The American journal of drug and alcohol abuse
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Background: The smoke generated from cannabis delivers biologically active cannabinoids and a number of combustion-derived toxins, both of which raise questions regarding the impact of cannabis smoking on lung function, airway inflammation and smoking-related lung disease. Objectives: Review the potential effects of cannabis smoking on respiratory symptoms, lung function, histologic/molecular alterations in the bronchial mucosa, smoking-related changes in alveolar macrophage function and the potential clinical impact of cannabis smoking on chronic obstructive pulmonary disease, lung cancer and pulmonary infections. Methods: Focused literature review. ⋯ Evidence suggests that alveolar macrophages from cannabis smokers have deficits in cytokine production and antimicrobial activity not present in cells from tobacco smokers. Conclusions: Solid conclusions regarding the respiratory consequences of regular cannabis smoking are difficult to make due to a relative paucity of literature, confounding by concurrent tobacco smoking and reports of conflicting outcomes. Additional well-controlled clinical studies on the pulmonary consequences of habitual cannabis use are needed.
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Am J Drug Alcohol Abuse · Jan 2019
Development of a Cascade of Care for responding to the opioid epidemic.
Amid worsening opioid overdose death rates, the nation continues to face a persistent addiction treatment gap limiting access to quality care for opioid use disorder (OUD). Three FDA-approved medications (methadone, buprenorphine, and extended-release naltrexone) have high quality evidence demonstrating reductions in drug use and overdose events, but most individuals with OUD do not receive them. The development of a unified public health framework, such as a Cascade of Care, could improve system level practice and treatment outcomes. ⋯ Many currently employed interventions (prescriber guidelines, prescription monitoring programs, naloxone rescue) address prevention of OUD or downstream complications but not treatment of the underlying disorder itself. An OUD Cascade of Care framework could help structure local and national efforts to combat the opioid epidemic by identifying key targets, interventions, and quality indicators across populations and settings to achieve these ends. Improved data collection and reporting methodology will be imperative.
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Am J Drug Alcohol Abuse · Jan 2019
Anxiety sensitivity and opioid misuse among opioid-using adults with chronic pain.
Background: The opioid epidemic is a significant public health crisis, and this problem is particularly prevalent among individuals with chronic pain. Accordingly, there is an urgent need for interventions to mitigate the risk for opioid misuse and opioid use disorder among people with pain. Given that mental health problems, specifically anxiety, are common among people who misuse opioids, it is important to examine factors that link mental health problems with opioid misuse to ultimately inform the development of novel interventions. ⋯ Associations between anxiety sensitivity and opioid misuse were observed over and above the variance accounted for by age, sex, income, education, perceived health, and pain severity. Conclusion: These findings suggest that anxiety sensitivity may be an important treatment target among adults with chronic pain who misuse opioids. Future research should continue to explore the explanatory relevance of anxiety sensitivity in opioid misuse among individuals with chronic pain.
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Am J Drug Alcohol Abuse · Jan 2019
Comparative StudyPerceived prevalence of peer marijuana use: changes among college students before and after Oregon recreational marijuana legalization.
Background: Oregon students' rates of marijuana use have increased following recreational marijuana legalization (RML), but the relation between RML and students' perceived peer use of marijuana - or descriptive norms - is unknown. Objectives: This study examined whether perceived peer use of marijuana changed more following RML for college students in Oregon than in states without RML. Methods: Repeated cross-sectional data were collected from the National College Health Assessment-II surveys from 2008 to 2016 to assess changes in descriptive norms ("Within the last 30 days, what percent of students at your school used marijuana?") among 18-26 year-old undergraduates from two Oregon institutions and 123 institutions in non-RML states (N = 280,006; 66.23% female; 33.19% male) following Oregon RML (7/1/2015). ⋯ The effect was significant for respondents who had never used marijuana [Percent Increase = 3.72, p < .001], but not for respondents who recently or ever previously used marijuana. Respondents who had recently used marijuana had higher descriptive norms than those who had never used [Percent Increase = 12.83, p < .001]. Conclusions: Given the association between descriptive norms and personal use, RML-related increases in descriptive norms among non-using students could contribute to future marijuana use initiation and may be one mechanism linking RML with higher rates of marijuana use among college students.
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Am J Drug Alcohol Abuse · Jan 2019
A retrospective cohort study of mortality rates in patients with an opioid use disorder treated with implant naltrexone, oral methadone or sublingual buprenorphine.
Sustained release naltrexone has been shown to be a safer alternative to oral naltrexone in terms of mortality in patients with an opioid use disorder; however, a direct large-scale comparison has not been made between sustained release naltrexone and the more popular opioid pharmacotherapies: methadone and buprenorphine. ⋯ Crude mortality rates are comparable in patients with an opioid use disorder treated with implant naltrexone, methadone, and buprenorphine. However, implant naltrexone may be associated benefits during the first 28 days of treatment and in female patients compared to methadone.