Research News Roundup: August 4, 2022

    Association of Postsurgical Opioid Refills for Patients with Risk of Opioid Misuse and Chronic Opioid Use among Family Members

    Journal: JAMA Network Open, 2022, doi: 10.1001/jamanetworkopen.2022.21316

    Authors: Denis Agniel, Gabriel A. Brat, Jayson S. Marwaha, Kathe Fox, Daniel Knecht, Harold L. Paz, Mark C. Bicket, Brian Yorkgitis, Nathan Palmer & Isaac Kohane


    Importance: The US health care system is experiencing a sharp increase in opioid-related adverse events and spending, and opioid overprescription may be a key factor in this crisis. Ambient opioid exposure within households is one of the known major dangers of overprescription.

    Objective: To quantify the association between the postsurgical initiation of prescription opioid use in opioid-naive patients and the subsequent prescription opioid misuse and chronic opioid use among opioid-naive family members.

    Design, setting, and participants: This cohort study was conducted using administrative data from the database of a US commercial insurance provider with more than 35 million covered individuals. Participants included pairs of patients who underwent surgery from January 1, 2008, to December 31, 2016, and their family members within the same household. Data were analyzed from January 1 to November 30, 2018.

    Exposures: Duration of opioid exposure and refills of opioid prescriptions received by patients after surgery.

    Main outcomes and measures: Risk of opioid misuse and chronic opioid use in family members were calculated using inverse probability weighted Cox proportional hazards regression models.

    Results: The final cohort included 843 531 pairs of patients and family members. Most pairs included female patients (445 456 [52.8%]) and male family members (442 992 [52.5%]), and a plurality of pairs included patients in the 45 to 54 years age group (249 369 [29.6%]) and family members in the 15 to 24 years age group (313 707 [37.2%]). A total of 3894 opioid misuse events (0.5%) and 7485 chronic opioid use events (0.9%) occurred in family members. In adjusted models, each additional opioid prescription refill for the patient was associated with a 19.2% (95% CI, 14.5%-24.0%) increase in hazard of opioid misuse in family members. The risk of opioid misuse appeared to increase only in households in which the patient obtained refills. Family members in households with any refill had a 32.9% (95% CI, 22.7%-43.8%) increased adjusted hazard of opioid misuse. When patients became chronic opioid users, the hazard ratio for opioid misuse among family members was 2.52 (95% CI, 1.68-3.80), and similar patterns were found for chronic opioid use.

    Conclusions and relevance: This cohort study found that opioid exposure was a household risk. Family members of a patient who received opioid prescription refills after surgery had an increased risk of opioid misuse and chronic opioid use.

    To read the full text of the article, please visit the publisher’s website.

    Cumulative Barriers to Retention in Methadone Treatment among Adults from Rural and Small Urban Communities

    Journal: Addiction Science & Clinical Practice, 2022, doi: 10.1186/s13722-022-00316-3

    Authors: Emily Pasman, Rachel Kollin, Michael Broman, Guijin Lee, Elizabeth Agius, Jamey J. Lister, Suzanne Brown & Stella M. Resko


    Background: Though methadone has been shown to effectively treat opioid use disorder, many barriers prevent individuals from accessing and maintaining treatment. Barriers are prevalent in less populated areas where treatment options are limited. This study examines barriers to retention in methadone treatment in a small Midwest community and identifies factors associated with greater endorsement of barriers.

    Methods: Patients at an opioid treatment program (N = 267) were recruited to complete a computer-based survey onsite. Surveys assessed demographics, opioid misuse, depression and anxiety symptoms, trauma history and symptoms, social support, and barriers to retention in treatment (e.g., childcare, work, housing, transportation, legal obligations, cost, health). Descriptive statistics were used to examine individual barriers and multiple regression was calculated to identify demographic and psychosocial factors associated with greater cumulative barriers.

    Results: Most participants reported at least one barrier to retention in treatment and more than half reported multiple barriers. Travel hardships and work conflicts were the most highly endorsed barriers. Past year return to use (B = 2.31, p = 0.004) and more severe mental health symptomology (B = 0.20, p = 0.038) were associated with greater cumulative barriers. Greater levels of social support were associated with fewer barriers (B = − 0.23, p < 0.001).

