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Pulido J, Sanchez-Niubo A, Llorens N, Hoyos J, Barrio G, Belza MJ, Cea-Soriano L, Angulo-Brunet A, Sordo L. Estimating the Prevalence of Recreational Opioid Use in Spain Using a Multiplier Method. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084815. [PMID: 35457681 PMCID: PMC9027743 DOI: 10.3390/ijerph19084815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 01/27/2023]
Abstract
Acknowledgement of the prevalence of recreational opioid use (PROU) is key to the planning and evaluation of care services. However, in Spain, the prevalence of PROU in recent years is unknown. The objective of this study was to estimate the PROU between 2005 and 2019 in the general populations of six Spanish cities. A benchmark-multiplier methodology was used to estimate the PROU population size. The benchmark used was overdose deaths from recreational opioid use in Spain’s six most populated cities. The multiplier was the overdose death rate in a cohort of heroin users. Linear regression was used to estimate the trend of the PROU estimate over the set period of years. In 2005, the PROU was 4.78 (95%CI 3.16–7.91) per 1000 people. The estimated trend decreased, with the two lowest values being 2.35 per 1000 in 2015 and 2.29 in 2018. In 2019 the PROU was 2.60 per 1000 (95%CI 1.72–4.31), 45% lower than in 2005. While the decline in the PROU continues, its deceleration over the last four years calls for increased vigilance, especially in light of the opioid crisis in North America that has occurred over the last few years.
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Affiliation(s)
- José Pulido
- Departamento de Salud Pública y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.P.); (J.H.); (L.C.-S.); (L.S.)
- CIBER en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (G.B.); (M.J.B.)
| | - Albert Sanchez-Niubo
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, 08035 Barcelona, Spain
- CIBER en Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence:
| | - Noelia Llorens
- Delegación del Gobierno Para el Plan Nacional Sobre Drogas, Ministerio de Sanidad, Gobierno de España, 28008 Madrid, Spain;
| | - Juan Hoyos
- Departamento de Salud Pública y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.P.); (J.H.); (L.C.-S.); (L.S.)
- CIBER en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (G.B.); (M.J.B.)
| | - Gregorio Barrio
- CIBER en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (G.B.); (M.J.B.)
- Escuela Nacional de Salud, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Maria Jose Belza
- CIBER en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (G.B.); (M.J.B.)
- Escuela Nacional de Salud, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Lucía Cea-Soriano
- Departamento de Salud Pública y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.P.); (J.H.); (L.C.-S.); (L.S.)
| | - Ariadna Angulo-Brunet
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya, Rambla del Poblenou, 08018 Barcelona, Spain;
| | - Luis Sordo
- Departamento de Salud Pública y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.P.); (J.H.); (L.C.-S.); (L.S.)
- CIBER en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (G.B.); (M.J.B.)
