scholarly journals Recent Increase in Methamphetamine Use in a Cohort of Rural People Who Use Drugs: Further Evidence for the Emergence of Twin Epidemics

2022 ◽  
Vol 12 ◽  
Author(s):  
Jennifer R. Havens ◽  
Hannah K. Knudsen ◽  
Justin C. Strickland ◽  
April M. Young ◽  
Shanna Babalonis ◽  
...  
Keyword(s):  
Treatment Options ◽  
Prescription Opioid ◽  
People Who Use Drugs ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Rural People ◽  
Heroin Use ◽  
Stimulant Use ◽  
Methamphetamine Use ◽  
Appalachian Kentucky

Appalachian Kentucky was at the epicenter of the prescription opioid epidemic in the early 2000's. As we enter the third decade of the epidemic, patterns have begun to emerge as people who use drugs (PWUD) transition from use of opioids to other drugs. The purpose of this analysis was to examine longitudinal changes in methamphetamine use in an ongoing cohort of rural people who use drugs (PWUD) in Appalachian Kentucky. All but five of the cohort participants (N = 503) reported nonmedical prescription opioid use (NMPOU) at baseline and those 498 are included in this longitudinal analysis encompassing eight waves of data (2008–2020). Past 6-month use of methamphetamine was the dependent variable. Given the correlated nature of the data, mixed effects logistic regression was utilized to examine changes in methamphetamine use over time. Significant increases in methamphetamine use were observed over the past decade in this cohort of PWUD, especially in recent years (2017–2020). Prevalence of recent use at baseline and each of the follow-up visits was as follows: 9.4, 5.6, 5.0, 5.4, 8.1, 6.8, 6.9, and 33.1%, respectively (p < 0.001). On the contrary, significant reductions in NMPO and heroin use were observed in the same time period. The odds of methamphetamine use at the most recent visit were 25.8 times greater than at baseline (95% CI: 14.9, 44.6) and 52.6% of those reporting methamphetamine use reported injecting the drug. These results provide further evidence of “twin epidemics” of methamphetamine use among NMPOU. While problematic on several fronts, of particular concern is the lack of effective treatment options for methamphetamine use disorder. As policies around the opioid epidemic continue to evolve, particular attention should be paid to the surge in stimulant use in opioid-endemic areas.

Identification of Distinct Etiologies across Prescription Misuse and Illicit Drug Use: Opioids and Stimulants Compared

2020 ◽  
Author(s):  
Genevieve Fullerton Dash ◽  
Nicholas G. Martin ◽  
Arpana Agrawal ◽  
Michael Lynskey ◽  
Wendy S. Slutske
Keyword(s):  
Illicit Drugs ◽  
Genetic Influence ◽  
Prescription Opioid ◽  
Future Research ◽  
Opioid Use ◽  
Stimulant Use ◽  
Drug Classes ◽  
Illicit Use ◽  
Prescription Opioid Misuse ◽  
Illicit Opioid Use

Background. Drug classes are grouped based on their chemical and pharmacological properties, but prescription and illicit drugs differ in other important ways. Opioid and stimulant classes contain prescription and illicit forms differentially associated with salient risk factors (common route of administration, legality), making them useful comparators for examining the potential differences in the etiological influences on (mis)use of prescription and illicit drugs. Methods. 2,410 individual Australian twins (Mage=31.77 [SD=2.48]; 67% women) were interviewed about prescription misuse and illicit use of opioids and stimulants. Univariate and bivariate biometric models partitioned variances and covariances into additive genetic, shared environmental, and unique environmental influences across drug types. Results. Variation in the propensity to misuse prescription opioids was primarily attributable to genes (37%) and unique environment (59%). Illicit opioid use was attributable to shared (71%) and unique (29%) environment. Prescription stimulant misuse was primarily attributable to genes (78%) and unique environment (21%). Illicit stimulant use was influenced by genes (48%), and shared (29%) and unique environment (23%). There was evidence for genetic influence common to both stimulant types, but limited evidence for genetic influence common to both opioid types. Conclusions. Prescription opioid misuse may share little genetic influence with illicit opioid use. Future research may consider avoiding unitary drug classifications, particularly when examining genetic influences.

Are prescription misuse and illicit drug use etiologically distinct? A genetically-informed analysis of opioids and stimulants

2021 ◽  
pp. 1-8
Author(s):  
Genevieve F. Dash ◽  
Nicholas G. Martin ◽  
Arpana Agrawal ◽  
Michael T. Lynskey ◽  
Wendy S. Slutske
Keyword(s):  
Illicit Drugs ◽  
Environmental Influences ◽  
Genetic Influence ◽  
Prescription Opioid ◽  
Future Research ◽  
Shared Environment ◽  
Opioid Use ◽  
Stimulant Use ◽  
Prescription Opioid Misuse ◽  
Illicit Opioid Use

