Opioid Drug Use Research Articles

Post-acute Use of Opioids and Psychotropics in Patients after Hip Fracture: Unintended Consequences of Implementing Diagnosis-Related Grouping Payment.

How implementing diagnostic-related grouping (DRG) payment affected the use of opioids and psychotropics by hip fracture patients following hospitalization remained unknown. A retrospective, pre-post design, cohort study of data excerpted from Taiwan's National Health Insurance Research database (NHIRD). Adults aged ≥ 65 years first admitted for hip fracture surgery from 2007 to 2012 were identified and divided into two 1:1 propensity-score matched groups: pre-DRG (2007-2009); DRG (2010-2012). The outcome measures were use of opioid and/or psychotropic drugs within 30 days, 90 days, 180 days, and 365 days after discharge. Data of 16,522 subjects were excerpted, and 8,261 propensity-score matched subjects each classified into the pre-DRG and DRG groups. After adjustment, the DRG group was significantly more likely than the pre-DRG group to have used antipsychotics after discharge from hip fracture surgery (≤30 days, ≤90 days, ≤180 days and ≤365 days). The DRG group also had significantly higher prescription rates of benzodiazepines and antipsychotics during the observation period. Moreover, the DRG group was less likely to use non-steroidal anti-inflammatory drugs (≤30 days, ≤90 days, ≤180 days and ≤365 days) and more likely to use acetaminophen (≤30 days, ≤180 days, and ≤365 days). In conclusion, DRG implementation in Taiwan substantially increased post-acute prescription of antipsychotic and psychotropic agents for hip fracture patients, and changed use of analgesics, which may result in suboptimal quality and safety for these patients. Further research is needed to evaluate the long-term outcomes of DRG implementation, and the potential benefits of appropriate post-acute care bundled with DRG payment.

Urine Screening for Opiod and Illicit Drugs in the Total Joint Arthroplasty Population

Recent studies have shown an increase in post-operative orthopaedic complications associated with pre-operative opioid use. It is, therefore, important to know if patients use opioids before scheduled surgery. The purpose of this study was to determine if urine drug screening (UDS) is an effective screening tool for detecting opioid and illicit drug use prior to joint arthroplasty (JA) procedures. This retrospective chart review was performed with IRB approval on 166 out of 172 consecutive patients in a community-based practice. All the patients had a pre-operative UDS prior to primary or revision JA by a fellowship trained orthopaedic surgeon between March 2016 and April 2017. Patient demographics documented opioid and illicit drug use, co-morbid diagnosis, and UDS results were collected from clinical charts. Statistical analysis was conducted using Pearson Chi-square, Fisher's exact, McNemar test, and t-tests with IBM SPSS Statistics, ver. 23. Significant differences were p < 0.05. Sixty-four of 166 patients (38.6%) tested positive for opioids. Among them, 55.0% (35/64) had no history of prescription opioid use. Significant differences were observed when comparing the test results of the UDS with the patient reported history of prescribed opioids (p = 0.001). With a significant number of patients testing positive for opioids without evidence of a previous prescription, UDS may be beneficial for initial risk assessment for patients undergoing JA procedures.

Opioid drug use in emergency and adverse outcomes among patients with chronic obstructive pulmonary disease: a multicenter observational study

There is still debate as to the safety of non-palliative opioid administration to chronic obstructive pulmonary disease (COPD) patients punctually treated for an acute complaint. All patients over 40 presenting at two university hospital emergency departments (Montréal Qc, Grenoble Fr) from March 2008 to September 2014 with dyspnea, abdominal pain or trauma were retrieved, and COPD patients were selected. Our primary endpoint was a composite criterion including invasive ventilation and death. Comparisons between visits in which opioid drugs were prescribed and those without opioids were performed using an inverse probability of treatment and censoring weight (IPTCW) estimator to adjust for baseline confounders. A survival weighted Cox model was used. 7799 visits by COPD patients were identified, corresponding to 4173 unique patients. Opioid drug prescription was reported in 1317 (16.9%) visits. After applying IPCTW weighting, opioid prescription was found to be associated with the composite criterion of poor clinical outcomes (HR = 4.73 (2.94; 7.61), p < 0.01). When taken separately, this association remained significant for invasive ventilation and death, but not for NIV. All sensitivity analyses confirmed the association, except for patients with trauma or abdominal pain as the main complaint. This excess risk is observed whatever the route of administration.

