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Erinoso O, Watts T, Koning S, Lu M, Wagner K, Pearson J. Choice of smoking cessation products among people with substance use problems in the US: Findings from the Population Assessment of Tobacco and Health (PATH) study Wave 6. Addict Behav 2024; 158:108104. [PMID: 39042998 DOI: 10.1016/j.addbeh.2024.108104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/06/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE The aim of this study was to compare past 12-month use of cigarette smoking cessation aids (e.g., Food and Drug Administration (FDA)-approved cessation products or e-cigarettes for smoking cessation) among people with substance use problems (PWSUPs) who currently smoke to people without substance use problems (SUPs) who currently smoke cigarettes in a nationally representative US sample. METHODS We used the Population Assessment of Tobacco and Health (PATH) Wave 6 Study [n = 30,516]. Our sample comprised adult (18+) established cigarette smokers (100+ lifetime-sticks with daily/non-daily use) [n = 5,895]. The independent variable was SUP status (no, moderate, and high). The dependent variables were past-year use of: nicotine replacement therapies (NRTs), cessation medications [i.e., varenicline or bupropion], or e-cigarettes [for cigarette cessation and reduction]. Weighted multivariable logistic regression models for each dependent variable examined the associations between SUP status and each cessation aid, adjusting for cigarette dependence, daily cigarette smoking, and demographic factors. RESULTS Among people who smoke, a higher proportion of respondents with high SUP severity used NRTs, cessation medications, and e-cigarettes for cigarette cessation, respectively (12.3%, 8.4%, 15.7%), compared to those with no/low SUP severity (9.8%, 6.0%, 8.9%). In the multivariable models, respondents with high SUPs had 63% (95% CI:1.16-2.29) higher odds of using e-cigarettes for cessation than those without SUPs. No significant differences were seen between high (vs. no/low SUPs) in the past-year use of NRTs and cessation medications. CONCLUSION Our findings indicate that cigarette smokers with high SUPs had higher odds of using e-cigarettes for cessation and reduction compared to smokers without SUPs.
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Affiliation(s)
- Olufemi Erinoso
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, United States.
| | - Theresa Watts
- Orvis School of Nursing, University of Nevada, Reno, United States
| | - Stephanie Koning
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Minggen Lu
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Karla Wagner
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Jennifer Pearson
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
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Encinosa W, Bernard D, Valdez RB. Heavy Versus Light Smoking: Its Association With Opioid Use, Chronic Pain, and Mental Health. Am J Prev Med 2024:S0749-3797(24)00249-6. [PMID: 39025246 DOI: 10.1016/j.amepre.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION There is much concern that substance use treatment programs are rarely integrated with smoking cessation programs. Here, the first national statistics are presented on the connection between heavy vs. light smoking and the opioid epidemic. METHODS Using the 2013-2021 Medical Expenditure Panel Survey linked to the National Health Interview Survey, N=81,400 adults-years, logit regressions estimate the impact of heavy vs. light smoking on opioid use, chronic pain, work limitations due to pain, and poor mental health. Analyses were conducted from October 2023 to May 2024. RESULTS Only 37 percent of the population has ever smoked, but they used 69% of the nation's annual prescription opioids. Adults who smoked more than 5 cigarettes a day composed 12% of the population but used about the same number of opioids as the 63% of the population who never smoked. Adults who formerly smoked used 16% fewer opioids than adults who currently smoke (p<0.01). The percent with chronic pain during the year varied from 12.2% for adults who never smoked to 14.2% for light smoking, to 16.5% for those smoking more than a pack a day (p<0.01). Severe work limitations due to pain varied from 7.3% for adults who never smoked to 16.9% for those smoking more than a pack a day (p<0.01). Adults smoking more than a pack a day were twice as likely to report fair or poor mental health compared to those who never smoked (29.2% vs 13.6%) (p<0.01). CONCLUSIONS As nations deal with the opioid epidemic, integrating smoking cessation programs into substance abuse treatment programs appears prudent.
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Ericson ØB, Eide D, Lobmaier P, Clausen T. Mortality risk and causes of death among people who use opioids in a take-home naloxone cohort. Drug Alcohol Depend 2024; 255:111087. [PMID: 38228056 DOI: 10.1016/j.drugalcdep.2024.111087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
BACKGROUND People who use opioids (PWUO) have an excess mortality from a range of causes. The cumulative effect of behavioral, social, and health risk factors complicates the interpretation of the effects of suitable interventions. This study explores mortality causes among a cohort of PWUO in the take-home naloxone (THN) program. METHODS This was a prospective cohort study of PWUO who received THN between 2015 and 2023. Participant data was linked with death registry data. Crude mortality rates and standardized mortality ratios (SMRs) were calculated for all causes, internal causes, and accidental opioid overdoses (AOOs). In addition to age and gender, risk factors like main route of administration, polydrug use, self-experienced overdoses, and using while alone were fitted in a Cox Regression model to explore factors associated with mortality. RESULTS The 2194 participants had a considerably higher mortality ratio for all causes investigated when compared to the general population (SMR=10.9, 95 % CI = 9.3,12.6). AOOs were the most prevalent cause of death (49 %). Those who reported frequent opioid use while alone had an elevated risk of dying of 2.6 (95 % CI = 1.1,6.4) compared to those who never used while alone. CONCLUSIONS Frequent opioid use while alone was associated with elevated mortality risk, supporting the importance of overdose prevention education with naloxone distribution, and additional efforts to improve environmental and social areas for safer drug-use practices among PWUO. The variety of mortality causes found in this study illustrates the need for multifaceted and targeted interventions for people at risk of overdosing.
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Affiliation(s)
- Øystein Bruun Ericson
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. box 1039 Blindern, Oslo 0315, Norway.
| | - Desiree Eide
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. box 1039 Blindern, Oslo 0315, Norway
| | - Philipp Lobmaier
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. box 1039 Blindern, Oslo 0315, Norway; Diakonhjemmet Hospital, Division of Mental Health and Substance Abuse, P.O. box 23 Vinderen, Oslo 0319, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. box 1039 Blindern, Oslo 0315, Norway
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Qeadan F, Nicolson A, Barbeau WA, Azagba S, English K. The association between dual use of electronic nicotine products and illicit drugs with adverse cardiovascular and respiratory outcomes in a longitudinal analysis using the Population Assessment of Tobacco and Health (PATH) survey. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100166. [PMID: 37228861 PMCID: PMC10205457 DOI: 10.1016/j.dadr.2023.100166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/16/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
Background Drug use and electronic nicotine delivery systems (ENDS) are independently associated with increased risk of cardiovascular and respiratory outcomes. Literature on the association between the dual use of these key substances and potential health outcomes is limited. Methods We examined the association between dual use of ENDs and drugs (including heroin, methamphetamine, cocaine, painkillers, and misused stimulant medications) with adverse cardiovascular and respiratory outcomes in a longitudinal analysis using waves 1-5 from the Population Assessment of Tobacco and Health survey (2014-2018). Multivariable logistic regression with Generalized Estimating Equations was utilized. Results About 0.9% (n = 368) of respondents at wave 2 used both ENDS and drugs, 5.1% (n = 1,985) exclusively used ENDS, and 5.9% (n = 1,318) used drugs. Compared with people who do not use drugs, both those who used only ENDS (Adjusted Odds Ratio (AOR) 1.11 [95% CI 0.99-1.23], P = 0.07758) and those who used only drugs (AOR 1.36 [95% CI 1.15-1.60], P = 0.00027) were more likely to experience adverse respiratory conditions. Individuals who used drugs and ENDS compared to people who did not use drugs or ENDS had the largest odds of respiratory problems among all drug use category comparisons (AOR 1.52 [95% CI 1.20-1.93], P = 0.00054). Individuals who only used drugs had elevated odds of cardiovascular ailments compared to people who did not use drugs or ENDS (AOR 1.24 [95% CI 1.08-1.42], P = 0.00214) and compared to people who only used ENDS (AOR 1.22 [95% CI 1.04-1.42], P = 0.0117). Conclusions Inhaling electronic nicotine delivery systems and other substances may negatively affect the users' respiratory health.
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Affiliation(s)
- Fares Qeadan
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, 2160 S 1st Ave, Maywood, IL 60153, USA
| | - Alexander Nicolson
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, 2160 S 1st Ave, Maywood, IL 60153, USA
| | - William A. Barbeau
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, 2160 S 1st Ave, Maywood, IL 60153, USA
| | - Sunday Azagba
- Nese College of Nursing, Penn State University, University Park, PA, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, NM, USA
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Jhanjee S, Charan D, Mishra AK, Kaloiya GS, Jain R, Dayal P. Effectiveness of smoking cessation intervention in opioid-dependent male subjects on buprenorphine maintenance treatment: An open-label trial. Ind Psychiatry J 2023; 32:164-171. [PMID: 37274578 PMCID: PMC10236678 DOI: 10.4103/ipj.ipj_35_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/17/2022] [Accepted: 05/03/2022] [Indexed: 11/04/2022] Open
Abstract
Background High prevalence (more than 80%) rates of tobacco smoking have been found both in, opioid-dependent subjects and among opioid-dependent subjects on opioid substitution treatment (OST) with buprenorphine or methadone. Aim We aimed to explore the efficacy of combined nicotine replacement therapy (NRT) and individual counseling (IC) when compared to NRT alone in subjects on OST with buprenorphine. Methods This study was carried out in a tertiary medical care center. It was an open-label randomized clinical trial. A total of 57 buprenorphine maintained smokers were recruited and randomized into two groups. They were assigned nicotine gum for 4 weeks plus either (1) a baseline IC session, and a second IC session after 1 week, or (2) simple advice to quit. In the first group, 31 subjects received NRT with IC and in the second group, 26 subjects received NRT plus simple advice to quit. The primary outcomes of this study were seven days point prevalence abstinence, biochemically confirmed by carbon monoxide (CO) breath analyzer, and reduction in smoking (mean no. of cigarettes or bidis/day). The smoking behavior during the 4 weeks follow-up period was assessed by the timeline follow-back (TLFB) method and confirmed by the CO breath analyzer. Results The group of subjects who received NRT with IC showed higher rates of smoking cessation at the end of treatment (51%) as compared to the NRT and simple advice group where smoking cessation rates were around 8% (P < 0.001). Conclusion A multi-component approach (pharmacotherapy and counseling) enhances treatment outcomes and enhances rates of abstinence from smoking.
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Affiliation(s)
- Sonali Jhanjee
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Charan
- Department of Psychiatry, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Ashwani K. Mishra
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Gauri Shankar Kaloiya
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Raka Jain
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhoo Dayal
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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Meng Z, Li Q, Ma Y, Liu C. Transcranial direct current stimulation of the frontal-parietal-temporal brain areas reduces cigarette consumption in abstinent heroin users. J Psychiatr Res 2022; 152:321-325. [PMID: 35785574 DOI: 10.1016/j.jpsychires.2022.06.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/10/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022]
Abstract
Transcranial direct current stimulation (tDCS) has been demonstrated to modulate neural activity and related brain functions. In clinical studies, tDCS has been shown to reduce craving in various substance use disorders including cocaine, heroin and nicotine. Our previous report suggested that cathodal tDCS on the frontal-parietal-temporal (FPT) brain areas reduced cigarette consumption in moderate smokers. However, whether it is effective in smokers with history of drug use is unknown. This study investigated the effects of bilateral FPT areas cathodal tDCS on smokers with history of heroin use. 22 abstinent heroin users were recruited and randomly assigned to sham group and tDCS group. The sham group received 30 s tDCS treatment and tDCS group received normal tDCS (one trial of 20 min, 1 mA, cathodal electrodes were placed bilaterally on the FPT areas). The average of daily cigarettes consumption was recorded for the week before the tDCS and the following day after tDCS. In addition, pupil light reflex was measured right before and after tDCS treatment. One trial of tDCS stimulation significantly reduced daily cigarette consumption in smokers who had heroin use history. This reducing effect was also observed in heavy smokers. In addition, this effect on cigarette consumption lasted at least 48 h after the stimulation. Furthermore, it has been shown that opiates decrease pupillary size in humans, we found detectable changes of the dynamic pupil light reflex after bilateral tDCS stimulation. These findings suggest that FPT cathodal tDCS may be an effective approach to reduce cigarette craving in heroin users.
