Preventive medicine
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Preventive medicine · Nov 2019
ReviewA review of tobacco regulatory science research on vulnerable populations.
In 2013 the U. S. Food and Drug Administration and National Institutes of Health established fourteen Tobacco Centers of Regulatory Science (TCORS) to advance scientific knowledge relevant to conducting evidence-based tobacco regulation. ⋯ However, considerable variability was noted in the amount of research conducted across the various vulnerable populations and scientific domains. Most notably, relatively few studies focused on active military/veterans or sexual/gender minorities, and the scientific domains of marketing influences and communications were conspicuously underrepresented. These are important knowledge gaps to address going forward.
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Preventive medicine · Nov 2019
Comparative StudyRisk of death associated with kratom use compared to opioids.
Kratom use appears to be increasing across the United States, increasing attention to deaths in which kratom use was detected. Most such deaths have been ascribed to fentanyl, heroin, benzodiazepines, prescription opioids, cocaine and other causes (e.g., homicide, suicide and various preexisting diseases). Because kratom has certain opioid-like effects (e.g., pain relief), and is used by some people as a substitute for opioids for pain or addiction, kratom has been compared to "narcotic-like opioids" (e.g., morphine) with respect to risk of death despite evidence that its primary alkaloid, mitragynine, carries little of the signature respiratory depressing effects of morphine-like opioids. ⋯ By any of our assessments, it appears that the risk of overdose death is >1000 times greater for opioids than for kratom. The limitations of the mortality risk estimate warrants caution in individuals with unknown factors such as use of other substances and medications, or other preexisting conditions. More research on kratom safety and risks is needed, as is regulation of commercial kratom products to ensure that consumers are informed by FDA labeling and that kratom products are not contaminated or adulterated with other substances.
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Preventive medicine · Nov 2019
Post-release treatment uptake among participants of the Rhode Island Department of Corrections comprehensive medication assisted treatment program.
The Rhode Island Department of Corrections (RIDOC) recently implemented the first state-wide, comprehensive medications for addiction treatment (MAT) program in the US. The objective of this study was to elucidate perceived barriers for individuals who participated in RIDOC's MAT program while incarcerated. Of the 588 individuals eligible for this study, 227 phone surveys were completed with 214 individuals. ⋯ Participants reported reasons for why they did not continue MAT and had mixed intentions about continuing MAT in the future. Results provide identification of novel factors, such as side effects, time between release and treatment linkage, and family and friends' opinions that influence MAT continuation post-incarceration. Results highlight areas of exploration to influence treatment retention, including the role of probation/parole officers and the potential for peer support specialists to assist in reducing stigma and increasing interest in MAT.
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Preventive medicine · Nov 2019
Comparative StudyThe opioid epidemic in rural northern New England: An approach to epidemiologic, policy, and legal surveillance.
The opioid crisis presents substantial challenges to public health in New England's rural states, where access to pharmacotherapy for opioid use disorder (OUD), harm reduction, HIV and hepatitis C virus (HCV) services vary widely. We present an approach to characterizing the epidemiology, policy and resource environment for OUD and its consequences, with a focus on eleven rural counties in Massachusetts, New Hampshire and Vermont between 2014 and 2018. We developed health policy summaries and logic models to facilitate comparison of opioid epidemic-related polices across the three states that could influence the risk environment and access to services. ⋯ New Hampshire had high proportions of uninsured community members, the highest overdose rates, no HCV surveillance data, and no local access to SSPs. This combination of factors appeared to place PWID in rural New Hampshire at elevated risk. Study results facilitated the development of vulnerability indicators, identification of locales for subsequent data collection, and public health interventions.
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Preventive medicine · Nov 2019
Sensitivity of hypothetical purchase task indices when studying substance use: A systematic literature review.
Hypothetical Purchase Tasks (HPTs) simulate demand for a substance as a function of escalating price. HPTs are increasingly used to examine relationships between substance-related correlates and outcomes and demand typically characterized using a common battery of indices (Intensity, Omax, Pmax, Breakpoint, Elasticity). This review examines the relative sensitivity of the HPT indices. ⋯ The largest effect sizes were observed for Intensity (0.75 ± 0.04, CI 0.67-0.84) and Omax (0.64 ± 0.04, CI 0.56-0.71), followed by Elasticity (0.44 ± 0.04, CI 0.37-0.51), Breakpoint (0.30 ± 0.03, CI 0.25-0.36), and Pmax (0.25 ± 0.04, CI 0.18-0.33). Patterns were largely consistent across substances. In conclusion, HPTs can be highly effective in revealing relationships between demand and substance-related correlates and outcomes, with Intensity and Omax exhibiting the greatest sensitivity.