Opioid Drug Use Research Articles

HCV-HIV co-infection in people who inject drugs: Barriers to treatment and cure of HCV infection in the era of DAAs, a prospective study in Athens, Greece.

HIV/hepatitis C virus (HCV) co-infection among people who inject drugs (PWID) remains a global health problem. The goal of our study was to evaluate, in a real-world setting, success rates of sustained virological response (SVR) using direct-acting antivirals (DAAs) to treat a population of PWID living with HCV/HIV. This was a prospective single-center observational study. We collected demographic, socioeconomic, and clinical data pertaining to HIV and HCV infection in PWID with several barriers to care. We identified risk factors for SVR failure. Among 130 individuals retained to HIV care, we planned HCV treatment in 119/130 (91.5%); 106/119 (89.1%) started treatment with DAAs and 100/106 (94.3%) completed treatment. People not starting treatment were more often in active opioid drug use (odds ratio [OR] 0.25; 95% confidence interval [CI] 0.07-0.97, p = 0.045) and benzodiazepine abuse (OR 0.25; 95% CI 0.07-0.95, p = 0.042). Only 86/100 (86%) were tested for SVR at 12 weeks (SVR12) and 72/86 (83.7%) achieved SVR. PWID in opioid substitution programmes tended to return for SVR12 testing more often (54.7% vs. 30%, p = 0.081). Individuals in active opioid drug use (OR 0.226; 95% CI 0.064-0.793, p = 0.02) or with poor adherence (OR 0.187; 95% CI 0.043-0.814, p = 0.025) were less likely to achieve SVR. At the end of our study period, 113/119 (95%) treatment-eligible patients remained alive. HCV infection was cured in 68/113 (61.1%) people. Our findings underscore the importance of prioritizing combatting substance use to achieve HCV elimination goals. A systematic approach with effort to overcome barriers to receiving and completing treatment and encourage to enrol in opioid substitution programmes if not possible to completely abstain from use, can help increase chances of HCV cure.

Intelligent Generating Controller a Desflurane Concentration Value Which Helps to Decrease Blood Pressure.

The aim of the article is to determine the appropriate concentration of desflurane to effectively counteract the increase in blood pressure resulting from surgical stress. In medical practice, this increase is often limited by using additional doses of opioid drugs. Additional medications or higher doses of those already used may adversely affect your health. During anesthesia, physician must note the use of drugs and remember them, especially those that he has recently administered, which affect his concentration. For this purpose, the authors decided to propose support for the selection of desflurane concentration so that frequent use of opioid drugs is not necessary. The authors used a system based on AI issues to accomplish this task. The learned system supports the anesthesiologist's work by imitating him. The proposed method for selecting the desflurane concentration is based on a fuzzy controller. This system includes a learning mechanism that allows for minimizing the operating error. The main advantage of this system is the ability to build a function allowing the selection of anesthesia parameters without knowledge of the mathematical description of the process. To accomplish this task, you need an expert who will provide information in the construction of logical if-then sentences (points in space). The fuzzy controller connects the points in the consideration space appropriately, generating a hypersurface. The algorithm test was performed only by computer without the participation of patients. The operation of the proposed algorithm was verified by computer simulation. The authors of the article analyzed the compliance of the obtained results with the table provided by the expert. The desflurane concentration values obtained by computer simulation are similar to those given in the table Minimal driver error does not affect the patient's clinical response. This error results from the functions used in the fuzzy system and its settings. The results of the performance test of the proposed algorithm are presented in a time course, and it has the shape of a step function. The work proposes a function that allows you to enter the time needed for the body's reaction to reach the desired Etdes level. In this study, a controller was created to support the selection of the concentration of desflurane allowing for a reduction in blood pressure (resulting from surgical stress). The results obtained by computer simulation provide valuable insights for optimizing anesthesia. This system can also be used as an important simulation program for teaching purposes.

