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Smith LA, Kolokotroni KZ, Turner-Moore R. Adults' Understandings and Experiences of the Capacity to Consent to Substance-Involved Sexual Activity. JOURNAL OF SEX RESEARCH 2024; 61:495-514. [PMID: 37004160 DOI: 10.1080/00224499.2023.2189686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Most research on capacity to consent to substance-involved sex has focused exclusively on the implications of alcohol with little attention given to other or additional psychoactive drugs. This study aimed to explore people's understanding and experiences of the capacity to consent to alcohol- and/or drug-involved sexual activity. UK adults (N = 354) completed an online mixed-methods survey on sexual consent during sober, alcohol- and/or drug-involved sex. Qualitative data were analyzed using thematic analysis. Themes for capacity to consent were: (1) "There is no normative understanding of substance-involved sexual consent," (2) "Moving beyond the binary of consciousness versus incapacitation" and (3) "Substance-involved sexual decisions are viewed as irresponsible." The findings illustrated that capacity to consent is nuanced and multidimensional, and that people's understandings and experiences of capacity to consent to substance-involved sex are not solely individual, but rather, they are also shaped by their environment. We call for a multidimensional view of capacity to consent, where a standard of "unimpaired," rather than sober, is used and modeled by academics, legislators, and educators.
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Affiliation(s)
- Lauren A Smith
- Psychology, School of Humanities and Social Sciences, Leeds Beckett University
| | | | - Rhys Turner-Moore
- Psychology, School of Humanities and Social Sciences, Leeds Beckett University
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2
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Bhuptani PH, Orchowski LM, Forkus SR, Newberger NG, Weiss NH. The impact of exposure to physical and sexual violence on opioid consequences among trauma-exposed individuals recruited from the community who use opioids. Harm Reduct J 2023; 20:167. [PMID: 37950215 PMCID: PMC10638719 DOI: 10.1186/s12954-023-00901-y] [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: 03/08/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023] Open
Abstract
Interpersonal violence and opioid use disorder are significant and intersecting public health concerns in the USA. The current study evaluated the consequences associated with opioid use (e.g., physical, social, interpersonal, intrapersonal, and impulse control) as a function of a history of exposure to interpersonal trauma, specifically physical and sexual violence. Participants were 84 trauma-exposed individuals recruited from the community who use opioids (M age = 43.5 50% men; 55% white). Whereas no significant differences emerged in the consequences of opioid use based on a history of physical violence, individuals with a history of sexual violence demonstrated higher levels of impulsive consequences of opioid use compared to individuals without a history of sexual violence. These data highlight the importance of considering the role of exposure to sexual violence in the context of opioid use disorder treatment.
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Affiliation(s)
- Prachi H Bhuptani
- Department of Adult Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, RI, USA
| | - Lindsay M Orchowski
- Department of Adult Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, RI, USA
| | - Shannon R Forkus
- Department of Psychology, University of Rhode Island, 142 Flagg Rd., Kingston, RI, USA
- Medical University of South Carolina, Charleston, SC, USA
| | - Noam G Newberger
- Department of Psychology, University of Rhode Island, 142 Flagg Rd., Kingston, RI, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, 142 Flagg Rd., Kingston, RI, USA.
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3
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Feld H, Elswick A, Goodin A, Fallin-Bennett A. Partnering with recovery community centers to build recovery capital by improving access to reproductive health. J Nurs Scholarsh 2023; 55:692-700. [PMID: 36345125 DOI: 10.1111/jnu.12836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/19/2022] [Accepted: 10/08/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND People with substance use disorders (SUD), especially opioid use disorder (OUD) have the highest rates of unintended pregnancies (80-95%) and report unmet reproductive health needs. Women of childbearing age have some of the highest death rates from opioids and are notably rising the most rapidly, and when pregnancy does occur overdose is one of the leading causes of maternal mortality. There are numerous gender-based health disparities and social determinants of health shaped by the distribution of power and privilege that influence the risk trajectories of people who can get pregnant or are pregnant with a substance use disorder (SUD). PURPOSE The purpose of this paper is to describe how reproductive health is essential to recovery and building recovery capital for people who can get pregnant, (1) introduce a pilot implementation science study working with trained peer support coaches to promote reproductive autonomy in the community, and (2) make policy and advocacy recommendations relevant to the new reproductive health landscape in the United States. We will also describe the adaptation and feasibility of the initial pilot study where we partnered with a recovery community center to train peer recovery coaches to provide low barrier resources (contraception, pregnancy tests and prenatal vitamins) and referrals to health care. METHODS This initiative is the merging of best practices in recovery and community-based global reproductive health, to empower people with SUD who can get pregnant in an implementation science framework. The pilot study will last 3 months in each city and aims to (1) assess and describe the effectiveness of the training of local peer recovery coaches on the link between recovery capital and reproductive health, and (2) assess the feasibility, acceptability, appropriateness, scalability, sustainability, and uptake and reach of low barrier reproductive health resources (pregnancy tests, prenatal vitamins, and emergency contraception). In this paper we are only reporting the initial findings regarding adaptation and feasibility. FINDINGS Informed by qualitative interviews with stakeholders and participants, the method of contraception was adapted from injectable to emergency to meet the needs and context of the community with SUD. Early outcomes such as uptake and acceptability indicate that this is a feasible model with peer recovery coaches and recovery community centers, with the greatest uptake of emergency contraception and pregnancy tests. CONCLUSION Considering recent policies limiting access to reproductive health, innovative community-based solutions are needed to engage and empower people who can get pregnant or are pregnant while in active drug use and in recovery. Providing low barrier reproductive health items by people with lived experience with SUD can serve as a valuable harm reduction model and improve recovery capital. CLINICAL RELEVANCE This is the first study to propose a methodology and context to implement a community-based study merging best practices in recovery with those in reproductive health with the potential to improve recovery capital and maternal/child health trajectories for people with SUD.
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Affiliation(s)
- Hartley Feld
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Alex Elswick
- Family Sciences, University of Kentucky, Lexington, Kentucky, USA
- Voices of Hope, Lexington, Kentucky, USA
| | - Amie Goodin
- Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida, USA
| | - Amanda Fallin-Bennett
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
- Voices of Hope, Lexington, Kentucky, USA
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Ji M, Su L, Liu L, Zhuang M, Xiao J, Guan Y, Zhu S, Ma L, Pu H. CaMKII regulates the proteins TPM1 and MYOM2 and promotes diacetylmorphine-induced abnormal cardiac rhythms. Sci Rep 2023; 13:5827. [PMID: 37037889 PMCID: PMC10085977 DOI: 10.1038/s41598-023-32941-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/05/2023] [Indexed: 04/12/2023] Open
Abstract
Although opioids are necessary for the treatment of acute pain, cancer pain, and palliative care, opioid abuse is a serious threat to society. Heroin (Diacetylmorphine) is the most commonly abused opioid, and it can have a variety of effects on the body's tissues and organs, including the well-known gastrointestinal depression and respiratory depression; however, there is little known about the effects of diacetylmorphine on cardiac damage. Here, we demonstrate that diacetylmorphine induces abnormal electrocardiographic changes in rats and causes damage to cardiomyocytes in vitro by an underlying mechanism of increased autophosphorylation of CaMKII and concomitant regulation of myocardial contractile protein TPM1 and MYOM2 protein expression. The CaMKII inhibitor KN-93 was first tested to rescue the toxic effects of heroin on cardiomyocytes in vitro and the abnormal ECG changes caused by heroin in SD rats, followed by the TMT relative quantitative protein technique to analyze the proteome changes. Diacetylmorphine causes increased phosphorylation at the CaMKII Thr287 site in myocardium, resulting in increased autophosphorylation of CaMKII and subsequent alterations in myocardial contractile proteins, leading to myocardial rhythm abnormalities. These findings provide a theoretical basis for the treatment and prevention of patients with arrhythmias caused by diacetylmorphine inhalation and injection.
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Affiliation(s)
- Min Ji
- School of Basic Medicine, Xinjiang Medical University, Urumqi, 830017, China
| | - Liping Su
- Pathology, First Affiliated Hospital, Xinjiang Medical University, Urumqi, 830054, China
| | - Li Liu
- Pathology, First Affiliated Hospital, Xinjiang Medical University, Urumqi, 830054, China
| | - Mengjie Zhuang
- School of Basic Medicine, Xinjiang Medical University, Urumqi, 830017, China
| | - Jinling Xiao
- School of Basic Medicine, Xinjiang Medical University, Urumqi, 830017, China
| | - Yaling Guan
- School of Basic Medicine, Xinjiang Medical University, Urumqi, 830017, China
| | - Sensen Zhu
- School of Basic Medicine, Xinjiang Medical University, Urumqi, 830017, China
| | - Lijuan Ma
- School of Basic Medicine, Xinjiang Medical University, Urumqi, 830017, China
| | - Hongwei Pu
- Department of Academic Construction, First Affiliated Hospital, Xinjiang Medical University, Urumqi, 830054, China.
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Bhuptani PH, Orchowski LM, Forkus SR, Newberger NG, Weiss NH. The Impact of Physical and Sexual Violence on Opioid Consequences among Trauma- exposed Individuals Recruited from the Community who Use Opioids. RESEARCH SQUARE 2023:rs.3.rs-2669901. [PMID: 36993534 PMCID: PMC10055686 DOI: 10.21203/rs.3.rs-2669901/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Interpersonal violence and opioid use disorder are significant and intersecting public health concerns in the United States. The current study evaluated the consequences associated with opioid use as a function of history of interpersonal trauma, specifically physical and sexual violence. Participants were 84 trauma-exposed individuals recruited from the community who use opioids (M age = 43.5 50% men; 55% white). Whereas no significant differences emerged in the consequences of opioid use based on a history of physical violence, individuals with a history of sexual violence demonstrated higher levels of impulsive consequences of opioid use compared to individuals without a history of sexual violence. These data highlight the importance of considering the role of sexual violence in the context of opioid use disorder treatment.
