Medication Misuse Research Articles

Implementation of Screening, Brief Intervention, and Referral for Treatment in the Aging Network of Care to Prevent Alcohol, Recreational Drug, and Prescription Medication Misuse.

Implementation of Screening, Brief Intervention, and Referral for Treatment in the Aging Network of Care to Prevent Alcohol, Recreational Drug, and Prescription Medication Misuse.

Sense of Purpose and Subsequent Drug Misuse

Indicators of vulnerability to drug or medication misuse might point to useful prevention strategies. Because purpose in life has been associated with

Combined cocaine and clonazepam administration induces REM sleep loss and anxiety-like withdrawal behaviors in rats

Misuse of prescription medications has risen to popularity. Reasons for this practice include the self-medication of sleep and psychiatric disorders and attempts to counteract the dysphoric side effects of stimulant drugs. Clonazepam, a commonly prescribed benzodiazepine, has been increasingly used as a countermeasure to cocaine side-effects, including sleep reduction and anxiety. As both substances may impair sleep and aggravate psychiatric conditions, this study aimed to evaluate the long-term effects of the interaction of clonazepam and cocaine on anxiety-like behavior, and the short-term effects of this drug combination on sleep using male Wistar rats. Animals received saline, cocaine (15 mg/kg), clonazepam (1.25 mg/kg) or both drugs for 16 days. Sleep recording was performed on the first day of treatment to evaluate acute treatment effects. One day after the end of the treatment period, the open field and elevated plus-maze tests were used to assess anxiety-like behavior. Blood samples were collected for analysis of corticosterone levels. Rats receiving both drugs presented an increase in impulsivity when moving between arms in the elevated plus-maze and a reduction in exploratory behavior in the open field test. These findings suggest the presence of a withdrawal behavioral syndrome, which can manifest as a paradoxical increase in exploratory activity after a period without receiving the drug and may indicate the development of dependence. Combined treatment reduced paradoxical sleep time and increased its onset latency. There was no significant difference regarding corticosterone levels across any group. Our results contribute to the understanding of the risks of combining cocaine and clonazepam. Association of these drugs may impair sleep architecture and aggravate the dependence symptoms already seen when these substances are used separately. These findings may be useful in helping to counteract the impairments resulting from the combined use of these 2 substances and to raise awareness of these associated risks.

Cannabis use, other drug use, and risk of subsequent acute care in primary care patients

BackgroundCannabis and other drug use is associated with adverse health events, but little is known about the association of routine clinical screening for cannabis or other drug use and acute care utilization. This study evaluated whether self-reported frequency of cannabis or other drug use was associated with subsequent acute care. MethodThis retrospective cohort study used EHR and claims data from 8 sites in Washington State that implemented annual substance use screening. Eligible adult primary care patients (N = 47,447) completed screens for cannabis (N = 45,647) and/or other drug use, including illegal drug use and prescription medication misuse, (N = 45,255) from 3/3/15-10/1/2016. Separate single-item screens assessed frequency of past-year cannabis and other drug use: never, less than monthly, monthly, weekly, daily/almost daily. An indicator of acute care utilization measured any urgent care, emergency department visits, or hospitalizations ≤19 months after screening. Adjusted Cox proportional hazards models estimated risk of acute care. ResultsPatients were predominantly non-Hispanic White. Those reporting cannabis use less than monthly (Hazard Ratio [HR] = 1.12, 95 % CI = 1.03–1.21) or daily (HR = 1.24; 1.10–1.39) had greater risk of acute care during follow-up than those reporting no use. Patients reporting other drug use less than monthly (HR = 1.34; 1.13–1.59), weekly (HR = 2.21; 1.46–3.35), or daily (HR = 2.53; 1.86–3.45) had greater risk of acute care than those reporting no other drug use. ConclusionPopulation-based screening for cannabis and other drug use in primary care may have utility for understanding risk of subsequent acute care. It is unclear whether findings will generalize to U.S. states with broader racial/ethnic diversity.