Concurrent Opioid and Psychotropic Drug Use During Pregnancy: Descriptive Study from Two Canadian Provinces

ObjectivesThis study aims to describe the patterns of concurrent opioid and psychotropic drug use (CU) during pregnancy and the characteristics of the mothers dispensed these drugs. MethodsPregnancies between 2000-2020 were identified using administrative data from Manitoba and British Columbia, Canada. Prenatal opioid and psychotropic drug dispensations were assessed, and exposure groups created based on the number of dispensations within each drug category. Descriptive statistics are reported. ResultsApproximately 1.4% of 1,040,021 pregnancies involved CU. Odds of CU were greater for 2+ opioid pregnancies compared to pregnancies with only 1 opioid (OR=4.05). Among CU pregnancies, it was more likely for 2+ types of psychotropics to be dispensed for those involving 2+ opioids compared to 1 (OR=2.23). Percent of CU pregnancies did not change over time, while opioid pregnancies decreased, and psychotropic pregnancies increased. Average morphine equivalent dose of opioids/pregnancy was higher in CU than opioid only pregnancies. Compared to mothers without exposure, CU exposed mothers were of similar age, more likely to live rurally, in lower income areas, and have lower care continuity. ConclusionCU pregnancies remained stable over time. It was more likely for mothers dispensed 2+ opioids to be CU than mothers dispensed only 1 opioid, and more likely for CU mothers dispensed 2+ opioids to be dispensed 2+ psychotropic types. Overall strength of opioids was higher for CU mothers compared to opioid only exposed mothers. ImplicationsStudies measuring the impact of CU on maternal and child outcomes should be conducted to inform safe prescribing practices.

Designing and piloting a sequential multiple assignment randomized trial for opioid prevention among youth in the legal system.

Youth in the legal system are vulnerable to initiation and escalation of opioid use. The transition period during which a young person is released from the institutional setting to the community is a critical window of opportunity for preventive intervention targeting the uptake and intensification of opioid and other drug use. Adaptive preventive interventions are a promising approach to systematically varying the timing and intensity of substance use preventive interventions for these youth. This pilot study of 30 youth (97% young men; 37% White; Mage = 18.34, SD = 1.84) examined the feasibility and acceptability of adaptive and nonadaptive preventive interventions that incorporate components of the Adolescent Community Reinforcement Approach with Assertive Continuing Care, Trauma Affect Regulation: Guide for Education and Treatment, and Motivational Interviewing using the Sequential Multiple Assignment Randomized Trial study design. Participants completed assessments at baseline, 1-month postrelease, and 2-months postrelease. Enrollment rate was 65%. Nearly three-quarters (73%) of enrolled youth had substance use disorder at intake. Moreover, 60% of enrolled participants completed the 2-month postrelease follow-up assessment. Participants reported high satisfaction with the interventionist interactions, and 95% indicated they would recommend the program to other youth. The pilot study revealed the need for several adaptations to study and intervention protocols. This pilot study provides evidence of the feasibility of a research-practice partnership with state juvenile rehabilitation facilities, successful recruitment of youth involved in the legal system, and feasibility and acceptability of adaptive preventive interventions spanning pre- and post-release for legal system-involved youth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Illicit cocaine and opioid drug-related maxillofacial trauma: a 10-year review of a state-wide database of all hospitals admissions

The aim of this study was to investigate the characteristics of illicit cocaine and opioid drug-related facial trauma and determine whether the presence of cocaine or opioid drug use in facial trauma patients influenced the cause of injury, morbidity, or management. A retrospective observational cohort study was performed using records from a state-wide database of all patients who presented to a Victorian hospital with a facial fracture between 2004 and 2014. Data collected included demographics, concomitant opioid and cocaine use, mechanism of injury, facial injuries, and management. Statistical analysis was done using chi-square test, Student's t tests, binary logistic regression analysis, and multivariable linear regression analysis. Results were considered statistically significant if P < .05. A total of 54,613 patient presentations for facial trauma were analyzed with 363 patients in the cocaine and opioid-related group, and 54,250 patients in the nondrug-related group. Patients with illicit drug use were more likely to have facial fractures caused by interpersonal violence when compared with nondrug users (47.9% vs 23.5%, OR = 2.23, P < .001). Opioid and cocaine users had 0.3 more total fractures per presentation, which included more midface and skull fractures, and more facial lacerations (P < .001). There was no statistically significant difference in the need for surgical management between the two groups. Opioid and cocaine affected patients also on average had a longer hospital stay of 3.4 days and required 0.9 more allied health inputs during their admission when compared with nondrug users (P < .05). This effect was similarly reflected when controlling for confounding variables (P < .001). Concomitant cocaine or opioid use in facial trauma patients leads to more violence-related injuries with higher morbidity and healthcare costs.