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6
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Jessell L, Mateu-Gelabert P, Guarino H, Fong C. Why Young Women Who Use Opioids Are at Risk for Rape: The Impact of Social Vulnerabilities and Sexually Coercive Drug Using Contexts. Violence Against Women 2022:10778012221137921. [PMID: 36537102 DOI: 10.1177/10778012221137921] [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: 06/17/2023]
Abstract
This study tests a theoretically informed model to understand why women who use opioids (WWUO) are at risk of rape while using drugs. Structured interviews were conducted with 168 WWUO. Three domains were hypothesized to increase risk: the sexually coercive context of drug use, women's social vulnerability, and drug use severity. Logistic regression examined the odds of being raped by domain. One-third of WWUO had been raped while using drugs. The sexually coercive context and social vulnerability domains significantly increased women's odds of being raped. Prevention efforts should target social and contextual factors.
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Affiliation(s)
- Lauren Jessell
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
| | - Pedro Mateu-Gelabert
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
| | - Honoria Guarino
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
| | - Chunki Fong
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
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Guo M, Do B, Wong K, Lee TH, Talagi D, Lum B, Rahberg N, Ha E, Fan VY. Sexual Violence and Substance Use Diagnosed in Emergency Department Discharges in Hawaii, 2005-2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16220. [PMID: 36498293 PMCID: PMC9740929 DOI: 10.3390/ijerph192316220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/10/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Substance use (SU) and sexual violence (SV) present unique challenges when contextualizing their relationship due to underreporting of SU and SV. Both are significant public health concerns with a large magnitude and expense to the overall U.S. and to the state of Hawaii, which is identified as a high-intensity drug-trafficking area. Since substance users have a higher risk for sexual violence than the general public, this study aims to analyze the proportion and demographics of emergency department (ED) visit individuals reporting sexual violence with or without substance use disorder and examine how the number of ED visits of individuals diagnosed with SV and SU disorder compare to all individuals. METHODS Data from the Healthcare Cost and Utilization Project was used to examine the relationship between SV and SU. The database contained 3.5 million observations for 24 Hawaii hospitals from 2005-2014. The data was summarized in descriptive statistics and Chi-square tests were run to assess statistical significance for variables of interest. RESULTS A greater proportion of individuals reporting sexual violence also reported substance use disorders compared to the general population of individuals. While 8% of all ED visits were related to SU, 17% of ED visits involving SV were also related to SU, demonstrating a statistically significant association between SV and SU. CONCLUSIONS There is a greater need to further understand the complexity of the relationship between substance use and sexual violence. Sexual violence and substance use disorders share a complex relationship; survivors of sexual abuse may develop a substance use disorder, and those who use drugs and alcohol may be at an increased risk for sexual violence. Results from this study demonstrate visits for individuals reporting sexual violence have a greater proportion of substance use disorder than visits for the general population.
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Affiliation(s)
- Mary Guo
- Pacific Health Analytics Collaborative, Social Science Research Institute, College of Social Sciences, University of Hawaii at Manoa, Honolulu, HI 96822, USA
| | - Bobby Do
- Pacific Health Analytics Collaborative, Social Science Research Institute, College of Social Sciences, University of Hawaii at Manoa, Honolulu, HI 96822, USA
| | - Korben Wong
- Pacific Health Analytics Collaborative, Social Science Research Institute, College of Social Sciences, University of Hawaii at Manoa, Honolulu, HI 96822, USA
| | - Thomas H. Lee
- Pacific Health Analytics Collaborative, Social Science Research Institute, College of Social Sciences, University of Hawaii at Manoa, Honolulu, HI 96822, USA
| | - Deveraux Talagi
- Pacific Health Analytics Collaborative, Social Science Research Institute, College of Social Sciences, University of Hawaii at Manoa, Honolulu, HI 96822, USA
| | - Brandon Lum
- Pacific Health Analytics Collaborative, Social Science Research Institute, College of Social Sciences, University of Hawaii at Manoa, Honolulu, HI 96822, USA
| | - Nichole Rahberg
- Office of Planning, Policy and Program Development, Department of Health, Honolulu, HI 96813, USA
| | - Edra Ha
- Pacific Health Analytics Collaborative, Social Science Research Institute, College of Social Sciences, University of Hawaii at Manoa, Honolulu, HI 96822, USA
| | - Victoria Y. Fan
- Pacific Health Analytics Collaborative, Social Science Research Institute, College of Social Sciences, University of Hawaii at Manoa, Honolulu, HI 96822, USA
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Impact of individual and treatment characteristics on wearable sensor-based digital biomarkers of opioid use. NPJ Digit Med 2022; 5:123. [PMID: 35995825 PMCID: PMC9395337 DOI: 10.1038/s41746-022-00664-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/27/2022] [Indexed: 11/08/2022] Open
Abstract
Opioid use disorder is one of the most pressing public health problems of our time. Mobile health tools, including wearable sensors, have great potential in this space, but have been underutilized. Of specific interest are digital biomarkers, or end-user generated physiologic or behavioral measurements that correlate with health or pathology. The current manuscript describes a longitudinal, observational study of adult patients receiving opioid analgesics for acute painful conditions. Participants in the study are monitored with a wrist-worn E4 sensor, during which time physiologic parameters (heart rate/variability, electrodermal activity, skin temperature, and accelerometry) are collected continuously. Opioid use events are recorded via electronic medical record and self-report. Three-hundred thirty-nine discreet dose opioid events from 36 participant are analyzed among 2070 h of sensor data. Fifty-one features are extracted from the data and initially compared pre- and post-opioid administration, and subsequently are used to generate machine learning models. Model performance is compared based on individual and treatment characteristics. The best performing machine learning model to detect opioid administration is a Channel-Temporal Attention-Temporal Convolutional Network (CTA-TCN) model using raw data from the wearable sensor. History of intravenous drug use is associated with better model performance, while middle age, and co-administration of non-narcotic analgesia or sedative drugs are associated with worse model performance. These characteristics may be candidate input features for future opioid detection model iterations. Once mature, this technology could provide clinicians with actionable data on opioid use patterns in real-world settings, and predictive analytics for early identification of opioid use disorder risk.
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Sumetsky N, Burke JG, Mair C. Relationships Between Opioid-Related Hospitalizations and Intimate Partner Violence and Child Maltreatment Hospitalizations in Pennsylvania Across Space and Time. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP3474-NP3491. [PMID: 32799738 PMCID: PMC7887118 DOI: 10.1177/0886260520948525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Intimate partner violence (IPV) and child maltreatment outcomes are markedly associated with substance abuse disorders. However, few studies have explored these serious family violence outcomes in connection to the opioid epidemic or population-level geographic connections between these variables. This study assesses associations of ZIP code-level IPV and child maltreatment hospitalization outcomes with opioid- and alcohol-related diagnoses as well as economic and demographic neighborhood characteristics. We used 11 years (2004-2014) of ZIP code-level Pennsylvania hospital discharge data and U.S. Census neighborhood characteristics data. As nearby ZIP codes are more likely to be similar than those that are distant, we incorporated spatial autocorrelation using conditionally autoregressive Bayesian hierarchical space-time models. There was a positive relationship between ZIP code-level opioid-related diagnoses and both IPV (relative risk 1.061; 95% credible interval [1.015, 1.106]) and child maltreatment (relative risk 1.055; 95% credible interval [1.035, 1.070]) hospitalizations. There was a positive relationship between alcohol-related diagnoses and IPV but not child maltreatment. Higher median household incomes were associated with lower counts of both IPV and child maltreatment hospitalizations. To illustrate geographic heterogeneity of model estimates, posterior distributions were used to compare variability of effects across ZIP codes. Our findings emphasize the secondary implications of the opioid epidemic in the form of family violence within communities.
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Affiliation(s)
- Natalie Sumetsky
- University of Pittsburgh Graduate School of Public Health, PA, USA
| | - Jessica G. Burke
- University of Pittsburgh Graduate School of Public Health, PA, USA
| | - Christina Mair
- University of Pittsburgh Graduate School of Public Health, PA, USA
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10
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Ataiants J, Mazzella S, Roth AM, Robinson LF, Sell RL, Lankenau SE. Multiple Victimizations and Overdose Among Women With a History of Illicit Drug Use. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP1588-NP1613. [PMID: 32536256 PMCID: PMC7808297 DOI: 10.1177/0886260520927501] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The experiences of violence and overdose are highly prevalent among women who use illicit drugs. This study sought to ascertain whether multiple victimizations during adulthood increase the frequency of women's overdose. The sample comprised 218 women recruited at Philadelphia harm reduction sites during 2016-2017. Victimization was assessed as exposure to 16 types of adulthood violence. Three measures were constructed for multiple victimizations: continuous and categorical polyvictimization, and predominant violence domain. Negative binomial regression estimated the incidence rate ratio (IRR) of lifetime overdoses from multiple victimizations. Lifetime history of opioid use (88.6%) and drug injection (79.5%) were common. Among overdose survivors (68.5%), the median of lifetime overdoses was 3. The majority of participants (58.7%) were victims of predominantly sexual violence, 26.1% experienced predominantly physical abuse/assault, and 3.7% were victims of predominantly verbal aggression/coercive control. Participants reported a mean of seven violence types; the higher-score category of polyvictimization (9-16 violence types) comprised 41.7% of the total sample. In multivariable models, one-unit increase in continuous polyvictimization was associated with 4% higher overdose rates (IRR: 1.04, 95% confidence interval [CI]: [1.00, 1.08]). Compared to women who were not victimized (11.5%), those in the higher-score category of polyvictimization (IRR: 2.01; 95% CI: [1.06, 3.80]) and exposed to predominantly sexual violence (IRR: 2.10, 95% CI: [1.13, 3.91]) were expected to have higher overdose rates. Polyvictimization and sexual violence amplified the risk of repeated overdose among drug-involved women. Female overdose survivors need to be screened for exposure to multiple forms of violence, especially sexual violence. Findings underscore the need to scale-up victimization support and overdose prevention services for disenfranchised women.