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

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

Latent classes of lifetime drug use disorder in national epidemiological survey on alcohol and related conditions – III

Aims/BackgroundPeople diagnosed with multiple drug use disorders are high-risk subpopulations, but changes in diagnostic classification and drug use prevalence mean patterning of drug use disorders has changed in the past decade. We analyzed comorbidity patterns of lifetime drug use disorder in a general population sample. DesignUsing latent class analysis, we derived lifetime drug use disorder classes based on dichotomous indicators of sedative, cannabis, opioid, cocaine, stimulant, hallucinogen, inhalant/solvent, club drug, heroin, and other drug use disorders in the National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 36,309). Multinomial models assessed associations between sociodemographic and clinical correlates and latent class status. ResultsFour latent classes of lifetime substance use disorder were identified: A very low risk class, a class with high opioid, sedative and heroin comorbidity, a class based on cocaine and stimulant comorbidity, and class with high likelihood of multiple lifetime drug use disorders. All higher risk classes were associated with higher risk of lifetime personality disorder and mood disorder. Conduct disorder was also associated with higher risk, but level of risk varied by class. Opioid and sedative class was associated with higher odds of lifetime eating disorder diagnosis. ConclusionsComorbidity of drug use disorders is associated with a range of lifetime mental health disorder diagnoses. Unlike previous research, we did not identify a cannabis use class, possibly due to changes in diagnostic criteria and cannabis prevalence rates.

Preventing opioid overdose with peer-administered naloxone: findings from a rural state

BackgroundIn response to the opioid epidemic, naloxone distribution programs aim to prevent overdose death by making naloxone available and training people to use it. Peers of individuals at risk of opioid overdose are well-positioned to administer naloxone and prevent overdose death.MethodsWe conducted key informant interviews with 18 individuals with past or current opioid and heroin drug use who had administered naloxone to a peer during an overdose emergency. Interviews explored individuals’ experiences with administration and their recommendations for program and policy improvement. Data were systematically coded and analyzed for themes.ResultsParticipants sought naloxone rescue kits because they perceived high risk of overdose. They described high satisfaction with training and felt prepared to administer naloxone during overdose incidents. Overwhelmingly, participants perceived naloxone to be effective and emphasized the need to make it widely available. Findings suggest that engagement in overdose prevention strategies other than naloxone differs by gender, with females more likely than males to use multiple different strategies. Participants described that overdose experiences do not have a lasting impact on drug use behaviors.ConclusionsFindings support the feasibility of naloxone distribution to peer opioid and heroin users and provide recommendations for policy improvement, including effective and well-advertised Good Samaritan laws and links to treatment for opioid use disorder.

Immunohistochemical studies of codeine medication on the prefrontal cortex and cerebellum of adult Wistar rats

Despite the dangers associated with the increased use of prescription opioid drugs, limited researches have addressed the specific effects of prescription opioids on the brain. The objective of thi...

From time use to contingent work to labor supply: thoughts on the contributions of Alan Kreuger

Alan had a real concern with “getting it right,” even when getting it right was something that was going to be very, very difficult to do. I focus on some trends in labor supply that Alan was very concerned about. There has been a huge employment and earnings shift in recent years toward those with a Bachelor’s Degree or greater. Moreover, within each educational attainment group, the earnings of those who either have a certificate but no license, or a license, are higher. As for labor force participation, there has been a consistent decline for white men aged 25–54. Alan demonstrated that geographic areas with the greatest decline in labor force participation rates have been those with the highest use of prescription opioid drugs. My work with the National Longitudinal Survey further shows that, in the wake of the Great Recession, younger cohorts of workers are more prone to spells of unemployment or nonpartication in the labor force than those of the past.

Initial Management of Incarcerated Pregnant Women With Opioid Use Disorder.

