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Bunting AM, Shearer R, Linden-Carmichael AN, Williams AR, Comer SD, Cerdá M, Lorvick J. Are you thinking what I'm thinking? Defining what we mean by "polysubstance use.". THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:1-7. [PMID: 37734160 PMCID: PMC10939915 DOI: 10.1080/00952990.2023.2248360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/10/2023] [Indexed: 09/23/2023]
Abstract
The rise in drug overdoses and harms associated with the use of more than one substance has led to increased use of the term "polysubstance use" among researchers, clinicians, and public health officials. However, the term retains no consistent definition across contexts. The current authors convened from disciplines including sociology, epidemiology, neuroscience, and addiction psychiatry to propose a recommended definition of polysubstance use. An iterative process considered authors' formal and informal conversations, insights from relevant symposia, talks, and conferences, as well as their own research and clinical experiences to propose the current definition. Three key concepts were identified as necessary to define polysubstance use: (1) substances involved, (2) timing, and (3) intent. Substances involved include clarifying either (1) the number and type of substances used, (2) presence of more than one substance use disorder, or (3) primary and secondary substance use. The concept of timing is recommended to use clear terms such as simultaneous, sequential, and same-day polysubstance use to describe short-term behaviors (e.g., 30-day windows). Finally, the concept of intent refers to clarifying unintentional use or exposure when possible, and greater attention to motivations of polysubstance use. These three components should be clearly defined in research on polysubstance use to improve consistency across disciplines. Consistent definitions of polysubstance use can aid in the synthesis of evidence to better address an overdose crisis that increasingly involves multiple substances.
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Affiliation(s)
- Amanda M Bunting
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Riley Shearer
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Ashley N Linden-Carmichael
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Arthur Robin Williams
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Sandra D Comer
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Jennifer Lorvick
- Community Health and Implementation Research Program, RTI International, Berkeley, CA, USA
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Green VR, Kennedy-Hendricks A, Saloner B, Bandara S. Substance use and treatment characteristics among pregnant and non-pregnant females, 2015-2019. Drug Alcohol Depend 2024; 254:111041. [PMID: 38043227 DOI: 10.1016/j.drugalcdep.2023.111041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION In the United States (US), pregnant females who use substances face increased morbidity and mortality risks compared to non-pregnant females. This study provides a national snapshot of substance use and treatment characteristics among US reproductive-aged females, including those who are pregnant. METHODS Our sample included females aged 15-44 years (n=97,830) from the 2015-2019 National Survey on Drug Use and Health (NSDUH) data. We calculated weighted percentages of past-month alcohol or drug use and past-year substance use disorder (SUD), stratified by pregnancy status. We also calculated weighted percentages of past-year treatment setting and payer. Pearson chi-square tests were conducted to determine if percentages were statistically significantly different. RESULTS Compared to non-pregnant females, pregnant females had lower prevalence of past-month illicit drug use excluding cannabis (1.6% vs. 4.3%, p<0.01), cannabis use (5.3% vs. 12.5%, p<0.01), binge drinking (4.5% vs. 29.3%, p<0.01) and past-year SUD (7.1 vs. 8.8%, p<0.01). Less than 13% of females with SUD received treatment regardless of pregnancy status, but treatment use was higher among pregnant females compared to non-pregnant females (12.8% vs. 10.5%). However, there were no statistically significant differences in past-year treatment use, setting, or treatment payer. DISCUSSION The prevalence of substance use and SUD was lower among pregnant females compared to non-pregnant females in 2015-2019. Low uptake of substance use treatment suggests that barriers exist to treatment-seeking among reproductive-aged women. Further exploration of stigma, payment, and access to treatment, and how they differ by pregnancy status, is needed.
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Affiliation(s)
- Victoria R Green
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Alene Kennedy-Hendricks
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Brendan Saloner
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Sachini Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Fuchs JR, Schiff MA, Coronado E. Substance Use Disorder-Related Deaths and Maternal Mortality in New Mexico, 2015-2019. Matern Child Health J 2023; 27:23-33. [PMID: 37306823 PMCID: PMC10691991 DOI: 10.1007/s10995-023-03691-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND In recent decades, maternal mortality has increased across the U.S. Experiences of pregnant and postpartum people with Substance Use Disorder (SUD)-related deaths have not been previously evaluated in New Mexico. The aim of this study was to analyze risk factors related to substance use and explore substance use patterns among pregnancy-associated deaths in New Mexico from 2015 to 2019. METHODS We conducted an analysis of pregnancy-associated deaths to assess the association between demographics, pregnancy factors, circumstances surrounding death, treatment of mental health conditions, and experiences with social stressors among Substance Use Disorder (SUD)-related and non-SUD-related deaths. We performed univariate analyses of risk factors using chi-square tests to assess the differences between SUD-related and non-SUD-related deaths. We also examined substance use at time of death. RESULTS People with SUD-related deaths were more likely to die 43-365 days postpartum (81% vs. 45%, p-value = 0.002), have had a primary cause of death of mental health conditions (47% vs 10%, p < 0.001), have died of an overdose (41% vs. 8%, p-value = 0.002), have had experienced any social stressors (86% vs 30%, p < 0.001) compared to people with non-SUD-related deaths, and received treatment for SUD at any point before, during, or after pregnancy (49% vs. 2%, p < 0.001). The substances most used at time of death were amphetamines (70%), and most cases engaged in polysubstance use (63%). CONCLUSIONS FOR PRACTICE Providers, health departments, and community organizations must prioritize supporting people using substances during and after pregnancy to prevent death and improve quality of life for pregnant and postpartum people.
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Affiliation(s)
- Jessica R Fuchs
- New Mexico Department of Health, 2040 S. Pacheco St, Santa Fe, NM, 87505, USA.
| | - Melissa A Schiff
- Department of Internal Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, Albuquerque, NM, 8713, USA
| | - Eirian Coronado
- New Mexico Department of Health, 2040 S. Pacheco St, Santa Fe, NM, 87505, USA
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Eide D, McDonald R, Hamina A, Clausen T, Odsbu I, Skurtveit S. Prescription high-risk polysubstance use among opioid maintenance treatment patients. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104196. [PMID: 37741700 DOI: 10.1016/j.drugpo.2023.104196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/01/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Among individuals receiving buprenorphine or methadone as opioid maintenance treatment (OMT), concomitant use of other central nervous system depressants, including prescription drugs, can increase risk of overdose. We aimed to 1) determine the prevalence of use of high-risk prescription drugs (opioid analgesics, benzodiazepines, benzodiazepine-related drugs, and gabapentinoids) among OMT patients, 2) calculate its associations with different mental health and pain-related diagnoses, and 3) compare prevalence of concomitant use with the general population. METHODS A national sample comprising all individuals filling at least one prescription of OMT drugs in Norway in 2019 was formed. Healthcare registry data were linked to investigate high-risk prescription drug use and different diagnoses. We calculated one-year prevalence of use, amount dispensed in defined daily doses (DDDs), and the number of prescribers for the different high-risk prescription drugs. Logistic regression was used to determine associations (adjusted odds ratios; aOR, 95% confidence intervals (CIs)) between diagnoses and use. Prevalence of use was calculated both in the OMT patient sample and the general population. RESULTS Among the OMT patient sample (n=7,299), 47.6% (n=3,476) filled prescriptions for benzodiazepines. For each high-risk prescription drug group, there was a median of 1-2 prescribers. Musculoskeletal diagnoses were the strongest factor for concomitant high-risk prescription drug use for both males (aOR 3.23, CI: 2.72-3.85) and females (aOR 3.07, CI: 2.42- 3.90). The 1-year prevalence of benzodiazepine use was 11.4 times higher for males and 7.1 times higher for females in OMT than the general population. The amount in DDDs was higher for every drug for OMT patients than the general population, particularly for benzodiazepines. CONCLUSIONS OMT patients frequently filled prescriptions for high-risk drugs, and in higher dosages than the general population. However, we found little evidence of 'doctor shopping.' Given that these prescription drugs carry overdose risk, particularly when combined with OMT drugs, our findings emphasize the continued need for education and caution to both prescribers and patients on their concomitant use with OMT.
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Affiliation(s)
- Desiree Eide
- Norwegian Centre for Addiction Research University of Oslo, 166 Kirkeveien 0450 Oslo, Norway.
| | - Rebecca McDonald
- Norwegian Centre for Addiction Research University of Oslo, 166 Kirkeveien 0450 Oslo, Norway
| | - Aleksi Hamina
- Norwegian Centre for Addiction Research University of Oslo, 166 Kirkeveien 0450 Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research University of Oslo, 166 Kirkeveien 0450 Oslo, Norway
| | - Ingvild Odsbu
- Department of Chronic Diseases Norwegian Institute of Public Health, PO Box 222 Skøyen 0213 Oslo, Norway
| | - Svetlana Skurtveit
- Norwegian Centre for Addiction Research University of Oslo, 166 Kirkeveien 0450 Oslo, Norway; Department of Chronic Diseases Norwegian Institute of Public Health, PO Box 222 Skøyen 0213 Oslo, Norway
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Park Y, Dang EP, Board A, Gilboa SM, Ondersma SJ, Smid MC, Shakib JH, Mitchell KT, England LJ, Broussard CS, Meaney-Delman D, Iskander J, Kim SY. Polysubstance Use in Pregnancy: Surveillance, Interventions, and Next Steps. J Womens Health (Larchmt) 2023; 32:899-904. [PMID: 37552850 PMCID: PMC10558011 DOI: 10.1089/jwh.2023.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
Substance use during pregnancy increases risk for a wide range of adverse maternal and neonatal health outcomes. Polysubstance use is common among people who use substances during pregnancy; however, the risks of combined substance exposures during pregnancy are poorly understood. In this report, we provide an overview of the activities of the Centers for Disease Control and Prevention (CDC) and partners and identified gaps related to (1) surveillance, (2) routine screening, and (3) prevention of polysubstance use during pregnancy. Efforts by CDC and other partners to reduce polysubstance use during pregnancy can improve the health of pregnant people and their infants and children.
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Affiliation(s)
- Youngjoo Park
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee, USA
| | - Elizabeth P. Dang
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy Board
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suzanne M. Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Steven J. Ondersma
- Department of Public Health, Michigan State University, East Lansing, Michigan, USA
| | - Marcela C. Smid
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA
| | - Julie H. Shakib
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | | | - Lucinda J. England
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cheryl S. Broussard
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dana Meaney-Delman
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John Iskander
- Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shin Y. Kim
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Jones AA, Schneider KE, Tobin KE, O'Sullivan D, Latkin CA. Daily opioid and stimulant co-use and nonfatal overdoses in the context of social disadvantage: Findings on marginalized populations. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 151:208986. [PMID: 36822268 PMCID: PMC10313799 DOI: 10.1016/j.josat.2023.208986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/28/2022] [Accepted: 02/12/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Opioids and stimulants are increasingly implicated in overdose deaths, particularly among minoritized groups. We examined daily opioid and cocaine co-use, nonfatal overdoses, and naloxone carrying among minoritized people who inject drugs (PWID). METHODS The study derived data from 499 PWID in Baltimore City, MD, recruited using street-based outreach between 2016 and 2019. Participants reported overdoses; sociodemographic characteristics; and use of nonmedical prescription opioids, heroin, cocaine, and naloxone. RESULTS Among the participants, the mean age was 46, 34 % were female, 64 % self-identified as Black, and 53 % experienced recent homelessness. Black PWID, compared to White PWID, were as likely to use opioids and cocaine daily but were 61 % less likely to have naloxone. After controlling for sociodemographic characteristics, women (aOR:1.88, 95%CI: 1.14, 3.11), persons experiencing homelessness (aOR:3.07, 95%CI: 1.79, 5.24), and those who experienced a recent overdose (aOR:2.14, 95%CI: 1.29, 3.58) were significantly more likely to use opioids and any form of cocaine every day. In a subanalysis of only female PWID, females engaged in sex work (aOR:2.27, 95%CI: 1.02, 5.07) and females experiencing recent homelessness (aOR:5.82, 95%CI: 2.50, 13.52) were significantly more likely to use opioids and cocaine daily. Furthermore, females (aOR:1.69, 95%CI:1.03, 2.77), persons experiencing homelessness (aOR:1.94, 95%CI:1.16, 3.24), and those with higher educational attainment (aOR:2.06, 95%CI:1.09, 3.91) were more likely to often/always carry naloxone, while Black PWID were less likely to have naloxone (aOR:0.39, 95%CI:0.22, 0.69). CONCLUSIONS These findings highlight the need for targeted naloxone distribution and other harm-reduction interventions among minoritized groups in urban areas.
