OBJECTIVES:Limited evidence describes how geographic context and the built environment relate to non-fatal overdose. We examined demographic and spatial patterns of non-fatal overdoses in Palm Beach County, Florida, including differences between indoor and outdoor events and proximity to built environment features. METHODS:Emergency department encounters for suspected non-fatal overdoses were obtained from Florida's Overdose Data to Action surveillance system for 2024. Multivariable logistic regression examined factors associated with outdoor overdose and proximity to gas stations. Spatial analyses assessed proximity to gas stations and major roadways and identified geographic clustering. RESULTS:Among 1661 non-fatal overdose events, 39.6% occurred outdoors. Outdoor overdoses were more common among men, younger adults, uninsured individuals, and those identified as unstably housed, with housing status showing the strongest association. Overdoses involving stimulants and combined drug and alcohol use were also more likely to occur outdoors. In the gas-station proximity model, unstable housing was associated with more than fivefold higher odds of an overdose occurring within 0.25 miles of a gas station. Outdoor overdoses clustered in eastern PBC along major transportation corridors. Nearly 44% of outdoor overdoses occurred within 0.25 miles of a gas station and 33.6% within 0.25 miles of a major highway, proportions significantly higher than for indoor overdoses. CONCLUSIONS:Non-fatal overdoses in PBC show distinct spatial patterns by setting. Outdoor overdoses were concentrated near transportation corridors and gas stations and are more commonly observed among individuals experiencing housing instability. Spatial surveillance may inform targeted overdose intervention, outreach, and linkage to treatment.
Background Cannabis demand, a behavioural economic measure of cannabis relative reinforcing value (i.e., incentive salience), is robustly associated with cannabis involvement. Recreational cannabis legalization in Canada has shifted the availability and social acceptability of cannabis, potentially altering its reinforcing value. Though prior studies have examined legalization-related changes in cannabis use and misuse, none have examined changes in cannabis demand. Thus, we investigated intraindividual changes in cannabis demand over the six years following legalization, overall and moderated by pre-legalization cannabis use frequency, sex, and age, predicting an increase in reinforcing value in the post-legalization period. Method Community adults (n=1103) completed measures of cannabis demand in 14 assessment waves (median retention = 86.86%) from September 2018 to April 2025. Results Multilevel growth models indicated that, on average, all cannabis demand indices significantly decreased over time, contrary to hypotheses, and in contrast to cannabis consumption itself, which was relatively stable. Trajectories systematically differed based on pre-legalization cannabis use frequency and sex. Participants who were actively using cannabis pre-legalization exhibited declining cannabis demand over time, with steeper declines corresponding to more frequent pre-legalization cannabis use, whereas those not using cannabis pre-legalization exhibited stable or increasing cannabis demand. Males exhibited steeper decline in selected cannabis demand indices (intensity, Omax, breakpoint) relative to female participants. Conclusions These results reveal that Canadian recreational cannabis legalization was associated with overall declines in the reinforcing value of cannabis, even as actual cannabis use frequency remained relatively stable. These findings suggest that increased cannabis availability following legalization may have led to seemingly positive within-person shifts, albeit within a community sample.
Background Adverse-childhood-experiences (ACEs) are prevalent in substance-use-disorder (SUD) but show complex interplay with resilience, psychopathology and addictive-behaviour. The stress-diathesis model predicts that ACEs can induce psychopathologies and undermine resilience, leading to addictive-behaviour. However, previous research seldom investigated these variables using network analysis, and evidence remains limited to the Western population. We aimed to study the symptom-behaviour network for ACEs and resilience in the Chinese setting. Methods This cross-sectional study recruited 400 Chinese SUD patients, with 67% having comorbid psychiatric disorders, 61.5% having polysubstance use, and 63.3% having actively used substance within 30 days. We administered self-report scales to measure ACEs, resilience and psychological dependence. Clinician-rated scales measured substance-use-severity and psychopathologies. The regularized-partial-correlation-network with centrality indices examined the interplay of ACEs and resilience with psychopathologies and addictive-behaviour. The shortest-path-analysis outlined the graph-theoretic paths within the network, which linked ACEs (the independent variable) to substance-use-severity (the outcome variable) through intermediate variables. Results In the network, ACEs and resilience showed weak connections with psychopathology, psychological dependence and substance-use-severity. Moreover, anxiety and depressive symptoms, emotional and physical abuse showed high centrality. The graph-theoretic paths linking childhood abuse and substance-use-severity did not include psychopathological nodes but psychological dependence; whereas the paths linking childhood neglect and substance-use-severity included resilience and psychological dependence. Conclusions ACEs, in particular physical and emotional abuse, may be intervention targets for bringing changes to the symptom-behaviour network. Trauma-informed assessments and interventions should be considered. Longitudinal research is needed to verify causal mechanisms for the associations of ACEs with addictive-behaviour.