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11
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Scheidell JD, Ataiants J, Lankenau SE. Miscarriage and Abortion Among Women Attending Harm Reduction Services in Philadelphia: Correlations With Individual, Interpersonal, and Structural Factors. Subst Use Misuse 2022; 57:999-1006. [PMID: 35277115 PMCID: PMC9101319 DOI: 10.1080/10826084.2022.2046100] [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: 10/18/2022]
Abstract
Background: Reproductive health research among women who use drugs has focused on pregnancy prevention and perinatal/neonatal outcomes, but there have been few investigations of miscarriage and abortion, including prevalence and associated factors. Methods: Using cross-sectional data from a sample of non-pregnant women receiving harm reduction services in Philadelphia in 2016-2017 we examined lifetime miscarriage and abortion (n = 187). Separately for both outcomes, we used modified Poisson regression to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for associations with each correlate. We also explored correlates of reporting both miscarriage and abortion. Results: Approximately 47% experienced miscarriage, 42% experienced abortion, and 18% experienced both. Miscarriage correlates included: prescription opioid misuse (e.g., OxyContin PR 1.82, 95% CI 1.23, 2.69); 40% increase in prevalence associated with housing instability, 50% increase with survival sex, and two-fold increase with arrest. Abortion correlates included: mental health (e.g., depression PR 2.09, 95% CI 1.18, 3.71), stimulant use (e.g., methamphetamine PR 1.83, 95% CI 1.22, 2.74), and drug injection (PR 1.76, 95% CI 1.03, 3.02); partner controlling access to people/possessions, physical and emotional violence; and a two-fold increase associated with survival sex and arrest. Experiencing both reproductive outcomes was correlated with mental health, opioid and simulant use, housing instability, survival sex, and arrest. Conclusion: Miscarriage and abortion was common among women with history of drug misuse suggesting a need for expanded access to family planning, medication-assisted therapy, and social support services, and for the integration of these with substance use services. Future research in longitudinal data is needed.
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Affiliation(s)
- Joy D Scheidell
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Janna Ataiants
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
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12
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Friedman SR, Williams LD, Guarino H, Mateu-Gelabert P, Krawczyk N, Hamilton L, Walters SM, Ezell JM, Khan M, Di Iorio J, Yang LH, Earnshaw VA. The stigma system: How sociopolitical domination, scapegoating, and stigma shape public health. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:385-408. [PMID: 34115390 PMCID: PMC8664901 DOI: 10.1002/jcop.22581] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 05/26/2023]
Abstract
Stigma is a fundamental driver of adverse health outcomes. Although stigma is often studied at the individual level to focus on how stigma influences the mental and physical health of the stigmatized, considerable research has shown that stigma is multilevel and structural. This paper proposes a theoretical approach that synthesizes the literature on stigma with the literature on scapegoating and divide-and-rule as strategies that the wealthy and powerful use to maintain their power and wealth; the literatures on racial, gender, and other subordination; the literature on ideology and organization in sociopolitical systems; and the literature on resistance and rebellion against stigma, oppression and other forms of subordination. we develop a model of the "stigma system" as a dialectic of interacting and conflicting structures and processes. Understanding this system can help public health reorient stigma interventions to address the sources of stigma as well as the individual problems that stigma creates. On a broader level, this model can help those opposing stigma and its effects to develop alliances and strategies with which to oppose stigma and the processes that create it.
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Affiliation(s)
- Samuel R Friedman
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Leslie D Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, Illinois, USA
| | - Honoria Guarino
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Pedro Mateu-Gelabert
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Noa Krawczyk
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Leah Hamilton
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Suzan M Walters
- NYU Rory Meyers College of Nursing, Interdisciplinary Research Training Institute on Hispanic Drug Abuse, University of Southern California, Los Angeles, California, USA
| | - Jerel M Ezell
- Department of Sociology, University of Chicago, Chicago, Illinois, USA
- Department of Medicine, Section on Global Health and Infectious Diseases, University of Chicago, Chicago, Illinois, USA
| | - Maria Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Jorgelina Di Iorio
- Faculty of Psychology and Intercambios Civil Association, CONICET/Buenos Aires University, Buenos Aires, Argentina
| | - Lawrence H Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware, USA
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Meyers SA, Earnshaw VA, D’Ambrosio B, Courchesne N, Werb D, Smith LR. The intersection of gender and drug use-related stigma: A mixed methods systematic review and synthesis of the literature. Drug Alcohol Depend 2021; 223:108706. [PMID: 33901753 PMCID: PMC8168566 DOI: 10.1016/j.drugalcdep.2021.108706] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Substance use-related stigma is a significant barrier to care among persons who use drugs (PWUD). Less is known regarding how intersectional identities, like gender, shape experiences of substance use-related stigma. We sought to answer the following question: Do men or women PWUD experience more drug use stigma? METHODS Data were drawn from a systematic review of the global, peer-reviewed scientific literature on substance use-related stigma conducted through 2017 and guided by the Stigma and Substance Use Process Model and PRISMA guidelines. Articles were included in the present analysis if they either qualitatively illustrated themes related to the gendered nature of drug use-related stigma, or quantitatively tested the moderating effect of gender on drug use-related stigma. RESULTS Of the 75 studies included, 40 (53 %) were quantitative and 35 (47 %) were qualitative. Of the quantitative articles, 22 (55 %) found no association between gender and drug use-related stigma, 4 (10 %) identified women who use drugs (WWUD) were more stigmatized, and 2 (5 %) determined men who use drugs (MWUD) were more stigmatized. In contrast, nearly all (34; 97 %) of the qualitative articles demonstrated WWUD experienced greater levels of drug use-related stigma. CONCLUSION The quantitative literature is equivocal regarding the influence of gender on drug use-related stigma, but the qualitative literature more clearly demonstrates WWUD experience greater levels of stigma. The use of validated drug use-related stigma measures and the tailoring of stigma scales to WWUD are needed to understand the role of stigma in heightening the disproportionate harms experienced by WWUD.
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Affiliation(s)
- S. A. Meyers
- Department of Psychology, San Diego State University, 5500
Campanile Drive, San Diego, CA 92182, USA,Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla,
CA 92093, USA
| | - V. A. Earnshaw
- Human Development and Family Sciences, University of Delaware,
Newark, DE, 19716, USA
| | - B. D’Ambrosio
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla,
CA 92093, USA,School of Social Work, College of Health and Human Services,
San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - N. Courchesne
- Department of Psychiatry, University of California San Diego,
9500 Gilman Drive, La Jolla, CA 92093, USA
| | - D. Werb
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla,
CA 92093, USA,Centre for Urban Health Solutions, St. Michael’s
Hospital, 30 Bond Street, Toronto, ON, M5B 1W8 Canada
| | - L. R. Smith
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla,
CA 92093, USA
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14
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Ludwig A, Monico LB, Gryczynski J, Lertch E, Schwartz RP, Fishman M, Dionne R, Mitchell SG. Drug and sexual HIV-risk behaviors among adolescents and young adults with opioid use disorder. J Subst Abuse Treat 2021; 130:108477. [PMID: 34118711 DOI: 10.1016/j.jsat.2021.108477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
Opioid use disorder (OUD) among adolescents and young adults (youth) is associated with drug use and sexual HIV-related risk behaviors and opioid overdose. This mixed methods analysis assesses risk behaviors among a sample of 15-21-year-olds (N = 288) who were being treated for OUD in a residential drug treatment program in Baltimore, Maryland. Participants were enrolled in a parent study in which they received either extended-release naltrexone (XR-NTX) or Treatment as Usual (TAU), consisting of outpatient counseling with or without buprenorphine, prior to discharge. At baseline, participants were administered the HIV-Risk Assessment Battery (RAB), and clinical intake records were reviewed to determine participants' history of sexual, physical, or other abuse, as well as parental and partner substance use. A sub-sample of study participants completed semi-structured qualitative interviews (N = 35) at baseline, three-, and six-month follow-up periods. This analysis identified gender (e.g., female IRR = 1.63, CI 1.10-2.42, p = .014), the experience of dependence (e.g., previous detoxification IRR = 1.08, CI 1.01-1.15, p = .033) and withdrawal (e.g., severe withdrawal symptoms IRR = 1.41, CI 1.08-1.84, p = .012), and the role of relationships (e.g., using with partner IRR = 2.45, CI 1.15-5.22, p = .021) as influencing high-risk substance use behaviors. Similarly, high-risk sex was influenced by gender (e.g., female IRR = 1.43, CI 1.28-1.59, p < .001), and the role of relationships (e.g., using with partner IRR = 0.78, CI 0.62-0.98, p = .036). These are key targets for future prevention, treatment, and intervention.