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Affiliation(s)
- A A Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, USA.
| | - K E Schneider
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, USA
| | - K E Tobin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, USA
| | - D O'Sullivan
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University, USA
| | - C A Latkin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, USA
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Board A, D'Angelo DV, Salvesen von Essen B, Denny CH, Miele K, Dunkley J, Baillieu R, Kim SY. Polysubstance use during pregnancy: The importance of screening, patient education, and integrating a harm reduction perspective. Drug Alcohol Depend 2023; 247:109872. [PMID: 37182339 PMCID: PMC10332334 DOI: 10.1016/j.drugalcdep.2023.109872] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Substance use during pregnancy is associated with poor health outcomes. This study assessed substance use, polysubstance use, and use of select prescription medications during pregnancy. METHODS We analyzed 2019 data from the Pregnancy Risk Assessment Monitoring System in 25 United States jurisdictions that included questions on prescription medications, tobacco, and illicit substance use during pregnancy. Alcohol and electronic cigarette use were assessed during the last three months of pregnancy, and all other substances and medications were assessed throughout pregnancy. Weighted prevalence estimates and 95% confidence intervals (CIs) were calculated. RESULTS Nearly one-fifth of respondents who reported use of any substance reported use of at least one other substance during pregnancy. Cigarettes (8.1%; 95% CI 7.6-8.7%) and alcohol (7.4%; 95% CI 6.7-8.1%) were the most frequently reported substances, followed by cannabis (4.3%; 95% CI 3.9-4.7%). Substance use was higher among individuals who reported having depression or using antidepressants during pregnancy compared with those who did not report depression or antidepressant use. Illicit drug use prevalence was low (0.5%, 95% CI 0.4-0.7%); however, respondents reporting heroin use also frequently reported use of illicit stimulants (amphetamines: 51.7%, 95% CI 32.1-71.3% or cocaine: 26.5%, 95% CI 11.9-41.1%). Although prenatal clinician screening for alcohol and cigarette use was approximately 95%, fewer respondents (82.1%) reported being screened for cannabis or illicit substance use during pregnancy. CONCLUSIONS One in five individuals who reported use of any substance during pregnancy engaged in polysubstance use, highlighting the importance of comprehensive screening and evidence-based interventions including harm reduction.
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Affiliation(s)
- Amy Board
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop S106-3, Atlanta, GA 30341, United States.
| | - Denise V D'Angelo
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop S106-10, Atlanta, GA 30341, United States
| | - Beatriz Salvesen von Essen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop S107-2, Atlanta, GA 30341, United States; CDC Foundation, 600 Peachtree Street NE, Suite 1000, Atlanta, GA 30308, United States
| | - Clark H Denny
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop S106-3, Atlanta, GA 30341, United States
| | - Kathryn Miele
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop S106-3, Atlanta, GA 30341, United States
| | - Janae Dunkley
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop S106-3, Atlanta, GA 30341, United States; Oak Ridge Institute for Science and Education, P.O. Box 117, Oak Ridge, TN 37831-0117, United States
| | - Robert Baillieu
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857, United States
| | - Shin Y Kim
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop S106-3, Atlanta, GA 30341, United States
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Morton A. Hypoglycaemia in non-diabetic pregnancy. Obstet Med 2023; 16:123-125. [PMID: 37441658 PMCID: PMC10334043 DOI: 10.1177/1753495x211032787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 06/04/2024] Open
Abstract
Hypoglycaemia in non-diabetic pregnancy is rare, the majority of reported cases being due to insulinoma, acute fatty liver of pregnancy, malaria and inborn errors of metabolism. A case of hypoglycaemia in a woman with previous laparoscopic sleeve gastrectomy, and hypothalamic-pituitary-adrenal axis insufficiency in the setting of opioid dependence is presented. The timing of low interstitial glucose levels was atypical for late dumping syndrome following bariatric surgery, and a change in the woman's glucocorticoid replacement resulted in resolution of hypoglycaemic symptoms. The incidence of opioid dependence in pregnancy is increasing rapidly. Health professionals should be aware of the possibility of opioids causing hypothalamic-pituitary-adrenal axis insufficiency, and the additional mechanisms by which opioids may cause hypoglycaemia.
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Affiliation(s)
- Adam Morton
- Obstetric Medicine, Mater Health, South Brisbane, Australia
- University of Queensland, Brisbane, Australia
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Schmidt RD, Horigian VE, Shmueli-Blumberg D, Hefner K, Feinberg J, Kondapaka R, Feaster DJ, Duan R, Gonzalez S, Davis C, Vena A, Marín-Navarrete R, Tross S. High suicidality predicts overdose events among people with substance use disorder: A latent class analysis. Front Public Health 2023; 11:1150062. [PMID: 37261240 PMCID: PMC10228506 DOI: 10.3389/fpubh.2023.1150062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/14/2023] [Indexed: 06/02/2023] Open
Abstract
Introduction Suicide is the tenth leading cause of death in the United States and continues to be a major public health concern. Suicide risk is highly prevalent among individuals with co-occurring substance use disorders (SUD) and mental health disorders, making them more prone to adverse substance use related outcomes including overdose. Identifying individuals with SUD who are suicidal, and therefore potentially most at risk of overdose, is an important step to address the synergistic epidemics of suicides and overdose fatalities in the United States. The current study assesses whether patterns of suicidality endorsement can indicate risk for substance use and overdose. Methods Latent class analysis (LCA) was used to assess patterns of item level responses to the Concise Health Risk Tracking Self-Report (CHRT-SR), which measures thoughts and feelings associated with suicidal propensity. We used data from 2,541 participants with SUD who were enrolled across 8 randomized clinical trials in the National Drug Abuse Treatment Clinical Trials Network from 2012 to 2021. Characteristics of individuals in each class were assessed, and multivariable logistic regression was performed to examine class membership as a predictor of overdose. LCA was also used to analyze predictors of substance use days. Results Three classes were identified and discussed: Class (1) Minimal Suicidality, with low probabilities of endorsing each CHRT-SR construct; Class (2) Moderate Suicidality, with high probabilities of endorsing pessimism, helplessness, and lack of social support, but minimal endorsement of despair or suicidal thoughts; and Class (3) High Suicidality with high probabilities of endorsing all constructs. Individuals in the High Suicidality class comprise the highest proportions of males, Black/African American individuals, and those with a psychiatric history and baseline depression, as compared with the other two classes. Regression analysis revealed that those in the High Suicidality class are more likely to overdose as compared to those in the Minimal Suicidality class (p = 0.04). Conclusion Suicidality is an essential factor to consider when building strategies to screen, identify, and address individuals at risk for overdose. The integration of detailed suicide assessment and suicide risk reduction is a potential solution to help prevent suicide and overdose among people with SUD.
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Affiliation(s)
- Renae D. Schmidt
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Viviana E. Horigian
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | | | | | - Judith Feinberg
- Departments of Behavioral Medicine and Psychiatry and Medicine/Infectious Diseases, West Virginia University School of Medicine, Morgantown, WV, United States
| | | | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Rui Duan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sophia Gonzalez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Carly Davis
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ashley Vena
- The Emmes Company, LLC, Rockville, MD, United States
| | - Rodrigo Marín-Navarrete
- Division of Research and Translational Education, Centros de Integración Juvenil A.C, Mexico City, Mexico
| | - Susan Tross
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
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Charron E, Kent-Marvick J, Gibson T, Taylor E, Bouwman K, Sani GM, Simonsen SE, Stone RH, Kaiser JE, McFarland MM. Barriers to and facilitators of hormonal and long-acting reversible contraception access and use in the US among reproductive-aged women who use opioids: A scoping review. Prev Med Rep 2023; 32:102111. [PMID: 36747991 PMCID: PMC9898069 DOI: 10.1016/j.pmedr.2023.102111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/04/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Existing research has found that women who use opioids (WWUO) experience challenges to hormonal and long-acting reversible contraception (HC-LARC) access and use. Facilitators of such use are unclear. We conducted a scoping review to comprehensively map the literature on barriers to and facilitators of HC-LARC access and use in the United States among reproductive-aged WWUO. In accordance with the JBI Manual of Evidence Synthesis, we conducted literature searches for empirical articles published from 1990 to 2021. Independent reviewers screened references, first by titles and abstracts, then by full-text, and charted data of eligible articles. We coded and organized HC-LARC barriers and facilitators according to a four-level social-ecological model (SEM) and categorized findings within each SEM level into domains. We screened 4,617 records, of which 28 articles focusing on HC-LARC (n = 18), LARC only (n = 6), or testing an intervention to increase HC-LARC uptake (n = 4) met inclusion criteria. We identified 13 domains of barriers and 11 domains of facilitators across four SEM levels (individual, relationship, community, societal). The most frequently cited barriers and facilitators were methods characteristics, partner and provider relations, transportation, healthcare availability and accessibility, cost, insurance, and stigma. Future studies would benefit from recruiting participants and collecting data in community settings, targeting more diverse populations, and identifying neighborhood, social, and policy barriers and facilitators. Reducing barriers and improving equity in HC-LARC access and use among WWUO is a complex, multifaceted issue that will require targeting factors simultaneously at multiple levels of the social-ecological hierarchy to effect change.
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Affiliation(s)
- Elizabeth Charron
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, Schusterman Center, 4502 E. 41st Street, Tulsa, OK 74135, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 383 Colorow Lane, Salt Lake City, UT 84108, USA
| | | | - Tyler Gibson
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, USA
| | - Eliza Taylor
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, USA
| | - Kelsey Bouwman
- College of Pharmacy, University of Georgia, 250 W. Green St, Athens, GA 30602, USA
| | - Gelina M. Sani
- College of Pharmacy, University of Georgia, 250 W. Green St, Athens, GA 30602, USA
| | - Sara E. Simonsen
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, USA
| | - Rebecca H. Stone
- College of Pharmacy, University of Georgia, 250 W. Green St, Athens, GA 30602, USA
| | - Jennifer E. Kaiser
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah Health, 50N Medical Drive, Salt Lake City, UT 84132, USA
| | - Mary M. McFarland
- Spencer S. Eccles Health Sciences Library, University of Utah, 10 N. 1900 E, Salt Lake City, UT 84112, USA
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11
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Tran EL, England LJ, Park Y, Denny CH, Kim SY. Systematic Review: Polysubstance Prevalence Estimates Reported during Pregnancy, US, 2009-2020. Matern Child Health J 2023; 27:426-458. [PMID: 36752906 PMCID: PMC10521102 DOI: 10.1007/s10995-023-03592-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The objective of this systematic review is to describe polysubstance studies and their prevalence estimates among pregnant people in the US. METHODS This review was not subject to protocol preparation or registration with the International Prospective Register of Systematic Reviews (PROSPERO) because outcome data were not reported. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist was followed. Four scientific literature databases were used to identify articles published from January 1, 2009 to June 3, 2020 reporting prenatal exposure to two or more substances in the US. A standardized process of title and abstract screening followed by a two-phase full-text review was used to assess study eligibility. RESULTS A total of 119 studies were included: 7 case-control studies, 7 clinical trials, 76 cohort studies, and 29 cross-sectional studies. Studies varied with respect to study design, time period, region, sampling and participant selection, substances assessed, and method of exposure ascertainment. Commonly reported polysubstance prevalence estimates among studies of pregnant people included combinations with alcohol, marijuana, and/or tobacco/nicotine. The range of prevalence estimates was wide (alcohol 1-99%; marijuana 3-95%; tobacco/nicotine 2-95%). DISCUSSION Polysubstance use during pregnancy is common, especially with alcohol, marijuana, and/or tobacco/nicotine. Future research to assess polysubstance use during pregnancy could help better describe patterns and ultimately help mitigate its effects on maternal and infant health outcomes.
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Affiliation(s)
- Emmy L Tran
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA.