Descriptions of Gabapentin Misuse and Associated Behaviors among a Sample of Opioid (Mis)users in South Florida

ABSTRACT Gabapentin has received increased attention due to a growing number of reports of misuse and diversion. However, significant details about gabapentin misuse are scant. Data are drawn from a mixed-methods study examining gabapentin misuse in South Florida. The sample includes 49 respondents who were age 18 or over and reported past year use of illicit opioids and/or the misuse of prescription opioid medications, as well as, recent (past 90 days) gabapentin misuse. Respondents were female (40.8%), Hispanic (30.6%), Black (16.3%), white (49.0%), and other race/ethnicity (4.1%). Mean age was 37.6. Many respondents (43%) misused gabapentin without ever receiving a prescription and 14% misused prior to being prescribed. Mean frequency of recent misuse was 25.4 days and included a mean of 51.65 pills/doses. Prevalent routes of administration included swallowing (85.7%) and snorting (10.2%). Gabapentin misuse occurred concomitantly with any opioid (44.9%), benzodiazepines (38.8%), alcohol (24.5%), and powder cocaine (24.5), among others. Respondents’ descriptions indicate that gabapentin produces feelings reminiscent of alcohol intoxication or opioid-induced euphoria, but for some it produces no noticeable effect or only alleviates pain. Greater understanding of gabapentin misuse, especially associated behaviors and concomitant use is needed to inform prevention and intervention efforts, and to guide policy approaches.

American Civil War medical practice, the post-bellum opium crisis and modern comparisons.

The American Civil War resulted in massive numbers of injured and ill soldiers. Throughout the conflict, medical doctors relied on opium to treat these conditions, giving rise to claims that the injudicious use of the narcotic caused America's post-bellum opium crisis. Similar claims of medical misuse of opioids are now made as America confronts the modern narcotic crisis. A more nuanced thesis based on a broader base of Civil War era research suggests a more complex set of interacting factors that collectively contributed to America's post-war opium crisis.

Sense of Purpose in Life and Likelihood of Future Illicit Drug Use or Prescription Medication Misuse.

In the United States, 28.6 million people used illicit drugs or misused prescription drugs in the last 30 days. Thus, identifying factors linked with lower likelihood of future drug misuse is an important target for research and practice. Sense of purpose in life has been linked with better behavioral and physical health outcomes. Furthermore, a higher sense of purpose may reduce the likelihood of drug misuse because it has been linked with several protective factors including enhanced ability to handle stress, higher pain tolerance, and lower impulsivity. However, the association between sense of purpose and drug misuse has been understudied. Thus, we tested whether people with a higher sense of purpose at baseline had a lower likelihood of future drug misuse 9 to 10 years later. This study included 3535 middle-aged adults from the Midlife in the United States Study who were not misusing drugs at baseline. Using multiple logistic regression models, we assessed whether baseline purpose in life was associated with risk of misusing drugs 9 to 10 years later. Among respondents not misusing drugs at baseline, people in the highest quartile of purpose (versus lowest quartile) had a substantially lower likelihood of future drug misuse in a model adjusting for demographic variables (odds ratio = 0.50, 95% confidence interval = 0.31-0.83). Associations remained evident after additionally adjusting for psychological distress, baseline health, and health behaviors. A growing knowledge base suggests that a sense of purpose can be increased. Additional research is needed to evaluate sense of purpose as a novel target in the prevention and reduction of drug misuse.

Preventing Prescription Drug Abuse: A Pharmacy Technician Tool Kit.

The misuse of prescription medications in the United States is a worsening public health problem. Pharmacy technicians are often the first pharmacy staff member to receive newly dropped off prescriptions and to interact with patients in the pharmacy. Having a tool kit of the knowledge and skills needed to distinguish prescriptions that may result in misuse from the legitimate ones and to respond appropriately and professionally to each is essential to pharmacy technicians performing their role and function in the dispensing process.

Predictors of Prescription Drug Misuse among High School Students in the United States

ABSTRACT The misuse of prescription medication is a prominent public health concern in the United States. The current study examines prescription drug misuse among adolescents under age 18, a segment of the population that is particularly vulnerable to this issue. The study further explores the correlates of prescription drug misuse among adolescents through analysis of the Youth Risk Behavior Survey results. The analysis is framed through Routine Activities Theory. Results indicate that aspects of the theory are moderate to strong predictors of youth prescription drug misuse.

