Illicit Drug Problems Research Articles

Are long-term alcohol health harms overlooked in individuals with illicit drug problems? Alcohol-related morbidity and mortality in a Danish cohort of clients in residential rehabilitation for drug use disorders

Abstract Aims This study described the burden of alcohol-related morbidity and mortality among those who had been enrolled in residential treatment for drug use disorders in Denmark and investigated whether self-reported information on alcohol use provided at treatment admission can be used to assess risk for future serious alcohol-related harms. Methods At baseline (entry in drug use disorder treatment during 2000–10), clients completed a European adaptation of the Addiction Severity Index-5. We tracked 4981 clients through 2018 using multiple national registers to identify fully (100%) alcohol-attributable hospital contacts and deaths. Results The death rate due to fully alcohol-attributable causes was 411 per 100 000 person-years, with an average of 0.18 fully alcohol-attributable hospital contacts per person-year. Using the Addiction Severity Index-5 alcohol composite score as a predictor in an adjusted competing risks regression model, a higher score was associated with a higher risk of alcohol-related death. The alcohol composite score was a significant predictor of alcohol-related hospital contacts in an adjusted recurrent events model. Conclusions A substantial proportion of people originally identified as experiencing drug use disorders have alcohol problems that need to be monitored and managed to prevent serious complications. By demonstrating the predictive power of self-reported data, our study concludes that the Addiction Severity Index-5 can be used to identify individuals with drug use disorders at risk for severe long-term alcohol-related health outcomes.

The Role of Addiction Treatment in Building Recovery Capital: Findings From 2022 Life in Recovery Survey in Flanders, Belgium

Introduction: This paper examines life experiences before and during addiction recovery in a large sample of treated and untreated persons in Flanders (Belgium). Methods: A total of 343 participants in recovery from alcohol and/or illicit drug problems (≥3 months) completed the 2022 ‘Life in Recovery’ survey online. Participants were categorized into four groups based on their engagement with treatment services: (1) unassisted recovery, (2) mutual aid support only, (3) formal treatment only, and (4) formal treatment and mutual aid support. The questionnaire was supplemented with open-ended questions about facilitators and barriers to recovery. Findings: Group comparisons revealed significant differences in the severity of dependence and living conditions (recovery strengths and barriers, SABRS) during addiction between those in recovery without treatment and the treatment groups. However, similarities in strengths, barriers, and quality of life during recovery were observed across all groups. Differences in barriers during recovery were attributed to variations in initial conditions rather than treatment engagement. The complementary qualitative analysis revealed that the four clusters experienced similar factors as facilitating and hindering recovery. Discussion: These findings suggest that while various pathways can lead to recovery, those involving formal treatment and mutual aid support may be particularly valuable for individuals facing greater initial barriers and fewer strengths during addiction, highlighting treatment as an important but not universally necessary source of recovery capital.

Progress on the Electrochemical Sensing of Illicit Drugs.

Illicit drugs are harmful substances, threatening both health and safety of societies in all corners of the world. Several policies have been developed over time to deal with this illicit drug problem, including supply reduction and harm reduction policies. Both policies require on-site detection tools to succeed, i.e. sensors that can identify illicit drugs in samples at the point-of-care. Electrochemical sensors are highly suited for this task, due to their short analysis times, low cost, high accuracy, portability and orthogonality with current technologies. In this chapter, we evaluate the latest trend in electrochemical sensing of illicit drugs, with a focus on detection of illicit drugs in seizures and body fluids. Furthermore, we will also provide an outlook on the potential of electrochemistry in wearable sensors for this purpose.

Applying the PROSPER prevention delivery system with middle schools: Emerging adulthood effects on substance misuse and conduct problem behaviors through 14years past baseline.

