Prevalence Of Opioid Use Disorder Research Articles

Brief Report on Outpatient Treatment of Adolescent Opioid Use Disorder.

Adolescents are experiencing an increase in substance-related overdose fatalities, with most attributed to fentanyl and an increase in the prevalence of opioid use disorder (OUD). We know little about the characteristics of adolescents who use fentanyl, develop OUD, and seek addiction treatment. Here, we present demographic data and retention data on adolescent patients (≤18 years) who were treated at a pediatric addiction clinic. We included all patients who presented to an intake appointment at the pediatric addiction clinic between January 3, 2023, and October 17, 2023, and were diagnosed with OUD. We collected data on demographics, decision to start medicine for OUD (MOUD), choice of MOUD, and retention in treatment based on clinic visits at 1 month and 3 months postintake. Patients are consisted of 24 adolescents (Mage at intake = 16.8 ± 1.0 years, 67% Hispanic/Latinx, 75% public insurance) who met the criteria for moderate to severe OUD with known fentanyl use. All were offered MOUD, and 21 patients agreed to MOUD treatment; 16 adolescents selected buprenorphine/naloxone, and 5 selected naltrexone. At 3 months postintake, 14 patients (58%) were retained in treatment. Adolescent and family acceptance of MOUD treatment was high, and most patients were retained in treatment at 3 months postintake. More studies are needed to understand how to retain and support adolescent patients in outpatient treatment for OUD given the emergence of fentanyl.

Abstract B013: Sociodemographic differences and inpatient outcomes of opioid use disorder among patients hospitalized for head and neck cancer in the United States

Abstract Background: Opioid use disorder (OUD) is a rising public health concern in the United States. It poses substantial challenges in the management of head and neck cancers (HNC), given the pain associated with the disease. This study examines the sociodemographic differences in OUD among patients hospitalized for HNC in the United States as well as in-patient outcomes of HNC patients with OUD. Methods: We analyzed weighted retrospective data from the 2016 to 2020 National Inpatient Sample database. We included patients 18 years or older with principal discharge diagnoses of HNC with or without secondary diagnoses of OUD using specific ICD-10 codes. OUD was defined as opioid abuse, dependence, poisoning or adverse effects. Baseline sociodemographic and hospital characteristics of HNC patients with or without OUD were compared using χ2 for categorical variables and Student’s t-test for continuous variables. We examined sociodemographic characteristics associated with OUD using multivariable logistic regression models. We assessed three in-patient outcomes including mortality, length of stay and total hospitalization charge (THC) adjusted for inflation. Further we included interaction terms to explore the combined effects of relevant sociodemographic predictors with depression. Results: There were 117,085 hospitalizations for HNC between 2016 and 2020. Among HNC hospitalizations, 3.2% were opioid users and 2.36% had a secondary diagnosis of OUD. The mean age of HNC pts was 63.3 years (SD 0.08). 78.3% were Non-Hispanic White, 11.8% Non-Hispanic Black, 6.7% Hispanic and 3.2% Asians/Pacific Islanders. HNC patients with OUD had higher odds of being female (aOR 1.32; 95% CI 1.09, 1.59) and having more than one comorbidity (aOR 1.088; 95% CI 1.047, 1.132). There were lower odds of OUD with older age >70 years (aOR: 0.25; 95% CI 0.10, 0.59), private insurance (aOR 0.66; 95% CI 0.50, 0.87), higher income quartiles (aOR 0.66; 95% CI 0.50, 0.87) and with hospital regions in the South compared to the North-East United States (aOR 0.57; 95% CI 0.43, 0.74). There was no statistically significant interaction between MDD and gender (aOR 1.27; 95% CI 0.80, 2.04) among patients with HNC and OUD. OUD was not significantly associated with increased mortality in patients hospitalized for HNC (aOR 1.39, 95% CI 0.83, 2.33), however OUD was associated with a greater LOS by 3.6 days (95% CI 2.52, 4.60) and an increased THC of $26,947 (95% CI 13232, 40662). Conclusion: Our study demonstrates significant sociodemographic disparities in the prevalence of OUD among head and neck cancer hospitalizations in the US. Female patients and those with multiple comorbidities had higher odds of OUD. Additionally, OUD was significantly associated with an increased LOS and THC. These findings highlight the need for targeted interventions that address the unique needs of vulnerable populations with OUD and HNC. Citation Format: Ted O Akhiwu, Inemesit Akpan, Michael Imeh, Nosayaba Osazuwa-Peters. Sociodemographic differences and inpatient outcomes of opioid use disorder among patients hospitalized for head and neck cancer in the United States [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B013.

