Examining gender differences in substance use and age of first use among rural Appalachian drug users in Kentucky

Does Gender Moderate the Relationship Between Chronic Pain and Substance Use Disorder? Insights From a National Canadian Population Survey

BACKGROUND

Though it has been shown that men have a higher lifetime prevalence of substance use disorder and a lower prevalence of chronic pain than women, there is little research to date focusing on gender differences in the relationship between chronic pain and substance use disorder. This study examined whether gender moderates the relationship of chronic pain and substance use disorder. We also sought to examine the gender differences in the associations between specific pain types-arthritis, migraine, and back pain, and substance use disorder.

METHODS

The data were drawn from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH 2012) with individuals aged 20 years and older living in the 10 Canadian provinces (N = 23,089). A two-level logistic mixed effects model was used to account for provincial differences.

RESULTS

Our findings indicated gender moderated the association between arthritis as well as migraine, and substance use disorder. However, no moderation effect of gender on the relationship between back pain and substance use disorder was found. Specifically, the strength of the association between arthritis and substance use disorder was stronger among men (OR_interaction = 0.62, 95% CI: 0.53 to 0.73), whereas the strength of the association between migraine and substance use disorder was stronger among women (OR_interaction = 1.45, 95% CI: 1.18 to 1.79). In addition, geographical location was found to explain a small proportion (2.3%-2.4%) of the overall variance in SUD.

CONCLUSIONS

The results suggest that gender moderated the relations between arthritis as well as migraine, and substance use disorder, respectively. Treatment programs for pain and substance misuse might benefit from an approach tailored to gender differences.

Associations between Traumatic Brain Injury, Drug Abuse, Alcohol Use, Adverse Childhood Events, and Aggression Levels in Individuals with Foster Care History

Nearly 50,000 Canadian children live in foster care. Compared with their peers, foster children experience greater independence and decreased guidance, predisposing them to harmful exposures such as traumatic brain injury (TBI), illicit drugs, and alcohol. Foster children also report a higher level of childhood abuse compared with the general population. This study aimed to: 1) investigate substance/alcohol use disorder, adverse childhood events (ACE), TBI, aggression levels, and the difference between normalized percentages of brain regions of interest (ROIs) in a sample of Canadian youths with and without foster care history; 2) determine the prevalence of substance/alcohol use disorder, ACE, and aggression levels within individuals with foster care history when stratified by likelihood of TBI; and 3) determine the significant correlates of elevated aggression levels within this population. Participants completed standardized questionnaires that measured the prevalence of TBI, substance and alcohol use disorder, ACE, and aggression. Magnetic resonance imaging (MRI) was used to measure differences in brain ROI. Regression and network analysis were used to study interactions between variables. Seventy-four participants (51 individuals with foster care history and 23 age-matched controls from the general population) completed standardized questionnaires. Fifty-five of these individuals (39 foster participants and 16 controls) underwent brain MRI. Foster participants had higher prevalence of substance use disorder (p < 0.001), alcohol use disorder (p = 0.003), ACE (p < 0.001), and elevated aggression levels (p < 0.001) than healthy controls. No significant difference was found among brain ROI. The prevalence of TBI in foster participants was 65%. Foster participants with moderate or high likelihood of TBI exposure had higher levels of drug use and aggression than those with no or low likelihood of exposure. Brain volumes were not associated with substance/alcohol use disorder or ACE. No significant associations were found between aggression levels and the studied variables.

Latent Profiles of Health and Reproductive Risk and Protective Factors among Women in Appalachia

Women who use opiates and are involved in the criminal justice system in Appalachia may be prone to adverse health outcomes. In this study, we performed a latent class analysis of risk and protective factors on 400 drug-using women recruited from rural, Appalachian jails. A two-profile solution best fit the data. Both profiles evinced low levels of condom use, reproductive and physical health screens, and STD history. However, the primary substantive difference between the profiles was partner risk behavior: the higher risk class had main male partners with histories of injection drug use and incarceration. Results suggest that interventions need to be tailored to unique profiles of risk and protective factors, which should include taking partner risk into consideration.