This study evaluated emerging adult effects of the PROmoting School‐Community‐University Partnerships to Enhance Resilience (PROSPER) universal prevention delivery system implemented in middle schools. Twenty‐eight rural school districts were randomized to intervention and control conditions, with 1985 nineteen‐year‐old participants (90.6% White, 54.1% female) evaluated through age 25. Intent‐to‐treat, multi‐level, point‐in‐time analyses of covariance and growth analyses were conducted. Outcomes were assessed with self‐report measures of substance misuse (lifetime, current, frequency) and conduct problem behaviors. Analyses showed very limited point‐in‐time effects; there were growth pattern effects on measures of illicit drugs, non‐prescribed drugs, cigarettes, and drug problems. When risk moderation was observed, it favored higher‐risk participants. These emerging adult effects concerning slower growth of lifetime misuse combine with more robust adolescent stage findings to support PROSPER’s public health value.

Affected other interventions: a systematic review and meta-analysis across addictions.

Background and AimsIndividuals impacted by someone else’s alcohol, illicit drug, gambling and gaming problems (affected others) experience extensive harms. To our knowledge, this is the first systematic review and meta‐analysis to determine the effectiveness of psychosocial interventions delivered to affected others across addictions.MethodsThis review adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. An electronic database search (PsycInfo, Medline, Cinahl and EMBASE) of randomized controlled trials (RCTs) published until August 2021 was conducted. RCTs with passive control groups, evaluating psychosocial tertiary interventions delivered to affected others of people with addictions (problematic alcohol use, substance use, gambling or gaming) that did not require the involvement of the addicted person, were included.ResultsTwenty included studies, published in 22 articles, mainly evaluated interventions for alcohol use, followed by gambling and illicit drugs, with none investigating gaming interventions. The interventions mainly targeted partners/spouses and focused upon improving affected other outcomes, addicted person outcomes or both. Meta‐analyses revealed beneficial intervention effects over control groups on some affected other (depressive symptomatology [standardized mean difference (SMD) = −0.48, 95% confidence interval (CI) = −0.67, –0.29], life satisfaction (SMD = −0.37, 95% CI = −0.71, −0.03) and coping style (SMD = −1.33, 95% CI = −1.87, –0.79), addicted person [treatment entry, risk ratio (RR) = 0.86, 95% CI = 0.75–0.98] and relationship functioning outcomes (marital discord, SMD = −0.40, 95% CI = −0.61, −0.18) at post‐intervention. No beneficial intervention effects were identified at short‐term follow‐up (4–11 months post‐treatment). The beneficial intervention effects identified at post‐treatment remained when limiting to studies of alcohol use and therapist‐delivered interventions.ConclusionsPsychosocial interventions delivered to affected others of people with addictions (problematic alcohol use, substance use, gambling or gaming) may be effective in improving some, but not all, affected other (depression, life satisfaction, coping), addicted person (treatment) and relationship functioning (marital discord) outcomes for affected others across the addictions, but the conclusion remains tentative due to limited studies and methodological limitations.

The Correlates of Post-Traumatic Stress Disorder in Ambulance Personnel and Barriers Faced in Accessing Care for Work-Related Stress.

We investigated factors associated with increased risk for post-traumatic stress disorder (PTSD) in ambulance personnel and the barriers faced in accessing support for work-related stress (WRS). A cross-sectional study of 388 ambulance personnel used self-administered questionnaires to assess for PTSD and level of occupational stressors: Impact of Event Scale-Revised, Emergency Medical Services (EMS) Critical Incident Inventory, EMS Chronic Stress Questionnaire, SF-36 Quality of Life and the Connor–Davidson Resilience Scale. The prevalence of PTSD in the study population was 30%. The participants were predominantly female (55%), with a median age of 38 (IQR; 31–44) years. PTSD was associated with smoking (OR = 1.76, 95% CI: 1.05–2.95), illicit drug use (OR = 16.4, 95% CI: 1.87–143.86) and problem drinking (OR = 3.86, 95% CI: 1.80–8.23). A self-reported mental health condition (OR = 3.76, 95% CI: 1.96–7.21), being treated for a medical condition (OR = 1.95, 95% CI: 1.22–3.11), exposure to critical incident stress (OR = 4.27, 95% CI: 2.24–8.15) and chronic WRS (OR = 4.46, 95% CI: 1.93–10.31) were associated with PTSD risk. Barriers to seeking help included concerns that services were not confidential and the negative impact on the participant’s career. The increased levels of WRS, strong associations with substance use and barriers to accessing care offer starting points for workplace interventions to reduce the impact of PTSD in ambulance personnel.