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Colell E, Domingo-Salvany A, Espelt A, Parés-Badell O, Brugal MT. Differences in mortality in a cohort of cocaine use disorder patients with concurrent alcohol or opiates disorder. Addiction 2018; 113:1045-1055. [PMID: 29357115 DOI: 10.1111/add.14165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/21/2017] [Accepted: 01/12/2018] [Indexed: 12/24/2022]
Abstract
AIMS To study mortality in a cohort of cocaine use disorder patients, and compare results in those with concurrent alcohol or opiates disorder. DESIGN, SETTING AND PARTICIPANTS A cohort of 10 539 cocaine use disorder individuals entering drug treatment in public out-patient centres in the city of Barcelona was followed from 1997 to 2011. Participants were divided at baseline into three groups: those with only cocaine use disorder (CUD), those with cocaine and alcohol use disorder but not opioid (CAUD) and those with cocaine and opioid use disorder (COUD). Mortality was assessed through the Spanish National Mortality Register. MEASUREMENTS Crude mortality rates (CMR), standardized mortality ratios (SMR) and rate ratios (RR) were calculated for each group. A multivariable Cox regression model was fitted to obtain adjusted mortality hazard ratios (aHR) of CAUD and COUD with respect to CUD. Specific mortality causes were also examined. FINDINGS The total of 716 deaths registered resulted in a CMR = 6.0/1000 person-years (PY); 95% confidence interval (CI) = 5.1-7.0 for CUD, CMR = 5.8/1000 PY (95% CI = 4.9-6.7) for CAUD and CMR = 20.7/1000 PY (95% CI = 18.8-22.8) for COUD, with no significant differences among sexes. Compared with the general population, mortality was four times higher (SMR = 4.1, 95% CI = 3.5-4.8) among CUD, more than three times among CAUD (SMR = 3.4, 95% CI = 2.9-3.9) and more than 10 times among COUD (SMR = 11.6, 95% CI = 10.5-12.8), being always higher in women. External injuries, led by overdose, accumulated the biggest percentage of deaths among the three groups, but infectious diseases showed the highest excess mortality. Some differences regarding causes of death were observed between the three groups. CONCLUSIONS Mortality risk and excess mortality are significantly greater among those with cocaine and opiates use disorder than among people with only cocaine use disorder or cocaine and alcohol use disorder.
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Affiliation(s)
- Esther Colell
- Drug Abuse Epidemiology Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Antònia Domingo-Salvany
- Drug Abuse Epidemiology Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Albert Espelt
- Public Health Agency of Barcelona, Spain.,Institute of Biomedical Research Sant Pau, Barcelona, Spain.,Department of Psychobiology and Methodology of Health Sciences, Autonomous University of Barcelona, Bellaterra, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Biomedical Research Centre Network for Epidemiology and Public Health (Spain), Madrid, Spain.,Facultat de Ciències de la Salut de Manresa, Universitat de Vic. Universitat Central de Catalunya (UVicUCC), Av Universitària, Manresa, Spain
| | - Oleguer Parés-Badell
- Public Health Agency of Barcelona, Spain.,Institute of Biomedical Research Sant Pau, Barcelona, Spain
| | - M Teresa Brugal
- Public Health Agency of Barcelona, Spain.,Institute of Biomedical Research Sant Pau, Barcelona, Spain
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Bosque-Prous M, Brugal MT. [Harm reduction interventions in drug users: current situation and recommendations]. GACETA SANITARIA 2018; 30 Suppl 1:99-105. [PMID: 27837802 DOI: 10.1016/j.gaceta.2016.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/19/2016] [Accepted: 04/21/2016] [Indexed: 01/12/2023]
Abstract
Harm reduction encompasses interventions, programmes and policies that seek to reduce the negative consequences of the consumption of both legal and illegal drugs on the individual and public health. Harm reduction looks to mitigate the harm suffered by drug users through drug use monitoring and prevention, and promotes initiatives that respect and protect the human rights of this population. The harm reduction policies that have proven effective and efficient are: opioid substitution maintenance therapy (methadone); needle and syringe exchange programmes; supervised drug consumption rooms; and overdose prevention through peer-based naloxone distribution. In order to be effective, these policies must have comprehensive coverage and be implemented in areas where the target population is prevalent. Resident-based opposition to the implementation of these policies is known as the NIMBY (Not In My Back Yard) phenomenon, which is characterised by being against the implementation of new measures in a particular place, but does not question their usefulness. Given that any NIMBY phenomenon is a complex social, cultural and political phenomenon, it is important to conduct a thorough analysis of the situation prior to implementing any of these measures. Harm reduction policies must be extended to other substances such as alcohol and tobacco, as well as to other conditions beyond infectious/contagious diseases and overdose.
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Affiliation(s)
- Marina Bosque-Prous
- Agencia de Salut Pública de Barcelona, Barcelona; Institut d'Investigació Biomèdica Sant Pau, Barcelona; Universitat Pompeu Fabra, Barcelona, España
| | - María Teresa Brugal
- Agencia de Salut Pública de Barcelona, Barcelona; Institut d'Investigació Biomèdica Sant Pau, Barcelona; Universitat Pompeu Fabra, Barcelona, España.
