Substance use & misuse
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Substance use & misuse · Jan 2020
Improving Residency Education on Chronic Pain and Opioid Use Disorder: Evaluation of CDC Guideline-Based Education.
Background: National surveys show that primary care physicians feel responsible for addressing the opioid epidemic. They feel their training in managing chronic pain and addiction was insufficient, and commonly endorse the need for more residency training in these areas. However, residency training in these areas remains low, with a lack of faculty expertise and time as the most commonly cited barriers for improvement. ⋯ Results: Implementation of this educational intervention was feasible. Surveys showed improvement in resident confidence in detecting and managing addiction and improved prescribing practices and adherence to CDC recommendations. Conclusion: This pilot study demonstrates that increasing residency education in managing chronic pain and opioid use disorder is feasible, and no longer needs to be postponed due to lack of time or faculty expertise.
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Substance use & misuse · Jan 2020
Diseases of Despair and Social Capital: Findings from a Population-Based Survey on Opioid Misuse among Adolescents.
Deaths related to opioid overdose have increased substantially in the past few years, raising concerns about how to combat this public health emergency. Objectives: We investigated the association of family, school, and community social capital with opioid misuse in the adolescent population. In addition, we examined if adolescents' depressive symptoms have any mediating effects on opioid misuse. ⋯ Experience of depressive episodes acted as a mediator for the social capital effects on adolescents' opioid misuse. Conclusions: Our findings lend support that opioid misuse is associated with despair, and therefore, opioid prevention programs need to incorporate strategies to address mental health issues as well. Our findings also underscore the need for focusing on increasing parental awareness and involvement as well as scaling up prevention efforts in high schools where substance abuse is relatively higher.
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Substance use & misuse · Jan 2020
Who Uses Tobacco Products? Using Peer Crowd Segmentation to Identify Youth at Risk for Cigarettes, Cigar Products, Hookah, and E-Cigarettes.
Background: Understanding which adolescents are at greatest risk for cigarettes and other tobacco products is critical to inform tailored and targeted interventions. Objectives: We used peer crowds (macro-level subcultures) to identify subgroups of adolescents at-risk for using and being open to using cigarettes; cigars, cigarillos, and little cigars (cigar products); hookah; e-cigarettes; any tobacco product; and multiple products. Methods: In 2017, youth ages 12-17 in five U. ⋯ Popular (cigar products, e-cigarettes) and Alternative (cigarettes) demonstrated increased odds of use compared to Mainstream. We also observed elevated odds of cigarette openness among Alternative, Country, and Hip Hop youth, and of hookah openness among Hip Hop and Popular youth compared to Mainstream. Conclusions/Importance: Peer crowd-tailored cigarette education campaigns can be extended to address other tobacco product risk, especially for higher-risk peer crowds such as Hip Hop.
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Substance use & misuse · Jan 2020
Changes in Nicotine Product Use among Dual Users of Tobacco and Electronic Cigarettes: Findings from the Population Assessment of Tobacco and Health (PATH) Study, 2013-2015.
Background: Dual use of tobacco cigarettes and e-cigarettes ("dual use") is the most common poly-tobacco use pattern among U. S. adults. Whether dual use facilitates or inhibits smoking cessation is of concern, yet limited information exists regarding continuation of dual use over time. ⋯ Conclusions: Over a one year period, most dual users still smoked tobacco cigarettes. Frequency of cigarette and e-cigarette use at Wave 1 were each associated with odds of smoking abstinence. Findings suggest that daily e-cigarette use may increase dual users' chances of becoming smoke free.
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Substance use & misuse · Jan 2020
Urine Drug Testing among Opioid-Naïve and Long-Term Opioid Nevada Medicaid Beneficiaries.
Current guidelines recommend that, when prescribing opioids, providers use urine drug testing (UDT) for harm reduction. Objective: To identify whether Medicaid beneficiaries in Nevada at increased risk for opioid misuse received UDT. Methods: We used Nevada Medicaid claims data (2017-2018) to describe UDT among three samples: opioid naïve patients (N = 11,326), opioid naïve patients with a second follow-up prescription (N = 8,910), and long-term opioid patients (N = 19,173). ⋯ Adults with alcohol disorders and other substance use disorders had the highest PP of UDT, among both the naïve (alcohol related disorder: 3.1%; other substance use disorder: 7.7%) and the naïve with a second follow-up prescription (alcohol related disorder: 4.1%; other substance use disorder: 11.7%) samples. Among the long-term sample, similar predictors were significant. Conclusions: Although there was an association between having risk factors for opioid misuse (e.g. past alchohol disorders and other substance use disorder diagnoses) and receiving UDT, the percentage of patients who received UDT was unexpectedly low, pointing to the need to increase guideline adherence and implementation among providers who prescribe opioids.