Improving Estimates of the Prevalence of Opioid Use Disorder in the United States: Revising Keyes et al.

The United States faces an ongoing drug overdose crisis, but accurate information on the prevalence of opioid use disorder (OUD) remains limited. A recent analysis by Keyes et al used a multiplier approach with drug poisoning mortality data to estimate OUD prevalence. Although insightful, this approach made stringent and partly inconsistent assumptions in interpreting mortality data, particularly synthetic opioid (SO)-involved and non-opioid-involved mortality. We revise that approach and resulting estimates to resolve inconsistencies and examine several alternative assumptions. We examine 4 adjustments to Keyes and colleagues' estimation approach: (A) revising how the equations account for SO effects on mortality, (B) incorporating fentanyl prevalence data to inform estimates of SO lethality, (C) using opioid-involved drug poisoning data to estimate a plausible range for OUD prevalence, and (D) adjusting mortality data to account for underreporting of opioid involvement. Revising the estimation equation and SO lethality effect (adj. A and B) while using Keyes and colleagues' original assumption that people with OUD account for all fatal drug poisonings yields slightly higher estimates, with OUD population reaching 9.3 million in 2016 before declining to 7.6 million by 2019. Using only opioid-involved drug poisoning data (adj. C and D) provides a lower range, peaking at 6.4 million in 2014-2015 and declining to 3.8 million in 2019. The revised estimation equation presented is feasible and addresses limitations of the earlier method and hence should be used in future estimations. Alternative assumptions around drug poisoning data can also provide a plausible range of estimates for OUD population.

A National Survey of Pediatric Emergency Medicine Clinicians' Comfort Level, Beliefs, and Experiences With Initiating Buprenorphine in the Emergency Department.

The prevalence of opioid use disorder (OUD) among adolescents has seen an alarming rise, prompting an exploration of the utilization of buprenorphine as a treatment modality. This study aimed to understand the perceptions, experiences, and comfort levels of pediatric emergency medicine (PEM) clinicians in initiating medication-assisted treatment (MAT) for pediatric patients presenting with OUD in emergency departments. Utilizing a cross-sectional survey design, data from 110 respondents were collected from a potential participant pool of 3062 for a response rate of 3.6%. The survey assessed demographics, clinical encounters, comfort levels, and opinions concerning the use of buprenorphine in the pediatric emergency setting. Only 3.6% of respondents frequently evaluated and treated opioid withdrawal in the ED. A significant majority, 87.3%, indicated they had never prescribed buprenorphine for patients under 18 in the ED. While 53% of clinicians believed in initiating buprenorphine for adolescents with OUD in the ED, 33.6% expressed feeling "very uncomfortable" with the initiation process. Training in MAT appeared to influence attitudes and comfort levels significantly. In this convenience sample survey with a 3.6% response rate, we found that a pronounced discomfort exists among PEM clinicians in initiating MAT, predominantly rooted in a lack of experience. Addressing this barrier through comprehensive training, developing evidence-based protocols, and fostering interdisciplinary collaboration is imperative to ensure optimal care for adolescents with OUD in emergency settings.

Lost in transition: A protocol for a retrospective, longitudinal cohort study for addressing challenges in opioid treatment for transition-age adults.