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Affiliation(s)
- Ariel Ludwig
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America.
| | - Laura B Monico
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Jan Gryczynski
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Elizabeth Lertch
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America.
| | - Robert P Schwartz
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Marc Fishman
- Mountain Manor Treatment Center, 3800 Frederick Ave, Baltimore, MD 21229, United States of America
| | - Ross Dionne
- Pacifica Graduate Institute, 249 Lambert Rd., Carpinteria, CA 93013, United States of America
| | - Shannon Gwin Mitchell
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
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15
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O'Callaghan E, Ullman SE. Are All Substance-Involved Sexual Assaults Alike? A Comparison of Victim Alcohol Use, Drug Use, and Combined Substance Use in Sexual Assaults. WOMEN & CRIMINAL JUSTICE 2021; 34:88-106. [PMID: 38694969 PMCID: PMC11060709 DOI: 10.1080/08974454.2021.1914284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Sexual assaults involving victim substance use at the time of the assault are common, but little is known about how different types of substances used at the time of the assault impact post-assault outcomes. The current study sought to compare victim alcohol use, drug use, and combined substance use in sexual assaults among a community sample of 693 victims. It was hypothesized that victims in the combined substance use assault type would report overall worse post-assault outcomes, more contextual and interpersonal traumas, and higher assault severity. Our results partially confirmed these hypotheses, but victims in the drug-involved assault type group overall reported higher assault severity and worse post-assault outcomes. These findings are probably partially attributed to the demographic characteristics of victims in the drug-only group (e.g. Black victims) who are more likely to experience a higher severity of violence. Implications for future research and policy regarding drug decriminalization are discussed.
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Affiliation(s)
- Erin O'Callaghan
- Department of Criminology, Law and Justice, University of Illinois at Chicago
| | - Sarah E Ullman
- Department of Criminology, Law and Justice, University of Illinois at Chicago
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16
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Smith LA, Kolokotroni KZ, Turner-Moore T. Making and Communicating Decisions About Sexual Consent During Drug-Involved Sex: A Thematic Synthesis. JOURNAL OF SEX RESEARCH 2021; 58:469-487. [PMID: 31902239 DOI: 10.1080/00224499.2019.1706072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sexual consent is a central component in the primary prevention of sexual violence. There is growing evidence of the impact that alcohol consumption has on sexual consent. However, there has been no review examining sexual consent in the context of other drug-taking. Published literature was sought using searches of: PsycINFO, PsycARTICLES, Scopus, Web of Science, CINAHL, MEDLINE and Open Dissertations. Unpublished literature, such as unpublished government or charity reports, were identified through Google search engine. All 21 eligible studies employed qualitative or mixed methods; therefore, a thematic synthesis was deemed an appropriate method of analysis. Three themes were constructed: "Drug-taking changes sexual norms", "Drug-taking diminishes the capacity to make sexual decisions" and "Drug-taking reduces verbal and non-verbal ability to communicate consent". The findings demonstrated that prevailing models of sexual consent may not account for circumstances relevant to drug-involved sex, such as how drug-taking impacts freedom and capacity to consent to sex. We propose the use of the medical model of capacity to consent as a broader framework through which capacity to consent to sex in drug-taking contexts can be assessed. The importance of both the social and situational context for sexual decision-making following drug-taking is discussed.
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Affiliation(s)
- Lauren A Smith
- Leeds School of Social Sciences, Leeds Beckett University
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17
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Groenewald CB, Law EF, Rabbitts JA, Palermo TM. Associations between adolescent sleep deficiency and prescription opioid misuse in adulthood. Sleep 2021; 44:zsaa201. [PMID: 32978633 PMCID: PMC7953216 DOI: 10.1093/sleep/zsaa201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/24/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES The main aim of this study was to estimate the association between sleep deficiency in adolescence and subsequent prescription opioid misuse in adulthood using United States nationally representative longitudinal data. METHODS Self-reported data captured in the National Longitudinal Study of Adolescent to Adult Health at baseline (Wave 1; mean age = 16 years) and 12 year follow-up (Wave 4; mean age = 29 years). Participants (n = 12,213) reported on four measures of sleep during adolescence (Wave 1) and on lifetime prescription opioid misuse during adulthood (Wave 4). Associations between adolescent sleep and adult opioid misuse were estimated using multivariate logistic regression analysis controlling for sociodemographics, chronic pain, mental health, childhood adverse events, and a history of substance use. RESULTS During adolescence, 59.2% of participants reported sleep deficiency. Prospectively, adolescents reporting not getting enough sleep, chronic unrestful sleep, and insomnia were associated with an increased risk for prescription opioid misuse (adjusted odds ratios [OR] = 1.2, p < 0.005 for all three variables). Short sleep duration was not associated with opioid misuse. CONCLUSION This is the first study to longitudinally link sleep deficiency as an independent risk factor for the development of prescription opioid misuse. Sleep deficiency could be a driver of the opioid crisis affecting young people in the United States. Future studies should determine whether early and targeted sleep interventions may decrease risk for opioid misuse in high-risk patients prescribed opioids for pain.
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Affiliation(s)
- Cornelius B Groenewald
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
| | - Emily F Law
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
| | - Jennifer A Rabbitts
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
- Department of Psychiatry, University of Washington School of Medicine, Seattle, WA
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18
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Johnson ME, Zaidi F. Sex differences in the effects of physical and sexual abuse on the odds of past 30-day opioid misuse among Florida justice-involved children. ADDICTION RESEARCH & THEORY 2021; 29:479-489. [PMID: 35035335 PMCID: PMC8758115 DOI: 10.1080/16066359.2021.1891414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 06/14/2023]
Abstract
AIM Opioid misuse is a severe threat to justice-involved children and adolescents. Identifying risk factors and sex differences is critical to design accurate risk assessments and person-centered interventions. Stress theory and research posit that abuse may be linked to opioid misuse, and the consequences may be harsher for females. The study tests the hypothesis that physical and sexual abuse will individually and cumulatively increase the risk for opioid misuse, and females will have a higher risk than males. METHODS A statewide sample of 79,960 justice-involved children in Florida were examined. Opioid misuse, illicit and non-medical use, was measured by urine analysis or self-disclosure within the past-30 days. Bivariate and multivariate logistic regression analyses were employed. Marginal effects were estimated to investigate the interaction between abuse and sex. RESULTS Over 2000 youth met the criteria for opioid misuse. One-third of female opioid users experienced both physical and sexual abuse. Compared to those with no history of physical or sexual abuse, those who were physically abused had 43% higher odds of opioid misuse, those who were sexually abuse had 78% higher odds, and those who experienced both had twice as high odds of opioid misuse. The individual and combined effects of these abuse types were higher for females. For example, female youth who were sexually abused had 2.7-times higher odds of opioid misuse than males who were sexually abused. CONCLUSION Intervention efforts can be improved by integrating physical and sexual abuse into risk assessments and tailoring assessments by sex.
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Affiliation(s)
- Micah E. Johnson
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, USA
| | - Farwah Zaidi
- The Study of Teen Opioid Misuse and Prevention Laboratory, Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
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19
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Clinical Correlates of Opioid Prescription Among Pediatric Patients With Chronic Pain. Am J Prev Med 2021; 60:379-386. [PMID: 33160799 DOI: 10.1016/j.amepre.2020.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Up to 17%-20% of pediatric patients with chronic pain are prescribed opioid pharmacotherapy and face an increased risk of opioid misuse in adulthood. Little is known about the way clinical presentation may influence which children with chronic pain are prescribed opioids. This study examines the associations between child's and caregiver's report of child's pain, physical function, and socioemotional indices with opioid prescriptions in pediatric patients initiating treatment for chronic pain. METHODS Participants were 1,155 pediatric patients (71.26% female, n=823) aged 8-17 years and 1 of their caregivers (89% mothers) who presented for evaluation at a tertiary care pediatric pain clinic. Data were collected from 2015 to 2019 and analyzed in 2020. RESULTS Binary logistic regression analyses investigated the relative contribution of child's demographic, pain, and Patient-Reported Outcome Measurement Information System measures to opioid prescription status; separate models were conducted for child's and caregiver's report. Across child and caregiver models, findings were that child's age (older), pain duration (longer; child's report only), and increased physical limitations (mobility challenges and pain interference; caregiver's report only) were the most salient clinical correlates of positive opioid status. Contrary to the existing literature on adults with chronic pain, socioemotional indices (anxiety, depression, peer functioning) were nonsignificant. CONCLUSIONS A greater understanding of how clinical presentation may relate to prescribed opioid pharmacotherapy informs the field's conceptualization of the sequelae of opioid use and misuse in the context of pediatric chronic pain.