- Eagle Global Scientific, LLC, 2835 Brandywine Rd, Suite 200, Atlanta, GA, 30341, USA.
| | - Lucinda J England
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
| | - Youngjoo Park
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
| | - Clark H Denny
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
| | - Shin Y Kim
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
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12
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Anastario M, Firemoon P, Rodriguez AM, Wade C, Prokosch C, Rink E, Wagner E. A Pilot Study of Polysubstance Use Sequences across the Lifespan among Assiniboine and Sioux People Who Use Injection Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:543. [PMID: 36612865 PMCID: PMC9819103 DOI: 10.3390/ijerph20010543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Compared with other racial/ethnic groups in the United States, American Indians/Alaska Natives have the highest rates of acute Hepatitis C Virus (HCV) infection, the highest HCV-related mortality, and one of the fastest climbing rates of drug overdose deaths involving stimulants. In this pilot study, a life history calendar was administered to Indigenous people who use injection drugs (IPWIDs) to understand sequences of polysubstance use across the lifespan. 40 IPWIDs completed a questionnaire and life history calendar. Social sequence analysis was used to examine patterns in sequential phenomena among substances reported over years of the lifespan. Most participants (55%) began injecting substances before the age of 21, 62.5% shared syringes with others, and 45% had ever been diagnosed with HCV. An appreciably large increase in the use of stimulants occurred between the year prior to and following injection initiation (33% to 82%). A three-cluster solution distinguished younger IPWIDs transitioning into polysubstance use involving stimulants and/or narcotic analgesics from adults using narcotic analgesics with stimulants over longer periods of time, and adults most focused on stimulant use over time. Findings from this pilot study contribute to an understanding of how methamphetamine injection plays a role in the HCV epidemic among IPWIDs.
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Affiliation(s)
- Michael Anastario
- Robert Stempel College of Public Health & Social Work, Research Center in Minority Institutions, Florida International University, Miami, FL 33199, USA
| | | | - Ana Maria Rodriguez
- Robert Stempel College of Public Health & Social Work, Research Center in Minority Institutions, Florida International University, Miami, FL 33199, USA
| | | | | | - Elizabeth Rink
- Department of Health and Human Development, Montana State University, Bozeman, MT 59717, USA
| | - Eric Wagner
- Robert Stempel College of Public Health & Social Work, Research Center in Minority Institutions, Florida International University, Miami, FL 33199, USA
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13
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Pan Y, Feaster DJ, Odom G, Brandt L, Hu MC, Weiss RD, Rotrosen J, Saxon AJ, Luo SX, Balise RR. Specific polysubstance use patterns predict relapse among patients entering opioid use disorder treatment. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100128. [PMID: 36644227 PMCID: PMC9838120 DOI: 10.1016/j.dadr.2022.100128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction While polysubstance use has consistently been associated with higher rates of relapse, few studies have examined subgroups with specific combinations and time course of polysubstance use (i.e., polysubstance use patterns). This study aimed to classify and compare polysubstance use patterns, and their associations with relapse to regular opioid use in 2637 participants in three large opioid use disorder (OUD) treatment trials. Methods We explored the daily patterns of self-reported substance use in the 28 days prior to treatment entry. Market basket analysis (MBA) and repeated measure latent class analysis (RMLCA) were used to examine the subgroups of polysubstance use patterns, and multiple logistic regression was used to examine associations between identified classes and relapse. Results MBA and RMLCA identified 34 "associations rules " and 6 classes, respectively. Specific combinations of polysubstance use and time course (high baseline use and rapid decrease of use prior to initiation) predicts a worse relapse outcome. MBA showed individuals who co-used cocaine, heroin, prescription opioids, and cannabis had a higher risk for relapse (OR = 2.82, 95%CI = 1.13, 7.03). In RMLCA, higher risk of relapse was observed in individuals who presented with high baseline prescription opioid (OR = 1.9, 95% CI = 1.3, 2.76) or heroin use (OR = 3.54, 95%CI = 1.86, 6.72), although use decreased in both cases prior to treatment initiation. Conclusions Our analyses identified subgroups with distinct patterns of polysubstance use. Different patterns of polysubstance use differentially predict relapse outcomes. Interventions tailored to these individuals with specific polysubstance use patterns prior to treatment initiation may increase the effectiveness of relapse prevention.
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Affiliation(s)
- Yue Pan
- Department of Public Health Sciences, Division of Biostatistics, University of Miami, Office 1023, 1120 NW 14th St, Miami, FL 33136, USA,Corresponding author. (Y. Pan)
| | - Daniel J. Feaster
- Department of Public Health Sciences, Division of Biostatistics, University of Miami, Office 1023, 1120 NW 14th St, Miami, FL 33136, USA
| | - Gabriel Odom
- Department of Biostatistics, Florida International University, USA
| | - Laura Brandt
- Department of Psychology, The City College of New York, USA
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University, USA
| | - Roger D. Weiss
- Department of Psychiatry, Harvard Medical School, Boston, and McLean Hospital, USA
| | - John Rotrosen
- Department of Psychiatry, NYU Grossman School of Medicine, USA
| | - Andrew J. Saxon
- Department of Psychiatry and Behavioral Sciences, University of Washington, USA
| | - Sean X. Luo
- Department of Psychiatry, Columbia University, USA
| | - Raymond R. Balise
- Department of Public Health Sciences, Division of Biostatistics, University of Miami, Office 1023, 1120 NW 14th St, Miami, FL 33136, USA
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Nelson SD, McCoy AB, Rector H, Teare AJ, Barrett TW, Sigworth EA, Chen Q, Edwards DA, Marcovitz DE, Wright A. Assessment of a Naloxone Coprescribing Alert for Patients at Risk of Opioid Overdose: A Quality Improvement Project. Anesth Analg 2022; 135:26-34. [PMID: 35343932 PMCID: PMC10823563 DOI: 10.1213/ane.0000000000005976] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients taking high doses of opioids, or taking opioids in combination with other central nervous system depressants, are at increased risk of opioid overdose. Coprescribing the opioid-reversal agent naloxone is an essential safety measure, recommended by the surgeon general, but the rate of naloxone coprescribing is low. Therefore, we set out to determine whether a targeted clinical decision support alert could increase the rate of naloxone coprescribing. METHODS We conducted a before-after study from January 2019 to April 2021 at a large academic health system in the Southeast. We developed a targeted point of care decision support notification in the electronic health record to suggest ordering naloxone for patients who have a high risk of opioid overdose based on a high morphine equivalent daily dose (MEDD) ≥90 mg, concomitant benzodiazepine prescription, or a history of opioid use disorder or opioid overdose. We measured the rate of outpatient naloxone prescribing as our primary measure. A multivariable logistic regression model with robust variance to adjust for prescriptions within the same prescriber was implemented to estimate the association between alerts and naloxone coprescribing. RESULTS The baseline naloxone coprescribing rate in 2019 was 0.28 (95% confidence interval [CI], 0.24-0.31) naloxone prescriptions per 100 opioid prescriptions. After alert implementation, the naloxone coprescribing rate increased to 4.51 (95% CI, 4.33-4.68) naloxone prescriptions per 100 opioid prescriptions (P < .001). The adjusted odds of naloxone coprescribing after alert implementation were approximately 28 times those during the baseline period (95% CI, 15-52). CONCLUSIONS A targeted decision support alert for patients at risk for opioid overdose significantly increased the rate of naloxone coprescribing and was relatively easy to build.
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Affiliation(s)
- Scott D. Nelson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Allison B. McCoy
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hayley Rector
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew J. Teare
- Department of HealthIT, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tyler W. Barrett
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Qingxia Chen
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - David A. Edwards
- Department of Anesthesiology, Division of Pain Medicine, Anesthesiology, and Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David E. Marcovitz
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam Wright
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
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15
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Washio Y, Hayashi YP, Atreyapurapu S, Chang K, Ma T, Howard BN, van der Drift I, Browne FA, Wechsberg WM. A Scoping Review of Computer-Based and Telecommunication Technology Interventions to Address Drug and Alcohol Misuse and Smoking in Women. Subst Use Misuse 2022; 57:1257-1272. [PMID: 35582861 PMCID: PMC10083725 DOI: 10.1080/10826084.2022.2076878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Computer-based and telecommunication technology has become increasingly common to address addiction among women. This review assessed the effect of technology-based interventions on substance misuse, alcohol use, and smoking outcomes among women. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) guideline was used to conduct the scoping review. Four databases (PubMed, Web of Science, PsycINFO, and Scopus) were used to search for peer-reviewed articles published in English on computer-based and telecommunication technology use to address substance misuse, alcohol use, and smoking among women. RESULTS A total of 30 articles were selected after the final full-text review from the U.S., England, Japan, and the Netherlands. The types of technology used in the interventions included computer software (standalone or web-based), mobile applications, video calling, phone, and text messaging. Intervention outcomes included alcohol and other substance misuse reduction as polysubstance misuse (n = 5), smoking cessation (n = 10), substance misuse reduction only (n = 6), and alcohol use reduction only (n = 9). The populations reached included women who were pregnant (n = 13), postpartum (n = 4), or non-pregnant (n = 14) ranging from adolescent to adulthood. Interventions that targeted polysubstance misuse showed statistically significant reductions (p < .05). CONCLUSION Although effective in reducing alcohol and other substance misuse, mixed findings were identified for other outcomes targeting a single substance. Technology-based interventions might maximize their effects by targeting polysubstance misuse and addressing associated contextual issues in the form of a computer-delivered module(s).
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Affiliation(s)
- Yukiko Washio
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, NC, 27709 U.S.A
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University Lewis Katz School of Medicine, Philadelphia, PA, 19140 U.S.A
| | | | | | - Katie Chang
- Benten Technologies, Inc., Manassas, VA, U.S.A
| | - Tony Ma
- Benten Technologies, Inc., Manassas, VA, U.S.A
| | - Brittni N. Howard
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, NC, 27709 U.S.A
| | - Isa van der Drift
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, NC, 27709 U.S.A
| | - Felicia A. Browne
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, NC, 27709 U.S.A
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, U.S.A
| | - Wendee M. Wechsberg
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, NC, 27709 U.S.A
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, U.S.A
- Department of Psychology, North Carolina State University, Raleigh, NC, U.S.A
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, U.S.A
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16
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Woodhams E, Samura T, White K, Patton E, Terplan M. Society of Family Planning Clinical Recommendations: Contraception and abortion care for persons who use substances. Contraception 2022; 112:2-10. [DOI: 10.1016/j.contraception.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 11/24/2022]
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17
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Kurani S, Webb L, Cadet K, Ma M, Gibson M, Jallah N, Park JN, Johnson RM. Area-level deprivation and adverse childhood experiences among high school students in Maryland. BMC Public Health 2022; 22:811. [PMID: 35459200 PMCID: PMC9034595 DOI: 10.1186/s12889-022-13205-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/21/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Nearly one-half of Americans have been exposed to at least one adverse childhood experience (ACE) before turning 18, contributing to a broad array of problems spanning physical health, mental and behavioral health, and psychosocial functioning. METHODS This was a cross-sectional, survey research study, using 2018 data from a state adolescent health surveillance system, i.e., Maryland Youth Risk Behavior Survey/Youth Tobacco Survey. The population-based sample of Maryland high school students (n = 41,091) is representative at the state and county levels. The outcome variables included five binary measures of ACEs (i.e., food insecurity, parental substance use/gambling, parental mental illness, family member in jail/prison, and caregiver verbal abuse), and number of ACEs. The main exposure variable, area-level socioeconomic disadvantage, was assessed at the county level using a continuous measure of the area deprivation index (ADI). Additional covariates included: rural county status, age, race/ethnicity, sex, and sexual or gender minority (SGM) status. We used mixed-effect multivariate logistic regression to estimate the odds of ACEs in association with socioeconomic deprivation. Models were adjusted for all covariates. RESULTS County-level ADI was associated with 3 of the 5 ACES [i.e., food insecurity (OR = 1.10, 95% CI: 1.07-1.13), parental substance use/gambling (OR = 1.05, 95% CI: 1.02-1.07), and incarceration of a family member (OR = 1.14, 95% CI: 1.09-1.19)]; and with having at least one ACE (i.e., OR = 1.08, 95% CI: 1.05-1.10). Odds of reporting at least one ACE were higher among girls, older adolescents (i.e., aged 16 and ≥ 17 relative to those aged ≤ 14 years), and among SGM, Black, and Latinx students (all ORs > 1.20). CONCLUSIONS ACEs greatly increase risk for adolescent risk behaviors. We observed an increased likelihood of adversity among youth in more deprived counties and among Black, Latinx, or SGM youth, suggesting that social and structural factors play a role in determining the adversity that youth face. Therefore, efforts to address structural factors (e.g., food access, family financial support, imprisonment as a sanction for criminal behavior) could be a critical strategy for primary prevention of ACEs and promoting adolescent health.