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Affiliation(s)
- Zhiqiang Meng
- Shenzhen Key Laboratory of Drug Addiction, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518000, China; CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Shenzhen-Hong Kong Institute of Brain Sciences-Shenzhen Fundamental Research, Institutions, Shenzhen, 518000, China.
| | - Qing Li
- Shenzhen Key Laboratory of Drug Addiction, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518000, China; Medical School, Kunming University of Science and Technology, Kunming, China
| | - Yuanye Ma
- Medical School, Kunming University of Science and Technology, Kunming, China; Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
| | - Chang Liu
- Shenzhen Key Laboratory of Viral Vectors for Biomedicine, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518000, China; CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Shenzhen-Hong Kong Institute of Brain Sciences-Shenzhen Fundamental Research, Institutions, Shenzhen, 518000, China.
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Freda PJ, Kranzler HR, Moore JH. Novel digital approaches to the assessment of problematic opioid use. BioData Min 2022; 15:14. [PMID: 35840990 PMCID: PMC9284824 DOI: 10.1186/s13040-022-00301-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
The opioid epidemic continues to contribute to loss of life through overdose and significant social and economic burdens. Many individuals who develop problematic opioid use (POU) do so after being exposed to prescribed opioid analgesics. Therefore, it is important to accurately identify and classify risk factors for POU. In this review, we discuss the etiology of POU and highlight novel approaches to identifying its risk factors. These approaches include the application of polygenic risk scores (PRS) and diverse machine learning (ML) algorithms used in tandem with data from electronic health records (EHR), clinical notes, patient demographics, and digital footprints. The implementation and synergy of these types of data and approaches can greatly assist in reducing the incidence of POU and opioid-related mortality by increasing the knowledge base of patient-related risk factors, which can help to improve prescribing practices for opioid analgesics.
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Affiliation(s)
- Philip J Freda
- Cedars-Sinai Medical Center, Department of Computational Biomedicine, 700 N. San Vicente Blvd., Pacific Design Center Suite G540, West Hollywood, CA, 90069, USA.
| | - Henry R Kranzler
- University of Pennsylvania, Center for Studies of Addiction, 3535 Market St., Suite 500 and Crescenz VAMC, 3800 Woodland Ave., Philadelphia, PA, 19104, USA
| | - Jason H Moore
- Cedars-Sinai Medical Center, Department of Computational Biomedicine, 700 N. San Vicente Blvd., Pacific Design Center Suite G540, West Hollywood, CA, 90069, USA
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Felicione NJ, Ozga JE, Dino G, Berry JH, Sullivan CR, Blank MD. Timing of smoking cessation treatment integrated into outpatient treatment with medications for opioid use disorder: Feasibility trial. J Subst Abuse Treat 2022; 132:108579. [PMID: 34452780 PMCID: PMC8671242 DOI: 10.1016/j.jsat.2021.108579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/30/2021] [Accepted: 07/25/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Cigarette smoking rates among individuals with opioid use disorder (OUD) are notoriously high and may be improved by considering the timing of treatment integration for these two substances. The current study examined the feasibility of a method for assessing the timing of integrating smoking cessation pharmacotherapy within three different phases of outpatient treatment with medication for OUD (MOUD). METHODS Seventy-four buprenorphine-maintained smokers were enrolled in a quasi-experimental study across three MOUD treatment phases: 0-90 (Phase 1), 91-365 (Phase 2), and > 365 days of MOUD treatment (Phase 3). During a 12-week varenicline-based intervention, the study assessed outcomes daily via text messages (cigarette smoking, varenicline adherence, side effects) or monthly at in-person visits (quit motivation and carbon monoxide levels). RESULTS Thirty-five participants completed the study, with a lower retention rate in Phase 1 (37.5%) relative to Phases 2 (53.5%) or 3 (57.1%). A trend occurred for Phase 1 participants to report aversive side effects (e.g., abnormal dreams, gastrointestinal distress) on more study days. Among completers, adherence to text messaging and varenicline use was high and independent of MOUD treatment phase. Participants in all phases reported declines in cigarette smoking and increases in quit motivation over time; the study observed biochemically verified tobacco abstinence among only a few participants from Phases 2 or 3. CONCLUSIONS This feasibility study demonstrates a method to evaluate the timing of treatment integration for cigarette smoking and MOUD. Method strengths include a study schedule that coincided with the MOUD clinic schedule and use of text messaging to encourage varenicline adherence and evaluate outcomes regularly.
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Affiliation(s)
- Nicholas J. Felicione
- Psychology, West Virginia University, Morgantown, WV,Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Jenny E. Ozga
- Psychology, West Virginia University, Morgantown, WV,Behavioral Medicine & Psychiatry, West Virginia University School of Medicine, Morgantown, WV
| | - Geri Dino
- Social and Behavioral Sciences, West Virginia University School of Public Health, Morgantown, WV,West Virginia Prevention Research Center, West Virginia University School of Public Health, Morgantown, WV
| | - James H. Berry
- Behavioral Medicine & Psychiatry, West Virginia University School of Medicine, Morgantown, WV
| | - C. Rolly Sullivan
- Behavioral Medicine & Psychiatry, West Virginia University School of Medicine, Morgantown, WV
| | - Melissa D. Blank
- Psychology, West Virginia University, Morgantown, WV,West Virginia Prevention Research Center, West Virginia University School of Public Health, Morgantown, WV
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Ng SY, Chong JH, Mohd Mazlan MI, Lau BT. Illicit substance use among methadone maintenance therapy patients in a tertiary hospital in Malaysia: a cross-sectional study. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.2018733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Siew Yen Ng
- Department of Pharmacy, Hospital Tuanku Ja’afar Seremban, Ministry of Health Malaysia, Seremban, Malaysia
| | - Jian Hui Chong
- Department of Pharmacy, Hospital Tuanku Ja’afar Seremban, Ministry of Health Malaysia, Seremban, Malaysia
| | - Mohamad Ikhwan Mohd Mazlan
- Department of Pharmacy, Hospital Tuanku Ja’afar Seremban, Ministry of Health Malaysia, Seremban, Malaysia
| | - Boon-Tiang Lau
- Department of Pharmacy, Hospital Port Dickson, Ministry of Health Malaysia, Port Dickson, Malaysia
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Zvolensky MJ, Rogers AH, Garey L, Shepherd JM, Ditre JW. Opioid Misuse among Smokers with Chronic Pain: Relations with Substance Use and Mental Health. Behav Med 2021; 47:335-343. [PMID: 34719341 DOI: 10.1080/08964289.2020.1742642] [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: 10/24/2022]
Abstract
Opioid misuse is a significant public health concern with substantial medical, social, and economic costs. Cross cutting the personal and societal effects of this current crisis, opioid misuse is associated with poorer physical and mental health outcomes that impair function across numerous life domains. Importantly, opioid misuse disproportionately affects persons with chronic pain and individuals who smoke tobacco. Despite the higher risk for smokers with chronic pain to engage in opioid misuse, little work has examined how opioid misuse may be related to mental health problems, including other substance use, among this vulnerable group. The current study examined opioid misuse as a predictor of substance use and mental health problems among 187 (Mage = 39.02, SD = 9.94, 74.9% female) daily cigarette smokers with chronic pain who currently use opioids. Results indicated that opioid misuse is associated with greater tobacco (13% of variance), alcohol (27% of variance), and cannabis (22% of variance) problems, as well as anxiety (26% of variance) and depressive symptoms (26% of variance). These results highlight the potential importance of opioid misuse in terms of concurrent substance and mental health problems among smokers with chronic pain. Future work is needed to explicate directionality and temporal ordering in the observed relations.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,HEALTH Institute, University of Houston, Houston, Texas, USA
| | - Andrew H Rogers
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Justin M Shepherd
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, New York, USA
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Montgomery L, Winhusen T, Scodes J, Pavlicova M, Twitty D, Campbell ANC, Wang AL, Nunes EV, Rotrosen J. Reductions in tobacco use in naltrexone, relative to buprenorphine-maintained individuals with opioid use disorder: Secondary analysis from the National Drug Abuse Treatment Clinical Trials Network. J Subst Abuse Treat 2021; 130:108489. [PMID: 34118716 DOI: 10.1016/j.jsat.2021.108489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/10/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Smoking prevalence in individuals with opioid use disorder (OUD) is over 80%. Research suggests that opioid use significantly increases smoking, which could account for the strikingly low smoking-cessation rates observed in both methadone- and buprenorphine-maintained patients, even with the use of first-line smoking-cessation interventions. If opioids present a barrier to smoking-cessation, then better smoking outcomes should be observed in OUD patients treated with extended-release naltrexone (XR-NTX, an opioid antagonist) compared to those receiving buprenorphine (BUP-NX, a partial opioid agonist). METHODS The current study is a secondary analysis of a 24-week, multi-site, open-label, randomized clinical trial conducted within the National Drug Abuse Treatment Clinical Trials Network comparing the effectiveness of XR-NTX vs. BUP-NX for adults with OUD. Longitudinal mixed effects models were used to determine if there was a significant reduction in cigarette use among daily smokers successfully inducted to treatment (n = 373) and a subset of those who completed treatment (n = 169). RESULTS Among daily smokers inducted onto OUD medication, those in the XR-NTX group smoked fewer cigarettes per day (M = 11.36, SE = 0.62) relative to smokers in the BUP-NX group (M = 13.33, SE = 0.58) across all study visits, (b (SE) = -1.97 (0.55), p < .01). Results were similar for the treatment completers. CONCLUSIONS OUD patients treated with XR-NTX reduced cigarette use more than those treated with BUP-NX, suggesting that XR-NTX in combination with other smoking cessation interventions might be a better choice for OUD smokers interested in reducing their tobacco use.
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Affiliation(s)
- LaTrice Montgomery
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA.
| | - Theresa Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Jennifer Scodes
- Division of Mental Health Data Science, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY 10032, USA
| | - Dylanne Twitty
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
| | - An Li Wang
- Addiction Institute of Addiction of Mount Sinai, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1399 Park Ave, New York, NY 10029, USA
| | - Edward V Nunes
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
| | - John Rotrosen
- Department of Psychiatry, NYU Grossman School of Medicine, One Park Avenue, New York, NY 10016, USA
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Freda PJ, Moore JH, Kranzler HR. The phenomics and genetics of addictive and affective comorbidity in opioid use disorder. Drug Alcohol Depend 2021; 221:108602. [PMID: 33652377 PMCID: PMC8059867 DOI: 10.1016/j.drugalcdep.2021.108602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/21/2022]
Abstract
Opioid use disorder (OUD) creates significant public health and economic burdens worldwide. Therefore, understanding the risk factors that lead to the development of OUD is fundamental to reducing both its prevalence and its impact. Significant sources of OUD risk include co-occurring lifetime and current diagnoses of both psychiatric disorders, primarily mood disorders, and other substance use disorders, and unique and shared genetic factors. Although there appears to be pleiotropy between OUD and both mood and substance use disorders, this aspect of OUD risk is poorly understood. In this review, we describe the prevalence and clinical significance of addictive and affective comorbidities as risk factors for OUD development as a basis for rational opioid prescribing and OUD treatment and to improve efforts to prevent the disorder. We also review the genetic variants that have been associated with OUD and other addictive and affective disorders to highlight targets for future study and risk assessment protocols.