Abstract Background Drug classes are grouped based on their chemical and pharmacological properties, but prescription and illicit drugs differ in other important ways. Potential differences in genetic and environmental influences on the (mis)use of prescription and illicit drugs that are subsumed under the same class should be examined. Opioid and stimulant classes contain prescription and illicit forms differentially associated with salient risk factors (common route of administration, legality), making them useful comparators for addressing this etiological issue. Methods A total of 2410 individual Australian twins [Mage = 31.77 (s.d. = 2.48); 67% women] were interviewed about prescription misuse and illicit use of opioids and stimulants. Univariate and bivariate biometric models partitioned variances and covariances into additive genetic, shared environmental, and unique environmental influences across drug types. Results Variation in the propensity to misuse prescription opioids was attributable to genes (41%) and unique environment (59%). Illicit opioid use was attributable to shared (71%) and unique (29%) environment. Prescription stimulant misuse was attributable to genes (79%) and unique environment (21%). Illicit stimulant use was attributable to genes (48%), shared environment (29%), and unique environment (23%). There was evidence for genetic influence common to both stimulant types, but limited evidence for genetic influence common to both opioid types. Bivariate correlations suggested that prescription opioid use may be more genetically similar to prescription stimulant use than to illicit opioid use. Conclusions Prescription opioid misuse may share little genetic influence with illicit opioid use. Future research may consider avoiding unitary drug classifications, particularly when examining genetic influences.

scholarly journals Advances in the treatment of opioid use disorders

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 87 ◽  
Author(s):  
George E. Woody
Keyword(s):  
Treatment Options ◽  
Geographical Location ◽  
Psychosocial Problems ◽  
Psychosocial Treatment ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Improved Outcomes ◽  
Opioid Use Disorders ◽  
The Many ◽  
Prescription Opioid Use

The development of medications for treating persons with opioid use disorders has expanded the number of evidence-based treatment options, particularly for persons with the most severe disorders. It has also improved outcomes compared to psychosocial treatment alone and expanded treatment availability by increasing the number of physicians involved in treatment and the settings where patients can be treated. The medications include methadone, buprenorphine, buprenorphine/naloxone, and extended-release injectable naltrexone. Studies have shown that they are most effective when used over an extended, but as-yet-unspecified, period of time and with counseling and other services, particularly for the many with psychosocial problems. Though controversial in some cultures, well-designed studies in Switzerland, the Netherlands, Germany, and Canada have demonstrated the efficacy of supervised heroin injecting for persons who responded poorly to other treatments, and this treatment option has been approved by Switzerland and a few other E.U. countries. The degree to which medication-assisted therapies are available is dependent on many variables, including national and local regulations, preferences of individual providers and their geographical location, treatment costs, and insurance policies. Greater availability of medication-assisted therapies has become a major focus in the U.S. and Canada, where there has been a marked increase in deaths associated with heroin and prescription opioid use. This paper provides a brief summary of these developments.

scholarly journals Longitudinal trends in nonmedical prescription opioid use in a cohort of rural Appalachian people who use drugs

2020 ◽  
Vol 140 ◽  
pp. 106194 ◽  
Author(s):  
Jennifer R. Havens ◽  
Hannah K. Knudsen ◽  
April M. Young ◽  
Michelle R. Lofwall ◽  
Sharon L. Walsh
Keyword(s):  
Prescription Opioid ◽  
People Who Use Drugs ◽  
Opioid Use ◽  
Prescription Opioid Use

Tramadol for maintenance in opioid dependence: A retrospective chart revie

2017 ◽  
Vol 13 (5) ◽  
pp. 329 ◽  
Author(s):  
Siddharth Sarkar, MD, DNB ◽  
Rakesh Lal, MD ◽  
Mohit Varshney, MD ◽  
Yatan Pal Singh Balhara, MD, DNB, MNAMS
Keyword(s):  
Opioid Dependence ◽  
Maintenance Treatment ◽  
Evidence Base ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Heroin Use ◽  
Select Group ◽  
Treatment Centre ◽  
Icd 10

Background and aims: Tramadol is an opioid agonist which can be potentially used for maintenance treatment of patients with opioid use disorders. This chart review presents the characteristics of individuals with an ICD 10 diagnosis of opioid dependence who were maintained on tramadol for a period of at least 6 months.Methods: Records of patients seeking treatment for opioid dependence from the outpatient clinic of the National Drug Dependence Treatment Centre, Ghaziabad, India were screened. One hundred consecutive patients who received tramadol for more than 6 months were included.Results: The sample comprised exclusively of males and had a mean age of 40.9 years. The median dose of tramadol at initiation and continuation was 300 mg/ day. Sixty-two patients achieved complete abstinence during the course of treatment. Greater age, longer duration of opioid use, and better follow-up adherence were associated with abstinent status. The rates of abstinence were higher among those presenting with natural opioid use as compared to others (prescription opioid use or heroin use).Conclusion: Tramadol can be an alternative medication for harm reduction in select group of patients with opioid dependence. Further research is required to strengthen the evidence base of rational use of tramadol for maintenance treatment of patients with opioid dependence.