MISUSE AND ABUSE OF DRUGS: A CROSS-SECTIONAL SURVEY AMONG PHARMACY PROFESSIONALS IN SAUDI ARABIA

Prescription and non-prescription medication misuse or abuse is a global problem that has a negative impact on all human life aspects, including health, social, economic, and security status. According to the United Nations Office on Drug and Crime reports, over 5% of adult people used drugs at least once in the year 2015, and 29.5 million of them were suffered from the consequences of inappropriate use of drugs. Information on the knowledge and perception among pharmacists regarding the misuse and abuse medications in Saudi Arabia are limited, and therefore, a study was conducted among pharmacy staff to assess their knowledge and awareness on drug misuse and abuse. A cross-sectional study was carried out in Eastern Province, Saudi Arabia. Pharmacy professionals with more than three months of experience were included in the study. A structured questionnaire was used to obtain the participant's responses. A Chi-square test was used to evaluate the association of sociodemographic factors with the participant's responses. Ninety pharmacy professionals were responded. Overall, 69 (76.7%) participants agreed that misuse and abuse are two different terms. In addition, the study showed different responses for patients who suspected to be medication abusers. In conclusion, this study provides an initial picture of pharmacy staffs' knowledge and opinion regarding the misuse and abuse of medicines in Saudi Arabia. Participants' reactions toward such behaviors were different and not consistent. Therefore, there should be a clear policy to define the role of the pharmacy staff toward the misuse and abuse of medication in Saudi Arabia.

Misuse and Abuse of Drugs: a Cross-Sectional Survey Among Pharmacy Professionals in Saudi Arabia

Prescription and non-prescription medication misuse or abuse is a global problem that has a negative impact on all human life aspects, including health, social, economic, and security status. According to the United Nations Office on Drug and Crime reports, over 5% of adult people used drugs at least once in the year 2015, and 29.5 million of them were suffered from the consequences of inappropriate use of drugs. Information on the knowledge and perception among pharmacists regarding the misuse and abuse medications in Saudi Arabia are limited, and therefore, a study was conducted among pharmacy staff to assess their knowledge and awareness on drug misuse and abuse. A cross-sectional study was carried out in Eastern Province, Saudi Arabia. Pharmacy professionals with more than three months of experience were included in the study. A structured questionnaire was used to obtain the participant’s responses. A Chi-square test was used to evaluate the association of sociodemographic factors with the participant's responses. Ninety pharmacy professionals were responded. Overall, 69 (76.7%) participants agreed that misuse and abuse are two different terms. In addition, the study showed different responses for patients who suspected to be medication abusers. In conclusion, this study provides an initial picture of pharmacy staffs’ knowledge and opinion regarding the misuse and abuse of medicines in Saudi Arabia. Participants’ reactions toward such behaviors were different and not consistent. Therefore, there should be a clear policy to define the role of the pharmacy staff toward the misuse and abuse of medication in Saudi Arabia

Disentangling the Social Context of Nonmedical Use of Prescription Stimulants in College Students

The aim of this study was to investigate the social context of nonmedical use of prescription stimulants (NMUPS) among college students who endorsed NMUPS with co-occurring substance use disorders (SUD) compared with those without co-occurring SUDs. Presented here are new analyses based on data previously collected from college students aged 18 to 28 years derived from the Boston metropolitan area who endorsed NMUPS (N = 100) at least once in their lifetime. Differences between those with lifetime history of SUD (N = 46) and without a history of SUD (N = 54) on the Massachusetts General Hospital ADHD Medication Misuse and Diversion Assessment were analyzed using the Student t test, the Pearson χ2 test, and the Wilcoxon rank-sum test. College students who endorsed NMUPS with co-occurring SUD were more likely than those without SUD to have bought or traded stimulants, bought or traded in their car, used at parties with drugs/alcohol, or used intranasally (all P < .05). Intranasal administration was common (38% of all students endorsing NMUPS) and was associated with misuse at a party and simultaneous use with cocaine (P = .04), marijuana (P < .001), and alcohol (P < .001), compared with only oral use. Notable characteristics were identified among individuals who engaged in NMUPS in the type, amount, cost, and ascertainment of stimulants. The concurrence of SUD and/or intranasal administration appear to represent a more severe phenotype of NMUPS that should be considered in the implementation of future prevention and intervention protocols on college campuses. (Am J Addict 2020;29:476-484).