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Affiliation(s)
- Philip J. Freda
- University of Pennsylvania, Biostatistics, Epidemiology, & Informatics, The Perelman School of Medicine, University of Pennsylvania A201 R…, Philadelphia, Pennsylvania 19104, United States
| | - Jason H. Moore
- Edward Rose Professor of Informatics, Director, Institute for Biomedical Informatics, Director, Division of Informatics, Department of Biostatistics, Epidemiology, & Informatics, Senior Associate Dean for Informatics, The Perelman School of Medicine, University of Pennsylvania, Contact Information: D202 Richards Building, 3700 Hamilton Walk, University of Pennsylvania, Philadelphia, PA 19104-6116
| | - Henry R. Kranzler
- Benjamin Rush Professor in Psychiatry, Department of Psychiatry, University of Pennsylvania, Treatment Research Center, 3535 Market Street, Suite 500, Philadelphia, PA 19104-6178
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13
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Reciprocal influences of tobacco use on illicit opioid and alcohol use during the first six-months of specialist addiction treatment. Drug Alcohol Depend 2021; 218:108418. [PMID: 33262003 DOI: 10.1016/j.drugalcdep.2020.108418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/23/2020] [Accepted: 11/12/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND This is the first national study of lagged reciprocal associations between tobacco smoking frequency and change in illicit opioid or alcohol use frequency within six-months of treatment. METHODS All adults admitted to publicly-funded specialist addiction treatment in England in 2018/19 and enrolled for at least six months for either opioid use disorder (OUD; n = 22,046; 82.4 % of those eligible) or alcohol use disorder (AUD; n = 15,251; 78.8 % of those eligible). Two cross-lagged panel models estimated, separately for OUD and AUD patients, the relationships between smoking at admission and change in main drug over six months, and between main drug use at admission and change in smoking over six months. RESULTS Within the OUD cohort, illicit opioid use frequency reduced from 17.7 days to 8.0 days and smoking tobacco remained at 18.8 days. After controlling for available covariates, higher smoking frequency at admission was associated with a relative increase in illicit opioid use at six-months (0.02 days [95 % CI 0.00-0.03]). Within the AUD cohort, alcohol use frequency reduced from 21.2 days to 14.4 days while smoking tobacco reduced from 12.6 days to 11.5 days. Higher smoking frequency at admission was associated with a relative increase in alcohol use at six-months (0.03 days [95 % CI 0.02-0.04]) and higher alcohol use frequency at admission was associated with a relative increase in smoking at six-months (0.04 [95 % CI 0.02-0.06]), controlling for available covariates. CONCLUSIONS Higher smoking frequency at admission is associated with higher illicit opioid and alcohol use frequency after six-months of specialist addiction treatment.
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14
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Ainscough TS, Brose LS, Strang J, McNeill A. Contingency management for tobacco smoking during opioid addiction treatment: Implementation challenges. Drug Alcohol Rev 2020; 40:658-661. [PMID: 33233020 DOI: 10.1111/dar.13216] [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: 07/20/2020] [Revised: 10/05/2020] [Accepted: 10/28/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Tobacco smoking prevalence in opioid addiction patients is approximately six times that of the general population, highlighting the need for novel interventions. A pilot/feasibility study was conducted to investigate whether a contingency management (CM) intervention could be added to UK standard smoking cessation treatment. The aim of this report is to describe the challenges experienced during the implementation of this CM intervention. DESIGN AND METHODS A two-armed, randomised, pilot/feasibility study of a 5-week escalating with reset CM intervention, conducted as an adjunct to smoking cessation treatment in an outpatient drug and alcohol treatment centre. RESULTS Forty participants were recruited, but only 19 attended the baseline session. Ten participants attended all treatment sessions (25% retention), with only one contactable at 6-month follow-up. While smoking cessation clinic engagement was higher than previously, implementation issues included limited operating hours of the smoking treatment clinic, ineffective biochemical verification of abstinence and overly restrictive inclusion criteria. DISCUSSION AND CONCLUSIONS This study highlighted not only the difficulty of integrating CM interventions into standard smoking cessation treatment for this population, but also the potential of CM to engage this group with smoking cessation treatment. Future research in this area should consider increasing the availability and flexibility of smoking cessation treatment, and relaxing inclusion criteria to be more reflective of the opioid-treatment-seeking population. This study is registered on ClinicalTrials.gov (NCT03015597, https://clinicaltrials.gov/ct2/show/NCT03015597).
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Affiliation(s)
- Tom S Ainscough
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Leonie S Brose
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
| | - John Strang
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, Beckenham, UK
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
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15
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Life expectancy of people who are dependent on opioids: A cohort study in New South Wales, Australia. J Psychiatr Res 2020; 130:435-440. [PMID: 32905957 DOI: 10.1016/j.jpsychires.2020.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/20/2020] [Accepted: 08/14/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND People who are dependent on opioids have increased risk of premature death, but there are few estimates of life expectancy. METHODS We calculated age-specific mortality rates in a cohort of people who had at least one prescription of an opioid agonist (methadone or buprenorphine) between 2001 and 2018 in New South Wales, Australia. We used life tables to estimate life expectancy at age 18. We also estimated the potential years of life lost before age 75, decomposed by cause of death. RESULTS The cohort included 47,197 people, with a median of 9.8 years of follow-up. 5097 participants died, and the standardised mortality ratio (compared to the general population of New South Wales) was 6.06 (95% CI 5.90-6.23). Life expectancy at age 18 was an additional 47.5 years (95% CI 42.9-50.5) for men and 50.7 years (95% CI 45.4-54.8) for women; deficits of 14.7 and 15.8 years respectively when compared to the general population. The largest cause of death was non-communicable physical diseases, which accounted for 47% of deaths in life tables for men and 42% for women. Drug-related deaths accounted for 16% of deaths for men and 19% for women, but due to the young age at which these deaths occur, they contributed approximately one third of potential years of life lost. CONCLUSION In common with people with serious mental illnesses, people who are dependent on opioids have substantially reduced life expectancy. In both populations most excess deaths relate to non-communicable physical diseases.
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Abstract
The U.S. is in the midst of an opioid epidemic. At the same time, tobacco use remains the leading cause of preventable death and disability. While the shared biological underpinnings of nicotine and opioid addiction are well established, clinical implications for co-treatment of these two substance use disorders has not been emphasized in the literature, nor have researchers, clinicians, and policy makers adequately outlined pathways for incorporating co-treatment into existing clinical workflows. The current brief review characterizes the metabolic and neural mechanisms which mediate co-use of nicotine and opioids, and then outlines clinical and policy implications for concurrently addressing these two deadly epidemics. Screening, assessment, medication-assisted treatment (MAT), and tobacco-free policy are discussed. The evidence suggests that clinical care and policies that facilitate co-treatment are an expedient means of delivering healthcare to individuals that result in better health for the population while also meeting patients' substance abuse disorder recovery goals.
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Affiliation(s)
- Chad D Morris
- University of Colorado, Anschutz Medical Campus, 1784 Racine Street, Campus Box F478, Building 401, Aurora, CO, 80045, USA.
| | - Christine E Garver-Apgar
- University of Colorado, Anschutz Medical Campus, 1784 Racine Street, Campus Box F478, Building 401, Aurora, CO, 80045, USA
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17
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Gong H, Zhang Y, Ren Q, Zhou Z, Zhou H, Sun X, Zhang C, Voon V, Zhao M, Yu S. The Chinese version of obsessive compulsive drug use scale: validation in outpatient methadone maintenance treatment program. BMC Psychiatry 2020; 20:465. [PMID: 32977774 PMCID: PMC7517618 DOI: 10.1186/s12888-020-02843-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Obsessive Compulsive Drug Use Scale (OCDUS) measures the overall craving level within a period from a multidimensional perspective. However, no studies have addressed the validity of the new OCDUS factor structure, presented in 2016, in China. Additionally, there is lack of evidence on the interaction among risk factors for relapse. We aimed to assess the psychometric properties of the scores of the Chinese version of the OCDUS in patients with heroin dependence receiving methadone maintenance treatment (MMT). Further, we aimed to assess the correlations of the OCDUS scores with withdrawal symptoms, depression, anxiety, and nicotine dependence. METHODS We enrolled 113 adults (age 32-64 years) and administered them with the OCDUS, Subjective Opioid Withdrawal Scale (SOWS), Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory (STAI), and Fagerstrom Test for Nicotine Dependence (FTND). RESULTS Exploratory factor analysis identified a 3-dimensional component that included "Frequency of craving," "Inference of heroin," and "Control of heroin." These factors showed acceptable internal consistency, adequate item-total correlations, and significant item-subscale correlations. There was no correlation between the OCUDS scores and age, education, duration of receiving MMT, and MMT dosages. However, there was a significant correlation between the OCDUS total scores and the SOWS, STAI, BDI-II, and FTND scores. The scores of all the subscales were associated with the SOWS scores; further, the scores of the first two subscales were associated with BDI-II scores while only the scores of the first subscale were associated with the FTND scores. CONCLUSIONS Our findings support the reliability and structure validity of the OCDUS scores. Heroin craving, withdrawal symptoms, negative emotions, and nicotine dependence, which are considered as risk factors for heroin relapse, might interact with each other. There is a need for further studies on the underlying mechanism of these clinical phenomena.
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Affiliation(s)
- Hengfen Gong
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.24516.340000000123704535Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Yingying Zhang
- grid.16821.3c0000 0004 0368 8293Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qihuan Ren
- grid.415630.50000 0004 1782 6212Department of Clinical Psychology, Shanghai Hongkou Mental Health Center, Shanghai, China
| | - Zhirong Zhou
- Department of Functional Clinic of the Community Based Methadone Maintenance Therapy, Shanghai Xuhui Mental Health Center, Shanghai, China
| | - Huijing Zhou
- Department of Drug Dependence, Shanghai Yangpu Mental Health Center, Shanghai, China
| | - Xirong Sun
- grid.24516.340000000123704535Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- grid.16821.3c0000 0004 0368 8293Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Valerie Voon
- grid.5335.00000000121885934Department of Psychiatry and Behavioral and Clinical Neurosciences Institute, University of Cambridge, Cambridge, UK
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China. .,Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China.
| | - Shunying Yu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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18
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Wang AL, Shi Z, Elman I, Langleben DD. Reduced cigarette smoking during injectable extended-release naltrexone treatment for opioid use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:472-477. [PMID: 32379516 DOI: 10.1080/00952990.2020.1741001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The prevalence of tobacco cigarette smoking in the US has declined to approximately 15%, yet, it remains over 90% among individuals with opioid use disorder regardless of whether they are currently using opioids illicitly or as opioid substitution therapy. This disparity raises the question of whether opioids facilitate smoking among individuals with opioid use disorder and whether opioid antagonists may reduce it. OBJECTIVES Determine whether injectable extended-release naltrexone (XR-NTX) treatment of opioid use disorder patients is associated with a spontaneous smoking reduction. We hypothesized that treatment with XR-NTX for would lead to a reduction in smoking in tobacco cigarette smokers with opioid use disorder. METHODS We analyzed data from 64 tobacco cigarette smokers (38% female) with opioid use disorder who were induced on XR-NTX for prevention of relapse to opioids. The number of cigarettes smoked per day and opioid-related craving and withdrawal were assessed at baseline and during treatment. RESULTS Smoking was reduced from 14.4 ± 1.0 to 9.8 ± 1.0(p < 0.001) cigarettes per day after one month and 8.6 ± 1.1 cigarettes per day after two months of treatment. Daily cigarette consumption was positively correlated with the pre-treatment frequency of opioid use and opioid-related craving during the XR-NTX treatment. CONCLUSIONS XR-NTX treatment in smokers with opioid use disorder was associated with a 29% decline in daily cigarette consumption. Together with prior evidence of increased smoking during opioid agonist therapy, our finding suggests a pharmacodynamic interaction between nicotine and opioid systems that could influence treatment choices in this population. Our findings merit confirmation in a prospective controlled study. (NCT02324725 and NCT01587196).
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Affiliation(s)
- An-Li Wang
- Addiction Institute of Mount Sinai, Icahn School of Medicine at Mount Sinai , New York, NY, USA
| | - Zhenhao Shi
- Center for Studies of Addiction, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA, USA
| | - Igor Elman
- Center for Pain and the Brain, Boston Children's Hospital , Boston, MA, USA
| | - Daniel D Langleben
- Center for Studies of Addiction, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA, USA
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19
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Sharareh P, Leili T, Abbas M, Jalal P, Ali G. Determining correlates of the average number of cigarette smoking among college students using count regression models. Sci Rep 2020; 10:8874. [PMID: 32483160 PMCID: PMC7264191 DOI: 10.1038/s41598-020-65813-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/27/2020] [Indexed: 11/18/2022] Open
Abstract
College students, as a large part of young adults, are a vulnerable group to several risky behaviors including smoking and drug abuse. This study aimed to utilize and to compare count regression models to identify correlates of cigarette smoking among college students. This was a cross-sectional study conducted on students of Hamadan University of Medical Sciences. The Poisson, negative binomial, generalized Poisson, exponentiated-exponential geometric regression models and their zero-inflated counterparts were fitted and compared using the Vuong test (α = 0.05). A number of 1258 students participated in this study. The majority of students were female (60.8%) and their average age was 23 years. Most of the students were non-smokers (84.6%). Negative binomial regression was selected as the most appropriate model for analyzing the data (comparable fit and simpler interpretation). The significant correlates of the number of cigarettes smoked per day included gender (male: incident-rate-ratio (IRR = 9.21), birth order (Forth: IRR = 1.99), experiencing a break-up (IRR = 2.11), extramarital sex (heterosexual (IRR = 2.59), homosexual (IRR = 3.13) vs. none), and drug abuse (IRR = 5.99). Our findings revealed that several high-risk behaviors were associated with the intensity of smoking, suggesting that these behaviors should be considered in smoking cessation intervention programs for college students.