Treatment Response Prediction and Individualized Identification of Short-Term Abstinence Methamphetamine Dependence Using Brain Graph Metrics.

Background: The abuse of methamphetamine (MA) worldwide has gained international attention as the most rapidly growing illicit drug problem. The classification and treatment response prediction of MA addicts are thereby paramount, in order for effective treatments to be more targeted to individuals. However, there has been limited progress.Methods: In the present study, 43 MA-dependent participants and 38 age- and gender-matched healthy controls were enrolled, and their resting-state functional magnetic resonance imaging data were collected. MA-dependent participants who showed 50% reduction in craving were defined as responders to treatment. The present study used the machine learning method, which is a support vector machine (SVM), to detect the most relevant features for discriminating and predicting the treatment response for MA-dependent participants based on the features extracted from the functional graph metrics.Results: A classifier was able to differentiate MA-dependent subjects from normal controls, with a cross-validated prediction accuracy, sensitivity, and specificity of 73.2% [95% confidence interval (CI) = 71.23–74.17%), 66.05% (95% CI = 63.06–69.04%), and 80.35% (95% CI = 77.77–82.93%), respectively, at the individual level. The most accurate combination of classifier features included the nodal efficiency in the right middle temporal gyrus and the community index in the left precentral gyrus and cuneus. Between these two, the community index in the left precentral gyrus had the highest importance. In addition, the classification performance of the other classifier used to predict the treatment response of MA-dependent subjects had an accuracy, sensitivity, and specificity of 71.2% (95% CI = 69.28–73.12%), 86.75% (95% CI = 84.48–88.92%), and 55.65% (95% CI = 52.61–58.79%), respectively, at the individual level. Furthermore, the most accurate combination of classifier features included the nodal clustering coefficient in the right orbital part of the superior frontal gyrus, the nodal local efficiency in the right orbital part of the superior frontal gyrus, and the right triangular part of the inferior frontal gyrus and right temporal pole of middle temporal gyrus. Among these, the nodal local efficiency in the right temporal pole of the middle temporal gyrus had the highest feature importance.Conclusion: The present study identified the most relevant features of MA addiction and treatment based on SVMs and the features extracted from the graph metrics and provided possible biomarkers to differentiate and predict the treatment response for MA-dependent patients. The brain regions involved in the best combinations should be given close attention during the treatment of MA.

Impact of 12 step mutual help groups on drug use disorder patients across six clinical trials

Background12 step mutual help groups are widely accessed by people with drug use disorder but infrequently subjected to rigorous evaluation. Pooling randomized trials containing a condition in which mutual help group attendance is actively facilitated presents an opportunity to assess the effectiveness of 12 step groups in large, diverse samples of drug use disorder patients. MethodsData from six federally-funded randomized trials were pooled (n = 1730) and subjected to two-stage instrumental variables modelling, and, fixed and random effects regression models. All trials included a 12 step group facilitation condition and employed the Addiction Severity Index as a core measure. ResultsThe ability of 12 step facilitation to increase mutual help group participation among drug use disorder patients was minimal, limiting ability to employ two-stage instrumental variable models that correct for selection bias. However, traditional fixed and random effect regression models found that greater 12 step mutual help group attendance by drug use disorder patients predicted reduced use of and problems with illicit drugs and also with alcohol. ConclusionFacilitating significant and lasting involvement in 12 step groups may be more challenging for drug use disorder patients than for alcohol use disorder patients, which has important implications for clinical work and for effectiveness evaluations. Though selection bias could explain part of the results of traditional regression models, the finding that participation in 12 step mutual help groups predicts lower illicit drug and alcohol use and problems in a large, diverse, sample of drug use disorder patients is encouraging.

White Matter Abnormalities Based on TBSS and Its Correlation With Impulsivity Behavior of Methamphetamine Addicts.