The opioid and related drug epidemics in rural Appalachia: A systematic review of populations affected, risk factors, and infectious diseases

Background/aims: To examine trends in rural Appalachian opioid and related drug epidemics during the past 10 years, including at-risk populations, substance use shifts and correlates, and associated infections. Methods: We conducted this review in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Seven databases were searched for quantitative studies, published between January 2006 and December 2017, of drug use, drug-related mortality, or associated infections in rural Appalachia. Results: Drug-related deaths increased in study states, and a high incidence of polydrug toxicity was noted. Rural substance use was most common among young, white males, with low education levels. A history of depression/anxiety was common among study populations. Prescription opioids were most commonly used, often in conjunction with sedatives. Women emerged as a distinct user subpopulation, with different routes of drug use initiation and drug sources. Injection drug use was accompanied by risky injection behaviors and was associated with hepatitis C. Conclusions: This review can help to inform substance use intervention development and implementation in rural Appalachian populations. Those at highest risk are young, white males who often engage in polysubstance use and have a history of mental health issues. Differences in risk factors among other groups and characteristics of drug use in rural Appalachian populations that are conducive to human immunodeficiency virus (HIV) spread also warrant consideration.

Brief Report: Sex Differences in Substance Use, Mental Health, and Impaired Driving Among Rural DUI Offenders

BACKGROUND AND OBJECTIVES

Studies have documented sex differences among driving under the influence (DUI) offenders, but none have examined rural DUI offenders.

METHODS

Rural DUI offenders (83 males and 34 females) self-reported past year and lifetime substance use, mental health problems, and impaired driving history.

RESULTS

Substance use and impaired driving histories were similar, but significant disparities in mental health problems for female DUI offenders were found.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

This initial examination of sex differences among rural DUI offenders suggests additional research is needed to better understand their substance use and mental health problems and whether different treatment approaches are needed. (Am J Addict 2019;28:405-408).

Prevalence and Correlates of Electronic Cigarette Use Among a Clinical Sample of Polysubstance Users in Kentucky: Long Live the Cigarette?

BACKGROUND

E-cigarette use has increased in the US, yet, in some regions rates of cigarette use remain high.

PURPOSE

To describe the prevalence and features of lifetime and past-year e-cigarette use among a clinical sample of polysubstance users in Kentucky, and to determine significant associations of past-year e-cigarette use.

RESULTS

Of the final sample (N  =  497), 83.5% reported having ever used e-cigarettes and 97.2% reported having ever used cigarettes. These rates surpass those found among Kentucky's general population. Compared to those who did not report e-cigarette use, e-cigarette users were more likely to be younger ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mover><mml:mrow><mml:mi>x</mml:mi></mml:mrow><mml:mo>¯</mml:mo></mml:mover></mml:math> = 33.4 vs. 43.6, p<.001) and White (88.2.1% vs. 62.5%, p = .001). E-cigarette users showed higher rates for lifetime incarceration (91.1% vs. 72.8%, p = .001) and past-year arrest (75.0% vs. 47.5%, p = .001). This group also presented with more severe substance use history and lower mean age for illicit drug use initiation ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mover><mml:mrow><mml:mi>x</mml:mi></mml:mrow><mml:mo>¯</mml:mo></mml:mover></mml:math> = 13.8 vs. 16.4, p  =  .001). Approximately 65% of the sample reported past-year e-cigarette use and 96.6% reported past-year cigarette use. Logistic regression indicated that being younger (AOR = .973, p = .030), White (AOR = 1.92, .046), having a past-year arrest (AOR = 1.73, p = .047) and having used cigarettes (AOR = 8.93, p = .001) or kratom (AOR = 3.04, p = .025) within the past year were significantly associated with past-year e-cigarette use.

CONCLUSIONS

E-cigarette use was related to more severe drug-using patterns. Rates of dual tobacco use among this sample are high, particularly among younger individuals. In ecological contexts where cigarette use remains normative, it is likely that dual use will persist for nicotine-dependent, polysubstance-using individuals.

An Examination of the Age of Substance Use Onset and Adult Severity of Use Among Offenders Entering Treatment

Early onset of substance use has demonstrated a robust relationship with later severity of use, yet this relationship has been less examined in criminal justice contexts or examined differentially by gender. The present study utilized secondary data from a sample of offenders in one small Midwestern state entering corrections-based substance abuse treatment in prison, jail, or community settings to address these gaps in the literature. Findings indicated that age of regular cigarette use did not uniquely affect severity of illicit drug use in adulthood, defined as the frequency of use or endorsement of substance use disorder criteria. In comparison, ages of onset for alcohol and illicit drug use were significantly associated with multiple severity variables examined. Gender was not found to moderate these relationships. These findings emphasize that age of use onset for alcohol and illicit drugs can be valuable in identifying offenders at risk of severe substance use in adulthood.