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Marotta PL, McCullagh CA. A cross-national analysis of the association between years of implementation of opioid substitution treatments and drug-related deaths in Europe from 1995 to 2013. Eur J Epidemiol 2017; 33:679-688. [PMID: 29234968 DOI: 10.1007/s10654-017-0342-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 12/06/2017] [Indexed: 12/23/2022]
Abstract
Data at the individual-level provide evidence that opioid substitution treatment (OST) programs protect against mortality for opioid dependent populations. Prior research has not examined the merits of national implementation of opioid substitution programs for reducing mortality at the country-level. This study elucidates longitudinal associations between country-level implementation of opioid substitution treatment programs on mortality rates of drug related deaths (DRD) from 1995 to 2013 in 30 European nations. Cases of DRD were measured using National Definitions for each country from official sources of data. Preliminary analysis of dispersion of cases of DRD using means and variances justified use of the negative binomial regression model with a population offset. Year and country-level fixed effects negative binomial regression models investigated the association between years of implementation of methadone maintenance therapy (MMT), OST in prison, and high dose buprenorphine treatment (HDBT) implementation and mortality rates from drug related deaths after adjusting for unemployment rates, heroin seizures and per capita expenditures on health. Beta coefficients were converted to Incidence Rate Ratios (IRR) and standard errors bootstrapped using non-parametric methods to adjust for bias (SDbs). The mean mortality rate of DRD was 1.81 from 1995 to 2013. In adjusted models, each additional year of MMT (IRR = .61, SD = .04, p < .001; SDbs = .08, p < .001), prison OST (IRR = .90, SD = .01, p < .001; SDbs = .02, p < .001), and HDBT (IRR = .09, SD = .02, p < .001; SDbs = .02, p < .01) was significantly associated with lower rates of DRDs after adjusting for country and year fixed effects. Implementation of OST programs in the general population and in prison settings may have protected against mortality from drug use at the country-level in Europe from 1995 to 2013.
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Affiliation(s)
- Phillip L Marotta
- School of Social Work, New York, NY, USA.
- Columbia University, New York, NY, USA.
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Espelt A, Bosque-Prous M, Folch C, Sarasa-Renedo A, Majó X, Casabona J, Brugal MT. Is systematic training in opioid overdose prevention effective? PLoS One 2017; 12:e0186833. [PMID: 29088247 PMCID: PMC5663400 DOI: 10.1371/journal.pone.0186833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 10/09/2017] [Indexed: 12/03/2022] Open
Abstract
The objectives were to analyze the knowledge about overdose prevention, the use of naloxone, and the number of fatal overdoses after the implementation of Systematic Training in Overdose Prevention (STOOP) program. We conducted a quasi-experimental study, and held face-to-face interviews before (n = 725) and after (n = 722) implementation of systematic training in two different samples of people who injected opioids attending harm reduction centers. We asked participants to list the main causes of overdose and the main actions that should be taken when witnessing an overdose. We created two dependent variables, the number of (a) correct and (b) incorrect answers. The main independent variable was Study Group: Intervention Group (IG), Comparison Group (CG), Pre-Intervention Group With Sporadic Training in Overdose Prevention (PREIGS), or Pre-Intervention Group Without Training in Overdose Prevention (PREIGW). The relationship between the dependent and independent variables was assessed using a multivariate Poisson regression analysis. Finally, we conducted an interrupted time series analysis of monthly fatal overdoses before and after the implementation of systematic program during the period 2006–2015. Knowledge of overdose prevention increased after implementing systematic training program. Compared to the PREIGW, the IG gave more correct answers (IRR = 1.40;95%CI:1.33–1.47), and fewer incorrect answers (IRR = 0.33;95%CI:0.25–0.44). Forty percent of people who injected opioids who received a naloxone kit had used the kit in response to an overdose they witnessed. These courses increase knowledge of overdose prevention in people who use opioids, give them the necessary skills to use naloxone, and slightly diminish the number of fatal opioid overdoses in the city of Barcelona.
