Risk For Substance Use Disorders Research Articles

Neuromodulation With Burst and Tonic Stimulation Decreases Opioid Consumption: A Post Hoc Analysis of the Success Using Neuromodulation With BURST (SUNBURST) Randomized Controlled Trial

ObjectivesThe SUNBURST study was a prospective, multicenter, randomized crossover trial of a single device delivering burst and tonic spinal cord stimulation (SCS) for chronic trunk and/or limb pain. We performed a post hoc analysis of opioid consumption at baseline and after device implantation. Materials and MethodsAfter implantation, 100 patients were randomized to one mode (tonic or burst) for 12 weeks, and the other mode for the subsequent 12 weeks. After the crossover period (24 weeks), patients chose their preferred mode and were assessed for one year. We analyzed 69 patients who took opioid medication at baseline. The primary endpoint was opioid consumption in morphine milligram equivalents (MMEs) at baseline and 12 months postimplantation. Subgroup analysis included opioid consumption based on Center for Disease Control markers (<50, 50–90, 90–120, >120 MME/day) and stimulation mode preference. ResultsOpioid consumption at 12 months was lower compared to baseline (53.94 vs. 79.19 MME, MD −25.25, 95% CI −43.77 to 6.73, p = 0.008). By 12 months, 11 of 69 patients (15.9%) discontinued all opioid (p = 0.001). Based on CDC dose markers, the proportion of patients taking >120 MME/day decreased by 61.7% at 12 months postintervention compared to baseline (p = 0.043). Forty-five of 69 patients (65.2%) preferred burst SCS while 15 of 69 patients (21.7%) preferred tonic SCS (p < 0.001). ConclusionA device delivering tonic and burst SCS was associated with decreased opioid consumption after 12 months in patients with chronic trunk and/or limb pain. The proportion of patients reporting the highest opioid intake (>120 MME/day) decreased to a lower CDC dose category by 61.7%, carrying important implications for those at highest risk for opioid-related substance use disorder, overdose, and death.

Addressing Racial Trauma in the Treatment of Substance Use Disorders.

* Abbreviations: ACE — : adverse childhood experience SUD — : substance use disorder Recognition that trauma is a key contributor to the development of substance use disorders (SUDs) has been critical to developing effective clinical approaches for this patient population. Understanding the substantial increase in risk for SUDs conferred by a history of early traumatic experiences allows the health care community to shift the standard clinical frame from “What is wrong with you?” to “What has happened to you?” This framing promotes an attitude of compassion and understanding, which underlies effective treatment approaches to all individuals with SUDs. Not all groups, however, experience trauma the same way; and because of these differences, which often fall along racial lines, the precise nature of the relationship between trauma and SUDs also differs. Although Felitti and co-workers’1 original conceptualization of the relationship between adverse childhood experiences (ACEs) and increased risk of SUDs, mental illness, and physical illness was based on data from a largely white, employed, and insured population, these relationships have also been demonstrated in an urban Black population.2 However, the concept of ACEs itself, as well as widely used instruments to measure exposure to ACEs, does not incorporate the impact of racial trauma (ie, stress caused by interpersonal or systemic racism that may cause emotional and physical health problems).3 How ongoing racial trauma informs the development of SUDs and may limit the effectiveness … Address correspondence to Miriam Komaromy, MD, Grayken Center for Addiction Medicine, 801 Massachusetts Ave, Room 1039, Boston, MA, 02118. E-mail: miriam.komaromy{at}bmc.org

Brain responses during delay discounting in youth at high-risk for substance use disorders

Offspring of parents with substance use disorders (SUD) discount future rewards at a steeper rate on the monetary delay discounting task (DD) than typically developing youth. However, brain activation during DD has yet to be studied in drug naïve youth with a family history (FH) of SUD. Here, we investigate brain activation differences in high-risk youth during DD. We recruited substance naïve youth, aged 11–12, into three groups to compare brain activation during DD: (1) High-risk youth (n = 35) with a FH of SUD and externalizing psychiatric disorders, (2) psychiatric controls (n = 25) who had no FH of SUD, but with equivalent externalizing psychiatric disorders as high-risk youth, and (3) a healthy control group (n = 24) with no FH of SUD and minimal psychopathology. A whole-brain voxel wise analysis of the [Delay > Baseline], [Immediate > Baseline], and [Control > Baseline] contrasts identified functional regions of interest, from which extracted parameter estimates were tested for significant group differences. Relative to control youth, high-risk youth showed stronger activation in the left posterior insula and thalamus when making delayed choices, and stronger activation of the parahippocampal gyrus when making both delayed and control choices (ps < 0.05). Activation in the left posterior insula negatively correlated with both subscales of the Emotion Regulation Checklist, and positively correlated with the Stroop interference effect (ps < 0.05). Our findings suggest possible heritable SUD risk neural markers that distinguish drug naïve high-risk youth from psychiatric and healthy controls.