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Affiliation(s)
- Parami Sharareh
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Tapak Leili
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Moghimbeigi Abbas
- Department of Biostatistics, School of Public health, Alborz University of Medical Sciences, Alborz, Iran
| | - Poorolajal Jalal
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ghaleiha Ali
- Department of Psychiatry, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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20
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Moey CH, Yee A, Muhamud Kayat SB. Tobacco use disorder: Prevalence, associated factors and its influence on quality of life among patients on methadone assisted treatment. J Addict Dis 2020; 38:263-270. [PMID: 32329412 DOI: 10.1080/10550887.2020.1748990] [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: 10/24/2022]
Abstract
Background and Objectives: Smoking is the primary cause of preventable death and is highly prevalent among patients on methadone assisted treatment (MAT). This study aims to assess the prevalence of tobacco use disorder (TUD) among patients on MAT, the factors associated with TUD, and to examine the association between TUD and quality of life.Methods: A total of 171 male patients receiving MAT in two Malaysian government hospitals were assessed for TUD, levels of nicotine dependence, relevant associated factors and quality of life using DSM-5 criteria, Fagerström Test for Nicotine Dependence (FTND), Opiate Treatment Index (OTI), Mini-International Neuropsychiatric Interview (M.I.N.I.) and World Health Organization Quality of Life (WHOQOL)-BREF.Results: The prevalence of TUD was 81.3%. Being employed was significantly associated with having a TUD. Among the patients with TUD, the mean FTND score was 3.8 (SD ± 2.0). Being younger, having poorer social function, and presence of current opioid dependence were significantly correlated with higher FTND scores. There was no significant difference in the quality of life between patients with and without TUD. Following multiple linear regression analysis, being unmarried and poor health status were the two factors that significantly predicted a lower quality of life in all four domains of WHOQOL-BREF.Conclusions: Given the high prevalence of TUD among methadone-assisted patients, smoking cessation treatment should be integrated into the MAT program in Malaysia. Also, addressing patients' marital and health issues during MAT can be instrumental in improving their quality of life.
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Affiliation(s)
- Chee Hoong Moey
- Department of Psychological Medicine Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Anne Yee
- Department of Psychological Medicine, University Malaya Centre of Addiction Science (UMCAS), Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
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21
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Abstract
While prevalence of tobacco use in the US general population is declining, prevalence among those with opioid use disorder (OUD) remains high and results in excessive tobacco-related disease and premature mortality. Among smokers with OUD, tobacco cessation rates are negligible without treatment. However, both low-intensity behavioral interventions and more intensive motivational interventions yield negligible cessation rates. While contingency management has potent short-term cessation effects, effects are not maintained at post-intervention follow-up. Evidence-based smoking cessation pharmacotherapies, such as nicotine replacement therapy, bupropion, and varenicline, result in very modest cessation rates among smokers with OUD. Intensification of pharmacotherapy, such as high-dose and combination nicotine replacement therapy or extended medication treatment, has failed to improve cessation outcomes compared with standard treatment regimens. Targeting the unique challenges faced by smokers with OUD, including nicotine-opioid interactions and poor medication adherence, has potential to improve cessation outcomes, but further research is needed to optimize intervention efficacy among smokers with OUD.
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22
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Hall SM, Humfleet GL, Gasper JJ, Delucchi KL, Hersh DF, Guydish JR. Cigarette Smoking Cessation Intervention for Buprenorphine Treatment Patients. Nicotine Tob Res 2019; 20:628-635. [PMID: 28549161 PMCID: PMC7207071 DOI: 10.1093/ntr/ntx113] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 05/22/2017] [Indexed: 12/03/2022]
Abstract
Introduction Patients receiving medication assisted therapy (MAT) for opioid use disorder have high cigarette smoking rates. Cigarette smoking interventions have had limited success. We evaluated an intervention to increase cigarette abstinence rates in patients receiving buprenorphine-assisted therapy. Methods Cigarette smokers (N = 175; 78% male; 69% Caucasian; 20% Hispanic), recruited from a buprenorphine clinic were randomly assigned to either an extended innovative system intervention (E-ISI) or to Standard Treatment Control (STC). The E-ISI combined motivational intervention with extended treatment (long-term nicotine replacement therapy , varenicline, and extended cognitive behavioral therapy). STC received written information about quit-lines, medication, and resources. Assessments were held at baseline and 3, 6, 12, and 18 months. Seven-day biochemically verified point-prevalence cigarette abstinence was the primary outcome measure. Results Fifty-four percent of E-ISI participants entered the extended treatment intervention; E-ISI and STC differed at 3 months on abstinence status but not at months 6, 12, and 18. E-ISI participants were more likely to attempt to quit, to have a goal of complete abstinence, and to be in a more advanced stage of change than STC participants. A higher number of cigarettes smoked and the use of cannabis in the previous 30 days predicted continued smoking Conclusions The E-ISI was successful in increasing motivation to quit smoking but did not result in long-term abstinence. The failure of treatments that have been efficacious in the general population to produce abstinence in patients receiving MAT of opioid use disorder suggests that harm reduction and other innovative interventions should be explored. Implications This study demonstrates that an intervention combining motivational interviewing with an extended treatment protocol can increase cigarette quit attempts, enhance cigarette abstinence goals, and further movement through stages of change about quitting smoking in patients receiving MAT for opioid use disorder who smoke cigarettes. The intervention did not increase abstinence rates over those observed in a standard treatment control, however. The latter finding supports those of earlier investigators who also failed to find efficacy for smoking cessation in this population and who also used interventions effective in the general population. This pattern of findings suggests that patients with opioid use disorder can be motivated to change smoking behavior, but alternative and innovative approaches to cigarette smoking treatment should be studied.
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Affiliation(s)
- Sharon M Hall
- Department of Psychiatry, University of California, San Francisco, CA
| | - Gary L Humfleet
- Department of Psychiatry, University of California, San Francisco, CA
| | - James J Gasper
- California Department of Health Care Services, Sacramento, CA
| | - Kevin L Delucchi
- Department of Psychiatry, University of California, San Francisco, CA
| | | | - Joseph R Guydish
- Philip R. Lee institute for Health Policy studies, University of California, San Francisco, CA
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Montbriand JJ, Weinrib AZ, Azam MA, Ladak SSJ, Shah BR, Jiang J, McRae K, Tamir D, Lyn S, Katznelson R, Clarke HA, Katz J. Smoking, Pain Intensity, and Opioid Consumption 1-3 Months After Major Surgery: A Retrospective Study in a Hospital-Based Transitional Pain Service. Nicotine Tob Res 2019; 20:1144-1151. [PMID: 28472423 DOI: 10.1093/ntr/ntx094] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 05/01/2017] [Indexed: 12/25/2022]
Abstract
Introduction The present study investigated the associations between smoking, pain, and opioid consumption in the 3 months after major surgery in patients seen by the Transitional Pain Service. Current smoking status and lifetime pack-years were expected to be related to higher pain intensity, more opioid use, and poorer opioid weaning after surgery. Methods A total of 239 patients reported smoking status in their presurgical assessment (62 smokers, 92 past smokers, and 85 never smokers). Pain and daily opioid use were assessed in hospital before postsurgical discharge, at first outpatient visit (median of 1 month postsurgery), and at last outpatient visit (median of 3 months postsurgery). Pain was measured using numeric rating scale. Morphine equivalent daily opioid doses were calculated for each patient. Results Current smokers reported significantly higher pain intensity (p < .05) at 1 month postsurgery than never smokers and past smokers. Decline in opioid consumption differed significantly by smoking status, with both current and past smokers reporting a less than expected decline in daily opioid consumption (p < .05) at 3 months. Decline in opioid consumption was also related to pack-years, with those reporting higher pack-years having a less than expected decline in daily opioid consumption at 3 months (p < .05). Conclusions Smoking status may be an important modifiable risk factor for pain intensity and opioid use after surgery. Implications In a population with complex postsurgical pain, smoking was associated with greater pain intensity at 1 month after major surgery and less opioid weaning 3 months after surgery. Smoking may be an important modifiable risk factor for pain intensity and opioid use after surgery.
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Affiliation(s)
- Janice J Montbriand
- Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, University of Toronto, Ontario, Canada
| | - Aliza Z Weinrib
- Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, University of Toronto, Ontario, Canada.,Department of Psychology, York University, Toronto, Ontario, Canada
| | - Muhammad A Azam
- Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, University of Toronto, Ontario, Canada.,Department of Psychology, York University, Toronto, Ontario, Canada
| | - Salima S J Ladak
- Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, University of Toronto, Ontario, Canada
| | - B R Shah
- Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, University of Toronto, Ontario, Canada
| | - Jiao Jiang
- Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, University of Toronto, Ontario, Canada
| | - Karen McRae
- Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, University of Toronto, Ontario, Canada
| | - Diana Tamir
- Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, University of Toronto, Ontario, Canada
| | - Sheldon Lyn
- Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, University of Toronto, Ontario, Canada
| | - Rita Katznelson
- Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, University of Toronto, Ontario, Canada
| | - Hance A Clarke
- Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, University of Toronto, Ontario, Canada
| | - Joel Katz
- Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, University of Toronto, Ontario, Canada.,Department of Psychology, York University, Toronto, Ontario, Canada
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Kathuria H, Seibert RG, Cobb V, Herbst N, Weinstein ZM, Gowarty M, Jhunjhunwala R, Helm ED, Wiener RS. Perceived barriers to quitting cigarettes among hospitalized smokers with substance use disorders: A mixed methods study. Addict Behav 2019; 95:41-48. [PMID: 30836208 DOI: 10.1016/j.addbeh.2019.02.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 02/16/2019] [Accepted: 02/17/2019] [Indexed: 12/25/2022]
Abstract
AIMS Smoking cessation may promote long-term recovery in patients with substance use disorders (SUD). Yet smoking rates remain alarmingly high in this population. Using a sequential explanatory mixed methods approach, we examined smoking rates among hospitalized patients with SUD at a large safety-net hospital, and then characterized factors associated with smoking behaviors both quantitatively and qualitatively. METHOD We abstracted data from all hospital admissions (7/2016-6/2017) and determined demographics, substance use type, and other characteristics associated with cigarette use among those with SUD. We then conducted semi-structured qualitative interviews with 20 hospitalized SUD smokers. We analyzed transcripts to characterize factors that affect patients' smoking habits, focusing on the constructs of the Health Belief Model. RESULTS The prevalence of cigarette smoking among hospitalized smokers with SUD was three times higher than those without SUD. Qualitative analyses showed that patients perceived that smoking cigarettes was a less serious concern than other substances. Some patients feared that quitting cigarettes could negatively impact their recovery and perceived that clinicians do not prioritize treating tobacco dependence. Almost all patients with heroin use disorder described how cigarette use potentiated their heroin high. Many SUD patients are turning to vaping and e-cigarettes to quit smoking. CONCLUSION Hospitalized patients with SUD have disproportionately high smoking rates and perceive multiple barriers to quitting cigarettes. When designing and implementing smoking cessation interventions for hospitalized patients with SUD, policymakers should understand and take into account how patients with SUD perceive smoking-related health risks and how that influences their decision to quit smoking.