A scoping review of opioid misuse in the rural United States

INTRODUCTION

This study is a scoping review of the original research literature onthe misuse of opioids in the rural United States (US) and maps theliterature of interest to address the question: What does theoriginal research evidence reveal about the misuse of opioids inrural US communities?

METHODS

This study used a modified preferred reporting items for systematicreviews and meta-analyses (PRISMA) approach which is organized byfive distinct elements or steps: beginning with a clearly formulatedquestion, using the question to develop clear inclusion criteria toidentify relevant studies, using an approach to appraise the studiesor a subset of the studies, summarizing the evidence using anexplicit methodology, and interpreting the findings of the review.

RESULTS

The initial search yielded 119 peer reviewed articles and aftercoding, 41 papers met the inclusion criteria. Researcher generatedsurveys constituted the most frequent source of data. Most studieshad a significant quantitative dimension to them. All the studieswere observational or cross-sectional by design.

CONCLUSIONS

This analysis found an emerging research literature that hasgenerated evidence supporting the claim that rural US residents andcommunities suffer a disproportionate burden from the misuseof opioidscompared to their urban or metropolitan counterparts.

Marijuana use among youths in Mississippi, United States

Background Increased use of marijuana among youths in Mississippi, United States is of great concern to Public Health in the 21st century. This study examined the prevalence of marijuana use according to gender, race and ethnicity. Method The data for this study was obtained from Youth Risk Behavior Surveillance System (YRBSS) for 2015, a cross-sectional survey of the Mississippi High School Students, which examined the prevalence and trends in the use of marijuana according to gender, race and ethnicity. The trends in the percentage of students that reported the use of marijuana and its product was examined by univariate t-test statistical analysis at p < 0.05. The frequency distribution was used to determine the percentage differences in the groups. Results The students that ever used marijuana was 39.4% in Blacks, 39.1% in Hispanics and 31.0% in Whites. A total of 13.7% male and female (4.8%) used marijuana before 13 years of age. In addition, the students currently using marijuana include Blacks (10.9%), Hispanic (13.7%) and Whites (7.2%). Approximately 9.7% of students ever used the synthetic product, which was higher in Hispanic (18.7%) when compared to Blacks (8.8%) and Whites (9.1%). Conclusion The use of marijuana is significantly higher among the male youth in Mississippi than females, which is a major public health concern. Furthermore, there was higher rates of smoking marijuana in Hispanics and Blacks when compared to White youth.

Appalachian Women's Use of Substance Abuse Treatment: Examining the Behavioral Model for Vulnerable Populations

The Gelberg-Andersen Behavioral Model for Vulnerable Populations was applied to understand vulnerable Appalachian women's (N = 400) utilization of addiction treatment. A secondary data analyses included multiple multivariate analyses. Strongest correlates of treatment utilization included ever injecting drugs (OR = 2.77), limited availability of substance abuse treatment facilities (OR = 2.03), and invalidated violence abuse claims (OR = 2.12). This study contributes theory-driven research to the greater social work addiction literature by confirming that vulnerable domains related to substance abuse treatment utilization warrant unique considerations compared to non-vulnerable domains. Findings also highlight the importance of understanding the unique role that cultural factors play in treatment utilization among Appalachian women. Inferences relevant to clinicians and policymakers are discussed.

The female crack users: Higher rates of social vulnerability in Brazil

Female crack users who sought treatment are a hard to find part of the population. We studied sociodemographic and behavioral characteristics of crack users undergoing treatment in psychosocial care centers for alcohol and other drugs in six Brazilian cities. We carried out a cross-sectional study of 816 crack users and collected data with the Addiction Severity Index. Women were more likely to be in vulnerable situations: had worst levels of education, were not receiving money enough to their basic needs; more likely to be HIV positive (10.1%), to report sexual abuse (34%), and to be separated from their children (20%).