Functional connectivity in frontostriatal networks differentiate offspring of parents with substance use disorders from other high-risk youth

BackgroundFamily history (FH) of substance use disorders (SUDs) is known to elevate SUD risk in offspring. However, the influence of FH SUDs has been confounded by the effect of externalizing psychopathologies in the addiction risk neuroimaging literature. Thus, the current study aimed to assess the association between parental SUDs and offspring functional connectivity in samples matched for psychopathology and demographics. MethodsNinety 11−12-year-old participants with externalizing disorders were included in the study (48 FH+, 42 FH-). We conducted independent component analyses (ICA) and seed-based analyses (orbitofrontal cortex; OFC, nucleus accumbens (NAcc), dorsolateral prefrontal cortex) with resting state data. ResultsFH+ adolescents showed stronger functional connectivity between the right lateral OFC seed and anterior cingulate cortex compared to FH- adolescents (p < 0.05, corrected). Compared to FH-, FH+ adolescents showed stronger negative functional connectivity between the left lateral OFC seed and right postcentral gyrus and between the left NAcc seed and right middle occipital gyrus (p < 0.05, corrected). Poorer emotion regulation was associated with more negative connectivity between right occipital/left NAcc among FH+ adolescents based on the seed-based analysis. FH- adolescents had stronger negative functional connectivity between ventral attention/salience networks and dorsal attention/visuospatial networks in the ICA. ConclusionsBoth analytic methods found group differences in functional connectivity between brain regions associated with executive functioning and regions associated with sensory input (e.g., postcentral gyrus, occipital regions). We speculate that families densely loaded for SUD may confer risk by altered neurocircuitry that is associated with emotion regulation and valuation of external stimuli beyond what would be explained by externalizing psychopathology alone.

Brain-Derived neurotrophic factor Val66Met induces female-specific changes in impulsive behaviour and alcohol self-administration in mice

Substance use disorders are a debilitating neuropsychiatric condition, however it remains unclear why some individuals are at greater risk of substance use disorders than others and what genetic factors determine such individual differences. Impulsivity appears a promising candidate endophenotype to bridge the gap between genetic risk and addiction. Brain-derived neurotrophic factor (BDNF), and in particular the BDNFVal66Met polymorphism, has been suggested to be involved in both impulsivity and substance use disorders, however results so far have been inconsistent. To investigate the role of BDNF, and more specifically the BDNFVal66Met polymorphism, in both impulsivity and operant alcohol self-administration using the same animal model. Separate cohorts of humanized Val66Met transgenic mice were assessed for either trait impulsivity in the 5-choice serial reaction time (5-CSRT) touchscreen task, or propensity towards obtaining ethanol in an operant paradigm. It was found that female hBDNFVal/Val mice exhibited both greater impulsivity compared to hBDNFMet/Met mice of the same sex as shown by a higher number of premature responses at one of three increased inter-trial intervals tested in the 5-CSRT task, and a greater propensity toward stable ethanol self-administration relative to male mice of the same genotype in the operant paradigm. By contrast, male mice showed no difference between genotypes in impulsivity or stable ethanol self-administration. The hBDNFMet/Met genotype appears to sex-specifically alter aspects of both impulsive behaviour and addiction propensity. These results suggest that impulse behaviour may be a possible predictor of addiction risk.

Habitual Routines and Automatic Tendencies Differential Roles in Alcohol Misuse Among Undergraduates.