In the United States, there has been a concerning rise in the prevalence of opioid use disorders (OUD) among transition-age (TA) adults, 18 to 25-years old, with a disproportionate impact on individuals and families covered by Medicaid. Of equal concern, the treatment system continues to underperform for many young people, emphasizing the need to address the treatment challenges faced by this vulnerable population at a pivotal juncture in their life course. Pharmacotherapy is the most effective treatment for OUD, yet notably, observational studies reveal gaps in the receipt of and retention in medications for opioid use disorder (MOUD), resulting in poor outcomes for many TA adults in treatment. Few current studies on OUD treatment quality explicitly consider the influence of individual, organizational, and contextual factors, especially for young people whose social roles and institutional ties remain in flux. We introduce a retrospective, longitudinal cohort design to study treatment quality practices and outcomes among approximately 65,000 TA adults entering treatment for OUD between 2012 and 2025 in New York. We propose to combine data from multiple sources, including Medicaid claims and encounter data and a state registry of substance use disorder (SUD) treatment episodes, to examine three aspects of OUD treatment quality: 1) MOUD use, including MOUD option (e.g., buprenorphine, methadone, or extended-release [XR] naltrexone); 2) adherence to pharmacotherapy and retention in treatment; and 3) adverse events (e.g., overdoses). Using rigorous analytical methods, we will provide insights into how variation in treatment practices and outcomes are structured more broadly by multilevel processes related to communities, treatment programs, and characteristics of the patient, as well as their complex interplay. Our findings will inform clinical decision making by patients and providers as well as public health responses to the rising number of young adults seeking treatment for OUD amidst the opioid and polysubstance overdose crisis in the U.S.

Prevalence and factors associated with opioid use disorder among adolescents with sickle cell disease in Mulago hospital, Uganda

BackgroundOpioid use disorder (OUD) among adolescents with sickle cell disease (SCD) patients increases their risk of complications from sickle cell disease, such as infections, stroke, acute chest syndrome, sudden death, and organ failure. This negatively impacts families, communities, the national health system, and the economy. This study aimed to determine the prevalence and factors associated with opioid use disorder among adolescents with SCD at Mulago Hospital Uganda.MethodsThis study was carried out at the Sickle Cell Clinic of Mulago Hospital, the national referral hospital in Uganda. The study participants were adolescents aged 10 to 19 years. Following informed consent/ assent, a sociodemographic questionnaire, the WHO Alcohol, Smoking and Substance Involvement Screening Test - Young (ASSIST-Y), the Beck Depression Inventory-II (BDI II), and Generalized Anxiety Disorder − 7 (GAD-7) questionnaires were used to collect data. Data was entered in EpiInfo and analyzed in STATA 15.ResultsThe prevalence of opioid use disorder was 5.3%. The significant risk factor was increasing depressive score AOR: 1.11(95% CI: 1.01–1.22, p = 0.035), while living with a family was protective against opioid use disorders AOR: 0.01; (95% CI: 0.0004, 0.27, p = 0.007).ConclusionThere was a significant problem of OUD among adolescents with SCD. There is, therefore, needed to integrate screening of OUD and mental illnesses like depression among adolescents with SCD and to emphasize the importance of family support in their care.

Attitudinal barriers to buprenorphine prescription and former waiver training.

Opioid use disorder (OUD) can be effectively treated with buprenorphine maintenance. Recent changes in federal policy have removed the requirement for physicians to complete additional training to apply for a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine. At that time, few primary care providers (PCPs) had completed the training for a DEA waiver to prescribe buprenorphine. Our goal was to identify addressable barriers that may persist despite updates to federal legislation. A 42-item survey was distributed to 662 physicians and nurse practitioners at two academic medical centers with 100 respondents. The survey was sent via email and administered anonymously through SurveyMonkey. All participants were PCPs, and all PCPs at the two academic medical centers were eligible to participate. PCPs responded to the survey by answering questions online. PCPs answered questions regarding previous buprenorphine waiver training status, local OUD prevalence, the effectiveness of OUD treatment modalities, and previous barriers to training. Respondents were compared using descriptive statistics and logistic regression. Of the 100 respondents (response rate: 15 percent), 69 percent had not completed the training. Ninety-nine percent of PCPs agreed that OUD was an issue in their area, 94 percent saw patients with OUD, and 91 percent rated buprenorphine maintenance as a very effective treatment for OUD. Previously waivered and nonwaivered providers did not differ in their responses to these questions. Those who had been waivered were less likely to say they did not see enough patients with OUD to justify training (odds ratio [OR] 0.267, p = 0.005) and were less likely to express concern about allowing patients with OUD into their practice (OR 0.348, p = 0.020) than PCPs who had applied for the DEA waiver. Despite nonwaivered PCPs recognizing OUD's prevalence, they were concerned about allowing patients with OUD into their practice and said there were not enough patients to justify training. This suggests that attitudinal barriers are the most appropriate target for current intervention.