SAT-115 A Rare Case of Metastatic Insulinoma in a Patient with Huntington’s Disease

A 49-year-old female with past medical history of Huntington’s disease presents to the ED after being found unresponsive at her assisted-living facility. She was noted to be hypoglycemic with a glucose of 21 and responded to dextrose. For the past several months, patient had symptoms of dizziness, tremors. She has no history of diabetes, and only home medication is Zyprexa. Patient required D10 drip to maintain glucose levels. Given patient’s psychiatric history, there was concern for surreptitious use of diabetic medications. Labwork showed an insulin level of 163 and an elevated C-peptide of 7.0 consistent with endogenous insulin secretion. Patient underwent a 72-hour fasting protocol which revealed a glucose of 23, C-peptide of 4.1 and insulin of 101, undetectable beta-hydroxybutyrate levels and pro-insulin level of 782 which is consistent with a diagnosis of insulinoma. She was started on diazoxide, which diminishes insulin secretion, to treat the hypoglycemia. Patient underwent a pancreas CT protocol which showed multiple hypervascular hepatic masses up to 9 cm and one 4 cm mass in pancreatic tail concerning for metastasis. Pathology revealed metastatic well-differentiated neuroendocrine tumor grade 3. She was not a candidate for surgical resection of tumors and she was started on Octreotide 200 mcg TID. Patient underwent two Y90 radioembolization treatments, 2 months apart with improvement of hypoglycemia and discontinuation of diazoxide. Patient remains on Octreotide LAR injection every 4 weeks. Insulinoma, although rare, occurs in 1-4% of the population and is the most common type of functional neuroendocrine tumor of the pancreas. It secretes insulin which results in hyperinsulinemic hypoglycemia. Diagnosis involves persistent hypoglycemia with glucose <50 mg/dL, neuroglycopenic symptoms and prompt relief after glucose administration. Gold standard diagnosis is a 72-hour fast and measurement of plasma insulin, C-peptide and pro-insulin, which detects 99% of insulinomas. After lab confirmation, imaging is necessary with either CT, MRI or EUS. Surgical resection is curative in most patients. Other treatment modalities include injection of octreotide, EUS-aided alcohol ablation, radio-frequency ablation or embolization of insulinoma, as well as targeted therapy with everolimus or sunitinib. Malignant insulinomas are extremely rare and often invade into surrounding soft tissue or have lymph node or liver metastasis. They are usually unresectable and require targeted therapy. We present the case of a 49 YO patient with Huntington’s disease who presented with severe persistent hypoglycemia secondary to metastatic insulinoma. Diagnosis of insulinoma is often delayed or missed as symptoms may be attributed to psychiatric, cardiac or neurological disorders or medication misuse. Clinicians should be aware of insulinoma as a cause of life-threatening hypoglycemia.

Evaluación de la publicidad de medicamentos en los principales medios televisivos, radiofónicos y escritos en Costa Rica

La presente investigación evaluó la publicidad de medicamentos en los principales medios televisivos, radiofónicos y escritos en Costa Rica para conocer la información que se transmite al consumidor. Los medios de comunicación son interesantes objetos de estudios porque son usados por las industrias como una herramienta para poder llegar al consumidor. Este es un estudio observacional, descriptivo de tipo transversal, se realizó una encuesta a la población estudiantil de la Universidad Latina de Costa Rica y con la misma se hizo una observación de las pautas publicitarias en la radio, periódicos y la televisión en diferentes horarios. En la investigación se determinó que la mayoría de los anuncios encontrados en los diferentes medios de comunicación carecieron de ciertas disposiciones solicitadas por el reglamento. Las faltas que se encontraron fueron: composición del producto (principios activos), casa fabricante, categoría del producto, presentaciones disponibles. Se demostró que las regulaciones en la parte de la promoción de un medicamento son de gran importancia para poder proteger a los consumidores, porque las ganancias de las industrias farmacéuticas dependen en gran medida de su mercadotecnia. La promoción de productos busca aumentar las ganancias, sin embargo, si esto no se hace correctamente podría haber una mala utilización de los medicamentos.

