | - Kimberly Page
- University of New Mexico Hospital, Albuquerque, NM, USA
| | - Peter D Friedmann
- University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA
| | | | - Stephen Ryzewicz
- University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA
| | | | - Mia W Mazer
- Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Isabel Leamon
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90407-2138, USA
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29
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Osborne B, Larance B, Ivers R, Deane FP, Robinson LD, Kelly PJ. Systematic review of guidelines for managing physical health during treatment for substance use disorders: Implications for the alcohol and other drug workforce. Drug Alcohol Rev 2022; 41:1367-1390. [PMID: 35765725 PMCID: PMC9539873 DOI: 10.1111/dar.13504] [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: 01/13/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
Abstract
ISSUES Substance use disorders are associated with significant physical health comorbidities, necessitating an integrated treatment response. However, service fragmentation can preclude the management of physical health problems during addiction treatment. The aim of this systematic review was to synthesise the recommendations made by clinical practice guidelines for addressing the physical health of people attending alcohol and other drug (AOD) treatment. APPROACH An iterative search strategy of grey literature sources was conducted from September 2020 to February 2021 to identify clinical practice guidelines. Content pertaining to physical health care during AOD treatment was extracted. Quality of guidelines were appraised using the Appraisal of Guidelines Research and Evaluation II (AGREE-II) tool. FINDINGS Thirty-three guidelines were included for review. Fourteen guidelines were considered high quality based on AGREE-II scores. Neurological conditions (90.9%) and hepatitis (81.8%) were the most frequent health problems addressed. Most guidelines recommended establishing referral pathways to address physical health comorbidities (90.9%). Guidance on facilitating these referral pathways was less common (42.4%). Guidelines were inconsistent in their recommendations related to oral health, tobacco use, physical activity, nutrition and the use of standardised assessment tools. IMPLICATIONS AND CONCLUSIONS Greater consistency and specificity in the recommendations made for integrating physical health care within addiction treatment is needed. Ensuring that recommendations are applicable to the AOD workforce and to treatment services limited by funding and resource constraints should enhance implementation. Future guideline development groups should consider increased consultation with the AOD workforce and inclusion of clinical tools and decision aids to facilitate referral pathways.
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Affiliation(s)
- Briony Osborne
- School of Psychology, University of Wollongong, Wollongong, Australia.,Centre for Health Psychology Practice and Research, Wollongong, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Wollongong, Australia.,Centre for Health Psychology Practice and Research, Wollongong, Australia
| | - Rowena Ivers
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia.,Centre for Health Psychology Practice and Research, Wollongong, Australia
| | - Laura D Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia.,Centre for Health Psychology Practice and Research, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia.,Centre for Health Psychology Practice and Research, Wollongong, Australia
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Qiao S, Zhang J, Chen S, Olatosi B, Hardeman S, Narasimhan M, Bruner L, Diedhiou A, Scott C, Mansaray A, Weissman S, Li X. How Different Pre-existing Mental Disorders and Their Co-occurrence Affects COVID-19 Clinical Outcomes? A Real-World Data Study in the Southern United States. Front Public Health 2022; 10:831189. [PMID: 35784256 PMCID: PMC9244141 DOI: 10.3389/fpubh.2022.831189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/11/2022] [Indexed: 12/05/2022] Open
Abstract
Background Although a psychiatric history might be an independent risk factor for COVID-19 infection and mortality, no studies have systematically investigated how different clusters of pre-existing mental disorders may affect COVID-19 clinical outcomes or showed how the coexistence of mental disorder clusters is related to COVID-19 clinical outcomes. Methods Using a retrospective cohort study design, a total of 476,775 adult patients with lab-confirmed and probable COVID-19 between March 06, 2020 and April 14, 2021 in South Carolina, United States were included in the current study. The electronic health record data of COVID-19 patients were linked to all payer-based claims data through the SC Revenue and Fiscal Affairs Office. Pre-existing mental disorder diagnoses from Jan 2, 2019 to Jan 14, 2021 were extracted from the patients' healthcare utilization data via ICD-10 codes. Results There is an elevated risk of COVID-19-related hospitalization and death among participants with pre-existing mental disorders adjusting for key socio-demographic and comorbidity covariates. Co-occurrence of any two clusters was positively associated with COVID-19-related hospitalization and death. The odds ratio of being hospitalized was 1.26 (95% CI: 1.151, 1.383) for patients with internalizing and externalizing disorders, 1.65 (95% CI: 1.298, 2.092) for internalizing and thought disorders, 1.76 (95% CI: 1.217, 2.542) for externalizing and thought disorders, and 1.64 (95% CI: 1.274, 2.118) for three clusters of mental disorders. Conclusions Pre-existing internalizing disorders and thought disorders are positively related to COVID-19 hospitalization and death. Co-occurrence of any two clusters of mental disorders have elevated risk of COVID-19-related hospitalization and death compared to those with a single cluster.