scholarly journals Evaluating Differences in Opioid and Stimulant Use-associated Infectious Disease Hospitalizations in Florida, 2016–2017

2020 ◽  
Author(s):  
David P Serota ◽  
Tyler S Bartholomew ◽  
Hansel E Tookes
Keyword(s):  
Infectious Disease ◽  
Hospital Mortality ◽  
People Who Inject Drugs ◽  
Medical Advice ◽  
Acute Management ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Stimulant Use ◽  
Diagnostic Codes ◽  
Younger Age

Abstract Background The opioid epidemic has led to increases in injection drug use (IDU)-associated infectious diseases; however, little is known about how more recent increases in stimulant use have affected the incidence and outcomes of hospitalizations for infections among people who inject drugs (PWID). Methods All hospitalizations of PWID for IDU-associated infections in Florida were identified using administrative diagnostic codes and were grouped by substance used (opioids, stimulants, or both) and site of infection. We evaluated the association between substance used and the outcomes: patient-directed discharge (PDD, or “against medical advice”) and in-hospital mortality. Results There were 22 856 hospitalizations for infections among PWID. Opioid use was present in 73%, any stimulants in 43%, and stimulants-only in 27%. Skin and soft tissue infection was present in 50%, sepsis/bacteremia in 52%, osteomyelitis in 10%, and endocarditis in 10%. PWID using opioids/stimulants were youngest, most uninsured, and had the highest rates of endocarditis (16%) and hepatitis C (44%). Additionally, 25% of patients with opioid/stimulant use had PDD versus 12% for those using opioids-only. In adjusted models, opioid/stimulant use was associated with PDD compared to opioid-only use (aRR 1.28, 95% CI 1.17–1.40). Younger age and endocarditis were also associated with PDD. Compared to opioid-only use, stimulant-only use had higher risk of in-hospital mortality (aRR 1.26, 95% CI 1.03–1.46). Conclusions While opioid use contributed to most IDU-associated infections, many hospitalizations also involved stimulants. Increasing access to harm reduction interventions could help prevent these infections, while further research on the acute management of stimulant use disorder-associated infections is needed.

scholarly journals Association of Nonmedical Prescription Opioid Use With Subsequent Heroin Use Initiation in Adolescents

2019 ◽  
Vol 173 (9) ◽  
pp. e191750 ◽  
Author(s):  
Lorraine I. Kelley-Quon ◽  
Junhan Cho ◽  
David R. Strong ◽  
Richard A. Miech ◽  
Jessica L. Barrington-Trimis ◽  
...  
Keyword(s):  
Prescription Opioid ◽  
Opioid Use ◽  
Heroin Use ◽  
Prescription Opioid Use

scholarly journals Opioid Epidemic or Pain Crisis? Using the Virginia All Payer Claims Database to Describe Opioid Medication Prescribing Patterns and Potential Harms for Patients With Cancer

2019 ◽  
Vol 15 (12) ◽  
pp. e997-e1009 ◽  
Author(s):  
Virginia T. LeBaron ◽  
Fabian Camacho ◽  
Rajesh Balkrishnan ◽  
Nengliang (Aaron) Yao ◽  
Aaron M. Gilson
Keyword(s):  
Essential Element ◽  
The United States ◽  
Prescribing Patterns ◽  
Prescription Opioid ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Opioid Medication ◽  
Claims Database ◽  
Patients With Cancer ◽  
Controlled Substance

PURPOSE: A key challenge regarding the current opioid epidemic is understanding how concerns regarding opioid-related harms affect access to pain management, an essential element of cancer care. In certain regions of the United States where disproportionately high cancer mortality and opioid fatality rates coexist (such as southwest Virginia in central Appalachia), this dilemma is particularly pronounced. METHODS: This longitudinal, exploratory, secondary analysis used the Commonwealth of Virginia All Payer Claims Database to describe prescription opioid medication (POM) prescribing patterns and potential harms for adult patients with cancer living in rural southwest Virginia between 2011 and 2015. Descriptive and inferential statistical analyses were conducted at the patient, prescriber, and prescription levels to identify patterns and predictors of POM prescribing and potential harms. To explore geographic patterns, choropleth and heat maps were created. RESULTS: Of the total sample of patients with cancer (n = 4,324), less than 25% were prescribed a Controlled Substance Schedule II POM at least three times in any study year. More than 60% of patients never received a Controlled Substance Schedule II POM prescription. Six hundred fifty-two patients (15.1%) experienced 1,599 hospitalizations for any reason; 10 or fewer patients were admitted for 11 opioid use disorder–related hospitalizations. The main findings suggest potential undertreatment of cancer-related pain; no difference in risk for opioid-related hospitalization on the basis of frequency of POM prescriptions; and geographic disparities where opioid overdoses are occurring versus where POM prescription use is highest. CONCLUSION: These findings have significant opioid policy and practice implications related to the need for cancer-specific prescribing guidelines, how to optimally allocate health delivery services, and the urgent need to improve data interoperability and access related to POMs.

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