Opioid use disorder: a neglected human immunodeficiency virus risk in American adolescents

Development of a brief stigma and perceptions questionnaire for pharmacists: An exploratory factor analysis approach in New York state counties enrolled in the healing communities study

INTRODUCTION

Little is known about how pharmacists' attitudes and stigma toward naloxone and Medication for opioid use disorder (MOUD) influence effective linkage to treatment. We examine the psychometrics of a new Pharmacist Opioid Use Disorder Perceptions Questionnaire (P-OUDP-Q), a multidimensional measure to examine pharmacists' stigma and perceptions related to MOUD in the New York State (NYS) site of the HEALing Communities Study.

METHODS

The study recruited a sample of 324 pharmacists from 16 counties in NYS between January and June 2022. A 74-item questionnaire assessed pharmacists' familiarity with opioid-related medications, protocols, policies and attitudes regarding their role, confidence, and beliefs centered around delivery of MOUD and naloxone in the community. Exploratory factor analysis assessed individual and community-level factors associated with four underlying constructs. Factor scores were compared across the demographic predictors. Variables factor loadings <0.4 were eliminated from the factor analysis and the process was reiterated.

RESULTS

Eighty-six percent (n = 280) of the pharmacists were white. A little over half, 57 % (n = 186), were female, 35 % (n = 113) were 30-35 years old. The mean number of years practicing (SD) was 18 (SD: 13). Exploratory factor analysis identified four underlying constructs: (1) practice confidence, (2) practice familiarity, (3) practice attitudes, and (4) methadone attitudes. Statistically significant (p < .05) mean factor scale score differences by race were observed for practice familiarity (white reporting higher than non-white); by pharmacy size for practice familiarity (across all groups; non-significant Tukey post-hoc) and practice attitudes (hospital/clinic greater than big chain pharmacies); by gender (males greater than females) for practice familiarity and methadone attitudes; by poverty quartile for practice attitudes (lowest less than highest quartile); and urban versus rural pharmacist county setting for practice familiarity (rural greater than urban).

CONCLUSIONS

Findings show the P-OUDP-Q is a concise measure of pharmacists' perceptions of their role in dispensing MOUD and naloxone, including distinct "stigma" dimensions, which is valuable for use with pharmacists in communities highly impacted by the opioid epidemic. The development and validation of a reliable measure to assess pharmacists' perceptions of stigma and barriers represents a valuable contribution to the field, to inform the design/implementation of targeted interventions and support systems.

Gut microbiota profiling in injection drug users with and without HIV-1 infection in Puerto Rico

Introduction

The full extent of interactions between human immunodeficiency virus (HIV) infection, injection drug use, and the human microbiome is unclear. In this study, we examined the microbiomes of HIV-positive and HIV-negative individuals, both drug-injecting and non-injecting, to identify bacterial community changes in response to HIV and drug use. We utilized a well-established cohort of people who inject drugs in Puerto Rico, a region with historically high levels of injection drug use and an HIV incidence rate disproportionately associated with drug use.

Methods

Using amplicon-based 16S rDNA sequencing, we identified amplicon sequence variants (ASVs) that demonstrated significant variations in the composition of microbial communities based on HIV status and drug use.

Results and discussion

Our findings indicate that the HIV-positive group exhibited a higher abundance of ASVs belonging to the genera Prevotella, Alloprevotella, Sutterella, Megasphaera, Fusobacterium, and Mitsuokella. However, Bifidobacteria and Lactobacillus ASVs were more abundant in injectors than in non-injectors. We examined the effect of drug use on the gut microbiome in both HIV-infected and non-infected patients, and found that multiple drug use significantly affected the microbial community composition. Analysis of differential of bacterial taxa revealed an enrichment of Bifidobacterium spp., Faecalibacterium spp., and Lactobacillus spp. in the multiple drug-injecting group. However, in the non-injecting group, Parabacteroides spp., Prevotella spp., Paraprevotella spp., Sutterella spp., and Lachnoclostridium spp. The presence of multiple drug-injecting groups was observed to be more prevalent. Our findings provide detailed insight into ASV-level changes in the microbiome in response to HIV and drug use, suggesting that the effect of HIV status and drug injection may have different effects on microbiome composition and in modulating gut bacterial populations.