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Affiliation(s)
- Hasmeena Kathuria
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States of America.
| | - Ryan G Seibert
- Division of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States of America
| | - Vinson Cobb
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States of America
| | - Nicole Herbst
- Division of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States of America
| | - Zoe M Weinstein
- Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, Boston, MA, United States of America
| | - Minda Gowarty
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States of America
| | - Reha Jhunjhunwala
- Program of Clinical Investigation, Boston University School of Medicine, Boston, MA, United States of America
| | - Eric D Helm
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States of America
| | - Renda Soylemez Wiener
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States of America; Center for Healthcare Organization & Implementation Research, ENRM VA Hospital, Bedford, MA, United States of America
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Cosci F, Mansueto G, Zamboni L, Lugoboni F. Cigarette smoking in subjects maintained with methadone or buprenorphine: The role of psychiatric symptoms and psychological distress. J Psychosom Res 2019; 122:82-87. [PMID: 31003855 DOI: 10.1016/j.jpsychores.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The relationship between cigarette smoking, psychiatric symptoms/psychological distress in subjects maintained with methadone or buprenorphine was studied. METHODS 1049 subjects with a diagnosis of heroin use disorder were enrolled. The Symptom Checklist-90-Revised (SCL-90-R) and the General Health Questionnaire-12 (GHQ-12) were administered. The analyses were run in the whole sample and stratified for substitution therapies. RESULTS In the whole sample as well as among subjects maintained with methadone, the number of cigarettes smoked daily was associated with SCL-90-R Global score (whole sample: p = 0.001; ΔR2 = 0.012; subjects maintained with methadone: p ≤ 0.001; ΔR2 = 0.019) and with GHQ-12 (whole sample: p = 0.001; ΔR2 = 0.013; subjects maintained with methadone: p = 0.01; ΔR2 = 0.010) while among subjects maintained with buprenorphine, the number of cigarettes smoked daily was associated with SCL-90-R Global score (p = 0.05; ΔR2 = 0.020). CONCLUSION Psychiatric symptoms were associated with the number of cigarettes smoked daily among subjects maintained with methadone and among those maintained with buprenorphine, thus deserving clinical attention.
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Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy; Department of Psychiatry & Psychology, University of Maastricht, Maastricht, the Netherlands.
| | - Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy; Department of Psychiatry & Psychology, University of Maastricht, Maastricht, the Netherlands
| | - Lorenzo Zamboni
- Addiction Unit, Verona University Hospital, piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - Fabio Lugoboni
- Addiction Unit, Verona University Hospital, piazzale Aristide Stefani 1, 37126 Verona, Italy
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Shahraki G, Sedaghat Z, Fararouei M. Family and social predictors of substance use disorder in Iran: a case-control study. Subst Abuse Treat Prev Policy 2019; 14:17. [PMID: 31060577 PMCID: PMC6501311 DOI: 10.1186/s13011-019-0201-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/20/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The problem of substance use disorder in Iran is of great national concern. The aim of this study was to measure the association between substance use disorder and demographic, social and behavioral factors in Yasuj city, located at southwest of Iran. METHODS As the second phase of a previously published study, this case-control study was conducted in 2015-2016 on 362 addicted participants and 207 controls (with no history of substance use disorder). The control group was selected from male hospital visitors in Yasuj city during the same period of selection of the case group. The required information was collected via a self-administered questionnaire. RESULTS Based on the results of multivariate analysis, significant associations were found between the number of sisters (OR = 0.82, 95%CI = 0.68 to 0.99, P = 0.04), history of smoking (ORyes/no = 19.89, 95%CI = 10.02 to 39.49, P < 0.001), leisure time activity (ORwith friends/home = 8.98, 95%CI = 3.99 to 20.19, P < 0.001) and substance use disorder. CONCLUSION This study introduced smoking, number of sisters, education and way of spending leisure time as predictors of substance use disorder. Among these factors, smoking was the most powerful risk factor and spending leisure time with family and having sister were the most powerful preventive factors for substance use disorder.
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Affiliation(s)
- Gholamhossein Shahraki
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Zahra Sedaghat
- Research Center for Health Sciences, Department Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Fararouei
- HIV/AIDs Research Center, Shiraz University of Medical Sciences, Zand Street, Shiraz, 7143854188 Iran
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Self-Rated Physical Health and Unmet Healthcare Needs among Swedish Patients in Opioid Substitution Treatment. JOURNAL OF ADDICTION 2019; 2019:7942145. [PMID: 31139491 PMCID: PMC6500657 DOI: 10.1155/2019/7942145] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/25/2019] [Indexed: 01/16/2023]
Abstract
Background Individuals with opioid dependence are at increased risk of deteriorating health due to the lifestyle connected to heroin use. Barriers surrounding the healthcare system seem to hinder patients to seek help through conventional healthcare, even after entering opioid substitution treatment (OST), resulting in a high level of unmet healthcare needs. However, this field is still unexplored, with only a few studies focusing on general health within this population. The first step, in order to provide suitable and accessible primary healthcare, is to assess the extent of physical symptoms and unmet healthcare needs within the OST population, which, to this point, has been sparsely studied. Aim To assess OST patients' self-rated physical health and healthcare seeking behaviour. Methods Two-hundred and eighteen patients from four different OST sites answered a questionnaire regarding physical health and healthcare seeking. Results Patients in OST have a high degree of physical symptoms and a high degree of unmet healthcare needs. Sixty-six percent reported suffering from musculoskeletal pain. Fifty-six percent reported gastrointestinal symptoms. Genital problems and airway symptoms were reported by 47%, respectively, and dental problems were reported by 69% of the respondents. General unmet healthcare needs were reported by 82%. Musculoskeletal pain was positively correlated with having an unstable housing situation (AOR 4.26 [95% CI 1.73-10.48]), negatively correlated with male sex (AOR 0.45 [95% CI 0.22-0.91]), and positively correlated with age (AOR 1.04 [95% CI 1.01-1.07]). No statistically significant correlates of respiratory, gastrointestinal, genital, or dental symptoms were found. Conclusion Patients in OST carry a heavy burden of physical symptoms and unmet healthcare needs, potentially due to societal barriers. Patients' frequent visits to the OST clinics offer a unique opportunity to build a base for easily accessible on-site primary healthcare.
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Felicione NJ, Enlow P, Elswick D, Long D, Sullivan C, Blank MD. A pilot investigation of the effect of electronic cigarettes on smoking behavior among opioid-dependent smokers. Addict Behav 2019; 91:45-50. [PMID: 30006020 DOI: 10.1016/j.addbeh.2018.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/28/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Compared to the general population, smoking rates are 2-4 times higher among individuals with opioid use disorders (OUDs). These smokers also have poor long-term cessation rates, even with pharmacotherapy or other interventions. Low success rates with traditional approaches may prompt smokers with OUDs to try more novel products like electronic cigarettes (ECIGs). This pilot study was designed to examine the feasibility, acceptability, and effect of ECIGs on smoking behavior among smokers with OUD. METHODS Participants (N = 25) were daily smokers receiving buprenorphine/naloxone for OUD at an outpatient clinic. They were randomized to use a second-generation ECIG (0 or 18 ng/ml nicotine) ad libitum for two weeks while completing assessments via text messaging daily, and also via in-person visits at baseline, end of the two-week intervention, and a 4-week follow-up. RESULTS Feasibility was evidenced by high enrollment (93.9%) and retention (70.9%) rates. ECIG adherence was relatively high as measured by self-report (80.6% active, 91.7% placebo), while the average volume of liquid used per week was low (~3 ml). Both ECIG doses produced reductions in self-reported cigarettes per day that were not supported by average carbon monoxide levels. Biologically-confirmed smoking abstinence was observed in 8% of participants. CONCLUSIONS Preliminary results suggest that smokers with OUD are interested in using ECIGs, but their adherence may be less than ideal. Poor medication adherence rates are often observed in this disparate population, and future work should consider the use of other ECIG device types and a combination of methods to verify and quantify ECIG use.
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Zhong BL, Xu YM, Xie WX, Lu J. Cigarette Smoking Is Significantly Linked to Sexual Dissatisfaction in Chinese Heroin-Dependent Patients Receiving Methadone Maintenance Treatment. Front Psychiatry 2019; 10:306. [PMID: 31178762 PMCID: PMC6538806 DOI: 10.3389/fpsyt.2019.00306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/17/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Cigarette smoking is associated with sexual dysfunction in the general population. Both smoking and sexual dysfunction are common in heroin-dependent patients (HDPs) receiving methadone maintenance treatment (MMT), but their association in MMT HDPs is rarely studied. This study examined the association between smoking and sexual dissatisfaction in Chinese HDPs receiving MMT. Methods: In total, 480 Chinese HDPs, who had sex with their regular or irregular sex partners within one month prior to the study, were included from three MMT clinics in Wuhan, China. Sexual dissatisfaction was assessed with one single question. Socio-demographic and clinical data and smoking characteristics were collected with a standardized questionnaire. Multiple binary logistic regression was used to analyze the association between smoking and sexual dissatisfaction, as well as the associations between levels of smoking and nicotine dependence and sexual dissatisfaction. Results: The prevalence of current smoking was 95.6% in HDPs receiving MMT. Rates of sexual dissatisfaction were higher in current smokers than non-smokers (32.9% vs. 14.3%) with a borderline significant P value of 0.074. After adjusting potential socio-demographic and clinical confounders, current smoking was significantly linked to sexual dissatisfaction (OR = 1.95, P = 0.026), and heavy smoking and severe nicotine dependence were significantly linked to sexual dissatisfaction (OR = 1.80, P = 0.025; OR = 3.27, P < 0.001). Conclusion: Smoking is significantly associated with sexual dysfunction in HDPs receiving MMT. It deserves further investigation as to whether quitting smoking can improve the sexual function of methadone-maintained patients.
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Affiliation(s)
- Bao-Liang Zhong
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China.,Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yan-Min Xu
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Wu-Xiang Xie
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China
| | - Jin Lu
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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The Tangled Relation Between Tobacco and Substance Abuse in Egyptian Male Patients. ADDICTIVE DISORDERS & THEIR TREATMENT 2018. [DOI: 10.1097/adt.0000000000000132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Prevalence of obesity for opioid- and stimulant-dependent participants in substance use treatment clinical trials. Drug Alcohol Depend 2018; 190:255-262. [PMID: 30077926 DOI: 10.1016/j.drugalcdep.2018.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/08/2018] [Accepted: 06/13/2018] [Indexed: 12/14/2022]
Abstract
AIMS To estimate obesity prevalence among drug-dependent individuals and to compare prevalence across different types of drug dependence. METHODS 1596 opioid- and/or stimulant-dependent participants were extracted from six clinical trials within the National Drug Abuse Treatment Clinical Trials Network of the National Institute on Drug Abuse (NIDA CTN) to estimate obesity prevalence among drug-dependent users. Age-, sex-, and race-matched National Health and Nutrition Examination Survey (NHANES) samples were used as a general population reference. Standardized prevalence ratios (SPRs) were calculated to compare the CTN sample to NHANES as well as to compare within the CTN sample. Logistic regression estimated associations between the type of drug dependence and obesity. RESULTS The standardized obesity prevalence among the drug-dependent CTN trial participants was 67% of expected for age-, sex- and race-matched NIHANES participants (SPR = 0.67, 95% CI: 0.60-0.74). Obesity was least prevalent among opioid-dependent-only participants (SPR = 0.36, 95% CI: 0.27-0.46 compared to the NHANES, and SPR = 0.33, 95% CI: 0.23-0.46 compared to the stimulant-dependent-only participants). Compared to stimulant-dependent-only users (p < 0.0001), the odds of obesity were 67% lower among opioid-dependent-only users (adjusted odds ratio [AOR] = 0.33, 95% CI: 0.23-0.46) and 33% lower among opioid and stimulant-co-dependent users (AOR = 0.67, 95%CI: 0.49-0.90) after controlling for age, sex, race, education and employment pattern. CONCLUSIONS The prevalence of obesity among drug-dependent clinical trial participants was lower than the general population, and lowest among opioid-dependent-only users, suggesting an inverse relationship between obesity prevalence and drug dependence, most notable among opioid-dependent-only users.
