Chronicity Of Use Research Articles

Gonadotropin axis and semen quality in young Swiss men after cannabis consumption: Effect of chronicity and modulation by cannabidiol.

While cannabis is the most widely used recreational drug in the world, the effects of phytocannabinoids on semen parameters and reproductive hormones remain controversial. Cannabinoid receptors are activated by these compounds at each level of the hypothalamus-pituitary-gonadotropic axis. To assess the impact of the consumption of Δ-9-tetrahydrocannabinol and cannabidiol on semen parameters, as well as on male reproductive hormone and endocannabinoid levels, in a cohort of young Swiss men. The individuals in a Swiss cohort were divided according to their cannabis consumption. In the cannabis user group, we determined the delay between the last intake of cannabis and sample collection, the chronicity of use and the presence of cannabidiol in the consumed product. Urinary Δ-9-tetrahydrocannabinol metabolites were quantified via gas chromatography-mass spectrometry. Blood phytocannabinoids, endocannabinoids and male steroids were determined via liquid chromatography-mass spectrometry/mass spectrometry, and other hypothalamus-pituitary-gonadotropic axis hormones were determined via immunoassays. Semen parameters such as sperm concentration and motility were recorded using computer-assisted sperm analysis. Anandamide, N-palmitoyl ethanolamide, androgens, estradiol and sex hormone binding globulin levels were all higher in cannabis users, particularly in chronic, recent and cannabidiol-positive consumers. Gonadotropin levels were not significantly different in these user subpopulations, whereas prolactin and albumin concentrations were lower. In addition, cannabis users had a more basic semen pH and a higher percentage of spermatozoa with progressive motility. However, the two latter observations seem to be related to a shorter period of sexual abstinence in this group rather than to the use of cannabis. Because both cannabidiol and Δ-9-tetrahydrocannabinol are frequently used by men of reproductive age, it is highly relevant to elucidate the potential effects they may have on human reproductive health. This study demonstrates that the mode of cannabis consumption must be considered when evaluating the effect of cannabis on semen quality.

“I still partly think this is bullshit”: A qualitative analysis of cannabinoid hyperemesis syndrome perceptions among people with chronic cannabis use and cyclic vomiting

BackgroundCannabis is the most widely used psychoactive substance in the United States (US), with reported use patterns increasing among adults in recent years. Cannabinoid hyperemesis syndrome (CHS) has been one concern related to increased cannabis use patterns. US emergency departments have reported an increase of CHS cases over the last decade, yet little is known about CHS. This study explores the experiences of people with chronic cannabis use and cyclic vomiting and their perceptions of CHS. MethodsSemi-structured interviews were conducted with 24 people recruited from a prospective cohort of patients presenting to Rhode Island emergency departments with symptomatic cyclic vomiting and chronic cannabis use. Data were analyzed thematically using NVivo. FindingsParticipants characterized their cyclic vomiting as related to food and alcohol consumption patterns, stress, and existing gastrointestinal issues. Despite recurrent episodes of cyclic vomiting, nausea, and abdominal pain, many participants remained uncertain whether their symptoms were driven by cannabis. Many participants relied on at-home research to assess their symptoms and seek out management approaches. Clinical treatment recommendations focused on cannabis cessation. However, most participants felt clinical recommendations failed to consider the complexity and challenge of stopping cannabis use given the chronicity of use and therapeutic benefits some perceived cannabis to have. ConclusionsAlthough cannabis cessation is the only reported CHS cure to date, additional clinical and non-clinical treatment approaches are needed to better support people with chronic cannabis use and cyclic vomiting to meet their ongoing needs.

Perspectives of Food Insecurity and Service Delivery amongst Emergency Food Relief Clients in a Regional City in Victoria, Australia