BackgroundMethamphetamine (MA) abuse is one of the most rapidly growing illicit drug problems worldwide. Impulsivity has been considered as a core impairment underpinning addictive behavior. Studies have demonstrated that MA addicts have white matter abnormalities based on ROIs. There are few studies on whole brain, and the association between whole brain tracts and impulsivity in MA dependence remain unclear. Tract-based spatial statistics (TBSS) was used to detect four DTI measures, and these were correlated with the Barratt Impulsivity Scale (BIS) to verify and expand the previous results.MethodsA total of 28 MA addicts and 22 healthy controls were recruited. MRI was performed to evaluate the brain structural changes, the BIS was used to evaluate impulsivity behavior, white matter differences were compared between MA addicts and healthy controls, and then determine correlation between diffusion parameters and BIS scores.ResultsMA addicts had significantly lower FA, and higher AD, RD, and MD in a wide range of white matter, which mainly included: corona radiata, internal capsule, superior longitudinal fasciculus, external capsule, inferior fronto-occipital fascicules, posterior thalamic radiation, sagittal stratum, fornix and stria terminalis, cerebral peduncle, superior cerebellar peduncle, corpus callosum, and corticolspinal tract compared with controls. The MA group had significantly higher total score, attention and motor scores compared to healthy controls. Higher MD in the right corticospinal tract was significantly associated with higher total scores.ConclusionMA addicts exhibit a globally diminished white matter integrity. furthermore, they present with high levels of impulsivity, and this dysfunction is associated with MD in corticospinal tracts. Future studies on larger sample sizes, gender effects and longitudinal studies are needed.

Older-Adult Marijuana Users in Substance Use Treatment: Characteristics Associated with Treatment Completion

ABSTRACT More older adults are using marijuana and receiving substance use treatment. We used the 2015–2017 Treatment Episode Data Set-Discharges (TEDS-D) to identify characteristics associated with treatment discharge among those aged 50+ whose admission involved marijuana use. Among these discharges (N = 130,287), 7.0% had been admitted for marijuana use only and 93.0% for polysubstance use (13.0% marijuana-primary, 57.7% marijuana-secondary, and 22.3% marijuana-tertiary), and the overall treatment completion rate was 45%. Using logistic regression, we examined associations of detoxification, residential rehabilitation, and outpatient treatment completion with type of marijuana and other substance involvement. Compared to marijuana-only cases, marijuana-tertiary cases had higher odds of completing detoxification (AOR = 1.54, 95% CI = 1.16–2.03), marijuana-secondary cases had higher odds of completing residential rehabilitation (AOR = 1.19, CI = 1.01–1.40), and all polysubstance cases had lower odds of completing outpatient treatment. Of the polysubstance cases, treatment completion odds were higher for those with alcohol problems but lower for those with other illicit drug problems. Previous treatment, referral source, psychiatric problems, first age of marijuana use, and racial/ethnic minority status were significant factors in treatment completion. Better strategies are needed to promote treatment retention and completion among older adults admitted for marijuana use problems, especially those who also have other illicit drug problems.

Sedative/Tranquilizer Misuse is Associated With Alcohol and Illicit Drug Problems, Mental Health Issues, and Impulsivity and Compulsivity in University Students.

Background:This study examined the prevalence of sedative/tranquilizer misuse among university students and its associations with psychosocial correlates.Methods:Nine thousand four hundred forty-nine students received a 156-item anonymous online survey, which assessed the use of prescription sedative/tranquilizer (ever or past year), alcohol and drug use, mental health issues, and impulsive and compulsive traits. Sedative/tranquilizer misuse was defined as intake of these prescription drugs by individuals who had not been prescribed them.Results:Three thousand five hundred twenty-five university students (57.7% women) responded to the survey. The prevalence of past 12-month prescription sedative/tranquilizer misuse was 2.1%, with 2.8% reporting having used more than 12 months ago. Prescription sedative/tranquilizer misuse was associated with the use of multiple other drugs (eg, alcohol, opiates each P < 0.001). Those who misuse sedative/tranquilizers were significantly more likely to have mental health histories (P < 0.001), engage in riskier sexual behavior (ie, earlier sexual acts [P < 0.001] and less frequent use of barrier contraception [P = 0.001]), report low self-esteem (P = 0.001), and endorse traits of impulsivity (P < 0.001) and compulsivity (P < 0.001). Effect sizes were small to medium.Conclusions:Misuse of prescription sedative/tranquilizers was reported by 2% to 3% of university students and was associated with a variety of mental health and drug use problems. Clinicians should be aware that certain mental health conditions are more likely in those who misuse sedatives. This study indicates the need for longitudinal research into the effects of chronic sedative use on brain function and mental health, especially in young people. Such research should address the extent to which impulsive traits predispose to various substance use problems, versus the direct effects of sedatives (and other substances) on mental health