There is a debate over whether actions that resist devaluation (i.e., compulsive alcohol consumption) are primarily habit- or goal-directed. The incentive habit account of compulsive actions has received support from behavioral paradigms and brain imaging. In addition, the self-reported Creature of Habit Scale (COHS) has been proposed to capture inter-individual differences in habitual tendencies. It is subdivided into two dimensions: routine and automaticity. We first considered a French version of this questionnaire for validation, based on a sample of 386 undergraduates. The relationship between two dimensions of habit and the risk of substance use disorder and impulsive personality traits was also investigated. COHS has good psychometric properties with both features of habits positively associated with an Obsessive-Compulsive Inventory score. Besides, the propensity to rely more on routines was associated with lower levels of alcohol abuse and nicotine use, suggesting that some degree of routine might act as a protective factor against substance use. In contrast, a high automaticity score was associated with an increased risk of harmful alcohol use. These results demonstrate that the COHS is a valid measure of habitual tendencies and represents a useful tool for capturing inter-individual variations in drug use problems in undergraduates.

National rates and trends of tobacco and substance use disorders among atrial fibrillation hospitalizations

BackgroundAtrial Fibrillation (AF) has been associated with various behavioral risk factors such as tobacco, alcohol, and/or substances abuse. ObjectiveThe main objective is to describe the national trends and burden of tobacco and substance abuse in AF hospitalizations. Also, this study identifies potential population who are more vulnerable to these substance abuse among AF hospitalizations. MethodsThe National Inpatient Sample database from 2007 to 2015 was utilized and the hospitalizations with AF were identified using the international classification of disease, Ninth Revision, Clinical Modification code. They were stratified into without abuse, tobacco use disorder (TUD), substance use disorder (SUD), alcohol use disorder (AUD) and drug use disorder (DUD). ResultsOf 3,631,507 AF hospitalizations, 852,110 (23.46%) had TUD, 1,851,170 (5.1%) had SUD, 155,681 (4.29%) had AUD and 42,667 (1.17%) had DUD. The prevalence of TUD, SUD, AUD, and DUD was substantially increased across all age groups, races, and gender during the study period. Female sex was associated with lower odds TUD, SUD, AUD, and DUD. Among AF hospitalizations, the black race was associated with higher odds of SUD, and DUD. The younger age group (18–35 years), male, Medicare/Medicaid as primary insurance, and lower socioeconomic status were associated with increased risk of both TUD and SUDs. ConclusionTUD and SUD among AF hospitalizations in the United States mainly affects males, younger individuals, white more than black, and those of lower socioeconomic status which demands for the development of preventive strategies to address multilevel influences.

Shapes of Subcortical Structures in Adolescents With and Without Familial History of Substance Use Disorder

Background: To explore if intergenerational transmission of risk for substance use disorder (SUD) manifests in brain anatomy of substance naive adolescents. Differences in anatomical shapes of subcortical structures (SSS) have been detected in neuroimaging studies, even in the absence of volume differences and SSS have been shown to be heritable. Therefore, we examined if the SSS of adolescents with a family history (FH+) of SUD differed from the SSS of adolescents without a family history of SUD (FH-). Because risk for SUD is associated with anxiety and impulsivity, we also examined correlations between these psychological characteristics and SSS. Methods: Using structural MRI, we obtained indices of SSS from 64 FH+ and 58 FH- adolescents and examined group differences and correlations between shape indices, trait anxiety and impulsivity. Findings: FH+ adolescents had a significant inward deformation in the shape of the right anterior hippocampus compared to FH- adolescents, while the volume of the right anterior hippocampus did not differ. Compared to FH- adolescents, the shape deformation of the brainstem, amygdala, hippocampus, putamen, pallidum and nucleus accumbens of FH+ adolescents exhibited an inverted correlational pattern with trait anxiety and impulsivity. Interpretation: SSS appears to capture anatomical features that traditional volumetric analysis does not. The inward shape deformation in the right anterior hippocampus in the FH+ adolescents may be related to the known increased risk for behavioral dysregulation leading to SUD in FH+ offspring. This novel approach may reveal neural correlates of familial transmission of increased vulnerability to problematic substance use. Funding Statement: This study was supported in part by NIDA (5R01 DA038154, PI: Christina W. Hoven) Declaration of Interests: No authors report any financial relationships with commercial interests. Ethics Approval Statement: The New York State Psychiatric Institute’s Institutional Review Board approved this study, and informed consent/assent was obtained from every participant.