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20
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Wishik G, Gaeta JM, Racine MW, O'Connell JJ, Baggett TP. Substance consumption and intoxication patterns in a medically supervised overdose prevention program for people experiencing homelessness. Subst Abus 2021; 42:851-857. [PMID: 33617749 DOI: 10.1080/08897077.2021.1876201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Opioid overdose is a leading cause of death among homeless individuals. Combining psychoactive substances with opioids increases overdose risk. This study aimed to describe intoxication patterns at a drop-in space offering medical monitoring and harm reduction services to individuals who arrive intoxicated and at risk of overdose. Methods: We examined data from visits to the Supportive Place for Observation and Treatment at Boston Health Care for the Homeless Program between January 1, 2017 and December 31, 2017. We used k-means cluster analysis to characterize intoxication patterns based on clinically assessed sedation levels and vital sign parameters. Multinomial logistic regression analysis assessed demographic and substance consumption predictors of cluster membership. Linear and logistic regression models examined associations between cluster membership and care outcomes. Results: Across 305 care episodes involving 156 unique patients, cluster analysis revealed 3 distinct intoxication patterns. Cluster A (26.6%) had mild sedation and normal vital signs. Cluster B (44.5%) featured greater sedation with bradycardia and/or hypotension. Cluster C (28.9%) was comparable to cluster B but with the addition of hypoxia. Self-reported consumption of non-opioid sedatives prior to arrival was common (63.3% of episodes) and predicted membership in cluster B (aOR 2.75, 95% CI 1.40, 5.40) and cluster C (aOR 3.38, 95% CI 1.48, 7.70). In comparison to cluster A episodes, cluster C episodes were longer (mean 4.8 vs. 2.3 hours, p < 0.001) and more likely to require supplemental oxygen (27.3% vs. 2.5%, p < 0.001). Few episodes required hospital transfer (4.7%) or naloxone (1.0%). No deaths occurred. Conclusions: In a medically supervised overdose monitoring program, reported use of non-opioid sedatives strongly predicted more complex clinical courses and should be factored into overdose prevention efforts. Low-threshold medical monitoring in an ambulatory setting was sufficient for most episodes, suggesting a role for such programs in reducing harm and averting costly emergency services.
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Affiliation(s)
- Gabriel Wishik
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts, USA
| | - Jessie M Gaeta
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Melanie W Racine
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts, USA
| | - James J O'Connell
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Travis P Baggett
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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21
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Hurley EA, Duello A, Finocchario-Kessler S, Goggin K, Stancil S, Winnograd RP, Miller MK. Expanding Contraception Access for Women With Opioid-Use Disorder: A Qualitative Study of Opportunities and Challenges. Am J Health Promot 2020; 34:909-918. [PMID: 32468826 PMCID: PMC7577934 DOI: 10.1177/0890117120927327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE As almost nine in ten pregnancies among women with opioid use disorder (OUD) are unintended, expanding access to contraception is an underutilized but potentially effective strategy in increasing reproductive agency and reducing the overall burden of neonatal abstinence syndrome. We aimed to identify where and how contraceptive services could be integrated into existing points-of-contact for women with OUD. APPROACH In-depth qualitative interviews. SETTING Three diverse catchment areas in Missouri. PARTICIPANTS Women with OUD (n = 15) and professional stakeholders (n = 16) representing five types of existing OUD service points: syringe exchange programs, recovery support programs, substance use treatment programs, emergency departments, and Federally Qualified Health Centers. METHOD Interviews were audio-recorded, transcribed, and thematically coded using Dedoose software. RESULTS Six themes emerged as essential components for integrating contraceptive services into existing points-of-contact for women with OUD: (1) reach women with unmet need; (2) provide free or affordable contraception; (3) maximize service accessibility; (4) provide patient-centered care; (5) employ willing, qualified contraceptive providers; and (6) utilize peer educators. Participants affirmed the overall potential benefit of contraceptive service integration and illuminated various opportunities and challenges relevant to each type of existing service point. CONCLUSION As health promotion initiatives look to increase access to contraception among women with OUD, these six' participant-identified components offer essential guidance in selecting advantageous points-of-contact and addressing remaining gaps in services.
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Affiliation(s)
- Emily A. Hurley
- Division of Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
- Department of Pediatric, School of Medicine, University of Missouri–Kansas City, Kansas City, MO, USA
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Alex Duello
- Missouri Institute of Mental Health, University of Missouri–St. Louis, St. Louis, MO, USA
| | | | - Kathy Goggin
- Division of Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
- Department of Pediatric, School of Medicine, University of Missouri–Kansas City, Kansas City, MO, USA
- School of Pharmacy, University of Missouri–Kansas City, Kansas City, MO, USA
| | - Stephani Stancil
- Dvisions of Adolescent Medicine and Clinical Pharmacology, Children’s Mercy Kansas City, Kansas City, MO, USA
| | - Rachel P. Winnograd
- Missouri Institute of Mental Health, University of Missouri–St. Louis, St. Louis, MO, USA
| | - Melissa K. Miller
- Department of Pediatric, School of Medicine, University of Missouri–Kansas City, Kansas City, MO, USA
- Emergency Medicine, Children’s Mercy Kansas City, Kansas City, MO, USA
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22
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Mateu-Gelabert P, Guarino H, Zibbell JE, Teubl J, Fong C, Goodbody E, Edlin B, Salvati C, Friedman SR. Prescription opioid injection among young people who inject drugs in New York City: a mixed-methods description and associations with hepatitis C virus infection and overdose. Harm Reduct J 2020; 17:22. [PMID: 32228700 PMCID: PMC7106794 DOI: 10.1186/s12954-020-00367-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/13/2020] [Indexed: 01/02/2023] Open
Abstract
Aim Evidence is emerging that prescription opioid (PO) injection is associated with increased health risks. This mixed-methods study compares the mechanics of PO and heroin injection and examines the demographic and drug-related correlates of lifetime PO injection in a sample of young people who inject drugs (PWID) in New York City (NYC). Methods Qualitative analysis of 46 semi-structured interviews with young adult opioid users ages 18–32. Interview segments describing PO injection were analyzed for common themes. Quantitative analysis of structured interviews with 539 young adult opioid users ages 18–29 recruited via respondent-driven sampling (RDS). Analyses are based on the subsample of 353 participants (65%) who reported having ever injected drugs. All variables were assessed via self-report, except hepatitis C virus status, which was established via rapid antibody testing. Results Participants described injecting POs and reported that preparing abuse-deterrent pills for injection is especially cumbersome, requiring extended manipulation and large amounts of water. Injecting POs, in contrast to injecting heroin, requires repeated injections per injection episode. Among RDS-recruited participants, the majority of injectors reported injecting POs, sporadically (33%) or regularly (26%), but often infrequently (≤ 7 days/month). In separate multivariable analyses controlling for syringe- and cooker-sharing, ever injecting POs was a significant predictor of testing HCV antibody-positive (AOR = 2.97) and lifetime experience of non-fatal overdose (AOR = 2.51). Ever injecting POs was independently associated with lifetime homelessness (AOR = 2.93) and having grown up in a middle-income ($51,000–100,000/year vs. ≤ $50,000/year; AOR = 1.86) or a high-income household (> $100,000/year vs. ≤ $50,000/year; AOR = 2.54). Conclusions Even in an urban environment like NYC with widespread heroin access, most young PWID have injected POs, although less frequently than heroin. PO injection involves practices that are known to increase risk for blood-borne viral infection (e.g., repeated injections) and predicted testing HCV-positive, as well as overdose. PO injection may also serve as a marker for a subgroup of PWID at elevated risk for multiple drug use-related comorbidities. Programs that provide prevention services to PWID need to tailor harm reduction measures and messaging to the specific practices and harms associated with the injection of POs.
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Affiliation(s)
- Pedro Mateu-Gelabert
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125th Street, New York, NY, 10027, USA.
| | - Honoria Guarino
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125th Street, New York, NY, 10027, USA
| | - Jon E Zibbell
- RTI International, 2987 Clairmont Road, Century Plaza 1, Suite 400, Atlanta, GA, 30329-4434, USA
| | - Jennifer Teubl
- National Development Research Institutes, Inc., 71 West 23rd St, New York, NY, 10010, USA
| | - Chunki Fong
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125th Street, New York, NY, 10027, USA
| | - Elizabeth Goodbody
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125th Street, New York, NY, 10027, USA
| | | | - Carli Salvati
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125th Street, New York, NY, 10027, USA
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23
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Kennedy MC, Hayashi K, Milloy MJ, Boyd J, Wood E, Kerr T. Supervised injection facility use and exposure to violence among a cohort of people who inject drugs: A gender-based analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102692. [PMID: 32200269 DOI: 10.1016/j.drugpo.2020.102692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Supervised injection facilities (SIFs) have been established in many settings, in part to reduce risks associated with injecting in public, including exposure to violence. However, the relationship between SIF use and experiencing violence has not yet been thoroughly evaluated. We sought to longitudinally examine the gender-specific relationship between SIF use and exposure to violence among people who inject drugs (PWID) in a Canadian setting. METHODS Data were drawn from two prospective cohort studies of PWID in Vancouver, Canada, between December 2005 and December 2016. Semi-annually, participants completed questionnaires that elicited data concerning sociodemographic characteristics, behavioural patterns, violent encounters and health service utilization. We used multivariable generalized estimating equations (GEE) to estimate the independent association between exclusively injecting drugs at a SIF and experiencing physical or sexual violence among men and women PWID, respectively. RESULTS Of 1930 PWID followed for a median of four years, 679 (35.2%) were women and the median age was 41 years at baseline. In total, 353 (52.0%) women and 694 (55.5%) men reported experiencing at least one incident of violence during follow-up. In multivariable analyses, exclusive SIF use was associated with decreased odds of experiencing violence among men after adjusting for potential confounders (Adjusted Odds Ratio [AOR] = 0.64; 95% confidence interval [CI]: 0.46-0.89). Exclusive SIF use was not significantly associated with experiencing violence among women in adjusted analyses (AOR = 0.97; 95% CI: 0.57-1.66). CONCLUSION In light of the recent expansion of SIFs in Canada, our finding of a protective association between exclusive SIF use and exposure to violence among men is encouraging. The fact that we did not observe a significant association between SIF use and experiencing violence among women highlights the need for social-structural interventions that are more responsive to the specific needs of women PWID in relation to violence prevention.