Trend in Prescription Medication Utilization for Opioid Use Disorder and Alcohol Use Disorder From 2015 to 2021: A Population-wide Study in a Canadian Province.

To examine the quarterly incidence and prevalence of medications for opioid use disorder (OUD) and alcohol use disorder (AUD) from 2015 to 2021. A retrospective population-wide observational study in Manitoba, Canada, was conducted using administrative claims data from the Manitoba Centre for Health Policy to examine the incidence and prevalence of OUD (methadone, buprenorphine-naloxone, buprenorphine) or AUD medications (naltrexone, acamprosate, disulfiram) per 10,000 individuals in each quarter between January 1, 2015, and December 31, 2021. There were 1179 and 451 individuals who received at least one prescription for OUD and AUD, respectively, in the first quarter of 2020. The prevalence of OUD medications more than doubled from 6.3 to 14.3 per 10,000 from January 1, 2015, to December 31, 2021. Likewise, AUD medication prevalence increased almost 10-fold from 0.68 to 6.5 per 10,000 from January 1, 2015, to December 31, 2021, primarily due to naltrexone. The incidence of AUD prescription use increased 8.6-fold from 0.29 to 2.51 per 10,000 during the study period. In contrast, the incidence of opioid agonist therapy declined from 2.1 per 10,000 in the first quarter of 2015 to 0.53 per 10,000 the first quarter of 2016, primarily due to methadone. Whereas methadone incidence declined, buprenorphine-naloxone incidence increased almost 15-fold during the study period. An increase in both AUD medication prevalence and incidence in addition to an increase in buprenorphine-naloxone incidence was observed. These findings reflect an increase in the uptake of medications for treating AUD and OUD following changes to improve coverage and access to these medications.

S55 - Prevalence of Opioid Use Disorder and Overdose Rates Among People With Mental Illness in New York State

S55 - Prevalence of Opioid Use Disorder and Overdose Rates Among People With Mental Illness in New York State

Genome-wide association study reveals multiple loci for nociception and opioid consumption behaviors associated with heroin vulnerability in outbred rats.

The increased prevalence of opioid use disorder (OUD) makes it imperative to disentangle the biological mechanisms contributing to individual differences in OUD vulnerability. OUD shows strong heritability, however genetic variants contributing toward vulnerability remain poorly defined. We performed a genome-wide association study using over 850 male and female heterogeneous stock (HS) rats to identify genes underlying behaviors associated with OUD such as nociception, as well as heroin-taking, extinction and seeking behaviors. By using an animal model of OUD, we were able to identify genetic variants associated with distinct OUD behaviors while maintaining a uniform environment, an experimental design not easily achieved in humans. Furthermore, we used a novel non-linear network-based clustering approach to characterize rats based on OUD vulnerability to assess genetic variants associated with OUD susceptibility. Our findings confirm the heritability of several OUD-like behaviors, including OUD susceptibility. Additionally, several genetic variants associated with nociceptive threshold prior to heroin experience, heroin consumption, escalation of intake, and motivation to obtain heroin were identified. Tom1 , a microglial component, was implicated for nociception. Several genes involved in dopaminergic signaling, neuroplasticity and substance use disorders, including Brwd1 , Pcp4, Phb1l2 and Mmp15 were implicated for the heroin traits. Additionally, an OUD vulnerable phenotype was associated with genetic variants for consumption and break point, suggesting a specific genetic contribution for OUD-like traits contributing to vulnerability. Together, these findings identify novel genetic markers related to the susceptibility to OUD-relevant behaviors in HS rats.

Prevalence of Opioid Use Disorder and Opioid Overdose Rates Among People With Mental Illness.