This cross-sectional study examined the experiences of people accessing Emergency Food Relief (EFR) in the regional city of Ballarat, Victoria, Australia, including determinants, impacts of food insecurity, and service delivery recommendations. The forty-one item survey examined demographics, food security status (six-item adult US-Household Food Security Survey Module), food acquisition, use of charitable food services, and self-rated health. Adults n = 100 accessing meal programs and/or EFR services from three EFR organisations in 2018 were surveyed. Ninety-seven percent of participants received government social security payments. Food insecurity prevalence was 92% (USDA-HFSSM 6 item); of these, 63% were experiencing very low food security. Over half (54%) of households with children (n = 26) reported being sometimes unable to feed their children balanced meals and 50% indicated that they were not eating enough. Participants (47%) relied on EFR services for food between one and five years. Poor self-rated dental health was expressed by over 50% of participants and 97% indicated the importance for services to provide healthy food. Food insecurity prevalence was high and chronic among adults receiving EFR services in a large regional Australian city. Recipients’ poor dental health, chronicity of use of services for food assistance, and calls for healthier food suggest more was needed to secure pathways out of food insecurity. The chronicity of reliance on EFR is a concern. The results of this study are likely to be of interest to providers and funders of EFR, policy makers, academics, and client advocates. Whilst the provision of EFR is not a sustainable solution to the problem of food insecurity, scope exists to improve service delivery to uphold principles of dignity, choice, and access to nutritious food. Furthermore, this highlights that the key strategies to mitigate food insecurity lie beyond simply feeding people.

Anticonvulsant fatalities reported to the American Association of Poison Control Centers 2000 - 2019

BackgroundAnticonvulsants are frequently prescribed, and exposures are commonly reported to American Association of Poison Control Centers sites. The purpose of this study was to describe the epidemiology of fatalities associated with oral anticonvulsant use, including patient demographics, specific medications, and the circumstances surrounding the deaths. MethodsThis was a retrospective analysis of cases coded with oral anticonvulsants as a single substance and associated with a fatal outcome reported to the AAPCC National Poison Data System from 2000 to 2019. Polydrug ingestions and parenteral exposures were excluded. Patient characteristics, circumstances of the ingestion, specific medication, and chronicity of use were described. ResultsWe identified 126 cases that were classified as fatalities associated with single anticonvulsant use. The five most implicated anticonvulsants were carbamazepine, gabapentin, lamotrigine, phenytoin, and valproic acid. The majority (68.3%) of fatal cases were suicides. Phenytoin was implicated in eight (89%) adverse reactions and seven (70%) therapeutic errors. Valproic acid caused one (11.1%) adverse reaction and was associated with one (10%) therapeutic error. Three (75%) unintentional fatalities were caused by carbamazepine.The plurality (42.1%) of fatal ingestions occurred in acute-on-chronic use. An additional 40 (31.7%) were acute. Chronic use accounted for 15 (11.9%) of fatal exposures, including 5/10 of fatalities attributed to therapeutic error. The chronicity of medication use was unknown in 18 (14.3%) of fatal ingestions.Narrative summaries were available in 14 cases. Four of the patients presented to the emergency department with minimal symptoms. The other 10 had varying degrees of central nervous system (CNS) depression. Seizures were observed in six cases. Hyperammonemia was reported in seven of nine valproic acid ingestions. ConclusionsFatalities associated with isolated anticonvulsant use are uncommon and typically occur following intentional overdoses. Fatal adverse reactions and therapeutic errors are most associated with phenytoin use and disproportionately affect elderly patients.

Does a High Postoperative Opioid Dose Predict Chronic Use After ACDF?

The purpose of this study is to determine if increased postoperative prescription opioid dosing is an isolated predictor of chronic opioid use after anterior cervical diskectomy and fusion (ACDF). A retrospective cohort analysis of patients undergoing ACDF for degenerative diseases from 2016-2019 at a single institution was performed. Preoperative and postoperative opioid and benzodiazepine prescriptions, including morphine milligram equivalents (MMEs) and duration of use, were obtained from the Pennsylvania Prescription Drug Monitoring Program. Univariate analysis compared patient demographics and surgical factors across groups on the basis of postoperative opioid dose (high: MME ≥90, low: MME <90) and chronicity of use (chronic: ≥120 days or >10 prescriptions). Logistic regressions identified predictors of high opioid dose and chronic use. A total of 385 patients were included. Preoperative opioid tolerance and tobacco use were associated with high postoperative opioid dose and chronic usage. Younger age correlated with high-dose prescriptions. Increased body mass index and preoperative benzodiazepine use were associated with chronic opioid use. Chronic postoperative opioid use correlated with high-dose prescriptions, change in opioid prescribed, private pay scripts, and more than 1 prescriber and pharmacy. Logistic regression identified high postoperative opioid dose, opioid tolerance, increased body mass index, and no prior cervical surgery as predictors of chronic opioid use. Regression analysis determined younger age, increased medical comorbidities, and opioid tolerance to be predictors for high MME prescriptions. High postoperative opioid dose independently predicted chronic opioid use after ACDF regardless of preoperative opioid tolerance.

Is resting-state functional connectivity altered in regular cannabis users? A systematic review of the literature.