Factors associated with the use of benzodiazepine and opioid prescription drug in the student population: a cross-sectional study

The misuse of benzodiazepines and opioid medications is frequent in students. To improve our understanding of this behavior, we aimed to identify factors associated with separate and concomitant use of these substances. Anonymous self-reported questionnaires were e-mailed to students enrolled at a French university between March and July 2021, covering: sociodemographic characteristics, academics, psychoactive substance use, ADHD symptomatology (adulthood and childhood), and psychiatric/psychological or addiction follow-up. Factors associated with the use of benzodiazepines and opioid medications included female sex (OR = 1.41 [1.08; 1.86]) and OR = 1.38 [1.06; 1.79], respectively), older age (OR = 1.65 [1.04; 2.6] and OR = 2.17 [1.4; 3.36], respectively), current psychiatric/psychological follow-up (OR = 6.53 [5.18; 8.24] and OR= 1.5 [1.12; 2.0], respectively), ADHD symptomatology (OR= 2.33 [1.71;3.16] and OR= 1.61 [1.15; 2.24], respectively), polyconsumption (tobacco use for benzodiazepine users, OR = 1.38 [1.04; 1.82]; alcohol use OR = 1.67 [1.17; 2.39] and tobacco use OR = 1.62 [1.23; 2.14] for opioid users). These factors were even more strongly associated with the concomitant use of benzodiazepines and opioid medications: older age (OR = 3.64 [2.22; 5.99]), female sex (OR = 1.54 [1.1; 2.14]), grade repetition (OR = 1.7 [1.14; 2.54]), psychiatric/psychological follow-up (OR = 4.51 [3.35;6.06]), ADHD symptomatology (OR = 5.3 [3.69; 7.63]), polyconsumption (tobacco use OR = 2.05 [1.39; 3] and cannabis use, OR = 2.07 [1.97; 4.16]. The factors associated with the use of benzodiazepines and prescription opioids identified in this study could lead to the development of targeted prevention methods.

Prevalence and correlates of alcohol and drug harms to others: Findings from the 2020 U.S. National Alcohol Survey.

Measure prevalence and overlap of secondhand harms from other people's use of alcohol, cannabis, opioid, or other drugs and examine sociodemographic and other correlates of these secondhand harms. This cross-sectional analysis used data from 7,799 respondents (51.6% female; 12.9% Black, 15.6% Hispanic/Latiné; mean age: 47.6) in the 2020 U.S. National Alcohol Survey. Secondhand harms included family/marriage difficulties, traffic accidents, vandalism, physical harm, and financial difficulties. Weighted prevalence estimates provided nationally representative estimates of these harms. Logistic regression assessed associations between individual characteristics and secondhand harms. Lifetime prevalence of secondhand harms from alcohol, cannabis, opioid, or other drugs was 34.2%, 5.5%, 7.6%, and 8.3%, respectively. There was substantial overlap among lifetime harms: almost 30% of those reporting secondhand alcohol harms also reported secondhand drug harms. Significant correlates of secondhand substance harms included female sex (alcohol, other drug); white (alcohol, opioid), American Indian/Alaska Native (opioid), and Black (cannabis) race/ethnicity; and separated/divorced/widowed marital status (opioid). Those reporting family history of alcohol problems had significantly higher odds of reporting secondhand harms across substance types. Individuals who reported frequent cannabis use had higher odds of reporting secondhand alcohol and opioid harms compared to those with no cannabis use, (aOR=1.55; aOR=2.38), but lower odds of reporting secondhand cannabis harms (aOR=0.51). Although less prevalent than secondhand alcohol harms, 14% of participants reported secondhand harms from someone else's drug use and frequently experienced secondhand harms attributed to multiple substances. Population-focused interventions are needed to reduce the total burden of alcohol and drug use.

Opioid and other drug use and drug-related mortality as indicators of Hepatitis C and Human Immunodeficiency Virus in Oklahoma

Objectives Outbreaks of injection drug use (IDU)-associated infections have become major public health concerns in the era of the opioid epidemic. This study aimed to (1) identify county-level characteristics associated with acute HCV infection and newly diagnosed IDU-associated HIV in Oklahoma and (2) develop a vulnerability index using these metrics. Methods This study employs a county-level ecological design to examine those diagnosed with acute or chronic HCV or newly diagnosed IDU-associated HIV. Poisson regression was used to estimate the association between indicators and the number of new infections in each county. Primary outcomes were acute HCV and newly diagnosed IDU-associated HIV. A sensitivity analysis included all HCV (acute and chronic) cases. Three models were run using variations of these outcomes. Stepwise backward Poisson regression predicted new infection rates and 95% confidence intervals for each county from the final multivariable model, which served as the metric for vulnerability scores. Results Predictors for HIV-IDU cases and acute HCV cases differed. The percentage of the county population aged 18–24 years with less than a high school education and population density were predictive of new HIV-IDU cases, whereas the percentage of the population that was male, white, Pacific Islander, two or more races, and people aged 18–24 years with less than a high school education were predictors of acute HCV infection. Counties with the highest predicted rates of HIV-IDU tended to be located in central Oklahoma and have higher population density than the counties with the highest predicted rates of acute HCV infection. Conclusions There is high variability in county-level factors predictive of new IDU-associated HIV infection and acute HCV infection, suggesting that different public health interventions need to be tailored to these two case populations.

