Highlights • Of persons with opioid use disorder (OUD) nationally, 18% had heroin use disorder (HUD). • Persons with Rx OUD + HUD tended to be white, uninsured, or adults aged 18-49 years. • Of ...persons with OUD, 26% used any alcohol or drug use treatment in the past year. • Of persons with OUD, 19% used opioid-specific treatment. • Adolescents, the uninsured, blacks, those with Rx OUD only and had low odds of treatment use.
•Comorbidities of substance use disorders (SUDs) and chronic diseases were examined.•In the sample (N = 211,880), 48.3% had at least 1 of 9 chronic conditions examined.•The prevalence of any SUD ...(13.3%) increased with the number of comorbidities.•Hospitalization was more prevalent among patients with SUD than those without it.•Regardless of comorbidity, SUD was associated with elevated odds of hospitalization.
Chronic diseases are prevalent and the leading causes of mortality. Comorbidity of substance use disorders (SUDs) and chronic diseases is understudied to inform behavioral healthcare integration.
This study leveraged electronic health record (EHR) data of 211,880 adults from a large health system to examine prevalence and correlates of comorbidity of SUDs and nine chronic disease groups and to determine their association with hospitalization.
Logistic regression analyses were conducted to estimate associations between chronic diseases and SUDs. To control for severity of diagnosis, analyses of associations between SUD and hospitalization were stratified by the number of chronic conditions.
In the sample, 48.3% had ≥1 chronic condition (hypertension 33.7%, arthritis 16.2%, diabetes 13.7%, chronic kidney disease 9.9%, asthma 9.1%, chronic obstructive pulmonary disease 8.9%, ischemic heart disease 8.3%, cancer 4.6%, and hepatitis 1.3%). Prevalence of SUD (overall 13.3%) among patients increased with multiple chronic conditions (14.3% having SUD among patients with one condition; 21.2% having SUD among patients with two to three conditions; and 32.5% having SUD among patients with 4–9 conditions). Chronic conditions were associated with increased odds of SUDs. For all SUD groups, hospitalization was more prevalent among patients with SUD than those without it; prevalence of hospitalization increased with the number of comorbid chronic conditions.
Findings reveal a striking pattern of multicomorbidity of SUD and chronic diseases and its positive association with hospitalization. Behavioral healthcare integration should consider efforts to assess and treat comorbid SUD and chronic diseases, especially among adults with multiple chronic conditions.
Abstract Background Prevalence of obesity has increased dramatically. Obese individuals may undergo bariatric surgery to lose excessive body fat and mitigate obesity-related comorbidities. However, ...bariatric patients are particularly vulnerable to substance use problems. We conducted a review to examine the prevalence change and factors associated with substance use and determine the association between substance use and health status after weight loss among bariatric patients. Methods We searched peer-reviewed articles published between January 1990 and January 2015 in several databases (PubMed, PsycINFO, Cochrane Library, Google Scholar) using different keywords combinations. Studies that focused on pre-surgery substance use only or without reported effect measurements were excluded. Results Overall, 40 studies were included in the review. Preoperative history of substance use was a reliable correlate of postoperative substance use. The prevalence of postoperative alcohol use was higher among patients with preoperative history of alcohol use than those without. Postoperative prevalence of alcohol use ranged from 7.6% to 11.8%. No significant prevalence change in cigarette smoking from pre-to postoperative period was observed. Time effect was not observed on smoking or drug use prevalence, while an increase in alcohol consumption was inconsistent across studies. The proportion of new-onset substance users among bariatric patients after surgery ranged from 34.3% to 89.5%. Conclusion Substance use is associated with poor health among bariatric patients. Preoperative assessment and postoperative follow-up should include interventions to reduce relapse among users and prevent substance use initiation.
•Marijuana use for medical purposes was found among diverse patient groups.•Pain was the most commonly endorsed reason for medical marijuana use.•Medical marijuana appeared to relieve self-reported ...pain/anxiety for some patients.•Studies are needed to understand long-term outcomes of medical marijuana use.•Non-medical marijuana use was positively associated with medical marijuana use.
The use of marijuana for medical purposes is now legal in some U.S. states and other jurisdictions, such as Canada, and Israel. Despite the widespread legalization of medical marijuana globally, there is limited information on patterns and correlates of medical marijuana use (MMU). We conducted a literature review to assess prevalence, reasons, perceived effects, and correlates of MMU among adolescents and adults.
We searched peer-reviewed articles in English between January 1996 and August 2016 from several databases (PubMed, Google Scholar, Embase, CINAHL, and PsycINFO) using different combinations of keywords.