The authors examined the prevalence and correlates of co-occurring opioid use disorder and opioid overdose among individuals receiving psychiatric services. This was a cross-sectional study of adults with continuous enrollment in New York State Medicaid who received at least one psychiatric service in 2020 (N=523,885). Logistic regression models were used to examine the correlates of both opioid use disorder and overdose. In the study sample, the prevalence rate of opioid use disorder was 8.1%; within this group, 7.7% experienced an opioid overdose in the study year. Opioid use disorder rates were lower among younger (18-24 years; 2.0%) and older (≥65 years; 3.1%) adults and higher among men (11.1%) and among those residing in rural areas (9.9%). Compared with Whites (9.4%), opioid use disorder rates were lower for Asian Americans (2.0%, adjusted odds ratio [AOR]=0.22) and Blacks (6.8%, AOR=0.76) and higher for American Indians (13.2%, AOR=1.43) and Hispanics (9.6%, AOR=1.29). Individuals with any substance use (24.9%, AOR=5.20), posttraumatic stress (15.7%, AOR=2.34), bipolar (14.9%, AOR=2.29), or anxiety (11.3%, AOR=2.18) disorders were more likely to have co-occurring opioid use disorder; those with conduct (4.5%, AOR=0.51), adjustment (7.4%, AOR=0.88), or schizophrenia spectrum (7.4%, AOR=0.87) disorders were less likely to have opioid use disorder. Those with suicidality (23.9%, AOR=3.83) or economic instability (23.7%, AOR=3.35) had higher odds of having opioid use disorder. Overdose odds were higher among individuals with suicidality (34.0%, AOR=6.82) and economic instability (16.0%, AOR=2.57). These findings underscore the importance of providing opioid use disorder screening and treatment for patients receiving psychiatric services.

Public Health Interventions and Overdose-Related Outcomes Among Persons With Opioid Use Disorder

Given the high number of opioid overdose deaths in the US and the complex epidemiology of opioid use disorder (OUD), systems models can serve as a tool to identify opportunities for public health interventions. To estimate the projected 3-year association between public health interventions and opioid overdose-related outcomes among persons with OUD. This decision analytical model used a simulation model of the estimated US population aged 12 years and older with OUD that was developed and analyzed between January 2019 and December 2023. The model was parameterized and calibrated using 2019 to 2020 data and used to estimate the relative change in outcomes associated with simulated public health interventions implemented between 2021 and 2023. Projected OUD and medications for OUD (MOUD) prevalence in 2023 and number of nonfatal and fatal opioid-involved overdoses among persons with OUD between 2021 and 2023. In a baseline scenario assuming parameters calibrated using 2019 to 2020 data remained constant, the model projected more than 16 million persons with OUD not receiving MOUD treatment and nearly 1.7 million persons receiving MOUD treatment in 2023. Additionally, the model projected over 5 million nonfatal and over 145 000 fatal opioid-involved overdoses among persons with OUD between 2021 and 2023. When simulating combinations of interventions that involved reducing overdose rates by 50%, the model projected decreases of up to 35.2% in nonfatal and 36.6% in fatal opioid-involved overdoses among persons with OUD. Interventions specific to persons with OUD not currently receiving MOUD treatment demonstrated the greatest reduction in numbers of nonfatal and fatal overdoses. Combinations of interventions that increased MOUD initiation and decreased OUD recurrence were projected to reduce OUD prevalence by up to 23.4%, increase MOUD prevalence by up to 137.1%, and reduce nonfatal and fatal opioid-involved overdoses among persons with OUD by 6.7% and 3.5%, respectively. In this decision analytical model study of persons with OUD, findings suggested that expansion of evidence-based interventions that directly reduce the risk of overdose fatality among persons with OUD, such as through harm reduction efforts, could engender the highest reductions in fatal overdoses in the short-term. Interventions aimed at increasing MOUD initiation and retention of persons in treatment projected considerable improvement in MOUD and OUD prevalence but could require a longer time horizon for substantial reductions in opioid-involved overdoses.

A population-based time-series analysis of opioid agonist treatment dispensed during pregnancy.