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Use of Smoking Cessation Methods Among Patients Receiving Office-based Buprenorphine Maintenance Treatment. J Addict Med 2018; 11:494-497. [PMID: 28885300 DOI: 10.1097/adm.0000000000000356] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Provision of smoking-cessation treatment is limited in office-based buprenorphine maintenance treatment (BMT) settings. This study describes smoking and smoking-cessation behaviors among patients receiving office-based BMT. METHODS Cross-sectional study of patients receiving office-based BMT at a community health center in the Bronx, NY. We interviewed patients assessing sociodemographic, and substance use and tobacco use characteristics, including methods used for smoking cessation. We reported simple frequencies and explored associations of BMT characteristics with smoking behaviors. RESULTS Of 68 patients, 87.7% were current cigarette smokers, 7.9% were former smokers, and 4.4% had never smoked. Of lifetime smokers, 83.1% reported at least 1 prior quit attempt, and 78.5% had used medication (75.4% used nicotine replacement therapy, 29.2% varenicline, and 9.2% bupropion). Ten patients (15.4%) reported using electronic cigarettes to try to quit smoking. Stopping "cold turkey" (40.0%) and gradually decreasing the number of cigarettes smoked (32.3%) were nonpharmacological methods of quitting tried most often. Use of behavioral support, including stop-smoking programs and counseling, was low. Higher dose and longer duration of BMT was associated with greater smoking frequency. CONCLUSIONS Patients receiving BMT have a high prevalence of cigarette smoking, though most have tried to quit, and have prior experience with pharmacotherapy for smoking cessation. Efforts to optimize smoking-cessation treatments among BMT patients are needed.
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Palis H, Marchand K, Karamouzian M, MacDonald S, Harrison S, Guh D, Lock K, Brissette S, Anis AH, Krausz M, Marsh DC, Schechter MT, Oviedo-Joekes E. The association between nicotine dependence and physical health among people receiving injectable diacetylmorphine or hydromorphone for the treatment of chronic opioid use disorder. Addict Behav Rep 2018; 7:82-89. [PMID: 29892701 PMCID: PMC5993889 DOI: 10.1016/j.abrep.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 03/25/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION People with chronic opioid use disorder often present to treatment with individual and structural vulnerabilities and remain at risk of reporting adverse health outcomes. This risk is greatly compounded by tobacco smoking, which is highly prevalent among people with chronic opioid use disorder. Despite the known burden of tobacco smoking on health, the relationship between nicotine dependence and health has not been studied among those receiving injectable opioid agonist treatment. As such, the present study aims to explore the association between nicotine dependence and physical health among participants of the Study to Assess Longer-Term Opioid Medication Effectiveness (SALOME) at baseline and six-months. METHODS SALOME was a double-blind phase III clinical trial testing the non-inferiority of injectable hydromorphone to injectable diacetylmorphine for chronic opioid use disorder. Participants reporting tobacco smoking were included in a linear regression analysis of physical health at baseline (before receiving treatment) and at six-months. RESULTS At baseline, nicotine dependence score, lifetime history of emotional, physical, or sexual abuse and prior month safe injection site access were independently and significantly associated with physical health. At six-months nicotine dependence score was the only variable that maintained this significant and independent association with physical health. CONCLUSIONS Findings indicate that after six-months, the injectable treatment effectively brought equity to patients' physical health status, yet the association with nicotine dependence remained. Findings could inform whether the provision of treatment for nicotine dependence should be made a priority in settings where injectable opioid agonist treatment is delivered to achieve improvements in overall physical health in this population.
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Affiliation(s)
- Heather Palis
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Kirsten Marchand
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Mohammad Karamouzian
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Haft-Bagh Highway, Kerman, Iran
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Daphne Guh
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Kurt Lock
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Suzanne Brissette
- Centre Hospitalier de l'Université de Montréal, Hôpital Saint-Luc, CHUM Montréal, Montréal, QC H2X 3J4, Canada
| | - Aslam H. Anis
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Michael Krausz
- Department of Psychiatry, Faculty of Medicine, Detwiller Pavilion, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada
| | - David C. Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON P3E 2C6, Canada
| | - Martin T. Schechter
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
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Ieong HFH, Yuan Z. Emotion recognition and its relation to prefrontal function and network in heroin plus nicotine dependence: a pilot study. NEUROPHOTONICS 2018; 5:025011. [PMID: 29901032 PMCID: PMC5993953 DOI: 10.1117/1.nph.5.2.025011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 05/11/2018] [Indexed: 05/28/2023]
Abstract
Many patients with substance use disorders (SUDs) live in a stressful environment, and comorbidity is not uncommon. Understanding the neural mechanisms underlying heroin and nicotine dependences and their relationships to social cognition could facilitate behavioral therapy efficacy. We aimed to provide a translational approach that leads to identifying potential biomarkers for opioid use disorder (OUD) susceptibility during recovery. We examined the clinical characters and the relationships between theory of mind (ToM) and executive functions in three groups: heroin plus nicotine-dependent (HND) patients who had remained heroin abstinent ( ≥ 3 months), nicotine-dependent (ND) subjects, and healthy controls (C). The domains included emotion recognition, inhibition, shifting, updating, access, and processing speed. Resting-state functional connectivity (rsFC), ToM task-induced functional connectivity, and brain networks were then explored among 21 matched subjects using functional near-infrared spectroscopy. HND enhanced the severities of anxiety, depression, and hyperactivity. Inhibition domain was impaired in both HND and ND. No impairment in domains of emotion recognition, access, and update was observed. HND demonstrated enhanced rsFC in the medial prefrontal cortex and orbitofrontal cortex (OFC) and decreased ToM-induced connectivity across the PFC. The right superior frontal gyrus in the OFC (oSFG; x = 22 , y = 77 , and z = 6 ) was associated with working memory and emotion recognition in HND. Using a neuroimaging tool, these results supported the prominent reward-deficit-and-stress-surfeit hypothesis in SUDs, especially OUD, after protracted withdrawal. This may provide an insight in identifying potential biomarkers related to a dynamic environment.
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Affiliation(s)
- Hada Fong-ha Ieong
- University of Macau, Bioimaging Core, Faculty of Health Sciences, Macau SAR, China
| | - Zhen Yuan
- University of Macau, Bioimaging Core, Faculty of Health Sciences, Macau SAR, China
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Lugoboni F, Zamboni L, Federico A, Tamburin S. Erectile dysfunction and quality of life in men receiving methadone or buprenorphine maintenance treatment. A cross-sectional multicentre study. PLoS One 2017; 12:e0188994. [PMID: 29190831 PMCID: PMC5708835 DOI: 10.1371/journal.pone.0188994] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 11/16/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Erectile dysfunction (ED) is common among men on opioid replacement therapy (ORT), but most previous studies exploring its prevalence and determinants yielded contrasting findings. Moreover, the impact of ED on patients' quality of life (QoL) has been seldom explored. OBJECTIVE To explore the prevalence and determinants of ED in men on ORT, and the impact on QoL. METHODS In a multicentre cross-sectional study, we recruited 797 consecutive male patients on methadone and buprenorphine treatment, collected data on demographic, clinical, and psychopathological factors, and explored their role as predictors of ED and QoL through univariate and multivariate analysis. ED severity was assessed with a self-assessment questionnaire. RESULTS Nearly half of patients in our sample were sexually inactive or reported some degree of ED. Some demographic, clinical and psychopathological variables significantly differed according to the presence or absence of ED. Multivariate regression analysis indicated that age, employment, smoke, psychoactive drugs, opioid maintenance dosage, and severity of psychopathological factors significantly influenced the risk and severity of ED. QoL was worse in patients with ED and significantly correlated with ED severity. Age, education, employment, opioid maintenance dosage, ED score, and severity of psychopathology significantly influenced QoL in the multivariate analysis. CONCLUSIONS ED complaints can be explored in male opioid users on ORT through a simple and quick self-assessment tool. ED may have important effects on emotional and social well-being, and may affect outcome.
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Affiliation(s)
- Fabio Lugoboni
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Lorenzo Zamboni
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Angela Federico
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- * E-mail:
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Ainscough TS, Brose LS, Strang J, McNeill A. Contingency management for tobacco smoking during opioid addiction treatment: a randomised pilot study. BMJ Open 2017; 7:e017467. [PMID: 28864706 PMCID: PMC5589007 DOI: 10.1136/bmjopen-2017-017467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/12/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Smoking rates among individuals in treatment for opioid addiction are close to five times that of the general public. Moreover, drug-addicted smokers have a premature mortality rate four times greater than drug-addicted non-smokers. The aim of this pilot study was to investigate whether contingency management (CM) can be successfully added to evidence-based stop smoking treatment in individuals undergoing treatment for opioid addiction and assess preliminary evidence for its impact. PARTICIPANTS Forty tobacco smokers currently undergoing treatment for opioid addiction. INTERVENTION Escalating with reset CM as an adjunct to standard smoking cessation treatment. Financial incentives will be administered over a 5-week period for either biochemically verified abstinence from smoking or attendance at the clinic. Participants will be randomised to conditions stratified on current levels of smoking (high or low). OBJECTIVES AND ANALYSES To assess whether a CM intervention can be successfully added to standard stop smoking services treatment, in patients undergoing outpatient treatment for opioid addiction. This will be measured as the number of people completing the 5 weeks of the intervention. ETHICS AND DISSEMINATION Ethics approval for the study was granted on the 16 June 2016 by the London-city and east (reference 16/LO/0990) ethics committee. The pilot study was retrospectively registered on clincaltrials.gov in January 2017 (ID: NCT03015597). A SPIRIT checklist and figure are available for this protocol. It is planned that the results of this study will be published in an academic journal.
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Affiliation(s)
- Tom Stephen Ainscough
- UK Centre for Tobacco and Alcohol Studies, UK
- IoPPN, King's College London, London, UK
| | - Leonie S Brose
- UK Centre for Tobacco and Alcohol Studies, UK
- IoPPN, King's College London, London, UK
| | | | - Ann McNeill
- UK Centre for Tobacco and Alcohol Studies, UK
- IoPPN, King's College London, London, UK
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Stevenson RP, Semple C, Hussey K, McGovern J, Stuart WP, Kingsmore DB. Changes in the demographics of intravenous drug users with mycotic common femoral artery pseudoaneurysm as a consequence of self-injection does not influence outcome following emergency ligation. Vascular 2017; 25:520-524. [DOI: 10.1177/1708538117700763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The reported annual incidence of mycotic pseudoaneurysm of the common femoral artery in intravenous drug users has been estimated at 0.03%. Over the past 5 years in Scotland, the proportion of people receiving specialist attention for heroin use over the age of 40 years has increased from 15 to 22%. Although routinely managed with arterial ligation (without reconstruction), some series have reported rates of major limb amputation of up to 10%. We sought to define whether this management strategy was still acceptable in an older population. Methods Retrospective review of patients presenting to a tertiary vascular service with mycotic pseudoaneurysm of the common femoral artery due to arterial injection by intravenous drug users between October 2010 and March 2016. Variables of interest included patient demographics and requirement for major amputation. Results There were 55 patients identified. The annual incidence of mycotic pseudoaneurysm of the common femoral artery in intravenous drug users was 2.1%. It was more common in men (3:1) and the mean age at presentation was 41 years (standard deviation ± 8 years). Three patients underwent major limb amputation during the index admission for severe limb ischaemia (two transfemoral amputations; one hip-disarticulation). Following discharge two patients were readmitted (134 and 200 days, respectively, following primary ligation) for major limb amputation due to of critical limb ischaemia. Conclusions Despite the increasing age of intravenous drug users presenting with mycotic pseudoaneurysm of the common femoral artery primary ligation of pseudoaneurysm would seem to remain an appropriate therapeutic intervention.