The epidemic of opioid and other drug use and related arrests are a growing public health crisis in the United States. The national prevalence of pregnant women with opioid use disorder (OUD) has increased dramatically from 1.5 per 1,000 delivery hospitalizations in 1999 to 6.5 in 2014. The combination of these factors has led to an increased frequency of pregnant women with OUDs in the correctional health care system. This protocol provides evidence-based treatment recommendations including the initiation of methadone and buprenorphine in the inpatient or jail setting. It also explores many of the nuances around caring for this vulnerable patient population and discusses ways in which the medical and correctional health care teams can efficiently collaborate to improve patient outcomes.

Results of genicular nerve ablation by radiofrequency in osteoarthritis-related chronic refractory knee pain

Background/aim The aim of this study was to investigate the medium- to long-term effects of radiofrequency (RF) ablation of genicular nerves for chronic refractory knee pain due to osteoarthritis (OA).Materials and methodsForty-eight patients who underwent RF ablation of the genicular nerves were evaluated retrospectively. The visual analogue scale (VAS) score, Western Ontario and McMaster universities osteoarthritis index (WOMAC index), opioid and nonsteroidal antiinflammatory drug (NSAID) use score, quality of life score, and treatment satisfaction score were examined at 1, 3, and 6 months after the procedure.ResultsThe mean VAS scores were significantly lower at the 1-, 3-, and 6-month evaluations compared with the preoperative values (P < 0.001). A significant decrease was observed in the WOMAC index compared with preoperative values (P < 0.001). It was found that 66.7% of opioid users and 56.3% of NSAID users stopped using medication. No serious complications were encountered during or after the procedure. Conclusion In chronic refractory knee pain due to OA, the application of RF ablation to the genicular nerve is an effective and safe treatment option in the medium to long term.

Polysubstance Use: A Broader Understanding of Substance Use During the Opioid Crisis.

Objectives. To understand important changes in co-occurring opioid and nonopioid drug use (i.e., polysubstance use) within the opioid epidemic in the United States.Methods. We analyzed survey data on the past month co-use of prescription and illicit opioids and 12 nonopioid psychoactive drug classes from a national sample of 15 741 persons entering treatment of opioid use disorder.Results. Past-month illicit opioid use increased from 44.8% in 2011 to 70.1% in 2018, while the use of prescription opioids alone dropped from 55.2% to 29.9%, yet overall remained high (94.5% to 85.2%). Past-month use of at least 1 nonopioid drug occurred in nearly all participants (> 90%), with significant increases in methamphetamine (+85%) and decreases across nonopioid prescription drug classes (range: -40% to -68%).Conclusions. Viewing opioid trends in a "silo" ignores the fact not only that polysubstance use is ubiquitous among those with opioid use disorder but also that significant changes in polysubstance use should be monitored alongside opioid trends.Public Health Implications. Treatment, prevention, and policymaking must address not only the supply and demand of a singular drug class but also the global nature of substance use overall.

Community Treatment for Opioid Use Disorders in Urban and Rural Veterans.

The recent opioid crisis is characterized by a relatively greater increase in opioid use disorder and related mortality in rural populations when compared with urban populations.1-5 As almost a quarter of our nation's veterans reside in rural settings, the United States Veterans Health Administration (VHA) is interested in the impact of this epidemic on rural veterans. This study aims to develop a comprehensive understanding of the trends in substance use disorders (SUD) in veterans seeking treatment from community, non-VHA providers. Using Substance Abuse and Mental Health Services Administration (SAMHSA)'s Treatment Episode Data Set (TEDS), this study presents the prevalence of treatment for veterans seeking initial admission into publicly funded non-VHA SUD treatment centers for years 2011-2016. Comparisons were made for all SUD types. Multivariate trend analysis based on annual data from 2011 to 2016 compared urban and rural veterans for opioid use disorder treatment. Both urban and rural veterans had comparable rates of treatment for SUD, though rural veterans had slightly higher rates of injectable (11.2% vs 8.7%; P<.001) and opiate drug use disorder admissions (20.7% vs 18.1%; P=.014). Both urban and rural showed an increase in admissions for opioid, heroin, and injectable drug use disorders between 2011 and 2016 (P<.001). Comprehensive understanding of veteran SUD and treatment should include national-level data on community non-VHA treatment. SAMHSA's TEDS for years 2011-2016 provides clinical information for more than 90,000 veterans and indicates continued increase in treatment seeking for opioid use disorders, particularly for rural veterans.