OBJECTIVES:Self-reported tobacco use among youth often diverges from biomarker indicators raising concerns about the accuracy of surveillance estimates. However, few studies have examined factors associated with the inconsistencies. Guided by Bristol and Mangleburg's model of youth information disclosure, this study assessed parent, peer, and social correlates of inconsistency between self-reported tobacco use and biomarker-verified nicotine exposure. METHODS:Data were drawn from Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health Study. Youth aged 13-17 who self-reported no tobacco use in the past 7 days and had valid urinary cotinine data were included (unweighted N = 1659; weighted N = 22,867,704). Inconsistency was defined as cotinine levels above sex-specific thresholds (≥11.85ng/mL for males; ≥7.18ng/mL for females) despite reporting no tobacco use in the past 7 days. Confirmatory factor analysis was used to construct latent parent, peer, and social factors. Weighted logistic regression assessed associations between predicted scores of these factors and inconsistent reporting. RESULTS:Approximately 19.5% of participants showed biomarker-indicated nicotine exposure inconsistent with self-reported abstinence. Higher parent factor scores, reflecting adolescents' perception of non-negative parental communication about tobacco use, were associated with lower odds of inconsistent reporting (OR=0.74, p < 0.05). Peer and social factors were not significantly associated with reporting inconsistency. CONCLUSIONS:Non-negative parental communication was significantly associated with reduced inconsistency in tobacco use reporting. This finding underscores the importance of incorporating family context into youth tobacco surveillance and prevention efforts. Longitudinal research is needed to clarify the causal influence of interpersonal and environmental factors on reporting inconsistency.
BACKGROUND:[¹ ¹C]PHNO is a positron emission tomography (PET) radioligand for dopamine D2/D3 receptors (D2R/D3R), while [¹ ¹C]P943 selectively targets 5-HT1B receptors. Although prior studies have shown differences in dopaminergic and serotonergic receptor availability in people with and without cocaine use disorder (CUD), these systems have been examined in isolation across separate studies and samples. METHODS:Ten non-treatment-seeking individuals with CUD (3 women; mean [SD] age, 40.6 [7.5] years) underwent PET imaging with [¹ ¹C]PHNO and [¹ ¹C]P943 following an average of 7 ± 3 days of abstinence under inpatient monitoring. Availability of D2R- and D3R-related receptors was measured with [¹ ¹C]PHNO binding potentials (BPND) in the putamen and substantia nigra/ventral tegmental area (SN/VTA), respectively. Exploratory linear regression analyses using both D2R- and D3R-related receptor availability as independent variables were applied to 5-HT1BBPND in the medial orbitofrontal cortex (mOFC) and dorsomedial prefrontal cortex (dmPFC), with secondary analyses examining the same dopaminergic-serotonergic associations in additional addiction-related prefrontal regions. RESULTS:D2R-related receptor availability was positively associated with 5-HT1BBPND in the dmPFC (p = 0.038) but not in the mOFC (p = 0.945). Conversely, D3R-related receptor availability was positively associated with 5-HT1BBPND in the mOFC (p = 0.043) but not in the dmPFC (p = 0.850). Analyses of secondary 5-HT1B regions revealed a positive association between D3R-related receptor availability and 5-HT1BBPND in the lateral OFC (lOFC) (p = 0.050). CONCLUSIONS:In individuals with CUD, D2R- and D3R-related measures were associated with 5-HT1B binding in distinct prefrontal regions. These findings provide preliminary in vivo evidence of cross-system dopaminergic-serotonergic relationships and may inform future development efforts toward targeted treatments for CUD.
Preclinical experiments have revealed much about opioid withdrawal, but have failed to discover novel treatments. The preclinical literature is dominated by experiments examining naloxone-precipitated withdrawal from morphine in male rats. These studies report a number of putative treatments for opioid withdrawal, none of which have become clinically approved. A major problem, supported by both human and animal research, is that antagonist-precipitated withdrawal is distinct from the spontaneous opioid withdrawal experienced by most opioid users. A second problem is the widespread focus in animal research on somatic symptoms (e.g., wet dog shakes). Although somatic symptoms can be disruptive, anxiety, anhedonia, and aches are the symptoms that cause distress and drive relapse. Somatic symptoms are also problematic because they are easily suppressed by treatments that produce sedative or motor effects. A potential solution to these problems is the use of voluntary home cage wheel running as a more general measure of opioid withdrawal. Wheel running provides a continuous and objective measure ideal for assessing changes in the magnitude and duration of spontaneous withdrawal over time. The decrease in wheel running caused by opioid withdrawal changes the definition of an effective treatment from suppressing behavior (somatic symptoms) to restoring behavior (wheel running), thereby avoiding confounds produced by sedative or motor effects. This review provides a detailed analysis of rodent experiments on opioid withdrawal, highlighting potential problems with external validity and describing wheel running experiments that align animal experiments with the clinical manifestation of opioid withdrawal to enhance the development of novel treatments.
BACKGROUND:People taking medications for opioid use disorder (MOUD) commonly experience chronic pain. Yoga interventions show promise for decreasing pain-related disability in other populations. More time spent in yoga practice may improve pain-related outcomes. METHODS:The Multiphase Optimization Strategy (MOST) provided the framework for developing an optimized yoga intervention package. In a 2x2x2x2 factorial experiment, we evaluated four candidate intervention components which, when added to a weekly yoga class, might increase yoga engagement. The primary outcome was minutes per week of yoga practice (classes and other yoga practice) over the 12-week intervention period. We sought to determine which combination of intervention components was associated with the most yoga practice for people with chronic pain taking buprenorphine or methadone as MOUD. RESULTS:We enrolled 192 adults. There was a significant main effect for Component "B" (having two private sessions with a yoga teachers; IRR = 1.10, 90%CI 1.02; 1.18), and a synergistic interaction between Components "B" and "D" (D was financial incentives for attending class; IRR = 1.11, 90%CI 1.02; 1.19). This combination of these two components (without other potential components) was associated with the second highest model-predicted mean minutes of yoga per week (157.1min; 90% CI = 120.1-194.0) which was only 4min less than the combination including all four components. CONCLUSIONS:We identified a combination of intervention components as the optimized intervention. A next step will be to test the effect of this optimized intervention on pain and substance use outcomes in a randomized controlled clinical trial.