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Affiliation(s)
| | | | - Keith Hussey
- Department of Vascular Surgery, Queen Elizabeth University Hospital, UK
| | - Josh McGovern
- Department of Vascular Surgery, Queen Elizabeth University Hospital, UK
| | - Wesley P Stuart
- Department of Vascular Surgery, Queen Elizabeth University Hospital, UK
| | - David B Kingsmore
- Department of Vascular Surgery, Queen Elizabeth University Hospital, UK
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Lugoboni F, Mirijello A, Zamboni L, Faccini M, Casari R, Cossari A, Gasbarrini A, Addolorato G, On Behalf Of Gics. High prevalence of constipation and reduced quality of life in opioid-dependent patients treated with opioid substitution treatments. Expert Opin Pharmacother 2016; 17:2135-2141. [PMID: 27603712 DOI: 10.1080/14656566.2016.1232391] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives To evaluate prevalence and severity of constipation and quality of life (QoL) in a cohort of opioid-addicted patients treated with opioid substitution treatments (OST). METHODS A total of 1057 heroin-dependent patients treated with methadone or buprenorphine were enrolled in a multicenter observational study. Constipation was assessed by Wexner Constipation Scoring System (Wexner CSS), QoL by General Health Questionnaire (GHQ-12). RESULTS 38.5% patients reported mild constipation, 33.3% reported moderate constipation, 14.8% severe constipation and 5.1% very severe constipation. Mean Wexner CSS score was 6.6 ± 4.8. 44.9% patients showed a GHQ-12 score ≥14; of these 18.3% patients showed a GHQ-12 score ≥20. Mean GHQ score was 13.8 ± 6.5. Mean Wexner CSS score was significantly higher in methadone patients (p = 0.004), in those taking psychoactive drugs (p = 0.0001) and in female (p < 0.0001) with respect to counterparts. Similarly, GHQ-12 mean scores were higher methadone group (p = 0.003), in those taking psychoactive drugs (p < 0.0001), and in female (p = 0.039) with respect to counterparts. ANOVA and ANCOVA showed a significant influence of methadone and female gender on Wexner CSS score while psychoactive drugs significantly influenced both tests. CONCLUSIONS The present study shows that patients affected by opioid-dependence in OST with methadone and buprenorphine have a high prevalence of constipation and reduced QoL.
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Affiliation(s)
- Fabio Lugoboni
- a Addiction Unit, Department of Medicine , Verona University Hospital , Verona , Italy
| | - Antonio Mirijello
- b Alcohol Use Disorders Unit, Department of Internal Medicine, Gastroenterology and Hepatology , Catholic University of Rome , Rome , Italy.,c Department of Medical Sciences , IRCCS Casa Sollievo della Sofferenza Hospital , San Giovanni Rotondo , Italy
| | - Lorenzo Zamboni
- a Addiction Unit, Department of Medicine , Verona University Hospital , Verona , Italy
| | - Marco Faccini
- a Addiction Unit, Department of Medicine , Verona University Hospital , Verona , Italy
| | - Rebecca Casari
- a Addiction Unit, Department of Medicine , Verona University Hospital , Verona , Italy
| | - Anthony Cossari
- d Department of Economics, Statistics and Finance , University of Calabria , Rende , Italy
| | - Antonio Gasbarrini
- b Alcohol Use Disorders Unit, Department of Internal Medicine, Gastroenterology and Hepatology , Catholic University of Rome , Rome , Italy
| | - Giovanni Addolorato
- b Alcohol Use Disorders Unit, Department of Internal Medicine, Gastroenterology and Hepatology , Catholic University of Rome , Rome , Italy
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Hassamal S, Miotto K, Wang T, Saxon AJ. A narrative review: The effects of opioids on sleep disordered breathing in chronic pain patients and methadone maintained patients. Am J Addict 2016; 25:452-65. [DOI: 10.1111/ajad.12424] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/23/2016] [Accepted: 08/10/2016] [Indexed: 01/07/2023] Open
Affiliation(s)
- Sameer Hassamal
- Department of Addiction Psychiatry; UCLA-Kern; Bakersfield California
| | - Karen Miotto
- Department of Psychiatry and Biobehavioral Sciences; David Geffen School of Medicine at UCLA; Semel Institute of Neuroscience and Human Behavior; Los Angeles California
| | - Tisha Wang
- Division of Pulmonary; Critical Care, and Sleep Medicine; Department of Medicine; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Andrew J. Saxon
- Center of Excellence in Substance Abuse Treatment and Education; Veteran's Affairs Puget Sound Health Care System; Seattle Washington
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Levran O, Randesi M, Peles E, Correa da Rosa J, Ott J, Rotrosen J, Adelson M, Kreek MJ. African-specific variability in the acetylcholine muscarinic receptor M4: association with cocaine and heroin addiction. Pharmacogenomics 2016; 17:995-1003. [PMID: 27269905 DOI: 10.2217/pgs-2016-0028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
AIM This study was designed to determine whether polymorphisms in acetylcholine receptors contribute to opioid dependence and/or cocaine dependence. PATIENTS & METHODS The sample (n = 1860) was divided by drug and ancestry, and 55 polymorphisms (nine genes) were analyzed. RESULTS Of the 20 SNPs that showed nominally significant associations, the association of the African-specific CHRM4 SNP rs2229163 (Asn417=) with cocaine dependence survived correction for multiple testing (Pcorrected = 0.047). CHRM4 is located in a region of strong linkage disequilibrium on chromosome 11 that includes genes associated with schizophrenia. CHRM4 SNP rs2229163 is in strong linkage disequilibrium with several African-specific SNPs in DGKZ and AMBRA1. CONCLUSION Cholinergic receptors' variants may contribute to drug addiction and have a potential role as pharmacogenetic markers.
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Affiliation(s)
- Orna Levran
- The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, NY 10065, USA
| | - Matthew Randesi
- The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, NY 10065, USA
| | - Einat Peles
- Dr Miriam & Sheldon G Adelson Clinic for Drug Abuse Treatment & Research, Tel Aviv Elias Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joel Correa da Rosa
- Center for Clinical & Translational Science, The Rockefeller University, New York, NY 10065, USA
| | - Jurg Ott
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,The Laboratory of Statistical Genetics, The Rockefeller University, New York, NY 10065, USA
| | - John Rotrosen
- VA New York Harbor Healthcare System & NYU School of Medicine, New York, NY 10016, USA
| | - Miriam Adelson
- The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, NY 10065, USA.,Dr Miriam & Sheldon G Adelson Clinic for Drug Abuse Treatment & Research, Tel Aviv Elias Sourasky Medical Center, Tel Aviv, Israel.,Dr Miriam & Sheldon G Adelson Clinic for Drug Abuse Treatment & Research, Las Vegas, NV 89169, USA
| | - Mary Jeanne Kreek
- The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, NY 10065, USA
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Cooperman NA, Lu SE, Richter KP, Bernstein SL, Williams JM. Influence of Psychiatric and Personality Disorders on Smoking Cessation Among Individuals in Opiate Dependence Treatment. J Dual Diagn 2016; 12:118-28. [PMID: 27064523 PMCID: PMC5079427 DOI: 10.1080/15504263.2016.1172896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We aimed to evaluate how psychiatric and personality disorders influence smoking cessation goals and attempts among people with opiate dependence who smoke. This information could aid the development of more effective cessation interventions for these individuals. METHODS Participants (N = 116) were recruited from two methadone clinics, completed the Millon Clinical Multiaxial Inventory-III, and were asked about their smoking behavior and quitting goals. We used the Least Absolute Shrinkage and Selection Operator (LASSO) method, a technique commonly used for studies with small sample sizes and large number of predictors, to develop models predicting having a smoking cessation goal, among those currently smoking daily, and ever making a quit attempt, among those who ever smoked. RESULTS Almost all participants reported ever smoking (n = 115, 99%); 70% (n = 80) had made a serious quit attempt in the past; 89% (n = 103) reported current daily smoking; and 59% (n = 61) had a goal of quitting smoking and staying off cigarettes. Almost all (n = 112, 97%) had clinically significant characteristics of a psychiatric or personality disorder. White race, anxiety, and a negativistic personality facet (expressively resentful) were negative predictors of having a cessation goal. Overall, narcissistic personality pattern and a dependent personality facet (interpersonally submissive) were positive predictors of having a cessation goal. Somatoform disorder, overall borderline personality pattern, and a depressive personality facet (cognitively fatalistic) were negative predictors of ever making a quit attempt. Individual histrionic (gregarious self-image), antisocial (acting out mechanism), paranoid (expressively defensive), and sadistic (pernicious representations) personality disorder facets were positive predictors of ever making a quit attempt. Each model provided good discrimination for having a smoking cessation goal or not (C-statistic of .76, 95% CI [0.66, 0.85]) and ever making a quit attempt or not (C-statistic of .79, 95% CI [0.70, 0.88]). CONCLUSIONS Compared to existing treatments, smoking cessation treatments that can be tailored to address the individual needs of people with specific psychiatric disorders or personality disorder traits may better help those in opiate dependence treatment to set a cessation goal, attempt to quit, and eventually quit smoking.
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Affiliation(s)
- Nina A. Cooperman
- Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School
| | - Shou-En Lu
- Department of Biostatistics, Rutgers School of Public Health,
| | - Kimber P. Richter
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center,
| | | | - Jill M. Williams
- Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School,
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Diet and nutrient intake of people receiving opioid agonist treatment (OAT): implications for recovery. DRUGS AND ALCOHOL TODAY 2016. [DOI: 10.1108/dat-08-2015-0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose– The purpose of this paper is to provide new insights into the diet and nutrient intake of people receiving opioid agonist treatment (OAT) in the UK, offering implications for recovery-oriented treatment and care.Design/methodology/approach– Diet and nutrient intake were assessed using quantitative methods. The research tools used were: a socio-demographic and drug use questionnaire, 24-hour dietary recall interview and anthropometry measures. A four-month follow-up was conducted using the same methods.Findings– Mean (SD) body mass index for males (n=15) and females (n=10) exceeded the normal range (25.2 (5.9) kg/m2 and 33.3 (8.6) kg/m2, respectively) at baseline. Males decreased to the normal range at follow-up (mean (SD)=24.1 (±6.2) kg/m2]. Females increased to obesity Class II at follow-up (mean (SD)=35.1 (±8.0) kg/m2). Non-starch polysaccharide intakes were significantly lower than the reference nutrient intake (RNI). Iron intakes for females were significantly below the RNI. Saturated fat intake and sodium intake exceeded the RNI. In total, 11 (44 per cent) participants had multiple health conditions. Participants regularly consumed meals and reported frequent snacking events.Research limitations/implications– There is a need for better understanding of nutrition-related issues and dietary deficiencies amongst people receiving OAT, including larger studies that explore differences between males and females, other sub-groups and changes over time.Practical implications– Nutritional recommendations or guidelines and increased attention to nutrition and diet within treatment programmes are needed to help people receiving OAT.Originality/value– This paper demonstrates how diet and nutrient intake are essential to recovery processes and outcomes.
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Guydish J, Passalacqua E, Pagano A, Martínez C, Le T, Chun J, Tajima B, Docto L, Garina D, Delucchi K. An international systematic review of smoking prevalence in addiction treatment. Addiction 2016; 111:220-30. [PMID: 26392127 PMCID: PMC4990064 DOI: 10.1111/add.13099] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 04/30/2015] [Accepted: 08/06/2015] [Indexed: 11/27/2022]
Abstract
AIMS Smoking prevalence is higher among people enrolled in addiction treatment compared with the general population, and very high rates of smoking are associated with opiate drug use and receipt of opiate replacement therapy (ORT). We assessed whether these findings are observed internationally. METHODS PubMed, PsycINFO and the Alcohol and Alcohol Problems Science Database were searched for papers reporting smoking prevalence among addiction treatment samples, published in English, from 1987 to 2013. Search terms included tobacco use, cessation and substance use disorders using and/or Boolean connectors. For 4549 papers identified, abstracts were reviewed by multiple raters; 239 abstracts met inclusion criteria and these full papers were reviewed for exclusion. Fifty-four studies, collectively comprising 37,364 participants, were included. For each paper we extracted country, author, year, sample size and gender, treatment modality, primary drug treated and smoking prevalence. RESULTS The random-effect pooled estimate of smoking across people in addiction treatment was 84% [confidence interval (CI) = 79, 88%], while the pooled estimate of smoking prevalence across matched population samples was 31% (CI = 29, 33%). The difference in the pooled estimates was 52% (CI = 48%, 57%, P < .0001). Smoking rates were higher in programs treating opiate use compared with alcohol use [odds ratio (OR) = 2.52, CI = 2.00, 3.17], and higher in ORT compared to out-patient programs (OR = 1.42, CI = 1.19, 1.68). CONCLUSIONS Smoking rates among people in addiction treatment are more than double those of people with similar demographic characteristics. Smoking rates are also higher in people being treated for opiate dependence compared with people being treated for alcohol use disorder.