Sexual Orientation, Adverse Childhood Experiences, and Comorbid DSM-5 Substance Use and Mental Health Disorders

To assess the relationships between adverse childhood experiences (ACEs) and comorbid Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) substance use and mental health disorders across 5 sexual orientation subgroups: lesbian/gay, bisexual, unsure, discordant heterosexual (ie, heterosexual-identified with same-sex attraction or behavior), and concordant heterosexual. Data were from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a cross-sectional, nationally representative survey of non-institutionalized US adults. Data were collected in households via structured diagnostic face-to-face interviews; the overall response rate was 60.1%. The sample included 36,309 US adults aged 18 years and older. Sexual minorities (gay, lesbian, bisexual), especially bisexual women, reported the highest prevalence of ACEs and comorbid substance use and mental health disorders. Approximately 43.8% of bisexual women reported 4 or more ACEs, and 38.0% of bisexual women reported comorbid substance use and mental health disorders. Multivariable regression analyses indicated a curvilinear relationship between ACEs and comorbid substance use and mental health disorders, and sexual minorities consistently had a higher ACE mean than concordant heterosexual respondents. The majority of sexual minorities with high levels of ACEs had comorbid substance use and mental health disorders. Sexual minorities are exposed to more ACEs than their heterosexual counterparts in the US. We found evidence that US sexual minorities are at higher risk of comorbid substance use and mental health disorders. These findings reinforce the importance of identifying exposure to ACEs and developing trauma-informed interventions to treat comorbidities in those exposed to multiple ACEs, especially sexual minorities.​.

Early-life stress exacerbates the effects of WIN55,212-2 and modulates the cannabinoid receptor type 1 expression

Early-life stress induces an abnormal brain development and increases the risk of psychiatric diseases, including depression, anxiety and substance use disorders. We have developed a reliable model for maternal neglect, named maternal separation with early weaning (MSEW) in CD1 mice. In the present study, we evaluated the long-term effects on anxiety-like behaviours, nociception as well as the Iba1-positive microglial cells in this model in comparison to standard nest (SN) mice. Moreover, we investigated whether MSEW alters the cannabinoid agonist WIN55,212-2 effects regarding reward, spatial and emotional memories, tolerance to different cannabinoid responses, and physical dependence. Adult male offspring of MSEW group showed impaired responses on spatial and emotional memories after a repeated WIN55,212-2 treatment. These behavioural impairments were associated with an increase in basolateral amygdala and hippocampal CB1-expressing fibres and higher number of CB1-containing cells in cerebellum. Additionally, MSEW promotes a higher number of Iba1-positive microglial cells in basolateral amygdala and cerebellum. As for the cannabinoid-induced effects, rearing conditions did not influence the rewarding effects of WIN55,212-2 in the conditioned place preference paradigm. However, MSEW mice showed a delay in the development of tolerance to the cannabinoid effects. Moreover, CB1-positive fibres were reduced in limbic areas in MSEW mice after cannabinoid withdrawal precipitated with the CB1 antagonist SR141617A. These findings support that early-life stress promotes behavioural and molecular changes in the sensitivity to cannabinoids, which are mediated by alterations in CB1 signalling in limbic areas and it induces an increased Iba1-microglial marker which could interfere in emotional memories formation.

Genetic overlap and causality between substance use disorder and attention-deficit and hyperactivity disorder.

Substance use disorder (SUD) often co-occur at high prevalence with other psychiatric conditions. Among them, attention-deficit and hyperactivity disorder (ADHD) is present in almost one out of every four subjects with SUD and is associated with higher severity, more frequent polysubstance dependence and increased risk for other mental health problems in SUD patients. Despite studies suggesting a genetic basis in the co-occurrence of these two conditions, the genetic factors involved in the joint development of both disorders and the mechanisms mediating these causal relationships are still unknown. In this study, we tested whether the genetic liability to five SUD-related phenotypes share a common background in the general population and clinically diagnosed ADHD individuals from an in-house sample of 989 subjects and further explored the genetic overlap and the causal relationship between ADHD and SUD using pre-existing GWAS datasets. Our results confirm a common genetic background between ADHD and SUD and support the current literature on the causal effect of the liability to ADHD on the risk for SUD. We added novel findings on the effect of the liability of lifetime cannabis use on ADHD and found evidence of shared genetic background underlying SUD in general population and in ADHD, at least for lifetime cannabis use, alcohol dependence and smoking initiation. These findings are in agreement with the high comorbidity observed between ADHD and SUD and highlight the need to control for substance use in ADHD and to screen for ADHD comorbidity in all SUD patients to provide optimal clinical interventions.