A total of 25 articles met the inclusion criteria. In the U.S., national survey estimates of prescribed MMU was 1.1% among 12th graders and 17% among adults who reported past-year marijuana use. The reported prevalence of prescribed MMU ranged from <1.7% in Israeli cancer patients to 17.4% in American health care patients. The reported prevalence of self-medication with marijuana ranged from 15% in Canadian patients with chronic pain to 30% in British patients with multiple sclerosis. Pain was the most frequently endorsed reason for use. MMU appeared to provide symptom relief for a range of pain conditions, sleep disturbance, and anxiety symptoms, but it did not appear to provide sufficient relief of cluster headache symptoms. Non-medical marijuana use was a common factor associated with MMU across studies.
Either MMU or self-medication with marijuana was common, mainly due to pain management. Additional research is needed to evaluate temporal and causal associations of non-medical marijuana use with MMU.
Background and aims
Pharmacy administration and dispensing of methadone for methadone maintenance treatment (MMT) can expand treatment access for opioid use disorder (OUD). This study investigated ...the feasibility and acceptability of a novel model permitting an opioid treatment program (OTP) physician to prescribe methadone for OUD treatment through collaboration with a partnered pharmacy.
Design
Non‐randomized, single‐arm, open‐label feasibility trial.
Setting
One OTP and one community pharmacy in the United States.
Participants
One OTP physician, two pharmacists and 20 MMT patients receiving between six and 13 take‐home methadone doses at 5–160 mg/day.
Intervention
Patients’ methadone administration and dispensing of take‐home doses was transferred from the OTP to the pharmacy for 3 months.
Measurements
Primary outcome was medication adherence. Secondary outcomes were recruitment, treatment retention, substance use, counseling attendance at the OTP, pharmacist prescription drug monitoring program (PDMP) use, safety and satisfaction.
Findings
Of 29 patients eligible at pre‐screen, 20 patients (69%) enrolled into the study. Recruitment occurred from 6 August 2020 to 10 October 2020. Treatment retention rate at month 3 was 80% (16 of 20). Two participants returned early to the OTP because of a work/schedule change, one due to pregnancy and one following a non‐study‐related hospitalization. Medication adherence among 16 patients who were retained was 100%. Intervention fidelity was 100%. All participants attended random call‐back visits. None showed evidence of tampering/diversion of methadone. Pharmacists checked the PDMP at all visits. All participants attended psychosocial counseling as planned. There were no positive urine screens for illicit opioid use and no study‐related adverse events. All participants endorsed ‘pharmacy is the right location for receiving methadone for MMT’, 88% endorsed ‘convenient or very convenient to receive methadone at the pharmacy’ and 88% were satisfied or very satisfied with the quality of treatment offered.
Conclusions
This feasibility trial has found pharmacy administration and dispensing of physician‐prescribed methadone for methadone maintenance treatment to be feasible and acceptable.
Highlights • Across racial/ethnic groups, cannabis dependence was more common than cannabis abuse. • Three minority groups had greater odds than whites of having cannabis dependence. • Three minority ...groups also had greater odds than whites of using cannabis weekly. • Adjusted analyses showed an increased trend in weekly cannabis use. • Low education was associated with elevated odds of cannabis dependence.
The use of the electronic health record to study the relationship between substance use disorders, diabetes and hypertension has identified high-severity, high-cost conditions. Improving data quality ...and validation will enhance our ability to perform medical record-based screening of substance use disorders and treatment of their complications among patients with multiple chronic illnesses.
Drug use-associated infective endocarditis (DUA-IE) is increasing as a result of the opioid epidemic. Infective endocarditis may require valve surgery, but surgical treatment of DUA-IE has invoked ...controversy, and the extent of its use is unknown.
To examine hospitalization trends for DUA-IE, the proportion of hospitalizations with surgery, patient characteristics, length of stay, and charges.
10-year analysis of a statewide hospital discharge database.
North Carolina hospitals, 2007 to 2017.
All patients aged 18 years or older hospitalized for IE.
Annual trends in all IE admissions and in IE hospitalizations with valve surgery, stratified by patients' drug use status. Characteristics of DUA-IE surgical hospitalizations, including patient demographic characteristics, length of stay, disposition, and charges.