Interventions to Increase Completion of Hepatitis B Vaccination in People who Inject Drugs: A Systematic Review and Meta-analysis.

Increases in opioid misuse and injection drug use have resulted in a rise in acute cases of hepatitis B. We conducted a systematic review and meta-analysis of randomized studies to determine the effect (pooled odds ratio) of interventions to increase hepatitis B vaccination completion in people who inject drugs (PWID). Odds ratios from the included studies were combined to create a pooled odds ratio (OR) using the Inverse Heterogeneity Model. Eleven studies met the eligibility criterion of having a randomized intervention to increase hepatitis B virus vaccination completion among PWID. The odds of vaccine completion in the intervention group were greater than in the control/comparison group (pooled OR, 2.53; 95% confidence interval [CI], 1.07–5.99). Subgroup analysis indicated that financial incentives were most effective (OR, 7.01; 95% CI, 2.88–17.06), followed by accelerated vaccine schedules (OR, 1.90; 95% CI, 1.14–3.14). Interventions using financial incentives and accelerated vaccine schedules are moderately effective at increasing hepatitis B vaccination completion in PWID.

A multimodal analgesic protocol reduced opioid use/misuse after third molar surgery

Objective This institutional review board–approved prospective study was designed to assess the number of opioid doses available to patients from filled prescriptions (Rx) and the opioid doses taken and left over after adoption of a multimodal analgesic protocol to manage pain after surgery in 2018. Study Design The inclusion criteria were (1) American Society of Anesthesiologists risk classification I/II, (2) age 18 to 35 years, and (3) at least 2 lower third molars removed. The exclusion criterion was treatment for opioid addiction/abuse. All enrolled, consented subject-patients were treated with the multimodal analgesic protocol. In addition, subject-patients were given 2 Rx for 4 doses of hydrocodone 5 mg or acetaminophen 325 mg each: one Rx dated to be filled on the day of surgery, one Rx dated to be filled on any subsequent day; both Rx could be filled at the patient's discretion. Data were derived from an encounter form completed by the patient at surgery; a 14-day diary by the patient, which tracked opioid drugs taken; and the Rx filled as recorded in the North Carolina RxSentry Prescription Drug Monitoring Program. The primary outcome variable was the number of opioid doses filled by Rx for each subject-patient. The primary predictor variable was the multimodal analgesic protocol. Descriptive statistics were used. Results Data from 50 patients were analyzed. Of these patients, 32 (64%) were females. Median age was 22 years (interquartile range [IQR] 19–26 years). Twenty-nine (58%) subject-patients filled no Rx, 9 filled 1 Rx (18%), 12 filled 2 Rx (24%). Within the group that filled 1 Rx, 23 left-over doses out of 36 doses (64%) were not consumed. Within the group that filled 2 Rx, 36 left-over doses out of 96 doses (38%) were not consumed. Conclusions Outcomes suggest that implementation of a multimodal analgesic protocol with third molar surgery may be effective in reducing use and misuse of opioid drugs.

Trends in college students’ alcohol, nicotine, prescription opioid and other drug use after recreational marijuana legalization: 2008–2018

BackgroundYoung adult college students may be particularly sensitive to recreational marijuana legalization (RML). Although evidence indicates the prevalence of marijuana use among college students increased after states instituted RML, there have been few national studies investigating changes in college students’ other substance use post-RML. MethodThe cross-sectional National College Health Assessment-II survey was administered twice yearly from 2008 to 2018 at four-year colleges and universities. Participants were 18–26 year old undergraduates attending college in states that did (n = 243,160) or did not (n = 624,342) implement RML by 2018. Outcome variables were self-reported nicotine use, binge drinking, illicit drug use, and misuse of prescription stimulants, sedatives, and opioids. Other variables included individual and contextual covariates, and institution-reported institutional and community covariates. Publicly available information was used to code state RML status at each survey administration. ResultsAccounting for state differences and time trends, RML was associated with decreased binge drinking prevalence among college students age 21 and older [OR (95% CI) = 0.91 (0.87 − 0.95), p < .0001] and increased sedative misuse among minors [OR (95% CI) = 1.20 (1.09 − 1.32), p = .0003]. RML did not disrupt secular trends in other substance use. ConclusionsIn the context of related research showing national increases in college students’ marijuana use prevalence and relative increases following state RML, we observed decreases in binge drinking and increases in sedative use that both depended on age. Findings support some specificity in RML-related changes in substance use trends and the importance of individual factors.