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Affiliation(s)
- Mary Clare Kennedy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada.
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
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Grossesses non prévues, violences sexuelles et contraception chez les femmes consommant du cannabis ou d’autres substances psychoactives illégales en Île-de-France : données du Baromètre Santé 2016. Rev Epidemiol Sante Publique 2020; 68:9-15. [DOI: 10.1016/j.respe.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/05/2019] [Accepted: 09/16/2019] [Indexed: 11/17/2022] Open
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Moore SK, Grabinski M, Bessen S, Borodovsky JT, Marsch LA. Web-Based Prescription Opioid Abuse Prevention for Adolescents: Program Development and Formative Evaluation. JMIR Form Res 2019; 3:e12389. [PMID: 31325289 PMCID: PMC6676791 DOI: 10.2196/12389] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 05/24/2019] [Accepted: 05/29/2019] [Indexed: 12/14/2022] Open
Abstract
Background The unprecedented number of youths engaged in nonmedical use of prescription opioids (POs), as well as the myriad negative consequences of such misuse, emphasizes the importance of prevention efforts targeting this public health crisis. Although there are several science-based, interactive drug abuse prevention programs focused on preventing the use of nonprescription drugs in youths, to our knowledge, there are no science-based interactive programs that focus on the prevention of PO abuse among adolescents. Objective The aim of this study was to develop and conduct a formative evaluation of a science-based interactive Web-based program focused on the prevention of PO abuse among adolescents aged 12 to 17 years (Pop4Teens). This study was conducted to prepare for a randomized controlled trial designed to evaluate the effectiveness of Pop4Teens compared with an active control website, JustThinkTwice.com (Drug Enforcement Administration), in impacting knowledge and attitudes about POs and perceptions of risk associated with the abuse of POs, as well as intentions to use and actual use of POs. Methods We conducted 6 focus groups with 30 youths (a mean of 5 per group: the eligibility being aged 12-19 years) along a continuum of exposure to POs (in treatment for opioid use disorder, in general treatment for other substance use disorder, prescribed an opioid, and opioid-naïve) and writing sessions with 30 youths in treatment for opioid use disorder (12-19 years) to inform the development of the Web-based prevention tool. Feasibility and acceptability of a prototype of the Web-based intervention were then assessed through individual feedback sessions with 57 youths (drawn from the same populations as the focus groups). Results We successfully completed the development of a Web-based PO abuse prevention program (Pop4Teens). Analyses of focus group transcripts informed the development of the program (eg, quiz content/format, script writing, and story editing). Selected writing session narratives anchored the planned scientific content by lending credibility and informing the development of compelling storylines intended to motivate the youth to engage with the program. Feedback session data indicated that the Web-based tool could be potentially useful and acceptable. In addition, feedback session participants demonstrated significant increases in their knowledge of key topics related to the prevention of PO abuse after the exposure to sections of the Web-based program. Conclusions The opioid crisis is predicted to get worse before it gets better. An effective response will likely require a multipronged strategy inclusive of effective evidence-based prevention programs acceptable to, and accessible by, a majority of youths.
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Affiliation(s)
- Sarah K Moore
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Michael Grabinski
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Sarah Bessen
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Jacob T Borodovsky
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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Abstract
BACKGROUND AND OBJECTIVES The opioid crisis in America affects both adults and children. However, knowledge about the epidemiology of the opioid crisis, opioid prescribing patterns, and the link between opioid prescribing and problematic opioid behaviors remain limited. Thus, children are often excluded from health care policies and guidelines aimed at curbing the opioid crises. The primary aim of this topical review is to provide a brief overview of the opioid crises affecting children, followed by a synopsis of recent research on opioid prescribing patterns and data on the links between legitimate opioid use and risk for problematic opioid use behaviors. METHODS This is a narrative review. RESULTS Opioid misuse is a public health crisis facing children and adolescents in the United States and serves as a key antecedent for other problematic opioid behaviors, including opioid use disorder, heroin use, and opioid overdose. Furthermore, the United States experienced a significant increase in opioid prescribing to children and adolescents as compared with prescribing rates before the year 2000. Yet, data on the associations between opioid prescribing patterns and risk for problematic opioid use remains limited. DISCUSSION There exist an urgent need to identify adolescents at increased risk for problematic opioid use behaviors following a receipt of medically prescribed opioids. The article closes with some general guidelines that providers may follow to reduce the risk of opioids in pediatric patients.
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Affiliation(s)
- Cornelius B Groenewald
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
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Espelage DL, Davis JP, Basile KC, Rostad WL, Leemis RW. Alcohol, Prescription Drug Misuse, Sexual Violence, and Dating Violence Among High School Youth. J Adolesc Health 2018; 63:601-607. [PMID: 30172675 PMCID: PMC6200598 DOI: 10.1016/j.jadohealth.2018.05.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE Sexual violence (SV), teen dating violence (TDV), and substance use are significant public health concerns among U.S. adolescents. This study examined whether latent classes of baseline alcohol and prescription drug misuse longitudinally predict SV and TDV victimization and perpetration (i.e., verbal,relational, physical/threatening, and sexual) 1 year later. METHODS Students from six Midwestern high schools (n = 1,875; grades 9-11) completed surveys across two consecutive spring semesters. Latent class analysis was used to identify classes of individuals according to four substance use variables. A latent class regression and a manual three-step auxiliary approach were used to assess concurrent and distal relationships between identified classes and SV and TDV victimization and perpetration. RESULTS Three classes of substance use were identified: low/no use (41% of sample), alcohol only use (45%), and alcohol and prescription drug misuse (APD) (14%). Youth in the APD class experienced greater SV and TDV victimization and perpetration than the alcohol only class at baseline. At Time 2 (one year later), youth in the baseline APD class experienced significantly higher SV and TDV victimization and perpetration outcomes than youth in the alcohol only class with the exception of sexual and physical TDV perpetration. CONCLUSIONS The misuse of both alcohol and prescription drugs emerged as a significant risk factor for later SV and TDV among adolescents. As such, it would be beneficial if future research continued to assess the nature of these associations and incorporate prescription drug use and misuse into heath education,substance use, and violence prevention programs.
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Affiliation(s)
- Dorothy L. Espelage
- University of Florida, Gainesville, Florida,Address correspondence to: Dorothy L. Espelage, Ph.D., University of Florida, 945 Center Dr., Gainesville, FL 32611. (D.L. Espelage)
| | | | - Kathleen C. Basile
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - Whitney L. Rostad
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - Ruth W. Leemis
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia
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Gilmore AK, Hahn CK, Jaffe AE, Walsh K, Moreland AD, Ward-Ciesielski EF. Suicidal ideation among adults with a recent sexual assault: Prescription opioid use and prior sexual assault. Addict Behav 2018; 85:120-124. [PMID: 29902682 DOI: 10.1016/j.addbeh.2018.05.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Sexual assault (SA) is common, and recent sexual assault is associated with suicidal ideation and prescription opioid (PO) use. PO use is also associated with increased risk of suicidal ideation. The current study examined suicidal ideation among adults seeking medical and psychological follow-up care after a SA medical forensic examination based on PO use and prior SA. METHODS Adults (n = 60) who received a SA medical forensic exam at the emergency room within 120 h of a SA were invited to receive medical and psychological follow-up care, which included a questionnaire about current mental health symptoms. RESULTS Results from a linear regression model revealed that more acute stress symptoms were associated with higher suicidal ideation. Further, there was a significant association between PO use and suicidal ideation among those with a prior SA such that those with a prior SA and who used POs reported more severe suicidal ideation than those with a prior SA who did not use POs. CONCLUSIONS Routine screening at the emergency department for PO use and prior SA may help prevention efforts for suicide among adults who recently experienced SA.
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Affiliation(s)
- Amanda K Gilmore
- College of Nursing, Medical University of South Carolina, United States; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States.
| | - Christine K Hahn
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States
| | - Anna E Jaffe
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States
| | - Kate Walsh
- Ferkauf Graduate School of Psychology, Yeshiva University, United States
| | - Angela D Moreland
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States
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Groenewald CB, Law EF, Fisher E, Beals-Erickson SE, Palermo TM. Associations Between Adolescent Chronic Pain and Prescription Opioid Misuse in Adulthood. THE JOURNAL OF PAIN 2018; 20:28-37. [PMID: 30098405 DOI: 10.1016/j.jpain.2018.07.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/11/2018] [Accepted: 07/14/2018] [Indexed: 12/31/2022]
Abstract
Prescription opioid misuse is a serious public health concern, yet antecedent factors are poorly described. Using data from the National Longitudinal Study of Adolescent to Adult Health (N = 14,784), we examined the longitudinal relationship between a history of adolescent chronic pain and the odds of misusing prescription opioids in adulthood. The primary predictor variable was chronic pain status during adolescence. The primary outcome variables were prescription opioid misuse during early adulthood and adulthood. Multivariate models controlled for known risk factors of opioid misuse, including sociodemographics (sex, race, and ethnicity), adolescent mental health symptoms (anxiety, depression), adolescent self-reported physical health status, adolescent substance use/abuse, childhood trauma, and adult legitimate opioid use. We found that adults with a history of adolescent chronic pain were more likely to misuse opioids than those without history of chronic pain, even after controlling for other known risk factors. Further, we found that among individuals with history of adolescent chronic pain that race (white), other substance use, and exposure to trauma were risk factors for later opioid misuse. Longitudinal associations between adolescent chronic pain and subsequent adult prescription opioid misuse highlight the need for early targeted screening and prevention efforts that may reduce later opioid misuse. Perspective: Using a large, nationally representative sample, we found that chronic pain during adolescence was an independent risk factor for opioid misuse in adulthood, over and above other known risk factors. Furthermore, among those individuals with adolescent chronic pain, substance use, exposure to trauma, and race were associated with opioid misuse.