Regular cannabis use has been associated with brain functional alterations within frontal, temporal, and striatal pathways assessed during various cognitive tasks. Whether such alterations are consistently reported in the absence of overt task performance needs to be elucidated to uncover the core neurobiological mechanisms of regular cannabis use. We aim to systematically review findings from studies that examine spontaneous fluctuations of brain function using functional Magnetic Resonance Imaging (fMRI) resting-state functional connectivity (rsFC) in cannabis users versus controls, and the association between rsFC and cannabis use chronicity, mental health symptoms, and cognitive performance. We conducted a PROSPERO registered systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched eight databases. Twenty-one studies were included for review. Samples comprised 1396 participants aged 16 to 42years, of which 737 were cannabis users and 659 were controls. Most studies found greater positive rsFC in cannabis users compared to controls between frontal-frontal, fronto-striatal, and fronto-temporal region pairings. The same region pairings were found to be preliminarily associated with varying measures of cannabis exposure. The evidence to date shows that regular cannabis exposure is consistently associated with alteration of spontaneous changes in Blood Oxygenation Level-Dependent signal without any explicit cognitive input or output. These findings have implications for interpreting results from task-based fMRI studies of cannabis users, which may additionally tax overlapping networks. Future longitudinal rsFC fMRI studies are required to determine the clinical relevance of the findings and their link to the chronicity of use, mental health, and cognitive performance.

P67. Does a high postoperative opioid dose predict chronic use after ACDF?

<h3>BACKGROUND CONTEXT</h3> Currently there is an incomplete understanding of the patient level risk factors for chronic opioid use after anterior cervical discectomy and fusion (ACDF). Postoperative opioid prescriptions in spine surgery have been found to commonly exceed the dose necessary for return to function and pain relief, however the direct relationship between postsurgical opioid dose and chronic opioid abuse has yet to be explored. <h3>PURPOSE</h3> To determine if increased postoperative prescription opioid dosing is an isolated predictor of chronic opioid use after ACDF. <h3>STUDY DESIGN/SETTING</h3> Retrospective Cohort Analysis. <h3>PATIENT SAMPLE</h3> All patients over age 18 who underwent one- to four-level primary or revision ACDF for cervical spondylosis associated with radiculopathy and/or myelopathy at an academic center between 2016- 2019 were retrospectively identified. Patients lacking descriptive data or opioid utilization records or who had surgery performed for trauma, infection, or malignancy were excluded. <h3>OUTCOME MEASURES</h3> Postoperative opioid use prescription metrics: mean morphine equivalent (MME) opioid dose, duration of usage, and the number of prescriptions and pharmacies utilized. Preoperative opioid and benzodiazepine tolerance. Chronicity of postoperative opioid use. <h3>METHODS</h3> Pre- and postsurgical opioid and benzodiazepine prescriptions, including the postoperative peak MME and duration of use, were obtained from the Pennsylvania Prescription Drug Monitoring Program (PDMP). Univariate analysis compared patient demographics and surgical factors across two binary groups of high vs low postoperative opioid dose (high: MME≥ 90, low: MME< 90) and chronic vs short-term opioid use (chronic: ≥120 days or >10 prescriptions). The relationship between chronic opioid use and patterns of immediate postoperative opioid use was evaluated. Binary logistic regressions were created to identify patient specific predictors of high opioid dose and chronic use. <h3>RESULTS</h3> A total of 385 patients met the inclusion criteria. Preoperative opioid tolerance and history of tobacco use were found to be associated with both high postoperative opioid dose and chronic postoperative usage. In addition, younger age correlated with receiving high dose prescriptions and obesity and preoperative benzodiazepine use were associated with chronic opioid use patterns. Chronicity of postoperative opioid use correlated meaningfully with immediate postoperative opioid use metrics including high single prescription dose, change in opioid prescribed, private pay scripatients, and greater than one prescriber and pharmacy. High postoperative opioid dose and preoperative opioid tolerance were identified as isolated predictors of chronic postsurgical opioid use on logistic regression. Regression also determined younger age, increased medical comorbidities, and opioid tolerance were significant predictors for high MME prescriptions. <h3>CONCLUSIONS</h3> High postoperative opioid dose was found to be a significant predictor of chronic opioid use after ACDF regardless of preoperative opioid tolerance. Because a multitude of factors increase patient opioid dose requirements after surgery, further research is required to determine if there exists a causal relationship between high postoperative opioid dosing and chronicity of use. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Impact of angiotensin system inhibitors on esophageal cancer survival

