Nonmedical Opioid Use Research Articles

Preventing opioid use among justice-involved youth as they transition to adulthood: leveraging safe adults (LeSA)

BackgroundJuvenile justice (JJ) youth are at high risk of opioid and other substance use (SU), dysfunctional family/social relationships, and complex trauma. The purpose of the Leveraging Safe Adults (LeSA) Project is to examine the effectiveness of Trust-Based Relational Intervention® (TBRI®; leveraging family systems by providing emotional and instrumental guidance, support, and role modeling) in preventing opioid and other SU among youth after release from secure residential facilities.MethodsAn effectiveness-implementation Hybrid Type 1 design is used to test the effectiveness of TBRI for preventing non-medical use of opioids among JJ-youth (delayed-start at the site level; a randomized controlled trial at participant level) and to gain insight into facility-level barriers to TBRI implementation as part of JJ re-entry protocols. Recruitment includes two samples (effectiveness: 360 youth/caregiver dyads; implementation: 203 JJ staff) from nine sites in two states over 3 years. Participant eligibility includes 15 to 18-year-olds disposed to community supervision and receiving care in a secure JJ facility, without active suicide risk, and with one caregiver willing to participate. Effectiveness data come from (1) youth and caregiver self-report on background, SU, psychosocial functioning, and youth-caregiver relationships (Months 0, 3, 6, 12, and 18), youth monthly post-release check-ins, and caregiver report on youth psychological/behavioral symptoms, and (2) JJ facility records (e.g., recidivism, treatment utilization). Fidelity assessment includes post-session checklists and measures of TBRI strategy use. Collected four times over four years, implementation data include (1) JJ staff self-report on facility and staff characteristics, use of trauma-informed care and TBRI strategies, and (2) focus groups (line staff, leadership separately) on use of trauma-informed strategies, uptake of new interventions, and penetration, sustainment, and expansion of TBRI practices.DiscussionThe LeSA study is testing TBRI as a means to empower caregivers to help prevent opioid use and other SU among JJ-youth. TBRI’s multiple components offer an opportunity for caregivers to supplement and extend gains during residential care. If effective and implemented successfully, the LeSA protocol will help expand the application of TBRI with a wider audience and provide guidance for implementing multi-component interventions in complex systems spanning multiple contexts.Trial registrationClinicalTrials.govNCT04678960; registered November 11, 2020; https://clinicaltrials.gov/ct2/show/NCT04678960.

Treating Chronic Pain with Buprenorphine-The Practical Guide.

Buprenorphine has unique and favorable pharmacological properties that make it useful in a variety of clinical scenarios. It has been recommended to consider buprenorphine first-line opioid for chronic pain, especially in the elderly as it may be associated with less cognitive impairment, falls, sexual dysfunction, and sarcopenia when compared with schedule II opioids. It may be useful in patients with comorbid substance use disorder or non-medical opioid use, as there is less risk of misuse, euphoria and it may improve mood. When used to treat opioid use disorder, the training and waiver was recently waived for licensed practitioners with a DEA and any provider may prescribe buprenorphine. For many reasons outlined in this article, the popularity of using buprenorphine for analgesia continues to grow and a practitioner should consider this as an excellent and safe option for chronic pain.

Pain Management in Oncology Patients Amidst the Opioid Epidemic: How To Minimize Non-Medical Opioid Use.

The opioid epidemic continues to be a significant public health concern. On the surface, it appears difficult to understate the profound consequences and unnecessary loss of life at the hands of the opioid crisis throughout the 2010s. This reality should not dissuade rigorous attention toward those who have suffered unnecessarily due to an overreaching backlash toward the opioid crisis.Oncology patients have been significantly impacted on both ends of the opioid crisis. Like other populations, cancer patients were first affected during the initial surge of opioid availability, prescription, and use at the beginning of the crisis, where opioid abuse and overdose negatively impacted cancer patient populations at similar rates as the general population. Yet, cancer patients were perhaps even more heavily affected during secondary events after the initial crisis, as opioid restrictions and the stigmatization, undoubtedly beneficial in many spaces, of opioid use became prevalent across the American society. During this second period of the opioid crisis (loosely from 2013 to the present day after the Veterans Health Administration Opioid Safety Initiative started), restrictions on opioids have significantly decreased the use and access of opioids for cancer patients.Management of pain, in general, is a complex topic, and cancer pain is no exception. Cancer patients may experience pain related to the disease itself, its treatment, or other comorbidities. This review aims to clarify the impact of reducing opioid use on cancer patients over the past eight years. We summarize the challenges facing providers as they attempt to manage cancer-related pain. Additionally, we propose tools for best practices to reduce the unnecessary suffering of cancer patients and protect against the overuse and abuse of opioids.