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Affiliation(s)
- Shaheen Kurani
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
| | - Lindsey Webb
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Kechna Cadet
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ming Ma
- Department of Community & Behavioral Health, Colorado School of Public Health, Denver, CO, USA
| | - Marianne Gibson
- Maryland Department of Health, Opioid Operational Command Center, Crownsville, MD, USA
| | - Nikardi Jallah
- Maryland Department of Health, Prevention & Health Promotion, Baltimore, MD, USA
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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18
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Lardier DT, Gilmore Powell K, Peterson NA, Borys S, Hallcom DK. Polysubstance use latent class membership in New Jersey: Association with prior overdoses, prior emergency department peer recovery engagement, and mental health diagnosis among participants in an opioid overdose recovery program. Subst Abus 2022; 43:1011-1022. [DOI: 10.1080/08897077.2022.2060436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- David T. Lardier
- Department of Psychiatry and Behavioral Sciences, Division of Community and Behavioral Health, University of New Mexico School of Medicine, 1 University of New Mexico, Albuquerque, New Mexico, USA
| | - Kristen Gilmore Powell
- Center for Prevention Science and the Northeast and Caribbean Prevention Technology Transfer Center, School of Social Work, Rutgers University, New Brunswick, New Jersey, USA
| | - N. Andrew Peterson
- Center for Prevention Science and the Northeast and Caribbean Prevention Technology Transfer Center, School of Social Work, Rutgers University, New Brunswick, New Jersey, USA
| | - Suzanne Borys
- Office of Planning, Research, Evaluation and Prevention, New Jersey Division of Mental Health and Addiction Services, Hamilton, New Jersey, USA
| | - Donald K. Hallcom
- Office of Planning, Research, Evaluation and Prevention, New Jersey Division of Mental Health and Addiction Services, Hamilton, New Jersey, USA
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19
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Peddireddy SR, Austin AE, Gottfredson NC. Factors contributing to level and type of child welfare involvement following prenatal substance exposure: A scoping review. CHILD ABUSE & NEGLECT 2022; 125:105484. [PMID: 35032823 DOI: 10.1016/j.chiabu.2022.105484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/14/2021] [Accepted: 01/03/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND An understanding of factors contributing to variation in child welfare outcomes in cases of prenatal substance exposure (PSE) can help identify gaps in research and practice and guide state and agency policy. OBJECTIVE To summarize the evidence base and identify critical gaps in the literature, we conducted a scoping review regarding individual- and institutional-level factors associated with child welfare decision-marking across the service continuum and caregivers' perceptions of child welfare involvement in cases of PSE. PARTICIPANTS AND SETTING The sample included peer-reviewed studies based in the United States. METHODS We conducted a comprehensive search of four databases for studies investigating 1) sociodemographic, behavioral, policy, or other factors contributing to variation in child welfare outcomes and 2) maternal, family, or provider perceptions of the child welfare process in cases of PSE. We followed an established methodological framework for conducting scoping reviews. RESULTS Of the 23 articles included in the review, 20 explored variation in decision-making across the child welfare services continuum and three examined caregivers' perceptions of child welfare involvement. At the institutional level, provider characteristics, such as agency capacity, were linked to specific child welfare outcomes including reports and removals. At the individual level, factors such as socioeconomic status, race, and substance type were also associated with outcomes across the service continuum. CONCLUSIONS Child welfare agencies use an unsystematic approach in addressing PSE, contributing to a variation in child welfare outcomes and potentially allowing for bias. This review highlights a need for increased resources and guidance for caseworkers.
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Affiliation(s)
- Snigdha R Peddireddy
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC 27599, USA; Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA 30322, USA
| | - Anna E Austin
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC 27599, USA
| | - Nisha C Gottfredson
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC 27599, USA.
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20
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Garrison-Desany HM, Hong X, Maher BS, Beaty TH, Wang G, Pearson C, Liang L, Wang X, Ladd-Acosta C. Individual and Combined Association Between Prenatal Polysubstance Exposure and Childhood Risk of Attention-Deficit/Hyperactivity Disorder. JAMA Netw Open 2022; 5:e221957. [PMID: 35275164 PMCID: PMC8917426 DOI: 10.1001/jamanetworkopen.2022.1957] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Polysubstance use among pregnant women has increased because of the opioid epidemic and the increasing legalization of cannabis along with persistent tobacco and alcohol consumption. Previous research on prenatal substance use and the child's risk of attention-deficit/hyperactivity disorder (ADHD) has mostly focused on single-substance exposures; simultaneous examination of multiple substance use and assessment of their synergistic health consequences is needed. OBJECTIVES To assess the consequences of the use of specific substances during pregnancy, investigate whether the interaction of multiple prenatal substance exposures is associated with increases in the risk of childhood ADHD, and estimate the aggregate burden of polysubstance exposure during gestation. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from the Boston Birth Cohort from 1998 to 2019. The sample of the present study comprised a multiethnic urban cohort of mother-child pairs who were predominantly low income. A total of 3138 children who were enrolled shortly after birth at Boston Medical Center were included and followed up from age 6 months to 21 years. EXPOSURES Substance use during pregnancy was identified based on self-reported tobacco smoking, alcohol consumption, and use of cannabis, cocaine, or opioids in any trimester of pregnancy. Diagnostic codes for neonatal opioid withdrawal syndrome or neonatal abstinence syndrome from the International Classification of Diseases, Ninth Revision, and the International Classification of Diseases, Tenth Revision, were also used to identify opioid exposure during gestation. MAIN OUTCOMES AND MEASURES ADHD diagnosis in the child's electronic medical record. RESULTS Among 3138 children (1583 boys [50.4%]; median age, 12 years [IQR, 9-14 years]; median follow-up, 10 years [IQR, 7-12 years]) in the final analytic sample, 486 (15.5%) had an ADHD diagnosis and 2652 (84.5%) were neurotypical. The median postnatal follow-up duration was 12 years (IQR, 9-14 years). Among mothers, 46 women (1.5%) self-identified as Asian (non-Pacific Islander), 701 (22.3%) as Hispanic, 1838 (58.6%) as non-Hispanic Black, 227 (7.2%) as non-Hispanic White, and 326 (10.4%) as other races and/or ethnicities (including American Indian or Indigenous, Cape Verdean, Pacific Islander, multiracial, other, or unknown). A total of 759 women (24.2%) reported the use of at least 1 substance during pregnancy, with tobacco being the most frequently reported (580 women [18.5%]). Cox proportional hazards models revealed that opioid exposure (60 children) had the highest adjusted hazard ratio (HR) for ADHD (2.19; 95% CI, 1.10-4.37). After including main statistical effects of all individual substances in an elastic net regression model, the HR of opioids was reduced to 1.60, and evidence of a statistical interaction between opioids and both cannabis and alcohol was found, producing 1.42 and 1.15 times higher risk of ADHD, respectively. The interaction between opioids and smoking was also associated with a higher risk of ADHD (HR, 1.17). CONCLUSIONS AND RELEVANCE The findings of this study suggest that it is important to consider prenatal concurrent exposure to multiple substances and their possible interactions when counseling women regarding substance use during pregnancy, the future risk of ADHD for their children, and strategies for cessation and treatment programs.
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Affiliation(s)
- Henri M. Garrison-Desany
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Xiumei Hong
- Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Brion S. Maher
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Terri H. Beaty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Guoying Wang
- Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Colleen Pearson
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Liming Liang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Xiaobin Wang
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore MD
| | - Christine Ladd-Acosta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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Ataiants J, Mazzella S, Roth AM, Robinson LF, Sell RL, Lankenau SE. Multiple Victimizations and Overdose Among Women With a History of Illicit Drug Use. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP1588-NP1613. [PMID: 32536256 PMCID: PMC7808297 DOI: 10.1177/0886260520927501] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The experiences of violence and overdose are highly prevalent among women who use illicit drugs. This study sought to ascertain whether multiple victimizations during adulthood increase the frequency of women's overdose. The sample comprised 218 women recruited at Philadelphia harm reduction sites during 2016-2017. Victimization was assessed as exposure to 16 types of adulthood violence. Three measures were constructed for multiple victimizations: continuous and categorical polyvictimization, and predominant violence domain. Negative binomial regression estimated the incidence rate ratio (IRR) of lifetime overdoses from multiple victimizations. Lifetime history of opioid use (88.6%) and drug injection (79.5%) were common. Among overdose survivors (68.5%), the median of lifetime overdoses was 3. The majority of participants (58.7%) were victims of predominantly sexual violence, 26.1% experienced predominantly physical abuse/assault, and 3.7% were victims of predominantly verbal aggression/coercive control. Participants reported a mean of seven violence types; the higher-score category of polyvictimization (9-16 violence types) comprised 41.7% of the total sample. In multivariable models, one-unit increase in continuous polyvictimization was associated with 4% higher overdose rates (IRR: 1.04, 95% confidence interval [CI]: [1.00, 1.08]). Compared to women who were not victimized (11.5%), those in the higher-score category of polyvictimization (IRR: 2.01; 95% CI: [1.06, 3.80]) and exposed to predominantly sexual violence (IRR: 2.10, 95% CI: [1.13, 3.91]) were expected to have higher overdose rates. Polyvictimization and sexual violence amplified the risk of repeated overdose among drug-involved women. Female overdose survivors need to be screened for exposure to multiple forms of violence, especially sexual violence. Findings underscore the need to scale-up victimization support and overdose prevention services for disenfranchised women.
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What Obstetrician–Gynecologists Should Know About Substance Use Disorders in the Perinatal Period. Obstet Gynecol 2022; 139:317-337. [DOI: 10.1097/aog.0000000000004657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/01/2021] [Indexed: 11/26/2022]
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Explaining Racial-ethnic Disparities in the Receipt of Medication for Opioid Use Disorder during Pregnancy. J Addict Med 2022; 16:e356-e365. [PMID: 35245918 PMCID: PMC9440158 DOI: 10.1097/adm.0000000000000979] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Factors contributing to racial and ethnic disparities in medication for opioid use disorder (MOUD) receipt during pregnancy are largely unknown. We quantified the contribution of individual, healthcare access and quality, and community factors to racial-ethnic disparities in MOUD during pregnancy and postpartum among Medicaid-enrolled pregnant women with opioid use disorder (OUD). METHODS This retrospective cohort study used regression and nonlinear decomposition to examine how individual, healthcare access and quality, and community factors explain racial-ethnic disparities in MOUD receipt among Medicaid-enrolled women with OUD who had a live birth from 2011 to 2017. The exposure was self-reported race and ethnicity. The outcomes were any MOUD receipt during pregnancy or postpartum. All factors included were identified from the literature. RESULTS Racial-ethnic disparities in individual, healthcare access and quality, and community factors explained 15.8% of the racial-ethnic disparity in MOUD receipt during pregnancy and 68.9% of the disparity in the postpartum period. Despite comparable healthcare utilization, non-White/Hispanic women were diagnosed with OUD 37 days later in pregnancy, on average, than non-Hispanic White women, which was the largest contributor to the racial-ethnic disparity in MOUD receipt during pregnancy (111.0%). The racial-ethnic disparity in MOUD receipt during pregnancy was the largest contributor (112.2%) to the racial-ethnic disparity in MOUD in the postpartum period. CONCLUSIONS Later diagnosis of OUD in pregnancy among non-White/Hispanic women partially explains the disparities in MOUD receipt in this population. Universal substance use screening earlier in pregnancy, combined with connecting patients to evidence-based and culturally competent care, is one approach that could close the observed racial-ethnic disparity in MOUD receipt.