Maternal use of illicit drugs, tobacco or alcohol and the risk of childhood cancer before 6 years of age

BackgroundPrevious studies provide conflicting evidence of a link between maternal substance use and risk of childhood cancer. MethodsWe analyzed a cohort of 785,438 newborns in Quebec (2006–2016). We identified infants whose mothers had problematic illicit drug, tobacco, or alcohol use before or during pregnancy. The primary outcomes were childhood hematopoietic cancer or solid tumors within 0–5 years of age. Using Cox proportional hazards models, we computed hazard ratios (HR) and 95% confidence intervals (CI) for the association between maternal substance use and childhood cancer, adjusted for potential confounders. ResultsA total of 925 cases of cancer occurred during 3.5 million person-years of follow-up. Children exposed to any maternal substance use had marginally elevated cancer incidence rates compared with unexposed children (29.4 vs. 26.1 per 100,000 person-years). Maternal illicit drug use was associated with the risk of acute lymphoblastic leukemia (HR 1.63, 95% CI 0.79–3.36) and fibrosarcoma (HR 2.11, 95% CI 0.86–5.16). Maternal tobacco use was associated with acute myeloid leukemia (HR 2.01, 95% CI 0.72–5.60) and fibrosarcoma (HR 2.13, 95% CI 1.05–4.32), but a weak association with neuroblastoma (HR 1.21, 95% CI 0.61–2.40) and renal tumors (HR 1.14, 95% CI 0.42–3.13) also appeared to be present. ConclusionsWe found a potential association between maternal substance use and certain types of early childhood cancer. Although effects were modest, maternal substance use may contribute to some types of childhood cancer, especially leukemia and fibrosarcoma.

STATE ANTI-DRUG HEALTH POLICY IN RUSSIA (ON THE EXAMPLE OF THE KHANTY-MANSIYSK AUTONOMOUS DISTRICT OF THE RUSSIAN FEDERATION)

In recent decades, the illicit drug problem within Russia’s population has become more severe. The threat of drug addiction is not only socially unacceptable but, in general, is fast becoming a major public health problem in Russia. The study objective is to identify factors that determine the availability of support from the state anti-drug policy of Russia, as exemplified by the Khanty-Mansiysk Autonomous District, Yugra. Monitoring of the drug situation, carried out in Khanty-Mansiysk, Yugra in 2014 - 2016, provides the background data along with results of a sociological survey of 2000 residents, and input from an expert panel. Indicators of drug-related morbidity in Khanty-Mansiysk, Yugra, are compared with those for the Russian Federation as a whole. Parameters and criteria for providing access to health care for the population are established along with recommendations for the authorities on how to optimize drug treatment for the population. The monitoring not only provides data to identify the vulnerabilities but, with the accumulated positive experience from Russia, also assists those providing drug treatment to the population to focus efforts in alleviating this major social problem.

Prospective associations between childhood externalising and internalising problems and adolescent alcohol and drug use: The Bergen Child Study.

