Preventive medicine
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Preventive medicine · Nov 2021
The rapid anti-suicidal ideation effect of ketamine: A systematic review.
In many countries suicide rates have been trending upwards for close to twenty years-presenting a public health crisis. Most suicide attempts and deaths are associated with psychiatric illness, usually a depressive disorder. Subanesthetic ketamine is the only FDA-approved antidepressant that works in hours not weeks-thus potentially transforming treatment of suicidal patients. ⋯ One study examined outcome six weeks after a single intravenous dose of ketamine and found benefit for SI sustained relative to 24 h post-dose. Further research is warranted into: optimal dosing strategy, including number and frequency; and long-term efficacy and safety. Ultimately, it remains to be shown that ketamine's benefit for SI translates into prevention of suicidal behavior.
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Preventive medicine · Nov 2021
EditorialBehavior change, health, and health disparities 2021: Rural addiction and health.
This Special Issue of Preventive Medicine (PM) is the 8th in a series on behavior change, health, and health disparities. This is a topic of critical importance to improving U. S. population health. ⋯ As in prior Special Issues in this series, we devote considerable space to the ongoing U. S. opioid epidemic while also examining selected issues in rural health disparities involving tobacco use, cancer, and cardiovascular disease. Across each of these topics we have recruited contributions from accomplished investigators, clinicians, and policymakers to acquaint readers with recent advances while also noting knowledge gaps and unresolved challenges.
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Preventive medicine · Nov 2021
Polysubstance use trends and variability among individuals with opioid use disorder in rural versus urban settings.
Rural areas of the United States have been disproportionately impacted by the opioid epidemic, exacerbated by COVID-19-related economic upheavals. While polysubstance use is an important determinant of overdose risk, variability in polysubstance use as a result of numerous factors (e.g., access, preference) has yet to be described, particularly among rural persons with opioid use disorder (PWOUD). Survey data on past-month use of prescription and illicit opioids and 12 non-opioid psychoactive drug classes were analyzed from a national sample of rural (n = 3872) and urban (n = 8153) residents entering treatment for OUD from 2012 to 2019. ⋯ Polyprescription was highest in rural areas, with illicit opioid-focused use highest in urban areas. Demographic characteristics, co-morbid conditions and healthcare coverage were all associated with between-group differences. There is significant variability in polysubstance use that may identify specific prevention and treatment needs for subpopulations of OUD patients: interventions focused on reducing opioid prescriptions, early engagement with mental health resources, wider distribution of naloxone, and screening/treatment plans that take into account the use of multiple substances.
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Preventive medicine · Nov 2021
Challenges of addressing opioid use disorder in rural settings: A state perspective.
Rural states and communities continue to face significant challenges as they work to address the ongoing opioid epidemic and to implement specific strategies for prevention and treatment of opioid use disorder (OUD) and other substance use disorders (SUDs). While a growing number of innovative strategies have been identified that can offer promise for rural communities, state and clinical leaders from rural communities will need to identify evidence-based approaches that can work best in their communities, and ways to tailor options to meet their unique needs. This article identifies a set of five considerations for rural states and communities as they continue their work to identify solutions to this deadly epidemic.
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Preventive medicine · Nov 2021
Long-acting buprenorphine injectables: Opportunity to improve opioid use disorder treatment among rural populations.
The opioid epidemic continues with escalating overdose deaths further exacerbated by the coronavirus pandemic, despite having efficacious medication treatments for opioid use disorder (MOUD). Most persons with OUD remain undiagnosed, without ever receiving MOUD, and even among those who initiate MOUD, retention is infrequently longer than 6 months (Williams et al., 2019). Treatment access remains particularly problematic in rural areas that often have few providers and limited resources (Ghertner, 2019). ⋯ They hold promise to improve treatment access and retention by decreasing risks of nonadherence, diversion and misuse and may be particularly attractive during a pandemic in order to minimize provider and pharmacy contacts (Roberts et al., 2020) and help improve access to care in rural areas. There are several ongoing evaluations of LAB injectables in large multi-site randomized clinical trials sponsored by the National Institute on Drug Abuse and Veterans Administration Office of Research and Development in settings with special populations that exist in both urban and rural settings. Understanding the potential clinical benefits of LAB injectables along the care continuum, particularly for rural areas is essential to successful implementation in the complex healthcare system.