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Affiliation(s)
- Shan Qiao
- Department of Health Promotion Education and Behavior, South Carolina StateSmart Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Shujie Chen
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Bankole Olatosi
- Department of Health Services Policy and Management, School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Suzanne Hardeman
- Department of Neuropsychiatry and Behavioral Science, Prisma Health (Midlands), Columbia, SC, United States
| | - Meera Narasimhan
- Department of Neuropsychiatry and Behavioral Science, Prisma Health (Midlands), Columbia, SC, United States
| | - Larisa Bruner
- South Carolina Department of Health and Environmental Control, Columbia, SC, United States
| | - Abdoulaye Diedhiou
- South Carolina Department of Health and Environmental Control, Columbia, SC, United States
| | - Cheryl Scott
- South Carolina Department of Health and Environmental Control, Columbia, SC, United States
| | - Ali Mansaray
- South Carolina Department of Health and Environmental Control, Columbia, SC, United States
| | - Sharon Weissman
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, United States
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, South Carolina StateSmart Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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Owens MD, Banta-Green CJ, Newman A, Marren R, Takushi R. Insights into a Recovery Community Center Model: Results from Qualitative Interviews with Staff and Member Facilitators from Recovery Cafe in Seattle, Washington. ALCOHOLISM TREATMENT QUARTERLY 2022. [DOI: 10.1080/07347324.2022.2088323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mandy D. Owens
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Caleb J. Banta-Green
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Health Systems & Population Health, School of Public Health
| | - Alison Newman
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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Vallecillo G, Durán X, Canosa I, Roquer A, Martinez MC, Perelló R. COVID
‐19 vaccination coverage and vaccine hesitancy among people with opioid use disorder in Barcelona, Spain. Drug Alcohol Rev 2022; 41:1311-1318. [PMID: 35668697 PMCID: PMC9348033 DOI: 10.1111/dar.13502] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 02/06/2023]
Abstract
Introduction People with substance use disorders are considered a priority group for SARS‐CoV‐2 vaccination as they are at elevated risk of COVID‐19 and its severe complications. However, data are scarce about vaccination coverage in a real‐world setting. Methods A descriptive study was conducted in people with opioid use disorder (OUD) from three public centres for outpatient drug addiction treatment in Barcelona, Spain, who received brief medical advice and were referred to vaccination clinic sites. Results Three hundred and sixty‐two individuals were included: 277 (77%) were men with a mean age of 48.1 ± 8.9 years and 77% were Spanish. Most (90%) participants engaged in polysubstance use and all individuals were on opioid agonist therapy. Psychiatric comorbidity was present in 56% subjects and 32% individuals had ≥1 chronic disease, 30% had HIV and 13% hepatitis C. There were 258 fully vaccinated individuals (71%; 95% confidence interval [CI] 67, 76). Age (odds ratio [OR] 1.04; 95% CI 1.01, 1.08; P < 0.01) and Charlson Comorbidity Index (OR 1.67; 95% CI 1.11, 2.5; P < 0.01) were associated with full vaccination. The vaccination hesitancy causes cited were complacency (53, 51%), convenience (40, 39%) and confidence (11, 10%). Discussion and Conclusions More than two‐thirds of our sample of people with OUD were fully vaccinated. Complacency and convenience represented a significant barrier to complete vaccination among people with OUD on opioid agonist therapy referred to vaccination clinic sites. Additional measures are necessary to increase vaccination, especially for younger individuals and those with less medical comorbidity. Integrating vaccination services in drug outpatient centres could be a useful alternative.
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Affiliation(s)
- Gabriel Vallecillo
- Institute of Neuropsychiatry and Addictions Hospital del Mar Barcelona Spain
- Addiction Research Group, Neuroscience Research Program Hospital del Mar Medical Research Institute Barcelona Spain
| | - Xavier Durán
- Statistics Department Hospital del Mar Medical Research Institute Barcelona Spain
| | - Irene Canosa
- Institute of Neuropsychiatry and Addictions Hospital del Mar Barcelona Spain
| | - Albert Roquer
- Institute of Neuropsychiatry and Addictions Hospital del Mar Barcelona Spain
| | - Maria C. Martinez
- Institute of Neuropsychiatry and Addictions Hospital del Mar Barcelona Spain
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Dannenberg MD, Bruce ML, Barr PJ, Broglio K. Prevalence of Opioid Misuse Risk in Patients With Cancer. Clin J Oncol Nurs 2022; 26:261-267. [PMID: 35604731 DOI: 10.1188/22.cjon.261-267] [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: 11/17/2022]
Abstract
BACKGROUND Opioid misuse risk may be similar in individuals with chronic cancer and noncancer pain. However, risk screening is not uniformly used for patients with cancer, so its prevalence is unknown. OBJECTIVES The primary aim of this study was to estimate the level of risk for opioid misuse among patients with cancer. Secondary aims were to compare opioid misuse risk across cancer types and specialties and to explore psychosocial factors that may contribute to opioid misuse risk. METHODS Clinicians were trained to administer the Opioid Risk Tool during ambulatory visits. Data were retrieved from electronic health records and analyzed using descriptive statistics. FINDINGS Five percent of patients seen in the cancer center during the data collection period were screened for opioid misuse risk. Of the 226 patients screened, 163 were at low risk, 34 were at moderate risk, and 29 were at high risk for future opioid misuse. The most frequent cancer diagnoses for patients at moderate or high risk were lung (n = 15), breast (n = 16), gastrointestinal (n = 10), and genitourinary (n = 8). Of the 63 patients at moderate or high risk, 50 had a family history of substance misuse, 45 had a personal history of substance misuse, and 29 had a history of psychological disease.
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Olfson M, Mauro C, Wall MM, Choi CJ, Barry CL, Mojtabai R. Healthcare coverage and service access for low-income adults with substance use disorders. J Subst Abuse Treat 2022; 137:108710. [PMID: 34998642 PMCID: PMC9086121 DOI: 10.1016/j.jsat.2021.108710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Although health coverage facilitates service access to adults in the general population, uncertainty exists over the extent to which this relationship extends to low-income adults with substance use disorders. METHODS The health status and service use patterns of low-income adults with substance use disorders who had continuous, discontinuous, and no past year health coverage were compared using data from the 2015-2019 National Survey on Drug Use and Health (NSDUH). The NSDUH is a nationally representative survey of the civilian non-institutionalized population. RESULTS In the weighted sample (unweighted n = 9243), approximately 65.66% of low-income adults with substance use disorders had continuous coverage, 17.03% had discontinuous coverage, and 17.31% had no insurance coverage during the past year. Although few group differences were observed in self-reported health status, the uninsured group compared to the discontinously and continuously covered groups, respectively, was less likely to report a past year substance use treatment visit (11.03% vs. 14.83% vs. 15.61%), an outpatient care visit (53.39% vs. 71.27% vs. 79.04%), an emergency department visit (33.33% vs. 45.76% vs. 45.57%), or an inpatient admission (9.24% vs. 15.11% vs. 15.58%). CONCLUSIONS Although the cross sectional design limits causal inferences, the correlations between lacking health insurance and low rates of substance use treatment and healthcare use raise the possibility that increasing healthcare coverage might increase access to substance use treatment and other needed healthcare services for low-income adults with substance use disorders.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America; Mailman School of Public Health, Columbia University, New York, NY, United States of America.