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Affiliation(s)
- Albert Espelt
- Agència de Salut Pública de Barcelona, Plaça Lesseps, Barcelona, Spain
- Centros de Investigación Biomédica en Red. Epidemiología y Salud Pública (CIBERESP), Calle Melchor Fernández Almagro, Madrid, Spain
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic Universitat Central de Catalunya (UVicUCC), Av. Universitària, Manresa, Spain
- Departament de Psicobiologia i Metodologia en Ciències de la Salut, Universitat Autònoma de Barcelona, Campus UAB, Bellaterra, Spain
- * E-mail:
| | | | - Cinta Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Carretera Canyet s/n, Badalona, Spain
| | - Ana Sarasa-Renedo
- Agència de Salut Pública de Barcelona, Plaça Lesseps, Barcelona, Spain
- Programa de Epidemiología Aplicada y de Campo (PEAC), Instituto de Salud Carlos III, Calle Sinesio Delgado, Madrid, Spain
| | - Xavier Majó
- Subdirecció General de Drogodependències, Departament de Salut de la Generalitat de Catalunya, Carrer de Roc Boronat, Barcelona, Spain
| | - Jordi Casabona
- Subdirecció General de Drogodependències, Departament de Salut de la Generalitat de Catalunya, Carrer de Roc Boronat, Barcelona, Spain
| | - M. Teresa Brugal
- Agència de Salut Pública de Barcelona, Plaça Lesseps, Barcelona, Spain
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Parés-Badell O, Espelt A, Folch C, Majó X, González V, Casabona J, Brugal MT. Undiagnosed HIV and Hepatitis C infection in people who inject drugs: From new evidence to better practice. J Subst Abuse Treat 2017; 77:13-20. [PMID: 28476265 DOI: 10.1016/j.jsat.2017.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/03/2017] [Accepted: 03/08/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The objective of this study was to estimate the proportion of undiagnosed HIV or Hepatitis C virus (HCV) infection and to assess the risk factors associated with an undiagnosed infection. METHODS A questionnaire was distributed among people who inject drugs (PWID) in harm reduction centres in Catalonia, Spain 2008-2012 (n=2243). Self-report of HIV and HCV was compared to oral fluid tests to calculate the proportion of undiagnosed infection. Associations of undiagnosed HIV and HCV with age, origin, risk and protective factors of infection and services use were calculated using a Poisson regression model with robust variance. RESULTS The sensitivity of HIV self-report was 78.5% (75.2%-81.5%) and of HCV was 81.2% (79.1%-83.2%), being lower in younger and foreign-born PWID. Specificity for HCV was 55.9% (51.6%-60.1%). PWID who engaged in infection risk behaviors had lower risk of being undiagnosed. Being foreign-born and younger increased the risk of undiagnosed infection. PWID who had not accessed medical care in the last 6months had 1.46 (1.10-1.93) times more risk of undiagnosed HIV and 1.37 (1.11-1.70) times more risk of undiagnosed HCV. CONCLUSION Outreach programmes are essential to provide PWID, specially foreign-born and younger PIWD, access to HIV and HCV test.
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Affiliation(s)
- Oleguer Parés-Badell
- Public Health Agency of Barcelona, 1 Pl. de Lesseps, Barcelona 08023, Spain; Institute of Biomedical Research Sant Pau, 167 Sant Antoni Maria Claret, Barcelona 08025, Spain
| | - Albert Espelt
- Public Health Agency of Barcelona, 1 Pl. de Lesseps, Barcelona 08023, Spain; Institute of Biomedical Research Sant Pau, 167 Sant Antoni Maria Claret, Barcelona 08025, Spain; Department of Psychobiology and Methodology of Health Sciences, Autonomous University of Barcelona, Plaça Cívica, Bellaterra 08093, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Biomedical Research Centre Network for Epidemiology and Public Health (Spain), 5 Monforte de Lemos, Madrid 28029, Spain.