Correlates of Injection Drug Use Among Rural Appalachian Women

BACKGROUND

Limited research has focused on correlates of injection drug use (IDU) among high-risk subgroups of drug users, particularly women, who may be at increased risk for transmission of infectious diseases such as HIV and Hepatitis C. The purpose of this study is to better understand the contextual and health correlates of IDU among women living in rural Appalachia by examining (1) differences between injectors and noninjectors, and (2) the unique correlates of recent IDU and past IDU.

METHODS

This study involved random selection, screening, and face-to-face interviews with 400 rural Appalachian women from jails in one state. Analyses included descriptive statistics, multinomial logistic regression, and stepwise regression to identify significant correlates of recent IDU and past IDU compared to never injecting.

RESULTS

Findings indicated that 75.3% of this randomly selected sample reported lifetime injection of drugs. Contextual factors including drug use severity (RRR = 8.66, P < .001), more male sex partners (RRR = 1.01, P < .05), and having injecting partners (RRR = 7.60, P < .001) were robust correlates of recent injection practices.

CONCLUSIONS

This study makes an important contribution to understanding factors associated with IDU among rural Appalachian women drug users, which are strongly associated with both relational and health factors. Study findings on the specific factors associated with IDU risk have important implications for tailoring and targeting interventions that should include a focus on the relationship context reducing high-risk injection practices.

The effects of rurality on substance use disorder diagnosis: A multiple-groups latent class analysis

BACKGROUND

Rates of accidental overdose mortality from substance use disorder (SUD) have risen dramatically in the United States since 1990. Between 1999 and 2004 alone rates increased 62% nationwide, with rural overdose mortality increasing at a rate 3 times that seen in urban populations. Cultural differences between rural and urban populations (e.g., educational attainment, unemployment rates, social characteristics, etc.) affect the nature of SUD, leading to disparate risk of overdose across these communities.

METHODS

Multiple-groups latent class analysis with covariates was applied to data from the 2011 and 2012 National Survey on Drug Use and Health (n=12.140) to examine potential differences in latent classifications of SUD between rural and urban adult (aged 18years and older) populations. Nine drug categories were used to identify latent classes of SUD defined by probability of diagnosis within these categories. Once the class structures were established for rural and urban samples, posterior membership probabilities were entered into a multinomial regression analysis of socio-demographic predictors' association with the likelihood of SUD latent class membership.

RESULTS

Latent class structures differed across the sub-groups, with the rural sample fitting a 3-class structure (Bootstrap Likelihood Ratio Test P value=0.03) and the urban fitting a 6-class model (Bootstrap Likelihood Ratio Test P value<0.0001). Overall the rural class structure exhibited less diversity in class structure and lower prevalence of SUD in multiple drug categories (e.g. cocaine, hallucinogens, and stimulants).

CONCLUSIONS

This result supports the hypothesis that different underlying elements exist in the two populations that affect SUD patterns, and thus can inform the development of surveillance instruments, clinical services, and prevention programming tailored to specific communities.

Current Rural Drug Use in the US Midwest

The nature and challenge of illicit drug use in the United States continues to change rapidly, evolving in reaction to myriad social, economic, and local forces. While the use of illicit drugs affects every region of the country, most of our current information about drug use comes from large urban areas. Data on rural drug use and its harms justify greater attention. Record overdose rates, unexpected outbreaks of HIV, and a dearth of treatment facilities point to a rapidly worsening health situation. While health sciences have made considerable progress in understanding the etiology of drug use and uncovering the link between drug use and its myriad associated harms, this promising scientific news has not always translated to better health outcomes. The scope of the problem in the Central Plains of the US is growing, and can be estimated from available sources. Clear remedies for this rising level of abuse are available, but few have been implemented. Suggestions for short-term policy remedies are discussed.

Individual and Network Correlates of Antisocial Personality Disorder Among Rural Nonmedical Prescription Opioid Users

PURPOSE

Examination of the association of antisocial personality disorder (ASPD) with substance use and HIV risk behaviors within the social networks of rural people who use drugs.