| | - Christine Mauro
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Melanie M Wall
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America; Mailman School of Public Health, Columbia University, New York, NY, United States of America; Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY, United States of America
| | - C Jean Choi
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY, United States of America
| | | | - Ramin Mojtabai
- Department of Health Policy and Management, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America; Department of Mental Health, Bloomberg School of Public Health, Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States of America
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Braverman ER, Dennen CA, Gold MS, Bowirrat A, Gupta A, Baron D, Roy AK, Smith DE, Cadet JL, Blum K. Proposing a "Brain Health Checkup (BHC)" as a Global Potential "Standard of Care" to Overcome Reward Dysregulation in Primary Care Medicine: Coupling Genetic Risk Testing and Induction of "Dopamine Homeostasis". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5480. [PMID: 35564876 PMCID: PMC9099927 DOI: 10.3390/ijerph19095480] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 12/27/2022]
Abstract
In 2021, over 100,000 people died prematurely from opioid overdoses. Neuropsychiatric and cognitive impairments are underreported comorbidities of reward dysregulation due to genetic antecedents and epigenetic insults. Recent genome-wide association studies involving millions of subjects revealed frequent comorbidity with substance use disorder (SUD) in a sizeable meta-analysis of depression. It found significant associations with the expression of NEGR1 in the hypothalamus and DRD2 in the nucleus accumbens, among others. However, despite the rise in SUD and neuropsychiatric illness, there are currently no standard objective brain assessments being performed on a routine basis. The rationale for encouraging a standard objective Brain Health Check (BHC) is to have extensive data available to treat clinical syndromes in psychiatric patients. The BHC would consist of a group of reliable, accurate, cost-effective, objective assessments involving the following domains: Memory, Attention, Neuropsychiatry, and Neurological Imaging. Utilizing primarily PUBMED, over 36 years of virtually all the computerized and written-based assessments of Memory, Attention, Psychiatric, and Neurological imaging were reviewed, and the following assessments are recommended for use in the BHC: Central Nervous System Vital Signs (Memory), Test of Variables of Attention (Attention), Millon Clinical Multiaxial Inventory III (Neuropsychiatric), and Quantitative Electroencephalogram/P300/Evoked Potential (Neurological Imaging). Finally, we suggest continuing research into incorporating a new standard BHC coupled with qEEG/P300/Evoked Potentials and genetically guided precision induction of "dopamine homeostasis" to diagnose and treat reward dysregulation to prevent the consequences of dopamine dysregulation from being epigenetically passed on to generations of our children.
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Affiliation(s)
- Eric R. Braverman
- The Kenneth Blum Institute on Behavior & Neurogenetics, Austin, TX 78701, USA; (E.R.B.); (C.A.D.)
| | - Catherine A. Dennen
- The Kenneth Blum Institute on Behavior & Neurogenetics, Austin, TX 78701, USA; (E.R.B.); (C.A.D.)
| | - Mark S. Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA;
- Department of Psychiatry, Tulane School of Medicine, New Orleans, LA 70112, USA;
| | - Abdalla Bowirrat
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
| | - Ashim Gupta
- Future Biologics, Lawrenceville, GA 30043, USA;
| | - David Baron
- Division of Addiction Research & Education, Center for Psychiatry, Medicine & Primary Care (Office of Provost), Western University Health Sciences, Pomona, CA 91766, USA;
| | - A. Kenison Roy
- Department of Psychiatry, Tulane School of Medicine, New Orleans, LA 70112, USA;
| | - David E. Smith
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA 94158, USA;
| | - Jean Lud Cadet
- The Molecular Neuropsychiatry Research Branch, NIH National Institute on Drug Abuse, Baltimore, MD 21224, USA;
| | - Kenneth Blum
- The Kenneth Blum Institute on Behavior & Neurogenetics, Austin, TX 78701, USA; (E.R.B.); (C.A.D.)
- Division of Addiction Research & Education, Center for Psychiatry, Medicine & Primary Care (Office of Provost), Western University Health Sciences, Pomona, CA 91766, USA;
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Amundsen EJ, Bretteville-Jensen AL, Rossow I. Patients admitted to treatment for substance use disorder in Norway: a population-based case-control study of socio-demographic correlates and comparative analyses across substance use disorders. BMC Public Health 2022; 22:792. [PMID: 35443672 PMCID: PMC9020072 DOI: 10.1186/s12889-022-13199-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/30/2022] [Indexed: 11/26/2022] Open
Abstract
Background Improved knowledge regarding socio-demographic correlates of people with substance use disorders (SUDs) is essential to better plan and provide adequate services for SUD patients and their families, and to improve our understanding of the complex mechanisms underlying progression into and development of various SUDs. This study aimed to: i) describe demographic, economic, and social correlates of people with SUDs in comparison with those of the general population and ii) compare these correlates across SUDs from licit versus illicit substances, as well as across specific SUDs. Methods A national population-based case–control study included all SUD patients enrolled in specialized drug treatment in Norway in 2009–2010 (N = 31 245) and a population control sample, frequency-matched on age and gender (N = 31 275). Data on education level, labour market participation, income level and sources, and family/living arrangement were obtained by linkages to national registers. Results Demographic, economic, and social correlates of SUD patients differed substantially from those of the general population, and across specific SUDs. Among SUD patients, those with illicit – as compared to licit – SUDs were younger (mean quotient = 0.72 [0.71–0.72]), more often had low education level (RR = 1.68 [1.63–1.73]), were less often in paid work (RR = 0.74 [0.72–0.76]) and had lower income (mean quotient = 0.61 [0.60–0.62]). Comparison of patients with different SUD diagnoses revealed substantial demographic differences, including the relatively low mean age among cannabis patients and the high share of females among sedatives/hypnotics patients. Opioid patients stood out by being older, and more often out of work, receiving social security benefits, and living alone. Cocaine and alcohol patients were more often better educated, included in the work force, and had a better financial situation. Conclusion Findings revealed substantial and important differences in socio-demographic correlates between SUD patients and the general population, between SUD patients with illicit and with licit substance use, and across specific SUD patient groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13199-5.
