Opioid use continues to represent a significant public health problem in the United States, as well as globally. The opioid epidemic has motivated advances in the effective treatment of opioid use disorder (OUD), with a particular focus on medications for OUD (MOUD), including methadone, buprenorphine, and naltrexone. Although these medications are remarkably effective, MOUD expansion initiatives alone have not been sufficient to combat the opioid epidemic. Further, critical questions remain regarding the effectiveness of these medications for individuals who initiate opioid use under age 16. Key strategies to combat the opioid epidemic, including MOUD and naloxone distribution, target intervention for individuals who have already developed an OUD. Like every other health problem, shifting attention earlier in the etiological process can lend itself to a more cost-effective approach by preventing the onset of behaviors that contribute to subsequent increases in morbidity and mortality. Therefore, we argue that targeted interventions for adolescents with substance use problems, including for non-opioid drugs (i.e., cannabis, alcohol), is critical to prevent the onset of OUD and turn the tide of the opioid overdose epidemic. In line with this call to action to move toward earlier intervention as a public health strategy, we propose several concrete recommendations. These include use of universal screening and prevention strategies for teens, an enhanced focus on addressing mental health (i.e., depression, trauma-related anxiety) and ecological (i.e., low caregiver monitoring, affiliating with substance using peers) precursors of substance use initiation in adolescents, a significant restructuring of resource allocation to more effectively and equitably address youth substance use and mental health problems, and continuous efforts dedicated to the de-stigmatization of the disease of substance use disorders.
Background: Rural hospitals and patient population tend to be medically underserved. The states with more rural population dispensed the most opioids per person in the last 10 years. We aimed to explore if rurality contributed to the likelihood of higher opioid adversity and how it affected substance-use rehabilitation in federally designated Medically Underserved Areas (MUAs). Methods: We analyzed data dispensed by the South Dakota Department of Health (DOH) on opioid-led poisoning International Classification of Disease (ICD) codes that were active within the state in the last decade. After locating MUA rural and partially rural counties, we cross profiled the counties to the state datasets. Assessments were conducted using the PROC SURVEY methods in SAS version 9.3 (SAS Institute) and checked for multicollinearity with the Belsley-Kuh-Welsch technique. Finally, we used the American Hospital Association (AHA) database for analyzing substance use rehabilitation availability on per hospital basis. Results: The chi-square statistic for comparing opioid codes against non-opioid codes distributed among three categories, rural, non-rural, and partially rural was significant at the limit of p <0.05. 81.134% of opioid-led poisoning codes were activated in a rural county. Only four hospitals had substance-use rehabilitation, three of which were in a non-rural area. More people from the teenage and early-adulthood years (10–19) were prone to opioid usage. Conclusions: Rural counties in South Dakota were more likely to dispense opioid care and not have access to rehabilitation. We also found that as the opioid dispensing rate at hospitals within a state decreased as the state had less rural counties. Introducing public programs to train more physicians and cutting down cost of non-opioid based care may lower opioid distribution and increase rehabilitation options in rural hospitals.
Objective:Resting state functional magnetic resonance imaging (fMRI) functional connectivity has been used as a tool to study brain mechanisms associated with addictions. Recent research in substance use disorders has focused on three brain networks termed the default mode network (DMN), salience network (SN), and executive control network (ECN). The purpose of this study was to examine the functional connectivity of those three networks in opioid use disorder (OUD) subjects compared to healthy control subjects (HC).Methods:The present study investigated functional connectivity differences between OUD subjects compared to HC using independent component analysis. This study also examined the relationship between functional connectivity and negative urgency scores, as well as compared the functional connectivity of severe OUD to mild or moderate OUD.Results:In OUD subjects (n=25) compared to HC (n=25), a cluster in the left dorsolateral prefrontal cortex within the left ECN had significantly weaker functional connectivity. No significant differences were found between groups for the functional connectivity of the DMN, SN, or right ECN. No significant associations were found between functional connectivity and negative urgency, and no differences were found between severe OUD and mild or moderate OUD.Conclusion:These novel preliminary results suggest that ECN functional connectivity may differ between OUD and HC. This finding is consistent with previous research showing altered executive function in OUD and supports further examination of ECN functional connectivity in association with treatment response in OUD. Given our relatively small sample size (50 subjects total; 25 subjects per group), our results should be treated as preliminary for hypothesis generation, and replication will be needed in future studies.