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Affiliation(s)
- Cornelius B Groenewald
- Departments of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington.
| | - Emily F Law
- Departments of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Emma Fisher
- Department for Health, University of Bath, Claverton Down, Bath, UK
| | - Sarah E Beals-Erickson
- Division of Developmental and Behavioral Sciences, Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Missouri
| | - Tonya M Palermo
- Departments of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington; Pediatrics, University of Washington School of Medicine, Seattle, Washington; Psychiatry, University of Washington School of Medicine, Seattle, Washington; Division of Developmental and Behavioral Sciences, Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Missouri
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Linden M, Marullo S, Bone C, Barry DT, Bell K. Prisoners as Patients: The Opioid Epidemic, Medication-Assisted Treatment, and the Eighth Amendment. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:252-267. [PMID: 30146987 DOI: 10.1177/1073110518782926] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article argues that correctional institutions violate the Eighth Amendment when they refuse to establish MAT programs and prevent doctors from exercising medical judgment to properly treat incarcerated people with OUD.
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Affiliation(s)
- Michael Linden
- Michael Linden is a member of the class of 2019 at Yale Law School. Sam Marullo is a member of the class of 2020 at Yale Law School. Curtis Bone, M.D., M.H.S., completed medical school at the Johns Hopkins School of Medicine and a masters degree in epidemiology at the Johns Hopkins School of Public Health. He is currently an addiction medicine research fellow at the Yale University School of Medicine and West Haven VA. Declan T. Barry, Ph.D., is a psychologist and an associate professor of psychiatry at the Yale University School of Medicine. Dr. Barry is also the director of research at the APT foundation, a non-profit substance abuse treatment facility in Connecticut. Kristen Bell J.D., Ph.D., is a graduate of Stanford Law School and earned her Ph.D. in legal and moral philosophy at UNC-Chapel Hill. She is currently a Lecturer in Law, Associate Research Scholar in Law, and Senior Liman Fellow in Residence at Yale Law School
| | - Sam Marullo
- Michael Linden is a member of the class of 2019 at Yale Law School. Sam Marullo is a member of the class of 2020 at Yale Law School. Curtis Bone, M.D., M.H.S., completed medical school at the Johns Hopkins School of Medicine and a masters degree in epidemiology at the Johns Hopkins School of Public Health. He is currently an addiction medicine research fellow at the Yale University School of Medicine and West Haven VA. Declan T. Barry, Ph.D., is a psychologist and an associate professor of psychiatry at the Yale University School of Medicine. Dr. Barry is also the director of research at the APT foundation, a non-profit substance abuse treatment facility in Connecticut. Kristen Bell J.D., Ph.D., is a graduate of Stanford Law School and earned her Ph.D. in legal and moral philosophy at UNC-Chapel Hill. She is currently a Lecturer in Law, Associate Research Scholar in Law, and Senior Liman Fellow in Residence at Yale Law School
| | - Curtis Bone
- Michael Linden is a member of the class of 2019 at Yale Law School. Sam Marullo is a member of the class of 2020 at Yale Law School. Curtis Bone, M.D., M.H.S., completed medical school at the Johns Hopkins School of Medicine and a masters degree in epidemiology at the Johns Hopkins School of Public Health. He is currently an addiction medicine research fellow at the Yale University School of Medicine and West Haven VA. Declan T. Barry, Ph.D., is a psychologist and an associate professor of psychiatry at the Yale University School of Medicine. Dr. Barry is also the director of research at the APT foundation, a non-profit substance abuse treatment facility in Connecticut. Kristen Bell J.D., Ph.D., is a graduate of Stanford Law School and earned her Ph.D. in legal and moral philosophy at UNC-Chapel Hill. She is currently a Lecturer in Law, Associate Research Scholar in Law, and Senior Liman Fellow in Residence at Yale Law School
| | - Declan T Barry
- Michael Linden is a member of the class of 2019 at Yale Law School. Sam Marullo is a member of the class of 2020 at Yale Law School. Curtis Bone, M.D., M.H.S., completed medical school at the Johns Hopkins School of Medicine and a masters degree in epidemiology at the Johns Hopkins School of Public Health. He is currently an addiction medicine research fellow at the Yale University School of Medicine and West Haven VA. Declan T. Barry, Ph.D., is a psychologist and an associate professor of psychiatry at the Yale University School of Medicine. Dr. Barry is also the director of research at the APT foundation, a non-profit substance abuse treatment facility in Connecticut. Kristen Bell J.D., Ph.D., is a graduate of Stanford Law School and earned her Ph.D. in legal and moral philosophy at UNC-Chapel Hill. She is currently a Lecturer in Law, Associate Research Scholar in Law, and Senior Liman Fellow in Residence at Yale Law School
| | - Kristen Bell
- Michael Linden is a member of the class of 2019 at Yale Law School. Sam Marullo is a member of the class of 2020 at Yale Law School. Curtis Bone, M.D., M.H.S., completed medical school at the Johns Hopkins School of Medicine and a masters degree in epidemiology at the Johns Hopkins School of Public Health. He is currently an addiction medicine research fellow at the Yale University School of Medicine and West Haven VA. Declan T. Barry, Ph.D., is a psychologist and an associate professor of psychiatry at the Yale University School of Medicine. Dr. Barry is also the director of research at the APT foundation, a non-profit substance abuse treatment facility in Connecticut. Kristen Bell J.D., Ph.D., is a graduate of Stanford Law School and earned her Ph.D. in legal and moral philosophy at UNC-Chapel Hill. She is currently a Lecturer in Law, Associate Research Scholar in Law, and Senior Liman Fellow in Residence at Yale Law School
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Su S, Mao L, Zhao J, Chen L, Jing J, Cheng F, Zhang L. Epidemics of HIV, HCV and syphilis infection among synthetic drugs only users, heroin-only users and poly-drug users in Southwest China. Sci Rep 2018; 8:6615. [PMID: 29700352 PMCID: PMC5919913 DOI: 10.1038/s41598-018-25038-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/28/2018] [Indexed: 11/18/2022] Open
Abstract
The number of poly-drug users who mix use heroin and synthetic drugs (SD) is increasing worldwide. The objective of this study is to measure the risk factors for being infected with hepatitis C (HCV), human immunodeficiency virus (HIV) and syphilis among SD-only users, heroin-only users and poly-drug users. A cross-sectional study was conducted in 2015 from a national HIV surveillance site in Southwest China, 447 poly-drug, 526 SD-only and 318 heroin-only users were recruited. Poly-drug users have higher drug-use frequency, higher rates of drug-sharing and unsafe sexual acts than other users (p < 0.05). About a third (36.7%) of poly-drug users experienced sexual arousal due to drug effects, which is higher than the rate among other drug users. Poly-drug users had the highest prevalence of HIV (10.5%) and syphilis (3.6%), but heroin-only users had the highest prevalence of HCV (66.0%) (all p < 0.05) among three groups. Logistic regression shows among poly-drug users, having sex following drug consumption and using drugs ≥1/day were the major risk factors for both HIV (Adjusted odds ratio (AOR) = 2.4, 95% CI [1.8–3.4]; 2.3, [1.6–3.1]) and syphilis infection (AOR = 4.1, [2.1–6.9]; 3.9, [1.8–5.4]). Elevated risk of both HIV and syphilis infection have been established among poly-drug users.
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Affiliation(s)
- Shu Su
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Limin Mao
- Center for Social Research in Health, Arts and Social Sciences, UNSW Australia, Sydney, NSW, Australia
| | - Jinxian Zhao
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Liang Chen
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Jun Jing
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Feng Cheng
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.
| | - Lei Zhang
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia. .,Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China. .,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
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Rajan S, Ruggles KV, Guarino H, Mateu-Gelabert P. Heroin Use and Drug Injection among Youth Also Misusing Prescription Drugs. Am J Health Behav 2018; 42:144-155. [PMID: 29320347 DOI: 10.5993/ajhb.42.1.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We identified the prevalence of nonmedical prescription drug use and its relationship to heroin and injection drug use in 4 nationally representative samples of adolescents. METHODS We used the most recent data (2009-2015) from the Youth Risk Behavior Surveillance System (Ntotal= 61,132). Prevalence rates and 95% confidence intervals for prescription drug misuse, heroin use, and injection drug use were calculated across time points, sex, and race/ethnicity subgroups. Using odds ratios, we determined the likelihood of youth reporting nonmedical prescription drug use also reporting heroin and drug injection. RESULTS In 2015, one in 6 adolescents reported recent prescription drug misuse. High rates of nonmedical prescription drug use persisted or increased among Hispanic boys, black boys, and "other" youth, while declining among white youth. Youth who used prescription drugs nonmedically at least once were 17.5 times more likely to have used heroin (CI: 13.7, 22.4) and 14.6 times more likely to have injected drugs (CI: 11.2, 19.2) in their lifetime. CONCLUSIONS Public health programming focused on reducing prescription drug misuse also may reduce youth engagement in heroin and/or injection drug use. Preventive efforts to support communities of color in reducing rates of prescription drug misuse are crucial.