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Affiliation(s)
- Ellen J Amundsen
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, POB 222 Skøyen, 0213, Oslo, Norway.
| | - Anne Line Bretteville-Jensen
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, POB 222 Skøyen, 0213, Oslo, Norway
| | - Ingeborg Rossow
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, POB 222 Skøyen, 0213, Oslo, Norway
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Balasubramanian N, James TD, Pushpavathi SG, Marcinkiewcz CA. Repeated ethanol exposure and withdrawal alters ACE2 expression in discrete brain regions: Implications for SARS-CoV-2 infection. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2022:2022.03.29.486282. [PMID: 35378747 PMCID: PMC8978936 DOI: 10.1101/2022.03.29.486282] [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] [Indexed: 01/28/2023]
Abstract
Emerging evidence suggests that people with alcohol use disorders are at higher risk for SARS-CoV-2. SARS-CoV-2 engages angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) receptors for cellular entry. While ACE2 and TMPRSS2 genes are upregulated in the cortex of alcohol-dependent individuals, information on expression in specific brain regions and neural populations implicated in SARS-CoV-2 neuroinvasion, particularly monoaminergic neurons, is limited. We sought to clarify how chronic alcohol exposure affects ACE2 and TMPRSS2 expression in monoaminergic brainstem circuits and other putative SARS-CoV-2 entry points. C57BL/6J mice were exposed to chronic intermittent ethanol (CIE) vapor for 4 weeks and brains were examined using immunofluorescence. We observed increased ACE2 levels in the olfactory bulb and hypothalamus following CIE, which are known to mediate SARS-CoV-2 neuroinvasion. Total ACE2 immunoreactivity was also elevated in the raphe magnus (RMG), raphe obscurus (ROB), and locus coeruleus (LC), while in the dorsal raphe nucleus (DRN), ROB, and LC we observed increased colocalization of ACE2 with monoaminergic neurons. ACE2 also increased in the periaqueductal gray (PAG) and decreased in the amygdala. Whereas ACE2 was detected in most brain regions, TMPRSS2 was only detected in the olfactory bulb and DRN but was not significantly altered after CIE. Our results suggest that previous alcohol exposure may increase the risk of SARS-CoV-2 neuroinvasion and render brain circuits involved in cardiovascular and respiratory function as well as emotional processing more vulnerable to infection, making adverse outcomes more likely. Additional studies are needed to define a direct link between alcohol use and COVID-19 infection.
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Affiliation(s)
| | - Thomas D James
- Department of Neuroscience and Pharmacology, University of Iowa, Iowa City, IA-52242, USA
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Board AR, Kim S, Park J, Schieber L, Miller GF, Pike J, Cremer LJ, Asher A. Risk factors for COVID-19 among persons with substance use disorder (PWSUD) with hospital visits - United States, April 2020-December 2020. Drug Alcohol Depend 2022; 232:109297. [PMID: 35033956 PMCID: PMC8747842 DOI: 10.1016/j.drugalcdep.2022.109297] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/22/2021] [Accepted: 12/13/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Sociodemographic factors and chronic conditions associated with coronavirus disease 2019 (COVID-19) among persons with substance use disorder (PWSUD) are not well understood. We identified risk factors associated with COVID-19 among PWSUD with hospital visits. METHODS Using the Premier Healthcare Database Special COVID-19 Release, we conducted a case-control study using ICD-10-CM codes to identify PWSUD aged 12 years and older with hospital visits for any reason during April-December 2020. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) to identify factors associated with COVID-19 diagnosis among PWSUD (age, sex, race/ethnicity, U.S. Census Region, urban/rural classification, insurance payor type, comorbidities, and substance use disorder [SUD] type), and then stratified by SUD type. RESULTS From April-December 2020, 18,298 (1.3%) of 1,429,154 persons with SUD in the database had a COVID-19 diagnosis. Among PWSUD, opioid use disorder (OUD; aOR = 1.24, 95% CI = 1.18-1.32), alcohol use disorder (AUD; aOR = 1.16, 95% CI = 1.11-1.22), cocaine or other stimulant use disorder (COUD; aOR = 1.28, 95% CI = 1.22-1.34), and multiple SUDs (aOR = 1.20, 95% CI = 1.15-1.26) were associated with higher odds of COVID-19, as were comorbidities such as chronic lower respiratory disease (aOR = 1.32, 95% CI = 1.26-1.37), chronic hepatitis (aOR = 1.45, 95% CI = 1.34-1.57), and diabetes (aOR = 1.78, 95% CI = 1.71-1.86). CONCLUSIONS Among a sample of PWSUD, OUD, AUD, COUD, multiple SUDs, and associated comorbidities were associated with COVID-19 diagnosis. Integration of COVID-related care, care of other comorbidities, and SUD treatment may benefit PWSUD. Future studies are needed to better understand COVID-19 prevention in this population and to reduce disparities among subpopulations at increased risk.
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Affiliation(s)
- Amy R. Board
- CDC COVID-19 Response, United States,Epidemic Intelligence Service, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop S106-8, Atlanta, GA 30341, United States,Division of Overdose Prevention, National Center for Injury Prevention and Control, 4770 Buford Highway, Mailstop S106-8, Atlanta, GA 30341, United States,Corresponding author. Present address: Division for Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS-S106-3, Atlanta, GA 30341, United States
| | - Sunkyung Kim
- CDC COVID-19 Response, United States; Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, 1600 Clifton Rd., NE, Mailstop H24-10, Atlanta, GA 30333, United States.
| | - Joohyun Park
- CDC COVID-19 Response, United States; Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, Mailstop S107-3, Atlanta, GA 30341, United States.
| | - Lyna Schieber
- CDC COVID-19 Response, United States; Division of Overdose Prevention, National Center for Injury Prevention and Control, 4770 Buford Highway, Mailstop S106-8, Atlanta, GA 30341, United States.
| | - Gabrielle F. Miller
- CDC COVID-19 Response, United States,Division of Injury Prevention, National Center for Injury Prevention and Control, 4770 Buford Highway, Mailstop S106-8, Atlanta, GA 30341, United States
| | - Jamison Pike
- CDC COVID-19 Response, United States; Immunization Services Division, National Center for Immunization and Respiratory Diseases, 1600 Clifton Rd., NE, Mailstop H24-4, Atlanta, GA 30333, United States.
| | - Laura J. Cremer
- CDC COVID-19 Response, United States,Division of Overdose Prevention, National Center for Injury Prevention and Control, 4770 Buford Highway, Mailstop S106-8, Atlanta, GA 30341, United States
| | - Alice Asher
- CDC COVID-19 Response, United States; Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 12 Corp Sq Blvd, Mailstop US12-3, Atlanta, GA 30329, United States.