Introduction Smokers receiving mental health care are particularly in need of tailored interventions. Objective Study of patients enrolled in a specialized smoking cessation program based upon a 26-hour smoking abstinence period aimed better understanding of self-efficacy for smoking cessation and of the decision to quit. Methods A logistic regression predicting success/failure of abstinence included different variables. Self-efficacy for temporary abstaining from smoking (TASE) and for permanent quitting (QSE) were distinguished. Results In 174 subjects enrolled at baseline, TASE was the only predictor of successful abstinence (OR=1.43; p=.001). Assessment of 138 subjects present 1 week after intervention showed increases in TASE and QSE (median TASE from 8 to 10, p<.0001; median QSE from 8 to 9, p=.02). In subgroups of successful abstainers and of those engaging into smoking cessation, only TASE increased. Interestingly, for subjects who had planned a quit attempt already before the intervention, 52% were still abstinent at 1 week vs. 87% of those who decided to quit during the intervention (p=.02). Conclusion A multicomponent program for all smokers can be a powerful method to increase self-efficacy, in particular for temporary smoking abstinence, and trigger unplanned quit attempts, shown here to be more successful than planned attempts.
Alcohol is the psychoactive substance most consumed worldwide, young people are the age group with the highest consumption rate in the country and the entrance to the university is considered a risk factor for the intake of alcohol. About 92.7% of the interviewees use the substance. The objective of this study is to assess the frequency of alcohol consumption of students at the University Center. Questionnaires were distributed to students of Agronomy, Law, Civil Engineering and Veterinary Medicine. The results showed that the consumption of this substance in the past month was observed in 80.0% of the sample, 70.0% of students drink on weekends and 27.0% on weekday. The standard
Introduction: Alcohol use disorder is a common mental disorder that is associated with substantial disease burden around the world. Globally alcohol consumption caused 3.8 percent of all deaths and 4.5 percent of the total burden of disease in 2004. Alcohol use disorder is also a burden for individuals and society in Ethiopia. It is important to identify problematic alcohol use at an early stage, as this provides professionals with the opportunity to take preventive measures and hence, reduce the problems caused by this consumption.Objective: Assessment of the prevalence and determinants of alcohol use disorder among residents of Agaro town, Jimma, Southwest Ethiopia, 2016.Method: Community based cross-sectional study was conducted from May-June 2016 among 845 residents living in Agaro town. Multistage sampling technique was used to select study participants and assessed for alcohol use disorder using self-reported questionnaire (AUDIT). The collected data was coded, entered in to EPI-INFO 7 software and analyzed by using SPSS version 20. Logistic regression analyses were computed to determine the association between factors and alcohol use disorder.Results: With 96.9% of response rate the prevalence of alcohol use disorder was found to be 12.4% with 95% confidence interval (9.3%, 15.8%). The likelihood of alcohol use disorder was higher in males (AOR=4.0 (1.58, 10.49). Also, high level mental distress (AOR=3.8 (1.35, 10.67)), Family history of alcohol use (AOR=3.4 (1.32, 9.17) and smoking cigarette (AOR=4 (1.26, 12.03)) were factors significantly associated with alcohol use disorder in Agaro town.Conclusion: This study had showed that the prevalence of alcohol use disorder among urban resident of Agro town were significant public health issues that require a great emphasis. This study indicates that alcohol use disorder goes along with use of other substances. Being male sex, family history of alcohol use disorder, history of cigarette smoking and having mental distress symptoms were significantly associated with alcohol use disorder.
Nicotine exerts its reinforcing actions via activating the nicotinic acetylcholine receptors (nAChRs). Among an increasing number of nAChR subtypes, the α4β2 and α7 nAChRs are the two major ones, accounting for about 95% of the whole nAChR population in brain. Research findings from our own laboratory, together with other reports in the field, suggest critical and differential involvement of the α4β2 and α7 nAChRs in the process of nicotine dependence and tobacco addiction. Specifically, rat models of nicotine consumption and cue-induced relapse were used to examine the effects of selective antagonism of these two nAChR subtypes on the primary reinforcement of nicotine and the conditioned reinforcing actions of nicotine-associated environmental stimuli (cues). Results demonstrated that blockade of the α4β2 but not α7 subtype effectively reduced nicotine intake, whereas α7 but not α4β2 nAChR blockade reversed cue-triggered nicotine relapse behavior. These findings lend support for the continued effort to develop cholinergic agents aiming at the α4β2 nAChRs for reducing or stopping smoking. However, it is suggested that manipulation of α7 nAChR activity would be a promising target for preventing smoking relapse triggered by exposure to environmental cues.