Prescription opioid use and misuse among adolescents and young adults in the United States: Anational survey study.

BackgroundPrescription opioid misuse has become a leading cause of unintentional injury and death among adolescents and young adults in the United States. However, there is limited information on how adolescents and young adults obtain prescription opioids. There are also inadequate recent data on the prevalence of additional drug abuse among those misusing prescription opioids. In this study, we evaluated past-year prevalence of prescription opioid use and misuse, sources of prescription opioids, and additional substance use among adolescents and young adults.Methods and findingsThis was a retrospective analysis of the National Survey on Drug Use and Health (NSDUH) for the years 2015 and 2016. Prevalence of opioid use, misuse, use disorder, and additional substance use were calculated with 95% confidence intervals (CIs), stratified by age group and other demographic variables. Sources of prescription opioids were determined for respondents reporting opioid misuse. We calculated past-year prevalence of opioid use and misuse with or without use disorder, sources of prescription opioids, and prevalence of additional substance use. We included 27,857 adolescents (12–17 years of age) and 28,213 young adults (18–25 years of age) in our analyses, corresponding to 119.3 million individuals in the extrapolated national population. There were 15,143 respondents (27.5% [95% CI 27.0–28.0], corresponding to 32.8 million individuals) who used prescription opioids in the previous year, including 21.0% (95% CI 20.4–21.6) of adolescents and 32.2% (95% CI 31.4–33.0) of young adults. Significantly more females than males reported using any prescription opioid (30.3% versus 24.8%, P < 0.001), and non-Hispanic whites and blacks were more likely to have had any opioid use compared to Hispanics (28.9%, 28.1%, and 25.8%, respectively; P < 0.001). Opioid misuse was reported by 1,050 adolescents (3.8%; 95% CI 3.5–4.0) and 2,207 young adults (7.8%; 95% CI 7.3–8.2; P < 0.001). Male respondents using opioids were more likely to have opioid misuse without use disorder compared with females (23.2% versus 15.8%, respectively; P < 0.001), with similar prevalence by race/ethnicity. Among those misusing opioids, 55.7% obtained them from friends or relatives, 25.4% from the healthcare system, and 18.9% through other means. Obtaining opioids free from friends or relatives was the most common source for both adolescents (33.5%) and young adults (41.4%). Those with opioid misuse reported high prevalence of prior cocaine (35.5%), hallucinogen (49.4%), heroin (8.7%), and inhalant (30.4%) use. In addition, at least half had used tobacco (55.5%), alcohol (66.9%), or cannabis (49.9%) in the past month. Potential limitations of the study are that we cannot exclude selection bias in the study design or socially desirable reporting among participants, and that longitudinal data are not available for long-term follow-up of individuals.ConclusionsResults from this study suggest that the prevalence of prescription opioid use among adolescents and young adults in the US is high despite known risks for future opioid and other drug use disorders. Reported prescription opioid misuse is common among adolescents and young adults and often associated with additional substance abuse, underscoring the importance of drug and alcohol screening programs in this population. Prevention and treatment efforts should take into account that greater than half of youths misusing prescription opioids obtain these medications through friends and relatives.

Endogenous endophthalmitis and other ocular manifestations of injection drug use.

The United States has experienced a dramatic rise in opioid and injection drug use over the past 2 decades. A public health emergency was declared in 2017 and subsequently, there have been several new reports on the rise of endogenous endophthalmitis specifically associated with injection drug use. The purpose of this review is to provide a current perspective of the ocular harms posed by injection drug use. The opioid epidemic has prompted several new studies from New England, one of the US regions most heavily affected, that examine the trends and characteristics of injection drug use-associated endogenous endophthalmitis. Patients may delay seeking care and may be infected with a variety of rare and atypical microbes, and as a result clinical appearance may vary widely. Injection drug use also leads to embolic phenomena such as talc retinopathy and septic emboli from endocarditis. HIV is highly associated with injection drug use and although HAART has drastically reduced the morbidity and mortality of HIV-associated infections, a variety of ocular disease may accompany an immunocompromised patient. Healthcare providers must remain vigilant in the recognition of injection drug use patients with vision loss and ocular inflammation to ensure prompt medical and/or surgical treatment.