Abstract 15131: National Rates and Trends of Tobacco and Substance Use Disorders Among Atrial Fibrillation Hospitalizations in the United States

Introduction: Atrial Fibrillation (AF) has been associated with various behavioral risk factors such as tobacco, alcohol, and/or substance abuse. Hypothesis: The main objective is to describe the national trends and burden of tobacco and substance abuse in AF hospitalizations. Methods: The National Inpatient Sample database from 2007 to 2015 was utilized and the hospitalizations with AF were identified using the international classification of disease, Ninth Revision, Clinical Modification (ICD-9-CM) code 427.31 in the primary diagnosis column. They were stratified into without abuse, tobacco use disorder (TUD), substance use disorder (SUD), alcohol use disorder (AUD), and drug use disorder (DUD). We used the Jonckheere-Terpstra trend test to analyze the trend in this study. Results: Out of 3,631,507 AF hospitalizations, 852,110 (23.46%) had TUD, 1851,170 (5.1%) had SUD, 155,681 (4.29%) had AUD and 42,667 (1.17%) had DUD. The trends of all increased substantially during the study period (Figure) . The prevalence of TUD, SUD, AUD, and DUD was substantially increased across all age groups, races, and gender during the study period. Female sex was associated with lower odds TUD (0.57 (0.56-0.57), P-value &lt;0.001), SUD (0.27 (0.26-0.27), P-value &lt;0.001), AUD (0.22 (0.22-0.22), P-value &lt;0.001), and DUD (0.51 (0.5-0.52), P-value &lt;0.001). Among AF hospitalizations, the black race was associated with higher odds of SUD (1.12 (1.1-1.14), P-value &lt;0.001), and DUD(1.42 (1.38-1.47), P-value &lt;0.001). The younger age group (18-35 years), male, Medicare/Medicaid as primary insurance, and lower socioeconomic status were associated with increased risk of both TUD and SUDs. Conclusions: Tobacco and substance use disorder among hospitalized AF patients in the US mainly affects males, younger individuals, white more than black, and those of lower socioeconomic status which demands the development of preventive strategies to address multilevel influences.

Risks versus consequences of adolescent and young adult substance use: A focus on executive control.

This review examines the role of executive control processes in the liability for substance misuse and whether substance use, once initiated, leads to subsequent decrements as proposed by neurotoxicity models of substance use disorder (SUD). As indicated by a number of recent meta-analyses, executive control processes, which include working memory, cognitive flexibility and numerous aspects of attentional, behavioral and emotional control, are impaired in the context of active SUD. Longitudinal studies of behaviorally disinhibited children, individuals with familial risks for SUD, and twins within whom genetic versus environmental influences on behavior can be modeled robustly indicate that relatively poor control is a vulnerability factor for early substance use initiation, binge patterns of use, and subsequent SUD. Evidence of further declines in executive control, once substance use is initiated, is mixed, although a growing number of neuroimaging studies indicate that frontostriatal, frontolimbic, and frontocerebellar systems are altered as a consequence of use. Together these patterns suggest strategies for identifying children and adolescents at high risk for SUD, avenues through which substance-related neurotoxicities can be more reliably detected, and the need to structure prevention efforts in a manner that is developmentally appropriate and perhaps personalized to individual vulnerabilities.

Polyvictimization and Substance Use Among Sexual Minority Cisgender Women

Background: Violent victimization and substance use are higher among sexual minority cisgender women (SMCW) than heterosexual cisgender women. Unknown, however, is how polyvictimization—experiencing multiple types of violent victimization—affects substance use among SMCW. Purpose/Objectives: This study explores the relationship between polyvictimization and substance use among a small sample of SMCW. Methods: An exploratory secondary data analysis was conducted on data from a convenience sample of 115 SMCW currently in relationships (70.4% lesbian, 73.9% non-Hispanic white) via a cross-sectional survey. Lifetime physical, sexual, and crime-related violent victimization were measured via the Trauma History Questionnaire. Past-year substance use was measured via the Drug Abuse Screening Test (DAST-10). Mann-Whitney U testing and linear regression modeling were used to examine differences in substance use by victimization status (victimized/non-victimized) and the association between polyvictimization and substance use. Results: Lifetime prevalence of violent victimization was high with 60.9% of the sample reporting at least one type of victimization: 10.4% experienced physical, 22.6% experienced sexual, and 22.6% experienced crime-related violent victimization. Substance use was significantly greater for victimized participants than non-victimized participants. Modeling showed that as violent victimization increased by one unit, substance use scores increased by .30 units. Conclusion/Importance: Preliminary evidence suggests that increase in violent victimization was associated with increased substance use among SMCW. Findings indicate a need for additional confirmatory research with more representative samples and longitudinal data. Behavioral health practitioners are urged to consider the implications of these findings and assess for past cumulative violence and current risk of substance use disorder, to appropriately facilitate treatment planning.