Investigating Serious Games That Incorporate Medication Use for Patients: Systematic Literature Review.

BackgroundThe United States spends more than US $100 billion annually on the impact of medication misuse. Serious games are effective and innovative digital tools for educating patients about positive health behaviors. There are limited systematic reviews that examine the prevalence of serious games that incorporate medication use.ObjectiveThis systematic review aimed to identify (1) serious games intended to educate patients about medication adherence, education, and safety; (2) types of theoretical frameworks used to develop serious games for medication use; and (3) sampling frames for evaluating serious games on medication use.MethodsPubMed, Scopus, and Web of Science databases were searched for literature about medication-based serious games for patients. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for article selection.ResultsUsing PRISMA guidelines, 953 publications and 749 unique titles were identified from PubMed, Scopus, and Web of Science. A total of 16 studies featuring 12 unique serious games were included with components of medication adherence, education, and safety, published from 2003 to 2019. Of the 12 games included, eight serious games were tested in adolescents, three games were tested in young adults, and one game was tested in adults. Most studies (n=11) used small sample sizes to test the usability of serious games. Theoretical frameworks identified in the 12 serious games included information, motivation, and behavior theory; social cognitive theory; precede-proceed model; middle-range theory of chronic illness; adult learning theory; experiential learning theory; and the theory of reasoned action. Existing reviews explore serious games focused on the management of specific disease states, such as HIV, diabetes, and asthma, and on the positive impact of serious game education in each respective disease state. Although other reviews target broad topics such as health care gamification and serious games to educate health care workers, no reviews focus solely on medication use. Serious games were mainly focused on improving adherence, whereas medication safety was not widely explored. Little is known about the efficacy and usability of medication-focused serious games often because of small and nonrepresentative sample sizes, which limit the generalizability of existing studies.ConclusionsLimited studies exist on serious games for health that incorporate medication use. The findings from these studies focus on developing and testing serious games that teach patients about medication use and safety. Many of these studies do not apply a theoretical framework in the design and assessment of these games. In the future, serious game effectiveness could be improved by increasing study sample size and diversity of study participants, so that the results are generalizable to broader populations. Serious games should describe the extent of theoretical framework incorporated into game design and evaluate success by testing the player’s retention of learning objectives.

MP45-13 AMPHETAMINE/DEXTROAMPHETAMINE SALTS FOR DELAYED ORGASM AND ANORGASMIA IN MEN

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy II (MP45)1 Apr 2020MP45-13 AMPHETAMINE/DEXTROAMPHETAMINE SALTS FOR DELAYED ORGASM AND ANORGASMIA IN MEN Petar Bajic*, Matthew Ziegelmann, and Laurence Levine Petar Bajic*Petar Bajic* More articles by this author , Matthew ZiegelmannMatthew Ziegelmann More articles by this author , and Laurence LevineLaurence Levine More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000900.013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current treatments for delayed orgasm (DO) and anorgasmia are sub-optimal, with low rates of partial/complete response. Amphetamine/dextroamphetamine salts (ADS), a treatment for Attention-Deficit/Hyperactivity Disorder (ADHD), is a concentration-enhancing central nervous system stimulant. We utilize ADS to improve DO/anorgasmia. METHODS: We evaluated men with DO/anorgasmia who were carefully selected and treated with low-dose ADS (5-20 mg 1-4 hours prior to sexual activity) from 2015-2019. Thorough medical/social histories were obtained and patients were counseled on the off-label medication use and potential side effects. Patient characteristics and subjective improvements were retrospectively reviewed. All patients were contacted by phone/email to assess outcomes. International Index of Erectile Function (IIEF), quantitative Androgen Deficiency in the Aging Male (qADAM) and Adult ADHD Self-Report Scale (ASRS) questionnaires were administered. Descriptive statistics were performed and P<0.05 was considered statistically significant. RESULTS: 21 men were treated with ADS -- 7/21 (33.3%) for anorgasmia and 14/21 (66.7%) for DO. Median follow-up was 1.1 yrs (Range: 21 days-6.5 yrs). Baseline characteristics of the cohort are shown in Table 1. Prior treatments included cabergoline (5/21), sex therapy (3/21), PDE5-inhibitors (9/15), and vibrator (4/21). In total, ADS was effective in 8/21 (38.1%) patients (2/7 with anorgasmia). Responders rated satisfaction a mean of 5.6/10 vs 2.4/10 by non-responders (p=0.177). 42.8% (3/7) of surveyed non-responders and 100% (4/4) of responders stated they would try the medication again (p=0.194). Patients with DO who reported effective treatment had mean latency time improvement of 31.9 min (SD: 33.3; p=0.042) with intercourse and 10.3 min (SD: 17.0; p=0.117) with masturbation. Minimal side effects were noted including insomnia and jitters, each in one patient respectively. CONCLUSIONS: Low dose ADS resulted in symptom improvement in 38% of patients with DO or anorgasmia, with mean intercourse latency time improvement of 31.9 minutes in responders with DO. Larger prospective studies are needed to characterize optimal patients for this treatment. Careful patient selection and counseling is mandatory given the potential for medication misuse. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e669-e669 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Petar Bajic* More articles by this author Matthew Ziegelmann More articles by this author Laurence Levine More articles by this author Expand All Advertisement PDF downloadLoading ...