METHODS

Interviewer-administered questionnaires were used to assess substance use, HIV risk behavior, and social network characteristics of drug users (n = 503) living in rural Appalachia. The MINI International Psychiatric Interview was used to determine whether participants met DSM-IV criteria for ASPD and Axis-I psychological comorbidities (eg, major depressive disorder, posttraumatic stress disorder, generalized anxiety disorder). Participants were also tested for herpes simplex 2, hepatitis C, and HIV. Multivariate generalized linear mixed modeling was used to determine the association between ASPD and risk behaviors, substance use, and social network characteristics.

RESULTS

Approximately one-third (31%) of participants met DSM-IV criteria for ASPD. In multivariate analysis, distrust and conflict within an individual's social networks, as well as past 30-day use of heroin and crack, male gender, younger age, lesser education, heterosexual orientation, and comorbid MDD were associated with meeting diagnostic criteria for ASPD.

CONCLUSIONS

Participants meeting criteria for ASPD were more likely to report recent heroin and crack use, which are far less common drugs of abuse in this population in which the predominant drug of abuse is prescription opioids. Greater discord within relationships was also identified among those with ASPD symptomatology. Given the elevated risk for blood-borne infection (eg, HIV) and other negative social and health consequences conferred by this high-risk subgroup, exploration of tailored network-based interventions with mental health assessment is recommended.

Gender differences in psychopathy links to drug use

Although the relationship between psychopathic personality traits and substance use has received some attention (Hart & Hare, 1989; Smith & Newman, 1990), gender differences have not been thoroughly assessed. The current study examined whether gender modified the relationship between 2 criminally relevant constructs, (a) psychopathy and its factors and (b) drug use. A sample of 318 participants with criminal histories and recent substance use was assessed for psychopathy using the Psychopathy Checklist: Screening Version and for illicit drug use using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. As expected, the impulsive-antisocial traits (Factor 2) of psychopathy were positively related to a number of drug use characteristics (symptoms, age of drug initiation, extent of drug experimentation), whereas the interpersonal-affective traits (Factor 1) showed a negative relationship with drug abuse symptoms and a positive relationship with age of first use. In terms of gender differences, analyses revealed that women showed a stronger association between Factor 1 traits and later age of initiation compared to men, and that Factor 2, and the antisocial facet in particular, were more strongly related to drug abuse in women than men. These findings suggest that psychopathic traits serve as both protective (Factor 1) and risk (Factor 2) correlates of illicit drug use, and Factor 1 may be especially protective in terms of initiation of drug use among women. These conclusions add to the growing literature on potential routes to substance use and incarceration in women.

Are baby boomer women unique? The moderating effect of birth cohort on age in substance use patterns during midlife

This study examined the relationships of age to use of alcohol, marijuana, and illicit drugs, and misuse of prescription drugs, among midlife women and whether these relationships are modified by birth cohort. Structural Equation Modeling was used to analyze National Survey on Drug Use and Health data, which included 2,035 baby boomer and silent generation cohort women, ages 30 to 55. Midlife women across cohorts reduced alcohol and marijuana use, but not illicit and prescription drug misuse, as they aged. A modifying effect of birth cohort was not supported, but findings did support differential aging effects across substances. Implications are discussed.

Effectiveness of A-CRA/ACC in treating adolescents with cannabis-use disorders

An evidence-based treatment for adolescent cannabis users, Adolescent Community Reinforcement Approach with Assertive Continuing Care, was implemented in a rural county and small city in the USA. A total of 147 adolescents, ages 12-18, were enrolled and assessed at baseline and three time points: 3, 6, and 12 months using the Global Appraisal of Individual Needs and related measures. Program effectiveness was confirmed. The treatment was equally effective for youth from the city versus the county. More than two-thirds (68.7%) of the adolescents reported quitting use of cannabis by 12 months. The days of cannabis use in the last 90 days decreased significantly from the first follow-up, controlling for age (p value < .01), and shows consistent decline until the end of the treatment. In addition to reduction in substance use, the average number of days missing school and expelled from school decreased significantly from baseline to the end of the treatment.

Gender differences in circumstances surrounding first injection experience of rural injection drug users in the United States

BACKGROUND

Research has demonstrated that there can be substantial gender differences in circumstances surrounding initiation of injection drug use; however, little is known about the gendered dynamics of first injection in rural areas where syringe exchange is inaccessible or among those who predominantly inject prescription medications. The present study examines gender differences in first injection experience among rural residents who predominantly inject prescription opioids.