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Agarwal AK, Guntuku SC, Meisel ZF, Pelullo A, Kinkle B, Merchant RM. Analyzing Online Reviews of Substance Use Disorder Treatment Facilities in the USA Using Machine Learning. J Gen Intern Med 2022; 37:977-980. [PMID: 33728567 PMCID: PMC8904697 DOI: 10.1007/s11606-021-06618-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/07/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Anish K Agarwal
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA. .,Center for Digital Health, University of Pennsylvania Health System, Philadelphia, PA, USA. .,Center for Emergency Care Policy Research, University of Pennsylvania, Philadelphia, PA, USA. .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Sharath C Guntuku
- Center for Digital Health, University of Pennsylvania Health System, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Zachary F Meisel
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Center for Digital Health, University of Pennsylvania Health System, Philadelphia, PA, USA.,Center for Emergency Care Policy Research, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Arthur Pelullo
- Center for Digital Health, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Bill Kinkle
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Raina M Merchant
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Center for Digital Health, University of Pennsylvania Health System, Philadelphia, PA, USA.,Center for Emergency Care Policy Research, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Vallecillo G, Fonseca F, Oviedo L, Durán X, Martinez I, García-Guix A, Castillo C, Torrens M, Llana S, Roquer A, Martinez MDLC, Aguelo S, Canosa I. Similar COVID-19 incidence to the general population in people with opioid use disorder receiving integrated outpatient clinical care. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 2:100027. [PMID: 35156106 PMCID: PMC8760741 DOI: 10.1016/j.dadr.2022.100027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 11/16/2022]
Abstract
Introduction During the COVID-19 pandemic, limited access to health care augmented COVID-19 risk in subjects with opioid use disorder (OUD). The aim of the study was to compare COVID-19 incidence in individuals with OUD receiving continuous clinical care with that of the general population. Methods A prospective cohort study was carried out from March 2020 to March 2021 comparing COVID-19 cumulative incidence of individuals presenting an OUD receiving integrated clinical care with that of an age-reference general population, in three public outpatient treatment centers for addiction in Barcelona, Spain. Results Over the study period, 366 individuals received clinical care. Mean age: 48.2±8.9 years, 280 (76.5%) were men and 283 (77.3%) native Spanish. All subjects were on opioid agonist therapy. Prevalence of communicable diseases were: HIV infection in 109 (29.8%) and hepatitis C in 46 (12.6%). Psychiatric comorbidity was present in 207 (56.6%), and 119 (32.5%) had >1 chronic medical disease. COVID-19 was diagnosed in 10 patients a cumulative incidence of 2,732 casesx100,000 people/year (C.I.95%: 1,318–4,967). There were no differences compared to the age-general population: 2,856 casesx100,000 people/year (C.I.95%: 2,830–2,880) (p=0.81). In the bivariate analysis, hypertension (5[50.0%] vs. 53[14.9%], p=0.01) and cardiovascular chronic diseases (2 [20.0%] vs. 8 [2.2%], p=0.03) were more prevalent in patients with OUD and COVID-19. Conclusions Individuals with OUD who received integrated clinical care had a COVID-19 incidence comparable to the general population. Ensuring comprehensive healthcare is essential to prevent the clinical impact of COVID-19 on individuals with OUD.
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Vallecillo G, Pedro-Botet J, Fernandez S, Román I, Elosua R, Camps A, Torrens M, Marrugat J. High cardiovascular risk in older patients with opioid use disorder: Differences with the general population. Drug Alcohol Rev 2022; 41:1078-1084. [PMID: 35178806 DOI: 10.1111/dar.13449] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cardiovascular disease is a health concern in ageing population with opioid use disorders (OUD). The study aims to analyse the cardiovascular risk factors in individuals with OUD. METHODS An observational study was carried out to compare cardiovascular risk factors of adults >50 years with OUD on methadone therapy from public outpatient drug treatment centres, with that of an age- and gender-matched sample (ratio of 1:5) of subjects from a sample of the Spanish population (REGICOR cohort). High cardiovascular risk (HCVR) at 10 years was defined according to Framingham-REGICOR and SCORE risk functions. RESULTS The individuals studied included 94 people with OUD and 495 from the general population; the mean age was 55.7 ± 4.8 years and 432 (72.7%) were men. Obesity (21.2% vs. 35.2%), hypertension (26.3% vs. 42.1%), total cholesterol (30.3% vs. 65.4%) and LDL-cholesterol ≥130 mg/dL (27.2% vs. 59.3%) were significantly more prevalent in the general population group, while tobacco smoking (96.0% vs. 25.9%), low HDL-cholesterol (46.5% vs. 21.2%), hypertriglyceridaemia (39.4% vs. 18.8%) and atherogenic dyslipidaemia (30.3% vs. 10.5%) were significantly higher in individuals with OUD. Differences in abdominal obesity (62.6% vs. 65.3%) were not significant. HCVR was more prevalent in patients with OUD: 15.2% versus 5.8% (Framingham-REGICOR function) and 21.2% versus 11.3% (SCORE function). DISCUSSION AND CONCLUSIONS Older adults with OUD on methadone therapy have a different prevalence of cardiovascular risk factors and HCVR than the general population. Preventive measures, particularly tobacco smoking cessation and weight control, should be included in the routine care of individuals with OUD.