IntroductionAngiotensin system inhibitors are associated with improved prognosis in patients with gastrointestinal and hepatobiliary cancers. Data suggest that renin–angiotensin system signaling stimulates the tumor's immune microenvironment to impact overall survival. The goal of this study is to investigate the role of angiotensin system inhibitor use on the overall survival and disease-free survival of esophageal cancer patients. MethodsRetrospective review of esophagectomy patients with esophageal adenocarcinoma and squamous cell cancer at a single institution tertiary care center from 2007 to 2018 was performed. Outcomes include overall survival and disease-free survival. Patient characteristics were compared with t test and χ2 test. Survival was analyzed with Kaplan–Meier and Cox proportional-hazards regression. ResultsOne hundred seventy-one patients were identified and 123 underwent esophagectomy for cancer. No significant differences in patient demographics were found between angiotensin system inhibitor users and non–angiotensin system inhibitor users except for the rates of hypertension (40% vs 94%, P < .01) and diabetes (16% vs 47%, P < .01). Distributions of tumor neoadjuvant therapy, adjuvant therapy, pathology, staging, margins, and surgical approach were similar. Postoperatively, there was no difference in major adverse cardiovascular events or infection rates. This study did not find any differences in overall survival and disease-free survival between angiotensin system inhibitor users and non–angiotensin system inhibitor users. ConclusionAngiotensin system inhibitors have been shown to improve survival and decrease relative risk for several types of cancers; however, our data do not support the same effect on esophageal cancer patients undergoing curative intent surgery. Further research is needed to investigate potential nuances in angiotensin system inhibitor dose, chronicity of use, esophageal pathology, and applicability to nonsurgical candidates.

Challenges of Developing a Natural Language Processing Method With Electronic Health Records to Identify Persons With Chronic Mobility Disability

ObjectiveTo assess the utility of applying natural language processing (NLP) to electronic health records (EHRs) to identify individuals with chronic mobility disability. DesignWe used EHRs from the Research Patient Data Repository, which contains EHRs from a large Massachusetts health care delivery system. This analysis was part of a larger study assessing the effects of disability on diagnosis of colorectal cancer. We applied NLP text extraction software to longitudinal EHRs of colorectal cancer patients to identify persons who use a wheelchair (our indicator of mobility disability for this analysis). We manually reviewed the clinical notes identified by NLP using directed content analysis to identify true cases using wheelchairs, duration or chronicity of use, and documentation quality. SettingEHRs from large health care delivery system ParticipantsPatients (N=14,877) 21-75 years old who were newly diagnosed with colorectal cancer between 2005 and 2017. InterventionsNot applicable. Main Outcome MeasuresConfirmation of patients’ chronic wheelchair use in NLP-flagged notes; quality of disability documentation. ResultsWe identified 14,877 patients with colorectal cancer with 303,182 associated clinical notes. NLP screening identified 1482 (0.5%) notes that contained 1+ wheelchair-associated keyword. These notes were associated with 420 patients (2.8% of colorectal cancer population). Of the 1482 notes, 286 (19.3%, representing 105 patients, 0.7% of the total) contained documentation of reason for wheelchair use and duration. Directed content analysis identified 3 themes concerning disability documentation: (1) wheelchair keywords used in specific EHR contexts; (2) reason for wheelchair not clearly stated; and (3) duration of wheelchair use not consistently documented. ConclusionsNLP offers an option to screen for patients with chronic mobility disability in much less time than required by manual chart review. Nonetheless, manual chart review must confirm that flagged patients have chronic mobility disability (are not false positives). Notes, however, often have inadequate disability documentation.