Identifying effective opioid treatment options during pregnancy is a high priority due to the growing prevalence of opioid use disorder across North America. We assessed the temporal impact of three population-level interventions on the use of opioid agonist treatment (OAT) during pregnancy in Ontario, Canada. This was a population-based time-series analysis to identify trends in the monthly prevalence of pregnant people dispensed methadone and buprenorphine. The impact of adding buprenorphine/naloxone to the public drug formulary, the release of pregnancy-specific guidance and the start of the COVID-19 pandemic were assessed. The study was conducted in Ontario, Canada between 1 July 2013 and 31 March 2022, comprising people who delivered a live or stillbirth in any Ontario hospital during the study period. We identified any prescription for methadone or buprenorphine dispensed between the estimated conception date and delivery date and calculated the monthly prevalence of OAT-exposed pregnancies among all pregnant people in Ontario. Overall, rates of OAT during pregnancy have declined since mid-2018. Methadone-exposed pregnancies decreased from 0.46% of all pregnancies in Ontario in 2015 to a low of 0.16% in 2022. In the primary analysis, none of the interventions had a statistically significant impact on overall OAT rates; however, in the stratified analyses, there was a small increase in buprenorphine after the formulary change [0.006%, 95% confidence interval (CI) = 0.0032-0.0081, P < 0.0001] and a decrease in buprenorphine after the release of the 2017 guidelines (-0.005%, 95% CI = -0.0080 to -0.0020, P = 0.001) and the start of the COVID-19 pandemic (-0.003%, 95% CI = -0.0054 to -0.0006, P = 0.015). Despite changes in guidance and funding, opioid agonist treatment during pregnancy has been declining in Ontario, Canada since 2018.

Intersectional inequities and longitudinal prevalence estimates of opioid use disorder in Massachusetts 2014–2020: a multi-sample capture-recapture analysis

As overdoses continue to increase worldwide, accurate estimates are needed to understand the size of the population at risk and address health disparities. Capture-recapture methods may be used in place of direct estimation at nearly any geographic level (e.g., city, state, country) to estimate the size of the population with opioid use disorder (OUD). We performed a multi-sample capture-recapture analysis with persons aged 18-64 years to estimate the prevalence of OUD in Massachusetts from 2014 to 2020, stratified by sex and race/ethnicity. We used seven statewide administrative data sources linked at the individual level. We developed log-linear models to estimate the unknown OUD-affected population. Uncertainty was characterized using 95% confidence intervals (95% CI) on the total counts and prevalence estimates. The estimated OUD prevalence increased from 5.47% (95% CI=4.89%, 5.98%) in 2014 to 5.79% (95% CI=5.34%, 6.19%) in 2020. Prevalence among Hispanic females doubled (2.46% in 2014 to 4.23% in 2020) and prevalence rose to nearly 10% among Black non-Hispanic males and Hispanic males from 2014 through 2019. Estimates for Black non-Hispanic females more than doubled from 2014 through 2019 (3.39% to 7.09%), and then decreased to 5.69% in2020. This study is the first to provide OUD prevalence trend estimates by binary sex and race/ethnicity at a state level using capture-recapture methods. Using these methods as the international overdose crisis worsens can allow jurisdictions to appropriately allocate resources and targeted interventions to marginalised populations. NIDA.

Factors associated with frequent buprenorphine / naloxone initiation in a national survey of Canadian emergency physicians.

To identify individual and site-related factors associated with frequent emergency department (ED) buprenorphine/naloxone (BUP) initiation. BUP initiation, an effective opioid use disorder (OUD) intervention, varies widely across Canadian EDs. We surveyed emergency physicians in 6 Canadian provinces from 2018 to 2019 using bilingual paper and web-based questionnaires. Survey domains included BUP-related practice, demographics, attitudes toward BUP, and site characteristics. We defined frequent BUP initiation (the primary outcome) as at least once per month, high OUD prevalence as at least one OUD patient per shift, and high OUD resources as at least 3 out of the following 5 resources: BUP initiation pathways, BUP in ED, peer navigators, accessible addiction specialists, and accessible follow-up clinics. We excluded responses from sites with <50% participation (to minimize non-responder bias) and those missing the primary outcome. We used univariate analysis to identify associations between frequent BUP initiation and factors of interest, stratifying by OUD prevalence. We excluded 3 responses for missing BUP initiation frequency and 9 for low response rate at one ED. Of the remaining 649 respondents from 34 EDs, 374 (58%) practiced in metropolitan areas, 384 (59%) reported high OUD prevalence, 312 (48%) had high OUD resources, and 161 (25%) initiated BUP frequently. Age, gender, board certification and years in practice were not associated with frequent BUP initiation. Site-specific factors were associated with frequent BUP initiation (high OUD resources [OR 6.91], high OUD prevalence [OR 4.45], and metropolitan location [OR 2.39],) as were individual attitudinal factors (willingness, confidence, and responsibility to initiate BUP.) Similar associations persisted in the high OUD prevalence subgroup. Individual attitudinal and site-specific factors were associated with frequent BUP initiation. Training to increase physician confidence and increasing OUD resources could increase BUP initiation and benefit ED patients with OUD.