| | - Cinta Folch
- CIBER en Epidemiología y Salud Pública (CIBERESP), Biomedical Research Centre Network for Epidemiology and Public Health (Spain), 5 Monforte de Lemos, Madrid 28029, Spain; Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, 81 Roc Boronat, Barcelona 08005, Spain; Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Pública, Facultat de Medicina, Autonomous University of Barcelona, Plaça Cívica, Bellaterra 08093, Spain
| | - Xavier Majó
- Subdirecció General de Drogodependències, Departament de Salut de la Generalitat de Catalunya, 131 Travessera de les Corts, Barcelona 08021, Spain
| | - Victoria González
- Microbiology Service, Hospital Universitari Germans Trias i Pujol, Carretera Can Ruti, Badalona 08916, Spain
| | - Jordi Casabona
- CIBER en Epidemiología y Salud Pública (CIBERESP), Biomedical Research Centre Network for Epidemiology and Public Health (Spain), 5 Monforte de Lemos, Madrid 28029, Spain; Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, 81 Roc Boronat, Barcelona 08005, Spain; Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Pública, Facultat de Medicina, Autonomous University of Barcelona, Plaça Cívica, Bellaterra 08093, Spain
| | - M Teresa Brugal
- Public Health Agency of Barcelona, 1 Pl. de Lesseps, Barcelona 08023, Spain; Institute of Biomedical Research Sant Pau, 167 Sant Antoni Maria Claret, Barcelona 08025, Spain
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Winstanley EL, Clark A, Feinberg J, Wilder CM. Barriers to implementation of opioid overdose prevention programs in Ohio. Subst Abus 2017; 37:42-6. [PMID: 26682929 DOI: 10.1080/08897077.2015.1132294] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Nationally, overdose fatalities have reached epidemic proportions. Ohio has one of the highest overdose death rates in the country, as well as high rates of prescription opioid trafficking. METHODS A cross-sectional self-report survey of opioid overdose prevention programs (OOPPs) in Ohio was conducted between August and October 2014 to characterize programs and ascertain barriers to successful implementation. A 91% response rate was achieved with 18 programs participating in the study. RESULTS The first Ohio OOPP opened in August 2012, a second program opened in 2013, and the remaining programs began in 2014. All of the programs distribute nasal naloxone and provide overdose prevention education, and 89% (n = 16) provide overdose kits for free. Six OOPPs are funded by the Ohio Department of Health, 3 programs are funded by a local health foundation, and several other public and private funding sources were reported. The OOPPs have funding to distribute a combined total of 8,670 overdose kits and had distributed 1998 kits by October 2014. The OOPPs reported 149 overdose reversals. Fifteen programs (83%) reported implementation barriers that were categorized as stigma-, cost-, staffing-, legal, regulatory, and client-related problems. Legislative changes aimed at removing some of the obstacles to distribution and lay administration of naloxone have recently been enacted in Ohio. CONCLUSIONS OOPPs have rapidly expanded in Ohio during the past 3 years. Although recent legislative changes have addressed some of the reported implementation barriers, stigma and the cost of naloxone remain significant problems.
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Affiliation(s)
- Erin L Winstanley
- a James L. Winkle College of Pharmacy , University of Cincinnati , Cincinnati , Ohio , USA
| | - Angela Clark
- b College of Nursing , University of Cincinnati , Cincinnati , Ohio , USA
| | - Judith Feinberg
- c Behavioral Medicine & Psychiatry , College of Medicine , West Virginia University, Morgantown , West Virginia , USA
| | - Christine M Wilder
- d Department of Veterans Affairs Medical Center , Cincinnati , Ohio , USA.,e Addiction Sciences Division , Department of Psychiatry and Behavioral Neuroscience , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA
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