545 A PRospective, Case-controlled Evaluation of oLIceridine for Moderate or sEVEre Pain After Burn Injury. (RELIEVE)

Abstract Introduction After acute burn injury, injured tissue and adjacent non-burned tissue, upregulate response to painful and non-painful stimulus (hyperalgesia and allodynia, respectively). Currently, high-dose fentanyl, oxycodone, hydromorphone, and morphine are used at profound doses to mitigate pain. Oliceridine (OLI), a biased, selective opioid agonist, has shown a 3-fold preferential activation of the G-protein (i.e., analgesia) over β-arrestin pathway. There is no literature of use in patients with burn injuries. We hypothesized the use of OLI would provide adequate and safe analgesia after acute burn injury. Methods This single-center, prospective, case-controlled trial was dual IRB approved and included patients with burn injuries admitted between April and September 2023. Informed consent was obtained from the 10 patients receiving OLI. OLI was the only allowed analgesic except for acetaminophen. Dosing and assessments were followed per study protocol and safety and efficacy assessed per study team daily at a minimum. The historical control (CTL) group (i.e., fentanyl, oxycodone, hydromorphone, morphine, etc) was matched 2:1 with the prospective OLI group. The CTL were screened in reverse chronology to find comparable groups according to age, % total body surface area burned (TBSA), history of opioid and illicit drug use, and number of operations. SAS 9.4 was used for descriptive statistics and modelling via UNIVARIATE and GLM procedures. Results Two CTL patients were excluded in the final analysis due to missing assessments. The OLI (n = 10) and CTL (n = 18) groups were comparable in age (52.3 ± 12.3 vs 63.1 ± 17.3 years, p = 0.228), TBSA [8 (3.3, 11.2) vs 6 (2.6, 9.3) percent], operations (0.5 per patient for both), and burn mechanism. No patient had a known history of opioid, cocaine, or methamphetamine use. The baseline Numeric Pain Rating Scale (NRS) for OLI and CTL were similar [9 (7.8, 10) vs 9.5 (8.8, 10); p = 0.360); however, the first day’s mean pain score was higher for CTL (4.8 vs. 5.9, p = 0.035). Over the 7-day period, mean daily pain scores significantly declined in patients receiving OLI (-2.65, p = 0.010), but not for CTL (+0.69, p = 0.496). Whereas, opioid usage [i.e., oral morphine milligram equivalents (MME)] was not significantly different across groups (p = 0.689) or days (p = 0.684). Total MME averaged per patient day were 65.2 and 69.6 mg/day in the OLI and control groups, respectively (P = 0.688). There were no unexpected adverse events related to OLI. Conclusions Although this sample of 10 patients limits inferences outside of acute burn injuries less than 20% TBSA, OLI demonstrated significant pain relief, which was maintained over the 7 days study period. Importantly, the control group demonstrated initial relief, but was not maintained, despite similar MME. Applicability of Research to Practice Oliceridine offers an effective solution for analgesia in patients with acute burn injury.

Analgesic Peptides: From Natural Diversity to Rational Design.

Pain affects one-third of the global population and is a significant public health issue. The use of opioid drugs, which are the strongest painkillers, is associated with several side effects, such as tolerance, addiction, overdose, and even death. An increasing demand for novel, safer analgesic agents is a driving force for exploring natural sources of bioactive peptides with antinociceptive activity. Since the G protein-coupled receptors (GPCRs) play a crucial role in pain modulation, the discovery of new peptide ligands for GPCRs is a significant challenge for novel drug development. The aim of this review is to present peptides of human and animal origin with antinociceptive potential and to show the possibilities of their modification, as well as the design of novel structures. The study presents the current knowledge on structure-activity relationship in the design of peptide-based biomimetic compounds, the modification strategies directed at increasing the antinociceptive activity, and improvement of metabolic stability and pharmacodynamic profile. The procedures employed in prolonged drug delivery of emerging compounds are also discussed. The work summarizes the conditions leading to the development of potential morphine replacements.

