Journal: Harm Reduction Journal, 2024, doi: 10.1186/s12954-024-00964-5
Authors: Julia Dickson-Gomez, Sarah Krechel, Jessica Ohlrich, Helena Danielle Green Montaque, Margaret Weeks, Jianghong Li, Jennifer Havens, & Antoinette Spector
Abstract:
Introduction: The United States is currently facing an opioid overdose crisis. Research suggests that multiple interventions are needed to reduce overdose deaths including increasing access and retention to medications to treat opioid use disorders (MOUD, i.e., methadone, buprenorphine, and naltrexone) and increasing the distribution and use of naloxone, a medication that can reverse the respiratory depression that occurs during opioid overdoses. However, barriers to MOUD initiation and retention persist and discontinuations of MOUD carry a heightened risk of overdose. Many times, MOUD is not sought as a first line of treatment by people with opioid use disorder (OUD), many of whom seek treatment from medically managed withdrawal (detox) programs. Among those who do initiate MOUD, retention is generally low. The present study examines the treatment experiences of people who use opioids in three states, Connecticut, Kentucky, and Wisconsin.
Methods: We conducted in-depth interviews with people who use opioids in a rural, urban, and suburban area of three states: Connecticut, Kentucky and Wisconsin. Data analysis was collaborative and key themes were identified through multiple readings, coding of transcripts and discussion with all research team members.
Results: Results reveal a number of systemic issues that reduce the likelihood that people initiate and are retained on MOUD including the ubiquity of detox as a first step in drug treatment, abstinence requirements and requiring patients to attend group treatment. MOUD-related stigma was a significant factor in the kinds of treatment participants chose and their experiences in treatment.
Conclusions: Interventions to reduce MOUD stigma are needed to encourage MOUD as a first course of treatment. Eliminating abstinence-based rules for MOUD treatment may improve treatment retention and decrease overdose risk.
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Journal: MMWR: Morbidity Mortality Weekly Reports, 2024, doi: 10.15585/mmwr.mm7308a1
Authors: Marissa B. Esser, Adam Sherk, Yong Liu, & Timothy S. Naimi
Abstract:
Deaths from causes fully attributable to alcohol use have increased during the past 2 decades in the United States, particularly from 2019 to 2020, concurrent with the onset of the COVID-19 pandemic. However, previous studies of trends have not assessed underlying causes of deaths that are partially attributable to alcohol use, such as injuries or certain types of cancer. CDC’s Alcohol-Related Disease Impact application was used to estimate the average annual number and age-standardized rate of deaths from excessive alcohol use in the United States based on 58 alcohol-related causes of death during three periods (2016-2017, 2018-2019, and 2020-2021). Average annual number of deaths from excessive alcohol use increased 29.3%, from 137,927 during 2016-2017 to 178,307 during 2020-2021; age-standardized alcohol-related death rates increased from 38.1 to 47.6 per 100,000 population. During this time, deaths from excessive alcohol use among males increased 26.8%, from 94,362 per year to 119,606, and among females increased 34.7%, from 43,565 per year to 58,701. Implementation of evidence-based policies that reduce the availability and accessibility of alcohol and increase its price (e.g., policies that reduce the number and concentration of places selling alcohol and increase alcohol taxes) could reduce excessive alcohol use and alcohol-related deaths.
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Journal: BMC Public Health, 2024, doi: 10.1186/s12889-024-18072-1
Authors: Osika Tripathi, Humberto Parada Jr, Yuyan Shi, Georg E. Matt, Penelope J. E. Quintana, Sandy Liles, & John Bellettiere
Abstract:
Background: Perception of health risk can influence household rules, but little is known about how the perception of harm from cannabis secondhand smoke (cSHS) is related to having a complete ban on in-home cannabis smoking. We examined this association among a nationally representative sample of United States adults.
Methods: Respondents were 21,381 adults from the cross-sectional Marijuana Use and Environmental Survey recruited from December 2019-February 2020. Perceived harm of cSHS exposure (extremely harmful, somewhat harmful, mostly safe, or totally safe) and complete ban of cannabis smoking anywhere in the home (yes or no) were self-reported. Logistic regression for survey-weighted data estimated covariate-adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between perceived harm of cSHS and complete ban on in-home cannabis smoking. Stratified subgroup analyses (by cannabis smoking status, cannabis use legalization in state of residence, and children under age 6 living in the home) were conducted to quantify effect measure modification of the association between perception of harm and complete ban.
Results: A complete ban on in-home cannabis smoking was reported by 71.8% of respondents. Eight percent reported cSHS as “totally safe”; 20.5% “mostly safe”; 38.3% “somewhat harmful”; and 33.0% “extremely harmful”. Those who reported cSHS as “extremely harmful” had 6 times the odds of a complete ban on in-home cannabis smoking (OR = 6.0, 95%CI = 4.9-7.2) as those reporting smoking as “totally safe”. The odds of a complete ban were higher among those reporting cSHS as “somewhat harmful” (OR = 2.6, 95%CI = 2.2-3.1) or “mostly safe” (OR = 1.4, 95%CI = 1.2-1.7) vs those reporting cSHS as “totally safe”. In each subgroup of cannabis smoking status, state cannabis use legalization, and children under the age of 6 living in the home, perceived harm was associated with a complete ban on in-home cannabis smoking.
Conclusions: Our study demonstrates perceiving cSHS as harmful is strongly associated with having a complete in-home cannabis smoking ban. With almost a third of US adults perceiving cSHS as at least “mostly safe”, there is strong need to educate the general population about potential risks associated with cSHS exposure to raise awareness and encourage adoption of household rules prohibiting indoor cannabis smoking.
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Journal: JAMA Network Open, 2024, doi: 10.1001/jamanetworkopen.2024.0572
Author: Martin Hochheimer, Justin C. Strickland, Jill A. Rabinowitz, Jennifer D. Ellis, Kelly E. Dunn, & Andrew S. Huhn
Abstract:
This cross-sectional study evaluates aspects of xylazine adulteration of opioids among individuals entering substance use disorder treatment Non-Hispanic White individuals (1023 respondents [48%]; P < .001) and those who identified heroin or fentanyl (485 respondents [52%]; P < .001) or commercial opioids (550 respondents [49%]; P = .002) as their primary substance were most likely to have knowledge of xylazine adulteration compared with people who reported a different primary substance. Conversely, Hispanic or Latino individuals (99 respondents [35%]; P < .001) and those who primarily used alcohol (59 respondents [28%]; P < .001) or methamphetamine (100 respondents [31%]; P < .001) were significantly less likely to have awareness of xylazine. Findings indicate a widespread lack of awareness among persons using opioids regarding risk for xylazine exposure and potential inclusion of xylazine within their opioid supply. Preference for xylazine was associated with increased adverse effects.
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Book Title: Leading an Academic Medical Practice
Chapter: Leading a Substance Use Disorder Clinic (pp 255–274)
Authors: Carolyn A. Chan, Jeanette M. Tetrault, & Stephen R. Holt
Abstract:
Substance use disorders (SUDs) are widespread and are urgent public health issues that must be addressed within academic medicine. This chapter outlines a series of practical steps and considerations to develop a dedicated SUD clinic within an academic medical practice. Topics covered in this chapter include a stepwise approach to the development of such a clinic: defining clinic goals, defining a curricular approach, exploring institutional support, establishing clinic logistics, and “taking it to the next level” by expanding clinical and educational initiatives. To address the alarming rates of overdose deaths due to opioids and other substances, there is a critical need for academic medical centers to expand access to addiction treatment services within their departments.
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