Feasibility and acceptability of electronic administration of patient reported outcomes using mHealth platform in emergency department patients with non-medical opioid use

BackgroundThe emergency department (ED) offers an important opportunity to identify patients with opioid use disorder (OUD) and initiate treatment. However, post-ED follow-up is challenging, and novel approaches to enhance care transitions are urgently needed. Outcomes following ED visits have traditionally focused on overdose, treatment engagement, and mortality with an absence of patient reported outcomes (PROs), for example patient ability to schedule follow-up OUD treatment appointments or pick up a prescription medication, that may better inform evaluation of treatment pathways and near-term outcomes after acute events. In the context of increasing novel secure mobile health (mHealth) platforms, we explored the feasibility and acceptability of electronically collecting PROs from ED patients with non-medical opioid use to enhance care in the ED and transitions of care.MethodsED patients with non-medical opioid use or opioid overdose who endorsed willingness and ability to complete electronic surveys after discharge were enrolled from a tertiary, urban academic ED. Participants were enrolled in an mHealth platform, shared electronic health records with researchers, and completed electronic surveys of PROs at baseline, three- and thirty-days post discharge from the hospital, including questions about ability to schedule a follow-up appointment, pick up a prescription medication and overdose risk behaviors. Primary outcomes were measures of feasibility and acceptability of electronic PRO collection among ED patients with non-medical opioid use.ResultsAmong 1,808 patients assessed for eligibility between June-December 2019, 101 of 130 (78%) eligible adult patients consented to participate. Ninety-six (95%) of 101 patients completed registration in the mHealth platform, and 77/96 (80%) were successful in sharing their electronic health data. Completion rates for the baseline, three-day and thirty-day surveys were 97% (93/96), 49% (47/96) and 42% (40/96). Implementation challenges included short engagement window during ED visit, limited access to smartphones/computers, insufficient battery life of participant phone to access email and password, forgotten emails and passwords, multi-step verification processes for account set-up, and complaints about hospital care, most of which were effectively addressed by study personnel.ConclusionsED patients with OUD were willing to share electronic health information and PROs, although implementation challenges were common, and more than half of participants were lost-to-follow-up after hospital discharge at 30 days. Efforts to streamline communication and remove barriers to engagement are needed to improve the collection of PROs and pathways of care in ED patients with OUD.Clinical Trial Registration ClinicalTrials.gov (NCT03985163). Date of Registration: June 10, 2019, Retrospectively registered (First enrollment June 8, 2019). https://clinicaltrials.gov/ct2/show/record/NCT03985163

Medical and Non-Medical Opioid Use at the Intersection of Gender and Sexual Identity: Associations with State Medical Cannabis Law Status in a U.S. National Sample of Adults.

At the structural level, medical cannabis laws (MCLs) have been negatively associated with opioid prescribing practices, and sexual minority adults report disproportionately high non-medical prescription opioid use. We examined medical/non-medical prescription opioid use by intersecting sexual identity and gender and explored associations with MCLs using the 2015-2017 National Survey on Drug Use and Health, which captured sexual identity and MCL state residence for adults 18 + years (N = 126,463). Survey-weighted gender-stratified multinomial logistic models estimated adjusted relative risk ratios (aRRR) of medical vs. no prescription opioid use, and any non-medical vs. no prescription opioid use, by sexual identity and MCL, and tested moderation by MCL. Past-year medical prescription opioid use was higher among women than men across sexual identities (e.g., bisexual: 38.5% women vs. 30.2% men). Non-medical prescription opioid use was lower among women than men, except for bisexual adults (12.4% women vs. 7.6% men). MCL was associated with lower medical prescription opioid vs. no use among heterosexual women (aRRR = 0.86, 95% confidence interval [CI] = 0.81-0.91), bisexual women (aRRR = 0.74, 95% CI = 0.62-0.89), and heterosexual men (aRRR = 0.91, 95% CI = 0.85-0.97). Living in an MCL state was associated with lower non-medical vs. no use among heterosexual and bisexual women, but not among men or lesbian/gay women. MCL status did not moderate associations between sexual identity and prescription opioid outcomes. Future studies should assess whether implementing MCLs could particularly affect bisexual women who reported the highest prescription opioid use and may need targeted services.