INDICES OF THE CAPILLARY DIAMETER IN NORMAL RETINA AT DIFFERENT TERMS OF EXPERIMENTAL OPIOID INFLUENCE AND IN THE SUBCHRONIC AND CHRONIC PERIODS OF THEIR CORRECTION

In Ukraine, according to the latest biobehavioral research, the estimated number of people who inject drugs was 317000 people (on the controlled territory of Ukraine), of which 200661 people (63.3% of the total number) use only opioids, 38674 people use stimulants (12.2% of the total number), 77665 people practiced mixed use of narcotic substances (24.5%). Increasingly, doctors of various specialties face the problem of treating various nosologies in people with opioid addiction. It dramatically complicates the process of correcting the main pathology due to the consequences arising from the chronic use of opioid drugs. One of these factors is the long-term use of opioid analgesics for therapeutic purposes, as well as the use of opioid drugs without medical indications by people belonging to the category of drug addicts. At present, the issue of structural reorganization in the layers of the retina and links of its hemomicrocirculatory bed during long-term use of opioid drugs and the possibility of correcting the resulting changes in the subchronic and chronic periods of experimental opioid exposure remains unclear. That is why we decided to supplement, expand and deepen information about these processes by conducting our own research in this direction.The purpose of the study is to find out the dynamics of changes in the diameter of the capillary link of the hemomicrocirculatory bed of the retina at different times of experimental opioid exposure and to establish the possibility of correcting these changes in the subchronic and chronic periods. Material and methods. The research material was sexually mature, outbred, white male rats, in number 125 animals weighing 160-270 g, aged 4.5-7.5 months. The initial dose of nalbuphine during the first 2 weeks was 0.212 mg/kg, the next 2 weeks (III-IV weeks) – 0.225 mg/kg, the next (V-VI weeks) – 0.252 mg/kg, the next (VII-VIII weeks ) – 0.260 mg/kg, the next (IX – X weeks) – 0.283 mg/kg, the next (XI – XII weeks) – 0.3 mg/kg, and during (XIII – XIV weeks) – 0.45 mg/ kg Correction was carried out in the early and late periods of opioid exposure, where the dose of pentoxifylline was 2.857 mg/kg. The morphometric study of the diameter of retinal capillaries in normal conditions at different times of experimental opioid exposure and during correction was performed using histological preparations according to generally accepted methods.Research results. With the help of our statistical analysis of the capillary component of the retina, we established the diameter parameters of the retinal capillaries, which were 5.9 [5.6; 6.1] μm., which made it possible to assess the degree of vascularization of the retina in the norm. When corrected at the subchronic period, we found that there was no significant difference between the average values of capillary diameters (p&gt;0.05) between the control group and the 14th subgroup (2 weeks of nalbuphine administration with withdrawal followed by 4 weeks of pentoxifylline administration). There was a significant increase in mean capillary diameter when comparing subgroup 10 (2 weeks of nalbuphine followed by 4 weeks withdrawal) (p&lt;0.05) with subgroup 12 (2 weeks of nalbuphine followed by 4 weeks of pentoxifylline) (p&lt;0.05). 0.001), compared to the data of the control group. Capillary diameters in subgroup 10 (2 weeks of nalbuphine administration followed by 4 weeks withdrawal) were increased by 18.7% (p&gt;0.05), compared to subgroup 5 (6 weeks of nalbuphine administration). The situation was significantly unfavorable in comparison with the previous results in subgroup 12 (2 weeks of nalbuphine administration with the addition of 4 weeks of pentoxifylline) - by 32%, compared to the diameters of capillaries in subgroup 14 (2 weeks of nalbuphine administration with withdrawal and followed by 4 weeks of pentoxifylline administration). When corrected for the chronic period, we found that, compared to the control group, capillary diameters increased the least in the 15 subgroup of 10 weeks (6 weeks of administration of nalbuphine with withdrawal and followed by 4 weeks of administration of pentoxifylline) (by 35%). Capillary diameters were significantly larger in the 11-week 10-week subgroup (6 weeks of nalbuphine followed by 4-week withdrawal) (by 49%), while in the group with ten weeks of experimental opioid exposure (by 57%). The most unfavorable situation was in the 13th subgroup of 10 weeks (6 weeks of administration of nalbuphine with the addition of pentoxifylline for 4 weeks) (by 63%).Conclusion. As a result of our research, we can conclude that in the subchronic and chronic periods of correction of opioid exposure, the situation was most unfavorable in the subgroups where correction was carried out with simultaneous administration of nalbuphine and pentoxifylline. From the above, it is possible to draw a clear conclusion that in no case can these drugs be combined during the medical correction of pathomorphological changes in the retina and links of its hemomicrocirculatory bed in experimental opioid retinopathy.