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Affiliation(s)
- Sonali Rajan
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, USA
| | - Kelly V. Ruggles
- Department of Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Honoria Guarino
- National Development and Research Institutes, Incorporated, New York, NY, USA
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McHugh RK, Votaw VR, Sugarman DE, Greenfield SF. Sex and gender differences in substance use disorders. Clin Psychol Rev 2017; 66:12-23. [PMID: 29174306 DOI: 10.1016/j.cpr.2017.10.012] [Citation(s) in RCA: 457] [Impact Index Per Article: 65.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 12/18/2022]
Abstract
The gender gap in substance use disorders (SUDs), characterized by greater prevalence in men, is narrowing, highlighting the importance of understanding sex and gender differences in SUD etiology and maintenance. In this critical review, we provide an overview of sex/gender differences in the biology, epidemiology and treatment of SUDs. Biological sex differences are evident across an array of systems, including brain structure and function, endocrine function, and metabolic function. Gender (i.e., environmentally and socioculturally defined roles for men and women) also contributes to the initiation and course of substance use and SUDs. Adverse medical, psychiatric, and functional consequences associated with SUDs are often more severe in women. However, men and women do not substantively differ with respect to SUD treatment outcomes. Although several trends are beginning to emerge in the literature, findings on sex and gender differences in SUDs are complicated by the interacting contributions of biological and environmental factors. Future research is needed to further elucidate sex and gender differences, especially focusing on hormonal factors in SUD course and treatment outcomes; research translating findings between animal and human models; and gender differences in understudied populations, such as those with co-occurring psychiatric disorders and gender-specific populations, such as pregnant women.
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Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02155, United States.
| | - Victoria R Votaw
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| | - Dawn E Sugarman
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02155, United States
| | - Shelly F Greenfield
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02155, United States
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High enhancer, downer, withdrawal helper: Multifunctional nonmedical benzodiazepine use among young adult opioid users in New York City. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 46:17-27. [PMID: 28577506 DOI: 10.1016/j.drugpo.2017.05.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 04/08/2017] [Accepted: 05/03/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Benzodiazepines are a widely prescribed psychoactive drug; in the U.S., both medical and nonmedical use of benzodiazepines has increased markedly in the past 15 years. Long-term use can lead to tolerance and dependence, and abrupt withdrawal can cause seizures or other life-threatening symptoms. Benzodiazepines are often used nonmedically in conjunction with other drugs, and with opioids in particular-a combination that can increase the risk for fatal and non-fatal overdose. This mixed-methods study examines nonmedical use of benzodiazepines among young adults in New York City and its relationship with opioid use. METHODS For qualitative analysis, 46 90-minute semi-structured interviews were conducted with young adult opioid users (ages 18-32). Interviews were transcribed and coded for key themes. For quantitative analysis, 464 young adult opioid users (ages 18-29) were recruited using Respondent-Driven Sampling and completed structured interviews. Benzodiazepine use was assessed via a self-report questionnaire that included measures related to nonmedical benzodiazepine and opioid use. RESULTS Participants reported using benzodiazepines nonmedically for a wide variety of reasons, including: to increase the high of other drugs; to lessen withdrawal symptoms; and to come down from other drugs. Benzodiazepines were described as readily available and cheap. There was a high prevalence (93%) of nonmedical benzodiazepine use among nonmedical opioid users, with 57% reporting regular nonmedical use. In bivariate analyses, drug-related risk behaviours such as polysubstance use, drug binging, heroin injection and overdose were strongly associated with regular nonmedical benzodiazepine use. In multivariate analysis, growing up in a middle-income household (earning between $51,000 and $100,000 annually), lifetime overdose experience, having ever used cocaine regularly, having ever been prescribed benzodiazepines, recent drug binging, and encouraging fellow drug users to use benzodiazepines to cope with opioid withdrawal were consistently strong predictors of regular nonmedical benzodiazepine use. CONCLUSION Nonmedical benzodiazepine use may be common among nonmedical opioid users due to its drug-related multi-functionality. Harm reduction messages should account for the multiple functions benzodiazepines serve in a drug-using context, and encourage drug users to tailor their endorsement of benzodiazepines to peers to include safer alternatives.
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35
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Friedman SR, Mateu-Gelabert P, Ruggles KV, Goodbody E, Syckes C, Jessell L, Teubl J, Guarino H. Sexual Risk and Transmission Behaviors, Partnerships and Settings Among Young Adult Nonmedical Opioid Users in New York City. AIDS Behav 2017; 21:994-1003. [PMID: 28058567 PMCID: PMC5344710 DOI: 10.1007/s10461-016-1672-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Nonmedical prescription opioid use has become widespread. It can lead to heroin use, drug injection and HIV infection. We describe young adult opioid users' sexual risk behavior, partnerships and settings. 464 youth aged 18-29 who reported opioid use in the past 30 days were recruited using Respondent-Driven Sampling. Eligible participants completed a computer-assisted, interviewer-administered risk questionnaire and were tested for STIs and HIV. Participants (33% female; 66% white non-Hispanic) almost all had sex in the prior 90 days; 42% reported more than one partner. Same-sex sex was reported by 3% of men and 10% of women. Consistent condom use was rare. Seven percent reported group sex participation in the last 90 days but lifetime group sex was common among men and women. Young opioid users' unprotected sex, multiple partners and group sex puts them and others at high HIV and STI risk.
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Affiliation(s)
- S R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Floor, New York, NY, 10010, USA.
| | - P Mateu-Gelabert
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Floor, New York, NY, 10010, USA
| | - K V Ruggles
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - E Goodbody
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Floor, New York, NY, 10010, USA
| | - C Syckes
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Floor, New York, NY, 10010, USA
| | - L Jessell
- Silver School of Social Work, New York University, New York, NY, USA
| | - Jennifer Teubl
- Sackler Institute of Graduate Biomedical Sciences, New York University, New York, NY, USA
| | - H Guarino
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Floor, New York, NY, 10010, USA
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Buttram ME, Kurtz SP. Alternate Routes of Administration among Prescription Opioid Misusers and Associations with Sexual HIV Transmission Risk Behaviors. J Psychoactive Drugs 2016; 48:187-94. [PMID: 27224253 DOI: 10.1080/02791072.2016.1187319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Literature suggests that young adult prescription opioid misusers who are using alternate routes of administration (e.g., snorting, injecting) may be engaging in sexual and non-sexual HIV risk behaviors. This study examines demographics, substance use, sexual risk behavior, and health and social problems associated with alternate routes of administration of prescription opioids among a sample of young adult prescription opioid misusers. Data are drawn from baseline assessments from a behavioral intervention trial. Eligible participants were ages 18-39, and reported recent (past 90 days) heterosexual sex, and recent and regular substance use and attendance at large, recognized local nightclubs. The analyses include 446 racially/ethnically diverse participants. In bivariate regression models, compared to those who did not, participants reporting alternate routes of administration (n = 209) were more likely to be White (p < 0.025) and report group sex participation history (p = 0.002), sex with an injection drug user (p = 0.003), sexual victimization history (p = 0.003), and severe mental distress (p < 0.000). White race, group sex participation history, and severe mental distress remained significant in the multivariate model. Alternate routes of administration of prescription opioids are associated with sexual HIV transmission risk behaviors. Early prevention and intervention efforts that address sexual and non-sexual HIV risk behaviors are warranted.
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Affiliation(s)
- Mance E Buttram
- a Assistant Professor and Associate Director, Center for Applied Research on Substance Use and Health Disparities , Nova Southeastern University , Miami , FL , USA
| | - Steven P Kurtz
- b Professor and Director, Center for Applied Research on Substance Use and Health Disparities , Nova Southeastern University , Miami , FL , USA
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Nonmedical opioid use and heroin use in a nationally representative sample of us high school seniors. Drug Alcohol Depend 2016; 158:132-8. [PMID: 26653341 PMCID: PMC4698068 DOI: 10.1016/j.drugalcdep.2015.11.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/09/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Nonmedical use of opioids has become increasingly problematic in recent years with increases in overdoses, treatment admissions, and deaths. Use also appears to be contributing to heroin initiation, which has increased in recent years. Further research is needed to examine which adolescents are at highest risk for nonmedical use of opioids and heroin and to explore potential links between nonmedical opioid use and heroin use. METHODS Data were analyzed from a nationally representative sample of American high school seniors in the Monitoring the Future study (2009-2013, Weighted N=67,822). We examined associations between frequency and recency of nonmedical use of opioids and heroin. Sociodemographic correlates of use of each drug were also examined. RESULTS 12.4% of students reported lifetime nonmedical opioid use and 1.2% reported lifetime heroin use. As frequency of lifetime nonmedical opioid use increased, so too did the odds for reporting heroin use, with over three-quarters (77.3%) of heroin users reporting lifetime nonmedical opioid use. Recent (30-day) nonmedical opioid use was a robust risk factor for heroin use and almost a quarter (23.2%) of students who reported using opioids ≥40 times reported lifetime heroin use. Black and Hispanic students were less likely to report nonmedical opioid or heroin use than white students, but they were more likely to report heroin use in absence of nonmedical opioid use. DISCUSSION Recent and frequent nonmedical opioid use are risk factors for heroin use among adolescents. Prevention needs to be targeted to those at highest risk.
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