The influence of undertreated chronic pain in a national survey: Prescription medication misuse among American indians, Asian Pacific Islanders, Blacks, Hispanics and whites.

ObjectiveDisparities in the assessment and treatment of chronic pain among racial/ethnic may lead to self-treatment for undertreated pain. This study examines whether pain intensity among US racial/ethnic groups’ influences rates of psychotherapeutic prescription drug misuse.MethodsData included civilian, non-institutionalized adults (age 18–99 years) residing in the United States (n = 34,653) from Waves 1 and 2 of the National Epidemiological Survey on Alcoholism and Related Conditions (NESARC; 2004–2005). The primary outcome variable was prescription drug misuse/PDM (i.e., use without a prescription or other than as prescribed) including tranquilizers, sedatives, stimulants, or opioids. Predictor variables included self-reported race/ethnicity (American Indian, Black, Hispanic, or White) and pain intensity. Data were analyzed in 2019.ResultsOverall, White and Hispanic participants’ pain intensity had a significantly curvilinear relationship with frequency of prescription medication (p < 0.01). PDM rose with pain intensity until pain levels reached “severe,” then PDM rates fell, not significantly differing from the “no pain” levels (χ2(1) = 0.65, p = 0.42). PDM rates for Black participants remained lowest of all other racial/ethnic groups and plateaued with increasing pain intensity.ConclusionsOur results indicate that undertreated chronic pain may drive rates of PDM among varying racial/ethnic groups. Providing equitable assessment and treatment of pain intensity remains critical. Additional research is needed to examine provider decision-making and unconscious bias, as well as patient health beliefs surrounding perceived need for prescription pain medications.

Self-Reported Drug Use and Hearing Measures in Young Adults.

Purpose The purpose of this study was to examine marijuana or other substance use on pure-tone thresholds and distortion product otoacoustic emissions (DPOAEs) in young adults. Method Young adults (n = 243; 182 women, 61 men; M age = 20.9 years, SD = 2.7 years) participated in this study. Survey data included personal music system use, marijuana use, and misuse of prescription medications. Otoscopy, tympanometry, pure-tone audiometry, and DPOAEs were obtained. Pure tones from octave frequencies of 0.25 through 8 kHz were obtained, and DPOAEs were recorded between f2 frequencies of 1 and 6 kHz using two continuously presented stimulus tones swept in frequency. Results Those who reported marijuana or stimulant use had similar pure-tone averages (0.5, 1, 2, and 4 kHz) compared to those who reported never using marijuana or stimulants. Women who reported marijuana use in the past 30 days > two times had statistically significant higher mean DPOAEs compared to women who reported ≤ two times or no marijuana use in the past 30 days. Men, however, who reported marijuana use in the past 30 days > two times had lower, but not statistically significant, mean DPOAEs compared to men who reported ≤ two times or no marijuana use in the past 30 days. Women who reported ever using stimulants had statistically significant higher mean DPOAEs compared to women who reported never using stimulants; for men, mean DPOAEs were similar between those who reported ever using stimulants and those who never used stimulants. Conclusions The results of this study demonstrate different and contradictory associations between marijuana use, stimulant use, and hearing outcomes as a function of sex. Future research is needed to explore these associations utilizing larger sample sizes while accounting for additional harmful exposures to other noise exposures.