94 Short-term use of therapeutic opioids for children and future opioid use disorders: A systematic review and qualitative study of decision-maker information needs

Abstract Primary Subject area Emergency Medicine - Paediatric Background Healthcare visits, hospitalizations, and deaths due to opioid-related harms continue to rise for children, despite an overall decline in opioid prescriptions. Decision-makers (including patients and families, clinicians, and policy-makers) require high quality syntheses to inform decisions regarding opioid use. Previous research has found that how systematic review (SR) results are presented may influence uptake by decision-makers. Evidence summaries are appealing to decision-makers as they provide key messages in a succinct manner. Objectives 1) To conduct an SR examining the association between short-term therapeutic exposure to opioids in children and development of opioid use disorder, and 2) To gain perspectives from policy decision-makers on the usability and presentation of results through the form of an evidence summary. Design/Methods We conducted an SR following methods recommended by Cochrane. A medical librarian conducted a comprehensive search and two authors were involved in study selection, data extraction and quality assessment. Studies were eligible if they reported primary research in English or French, and study participants had therapeutic exposure to opioids before age 18 years. Results were described narratively. Decision makers were recruited through purposive and snowball sampling methods, and they participated in interviews to discuss an evidence summary based on the SR. Interviews were transcribed and data were analyzed using content analysis. Ethics approval was obtained for the qualitative study. Results Nineteen American studies involving 47,191,990 participants were included. One study demonstrated that short-term therapeutic exposure may be associated with opioid abuse. Four others showed an association without specifying duration of exposure. Fourteen studies provided information on prevalence or incidence of opioid misuse following therapeutic exposure, median 27.8% [interquartile range 21.4% – 30.7%]; notably, 12 of them did not specify duration of therapeutic exposure. Identified risk factors were contradictory and remain unclear. Decision makers had mixed preferences for the presentation of evidence, depending on their degree of involvement in research versus practice. A majority preferred having methods and key characteristics of studies included in the first page of the evidence summary. They noted that the summary should not be text-heavy and details should be appended. Conclusion A number of studies suggest there is an association between lifetime therapeutic opioid use (unknown duration) and future nonmedical opioid use; however, there is limited evidence to determine whether short-term exposure is specifically associated with these outcomes. Policy and decision-makers prefer a succinct evidence summary for this SR, with study-specific details provided as an appendix. PROSPERO Registration: 122681.

Commentary on McCoy et al.: More pieces of the mosaic describing outcomes of the Australian up-scheduling of over-the-counter codeine to prescription only.