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Preconception Substance Use and Risk of Unintended Pregnancy: Pregnancy Risk Assessment Monitoring System 2016-17. J Addict Med 2022; 16:278-285. [PMID: 34334685 PMCID: PMC9444263 DOI: 10.1097/adm.0000000000000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study examined the association between preconception substance use and unintended pregnancy in a large, nationally representative sample of women. METHODS In this cross-sectional study, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) comprising, 74,543women who had birth during 2016-17. Logistic regression was used to assess the independent association of unintended pregnancy overall and by subtypes to preconception substance use (smoking and other nicotine/tobacco use, alcohol consumption, and use of cannabis, illicit/recreational drugs) and specific medication including prescription opioids, antidepressants and over the counter pain relief. RESULTS Overall, 41% of pregnancies were unintended. Nearly 57% of participants reported alcohol consumption during the preconception period, with 32% indicating binge drinking, 17% reported preconception smoking, and 10% cannabis use. Unintended pregnancy was significantly associated with substance use, including smoking (adjusted odds ratio [AOR]:1.5, 95% confidence interval [CI]: 1.4-1.6); as well as the use of other nicotine/tobacco (AOR:1.4, 95% CI: 1.3-1.5); cannabis (AOR: 1.9, 95% CI: 1.5-2.3); illicit/recreational drugs (AOR:1.7, 95% CI: 1.2-2.4), prescription opioids (AOR:1.4, 95% CI: 1.02-1.9), and prescription antidepressants (AOR 1.8, 95% CI: 1.1-3.0). The likelihood of unintended pregnancy was significantly elevated with heavy smoking, heavy alcohol consumption, and binge drinking. Analyses by unintended pregnancy subtype yielded similar results. CONCLUSIONS Preconception substance use was significantly and positively associated with unintended pregnancy. Evidence-based interventions are needed addressing substance use behavior and effective contraceptive use to prevent unintended pregnancy and related adverse effects on maternal and child health.
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Abstract
OBJECTIVES To elucidate the main latent classes of substances detected among overdose decedents, and latent class associations with age, sex, race, and jurisdiction of death in Maryland. METHODS We used toxicology data from the Office of the Chief Medical Examiner of Maryland for all decedents. We analyzed all cases of drug overdose deaths that occurred from 2016 to 2018 (N = 6566) using latent class analysis and regression. RESULTS Drug overdose deaths were concentrated in 2 of 24 counties in Maryland (Baltimore City and County). Fentanyl was involved in 71% of all drug overdose deaths, and the majority (76%) of these deaths included multiple substances. Three latent classes emerged: (1) fentanyl/heroin/cocaine (64%); (2) fentanyl/alcohol (18%); and (3) prescription drugs including opioids, benzodiazepines and antidepressants (18.0%). The fentanyl/heroin/cocaine class members were significantly younger (<30 years), female and White compared to the fentanyl/alcohol class, but more male and non-White than the prescription drugs class (all P < 0.05). Deaths in Baltimore City/County were more likely than in other locations to involve fentanyl/alcohol (P < 0.05). CONCLUSIONS The majority of fentanyl-involved overdose deaths in Maryland involved multiple substances, and several demographic and geographic differences in these patterns emerged. Geographically-targeted interventions that are tailored to reduce the harms associated with polysubstance use (including cocaine, alcohol, and prescription drugs) for different demographic groups are warranted.
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Jarlenski M, Krans EE. Co-occurring Substance Use Disorders Identified Among Delivery Hospitalizations in the United States. J Addict Med 2021; 15:504-507. [PMID: 33273252 PMCID: PMC8166954 DOI: 10.1097/adm.0000000000000792] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Substance use in pregnancy is increasing in the United States (US), although little is know about co-occurring substance use disorders in pregnancy. Our objective was to determine the prevalence and patterns of co-occurring substance use disorders identified at delivery hospitalizations among US women. METHODS Using data from the National Inpatient Sample, a nationally representative sample of hospitalizations in the US, we identified females ages 15 to 44 years with a delivery hospitalization from 2007 to 2016 (weighted N = 38 million). We identified diagnoses for use of any of the following substance use disorders: alcohol, amphetamines, cannabis, cocaine, opioids, sedatives, or tobacco. Using multivariable regression, we calculated the weighted adjusted prevalence of additional substances used within each specific substance use disorder category. RESULTS Seven percent of women were diagnosed with any substance use disorder at delivery hospitalization (6.5% tobacco, 1% cannabis, 0.5% opioids, and <1% amphetamines, alcohol, cocaine, and sedatives). Among those with any substance use disorder diagnosis, the adjusted prevalence of any co-occurring use disorder was greatest for those who used alcohol (69%), cocaine (69%), amphetamines (63%), and opioids (62%). Among pregnant women who were diagnosed with cocaine, amphetamines, alcohol or opioid use disorder, tobacco (>45% in all groups), and cannabis (>10% in all groups) were the most common additional substances used. Tobacco and cannabis use disorders were commonly diagnosed together. CONCLUSIONS Co-occurring substance use disorders are common among women with any substance use disorder in pregnancy. Findings support the need for public health efforts to monitor and address multiple, concurrent use of substances in pregnancy.
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Affiliation(s)
- Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh PA USA
| | - Elizabeth E. Krans
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute, Pittsburgh PA USA
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Lynn E, Cousins G, Lyons S, Bennett KE. Trends in drug poisoning deaths, by sex, in Ireland: a repeated cross-sectional study from 2004 to 2017. BMJ Open 2021; 11:e048000. [PMID: 34479934 PMCID: PMC8420717 DOI: 10.1136/bmjopen-2020-048000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 08/16/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To examine sex differences in age-standardised rates (ASR) of overall and drug-specific drug poisoning deaths in Ireland between 2004 and 2017. DESIGN Repeated cross-sectional study. SETTING Drug poisoning deaths in Ireland. PARTICIPANTS National Drug-Related Deaths Index and pharmacy claims database (Primary Care Reimbursement Service-General Medical Services) data from 2004 to 2017. OUTCOME MEASURES The primary outcome was trends in drug poisoning death rates by sex. The secondary outcomes were trends in drug poisoning death rates involving (1) any CNS (Central Nervous System) depressants, (2) ≥2 CNS depressants and (3) specific drugs/drug classes (eg, prescription opioids, benzodiazepines, antidepressants, alcohol, cocaine and heroin) by sex. Joinpoint regression was used to examine trends, stratified by sex, in the ASR of drug poisoning deaths (2004-2017), change points over time and average annual percentage changes (AAPCs) with 95% CI. RESULTS Increased ASR for all drug poisoning deaths from 6.86 (95% CI 6.01 to 7.72) per 100 000 in 2004 to 8.08 (95% CI 7.25 to 8.91) per 100 000 in 2017 was mainly driven by increasing deaths among men (AAPC 2.6%, 95% CI 0.2 to 5.1), with no significant change observed among women. Deaths involving ≥2 CNS depressants increased for both men (AAPC 5.6%, 95% CI 2.4 to 8.8) and women (AAPC 4.0%, 95% CI 1.1 to 6.9). Drugs with the highest significant AAPC increases for men were cocaine (7.7%, 95% CI 2.2 to 13.6), benzodiazepines (7.2%, 95% CI 2.9 to 11.6), antidepressants (6.1%, 95% CI 2.4 to 10.0) and prescription opioids (3.5%, 95% CI 1.6 to 5.5). For women, the highest AAPC was for antidepressants (4.2%, 95% CI 0.2 to 8.3), benzodiazepines (3.3%, 95% CI 0.1 to 6.5) and prescription opioids (3.0%, 95% CI 0.7 to 5.3). CONCLUSION Drugs implicated in drug poisoning deaths vary by sex. Policy response should include prescription monitoring programmes and practical harm reduction information on polydrug use, especially CNS depressant drugs.
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Affiliation(s)
- Ena Lynn
- National Health Information Systems, Health Research Board, Dublin 2, Ireland
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gráinne Cousins
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Suzi Lyons
- National Health Information Systems, Health Research Board, Dublin 2, Ireland
| | - Kathleen E Bennett
- Data Science Centre, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Jarlenski MP, Krans EE, Kim JY, Donohue JM, James AE, Kelley D, Stein BD, Bogen DL. Five-Year Outcomes Among Medicaid-Enrolled Children With In Utero Opioid Exposure. Health Aff (Millwood) 2021; 39:247-255. [PMID: 32011940 DOI: 10.1377/hlthaff.2019.00740] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The health of women and children affected by opioid use disorder is a priority for state Medicaid programs. Little is known about longer-term outcomes among Medicaid-enrolled children exposed to opioids in utero. We examined well-child visit use and diagnoses of pediatric complex chronic conditions in the first five years of life among children with opioid exposure, tobacco exposure, or neither exposure in utero. The sample consisted of 82,329 maternal-child dyads in the Pennsylvania Medicaid program in which the children were born in the period 2008-11 and followed up for five years. Children with in utero opioid exposure had a lower predicted probability of recommended well-child visit use at age fifteen months (42.1 percent) compared to those with tobacco exposure (54.1 percent) and those with neither exposure (55.7 percent). Children with in utero opioid exposure had a predicted probability of being diagnosed with a pediatric complex chronic condition similar to that among children with tobacco exposure and those with neither exposure (20.4 percent, 18.7 percent, and 20.2 percent, respectively). Our findings were consistent when we examined a subgroup of opioid-exposed children identified as having neonatal opioid withdrawal symptoms.
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Affiliation(s)
- Marian P Jarlenski
- Marian P. Jarlenski ( marian. jarlenski@pitt. edu ) is an assistant professor in the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, in Pennsylvania
| | - Elizabeth E Krans
- Elizabeth E. Krans is an assistant professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, and at the Magee-Womens Research Institute, in Pittsburgh
| | - Joo Yeon Kim
- Joo Yeon Kim is a senior data analyst in the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health
| | - Julie M Donohue
- Julie M. Donohue is a professor in the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health
| | - A Everette James
- A. Everette James III is a professor in the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health
| | - David Kelley
- David Kelley is senior medical director in the Pennsylvania Department of Human Services, in Harrisburg
| | - Bradley D Stein
- Bradley D. Stein is a senior physician policy researcher at the RAND Corporation in Pittsburgh
| | - Debra L Bogen
- Debra L. Bogen is a professor in the Department of Pediatrics, University of Pittsburgh School of Medicine
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Rogers AH, Zvolensky MJ, Ditre JW, Buckner JD, Asmundson GJG. Association of opioid misuse with anxiety and depression: A systematic review of the literature. Clin Psychol Rev 2021; 84:101978. [PMID: 33515811 DOI: 10.1016/j.cpr.2021.101978] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/19/2020] [Accepted: 11/29/2020] [Indexed: 12/14/2022]
Abstract
The opioid epidemic is a public health problem associated with a host of negative outcomes. Although clinicians recognize covariation between opioid misuse with anxiety and depressive symptoms and disorders, research on this topic has only recently accumulated. Progress in this domain is impeded by the lack of systematic and integrative research to better understand and treat these co-occurring problems. This paper represents the first attempt to systematically review the empirical literature examining relations between opioid use and misuse, and anxiety and depression. In the first section, we define key terms and describe the article selection strategy. In the second section, we review the prevalence of anxiety and depressive symptoms among individuals who use and misuse prescription and illicit opioids. In the third section, we review the magnitude of associations between anxiety and depressive symptoms and disorders with opioid misuse, as well as highlight studies examining the longitudinal and temporal sequence of the relations between these variables. In the fourth section, we focus on experimental therapeutics, reviewing what is known about individual difference and transdiagnostic vulnerability factors for anxiety and depression that might contribute to opioid misuse and its symptoms. Finally, we discuss current knowledge gaps and present a heuristic model to guide future research.
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Affiliation(s)
- Andrew H Rogers
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; HEALTH Institute, University of Houston, Houston, TX, United States.
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Julia D Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
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Esser MB, Pickens CM, Guy GP, Evans ME. Binge Drinking, Other Substance Use, and Concurrent Use in the U.S., 2016-2018. Am J Prev Med 2021; 60:169-178. [PMID: 33482979 PMCID: PMC8908897 DOI: 10.1016/j.amepre.2020.08.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/31/2020] [Accepted: 08/25/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The use of multiple substances heightens the risk of overdose. Multiple substances, including alcohol, are commonly found among people who experience overdose-related mortality. However, the associations between alcohol use and the use of a range of other substances are often not assessed. Therefore, this study examines the associations between drinking patterns (e.g., binge drinking) and other substance use in the U.S., the concurrent use of alcohol and prescription drug misuse, and how other substance use varies by binge-drinking frequency. METHODS Past 30-day alcohol and other substance use data from the 2016-2018 National Survey on Drug Use and Health were analyzed in 2020 among 169,486 U.S. respondents aged ≥12 years. RESULTS The prevalence of other substance use ranged from 6.0% (nondrinkers) to 24.1% (binge drinkers). Among people who used substances, 22.2% of binge drinkers reported using substances in 2 additional substance categories. Binge drinking was associated with 4.2 (95% CI=3.9, 4.4) greater adjusted odds of other substance use than nondrinking. Binge drinkers were twice as likely to report concurrent prescription drug misuse while drinking as nonbinge drinkers. The prevalence of substance use increased with binge-drinking frequency. CONCLUSIONS Binge drinking was associated with other substance use and concurrent prescription drug misuse while drinking. These findings can guide the implementation of a comprehensive approach to prevent binge drinking, substance misuse, and overdoses. This might include population-level strategies recommended by the Community Preventive Services Task Force to prevent binge drinking (e.g., increasing alcohol taxes and regulating alcohol outlet density).