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Affiliation(s)
- Gabriel Vallecillo
- Drug Addiction Program, Instituto de Neuropsiquiatría y Adicciones, Barcelona, Spain.,IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Juan Pedro-Botet
- Lipid and Cardiovascular Risk Unit, Department of Endocrinology, Hospital del Mar, Barcelona, Spain.,Departmento de Medicina, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Silvia Fernandez
- Registre Gironí del COR (REGICOR) Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Irene Román
- Registre Gironí del COR (REGICOR) Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,Cardiovascular Epidemiology and Genetics Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,CIBERCV of Cardiovascular Research, Madrid, Spain
| | - Anna Camps
- Registre Gironí del COR (REGICOR) Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Marta Torrens
- Drug Addiction Program, Instituto de Neuropsiquiatría y Adicciones, Barcelona, Spain.,IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,Departmento de Medicina, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Jaume Marrugat
- Registre Gironí del COR (REGICOR) Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,CIBERCV of Cardiovascular Research, Madrid, Spain
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Saviano A, Heroin L, Mayer P, Baumert TF. Hepatitis C treatment in patients with substance use disorder: the faster the better. Hepatobiliary Surg Nutr 2022; 11:129-131. [PMID: 35284517 PMCID: PMC8847865 DOI: 10.21037/hbsn-21-507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 06/30/2024]
Affiliation(s)
- Antonio Saviano
- Institut de Recherche sur les Maladies et Hépatiques (IVH), Inserm U1110, Strasbourg, France
- Institut Hospitalo-Universitaire, Service d’hépato-gastroentérologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | - Lucile Heroin
- Institut Hospitalo-Universitaire, Service d’hépato-gastroentérologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | - Pierre Mayer
- Institut Hospitalo-Universitaire, Service d’hépato-gastroentérologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | - Thomas F. Baumert
- Institut de Recherche sur les Maladies et Hépatiques (IVH), Inserm U1110, Strasbourg, France
- Institut Hospitalo-Universitaire, Service d’hépato-gastroentérologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- University of Strasbourg, Strasbourg, France
- Institut Universitaire de France (IUF), Paris, France
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Nigatu YT, Elton-Marshall T, Mann RE, Hamilton HA. Associations of cannabis use, opioid use, and their combination with serious psychological distress among Ontario adults. Stress Health 2022; 38:38-46. [PMID: 34038026 DOI: 10.1002/smi.3071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/22/2021] [Accepted: 05/22/2021] [Indexed: 11/08/2022]
Abstract
Considering the widespread use of cannabis and opioids, examining the use of cannabis, opioids and their combination with serious psychological distress (SPD) is important. A total of N = 12,358 adults participating in the Monitor surveillance study between 2014 and 2019 were included. Cannabis and opioid use reflected any use of the substances in the past 12 months. SPD was defined as having a score of 13 or more on the Kessler-6 questionnaire, a 6-item scale that includes feeling nervous, hopeless, restless or fidgety, sad or depressed. Odds ratios (ORs) were estimated from logistic regression models accounting for complex survey design and sociodemographic factors. Overall, 12.8% of the sample reported cannabis use only, 18% reported opioid use only, and 4.9% reported both cannabis and opioid use. Use of both cannabis and opioids was significantly associated with SPD in both women (OR = 4.24; 95% CI, 2.34 to 7.69), and in men (OR = 2.99; 95% CI, 1.56 to 5.73) compared to use of neither. The joint association of cannabis and opioids with SPD was additive. Addressing those who use both cannabis and opioids may help reduce the burden of SPD among adults in Ontario.
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Affiliation(s)
- Yeshambel T Nigatu
- Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tara Elton-Marshall
- Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, London, Canada
| | - Robert E Mann
- Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hayley A Hamilton
- Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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del Palacio-Gonzalez A, Thylstrup B, Houborg E. The impact of the COVID-19 lockdown on services for substance use in Denmark: Implications for meeting users’ needs and recommendations for the future. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:175-189. [PMID: 35757093 PMCID: PMC9189563 DOI: 10.1177/14550725211069229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The aim of this study was to document employees’ experiences of changes in service provision for substance use disorders (SUDs) during the first COVID-19 lockdown in Denmark (spring 2020), as well as to examine their relation to challenges in meeting the service users’ needs. Methods: Employees (N = 373) working in SUD treatment and harm reduction services completed an online survey soon after the first national lockdown. The survey included questions about changes in service provision during the lockdown, perceived concerns of the service users, and challenges in meeting the users’ emerging needs. Results: Employees reported some positive changes in service provisions, such as increased flexibility in appointments, administering medication-assisted treatment (MAT), and use of telehealth. Negative changes were related to reduced contact with practitioners and harm reduction facilities. Approximately one third of employees reported significant challenges in meeting the users’ emerging needs. This was particularly so when users’ concerns were about physical and mental well-being, and substance use. In regression models, negative changes in the access to practitioners and MAT administration (but not other changes) predicted difficulties meeting the users’ needs. Conclusion: Employees in SUD treatment and harm reduction services in Denmark experienced both positive and negative changes as a result of the first lockdown. However, not all the provision changes were linked to challenges in meeting the users’ needs. We discuss practical and research implications of our findings with a focus on the users’ physical and mental health, use of telehealth, MAT, and overall service reorganisation.
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Patton T, Revill P, Sculpher M, Borquez A. Using Economic Evaluation to Inform Responses to the Opioid Epidemic in the United States: Challenges and Suggestions for Future Research. Subst Use Misuse 2022; 57:815-821. [PMID: 35157549 PMCID: PMC8969147 DOI: 10.1080/10826084.2022.2026969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Several aspects of the opioid epidemic and of public health care organization in the United States (US) make the conduct of economic evaluation and the design of policies to respond to this crisis particularly challenging. Objectives: This commentary offers suggestions for how economic evaluation may address and overcome four key features of the opioid epidemic: 1) its magnitude and geographical distribution, 2) its intersection with multiple epidemics, 3) its rapidly changing dynamics, 4) its multi-sectoral causes and consequences. Results: We first offer pragmatic suggestions to address the difficulties in delivering a coordinated response given the fragmented nature of health care in the US. In view of the broad suite of responses required to address opioid use disorder and its associated comorbidities, we highlight the need for economic evaluations which consider interventions throughout the continuum of care (i.e. primary, secondary and tertiary levels of prevention). We examine how the use of predictive modelling alongside economic evaluation might be adopted to address the rapidly evolving situation affecting distinct populations and geographic areas and encourage investments in epidemic preparedness. Finally, we propose methods to capture the interdependence of various sectors of government affected by the opioid crisis in economic evaluations to ensure optimal levels of investment towards a comprehensive response. Conclusions: The opioid epidemic in the US represents an unprecedented public health challenge, but sound epidemiological modelling and economic analysis can help to guide use of limited resources committed to addressing it in ways that can have greatest impact in limiting its adverse consequences.
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Affiliation(s)
- Thomas Patton
- Division of Infectious Diseases and Global Public Health, University of California San Diego, California, USA
| | - Paul Revill
- Centre for Health Economics, University of York, York, UK
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, California, USA
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Nigatu YT, Elton-Marshall T, Hamilton HA. Exploring the Association of e-Cigarette and/or Cannabis Use with Heavy Episodic Drinking among Ontario Adults. Subst Use Misuse 2022; 57:1953-1960. [PMID: 36126159 DOI: 10.1080/10826084.2022.2125268] [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] [Indexed: 10/14/2022]
Abstract
Background: The use of electronic cigarettes and cannabis has significantly increased in recent years, which raises public health concerns. There are also concerns about the association of these substances with drinking behaviors. The main objective of the present study is to examine the association of e-cigarettes and/or cannabis use with heavy episodic drinking (HED) among Ontario adults. Methods: The sample consisted of 5,564 adults from the Monitor Survey in 2018 and 2019. Cannabis and e-cigarette use reflected any use of the substances in the past 12 months. HED was defined as consumption of four/five or more drinks on a single occasion at least monthly in the past 12 months. Odds ratios (OR) were estimated from logistic regression models accounting for complex survey design and sociodemographic factors. Results: Overall, the prevalence of HED was 17.5% in 2018 and 2019. Among participants who reported both e-cigarette and cannabis use, about one-half (50.4%) reported HED at least monthly. Adjusting for covariates, the odds of HED were 5.71 (95%CI, 3.92-8.30) times higher among those who reported both e-cigarette and cannabis use compared to those who used neither substance. Conclusions: The use of e-cigarettes and cannabis are significantly associated with heavy episodic drinking among adults, indicating that those who engage in the dual use of e-cigarette and cannabis may be an important group to target with intervention programs.