Data from the Australian Institute of Health and Welfare (AIHW) about trends in treatment and non-medical use of codeine and other opioids supports other recent studies indicating there has been no unintended harm from the February 2018 upscheduling of over-the-counter codeine to prescription only. Understanding the trends in non-medical use of pharmaceutical drugs and its consequences relies upon triangulating signals from different data sources to provide a mosaic overview [1]. McCoy et al.’s recent work forms an integral part of the picture in understanding outcomes from a major Australian opioid policy decision: the removal of codeine sales without a prescription [2]. The study examined those who regularly used codeine prior to the re-scheduling change and found reductions in codeine use, no increase in use of other opioids and reduced levels of opioid dependence following codeine re-scheduling. Small increases in general practitioner visits but a reduction in emergency department visits for opioids was also observed, alongside no change in mental health symptoms and an overall reduction in pain. These findings are consistent with work demonstrating a reduction in intentional poisonings with codeine [3], an analysis of population-level opioid supply showing no evidence of substitution to other opioids [4] and a study that found decreased codeine deaths, emergency department presentations and poisonings [5]. Collectively, these data sources provide a coherent picture indicating this policy change did not appear to have unintended harms. This may be linked to the substantial investment and implementation efforts that occurred at the time to raise awareness and support referral for pain management and alcohol and other drug treatment [6]. We write to describe the effects of up-scheduling using several sources provided by the AIHW, which represent a final piece of the puzzle. The National Drug Strategy Household Survey is conducted every 3 years. In 2016, past 12-month non-medical use of pharmaceuticals was the second leading category of drug misuse (4.8% of adults aged 14 or more years) after cannabis [7]. Non-medical use of painkillers/opioids was reported by 3.6% of the population: 29% misused painkillers/opioids at least weekly and 10.7% reported not being able to stop or cut back. Of those reporting misuse of painkillers/opioids, 74.8 and 40.6% reported non-medical use of OTC or prescription codeine, respectively. The prevalence of OTC codeine product misuse was highest in youths aged 14–19 years; 89% of those misusing painkillers/opioids reported this in the previous 12 months. In the 2019 survey, with codeine no longer available without a prescription, the proportion of people using codeine for non-medical purposes halved from 3.0% in 2016 to 1.5% [8]. The proportion of people who had recently misused pharmaceuticals decreased from 4.8% in 2016 to 4.2% in 2019. This included a decrease in the proportion of those recently misusing pain-killers/opioids from 3.6 to 2.7% during this period: of these, there was a statistically significant decrease in the proportion who had misused codeine, from 87.95% in 2016 to 60.7% in 2019. AIHW reports on episodes of care for clients seeking treatment from publicly funded Australian drug treatment services [9, 10] including reporting on trends where codeine was a drug of concern (Fig. 1). The number of codeine-related combined principal and additional drugs of concern closed episodes more than halved (51.1%), from 2711 in the last full financial year when codeine was available OTC (2016–17) to 1326 in the most recent year (2019–20). AIHW also reports standardized data concerning opioid agonist treatment with methadone or buprenorphine for the treatment of opioid use disorder [11]. From 2014 to 2020 heroin and pharmaceutical opioids accounted for 60–65% and 35–40% of the opioid of dependence, respectively (where reported). In the last calendar year (2017), when codeine was available OTC without a prescription, it accounted for 2095 cases (17.5% of all pharmaceutical opioids of dependence reported). This increased to 2332 (19%) in 2018, the first year following up-scheduling on 1 February 2018, and decreased each subsequent year to 2014 (15.7%) in 2020—the lowest proportion since 2015. The treatment and non-medical use data presented here support recent studies that indicate no evidence of unintended harms with codeine re-scheduling. This differs from that seen with re-scheduling of hydrocodone in the United States with a shift to other opioids [12]. This also contrasts with perceptions of pharmacists and consumers, and with concerns raised in submissions to the Therapeutic Goods Administration [13]. These findings may give the small number of countries who continue to supply codeine without a prescription confidence that, with appropriate implementation efforts, such a change can be made without adverse consequences for individuals and the community. Suzanne Nielsen was a co-author in the Addiction paper McCoy et al. to which we refer for this commentary.

Impact of “race” as a social variable for screening for the risk of non-medical opioid use using nomogram

Impact of “race” as a social variable for screening for the risk of non-medical opioid use using nomogram

The use of diverted pharmaceutical opioids is associated with reduced risk of fentanyl exposure among people using unregulated drugs in Vancouver, Canada