Abstract WMP52: Demographic Trends in Stroke-Related Mortality in Young Adults (Age:15-55 Year) With Concomitant Opioid Use in the United States From 1999-2020

Background: The estimated range for the prevalence of Opioid Use Disorder (OUD) among adolescents and adults in the United States in 2019 was between 6.7 million and 7.6 million individuals. The overall mortality rate is increasing over the last 20 years. Objective: This study aimed to assess the trends in stroke-related mortality in chronic opioid users in different demographics in the United States. Methods: We analyzed Center for Disease Control and Prevention Wide-Ranging On-Line Data for the Epidemiologic Research database examined from 1999 to 2020 for multiple causes of death MCD-ICD 10 Codes. Stroke-related mortality rates, with and without opioid use, were stratified by age, sex, and race/ethnicity and expressed as age-adjusted mortality rates (AAMRs) per 100,000 persons. Annual percent change (APC) from 1999-2020 was calculated and graphically plotted. Results: Between 1999 and 2020, The were 307,615 stroke-related deaths and 358,322 opioid-related deaths occurred among adults (15-55), and 1615 deaths were related to stroke and opioid use. The age-adjusted mortality rate (AAMR) steadily increased from 0.1 in 1999 to 0.8 in 2020, with an annual percent change (APC):9.6 % (CI: 8.0-12.14). Men and women had unreliable differences from 1999 till 2011. Men had consistently higher AAMR than women from 2011 (AAMR men: 0.4 vs. women: 0.2; p:&lt;0.005) to 2020 (AAMR men: 1.1 vs. women: 0.5 p:&lt;0.006). Non-Hispanic (NH) Black or African American adults had the highest overall AAMR (0.5), followed by NH White (0.4), followed by Hispanic or Latino (0.3). Conclusion: There has been a steady increase in opioid-related Stroke mortality in the U.S. among adults 15-55 years with opioid use from 1999-2020. African American adults and men possessed the highest age-adjusted mortality rates (AAMRs) related to stroke with concomitant opioid use. Young adults require targeted stroke prevention and management strategies to reduce stroke-related mortality in the presence of concomitant opioid use.

Perioperative Opioid-Related Harms: Opportunities to Minimize Risk.

Although substantial attention has been given to opioid prescribing in the United States, opioid-related mortality continues to climb due to the rising incidence and prevalence of opioid use disorder. Perioperative care has an important role in the consideration of opioid prescribing and the care of individuals at risk for poor postoperative pain- and opioid-related outcomes. Opioids are effective for acute pain management and commonly prescribed for postoperative pain. However, failure to align prescribing with patient need can result in overprescribing and exacerbate the flow of unused opioids into communities. Conversely, underprescribing can result in the undertreatment of pain, complicating recovery and impairing well-being after surgery. Optimizing pain management can be particularly challenging for individuals who are previously exposed to opioids or have critical risk factors, including opioid use disorder. In this review, we will explore the role of perioperative care in the broader context of the opioid epidemic in the United States, and provide considerations for a multidisciplinary, comprehensive approach to perioperative pain management and optimal opioid stewardship.

Multiple diagnoses in the context of parallel epidemics: methamphetamine, opioid use disorder and psychiatric conditions

PurposeThe most recent wave of the opioid epidemic in the USA has been complicated by a sharp increase in methamphetamine use. In addition, many people classified with opioid use disorder (OUD) and methamphetamine use disorder (MUD) present indications of psychiatric conditions. These diagnoses are also highly prevalent among people who are admitted to jails, but research conducted with this population is limited, due in part to the challenges associated with gaining access to local detention centers. This paper aims to examine the patterns of psychiatric conditions, OUD, and MUD among an understudied population to help inform the development of service delivery systems.Design/methodology/approachThe present study was designed to assess the prevalence of OUD, MUD and common psychiatric conditions in a large sample of adults (n = 846) collected from four local jails. Diagnostic patterns were evaluated according to the current criteria established in the Diagnostic and Statistical Manual of Mental Disorders (5th ed; American Psychiatric Association, 2013).FindingsMore than half (57.3%) of the sample met criteria for MUD, one-third (37.2%) exceeded the threshold for an OUD diagnosis and 15.7% were classified with both conditions. Participants who met criteria for both MUD and OUD were significantly more likely to experience symptoms of major depression [adjusted odd ratios (aOR) = 1.76, 9, confidence intervals (CI) = 1.16–2.67], post-traumatic stress disorder (aOR = 2.51, 1.64–3.83), panic attacks (aOR = 3.24, 95% CI = 2.05–5.13), obsessive compulsive disorder (aOR = 2.74, 95% CI = 1.66–4.51) and antisocial personality (aOR = 3.03, 95% CI = 1.97–4.64).Originality/valueThese results, which were derived from an understudied population of adults detained in local jails, indicate the co-–occurrence of MUD and OUD are associated with certain psychiatric conditions.