Aims:The literature on associations between internalising problems and subsequent alcohol/drug use and problems shows mixed results, and it is important to consider different aspects of internalising problems along with co-occurring externalising problems.Methods:In a longitudinal study (n = 2438) followed up when the subjects were 7–9, 11–13, and 16–19 years of age, we investigated associations between parent/teacher-reported externalising and internalising problems (Strengths and Difficulties Questionnaire, SDQ) and adolescent self-reported alcohol and illicit drug use and problems. Socioeconomic status (SES), gender, and age were included as potential confounding variables. We also adjusted for the potential confounding effects from externalising problems on the association between internalising problems and alcohol/drug use, and vice versa.Results:Externalising problems were positively associated with all measures of alcohol/drug use and problems (adjusted odds ratios [AORs] ranging from 1.24 to 1.40, all p < .05), while internalising problems were negatively associated with all measures of alcohol/drug use (AORs ranging 0.83 to 0.88, all p < .05). Full-scale SDQ externalising problems were somewhat stronger and more robust predictors of adolescent alcohol/drug-related problems compared with SDQ externalising subscales, while only full-scale SDQ internalising problems were negatively associated with alcohol/drug-related problems. All estimates were similar across genders.Conclusions:Childhood externalising problems are positively associated while internalising problems are negatively associated with alcohol/drug use and problems in late adolescence.

REC-PATH (Recovery Pathways): Overview of a Four-Country Study of Pathways to Recovery from Problematic Drug Use

ABSTRACTAlthough there has been a growth in recent years in recovery research, much of this has been from the United States, and there is very little comparative research in this area. This article describes the rationale, conceptual foundations and methods for a prospective, multicountry, cohort study aimed to map pathways to recovery from problematic illicit drug use, with a specific focus on gender differences in recovery pathways. This study combines qualitative and quantitative components and examines the impact of recovery policy on the accessibility and viability of recovery pathways in England, Scotland, Belgium, and The Netherlands. Additionally, the article describes five processes through which mechanisms for behavior change for recovery may be triggered. This study will provide opportunities for linking recovery outcome research with analyses of national recovery policies, while also addressing the gap in literature around female pathways to recovery.

Using NIATx strategies to implement integrated services in routine care: a study protocol

BackgroundAccess to integrated services for individuals with co-occurring substance use and mental health disorders is a long-standing public health issue. Receiving integrated treatment services are both more effective and preferred by patients and families versus parallel or fragmented care. National policy statements and expert consensus guidelines underscore the benefits of integrated treatment. Despite decades of awareness, adequate treatment for individuals with co-occurring substance use and mental health disorders occurs infrequently. The underlying disease burden associated with alcohol, illicit and prescription drug problems, as well as mental health disorders, such as depression, posttraumatic stress disorder and schizophrenia, is substantial.MethodsThis cluster randomized controlled trial (RCT) is designed to determine if the multi-component Network for the Improvement of Addiction Treatment (NIATx) strategies are effective in implementing integrated services for persons with co-occurring substance use and mental health disorders. In this study, 50 behavioral health programs in Washington State will be recruited and then randomized into one of two intervention arms: 1) NIATx implementation strategies, including coaching and learning sessions over a 12-month intervention period to implement changes targeting integrated treatment services; or 2) wait-list control. Primary outcome measures include: 1) fidelity - a standardized organizational assessment of integrated services (Dual Diagnosis in Addiction Treatment [DDCAT] Index); and 2) penetration - proportion of patients screened and diagnosed with co-occurring disorders, proportion of eligible patients receiving substance use and mental health services, and psychotropic or substance use disorder medications. Barriers and facilitators, as determinants of implementation outcomes, will be assessed using the Consolidated Framework for Implementation Research (CFIR) Index. Fidelity to and participation in NIATx strategies will be assessed utilizing the NIATx Fidelity Scale and Stages of Implementation Completion (SIC).DiscussionThis study addresses an issue of substantial public health significance: the gap in access to an evidence-based practice for integrated treatment for individuals with co-occurring mental health and substance use disorders. The study utilizes rigorous and reproducible quantitative approaches to measuring implementation determinants and strategies, and may address a longstanding gap in the quality of care for persons with co-occurring disorders.Trial registrationClinicalTrials.gov NCT03007940. Registered 02 January 2017 – Retrospectively Registered

Body mass index across adolescence and substance use problems in early adulthood.