BackgroundAlthough non-medical use of pharmaceutical opioids (POs) is associated with a number of risks, in the context of the opioid-overdose crisis, it may have the secondary benefit of decreasing the risk of exposure to more potent opioids from unregulated sources. The aim of this study was to assess the effects of using diverted POs on fentanyl exposure. MethodsUsing data from two prospective community-recruited cohorts of people who use drugs (PWUD) in Vancouver, Canada, we estimated the independent relationship between using diverted POs and fentanyl exposure (assessed through urine drug test [UDT]) between 2016 and 2018. We also explored if participant characteristics modified this relationship. ResultsOver the study period, among 1150 participants, 241 (21.0%) reported using diverted POs in 292 (12.8%) occasions. In adjusted analyses, PWUD using diverted POs had decreased odds of fentanyl exposure (Adjusted odds ratio [AOR] = 0.70, 95% CI: 0.52–0.94). The reduced odds of fentanyl exposure persisted among participants with morphine positive UDT (AOR = 0.57, 95% CI: 0.40–0.82), but not among those with negative morphine UDT (AOR = 0.91, 95% CI: 0.54–1.55). ConclusionPWUD using diverted POs in our sample were 30% less likely to be exposed to fentanyl. This reduced likelihood was primarily observed among PWUD with morphine positive UDT, which could partially be explained by longer duration of action and lower street cost of slow-release oral morphine relative to other POs and fentanyl. Findings suggest that access to a regulated supply of pharmaceutical-grade opioids may serve to reduce fentanyl-related harms.

The Risk of Infective Endocarditis among COVID-19 Patients with Non-Medical Opioid Use

Patients with opioid use disorder are more likely to get coronavirus disease 2019 (COVID-19). Cardiovascular diseases frequently present in COVID-19 patients and can increase their susceptibility to invasive infectious diseases, such as infective endocarditis (IE). This study examines the difference in IE incidence following COVID-19 diagnosis between individuals with and without non-medical opioid use. De-identified electronic medical records data were retrieved from TriNetX, a web-based database. Patients in the U.S., aged 18-60 years, with a diagnosis of COVID-19 during January 2020 - January 2021 were included in this study. Development of IE was determined within three months after COVID-19 diagnosis. Logistic regression was conducted to estimate the risk of developing IE between COVID-19 patients with and without opioid use after propensity score matching. COVID-19 patients with non-medical opioid use had 6.8 times the risk of developing IE compared with COVID-19 patients without opioid use (95% CI: 5.44, 8.56; p<0.0001) after propensity score matching. Findings suggest a significant risk of IE among COVID-19 patients with a history of non-medical opioid use. It provides objective evidence to account for baseline opioid use in the risk assessment of IE among COVID-19 patients.

Pediatric Opioid Prescribing: A Call for Calm.

Pediatric Opioid Prescribing: A Call for Calm.

Non-medical Use of Prescription Stimulants Among College Students: Non-oral Routes of Administration, Risk Factors, Motivations, and Pathways.

Introduction: Non-medical use (NMU) of prescription stimulant medications is a continuing public health concern. Stimulant medications prescribed for attention-deficit/hyperactivity disorder (ADHD) are widely available on college campuses, and, as a consequence, college students may have multiple opportunities to engage in prescription stimulant NMU. This online self-report survey examined prescription stimulant NMU among college students, including: (1) patterns of non-oral route of administration (ROA); (2) motivations for non-oral ROAs; and (3) retrospectively recalled pathways of initiation.Method: The survey sample was created from a pool of 3,379 respondents, who were matched to a sampling frame constructed from the 18–26-year-old, college student sample of the 2016 American Community Survey (ACS). About 14% (n = 486) from the overall pool were identified as college students with self-reported prescription stimulant NMU, all of whom completed the survey. The survey covered user characteristics, prescription and illicit substance use, age of first NMU, motivations for NMU, sources of procurement, and ROAs used.Results: Among 486 students reporting prescription stimulant NMU, 43% had a lifetime diagnosis of ADHD. More than 90% reported polysubstance use, with 55% using illicit substances other than marijuana. Slightly more than 2 in 5 (43.3%) reported using illicit substances prior to prescription stimulant NMU, 24.6% used both at the same age, and 32.0% engaged in NMU of prescription stimulants prior to using illicit substances. Prescription stimulant NMU preceded prescription opioid NMU 45% of the time. More than a quarter of those engaged in prescription stimulant NMU (27.9%) initiated prescription stimulants alone or at the same age as other drugs. Most prescription stimulant NMU was oral, however 23.0% reported any non-oral use: snorting (20.4%), smoking (6.0%)and/or injection (3.5%). Non-oral use was associated with being male, obtaining medication from a dealer, use to get high, and/or a substance use disorder diagnosis.Conclusions: Prescription stimulant NMU often occurs in the larger context of other substance use among college students. Injection, an under-researched route for prescription stimulants, was associated with male gender, history of substance use and higher likelihood of illicit substance use. Nearly a quarter of college student survey respondents reported use with non-oral routes, which is associated with other high-risk behaviors. Efforts to reduce non-oral prescription stimulant NMU in college students are warranted.