Trends in Opioid and Nonsteroidal Anti-Inflammatory Drug Use for Patients with Kidney Stones in United States Emergency Departments from 2015 to 2021.

Introduction: Renal colic is frequently treated with opioids; however, narcotic analgesic use can lead to dependence and abuse. We evaluated use trends of opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management of kidney stones in United States emergency departments (EDs) from 2015 to 2021. Methods: Kidney stone encounters were identified using National Hospital Ambulatory Medical Care Survey data. We applied a multistage survey weighting procedure to account for selection probability, nonresponse, and population weights. Medication use trends were estimated through logistic regressions on the timing of the encounter, adjusted for selected demographic and clinical characteristics. Results: Between 2015 and 2021, there were an estimated 9,433,291 kidney stone encounters in United States EDs. Opioid use decreased significantly (annual odds ratio [OR]: 0.87, p = 0.003), and there was no significant trend in NSAID use. At discharge, male patients were more likely than females (OR: 1.93, p = 0.001) to receive opioids, and Black patients were less likely than White patients (OR: 0.34, p = 0.010) to receive opioids. Regional variation was also observed, with higher odds of discharge prescriptions in the West (OR: 3.15, p = 0.003) and Midwest (OR: 2.49, p = 0.010), compared with the Northeast. Thirty-five percent of patients received opioids that were stronger than morphine. Conclusion: These results suggest improved opioid stewardship from ED physicians in response to the national opioid epidemic. However, regional variation as well as disparities in discharge prescriptions for Black and female patients underscore opportunities for continued efforts.

Rural-urban differences in out-of-network treatment initiation and engagement rates for substance use disorders.

To examine rural-urban disparities in substance use disorder treatment access and continuation. We analyzed a 2016-2018 U.S. national secondary dataset of commercial insurance claims. This cross-sectional study examined individuals with a new episode of opioid, alcohol, or other drug use disorders. Treatment initiation and engagement rates, and rates of using out-of-network providers for these services, were compared between rural and urban patients. We included individuals 18-64 years old with continuous employer-sponsored insurance. Patients in rural settings experienced lower treatment initiation rates for alcohol (36.6% vs. 38.0%, p < 0.001), opioid (41.2% vs. 44.2%, p < 0.001), and other drug (37.7% vs. 40.1%, p < 0.001) use disorders, relative to those in urban areas. Similarly, rural patients had lower treatment engagement rates for alcohol (15.1% vs. 17.3%, p < 0.001), opioid (21.0% vs. 22.6%, p < 0.001), and other drug (15.5% vs. 17.5%, p < 0.001) use disorders. Rural patients had higher out-of-network rates for treatment initiation for other drug use disorders (20.4% vs. 17.2%, p < 0.001), and for treatment engagement for alcohol (27.6% vs. 25.2%, p = 0.006) and other drug (36.1% vs. 31.1%, p < 0.001) use disorders. These findings indicate that individuals with substance use disorders in rural areas have lower rates of initial and ongoing treatment, and are more likely to seek care out-of-network.

Behavioral/Mood Disorders and Opioid-Drug Use in Chicago Community Areas Associated with Oral Health and Oral Surgery Need

Introduction: We hypothesize gender, race in Chicago’s community areas (CAs) associated significantly with mood and depressive-behavior disorders, drug related hospitalizations (MDD/DRH) and oral health problems and need for oral surgery services. Methods: We reviewed 18,846 dental records (AxiUm) sorted by zip codes associated with CAs. “Med Alerts” and 185 (14 types) neurotropic medications identified MDD/DRH. Chicago’s Health Atlas 2.0, 77 CAs provided age-adjusted prevalence rates for 29 MDD/DRH related variables, with ORs at 95% confidence limit. Linear regression and relative risk (RR) predicted racial and gender associations for MDD/DRH and opioid prescriptions sites (DEA-2017+ARCOS database). We also tested significance at 95% CI for residents from 16 CAs for oral health association with high MDD/DRH probability by counting decay, missing, and filled teeth (DMFT), bleed on touch (BT), periodontal clinical attachment loss and use of oral surgery services. Results: CAs significantly associated to MDD/DRH variables. MDD/DRH and opioid use were also significantly associated to non-Hispanic Black (NHB) &gt; other persons. NHB from specific geographic CAs showed ANOVA’s significant probability with OR (at 95% CI) and RRs for behavioral disorder indicators. Significantly (p&lt;0.0001) oral health problems and need for oral surgery service consulting associated with medication users and MDD/DRH subjects identified by gender (F&gt;M) and race/ethnicity (NHB&gt;other). Conclusion: Limitations included self-reporting and reliance on dental college populations although we showed statistically significant odds ratios and relative risk for MDD/DRH related to race and gender’s oral health issues and oral surgery needs to suggest a broader role.