Recreational Cannabis Use and Risk of Prescription Opioid Overdose: Insights from Pediatric Inpatients.

ObjectivesOur first goal is to evaluate the prevalence of hospital admissions for prescription opioid overdose (POD) in pediatric inpatients, and next goal is to measure the independent association between cannabis use disorders (CUD) and POD.MethodsWe used the nationwide inpatient sample (NIS) and included 27,444,239 pediatric inpatients (age ≤ 18 years), and 10,562 (0.04%) were managed primarily for POD. The odds ratio (OR) of the association of variables in POD inpatients was measured using the binomial logistic regression model that was adjusted for demographic confounders and psychiatric comorbidities.ResultsAdolescents have higher odds (OR 10.75, 95% CI 10.16-11.36) of POD-related hospitalization compared to children ≤ 12 years. Whites formed the significant proportion (67%), and those from low-income families (<50th percentile) had higher likelihood for POD-related hospitalization. The most prevalent psychiatric comorbidities were mood disorders (44.3%) and anxiety disorders (14.6%). Prevalent comorbid substance use disorders (SUDs) included cannabis (14.2%), tobacco (13.1%), and opioid (9.4%). A higher odds of association with POD-related hospitalizations were seen in pediatric inpatients with comorbid opioid (OR 8.79, 95% CI 8.08-9.56), tobacco (OR 1.58, 95% CI 1.47-1.70), and cannabis (OR 1.68, 95% CI 1.57-1.81) use disorders.ConclusionThe prescription opioid is a bridge to opioid abuse/dependence, thereby increasing the risk of other SUDs like tobacco (by 58%) and cannabis (by 68%). Regulating the easy availability of prescription opioids and also improving the existing prescription trends are an essential way to reduce this problem. Finally, awareness and counseling are recommended strategies for harm reduction/rehabilitation among the pediatric population.

A Relationship between Endothelial Nitric Oxide Synthetase Gene Variants and Substance Use Disorder.

Addictive substances are known to result in oxidative stress (OS). OS enhances the generation of free radicals and reactive oxygen species (ROS) and reduces antioxidant capacity. Peroxides and oxygen radicals, including hydrogen peroxide and superoxide and radical nitrogen species, including nitric oxide (NO), are parts of the ROS. Gene variants of the endothelial nitric oxide (eNOS) affect the plasma levels of NO. This study aimed to investigate whether there was an association between eNOS variants and substance use disorders (SUDs) risk in the Turkish population. Two eNOS variants (G894T and 27 bp VNTR 4b/a in intron 4) were examined in 216 SUD patients and 140 healthy controls. The eNOS variants were assessed with the PCR based on the RFLP analysis. Since the patient group consisted only of men, the control group was examined as a mixed and male-only. The eNOS G894T homozygous T/T genotype revealed a significant association with susceptibility to SUD. The patients carrying T/T genotype had SUD risk 1.054 times as much as the controls and male controls had (p=0.004 and p=0.038, respectively). eNOS 4a/4a genotype increased in patients as compared to male controls (p=0.048). The homozygous 4b/4b genotype was higher in the male control group than in SUD patients (p=0.029). eNOS VNTR 4a allele was more prevalent in the patients than in both controls and male controls (p=0.026 and p=0.0033, respectively). This study is one of the first studies investigating the relationship between two eNOS gene variants and SUD in our country. Our findings show that eNOS G894T and VNTR variants may be the significant risk factor for SUDs in Turkish subjects.