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Affiliation(s)
- Marissa B Esser
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Cassandra M Pickens
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gery P Guy
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary E Evans
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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O'Brien P, Henke RM, Schaefer MB, Lin J, Creedon TB. Utilization of treatment by Medicaid enrollees with opioid use disorder and co-occurring substance use disorders. Drug Alcohol Depend 2020; 217:108261. [PMID: 32979735 DOI: 10.1016/j.drugalcdep.2020.108261] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/27/2020] [Accepted: 08/22/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Multiple substance use is common among adults who misuse opioids. Adverse consequences of drugs are more severe among multisubstance users than among single drug users. This study sought to determine whether adults with opioid use disorder (OUD) and at least one other substance use disorder (SUD) are less likely than adults with OUD only to receive certain services. METHODS We conducted a retrospective longitudinal study using the IBM® MarketScan® Multi-State Medicaid Database. We used logistic regression to measure associations between clinical characteristics and service utilization. The sample included non-Medicare-eligible adults aged 18-64 years with at least one claim in 2016 with a primary diagnosis of OUD who were continuously enrolled in Medicaid in 2016 and 2017. RESULTS Of the 58,745 Medicaid enrollees with an initial OUD diagnosis in 2016, 29,267 had one or more additional SUD diagnoses. In the year following diagnosis, these adults were less likely than adults with OUD only to receive OUD medication treatment (OR = 0.88, p < .0001). This was true for all specifically diagnosed co-occurring SUDS. Adults with OUD and a co-occurring SUD, however, were more likely than those with OUD only to use any type of high-intensity services. CONCLUSIONS Adults with OUD and at least one co-occurring SUD received more intensive services, which may reflect severity and lack of OUD medication treatment before misuse escalation. Programs should account for barriers to connecting these individuals to appropriate OUD treatment.
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Affiliation(s)
- Peggy O'Brien
- IBM Watson Health, 5425 Hollister Avenue, Suite 140, Santa Barbara, CA 93111, USA.
| | | | | | - Janice Lin
- IBM Watson Health, 7700 Old Georgetown Road, Suite 650, Bethesda, MD 20814, USA.
| | - Timothy B Creedon
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02141, USA.
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Vanderziel A, Parker MA, Alshaarawy O. Trends in heroin use among women of reproductive age in the United States, 2004-2017. Addict Behav 2020; 110:106518. [PMID: 32622023 PMCID: PMC7415610 DOI: 10.1016/j.addbeh.2020.106518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 01/02/2023]
Abstract
Opioid use during pregnancy has been linked to several adverse outcomes including stillbirth, preterm birth and neonatal abstinence syndrome. Recent data suggest that heroin use has increased in the United States (US) whereas prescription opioid use has decreased. Prevalence estimates for reproductive age women combine heroin and non-medical prescription opioid use, which might mask the increasing heroin trend. The aim of the current study is to estimate the prevalence of heroin use among US women of reproductive age, stratified by pregnancy status. For each year, a representative sample of the US civilian non-institutionalized population is recruited for the National Survey on Drug Use and Health (NSDUH). Pregnancy status and heroin use were assessed in women 15-44 years of age (n = 277,333) using audio computerized-assisted self-interviews. From 2004 to 2017, the prevalence of past 30-day heroin use was 12 per 10,000 reproductive age women (95% confidence interval [CI] = 11, 14). Heroin use has increased from 6 per 10,000 women in 2004-05 to 18 per 10,000 women in 2016-17 (Average percent change = 20.8; 95% 11.2, 31.2). The increase was evident among non-pregnant women, but not among pregnant women. Heroin use remains uncommon among women of reproductive age, yet its prevalence has increased over time. Screening for heroin use might be needed at multiple time points including prior to pregnancy to mitigate adverse outcomes associated with use during pregnancy.
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Affiliation(s)
- Alyssa Vanderziel
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA; Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Maria A Parker
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Omayma Alshaarawy
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
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Valente PK, Bazzi AR, Childs E, Salhaney P, Earlywine J, Olson J, Biancarelli DL, Marshall BDL, Biello KB. Patterns, contexts, and motivations for polysubstance use among people who inject drugs in non-urban settings in the U.S. Northeast. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102934. [PMID: 32911318 PMCID: PMC7770041 DOI: 10.1016/j.drugpo.2020.102934] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/12/2020] [Accepted: 08/20/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Polysubstance use (i.e., using ≥2 psychoactive substances concomitantly) is associated with increased morbidity and mortality and complicates drug treatment needs among people who inject drugs (PWID). We explored patterns, contexts, motivations, and perceived consequences of polysubstance use among PWID in small cities and towns in the U.S. Northeast. METHODS Between October 2018 and March 2019, we conducted semi-structured interviews with 45 PWID living outside of the capital cities of Rhode Island and Massachusetts recruited online and through community-based organizations. Written transcripts were coded inductively and deductively using a team-based approach and analyzed thematically. RESULTS All participants reported recent polysubstance use, with most using five or more classes of substances in the past three months. Polysubstance use often followed long personal drug use histories (i.e., years or decades of occasional drug use). Reasons for polysubstance use included obtaining synergistic psychoactive effects as a result of mixing drugs (i.e., using drugs to potentiate effects of other drugs) and managing undesirable effects of particular drugs (e.g., offsetting the depressant effects of opioids with stimulants or vice-versa). Polysubstance use to self-medicate poorly managed physical and mental health conditions (e.g., chronic pain, anxiety, and depression) was also reported. Inadequately managed cravings and withdrawal symptoms prompted concomitant use of heroin and medications for opioid use disorder, including among individuals reporting cocaine or crack as their primary "issue" drugs. Polysubstance use was perceived to increase overdose risks and to be a barrier to accessing healthcare and drug treatment services. CONCLUSION Healthcare services and clinicians should acknowledge, assess, and account for polysubstance use among patients and promote harm reduction approaches for individuals who may be using multiple drugs. Comprehensive healthcare that meets the social, physical, mental health, and drug treatment needs of PWID may decrease the perceived need for polysubstance use to self-medicate poorly managed health conditions and symptoms.
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Affiliation(s)
- Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, USA
| | - Ellen Childs
- Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Peter Salhaney
- Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA
| | - Joel Earlywine
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, USA
| | - Jennifer Olson
- Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA
| | - Dea L Biancarelli
- Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, 2nd Floor, Providence, RI 02912, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA; Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, 2nd Floor, Providence, RI 02912, USA; The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA.
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Roth D, Loudin S, Andrews L, Evans J, Davies TH. Inclusion of Positive Self-reporting by Mothers of Substance Exposed Neonates Increases the Predictability of NAS Severity Over Toxicology Alone. Matern Child Health J 2020; 24:340-350. [PMID: 31916143 DOI: 10.1007/s10995-019-02871-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The rise in opioid use among pregnant women has resulted in an increase in the incidence of neonatal abstinence syndrome (NAS). Despite the focus on opioid use, prenatal polysubstance exposure is often associated with NAS diagnosis and severity. Drug toxicology screens such as urine drug screens and umbilical cord toxicology are dependent upon the substance, timing, frequency, and dose to detect substances present and can underestimate the neonatal exposure. The aim of this study was to identify the predictability of the consequences of prenatal polysubstance exposure versus opioid only exposure based on toxicology and toxicology plus self-report. METHODS Neonates > 35 weeks gestation with prenatal opioid exposure were included in this retrospective data analysis. NAS was identified using maternal urine drug screen (UDS) toxicology, self-reported exposure during pregnancy, and neonatal toxicology. Analysis was conducted using Stata 15.1 utilizing McNemar's test, chi-square for categorical outcomes, and Wilcoxon test for numerical outcomes. RESULTS A statistically significant difference in length of stay and length of treatment with poly-exposed neonates was observed when maternal self-report was considered with toxicology, but not with toxicology alone. This trend was observed for cumulative hospital length of stay as well as length and dose of treatment. CONCLUSIONS FOR PRACTICE The findings in this report demonstrate that self-report is important for identifying substance of exposure. Three substances in particular that often require a change in treatment paradigm went undetected by toxicology were Gabapentin (20.9% of the population), Heroin (20.5% of the population), and Benzodiazepines (8.5% of the population). A healthy rapport with patients is often critical to effective clinical practice. Women with substance use disorder anticipate negative reactions from healthcare providers. Empathetic interview techniques to facilitate accurate disclosure may be more important to the treatment of the exposed neonate.
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Affiliation(s)
- Danielle Roth
- Department of Pediatrics, Joan C Edwards School of Medicine at Marshall University, Huntington, WV, USA
| | - Sean Loudin
- Department of Pediatrics, Joan C Edwards School of Medicine at Marshall University, Huntington, WV, USA
| | - Lacey Andrews
- Division of Addiction Sciences, Family and Community Health, Joan C Edwards School of Medicine of Marshall University, 1600 Medical Center Drive, Huntington, WV, 25701, USA
| | - Joseph Evans
- Department of Pediatrics, Joan C Edwards School of Medicine at Marshall University, Huntington, WV, USA
| | - Todd H Davies
- Division of Addiction Sciences, Family and Community Health, Joan C Edwards School of Medicine of Marshall University, 1600 Medical Center Drive, Huntington, WV, 25701, USA.
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Richards T, Bertrand J, Newburg-Rinn S, McCann H, Morehouse E, Ingoldsby E. Children prenatally exposed to alcohol and other drugs: what the literature tells us about child welfare information sources, policies, and practices to identify and care for children. JOURNAL OF PUBLIC CHILD WELFARE 2020; 1:10.1080/15548732.2020.1814478. [PMID: 33897309 PMCID: PMC8064734 DOI: 10.1080/15548732.2020.1814478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 06/02/2023]
Abstract
Many parents who interact with the child welfare system present with substance use issues, which means their children are at risk for prenatal exposure to alcohol and other drugs. Because child welfare agencies play an important role in identifying and providing services to mitigate negative impacts of prenatal exposures, we conducted a search for literature addressing child welfare information sources, policies, and practices related to this population. The search yielded 16 research/evaluation and 16 policy/practice papers, with most addressing exposures to both alcohol and other drugs. The literature most commonly reports that children identified as exposed are referred to child protection agencies during the newborn period. This practice may lead to underidentification, especially of children with prenatal exposure to alcohol. Research suggests that this population is at risk for poorer child welfare outcomes and that there are specific service needs for these children. This review indicates that there is an overall lack of research literature regarding identification of prenatally exposed children involved in the child welfare system that could best inform child welfare policies and practices. Studies investigating how the child welfare system identifies and cares for children with prenatal exposures are needed.
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Affiliation(s)
| | - Jacquelyn Bertrand
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, U.S. Dept. of Health and Human Services, Atlanta, Georgia, USA
| | - Sharon Newburg-Rinn
- Children’s Bureau, Administration for Children and Families, U.S. Dept. of Health and Human Services, Washington, District of Columbia, USA
| | - Heather McCann
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, U.S. Dept. of Health and Human Services, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
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Jarlenski MP, Paul NC, Krans EE. Polysubstance Use Among Pregnant Women With Opioid Use Disorder in the United States, 2007-2016. Obstet Gynecol 2020; 136:556-564. [PMID: 32769641 PMCID: PMC7483798 DOI: 10.1097/aog.0000000000003907] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess trends in polysubstance use among pregnant women with opioid use disorder in the United States. METHODS We conducted a time trend analysis of pooled, cross-sectional data from the National Inpatient Sample, an annual nationally representative sample of U.S. hospital discharge data. Among 38.0 million females aged 15-44 years with a hospitalization for delivery from 2007 to 2016, we identified 172,335 pregnant women with an International Classification of Diseases, Ninth Revision, Clinical Modification or International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis of opioid use disorder. Polysubstance use among pregnant women with opioid use disorder was defined as at least one co-occurring diagnosis of other substance use, including alcohol, amphetamine, cannabis, cocaine, sedative, or tobacco. We fit weighted multivariable logistic regression models to produce nationally representative estimates, including an interaction between year and rural compared with urban county of residence; controlled for age, race, and insurance type. Average predicted probabilities and 95% CIs were derived from regression results. RESULTS Polysubstance use among women with opioid use disorder increased from 60.5% (95% CI 58.3-62.8%) to 64.1% (95% CI 62.8%-65.3%). Differential time trends in polysubstance use among women with opioid use disorder were found in rural compared with urban counties. Large increases in amphetamine use occurred among those in both rural and urban counties (255.4%; 95% CI 90.5-562.9% and 150.7%; 95% CI 78.2-52.7%, respectively), similarly to tobacco use (30.4%; 95% CI 16.9-45.4% and 23.2%; 95% CI 15.3-31.6%, respectively). Cocaine use diagnoses declined among women with opioid use disorder at delivery in rural (-70.5%; 95% CI -80.4% to -55.5%) and urban (-61.9%; 95% CI -67.6% to -55.1%) counties. Alcohol use diagnoses among those with opioid use disorder declined -57% (95% CI -70.8% to -37.7%) in urban counties but did not change among those in rural counties. CONCLUSION Over the past decade, polysubstance use among pregnant women with opioid use disorder has increased more rapidly in rural compared with urban counties in the United States, with amphetamines and tobacco use increasing most rapidly.