Excessive substance use and obesity are underpinned by a number of shared risk factors (e.g., reward dysfunction, impulsivity). Food and drugs of abuse engage similar reward-related neural circuitry and the food-drug competition hypothesis proposes that excess consumption of food may diminish desire for drugs of abuse by competing for neural receptors associated with reward and motivation. Adolescence is a high-risk period for both increased substance use and excessive weight gain. In the present study, the authors tested whether, consistent with the food-drug competition hypothesis, elevated body mass index (BMI) across adolescence predicted fewer substance use problems in young adulthood. In a multiwave prospective study of a community sample of families enriched for high levels of substance use disorders, the authors first identified BMI trajectories across adolescence in 565 participants using latent class growth analysis. They then used maximum likelihood methods to compare the equality of mean alcohol-, drug-, and nicotine-related problems during early adulthood across adolescent BMI trajectories. Participants in the obese relative to the normal weight trajectory in adolescence had fewer drinking and illicit drug problems in early adulthood. Relative to the overweight trajectory, nicotine dependence was significantly higher among both the normal weight and obese trajectories. The current findings provide partial support for the food-drug competition hypothesis, which suggests that highly palatable foods may be rewarding enough to compete with drugs of abuse and that transdiagnostic approaches to reducing problematic substance use and overeating in adolescence may be useful. However, the relationship between nicotine and food requires further study. (PsycINFO Database Record

Health Promotion Futures.

Health Promotion Futures.

Revisiting the 'paradigm shift' in opioid use: Developments and implications 10years later.

A decade ago, we queried the unfolding of a 'paradigm shift' in illicit opioid use in North America, specifically involving a shift away from heroin to prescription opioid (PO) use. Today, this situation is more acute than ever, with prescription opioid misuse, morbidity and mortality amounting to one of the most severe substance use-related public health crises ever, now even impacting life expectancy in key population segments. Despite medical system-based PO dispensing and practices being recognised as core drivers of the PO crisis, effective policy measures have been long absent or limited-including those to reduce medical PO use to levels supported by best evidence for pain care. At the same time, heroin use has been increasing again, now commonly tied into interdependent opioid use trajectories, initiated with POs yet shifting to heroin as influenced by economic or availability factors. For policy, there are now two major and urgent-yet partly conflicting-tasks: one is to reduce the determinants of PO misuse and harms by reducing medical prescribing to levels supported by good evidence, while the other is to effectively protect those many active problematic PO users from acute harms (including overdose mortality) by providing effective treatment and survival aids (e.g. naloxone). Surprisingly, it appears that a major 'homemade' and medical system-induced drug crisis has been at least as challenging for North American policy systems to address as other, more conventional illicit drug problems. Lessons for policy hence need to be urgently identified and applied for the future. [Fischer B, Rehm J. Revisiting the 'paradigm shift' in opioid use: Developments and implications 10 years later. Drug Alcohol Rev 2017;00:000-000].

Substance use among persons with homeless experience in primary care

ABSTRACTBackground: Community survey data suggest high prevalence of substance use disorders among currently homeless individuals. There are less data regarding illicit drug and alcohol use problems of homeless-experienced persons engaged in primary care. They may have less severe use and require different care responses from primary care teams. Methods: The authors surveyed currently and formerly homeless, i.e., homeless-experienced, persons engaged in primary care at five federally funded programs in the United States, administering the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST definitions of lower, moderate, and high risk were used to assess a spectrum of lifetime and recent substance use, from any use to likely dependence, and to identify sociodemographic and health status characteristics associated with severity of use. Results: Almost one half of the sample (N = 601) had recently (within the past three months) used alcohol, and one third had recently used an illicit drug. The most commonly used illicit drugs in the past three months were cannabis (19%), cocaine (16%), and opioids (7.5%). Over one half (59%) of respondents had ASSIST-defined moderate- or high-risk substance use. A significant proportion (31%) of those identified as at moderate risk had no recent substance use, but did report past problematic use. Ten percent of the lower-risk group had past problematic use of alcohol. Severity of use was associated with worse health status, but not with housing status or type of homelessness experienced. Conclusions: Less severe (moderate-risk) use and past problematic use, potentially indicative of remitted substance use disorders, were more common than high-risk use in this primary care, homeless-experienced sample. These findings highlight the urgency of identifying effective ways to reduce risky substance use and prevent relapse in homeless-experienced persons.