Relationship between opioid cross-tolerance during buprenorphine stabilization and return to opioid use during buprenorphine dose tapering.

Opioid injection drug use (IDU) has been linked to a more severe pattern of use (e.g. tolerance, overdose risk) and shorter retention in treatment, which may undermine abstinence attempts. This secondary data analysis of four human laboratory studies investigated whether current opioid IDU modulates subjective abuse liability responses to high-dose hydromorphone during intermediate-dose buprenorphine stabilization (designed to suppress withdrawal but allow surmountable agonist effects), and whether hydromorphone response magnitude predicts latency of return to opioid use during buprenorphine dose-tapering. Regular heroin users not currently seeking treatment (n = 54; 29 current injectors, 25 non-injectors) were stabilized on 8-mg/day sublingual buprenorphine and assessed for subjective responses (e.g. 'liking', craving) to hydromorphone 24-mg intramuscular challenge (administered 16-hr post-buprenorphine) under randomized, double-blinded, controlled conditions. A subgroup (n = 35) subsequently completed a standardized 3-week outpatient buprenorphine dose-taper, paired with opioid-abstinent contingent reinforcement, and were assessed for return to opioid use based on thrice-weekly urinalysis and self-report. During buprenorphine stabilization, IDU reported lower 'liking' of buprenorphine and post-hydromorphone peak 'liking', 'good effect' and 'high' compared to non-IDU. Less hydromorphone peak increase-from-baseline in 'liking' (which correlated with less hydromorphone-induced craving suppression) predicted significantly faster return to opioid use during buprenorphine dose-tapering. In these buprenorphine-stabilized regular heroin users, IDU is associated with attenuated 'liking' response (more cross-tolerance) to buprenorphine and to high-dose hydromorphone challenge and, in turn, this cross-tolerance (but not IDU) predicts faster return to opioid use. Further research should examine mechanisms that link cross-tolerance to treatment response.

Observations on the effects of buprenorphine and methadone on illicit drug use.

To determine if the agonistic effects of buprenorphine and methadone affect drug use. Quantitative examination of urine drug concentrations of patients treated with buprenorphine and methadone. Patients on buprenorphine had less opioid and methamphetamine drug use than those on methadone. Patients on buprenorphine therapy appear to use less illicit drugs.

Characterizing Opioid Withdrawal Experiences and Consequences Among a Community Sample of People Who Use Opioids

Background Opioid withdrawal symptoms are a highly salient and consequential health condition experienced by people who use opioids (PWUO). This study utilized qualitative interviews to explore opioid withdrawal experiences and consequences among PWUO in Los Angeles County, USA. Methods Semi-structured qualitative interviews were conducted with 22 PWUO (aged 27–63 years) between May 2021 and May 2022. Participants self-reported opioid and injection drug use in the last 30 days. We employed an inductive thematic approach to systematically code and synthesize textual interview data. Results Participants experienced withdrawal symptoms frequently, with many going to great lengths to avoid them. Withdrawal pain was described as incapacitating and interfered with PWUO’s ability to sustain regular employment and ensure stable housing. Avoiding withdrawal was described as influential in driving decisions to continue using opioids. Mechanisms for managing withdrawal included using other substances to the point of sedation. PWUO who transitioned from heroin to fentanyl use revealed more frequent, painful, and faster onset of withdrawal symptoms. Adverse withdrawal experiences and fear of precipitated withdrawal from buprenorphine were barriers to treatment initiation and continuation. Conclusion Withdrawal symptoms among PWUO increase health risk. Improved strategies to treat opioid withdrawal are urgently needed. Solutions such as safe supply and intentional opioid withdrawal interventions (educational trainings, withdrawal comfort kits) are needed to improve withdrawal management and reduce opioid-related harm.