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Affiliation(s)
- Joseph Guydish
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118
| | - Emma Passalacqua
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118
| | - Anna Pagano
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118
| | - Cristina Martínez
- Tobacco Control Unit, Cancer Prevention and Control Department, Catalan Institute of Oncology-Institut d'Investigació Biomèdica de Bellvitge – IDIBELL, Barcelona, Spain
| | - Thao Le
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118
| | - JongSerl Chun
- Department of Social Welfare, Ewha Womans University, 11-1 Daehyun-Dong, Seodaemun-Gu, Seoul, 120-750, South Korea
| | - Barbara Tajima
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118
| | - Lindsay Docto
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118
| | - Daria Garina
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118
| | - Kevin Delucchi
- University of California, San Francisco, Department of Psychiatry, University of California San Francisco, San Francisco, CA
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Methadone’s effect on nAChRs—a link between methadone use and smoking? Biochem Pharmacol 2015; 97:542-549. [DOI: 10.1016/j.bcp.2015.07.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/23/2015] [Indexed: 12/17/2022]
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Abstract
Practitioners are highly likely to encounter patients with concurrent use of nicotine products and opioid analgesics. Smokers present with more severe and extended chronic pain outcomes and have a higher frequency of prescription opioid use. Current tobacco smoking is a strong predictor of risk for nonmedical use of prescription opioids. Opioid and nicotinic-cholinergic neurotransmitter systems interact in important ways to modulate opioid and nicotine effects: dopamine release induced by nicotine is dependent on facilitation by the opioid system, and the nicotinic-acetylcholine system modulates self-administration of several classes of abused drugs-including opioids. Nicotine can serve as a prime for the use of other drugs, which in the case of the opioid system may be bidirectional. Opioids and compounds in tobacco, including nicotine, are metabolized by the cytochrome P450 enzyme system, but the metabolism of opioids and tobacco products can be complicated. Accordingly, drug interactions are possible but not always clear. Because of these issues, asking about nicotine use in patients taking opioids for pain is recommended. When assessing patient tobacco use, practitioners should also obtain information on products other than cigarettes, such as cigars, pipes, smokeless tobacco, and electronic nicotine delivery systems (ENDS, or e-cigarettes). There are multiple forms of behavioral therapy and pharmacotherapy available to assist patients with smoking cessation, and opioid agonist maintenance and pain clinics represent underutilized opportunities for nicotine intervention programs.
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McClure EA, Campbell ANC, Pavlicova M, Hu M, Winhusen T, Vandrey RG, Ruglass LM, Covey LS, Stitzer ML, Kyle TL, Nunes EV. Cigarette Smoking During Substance Use Disorder Treatment: Secondary Outcomes from a National Drug Abuse Treatment Clinical Trials Network study. J Subst Abuse Treat 2015; 53:39-46. [PMID: 25595301 PMCID: PMC4414703 DOI: 10.1016/j.jsat.2014.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/12/2014] [Accepted: 12/16/2014] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The majority of patients enrolled in treatment for substance use disorders (SUDs) also use tobacco. Many will continue to use tobacco even during abstinence from other drugs and alcohol, often leading to smoking-related illnesses. Despite this, little research has been conducted to assess the influence of being a smoker on SUD treatment outcomes and changes in smoking during a treatment episode. METHODS In this secondary analysis, cigarette smoking was evaluated in participants completing outpatient SUD treatment as part of a multi-site study conducted by the National Drug Abuse Treatment Clinical Trials Network. Analyses included the assessment of changes in smoking and nicotine dependence via the Fagerström Test for Nicotine Dependence during the 12-week study among all smokers (aim #1), specifically among those in the experimental treatment group (aim #2), and the moderating effect of being a smoker on treatment outcomes (aim #3). RESULTS Participants generally did not reduce or quit smoking throughout the course of the study. Among a sub-set of participants with higher baseline nicotine dependence scores randomized to the control arm, scores at the end of treatment were lower compared to the experimental arm, though measures of smoking quantity did not appear to decrease. Further, being a smoker was associated with poorer treatment outcomes compared to non-smokers enrolled in the trial. CONCLUSIONS This study provides evidence that patients enrolled in community-based SUD treatment continue to smoke, even when abstaining from drugs and alcohol. These results add to the growing literature encouraging the implementation of targeted, evidence-based interventions to promote abstinence from tobacco among SUD treatment patients.
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Affiliation(s)
- Erin A McClure
- Medical University of South Carolina School of Medicine, 67 President St., Charleston, SC, 29425, United States.
| | - Aimee N C Campbell
- Columbia University Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States; Mount Sinai St. Luke's Hospital, Department of Psychiatry and Behavioral Health, 1111 Amsterdam Avenue, New York, NY 10025, United States
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, CUMC, Columbia University, 722W. 168th street, New York, NY 10032, United States
| | - Meichen Hu
- Columbia University Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| | - Theresa Winhusen
- Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, United States
| | - Ryan G Vandrey
- Johns Hopkins University, School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD 21224, United States
| | - Lesia M Ruglass
- The City College of New York, CUNY, 160 Convent Avenue, New York, NY 10031, United States
| | - Lirio S Covey
- Columbia University Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| | - Maxine L Stitzer
- Johns Hopkins University, School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD 21224, United States
| | - Tiffany L Kyle
- Aspire Health Partners, 5151 Adanson St., Orlando, FL 32804, United States
| | - Edward V Nunes
- Columbia University Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
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Wang AL, Elman I, Lowen SB, Blady SJ, Lynch KG, Hyatt JM, O'Brien CP, Langleben DD. Neural correlates of adherence to extended-release naltrexone pharmacotherapy in heroin dependence. Transl Psychiatry 2015; 5:e531. [PMID: 25781230 PMCID: PMC4354350 DOI: 10.1038/tp.2015.20] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 01/12/2015] [Accepted: 01/12/2015] [Indexed: 11/17/2022] Open
Abstract
Injectable extended-release naltrexone (XRNTX) presents an effective therapeutic strategy for opioid addiction, however its utility could be hampered by poor adherence. To gain a better insight into this phenomenon, we utilized blood oxygenation level-dependent functional magnetic resonance imaging (fMRI) in conjunction with a validated cue-induced craving procedure to examine neural correlates of XRNTX adherence. We operationalized treatment adherence as the number of monthly XRNTX injections (range: 0-3) administered to a group of fully detoxified heroin-dependent subjects (n=32). Additional outcomes included urine toxicology screening and self-reported tobacco use. The presented heroin-related visual cues reliably elicited heroin craving in all tested subjects. Nine, five, three and 15 of the participants, respectively, received zero, one, two and three XRNTX injections, predicted by the individual baseline fMRI signal change in response to the cues in the medial prefrontal cortex, a brain region involved in inhibitory self-control and emotional appraisal. The incidence of opioid-positive urines during the XRNTX therapy was low and remained about half the pre-treatment rate after the XRNTX ended. During the treatment, cigarette smoking behaviors followed patterns of opioid use, while cocaine consumption was increased with reductions in opioid use. The present data support the hypothesis that medial prefrontal cortex functions are involved in adherence to opioid antagonist therapy. A potential role of concurrent non-opioid addictive substances consumption during the XRNTX pharmacotherapy warrants further investigation. Our findings set the stage for further bio-behavioral investigations of the mechanisms of relapse prevention in opioid dependence.
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Affiliation(s)
- A-L Wang
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA, USA
| | - I Elman
- Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
| | - S B Lowen
- Brain Imaging Center, McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA
| | - S J Blady
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - K G Lynch
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J M Hyatt
- Department of Criminology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - C P O'Brien
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - D D Langleben
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Behavioral Health Service, Veterans Administration Medical Center, Philadelphia, PA, USA
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Environmental tobacco smoke exposure among smokers and non-smokers receiving outpatient substance abuse treatment. Addict Behav 2014; 39:1718-22. [PMID: 25117848 DOI: 10.1016/j.addbeh.2014.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 06/17/2014] [Accepted: 07/10/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Environmental Tobacco Smoke (ETS) has been linked to numerous health problems. While research has demonstrated high prevalence of tobacco use among individuals receiving treatment for substance use disorders (SUDs), no studies have examined ETS among individuals receiving treatment for SUDs, paying specific attention to non-smokers who may be at risk for high exposure to ETS. METHODS Participants (N=261) enrolled in outpatient substance abuse treatment completed a survey, in which 14 items were used to quantify ETS exposure and smoking policies across several environments. RESULTS Among smokers, 85% reported that their significant others also smoked as compared to 15% among non-smokers (χ(2)=6.624, p<.05). A logistic regression examined the characteristics that predicted smoking in the home. The overall model was significant, (χ(2)=36.046, p<.0005) with variables that independently predicted smoking in the home included having less than a high school diploma, being female, and living with a smoker. Income, age, and living with children were not found to be significant. Overall, 42% white collar workers 26% of service workers and 30% of blue collar workers reported no exposure to ETS. Sixty-seven percent of smokers strongly agreed or agreed that the hazards of secondhand smoke have been clearly demonstrated versus 58% of non-smokers. CONCLUSIONS Smokers and non-smokers enrolled in outpatient substance abuse treatment are frequently exposed to ETS at home, work, and in social settings. The dangers of ETS should be addressed among this population through education, smoke-free policies, and cessation resources, with help from their treatment facility.
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Stein MD, Caviness CM, Grimone K, Audet D, Borges A, Anderson BJ. E-cigarette knowledge, attitudes, and use in opioid dependent smokers. J Subst Abuse Treat 2014; 52:73-7. [PMID: 25483740 DOI: 10.1016/j.jsat.2014.11.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/04/2014] [Accepted: 11/10/2014] [Indexed: 11/19/2022]
Abstract
Individuals in treatment for opioid dependence have smoking rates 3-5 times greater than the U.S. prevalence rate. Traditional smoking cessation strategies have been ineffective in this population. Novel approaches are needed as well as harm reduction avenues. E-cigarettes (e-cigs) may provide such a novel harm reduction and cessation opportunity, but little is known about the knowledge of, attitudes about, and usage of e-cigs in opioid dependent smokers. The current study enrolled 315 opioid dependent smokers (164 methadone, 151 buprenorphine), treated in the same health system in Fall River, Massachusetts. The sample was 49.7% male and 85.1% non-Latino White. Overall 98.7% had heard of e-cigs, 73.0% had ever tried e-cigs, and 33.8% had used e-cigs in the past 30 days. The most common reasons for use were curiosity (41.4%) and to quit all nicotine (26.0%). The proportion of opioid dependent smokers that had ever tried e-cigs and used them in the past month was substantially greater than that found in recent general population surveys. While e-cigs have been used to quit smoking, how to optimize their utility as a cessation tool remains undefined. E-cigs should be a part of smoking cessation discussions with this vulnerable, difficult-to-treat population.
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Affiliation(s)
- Michael D Stein
- Butler Hospital, Providence, Rhode Island; Alpert Medical School of Brown University, Providence, Rhode Island.
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Abramovitch A, Pizzagalli DA, Reuman L, Wilhelm S. Anhedonia in obsessive-compulsive disorder: beyond comorbid depression. Psychiatry Res 2014; 216:223-9. [PMID: 24564999 DOI: 10.1016/j.psychres.2014.02.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 01/31/2014] [Accepted: 02/01/2014] [Indexed: 01/08/2023]
Abstract
Obsessive-compulsive disorder (OCD) has been linked to reward dysfunctions, highlighting a possible role of anhedonia in OCD. Surprisingly, anhedonia in OCD has never been evaluated. Moreover, although nicotine typically has anti-anhedonic effects, anecdotal reports suggest low prevalence rates of smoking in OCD. To address these two phenomena, 113 individuals with OCD completed a battery of questionnaires assessing symptom severity, anhedonia, and smoking. 28.3% of the sample met criteria for clinically significant anhedonia, which correlated with Y-BOCS scores (r=0.44), even when controlling for depressive symptoms. 13.3% of the sample endorsed current smoking, a lower rate than seen in psychiatric disorders (40-90%) and the general adult population (19%). Results highlight high rates of anhedonia and yet reduced prevalence of smoking in OCD. In contrast to the known positive association between anhedonia and smoking, a negative association emerged. Future research is needed to address the unique interface between anhedonia and reward responsiveness in OCD. Potential clinical implications are discussed.
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Affiliation(s)
- Amitai Abramovitch
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Lillian Reuman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Sabine Wilhelm
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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