Association between prescribed opioid use for acute pain in adolescents and the subsequent development of opioid misuse and substance use disorders: a systematic review protocol.

This review aims to examine prescribed short-term opioid use in adolescents to treat acute pain. The review will analyze the influence of opioid use on future non-medical opioid use (misuse) or substance use disorders (addiction) in adolescents and young adults. Prescription opioids are medically indicated for acute pain. Descriptive studies of administrative datasets and surveys implicate adolescent opioid exposure as a risk factor for subsequent opioid misuse and addiction. This review will provide a synthesis of the literature on the association between prescribed opioid exposure to treat acute pain in adolescents and the subsequent development of opioid misuse or substance use disorders in adolescents and young adults. This review will consider quantitative studies on opioid misuse or substance use disorders in Canadian and US adolescents and young adults (12 to 25 years of age). Studies must include exposure during adolescence (12 to 17 years of age) to legitimately prescribed short-term opioid use to treat acute pain. Studies on chronic pain or exposure to opioids for longer duration (more than 30 doses or more than 7 days) will be excluded. This review will follow the JBI methodology for systematic reviews of etiology and risk. Published and unpublished studies will be sourced from multiple databases and resources. Two independent reviewers will screen, appraise, and extract data from studies that meet the inclusion criteria. Data synthesis will be conducted and a Summary of Findings will be presented. PROSPERO CRD42020179635.

Perianesthesia Nurses’ Knowledge, Attitude, and Intention to Promote Safe Use, Storage, and Disposal of Opioids

<h3>Introduction</h3> Opioid overdose deaths and opioid use disorders are a crisis in the United States. Perianesthesia nurses have an excellent opportunity to educate patients and families who are discharged to home after surgery. <h3>Identification of the problem</h3> In a prior study, the authors found that nurses and other providers do not routinely discuss safe use, storage, or disposal of medications; perianesthesia nurses are more likely to discuss side effects of opioids. <h3>Purpose of the Study</h3> The purpose of this study is to determine if a web-based educational intervention increases knowledge, attitude, and intention of perianesthesia nurses to promote safe use, storage and disposal of opioids. <h3>Methodology</h3> A one group pre-test, post-test interventional study was conducted using a survey of ASPAN nurses. The intervention was a web-based voiceover module with patient education scenarios focused on information for patients before discharge. Responses to the pre-survey and 2 post surveys were collected. Data analysis included descriptive summary and evaluation of changes in knowledge and domains of Theory of Planned Behavior using repeated measures mixed modeling. <h3>Results</h3> The participants included pre-test survey (n = 678), the immediate post-test (n = 247), and the 4-week post-test (n = 171). The analysis presented is limited to 247 who completed at least the first post-survey. For all outcomes, there was an immediate increase in the measure following the intervention; this pairwise difference (between pretest and the immediate post-test) was significant in each model. The immediate and 4-week post-test scores exceeded the corresponding pre-test score, though for perceived behavioral control, attitude, and intention, the difference between baseline and week 4 was not significant. <h3>Discussion</h3> These findings suggest a more intensive intervention with possibly the inclusion of booster sessions, particularly for the outcomes of perceived behavioral control and subjective norms may be needed. <h3>Conclusion</h3> This educational intervention can be implemented at the national level for optimum impact. <h3>Implications for perianesthesia nurses and future research</h3> Perianesthesia nurses are well-positioned to teach patients about the risks of diversion, nonmedical use, and proper disposal of opioids. Research to develop safe postdischarge prescription practices and encourage safe opioid practices after surgery is needed.