Risk‐factors for continuous long‐term use of prescription opioid drugs 3 years after hysterectomy: A nationwide cohort study

The widespread misuse of prescription pain medication, including opioids, has serious public health implications. Postoperative pain is a risk factor for persistent or chronic pain unless treated effectively. There are only a few studies that have assessed the use of opioid-containing drugs after gynecological surgery and most of these usually have a short follow-up period. The aim of this study was to identify risk-factors for long-term use of prescription opioid drugs following hysterectomy. We performed a nationwide cohort study based on prospectively collected data. Information from two population-based registers, the Swedish National Quality Register of Gynecological Surgery and the Swedish National Drug Register, was linked. The study population consisted of women with benign disease undergoing a total hysterectomy from 1 January 2012 until 31 December 2015. To identify long-term changes in prescription of opioids, individual data were collected from 1year prior to to 3years after surgery between 2011 and 2018. Data analysis was performed using multivariable logistic regression models. The population included 17385 women having had hysterectomy for benign disease. Of these women, 4233 (24.4%) were prescribed analgesics continuously for 3years postoperatively and 1225 (7.1%) used opioids long term. Perioperative predictors of opioid use 3years after surgery included a diagnosis of adenomyosis (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.2-2.7) and preoperative use of opioids (aOR 29.6, 95% CI 19.7-44.4), psycho- (aOR 3.5, 95% CI 2.4-5.0) and neuroactive drugs (aOR 1.8, 95% CI 1.0-3.1). For women with no opioid prescription preoperatively (n=260, 1.5%), mild (aOR 2.8, 95% CI 1.1-7.3) and severe (3.0% vs 6.2%: aOR 6.4, 95% CI 1.4-20.0) postoperative complications and preoperative prescription of psychoactive drugs (aOR 4.6, 95% CI 1.9-10.7) were associated with long-term use of drugs containing opioids. Long-term use of prescription opioids after hysterectomy is common and is, among other risk factors, strongly associated with preoperative use of opioids, as well as psychoactive drugs and adenomyosis. To avoid opioid misuse disorders among women at risk for long-term opioid drug prescriptions after hysterectomy, further studies and strategies are needed.

Examining the intersection of race/ethnicity and sexual orientation on suicidal ideation and suicide attempt among adolescents: Findings from the 2017 Youth Risk Behavior Survey

Although some studies have examined factors associated with suicidal behaviors, few studies have examined the intersection of sexual orientation and race/ethnicity on suicidal behaviors among adolescents. The objective of this study is to examine the intersection of sexual orientation and race/ethnicity on suicidal ideation and suicide attempt. We hypothesized that controlling for the effects of known risk factors for suicidal behaviors, there will be an interaction effect between sexual orientation and race/ethnicity on suicidal behaviors. Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 13,697 adolescents aged 14–18 years (51.8% female) was analyzed using binary logistic regression. Of the 13,697 adolescents, 17.7% reported suicidal ideation and 7.7% made at least one suicide attempt during the past 12 months. In the multivariate logistic regression models, non-White sexual minority adolescents are less likely to report suicidal ideation. However, Hispanic lesbian/gay adolescents had 1.71 times higher odds of making a suicide attempt. Odds of suicide attempt are 1.2 times higher for Black or African American bisexual adolescents and American Indian/Native Hawaiian/Pacific Islander bisexual adolescents had 2.44 times higher odds of making a suicide attempt. Other significant predictors of suicidal behaviors include a history of sexual assault, a victim of bullying, depression, cigarette smoking, misuse of prescription pain medication, and illicit drug use. The findings of the present study extend past research on the intersection of sexual orientation and race/ethnicity on mental health problems among adolescents including suicidal behaviors.