Medication safety, privacy, and stigma: A qualitative study of pharmacy opioid agonist treatment disruptions and adaptations in the 2022 Northern Rivers floods, Australia

BackgroundOpioid agonist treatment (OAT) involves the daily consumption of long-acting opioid medications to assist in managing health and wellbeing issues related to illicit or high-strength opioid drug use. Flooding events disrupted OAT service systems in the Northern Rivers region (Australia) in 2022. This study describes the experiences of OAT consumers and pharmacists during this time, including how structural stigma may have limited clinician behaviours and influenced consumer experiences. MethodsInterview transcripts from eleven pharmacists and thirteen consumers were collated and thematically analysed. ResultsOpioid agonist treatment consumers experienced disruptions when their prescribing and pharmacy treatment sites were destroyed by flood or where roads were cut off, and faced long delays if they attended the primary public clinic for emergency dosing or prescription re-issuing. Absent prescriptions were the main barrier to enabling emergency dosing. Pharmacists’ efforts in providing advance takeaways or discretionary doses reduced consumer hardships and distress. The treatment access difficulties that consumers experienced were found to be constrained by stigma, and this intensified risks related to medication safety and privacy. ConclusionsTreatment access was enabled when pharmacists operated outside of the restrictive medication safety protocols that opioid agonist treatment is uniquely subject to, and that is informed by structural stigma towards OAT consumers. Potential distress was averted where pharmacists took responsive approaches to protecting and maintaining OAT access. Future emergency planning should aim to protect and transmit OAT dose authorisation records more effectively, while striving to minimise adverse impacts including decreased privacy and accessibility.

Effects of preoperative anxiety level on pain level and joint functions after total knee arthroplasty

This study examined the effect of preoperative anxiety level on postoperative pain, opioid and nonopioid analgesic use requirements and joint function in patients undergoing primary knee arthroplasty for knee osteoarthritis. 106 patients were included in the study. Situational anxiety score (STAI-S) and trait anxiety score (STAI-T) were divided into two groups as below and above 40. Visual analog scale (VAS), Lysholm scores, and anxiety levels were assessed preoperatively, at the third and sixth month postoperatively to investigate their effects on the use of opioid and non-opioid drugs during the postoperative period. For those with low situational and trait anxiety scores, the median duration of hospital stays was significantly shorter compared to those with high anxiety scores. In groups where anxiety levels were initially low, the median anxiety levels at the postoperative 3rd month were also observed to be lower compared to the other group. In the same groups, the median VAS values and the median Lysholm knee scores were significantly better both preoperatively and at the postoperative 3rd month compared to the other group. There was no significant difference in Lysholm score between the two groups at the 6th postoperative month. Similarly, in the preoperative period, groups with low anxiety levels had a significantly lower median usage of both opioids and non-opioids compared to the other group. These findings suggest that high preoperative anxiety may have a negative effect on functional outcomes in the early postoperative period, but this effect disappeared at 6 months. It can be concluded that reducing preoperative anxiety may have a positive effect on early outcomes. We believe that preoperative psychological evaluation and treatment can increase the satisfaction level in patients undergoing total knee arthroplasty (TKA).

Mixed Methods Evaluation of Satisfaction with Two Culturally Tailored Substance use Prevention Programs for American Indian/Alaska Native Emerging Adults

American Indian/Alaska Native (AI/AN) communities are disproportionately affected by the opioid epidemic. AI/AN emerging adults (ages 18–25) in urban areas are at particularly high risk, with the overdose death rate among urban-dwelling AI/AN people 1.4 times higher than rural-dwelling AI/AN people. Despite these challenges, there are no evidence-based culturally tailored prevention or intervention programs to address opioid, alcohol and other drug use among urban AI/AN emerging adults. This study focused on understanding AI/AN emerging adults’ experiences with two culturally tailored programs addressing opioid, cannabis, and alcohol use as part of the randomized controlled trial for Traditions and Connections for Urban Native Americans (TACUNA) in order to enhance feasibility of this intervention. Using a convergent mixed methods design at 3-month follow-up, we collected satisfaction and experience ratings and written narratives (total n = 162; intervention n = 77; control n = 85) from a sample of urban-dwelling AI/AN emerging adults who participated in both programs. We analyzed data through simultaneous examination of qualitative and quantitative data. The quantitative ratings show that both programs were rated highly. The qualitative data contextualized these ratings, illustrating pathways through which specific components were perceived to cause desired or observed behavioral change in participants. Among the elements that mattered most to these participants were the convenience of the virtual format, having a comfortable and safe space to share personal stories, and learning new information about their social networks. Negative comments focused on workshop length and inconvenient scheduling. This is one of the first studies to explore participant satisfaction and experience with culturally tailored substance use programming among a historically marginalized and understudied population. It is important to consider the voices of urban-dwelling AI/AN people in program development because hidden factors, such as limited financial resources, limited time, and misalignment with cultural values may prevent existing programs from being feasible.