Frequency and recency of non-medical opioid use and death due to overdose or suicide among individuals assessed for risky substance use: A national registry study in Sweden

Sweden and many other countries have experienced increases in suicide and accidental overdose deaths. An analysis examined the associations between recency of non-medical opioid misuse and frequency of use of non-medical opioids with death due to either suicide or accidental overdose within a sample of 15,000 Swedish adults who completed an Addiction Severity Index (ASI) assessment for risky substance use or a substance use disorder. Methods and materialsSuicide (n = 136) and death due to overdose (n = 405) were identified in the official Cause of Death Registry from the Swedish National Board of Health and Welfare. Control variables included demographic characteristics and risks associated with either overdose or suicide. Cox regression analyses controlled for variables statistically significantly at the bivariate level. ResultsAt the multivariable level: a) a higher (modified) ASI Composite Score for mental health; b) history of suicide attempt; c) having used non-medical opioids for 1–2 times per week for at least a year; d) history of injection drug use; and, e) early onset of drug use, were all significantly and positively associated with death due to suicide. At the multivariable level: a) a higher the revised ASI Composite Score for mental health; b) recency of use of non-medical opioids; c) frequency of non-medical opioid use; d) being a male; and e) being of ages 18–24 years compared to ages 43–51 years were all positively and significantly associated with death due to accidental overdose. ConclusionThese findings underscore the need to integrate mental health and substance use disorder treatment and provide suicide and overdose prevention interventions for individuals with an opioid use disorder. Recency and frequency of non-medical opioids were only associated with death due to overdose and not suicide. However, other drug use related variables (using opioids 1–2 times per week for at least a year, early onset of drug use and drug injection) were significantly associated with death due to suicide.

Reliability of a Rapid Screener for an Intercept Survey about Drug Use

Background Intercept surveys are a relatively inexpensive method to rapidly collect data on drug use. However, querying use of dozens of drugs can be time-consuming. We determined whether using a rapid screener is efficacious in detecting which participants use drugs and should be offered a full survey which asks more extensively about use. Methods We surveyed 103 adults (age 18-29) on streets of Manhattan, NY in 2019 to test the reliability of a screener which queried past-year use of six drugs. Those reporting any drug use on the screener (and a third of those not reporting drug use) were offered the full survey which queried use of 97 drugs. We compared self-reported use on the screener to the full survey. Results Self-reported use of ecstasy, cocaine, and LSD had high test-retest reliability (Kappa = 0.90-1.00), and the screener had high sensitivity (1.00) and specificity (0.97-1.00) in detecting use of these drugs. Reliability for marijuana (Kappa = 0.62) and nonmedical opioid use (Kappa = 0.75) was lower. The screener had higher sensitivity (0.94) and lower specificity (0.64) in detecting marijuana use, and lower sensitivity (0.71) and higher specificity (0.98) in detecting nonmedical opioid use. Within the full survey, all participants reporting use of amphetamine (nonmedical use), shrooms, poppers, synthetic cannabinoids, synthetic cathinones, novel psychedelics, ketamine, or GHB reported use of at least one drug queried on the screener. Conclusions Self-reported use of common drugs on a screener can reliably be used as an inclusion criterion for more extensive intercept surveys about drug use behavior.

Association of Opioid Use Disorder With 2016 Presidential Voting Patterns: Cross-sectional Study in New York State at Census Tract Level.