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Affiliation(s)
- Marian P Jarlenski
- Department of Health Policy and Management, University of Pittsburgh, the University of Pittsburgh, and the Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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Deutsch SA, Donahue J, Parker T, Hossain J, De Jong A. Factors Associated with Child-Welfare Involvement among Prenatally Substance-Exposed Infants. J Pediatr 2020; 222:35-44.e1. [PMID: 32418814 PMCID: PMC8064022 DOI: 10.1016/j.jpeds.2020.03.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/25/2020] [Accepted: 03/17/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess factors impacting child-welfare involvement and child abuse and neglect outcomes among prenatally substance-exposed infants. STUDY DESIGN This was a retrospective review of case registry data regarding substance-exposed infants tracked statewide in Delaware from 2014 to 2018. Differences in maternal, infant, and substance exposure factors by level of child-welfare involvement (screened-in vs screened-out case status) and child abuse and neglect outcomes were examined. Screened-in status was defined as case acceptance for investigation, family assessment, or treatment referral. Using logistic regression, associations between factors and screened-in status and between factors and child abuse and neglect outcomes were assessed. Cases involving child abuse and neglect were analyzed qualitatively. RESULTS Among 1222 substance-exposed infants, 70% were screened-in by child welfare for ongoing involvement; 28 (2.3%) of substance-exposed infants were identified as child abuse and neglect victims sustaining serious physical or fatal injury before 1 year of age. Most substance-exposed infants remained with caregivers; few entered foster care. Polysubstance exposure and maternal mental health condition were factors associated with screened-in status. Neither substance exposure type nor maternal mental health condition reliably predicted future child abuse and neglect. CONCLUSIONS Substance-exposed infants had a significant risk for child abuse and neglect. Although maternal and substance exposure factors were associated with screened-in case status, they unreliably predicted future risk of child abuse and neglect.
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Affiliation(s)
- Stephanie Anne Deutsch
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
| | | | - Trenee Parker
- Department of Services for Children, Youth and their Families, Wilmington, DE
| | - Jobayer Hossain
- Biostatistics Core, Nemours Biomedical Research, Nemours Children’s Health System, Wilmington, DE
| | - Allan De Jong
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
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Cicero TJ, Ellis MS, Kasper ZA. Polysubstance Use: A Broader Understanding of Substance Use During the Opioid Crisis. Am J Public Health 2019; 110:244-250. [PMID: 31855487 DOI: 10.2105/ajph.2019.305412] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Theodore J Cicero
- All of the authors are with Washington University in St Louis, St Louis, MO
| | - Matthew S Ellis
- All of the authors are with Washington University in St Louis, St Louis, MO
| | - Zachary A Kasper
- All of the authors are with Washington University in St Louis, St Louis, MO
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Kroelinger CD, Rice ME, Cox S, Hickner HR, Weber MK, Romero L, Ko JY, Addison D, Mueller T, Shapiro-Mendoza C, Fehrenbach SN, Honein MA, Barfield WD. State Strategies to Address Opioid Use Disorder Among Pregnant and Postpartum Women and Infants Prenatally Exposed to Substances, Including Infants with Neonatal Abstinence Syndrome. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:777-783. [PMID: 31513558 PMCID: PMC6753967 DOI: 10.15585/mmwr.mm6836a1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Esser MB, Guy GP, Zhang K, Brewer RD. Binge Drinking and Prescription Opioid Misuse in the U.S., 2012-2014. Am J Prev Med 2019; 57:197-208. [PMID: 31200998 PMCID: PMC6642832 DOI: 10.1016/j.amepre.2019.02.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Prescription opioids were responsible for approximately 17,000 deaths in the U.S. in 2016. One in five prescription opioid deaths also involve alcohol. Drinkers who misuse prescription opioids (i.e., use without a prescription or use only for the experience or feeling it causes) are at a heightened risk of overdose. However, little is known about the relationship between drinking patterns and prescription opioid misuse. METHODS Data were analyzed from 160,812 individuals (aged ≥12 years) who responded to questions about prescription opioid misuse and alcohol consumption in the 2012, 2013, or 2014 National Survey on Drug Use and Health (analyzed in 2017-2018). The prevalence of self-reported past-30-days prescription opioid misuse was assessed by sociodemographic characteristics, other substance use (i.e., cigarettes, marijuana), and drinking patterns. Multiple logistic regression analyses were used to calculate AORs. RESULTS From 2012 to 2014, 1.6% (95% CI=1.5, 1.7) of all individuals aged ≥12 years (estimated 4.2 million) and 3.5% (95% CI=3.3, 3.8) of binge drinkers (estimated 2.2 million) reported prescription opioid misuse. Prescription opioid misuse was more common among binge drinkers than among nondrinkers (AOR=1.7, 95% CI=1.5, 1.9). Overall, the prevalence of prescription opioid misuse increased significantly with binge drinking frequency (p-value<0.001). CONCLUSIONS More than half of the 4.2 million people who misused prescription opioids during 2012-2014 were binge drinkers, and binge drinkers had nearly twice the odds of misusing prescription opioids, compared with nondrinkers. Widespread use of evidence-based strategies for preventing binge drinking might reduce opioid misuse and overdoses involving alcohol.
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Affiliation(s)
- Marissa B Esser
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Gery P Guy
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kun Zhang
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert D Brewer
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Zhou J, Ko JY, Haight SC, Tong VT. Treatment of Substance Use Disorders Among Women of Reproductive Age by Depression and Anxiety Disorder Status, 2008-2014. J Womens Health (Larchmt) 2019; 28:1068-1076. [PMID: 31298606 PMCID: PMC8893023 DOI: 10.1089/jwh.2018.7597] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Comorbid substance use disorder and mental health conditions are common in women of reproductive age. We sought to understand the prevalence of substance use and substance use disorder by depression and anxiety disorder status and the independent association between depression and anxiety disorder status with receiving substance use treatment. Materials and Methods: A sample of 106,142 women ages 18-44 years was drawn from the 2008 to 2014 National Survey on Drug Use and Health. Differences in demographics, substance use, substance use disorders, and treatment by major depressive episode (MDE), and anxiety disorder status, were assessed with chi-squared tests. The independent association between MDE and anxiety disorder with substance use treatment was assessed with adjusted prevalence ratios. Results: Women with MDE and/or anxiety disorder had higher prevalence of substance use and substance use disorder than women with no MDE or anxiety disorder (p < 0.001). Less than a quarter of women with substance use disorders and both MDE and anxiety disorder received mental health and substance use treatment. After adjustment, women with substance use disorder and MDE and anxiety disorder, MDE only, or anxiety disorder only were more likely to receive substance use treatment (respectively, 2.4, 1.6, and 2.2 times) than women with no MDE or anxiety disorder (p < 0.001). Conclusions: Women with MDE and/or anxiety disorder are significantly more likely to suffer from substance use and substance use disorders than their counterparts. Integrating substance use treatment services and mental health services in settings frequently visited by reproductive-aged women may increase receipt of combined treatment.
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Affiliation(s)
- Jiani Zhou
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, U.S. Department of Energy, Oak Ridge, Tennessee
| | - Jean Y. Ko
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- U.S. Public Health Service Commissioned Corps, Rockville, Maryland
| | - Sarah C. Haight
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, U.S. Department of Energy, Oak Ridge, Tennessee
| | - Van T. Tong
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Sanlorenzo LA, Cooper WO, Dudley JA, Stratton S, Maalouf FI, Patrick SW. Increased Severity of Neonatal Abstinence Syndrome Associated With Concomitant Antenatal Opioid and Benzodiazepine Exposure. Hosp Pediatr 2019; 9:569-575. [PMID: 31262946 DOI: 10.1542/hpeds.2018-0227] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Polysubstance use is common among opioid-using women, yet its association with pharmacotherapy for neonatal abstinence syndrome (NAS) remains unclear. We hypothesized that benzodiazepine exposure would increase risk of an infant developing pharmacologically treated NAS. METHODS We conducted a retrospective cohort study of maternal-infant dyads enrolled in Tennessee Medicaid, using individual-level data linkage of vital records and administrative (ie, outpatient, inpatient, and prescription) data from 2009 to 2011. These data underwent chart review from 2013 to 2016 to obtain clinically relevant exposure data (eg, toxicology testing). The association of antenatal exposures with pharmacologically treated NAS was evaluated by using multivariable logistic regression, controlling for maternal and infant factors and clustered by hospital. RESULTS Among 112 029 maternal-infant dyads, we confirmed 822 cases of NAS, of which 598 (72.7%) were cases of pharmacologically treated NAS. Infants who developed pharmacologically treated NAS were more likely to have been exposed to antenatal benzodiazepines compared with infants with confirmed NAS not treated pharmacologically (40.9% vs 30.8%; P = .008). In adjusted analyses, benzodiazepine exposure was associated with greater risk of developing pharmacologically treated NAS (odds ratio: 1.51; 95% confidence interval: 1.04-2.21). Alternatively, exposure to tobacco, marijuana, cocaine, gabapentin, and selective serotonin reuptake inhibitors were not associated with increased risk of developing pharmacologically treated NAS. CONCLUSIONS Among a population of infants with intrauterine polysubstance exposure, benzodiazepine exposure was an independent predictor of an infant developing pharmacologically treated NAS. Obtaining history of antenatal benzodiazepine exposure among opioid-exposed infants may allow for risk stratification and development of personalized care plans.
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Affiliation(s)
- Lauren A Sanlorenzo
- Departments of Pediatrics and .,Mildred Stahlman Division of Neonatology and.,Vanderbilt Center for Child Health Policy, Nashville, Tennessee; and
| | - William O Cooper
- Departments of Pediatrics and.,Vanderbilt Center for Child Health Policy, Nashville, Tennessee; and.,Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Judith A Dudley
- Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shannon Stratton
- Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Faouzi I Maalouf
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Stephen W Patrick
- Departments of Pediatrics and.,Mildred Stahlman Division of Neonatology and.,Vanderbilt Center for Child Health Policy, Nashville, Tennessee; and.,Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
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Sanmartin MX, Ali MM, Novak P, Chen J. Polysubstance use among reproductive-aged parenting women who misused prescription opioids in the United States. J Addict Dis 2019; 37:142-145. [PMID: 31232212 DOI: 10.1080/10550887.2019.1630237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Research has shown a significant increase in overdose deaths among reproductive-aged parenting women in the United States. Given the alarming rise of opioid use disorder, this study analyzes polysubstance use among reproductive-aged parenting women. Using data from 2015 to 2016 National Survey of Drug Use and Health (NSDUH), this study examines data on prevalence and patterns of polysubstance use among US reproductive-aged parenting women who misused prescription opioids in the past 30 days. Results show that 87% of parenting women who misused prescription opioids reported using other substances concurrently in the past 30 days.