METHODS

Interview-administered questionnaires collected data from a sample of injection drug users (n=394) recruited from Appalachian Kentucky using respondent-driven sampling.

RESULTS

Women were more likely to have initiated injection due to social-pressure (p=0.001), received the drugs as a gift (p=0.011), initiated in their partner's home (p=0.004) and in their partner's presence (p<0.001), been injected by their partner (p<0.001), used an unclean syringe (p=0.026), and received the syringe from their partner (p<0.001). Women were also more likely to report having engaged in sexual intercourse before or after initiation (p<0.001). Men were more likely to have personally purchased the drugs (p=0.002), to have acquired the syringe from a pharmacy/clinic (p=0.004), and to have injected with a friend (p=0.001) or family member (p=0.020). Men were also more likely to have a friend administer the first injection (p=0.007).

CONCLUSIONS

In this population of rural drug users, notable gender differences in injection initiation were observed. Social pressure played a more substantial role in women's first injection experience, and male partners had an integral role in women's initiation.

Gender differences in heroin users receiving methadone maintenance therapy in Taiwan

This study examined gender differences in heroin users who first received MMT. Compared with men, female heroin users were younger and more likely to be unemployed, to have family members using illicit substances, to initiate heroin use at a younger age, to begin MMT earlier after starting heroin use, to have methamphetamine use, to initiate methamphetamine use at a younger age, and to report a child-raising burden and a prior history of traumatic experiences. Men were more likely to have use of betel quid, and to initiate alcohol, nicotine and betel quid use at a younger age than women.

Concordance between self-report and urine drug screen data in adolescent opioid dependent clinical trial participants

Objective measures of drug use are very important in treatment outcome studies of persons with substance use disorders, but obtaining and interpreting them can be challenging and not always practical. Thus, it is important to determine if, and when, drug-use self-reports are valid. To this end we explored the relationships between urine drug screen results and self-reported substance use among adolescents and young adults with opioid dependence participating in a clinical trial of buprenorphine-naloxone. In this study, 152 individuals seeking treatment for opioid dependence were randomized to a 2-week detoxification with buprenorphine-naloxone (DETOX) or 12weeks of buprenorphine-naloxone (BUP), each with weekly individual and group drug counseling. Urine drug screens and self-reported frequency of drug use were obtained weekly, and patients were paid $5 for completing weekly assessments. At weeks 4, 8, and 12, more extensive assessments were done, and participants were reimbursed $75. Self-report data were dichotomized (positive vs. negative), and for each major drug class we computed the kappa statistic and the sensitivity, specificity, positive predictive value, and negative predictive value of self-report using urine drug screens as the "gold standard". Generalized linear mixed models were used to explore the effect of treatment group assignment, compensation amounts, and participant characteristics on self-report. In general, findings supported the validity of self-reported drug use. However, those in the BUP group were more likely to under-report cocaine and opioid use. Therefore, if used alone, self-report would have magnified the treatment effect of the BUP condition.

Gender differences in disability in a multiethnic Asian population: the Singapore Mental Health Study

PURPOSE

The aims of the current study were to examine the gender specific associations between 12-month mood, anxiety and alcohol use disorders with five disability domains - Role, Social, Cognitive, Self-care and Mobility - after controlling for covariates in the multi-ethnic population in Singapore.

METHODS

The Singapore Mental Health Study (SMHS) surveyed 6616 adult Singapore Residents with face-to-face interviews from December 2009 to December 2010. The diagnoses of mental disorders were established using the Composite International Diagnostic Interview version 3.0 (CIDI 3.0). Disability was assessed with the World Mental Health (WMH) Surveys version of the WHODAS-II, which assesses disability across 5 domains.

RESULTS

Overall rate of disability was higher among those with mental disorder than those without mental disorder in both men and women. Our study found that women with either 12-month mood or anxiety disorder reported significantly more disability in the Social, Cognitive and Mobility domains than men with these disorders.

CONCLUSION

This highlights the need for gender sensitivity in models of care and treatment for both men and women and emphasizes the importance of tailoring interventions differently for them.