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Affiliation(s)
- Yeshambel T Nigatu
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Hayley A Hamilton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Armoon B, Grenier G, Cao Z, Huỳnh C, Fleury MJ. Frequencies of emergency department use and hospitalization comparing patients with different types of substance or polysubstance-related disorders. Subst Abuse Treat Prev Policy 2021; 16:89. [PMID: 34922562 PMCID: PMC8684146 DOI: 10.1186/s13011-021-00421-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 01/20/2023] Open
Abstract
Background This study measured emergency department (ED) use and hospitalization for medical reasons among patients with substance-related disorders (SRD), comparing four subgroups: cannabis-related disorders, drug-related disorders other than cannabis, alcohol-related disorders and polysubstance-related disorders, controlling for various clinical, sociodemographic and service use variables. Methods Clinical administrative data for a cohort of 22,484 patients registered in Quebec (Canada) addiction treatment centers in 2012-13 were extracted for the years 2009-10 to 2015-16. Using negative binomial models, risks of frequent ED use and hospitalization were calculated for a 12-month period (2015-16). Results Patients with polysubstance-related disorders used ED more frequently than other groups with SRD. They were hospitalized more frequently than patients with cannabis or other drug-related disorders, but less frequently than those with alcohol-related disorders. Patients with alcohol-related disorders used ED more frequently than those with cannabis-related disorders and underwent more hospitalizations than both patients with cannabis-related and other drug-related disorders. Co-occurring SRD-mental disorders or SRD-chronic physical illnesses, more years with SRD, being women, living in rural territories, more frequent consultations with usual general practitioner or outpatient psychiatrist, and receiving more interventions in community healthcare centers increased frequency of ED use and hospitalization, whereas both adverse outcomes decreased with high continuity of physician care. Behavioral addiction, age less than 45 years, living in more materially deprived areas, and receiving 1-3 interventions in addiction treatment centers increased risk of frequent ED use, whereas living in semi-urban areas decreased ED use. Patients 25-44 years old receiving 4+ interventions in addiction treatment centers experienced less frequent hospitalization. Conclusion Findings showed higher risk of ED use among patients with polysubstance-related disorders, and higher hospitalization risk among patients with alcohol-related disorders, compared with patients affected by cannabis and other drug-related disorders. However, other variables contributed substantially more to the frequency of ED use and hospitalization, particularly clinical variables regarding complexity and severity of health conditions, followed by service use variables. Another important finding was that high continuity of physician care helped decrease the use of acute care services. Strategies like integrated care and outreach interventions may enhance SRD services. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-021-00421-7.
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Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances du Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain Est, Montréal, Québec, H2M 2E8, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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Haran M, Kelly JR, Kennedy L, Hennigan K, Farid H, Herteu C, Kreisel A, Salehin S, O' Sullivan M, Keating S, Ivers JH, Scully M. An audit of the cervical screening programme in the National Drug Treatment Centre (NDTC). Ir J Med Sci 2021; 190:1379-1386. [PMID: 33449334 PMCID: PMC7809234 DOI: 10.1007/s11845-020-02459-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/03/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Women diagnosed with substance use disorders (SUDs) have higher rates of major medical conditions compared to women without SUDs. Cervical cancer is the second leading cause of cancer death in women aged 20-39 years worldwide and women with SUDs have an increased risk of cervical cancer compared to women without SUD. The National Drug Treatment Centre (NDTC) cervical screening programme, derived from the national CervicalCheck programme, offers free cervical screening to patients attending for treatment of SUDs. AIMS This study aimed to audit adherence to the NDTC Cervical Screening guidelines before and after the implementation of an awareness-raising educational intervention. METHODS The electronic clinical records of women aged between 25 and 60 years attending the lead consultant's (M.S.) outpatient clinic were reviewed for documentary evidence indicating that information about the cervical screening programme had been discussed. This was completed before and one month after the implementation of an awareness-raising educational intervention. RESULTS All women (n = 46, mean age 36.3 (SD = 6.5) years) had an opioid use disorder; 85% had a benzodiazepine use disorder, and 24% had an alcohol use disorder. Of these, 80% had at least one chronic medical condition, 76% had a psychiatric disorder, and 59% were homeless. Adherence to the NDTC cervical screening guideline, as indicated by documentary evidence in clinical records, was 33% (14/43) at baseline, and rose to 88% (36/41) (p < 0.0001) one month after the intervention. CONCLUSIONS This completed audit cycle shows that an awareness-raising educational intervention can significantly improve adherence to a cervical screening programme in women with SUDs.
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Affiliation(s)
- Maeve Haran
- Daughters of Charity Disability Services, Navan Road, Dublin 7, Ireland.