Factors determining heroin addiction treatment outcome have not been studied extensively despite the practical and theoretical significance. It is uncertain whether we are able to predict the odds of sustained heroin abstinence and affect the factors that increase the likelihood of the recovery. This study aimed to identify factors that either individually or in synergy support the sustained multiannual abstinence. Method: In this translational am bidirectional cohort study, we evaluated two groups of heroin addicts that underwent the same therapeutic procedures with different outcomes (133 abstainers and 56 relapses) using the nonstandardized questionnaire to study: The history of addiction, motivation for the treatment, parental attitudes and control, job satisfaction, social and emotional relationships, alternative satisfactions, use of other substances during treatment and treatment characteristics. The chi square analysis was used to determine specific significant factors that act individually. The binary logistic regression provided a mathematical model of the synergistic effect of significant factors. Result: The study found a new variable, an abstinence marker, defined by the synergistic effect of the following factors: Use of tramadol before treatment (p=0.011), non-use of Benzodiazepines (p=0.001), length of Naltrexone use (p??0.0005), non-use of Cannabis (p=0.002), non-compulsive exercise (p=0.009) and employment and job satisfaction (p??0.0005) during recovery. Conclusion: This study reports a mathematical model that predicts multiannual sustained abstinence as an outcome of heroin addiction treatment.
Recently there has been epidemic of Opioid Use Disorders in certain parts of world and hence the mortality associated with Opioid overdose. Different studies show that Opioid overdose is generally witnessed; death takes a while and is generally due to respiratory failure Addiction is a chronic relapsing disorder where even a recovering patient can relapse anytime and die of Opioid overdose. Considering the fact that a large number of OUD patients come to addiction specialist for treatment, these physicians can play a major role in reducing the mortality of OUD by educating the patients and their Significant Others against Opioid overdose and prescribing Naloxone to them in addition to other addiction medicines. They can keep Naloxone at a safe place and use it in case they witness an Opioid overdose and save a life. Naloxone a pure Opioid antagonist is very safe, reliable, cheap, easily available and fast acting drug . Naloxone causes reversal of sedation and respiratory depression associated with Opioid Overdose within minutes and it has no side effect of its own even in higher doses. Recently newer preparation of Naloxone in form of Nasal Spray (Narcan) has been approved by FDA to prevent overdose deaths In some developed countries Naloxone Dispensing program is being practiced widely and they have been able to minimize the mortality associated with Opioid overdose. Also there is Good Samaritan law being implemented in these countries where even a layman can give Naloxone in case of witnessed Opioid overdose. Unfortunately in certain parts of world including India there is yet no hold of OEND even in tertiary health care centres
The current study tested the association of number of children and the age at which parents sought treatment for alcohol dependence for the first time in the life. From the sample of 1,316 patients 1,109 were included for analysis. The mean age was 44 (SD ± 12.6) years; 71% were males. Their histories were retrospectively reviewed for the descriptive study that focused on the number of children at the first time of patient entry into a specialized health facility for alcohol dependence treatment. The data were subjected to one-way analysis of variance (ANOVA). The results showed that a higher mean age of the patients at the time when they were for the first time seeking treatment for the problems diagnosed as alcohol dependence was associated in both sexes with having more children: male and female patients without children, 36 (SD ± 11.8) and 35 (SD ± 10.0) years, respectively; male and female patients with one child, 44 (SD ± 11.7) and 43 (SD ± 10.8) years; with two children, 50 (SD ± 10.1) and 50 (SD ± 9.5) years, respectively; with three and more children, 50 (SD ± 10.3) and 51 (SD ± 10.8) years. The association between number of children and age at treatment was statistically significant (p ≤ 0.000). Conversely, there were no significant differences between female and male patients. Parents with more children tended to seek the first treatment for alcohol use problems diagnosed as dependence later, than those with one child or those who were childless.