Opioid use disorder (OUD) and treatment for opioid problems among OUD symptom subtypes in individuals misusing opioids

Background

In 2021, approximately 60 million individuals worldwide and 9 million individuals in the United States (US) reported opioid misuse. In the US, 2.5 million have OUD, of which only about a third receive any substance abuse treatment. OUD is often regarded as a monolithic disorder but different opioid problem subtypes may exist beyond DSM-IV/5 criteria. Understanding the characteristics of these subtypes could be useful for informing treatment and intervention strategies.

Methods

Latent class analysis was used to identify OUD symptom subtypes among persons in the US who reported misusing prescription opioids or heroin in the 2015-2018 National Survey on Drug Use and Health (n=10,928). Regression analyses were utilized to determine associations between class membership and treatment receipt, as well as demographic characteristics and other comorbid conditions.

Results

Five classes were identified with unique OUD symptom patterns: Class 1: Asymptomatic (71.6%), Class 2: Tolerance/Time (14.5%), Class 3: Loss of Control/Pharmacological (LOC/Pharmacol) (5.7%), Class 4: Social Impairment (2.6%), and Class 5: Pervasive (5.6%). Nearly all persons in the LOC/Pharmacol, Social Impairment, and Pervasive classes met criteria for OUD (98-100%); however, they differed in receipt of past-year treatment for substance use (28%, 28%, 49%, respectively). Age, race, education, insurance status, and criminal activity were also associated with treatment receipt.

Conclusions

There were considerable differences in OUD symptom patterns and substance use treatment among individuals who misused opioids. The findings indicate a substantial unmet need for OUD treatment and point to patterns of heterogeneity within OUD that can inform development of treatment programs.

Opioid misuse among people with HIV: results from the National Survey on Drug Use and Health (NSDUH) 2015-2019

Aim: Pain is a major challenge in the management of HIV/AIDS. This research analyzed the prevalence of substance use and opioid misuse among people with HIV (PWH) and those without (PWoH) in the USA. Methods: Using data from the 2015-2019 National Survey on Drug Use and Health, the study assessed misuse of pain relievers and opioids in 279,025 individuals. Results: PWH were about 1.88-times more likely to misuse pain relievers and 1.85-times to misuse opioids than PWoH, with a notable rise in hydrocodone and tramadol misuse. Conclusion: The data highlights an imperative for interventions targeting substance misuse among PWH, addressing the complex nexus of HIV, chronic pain and opioid use.

Pre-existing Opioid Use Worsens Outcomes in Patients With Diverticulitis

Background and objective Diverticulitis occurs in 10-25% of patients with diverticulosis. Although opioids can decrease bowel motility, there is scarce data on the effect of chronic opioid use on the outcomes of diverticulitis. In this study, we aimed to explore the outcomes of diverticulitis in patients with pre-existing opioid use. Methods Data between 2008 and 2014 from the National Inpatient Sample (NIS) database was extracted using the International Classification of Diseases, 9th Revision (ICD-9) codes. Univariate and multivariate analyses were used to generate odds ratios (OR). Elixhauser Comorbidity Index (ECI) scores predicting mortality and readmission were calculated based on weighted scores from 29 different comorbidities. Scores were compared between the two groups using univariate analysis. Inclusion criteria included patients with a primary diagnosis of diverticulitis. Exclusion criteria included patients less than 18 years of age, and a diagnosis of opioid use disorder in remission. Studied outcomes included inpatient mortality, complications (including perforation, bleeding, sepsis event, ileus, abscess, obstruction, and fistula), length of hospital stay, and total costs.  Results A total of 151,708 patients with diverticulitis and no active opioid use and 2,980 patients with diverticulitis and active opioid use were hospitalized in the United States from 2008 to 2014. Opioid users had a higher OR for bleeding, sepsis, obstruction, and fistula formation. Opioid users had a lower risk of developing abscesses. They had longer lengths of stay, higher total hospital charges, and higher Elixhauser readmission scores. Conclusion Hospitalized diverticulitis patients with comorbid opioid use are at an elevated risk of in-hospital mortality and sepsis. This could be attributed to complications from injection drug use predisposing opioid users to these risk factors. Outpatient providers caring for patients with diverticulosis should consider screening their patients for opioid use and try offering them medication-assisted treatment to reduce their risk of poor outcomes.