Benzodiazepine misuse and cigarette smoking status in US adults: Results from the National Survey on Drug Use and Health, 2015-2018

Pupillary response to percutaneous auricular vagus nerve stimulation in alcohol withdrawal syndrome: A pilot trial

BACKGROUND

Autonomic symptoms in alcohol withdrawal syndrome (AWS) are associated with a sympathetic-driven imbalance of the autonomic nervous system. To restore autonomic balance in AWS, novel neuromodulatory approaches could be beneficial. We conducted a pilot trial with percutaneous auricular vagus nerve stimulation (pVNS) in AWS and hypothesized that pVNS will enhance the parasympathetic tone represented by a reduction of pupillary dilation in a parasympatholytic pharmacological challenge.

METHODS

Thirty patients suffering from alcohol use disorder, undergoing AWS, and stable on medication, were recruited in this open-label, single-arm pilot trial with repeated-measure design. Peripheral VNS (monophasic volt impulses of 1 msec, alternating polarity, frequency 1 Hz, amplitude 4 mV) was administered at the left cymba conchae for 72 h, followed by pupillometry under a tropicamide challenge. We assessed craving with a visual analog scale. We used pupillary mean as the dependent variable in a repeated-measures ANOVA (rmANOVA).

RESULTS

A repeated-measures ANOVA resulted in a significant difference for pupillary diameter across time and condition (F(2,116) = 27.97, p < .001, ηp2 > .14). Tukey-adjusted post hoc analysis revealed a significant reduction of pupillary diameter after pVNS. Alcohol craving was significantly reduced after pVNS (p < .05, Cohen's d = 1.27).

CONCLUSION

Our study suggests that pVNS activates the parasympathetic nervous system in patients with acute AWS, and that this activation is measurable by pupillometry. To this end, pVNS could be beneficial as a supportive therapy for AWS. Potential confounding effects of anti-craving treatment should be kept in mind.

Opioid and benzodiazepine misuse in the United States: The impact of socio-demographic characteristics

BACKGROUND AND OBJECTIVES

In 2021, drug overdose deaths in the United States reached a new record of 107,622. Misuse of opioids and benzodiazepines accounts for a large portion of drug overdose deaths. However, the effects of socio-demographic characteristics on misuse of opioids and benzodiazepines are not evident. Thus, this study examines the socio-demographic characteristics associated with misuse of opioids and benzodiazepines among adults in the United States.

METHODS

Data from 2015-2019 National Survey on Drug Use and Health was utilized in the multinomial logistic regression analysis and included 202,935 adults ages ≥18 years.

RESULTS

During 2015-2019, 3.3% of the adults misused opioids, 1.2% misused benzodiazepines, and 0.9% misused both drugs in the preceding year of the survey. Those who were younger, bisexual, non-Hispanic White, had a history of delinquency in the past year, had alcohol dependence/abuse, marijuana dependence/abuse, nicotine dependence and use, and experienced major depressive episodes were more likely to misuse opioids, benzodiazepines, or both.

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

A large portion of US adults are misusing opioids, benzodiazepines, and both drugs. Specifically, bisexual individuals experience higher odds of opioid misuse, benzodiazepine misuse and misuse of both drugs compared with heterosexuals, while males are experiencing lower odds of benzodiazepine misuse compared with females. Individuals aged 26-49 experience the highest odds of opioid misuse, though misuse of both drugs was higher among the 18-25 age group. Findings underscore the use of targeted preventive measures to reduce misuse of these drugs among at-risk populations identified in this study.