Developmental opioid exposures: Neurobiological underpinnings, behavioral impacts, and policy implications.

The devastating impact of opioid abuse and dependence on the individual, family, and society are well known but extremely difficult to combat. During pregnancy, opioid drugs and withdrawal also affect fetal brain development and newborn neural functions, in addition to maternal effects. Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome (NAS/NOWS) rates have drastically increased in the US in the past decade. Solutions to this complex problem must be multi-faceted, which would be greatly enhanced by a translational, multidisciplinary understanding. Therefore, this mini-review incorporates biomedical, clinical, and policy aspects of opioid use during pregnancy. We review the known roles for endogenous opioids in mediating circuit formation and function in the developing brain, discuss how exogenous opioid drug use and addiction impact these processes in animal models and humans, and discuss the implications of these data on public policy. We suggest that some current policy initiatives produce unintended harm on both mothers and their children and delineate recommendations for how legislation could better contribute to addiction recovery and increase neural resilience in affected children. Impact statement Opioid abuse is a critical epidemic affecting individuals, families, and communities. This mini-review summarizes current literature on the impact of opioid drugs—including prescription pain relievers and illicit opioids—on neurobiological and neurobehavioral development. Using concepts related to the medical model of addiction as a brain disease, we review the public policy implications of these data and identify needs for future investigations.

The Effects of Opioids on HIV Neuropathogenesis.

HIV associated neurocognitive disorders (HAND) are a group of neurological deficits that affect approximately half of people living with HIV (PLWH) despite effective antiretroviral therapy (ART). There are currently no reliable molecular biomarkers or treatments for HAND. Given the national opioid epidemic, as well as illegal and prescription use of opioid drugs among PLWH, it is critical to characterize the molecular interactions between HIV and opioids in cells of the CNS. It is also important to study the role of opioid substitution therapies in the context of HIV and CNS damage in vitro and in vivo. A major mechanism contributing to HIV neuropathogenesis is chronic, low-level inflammation in the CNS. HIV enters the brain within 4–8 days after peripheral infection and establishes CNS reservoirs, even in the context of ART, that are difficult to identify and eliminate. Infected cells, including monocytes, macrophages, and microglia, produce chemokines, cytokines, neurotoxic mediators, and viral proteins that contribute to chronic inflammation and ongoing neuronal damage. Opioids have been shown to impact these immune cells through a variety of molecular mechanisms, including opioid receptor binding and cross desensitization with chemokine receptors. The effects of opioid use on cognitive outcomes in individuals with HAND in clinical studies is variable, and thus multiple biological mechanisms are likely to contribute to the complex relationship between opioids and HIV in the CNS. In this review, we will examine what is known about both HIV and opioid mediated neuropathogenesis, and discuss key molecular processes that may be impacted by HIV and opioids in the context of neuroinflammation and CNS damage. We will also assess what is known about the effects of ART on these processes, and highlight areas of study that should be addressed in the context of ART.

Educational Intervention Changes College Students’ Attitudes toward Prescription Opioid Drug Use

Background: More than 47,000 people in the United States died from opioid drug overdoses in 2017. Among college students, opioid drugs are the second most abused drug. Objective: This study aimed to examine if an educational intervention impacted college students’ attitudes towards prescription opioid drugs (POD). Methods: Two hundred forty-two participants (72 males, 21 ± 3 years) from an American university participated. After collecting demographic data (questionnaire 1; Q1), investigators recited a narrative in which the protagonist was injured and prescribed POD. Next, participants rated their agreement on 10 Likert prompts and two visual analog scales (VAS) before (Q2) and after (Q3) an educational intervention, then noted (Q4) which topics were most or least influential in any changed responses. Results: 7/10 Likert prompts (all p < 0.002) and both VAS (both p < 0.001) changed between Q2 and Q3. Educational intervention topics related to risk were most influential and topics related to alternative therapies were least influential. Conclusion/Importance: Educational interventions may be beneficial for college students. Any interventions that are employed should focus on risks associated with POD use.