160 Trends of Reported Marijuana Use in a Pediatric Emergency Department

Thirty-three states have legalized recreational and/or medicinal marijuana, leading to normalization of its use, and desensitization of perceived risk. We utilized electronic health record data from a Pediatric ED located in a state which has legalized medicinal marijuana, and examined the changes in reported marijuana use among adolescents, and the relationship between marijuana use, use of other drugs, and risk for substance use disorder (SUD). We implemented a team-based adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) program in a Pediatric ED in January 2018, utilizing the CRAFFT tool to screen patients ages 12-17. Individual CRAFFT responses were examined for the 8,694 of 24,057 (36.1%) patients screened from January 2018 to October 2019. Pearson chi-square tests were used to compare use of reported substances from 2018 to 2019 to identify trends in the use of each substance (alcohol, marijuana, and other drugs). Binary logistic regression was used to examine the predictors of both a positive CRAFFT score (2 or higher in Part B, validated for identifying an SUD) and other drug use. Reported alcohol use decreased from 2018 to 2019, from 8.5% to 7.3% (p=0.04), marijuana use increased from 9.1% to 11.3% (p=0.09), and other drug use did not change (1.9%). 39.2% of those reporting substance use reported using only marijuana. Those reporting alcohol use had 4.9 (95% CI 3.3-7.2) times the odds of other drug use, and those reporting marijuana use had 14.5 (95% CI 9.4-22.4) times the odds, adjusting for age and sex. Among the 1,066 patients with a “Yes” in Part A for whom Part B was completed, those reporting other drug use, marijuana use, and alcohol use had 8.7 (95% CI 5.7-13.4), 5.4 (95% CI 3.5-8.2) and 1.5 (1.1-2.0) times the odds of a positive score, respectively, adjusting for age and sex. Marijuana use is the most prevalent form of reported substance use among adolescents in the ED and is increasing. Marijuana was a stronger predictor than alcohol of a positive CRAFFT, which has an 80% sensitivity and 86% specificity for a SUD. There is an association between reported use of marijuana and reported use of other drugs. Given the increase in social acceptance of marijuana use, and its association with additional drug use, it is critical for health care professionals to identify and address marijuana use with adolescent patients. One limitation of this study is that the version of the CRAFFT programmed into the EHR does not specifically ask about vaping, and therefore may not be capturing all patients who vape THC. Future directions include changing the CRAFFT embedded in the EHR to the CRAFFT 2.1+N, which specifically asks about vaping both marijuana/THC and nicotine. This will allow us to better identify and address the increasing marijuana use in our adolescent population.

42.13 IMPLEMENTING SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT IN A CHILD PSYCHIATRY DIVISION AND OUTPATIENT SERVICE: AN UPDATE

The objectives of this presentation are to: 1) initiate routine screening for substance use risk by using the CRAFFT (Car, Relax, Alone, Friends/Family, Forget, Trouble)+N 2.1 tool, an evidence-based screening tool that efficiently and effectively evaluates for riding and driving risk, along with risk of substance use disorders; and 2) promote early identification and treatment of at-risk patients using the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model.

The opioid crisis and the 2020 US election: crossroads for a national epidemic

Health care is a major point of differentiation in the upcoming US presidential elections. One priority area is the opioid crisis. In 2019, reported deaths from drug overdose in the USA reached an all-time high of almost 72 000, with opioids involved in more than two-thirds of the total deaths.1 The COVID-19 pandemic has exacerbated an already difficult situation by reducing access to life-saving treatment, harm reduction, and recovery support services, while increased stress and isolation might increase the risk of addiction and substance use disorders (SUDs).

Gambling Disorder and Childhood Trauma: A Complex Association.

Gambling disorder (GD) is classified as a behavioural addiction and has some phenotypic similarities with substance use disorders (SUDs). Childhood adversity and life stressors are associated with increased risk for SUDs in adulthood. However, there is limited research investigating the association between childhood trauma, stressors and behavioural addictions such as GD. In this case-control cross-sectional study, 31 adult patients with GD were compared to 31 matched healthy controls (HCs) in terms of exposure to early adversity using the Childhood Trauma Questionnaire (CTQ-SF). In addition, past 12-month stressful life event exposure was assessed using the Life Event Stress Scale (LESS) and investigated as a possible moderator of the relationship between childhood trauma and GD by means of a two-way analysis of variance (ANOVA). Logistic regression analyses were used to test if childhood trauma (CTQ-SF) and its subtypes were significant predictors of a diagnosis of GD. Severity of childhood trauma in general, and on all five subtypes, was significantly higher in GD patients compared to HCs. Childhood trauma was a significant predictor of a diagnosis of GD, with physical neglect being the single trauma subtype to significantly increase odds of GD in adulthood. Stressful life events moderated the relationship between childhood trauma and GD, i.e. childhood trauma was significantly higher in GD patients compared to HCs when LESS was low. The findings support a link between childhood trauma and GD, with current stress as a moderating variable, and may be useful for future individualized therapeutic strategies.