Of 22 825 IE hospitalizations, 2602 (11%) were for DUA-IE. Valve surgery was performed in 1655 IE hospitalizations (7%), including 285 (17%) for DUA-IE. Annual DUA-IE hospitalizations increased from 0.92 to 10.95 and DUA-IE hospitalizations with surgery from 0.10 to 1.38 per 100 000 persons. In the final year, 42% of IE valve surgeries were performed in patients with DUA-IE. Compared with other surgical patients with IE, those with DUA-IE were younger (median age, 33 vs. 56 years), were more commonly female (47% vs. 33%) and white (89% vs. 63%), and were primarily insured by Medicaid (38%) or uninsured (35%). Hospital stays for DUA-IE were longer (median, 27 vs. 17 days), with higher median charges ($250 994 vs. $198 764). Charges for 282 DUA-IE hospitalizations exceeded $78 million.
Reliance on administrative data and billing codes.
DUA-IE hospitalizations and valve surgeries increased more than 12-fold, and nearly half of all IE valve surgeries were performed in patients with DUA-IE. The swell of patients with DUA-IE is reshaping the scope, type, and financing of health care resources needed to effectively treat IE.
National Institutes of Health.
•Cocaine use and cocaine-related problems in the U.S. have increased from 2011 to 2015.•Recent demographic trends in problem cocaine use have not been examined.•Weekly cocaine use is increasing among ...older adults and heavy alcohol users.•Prevalence of cocaine use disorder is increasing among older adults.•Sex and racial correlates of cocaine use differed among adolescents and adults.
Recent epidemiological data suggest a resurgence in cocaine use (CU) and cocaine-related problems in the United States. Demographic trends and correlates of problem CU are needed to determine potential factors that may be influencing the increased trend and to inform targeted prevention and intervention strategies.
Trends in any past-year CU, weekly CU, and cocaine use disorder (CUD) were examined among persons aged ≥12 years using the National Survey on Drug Use and Health from 2011 to 2015. Logistic regression analyses were used to determine correlates of past-year and weekly CU and CUD among adolescents and adults.
The prevalence of past-year CU from 2011 to 2015 increased among females, ages 18–25, ages ≥50, non-Hispanic Blacks, and persons reporting low income, past-year tobacco use, past-year alcohol use, and past-month binge and heavy alcohol use. The prevalence of weekly CU increased among persons aged ≥50 years and persons reporting past-month heavy alcohol use. A significant increase in the prevalence of CUD was only found among persons aged ≥50 years. Adjusted logistic regression showed that older age, large metropolitan residence, past-year tobacco, alcohol, cannabis, and heroin use, and major depressive episode were associated with increased odds of CU or CUD among both adolescents and adults; however, sex and race/ethnicity correlates differed among adolescents and adults.
Findings have implications for increased monitoring of CU-related indicators among some high-risk groups, such as females, older adults, Blacks, and polysubstance users. Targeted screening and intervention strategies among these population subgroups may be needed.
National estimates of U.S. Native Hawaiian and other Pacific Islander (NHPI), American Indian/Alaskan Native (AIAN), and multiracial adolescent substance use and suicidality are scarce because of ...their small population sizes. The aim was to estimate the national prevalence of, and disparities in, substance use and suicidality among these understudied adolescents.
Analyses conducted in 2017 of U.S. adolescents (grades ninth to 12th) from the 1991–2015 Combined National Youth Behavioral Risk Surveys estimated (1) prevalence of lifetime and current (past 30-day) substance use, past 12-month depressed mood, and suicidality by racial group; and (2) AORs for depressed mood and suicidality regressed on current alcohol, cigarette, and marijuana use.
Among 184,494 U.S. adolescents, alcohol, cigarettes, and marijuana were commonly used with lifetime prevalence of 75.32%, 58.11%, and 40.55%, respectively, and current prevalence of 44.51%, 24.58%, and 22.01%, respectively. Past 12-month prevalence of suicidal thoughts, suicide planning, and attempted suicide were 18.87%, 14.75%, and 7.98%, respectively. Relative to non-Hispanic whites, NHPI, AIAN, and multiracial adolescents had higher prevalence of using many illicit substances (e.g., marijuana, heroin), depressed mood, and suicidal thoughts, planning, and attempts (p<0.05). Except for NHPIs and current alcohol use, current alcohol and cigarette use were independently associated with 2.0–2.3 times greater AORs (p<0.05) for attempted suicide among the target adolescents.
U.S. NHPI, AIAN, and multiracial adolescents are disproportionately burdened by illicit substance use, depressed mood, and suicidality. Current alcohol and cigarette use may predispose these adolescents toward suicidality, offering potential pathways to alleviate suicide risk.
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