Barriers to receiving substance abuse treatment among rural pregnant women in Kentucky

Research presenting outcomes for women who enter substance abuse treatment during pregnancy consistently shows benefits. While treatment has nearly universal benefits, there are many barriers to seeking substance abuse treatment for pregnant women. The purpose of this study is to explore barriers for rural pregnant women seeking substance abuse treatment. There were three eligibility criteria for study participation: (1) aged 18 and older, (2) pregnant, and (3) undergoing short-term inpatient detoxification at the University of Kentucky Chandler Medical Center. Eighty-five rural women (N = 85) were included in the analysis. Substance use history and previous treatment were assessed with measures adapted from the Addiction Severity Index. Treatment barriers were measured with three qualitative questions and were coded into four overarching categories: availability, accessibility, affordability, and acceptability barriers. This sample had an extensive substance use history. Almost all participants had used alcohol (98%), marijuana (98%), illicit opiates (99%), and cigarettes (97%). On average, participants reported about two barriers to receiving treatment (Mean = 1.8; SD = 1.3), with over 80% of the sample reporting having experienced any barrier to treatment. The majority experienced acceptability (51%) and accessibility (49%) barriers. Twenty-six percent (26%) of the sample reported availability barriers. A smaller percentage of participants reported affordability barriers (13%). Rural pregnant women seeking substance abuse treatment face many obstacles to receiving needed treatment. More studies on barriers to substance abuse treatment among rural pregnant women are needed. Identifying these barriers can help in improving treatment access and services.

Sexual identity and drug use harm among high-risk, active substance users

Research shows that sexual minorities are at greater risk for illicit substance use and related harm than their heterosexual counterparts. This study examines a group of active drug users to assess whether sexual identity predicts increased risk of substance use and harm from ecstasy, ketamine, alcohol, marijuana, cocaine and crack. Structured interviews were conducted with participants aged 15 years and older in Vancouver and Victoria, BC, Canada, during 2008-2012. Harm was measured with the World Health Organization's AUDIT and ASSIST tools. Regression analysis controlling for age, gender, education, housing and employment revealed lesbian, gay or bisexual individuals were significantly more likely to have used ecstasy, ketamine and alcohol in the past 30 days compared to heterosexual participants. Inadequate housing increased the likelihood of crack use among both lesbian, gay and bisexuals and heterosexuals, but with considerably higher odds for the lesbian, gay and bisexual group. Lesbian, gay and bisexual participants reported less alcohol harm but greater ecstasy and ketamine harm, the latter two categorised by the ASSIST as amphetamine and hallucinogen harms. Results suggest encouraging harm reduction among sexual minority, high-risk drug users, emphasising ecstasy and ketamine. The impact of stable housing on drug use should also be considered.

Inability to access buprenorphine treatment as a risk factor for using diverted buprenorphine

BACKGROUND

As buprenorphine prescribing has increased in the United States so have reports of its diversion. The study purpose was to examine frequency and source of and risk factors for diverted buprenorphine use over a 6-month period in an Appalachian community sample of prescription opioid abusers.

METHODS

There were 503 participants at baseline; 471 completed the 6-month follow-up assessment. Psychiatric disorders and demographic, drug use, and social network characteristics were ascertained at baseline and follow-up. Multivariable logistic regression was used to determine the predictors of diverted buprenorphine use over the 6-month period.

RESULTS

Lifetime buprenorphine use "to get high" was 70.1%. Nearly half (46.5%) used diverted buprenorphine over the 6-month follow-up period; among these persons, 9.6% and 50.6% were daily and sporadic (1-2 uses over the 6-months) users, respectively. The most common sources were dealers (58.7%) and friends (31.6%). Predictors of increased risk of use of diverted buprenorphine during the 6-month follow-up included inability to access buprenorphine treatment (AOR: 7.31, 95% CI: 2.07, 25.8), meeting criteria for generalized anxiety disorder, and past 30 day use of OxyContin, methamphetamine and/or alcohol.

CONCLUSIONS

These results suggest that improving, rather than limiting, access to good quality affordable buprenorphine treatment may be an effective public health strategy to mitigate buprenorphine abuse. Future work should evaluate why more persons did not attempt to access treatment, determine how motivations change over time, and how different motivations affect diversion of the different buprenorphine formulations.

Examining barriers to and motivations for substance abuse treatment among pregnant women: does urban-rural residence matter?