BackgroundOpioid overdose-related deaths have increased dramatically in recent years. Combating the opioid epidemic requires better understanding of the epidemiology of opioid poisoning (OP) and opioid use disorder (OUD).ObjectiveWe aimed to discover geospatial patterns in nonmedical opioid use and its correlations with demographic features related to despair and economic hardship, most notably the US presidential voting patterns in 2016 at census tract level in New York State.MethodsThis cross-sectional analysis used data from New York Statewide Planning and Research Cooperative System claims data and the presidential voting results of 2016 in New York State from the Harvard Election Data Archive. We included 63,958 patients who had at least one OUD diagnosis between 2010 and 2016 and 36,004 patients with at least one OP diagnosis between 2012 and 2016. Geospatial mappings were created to compare areas of New York in OUD rates and presidential voting patterns. A multiple regression model examines the extent that certain factors explain OUD rate variation.ResultsSeveral areas shared similar patterns of OUD rates and Republican vote: census tracts in western New York, central New York, and Suffolk County. The correlation between OUD rates and the Republican vote was .38 (P<.001). The regression model with census tract level of demographic and socioeconomic factors explains 30% of the variance in OUD rates, with disability and Republican vote as the most significant predictors.ConclusionsAt the census tract level, OUD rates were positively correlated with Republican support in the 2016 presidential election, disability, unemployment, and unmarried status. Socioeconomic and demographic despair-related features explain a large portion of the association between the Republican vote and OUD. Together, these findings underscore the importance of socioeconomic interventions in combating the opioid epidemic.

Some cancer patients at risk for nonmedical use of opioids

The Brown University Psychopharmacology UpdateVolume 32, Issue 4 p. 7-8 Research Roundup Some cancer patients at risk for nonmedical use of opioids First published: 05 March 2021 https://doi.org/10.1002/pu.30708Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume32, Issue4April 2021Pages 7-8 RelatedInformation

Pre-incarceration polysubstance use involving opioids: A unique risk factor of postrelease return to substance use

ObjectiveJustice-involved populations are at increased risk of overdose following release from prison and jail. This risk is exacerbated by polysubstance use, including the use of opioids with other substances. This study explored pre-incarceration polysubstance use involving opioids as a unique risk factor for postrelease return to substance use. MethodsThe study examined data from a cohort of 501 justice-involved persons who were enrolled in a therapeutic community treatment program while incarcerated. Latent profile validation identified profiles of polysubstance use involving opioids prior to incarceration. Multivariate logistic regression examined return to substance use, defined as self-reported relapse, and a time series model examined time in the community until a relapse event occurred. ResultsA latent profile validation found six unique polysubstance opioid patterns prior to incarceration. Two of these profiles, primarily alcohol and primarily buprenorphine, were at increased and accelerated risk for relapse postrelease relative to a less polysubstance use profile. Both profiles at increased risk had pre-incarceration co-use of marijuana (≈45% of month) and nonmedical use of opioids (≈40% of month) but were unique in their respective near daily use of alcohol and nonmedical buprenorphine. ConclusionsAmong persons who use opioids returning to the community, return to substance use occurs along a continuum of risk. Providers' consideration of polysubstance use patterns during treatment may assist in mitigating adverse outcomes for patients postrelease.

Nobody Wants to Be Narcan'd: A Pilot Qualitative Analysis of Drug Users' Perspectives on Naloxone.

IntroductionBystander naloxone distribution is an important component of public health initiatives to decrease opioid-related deaths. While there is evidence supporting naloxone distribution programs, the effects of increasing naloxone availability on the behavior of people who use drugs have not been adequately delineated. In this study we sought to 1) evaluate whether individuals’ drug use patterns have changed due to naloxone availability; and 2) explore individuals’ knowledge of, access to, experiences with, and perceptions of naloxone.MethodsWe conducted a pilot study of adults presenting to the emergency department whose medical history included non-medical opioid use. Semi-structured interviews were conducted with participants and thematic analysis was used to code and analyze interview transcripts.ResultsTen participants completed the study. All were aware of naloxone by brand name (Narcan) and had been trained in its use, and all but one had either currently or previously possessed a kit. Barriers to naloxone administration included fear of legal repercussions, not having it available, and a desire to avoid interrupting another user’s “high.” Of the eight participants who reported being revived with naloxone at least once during their lifetime, all described experiencing a noxious physical response and expressed a desire to avoid receiving it again. Furthermore, participants did not report increasing their use of opioids when naloxone was available.ConclusionsParticipants were accepting of and knowledgeable about naloxone, and were willing to administer naloxone to save a life. Participants tended to use opioids more cautiously when naloxone was present due to fears of experiencing precipitated withdrawal. This study provides preliminary evidence countering the unsubstantiated narrative that increased naloxone availability begets more high-risk opioid use and further supports increasing naloxone access.