PPI and False-positive THC Screen: False Positive Equal False Allegation

Introduction: Proton pump inhibitor (PPI) is a class of medication frequently prescribed to treat, gastroesophageal reflux disease (GERD), and peptic ulcer disease. Yet, it is important to be mindful of the potential cause of false-positive urine cannabinoid screen in PPI users. We describe a case of a false-positive (FP) urine cannabinoid screen in a patient with pantoprazole usage. Case: A 43-year old male with a history of orthotopic liver transplant secondary to cirrhosis secondary to chronic hepatitis C, gastroesophageal reflux disease on proton pump inhibitor (PPI) presented to outpatient liver clinic for routine post transplant monitoring. Patient denied illicit drug abuse. On investigations, patient's urine drug screen (UDS) was positive for tetrahydrocannabinol (THC). A review of the patient's home medications (including divalproic acid, lasix, spironolactone, atorvastatin, and risperidone) and multiple discussions with the patient did not reveal a source for the positive urine cannabinoid screen. Patient was subsequently switched from pantoprazole to a histamine receptor blocker as there was high suspicion for false positive THC on UDS. Patient's repeat UDS done 2 weeks later showed negative reactivity to THC and has had a negative UDS since. Discussion: Urine drug screening for cannabinoids looks for metabolites of delta-9-tetrahydrocannabinol (THC). THC is the active ingredient in marijuana and can persist in the urine for multiple days to weeks depending on the chronicity of use. Very few substances such as Hemp-containing foods and passive inhalation of marijuana smoke have been implicated in positive THC screens. The pre-Food and Drug Administration approval data has labeled pantoprazole as a cause of false-positive urine screen for THC as no other drug in the class of PPI have been implicated with FP results. However, the exact mechanism of action leading to FP test result is unknown. It takes 4-5 days for Pantoprazole to be eliminated from the body. In our patient a repeat UDS was negative after the discontinuation of Pantoprazole. As many states are resisting the idea of legalizing marijuana, it is of great importance to be aware of the potential FP results in urine THC screening as this could compromise patients' eligibility to work or compete in athletic events.

Opioids and breast cancer recurrence: A Danish population-based cohort study.

Opioids may alter immune function, thereby potentially affecting cancer recurrence. The authors investigated the association between postdiagnosis opioid use and breast cancer recurrence. Patients with incident, early stage breast cancer who were diagnosed during 1996 through 2008 in Denmark were identified from the Danish Breast Cancer Cooperative Group Registry. Opioid prescriptions were ascertained from the Danish National Prescription Registry. Follow-up began on the date of primary surgery for breast cancer and continued until breast cancer recurrence, death, emigration, 10 years, or July 31, 2013, whichever occurred first. Cox regression models were used to compute hazard ratios and 95% confidence intervals associating breast cancer recurrence with opioid prescription use overall and by opioid type and strength, immunosuppressive effect, chronic use (≥6 months of continuous exposure), and cumulative morphine-equivalent dose, adjusting for confounders. In total, 34,188 patients were identified who, together, contributed 283,666 person-years of follow-up. There was no association between ever-use of opioids and breast cancer recurrence (crude hazard ratio, 0.98; 95% confidence interval, 0.90-1.1; adjusted hazard ratio, 1.0; 95% confidence interval, 0.92-1.1), regardless of opioid type, strength, chronicity of use, or cumulative dose. Breast cancer recurrence rates were lower among users of strongly (but not weakly) immunosuppressive opioids, possibly because of channeling bias among those with a high competing risk, because mortality was higher among users of this drug type. This large, prospective cohort study provided no clinically relevant evidence of an association between opioid prescriptions and breast cancer recurrence. The current findings are important to cancer survivorship, because opioids are frequently used to manage pain associated with comorbid conditions.

Mismatch negativity in tobacco-naïve cannabis users and its alteration with acute nicotine administration

Chronic cannabis use may interact with factors, such as age of onset of cannabis use, family history, and genetic factors, to elicit schizophrenia (SZ)-like symptoms, including sensory and cognitive deficits. However, evidence of a relationship between cannabis use and cognitive impairment is confounded by concomitant use of tobacco. The objective of this study was to compare tobacco-naïve cannabis users with individuals without a history of tobacco/cannabis use on the auditory mismatch negativity (MMN) event-related potential (ERP), a neural measure of auditory deviance detection which is diminished in SZ. An exploratory arm of the study, conducted within a randomized, double-blind, placebo controlled design, examined the acute effects of nicotine gum (6mg) on MMN in cannabis users. MMN was recorded in response to 5 deviant stimuli within an optimal MMN paradigm in 44 healthy, non-tobacco smoking volunteers aged 18–26. Cannabis users (n=21) started smoking cannabis prior to age 17, at least 1 joint per month. To examine the effects of chronicity, users were grouped into relatively heavy long-term (HLT; n=11) users and light short-term (LST; n=10) users. Impaired deviance detection was shown in cannabis users vs. nonusers as reflected by a smaller MMN to duration deviants. Chronicity of use was also associated with MMN alterations, as HLTs displayed a reduced duration and gap MMN vs. LSTs. Compared with placebo, nicotine treatment enhanced select MMN deviants in cannabis user subgroups. As deficits associated with early and persistent cannabis use are similar to those seen in SZ, these dose-dependant disturbances in early sensory processing with cannabis use may be one cognitive pathway which mediates an increased risk for SZ in vulnerable youth, and be influenced by concurrent cigarette smoking behavior.