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Affiliation(s)
- Maria X Sanmartin
- Department of Health Professions, Hofstra University, Hempstead, NY, USA
| | - Mir M Ali
- Office of the Assistant Secretary for Planning & Evaluation, US Department of Health & Human Services, Washington, DC, USA
| | - Priscilla Novak
- Department of Health Services Administration, University of Maryland, College Park, MD, USA
| | - Jie Chen
- Department of Health Services Administration, University of Maryland, College Park, MD, USA
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Hassan AN, Le Foll B. Polydrug use disorders in individuals with opioid use disorder. Drug Alcohol Depend 2019; 198:28-33. [PMID: 30877954 DOI: 10.1016/j.drugalcdep.2019.01.031] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/07/2018] [Accepted: 01/15/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Understanding the association of polydrug use disorders (PUD) with psychosocial and clinical factors is essential for the treatment of individuals with opioid use disorder (OUD). The aim of this study is to examine whether there is an association between childhood maltreatment, mood disorders, anxiety disorders, personality disorders, or posttraumatic stress disorder (PTSD) and PUD in individuals with OUD. METHODS We used data from 356 individuals with OUD in the past 12 months from a nationally representative database in the United States. PUD patients were classified into two groups: a group with additional one substance disorder (OUD + 1) and that with two or more additional substance disorders (OUD + 2). We conducted multivariate logistic regression to predict the PUD status, after adjustment for confounders including childhood maltreatment. RESULTS Among all individuals, 57.3% were polydrug users (n = 204) and 42.7% were not (n = 152). There was a high prevalence of childhood maltreatment in both groups, ranging from 16.1% to 59.5%, but the difference was not statistically significant. After adjustment for confounders, we found an association between past-year PTSD and OUD + 2 (odds ratio: 3.98; 95% confidence interval: 1.15-13.72; p = 0.03) but not with OUD + 1. CONCLUSION PTSD is highly prevalent in individuals with OUD using multiple substances and could influence PUD. We recommend screening for PTSD in cases of PUD. Future studies should evaluate the effect of PTSD treatment on PUD.
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Affiliation(s)
- Ahmed N Hassan
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Departments of Family and Community Medicine, Pharmacology and Toxicology, and Psychiatry, Institute of Medical Sciences, University of Toronto, Toronto, Canada; Campbell Family Mental Health Research Institute, CAMH, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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Abstract
Objectives Substance use during pregnancy is a significant public health issue. Prenatal substance use increased in the past decade while prenatal cigarette smoking has remained stable. Co-use of tobacco and other drugs is a concern because of potential additive risks. This study aims to describe the prevalence rates of substance use among pregnant women and examine the association between smoking status (nonsmoker, recent quitter and current smoker) and other drug use. Methods In this cross-sectional study, pregnant women (n = 500) were recruited from two obstetric practices to complete three substance use screeners and have their urine tested for 12 different drug classes, including cannabis, opioids and cocaine. Participants were divided into three groups based on survey responses: nonsmokers, recent quitters (smoked in the month prior to pregnancy but not past month) and current smokers (past-month). Results Approximately 29% of participants reported smoking in the month before pregnancy. During pregnancy, 17, 12 and 71% were current smokers, recent quitters and nonsmokers respectively. Overall prevalence of illicit or prescription drug use in pregnancy was 27%. Cannabis was the most common drug used in pregnancy with prevalence of 22%, followed by opioids (4%), cocaine (1%), tricyclic antidepressants (TCAs) (1%), amphetamines (1%), and benzodiazepines (1%). On multivariable logistic regression, smoking in pregnancy was associated with a positive urine drug screen; with adjusted odds ratio (aOR) 4.7 (95% CI 2.6-8.3) for current smokers and 1.6 (95% CI 0.8-3.3) for recent quitters. Factors negatively associated with positive drug screen were second and third trimester pregnancies, 0.5 (0.3-0.9) and 0.3 (0.2-0.6) respectively; and employment, 0.5 (0.3-0.8). Conclusions for Practice Co-use of tobacco and illicit drugs, particularly cannabis, is relatively high during pregnancy. Additional research is needed to understand the health implications of co-use versus use of tobacco only. Given the strong association between smoking and other drug use, clinicians should routinely assess for illicit drug use in women who smoke during pregnancy.
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Smid MC, Metz TD, Gordon AJ. Stimulant Use in Pregnancy: An Under-recognized Epidemic Among Pregnant Women. Clin Obstet Gynecol 2019; 62:168-184. [PMID: 30601144 PMCID: PMC6438363 DOI: 10.1097/grf.0000000000000418] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Stimulant use, including cocaine, methamphetamines, ecstasy, and prescription stimulants, in pregnancy is increasingly common. In the United States, stimulants are the second most widely used and abused substances during pregnancy and pregnant women using stimulants in pregnancy are at increased risk of adverse perinatal, neonatal, and childhood outcomes. In this review, we describe the pharmacology, pathophysiology, and epidemiology of stimulants, summarize the maternal and neonatal effects of perinatal stimulant use, and outline treatment options for stimulant use disorders among pregnant women. Development of effective treatment strategies for stimulant use disorders identified among pregnant women are urgently needed.
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Affiliation(s)
- Marcela C Smid
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine
- Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS), Salt Lake City VA Health Care System, Salt Lake City, Utah
| | - Torri D Metz
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine
- Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS), Salt Lake City VA Health Care System, Salt Lake City, Utah
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Gressler LE, Shah S, Shaya FT. Association of Criminal Statutes for Opioid Use Disorder With Prevalence and Treatment Among Pregnant Women With Commercial Insurance in the United States. JAMA Netw Open 2019; 2:e190338. [PMID: 30848807 PMCID: PMC6484651 DOI: 10.1001/jamanetworkopen.2019.0338] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Inadequate treatment of opioid use disorder (OUD) in pregnant women increases the risk of life-threatening consequences on maternal and fetal outcomes. Untreated OUD during pregnancy is associated with higher rates of adverse outcomes among newborns. OBJECTIVE To examine the variation in the prevalence of OUD and the use of medication-assisted treatment among commercially insured pregnant women according to region and state legislature. DESIGN, SETTING, AND PARTICIPANTS Cohort study in which the patient cohort used was derived from a 10% random sample of enrollees within the IQVIA PharMetrics Plus adjudicated claims and enrollment database from 2007 to 2015. The database consists of a 10% random sample of private health insurance recipients in the United States and contains claims and enrollment data that are representative of the commercially insured US population. The cohort comprised women (n = 110 285) between 18 and 45 years of age with a code indicating a delivery and continuous insurance enrollment 9 months before and 12 months after delivery. Data analysis was performed from December 2017 to May 2018. EXPOSURES Based on their state of residence, the women were classified into 4 different regions: South, Midwest, West, and Northeast. Those residing in states with statutes that imposed civil or criminal penalties for OUD diagnosis during pregnancy were placed in a separate population from those residing in states without these statutes. MAIN OUTCOMES AND MEASURES Diagnosis of OUD in the 9 months before delivery and the receipt of medication-assisted treatment in the 9 months before or 12 months after delivery. RESULTS The 110 285 pregnant women included in the analysis had a mean (SD) age of 30.26 (5.59) years, with most (67 771 [61.5%]) falling within the 26- to 35-year age range. Of this cohort, 277 women (0.25%) had a diagnosis of OUD and 312 (0.28%) received treatment. Among the 277 women with OUD, 127 (45.9%) received treatment. The prevalence of an OUD diagnosis and receipt of treatment within regions was statistically significant (OUD diagnosis by region: Midwest, 0.05%; North, 0.09%; South, 0.06%; West, 0.06%; χ23 = 45.1148 [P < .001]; OUD treatment by region: Midwest, 0.05%; North, 0.08%; South, 0.10%; West, 0.05%; χ23 = 26.5654 [P < .001]). The prevalence of OUD diagnosis was also statistically significant when comparing women residing in states with statutes with those in states without statutes (OUD diagnosis by criminal statutes: criminalization, 0.07%; no criminalization, 0.18%; χ21 = 14.6456 [P < .001]; OUD treatment by criminal statutes: criminalization, 0.12%; no criminalization, 0.17%; χ21 = 0.0895); the receipt of treatment was not statistically significant (P = .76). CONCLUSIONS AND RELEVANCE These results appeared to show significant variations in the patterns of OUD diagnosis and receipt of medication-assisted treatment among pregnant women, suggesting the need to further explore the source of these variations.
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Affiliation(s)
- Laura E Gressler
- Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore
| | - Savyasachi Shah
- Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore
| | - Fadia T Shaya
- Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore
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Kozhimannil KB, Admon LK. Structural Factors Shape the Effects of the Opioid Epidemic on Pregnant Women and Infants. JAMA 2019; 321:352-353. [PMID: 30694302 DOI: 10.1001/jama.2018.20395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Katy B Kozhimannil
- Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - Lindsay K Admon
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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Ghertner R. U.S. county prevalence of retail prescription opioid sales and opioid-related hospitalizations from 2011 to 2014. Drug Alcohol Depend 2019; 194:330-335. [PMID: 30472572 DOI: 10.1016/j.drugalcdep.2018.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 10/25/2018] [Accepted: 10/28/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The role of prescription opioids in the opioid crisis has been well established. How the prevalence of prescription opioids relates to opioid hospitalizations has been understudied. Hospitalizations due to opioids are a distinct indicator of opioid misuse, have cost implications for health care systems, and may be an entry point into substance use treatment. METHODS Administrative data were drawn for counties in 32 U.S. states from 2011 to 2014 to associate retail opioid sales rates with opioid-related hospitalization rates. Data on hospitalizations comes from the Healthcare Cost and Utilization Project. Data on opioid sales come from the Automation of Reports and Consolidated Orders System. Statistical models were run accounting for error in the opioid sales measure and controlled for county and year effects and other factors. Sub-analyses explored hospitalizations by metropolitan status and maternal/neonatal stays. As a point of comparison, the analysis estimated the relationship of opioid sales to alcohol hospitalizations. RESULTS Retail opioid sales rates have a positive relationship with opioid-related hospitalization rates where a one morphine kilogram equivalent (MKE) increase in sales per 10,000 people predicts a 9.0% (CI 4.6%-13.7%) increase in opioid-related hospitalization rates. The relationship is higher in non-metropolitan counties. Maternal and neonatal opioid-related hospitalization rates increase by 14.1% (CI 4.9%-24.2%) with a one MKE increase in retail sales rates. There is no statistically significant relationship between opioid sales and alcohol hospitalizations. CONCLUSIONS Though not causal, results inform understanding of how opioid prescribing relate to adverse consequences of opioid use and misuse.
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Affiliation(s)
- Robin Ghertner
- Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, 200 Independence Ave, SW, Washington, D.C., 20201, USA.
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Lorvick J, Browne EN, Lambdin BH, Comfort M. Polydrug use patterns, risk behavior and unmet healthcare need in a community-based sample of women who use cocaine, heroin or methamphetamine. Addict Behav 2018; 85:94-99. [PMID: 29883856 DOI: 10.1016/j.addbeh.2018.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/05/2018] [Accepted: 05/17/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The use of multiple illicit drugs (polydrug use) is associated with health-related harms and elevated risk of drug overdose. Polydrug use in common among women who use 'hard' drugs, such as cocaine, heroin or methamphetamine. METHODS Quantitative data collection was conducted with a community-recruited sample of 624 women who used heroin, methamphetamine or cocaine in Oakland, CA during 2014-2015. We conducted latent class analysis to classify polydrug use patterns. We assessed associations between classes of polydrug use and infectious disease risk behaviors, health care utilization and unmet health care need. RESULTS We identified four distinct classes of drug use: (1) predominantly crack (52% of women); (2) powder cocaine & non-heroin opioids (8%); (3) moderate polydrug use (25%); (4) heavy polydrug use (15%). Odds of sexual risk, injection drug use and unmet healthcare need were twice as high in the heavy polydrug use class as the predominantly crack class (p > 0.01 for each outcome). The rate of binge drinking (as days per month) was also significantly higher in the heavy polydrug class (p = 0.01). The moderate polydrug use class had higher odds of injection drug use and drug treatment participation, compared to the mainly crack class (p < 0.001 for each outcome). There were no differences between classes in health insurance or health care utilization. DISCUSSION Reduction of polydrug use could be an effective harm reduction strategy to address sexual and injection risk among women. The use of both opioids and stimulants in three of the four classes suggests that multi-modal substance abuse treatment approaches may be most appropriate.
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Affiliation(s)
- Jennifer Lorvick
- RTI International, Behavioral and Urban Health Program, United States.
| | - Erica N Browne
- RTI International, Women's Global Health Imperative, United States
| | - Barrot H Lambdin
- RTI International, Behavioral and Urban Health Program, United States; University of Washington, United States
| | - Megan Comfort
- RTI International, Behavioral and Urban Health Program, United States; University of California, San Francisco, United States
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