Safety and feasibility clinical trial of nucleus accumbens deep brain stimulation for treatment-refractory opioid use disorder.

There were more than 107,000 drug overdose deaths in the US in 2021, the most ever recorded. Despite advances in behavioral and pharmacological treatments, over 50% of those receiving treatment for opioid use disorder (OUD) experience drug use recurrence (relapse). Given the prevalence of OUD and other substance use disorders (SUDs), the high rate of drug use recurrence, and the number of drug overdose deaths, novel treatment strategies are desperately needed. The objective of this study was to evaluate the safety and feasibility of deep brain stimulation (DBS) targeting the nucleus accumbens (NAc)/ventral capsule (VC) and potential impact on outcomes in individuals with treatment-refractory OUD. A prospective, open-label, single-arm study was conducted among participants with longstanding treatment-refractory OUD (along with other co-occurring SUDs) who underwent DBS in the NAc/VC. The primary study endpoint was safety; secondary/exploratory outcomes included opioid and other substance use, substance craving, and emotional symptoms throughout follow-up and 18FDG-PET neuroimaging. Four male participants were enrolled and all tolerated DBS surgery well with no serious adverse events (AEs) and no device- or stimulation-related AEs. Two participants sustained complete substance abstinence for > 1150 and > 520 days, respectively, with significant post-DBS reductions in substance craving, anxiety, and depression. One participant experienced post-DBS drug use recurrences with reduced frequency and severity. The DBS system was explanted in one participant due to noncompliance with treatment requirements and the study protocol. 18FDG-PET neuroimaging revealed increased glucose metabolism in the frontal regions for the participants with sustained abstinence only. DBS of the NAc/VC was safe, feasible, and can potentially reduce substance use, craving, and emotional symptoms in those with treatment-refractory OUD. A randomized, sham-controlled trial in a larger cohort of patients is being initiated.

Risk Factors for Opioid Misuse, Abuse, and Dependence Among Pain Clinic Patients: A Cross-Sectional Study at King Khalid University Hospital during 2020.

BACKGROUND Physicians are faced with the risk of patients developing opioid use disorders (OUDs) when prescribing patients opioids for long periods of time. Therefore, it is highly recommended to continuously monitor and evaluate long-term non-cancer pain patients who are prescribed opioids. This study aims to estimate the prevalence of OUDs in 103 patients with active opioid prescriptions attending the Pain Clinic at King Khalid University Hospital. MATERIAL AND METHODS A cross-sectional study was conducted at King Khalid University Hospital's pain clinic from 2020 to 2022. A list of all patients attending the Pain Clinic with an opioid prescription was provided by the hospital. Through telephone interviews, consent was secured followed by the collection of demographic variables and prescription-related variables. Additionally, patients were asked to complete the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST 3.1) opioid questionnaire. RESULTS Most of the 103 patients were at moderate risk for abuse (91.3%), while a smaller percentage were at high risk (dependence) (5.8%) and low risk (misuse) (2.9%). Tramadol was the most-prescribed opioid (43.7%). Young age (<50) (Z=2.534; P=0.011), opioid use for more than 90 days (Z=2.788; P=0.005), and the prescription of tramadol (Z=4.124; P<0.001) were associated with higher risk of OCDs. CONCLUSIONS Younger patients, opioid use >90 days, and tramadol are associated with a higher risk of opioid misuse. However, further studies on a larger scale and in various settings are needed to provide evidence accurately reflecting the general population, as this study focused on the population of pain clinic attendees.