Barriers to entering and motivations for substance abuse treatment were examined among rural and urban pregnant women. All pregnant women entering inpatient detoxification at the University of Kentucky Medical Center were approached about participating in a study on health and well-being. One hundred fourteen (N = 114) pregnant women voluntarily participated. Treatment barriers and motivators were measured with open-ended questions. The Treatment Attitude Profile quantitatively measured motivation. Both groups reported approximately two treatment barriers. Top treatment motivators were pregnancy (65.8%), needing help (23.7%), family (18.4%), and being tired of the lifestyle (16.7%). Overall, Treatment Attitude Profile scores were fairly high (Mean = 74.3, SD = 10.7), representing motivation for treatment. Multivariate analyses revealed a significant negative relationship between treatment motivation and gestational age (β = -0.233; p = 0.012), and a positive relationship between treatment motivation and reporting an acceptability barrier (e.g., denial, stigma) (β = 0.202; p = 0.024). Few between group differences existed in barriers and treatment motivation. Individuals residing in rural areas have unique beliefs, social ties, attitudes, and financial hardships. Research about the role of these factors in treatment access and motivation could be used to minimize treatment barriers.

Gender differences in brain regional homogeneity of healthy subjects after normal sleep and after sleep deprivation: a resting-state fMRI study

OBJECTIVE

To explore the gender differences of brain regional homogeneity (ReHo) in healthy subjects during the resting-state, after normal sleep, and after sleep deprivation (SD) using functional magnetic resonance imaging (fMRI) and the ReHo method.

METHODS

Sixteen healthy subjects (eight males and eight females) each underwent the resting-state fMRI exams twice, i.e., once after normal sleep and again after 24h's SD. According to the gender and sleep, 16 subjects were all measured twice and divided into four groups: the male control group (MC), female control group (FC), male SD group (MSD), and female SD group (FSD). The ReHo method was used to calculate and analyze the data, SPM5 software was used to perform a two-sample T-test and a two-pair T-test with a P value <0.001, and cluster volume ≥ 270 mm(3) was used to determine statistical significance.

RESULTS

Compared with the MC, the MSD showed significantly higher ReHo in the right paracentral lobule (BA3/6), but in no obviously lower regions. Compared with the FC, the FSD showed significantly higher ReHo in bilateral parietal lobes (BA2/3), bilateral vision-related regions of occipital lobes (BA17/18/19), right frontal lobe (BA4/6), and lower ReHo in the right frontal lobe. Compared with the FC, the MC showed significantly higher ReHo in the left occipital lobe (BA18/19), and left temporal lobe (BA21), left frontal lobe, and lower ReHo in the right insula and in the left parietal lobe. Compared with the FSD, the MSD showed significantly higher ReHo in the left cerebellum posterior lobe (uvula/declive of vermis), left parietal lobe, and bilateral frontal lobes, and lower ReHo in the right occipital lobe (BA17) and right frontal lobe (BA4).

CONCLUSIONS

The differences of brain activity in the resting state can be widely found not only between the control and SD group in a same gender group, but also between the male group and female group. Thus, we should take the gender differences into consideration in future fMRI studies, especially the treatment of brain-related diseases (e.g., depression).

OxyContin® as currency: OxyContin® use and increased social capital among rural Appalachian drug users

Studies have shown that position within networks of social relations can have direct implications on the health behaviors of individuals. The present study examines connections between drug use and individual social capital within social networks of drug users (n = 503) from rural Appalachian Kentucky, U.S.A. Respondent driven sampling was used to recruit individuals age 18 and older who had used one of the following drugs to get high: cocaine, crack, heroin, methamphetamine, or prescription opioids. Substance use was measured via self-report and social network analysis of participants' drug use network was used to compute effective size, a measure of social capital. Drug network ties were based on sociometric data on recent (past 6 month) drug co-usage. Multivariate multi-level ordinal regression was used to model the independent effect of socio-demographic and drug use characteristics on social capital. Adjusting for gender, income, and education, daily OxyContin(®) use was found to be significantly associated with greater social capital, and daily marijuana use was associated with less social capital. These results suggest that in regions with marked economic disparities such as rural Appalachia, OxyContin(®) may serve as a form of currency that is associated with increased social capital among drug users. Interventions focusing on increasing alternate pathways to acquiring social capital may be one way in which to alleviate the burden of drug use in this high-risk population.