Predictive Capacity of Self-Efficacy in Drug Dependence and Substance Abuse Treatment

Addiction to opiates has increased in recent years. This resurgence in its consumption shows the need to continue to investigate the role of personality in addictive behavior. Variables such as self-efficacy are quite helpful in the treatment of drug addicts. The purpose of this study was to examine and quantify the predictive capacity of self-efficacy in treatment groups (Methadone, Cognitive-Behavioral, Alcohol) and a Control group and in the severity of the substance abuse (quantity and chronicity of use). The sample was composed of 181 participants (97 men and 84 women), who were divided into 4 groups: Methadone, Cognitive-behavioral, Alcohol and Control. Their self-efficacy was measured using the Self-efficacy scale (SE) and the Addictive Behavior Research Interview (EICA). The results showed the self-efficacy is inversely related to the Methadone, Cognitive-behavioral and Alcohol groups and directly related to the Control group. Regarding the severity of the drug use, we found that self-efficacy was inversely related to the quantity of drugs consumed and directly related to chronicity. The study proposes the need to evaluate self-efficacy along with other personality measures, as it is not enough to believe that one is capable of successfully doing something (self-efficacy), but it is also important to show it (coping).

Implementing opioid overdose education and naloxone distribution in an outpatient community treatment program

Implementing opioid overdose education and naloxone distribution in an outpatient community treatment program

The pulmonary pathology of illicit drug and substance abuse

Illicit substance abuse causes diverse pulmonary manifestations that relate to specific agents as well as their mode of delivery, chronicity of use, and the presence of additives. The major categories of substances are cannabinoids, stimulants, and narcotics. The pulmonary effects of marijuana smoking include alveolar macrophage exudation, epithelial remodelling of airways, allergic bronchopulmonary fungal disease, and barotrauma. Inhalation of alkaloidal cocaine may also trigger pulmonary haemorrhage and haemosiderosis, interstitial pneumonia and fibrosis, eosinophilic pneumonia or exacerbations of asthma, in addition to epithelial remodelling and barotrauma. Life-threatening oedema is an important pulmonary complication of intravenous narcotic use. Foreign body emboli, angiothrombosis, and pulmonary hypertension result from intravenous injection of oral pharmaceutical tablets. A variety of tablet fillers—including talc, cornstarch, microcrystalline cellulose, and crospovidone—are discernible histologically. Panacinar emphysema or massive fibrosis are infrequent complications of this practice. Among all categories of substances there is broad overlap of associated lung pathology.

Effect of antiepileptic drugs on bone density in ambulatory patients

To the Editor: The article by Farhat et al.1 poses the following question: Do antiepileptic drugs (AED) and in particular chronicity of use give rise to an altered bone mineral density (BMD)? The use of the American database as a control group may flaw this study and invalidate the implication set out in the conclusion: that the differences found are due to antiepileptic medication. The population in Beirut is very different from the database and without first validating the database in Beirut we should be very cautious in suggesting that differences found relate to epilepsy or AED. Also, the authors found a significant correlation between duration of AED use and BMD. Was …

Drug dependence, parenting responsibilities, and treatment history: why doesn't mom go for help?

Despite longstanding concern that the presence of children deters drug-dependent women from entering treatment, there have been few empirical tests of the relationship between parenting responsibilities and treatment-seeking behavior. In this study, the relationship between number of biological children and treatment history was examined in a cohort of 153 women seeking methadone maintenance treatment. In a standard multiple regression analysis that also allowed for the potential influence of (a) age, (b) education, (c) ethnic minority status, (d) cohabitation with a sexual partner, (e) chronicity of opioid use, and (f) knowledge of HIV infection, there was a significant, negative relationship between number of children and number of earlier contacts for drug abuse treatment. Ethnic minority status and cohabitation with a sexual partner were also associated with fewer earlier contacts; greater chronicity and knowledge of HIV infection were associated with more earlier contacts. Moreover, there was significant moderation of the negative relationship between parenting responsibilities and treatment history by (a) ethnic minority status, (b) cohabitation, and (c) chronicity of use. Within a cross-sectional research design, the findings highlight ways parenting responsibilities may interact with other factors over time to influence the treatment-seeking behavior of drug-dependent women.