| | - John R Kelly
- Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin 24, Ireland
| | - Liam Kennedy
- Psychiatry of Later Life, Sarto House, Sarto Road, Naas, Co. Kildare, Ireland
| | - Kieran Hennigan
- General Adult Psychiatry, University College Hospital Galway, Newcastle Rd, Galway, Ireland
| | - Huma Farid
- General Adult Psychiatry, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9, 7AB 1841, Ireland
| | - Cristina Herteu
- The HSE National Drug Treatment Centre, 30-31 Pearse Street, Dublin 2, Ireland
| | - Anna Kreisel
- Adult Psychiatry Department, Aulingatan 22 C, SE-271 39, Ystad, Sweden
| | - Shamus Salehin
- The HSE National Drug Treatment Centre, 30-31 Pearse Street, Dublin 2, Ireland
| | - Marie O' Sullivan
- The HSE National Drug Treatment Centre, 30-31 Pearse Street, Dublin 2, Ireland
| | - Shay Keating
- The HSE National Drug Treatment Centre, 30-31 Pearse Street, Dublin 2, Ireland
| | - Jo-Hanna Ivers
- Department of Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, the University of Dublin, Russell Building, Tallaght Cross West, Tallaght, Dublin, D24 DH74, Ireland
| | - Mike Scully
- The HSE National Drug Treatment Centre, 30-31 Pearse Street, Dublin 2, Ireland
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Fond G, Nemani K, Etchecopar-Etchart D, Loundou A, Goff DC, Lee SW, Lancon C, Auquier P, Baumstarck K, Llorca PM, Yon DK, Boyer L. Association Between Mental Health Disorders and Mortality Among Patients With COVID-19 in 7 Countries: A Systematic Review and Meta-analysis. JAMA Psychiatry 2021; 78:1208-1217. [PMID: 34313711 PMCID: PMC8317055 DOI: 10.1001/jamapsychiatry.2021.2274] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Heterogeneous evidence exists for the association between COVID-19 and the clinical outcomes of patients with mental health disorders. It remains unknown whether patients with COVID-19 and mental health disorders are at increased risk of mortality and should thus be targeted as a high-risk population for severe forms of COVID-19. OBJECTIVE To determine whether patients with mental health disorders were at increased risk of COVID-19 mortality compared with patients without mental health disorders. DATA SOURCES For this systematic review and meta-analysis, MEDLINE, Web of Science, and Google Scholar were searched from inception to February 12, 2021. Bibliographies were also searched, and the corresponding authors were directly contacted. The search paradigm was based on the following combination: (mental, major[MeSH terms]) AND (COVID-19 mortality[MeSH terms]). To ensure exhaustivity, the term mental was replaced by psychiatric, schizophrenia, psychotic, bipolar disorder, mood disorders, major depressive disorder, anxiety disorder, personality disorder, eating disorder, alcohol abuse, alcohol misuse, substance abuse, and substance misuse. STUDY SELECTION Eligible studies were population-based cohort studies of all patients with identified COVID-19 exploring the association between mental health disorders and mortality. DATA EXTRACTION AND SYNTHESIS Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was used for abstracting data and assessing data quality and validity. This systematic review is registered with PROSPERO. MAIN OUTCOMES AND MEASURES Pooled crude and adjusted odds ratios (ORs) for the association of mental health disorders with mortality were calculated using a 3-level random-effects (study/country) approach with a hierarchical structure to assess effect size dependency. RESULTS In total, 16 population-based cohort studies (data from medico-administrative health or electronic/medical records databases) across 7 countries (1 from Denmark, 2 from France, 1 from Israel, 3 from South Korea, 1 from Spain, 1 from the UK, and 7 from the US) and 19 086 patients with mental health disorders were included. The studies covered December 2019 to July 2020, were of good quality, and no publication bias was identified. COVID-19 mortality was associated with an increased risk among patients with mental health disorders compared with patients without mental health disorders according to both pooled crude OR (1.75 [95% CI, 1.40-2.20]; P < .05) and adjusted OR (1.38 [95% CI, 1.15-1.65]; P < .05). The patients with severe mental health disorders had the highest ORs for risk of mortality (crude OR: 2.26 [95% CI, 1.18-4.31]; adjusted OR: 1.67 [95% CI, 1.02-2.73]). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis of 16 observational studies in 7 countries, mental health disorders were associated with increased COVID-19-related mortality. Thus, patients with mental health disorders should have been targeted as a high-risk population for severe forms of COVID-19, requiring enhanced preventive and disease management strategies. Future studies should more accurately evaluate the risk for patients with each mental health disorder. However, the highest risk seemed to be found in studies including individuals with schizophrenia and/or bipolar disorders.
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Affiliation(s)
- Guillaume Fond
- Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, Marseille, France,FondaMental Academic Advanced Center of Expertise for Bipolar Disorders and Schizophrenia (FACE-BD, FACE-SZ), Créteil, France
| | - Katlyn Nemani
- Department of Psychiatry, New York University Langone Medical Center, New York
| | - Damien Etchecopar-Etchart
- Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, Marseille, France
| | - Anderson Loundou
- Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, Marseille, France
| | - Donald C. Goff
- Department of Psychiatry, New York University Langone Medical Center, New York
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, South Korea
| | - Christophe Lancon
- Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, Marseille, France,FondaMental Academic Advanced Center of Expertise for Bipolar Disorders and Schizophrenia (FACE-BD, FACE-SZ), Créteil, France
| | - Pascal Auquier
- Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, Marseille, France
| | - Karine Baumstarck
- Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, Marseille, France
| | - Pierre-Michel Llorca
- FondaMental Academic Advanced Center of Expertise for Bipolar Disorders and Schizophrenia (FACE-BD, FACE-SZ), Créteil, France,Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France
| | - Dong Keon Yon
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Laurent Boyer
- Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, Marseille, France,FondaMental Academic Advanced Center of Expertise for Bipolar Disorders and Schizophrenia (FACE-BD, FACE-SZ), Créteil, France
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Murphy M, Ding A, Berk J, Rich J, Bayliss G. Kidney Disease among People Who Are Incarcerated. Clin J Am Soc Nephrol 2021; 16:1766-1772. [PMID: 34135025 PMCID: PMC8729426 DOI: 10.2215/cjn.01910221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CKD affects 15% of US adults and is associated with higher morbidity and mortality. CKD disproportionately affects certain populations, including racial and ethnic minorities and individuals from disadvantaged socioeconomic backgrounds. These groups are also disproportionately affected by incarceration and barriers to accessing health services. Incarceration represents an opportunity to link marginalized individuals to CKD care. Despite a legal obligation to provide a community standard of care including the screening and treatment of individuals with CKD, there is little evidence to suggest systematic efforts are in place to address this prevalent, costly, and ultimately fatal condition. This review highlights unrealized opportunities to connect individuals with CKD to care within the criminal justice system and as they transition to the community, and it underscores the need for more evidence-based strategies to address the health effect of CKD on over-represented communities in the criminal justice system.
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Affiliation(s)
- Matthew Murphy
- Department of Medicine, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Rhode Island Department of Corrections, Cranston, Rhode Island
| | - Ann Ding
- Department of Medicine and Pediatrics, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Justin Berk
- Rhode Island Department of Corrections, Cranston, Rhode Island
- Department of Medicine and Pediatrics, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Josiah Rich
- Department of Medicine, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - George Bayliss
- Department of Medicine, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
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