    Conclusion: This study adds to the limited research on barriers to retention in methadone treatment among patients in rural and small urban communities. Findings suggest flexible regulations for dispensing methadone, co-location or care coordination, and family or peer support programs may further reduce opioid use and related harms in small communities. Individuals with past year return to use reported a greater number of barriers, highlighting the time following return to use as critical for wraparound services and support. Those with co-occurring mental health issues may be vulnerable to poor treatment outcomes, as evidenced by greater endorsement of barriers. As social support emerged as a protective factor, efforts to strengthen informal support networks should be explored as adjunctive services to methadone treatment.

    To read the full text of the article, please visit the publisher’s website.

    Factors Associated with Prescription Opioid Abuse and Dependence among those Reporting Prescription Opioid Misuse: A Retrospective Cross-Sectional Study

    Journal: Pain Physician, 2022, Jul;25(4): E669-E679. PMID: 35793191

    Authors: A. Taylor Thomas, Kara G. Fields, Alan D. Kaye & Richard D. Urman


    Background: Prescription opioid misuse is an ongoing epidemic in the United States. Though the number of people misusing prescription opioids is declining, the prevalence of abuse and dependence remains stable. This highlights the need to identify and intervene in factors leading to the escalation of prescription opioid misuse.

    Objectives: The aim of this study was to explore the association of prescription opioid-specific misuse factors such as pill source, misuse motivation, and misuse habits with abuse and dependence.

    Study design: A retrospective cross-sectional study.

    Setting: Participants in the 2015 to 2018 National Survey on Drug Use and Health (NSDUH) reporting prescription opioid misuse in the past 12 months.

    Methods: Simple and multivariable logistic regression were used to estimate the association of prescription opioid-specific misuse factors with prescription opioid abuse and dependence, which were determined by participant responses to screening questions according to DSM-IV criteria.

    Results: After multivariable adjustment, prescription opioid abuse was associated with use in greater amounts than prescribed and misuse for 3-19 days in the past month, whereas dependence was associated with use in greater amounts and more often than prescribed, and misuse for 6 or more days in the past month. Initiating misuse in the past year and misuse without one’s own prescription in the past year were associated with lower odds of opioid dependence.

    Limitations: Only associations and not causal relationships can be claimed between the factors and outcomes. Second, the survey relies on self-reported data, and there is likely both underreporting and overreporting, leading to bias towards the null. The survey target population was civilian, so it excluded individuals living in institutional group quarters such as hospitals, treatment facilities, nursing homes, and prisons. This study does not differentiate between prescription opioids used for acute versus chronic pain.

    Conclusions: Study results suggest the importance of the frequency of prescription opioid misuse as a possible risk factor for dependence and emphasize the need to monitor for misuse even in instances of acute pain.

    To read the full text of the article, please visit the publisher’s website.

    Association between Family or Peer Views towards Tobacco Use and Past 30-Day Smoking Cessation among Adults with Mental Health Problems

    Journal: Preventive Medicine Reports, 2022, doi: 10.1016/j.pmedr.2022.101886

    Authors: Catherine S. Nagawa, Lori Pbert, Bo Wang, Sarah L. Cutrona, Maryann Davis, Stephenie C. Lemon & Rajani S. Sadasivam


    Adults with mental health problems have a higher prevalence of cigarette smoking. We examined the association between family or peer views towards tobacco use and past 30-day cessation among adult with mental health conditions who smoke.

    We used nationally representative data from the Population Assessment of Tobacco and Health Study. We included individuals who currently smoked and reported mental health symptoms over the past year (n = 4201). We used the Global Appraisal of Individual Needs Short Screener questionnaire to assess mental health conditions. Logistic regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (95%CI) in the association between family and peer views towards tobacco use and past 30-day smoking cessation.

    Compared to participants who had family or peers with negative views towards tobacco use, those with family or peers with neutral or positive views were 32% less likely (adjusted OR: 0.68, 95%CI: 0.51 – 0.93) to report past 30-day smoking cessation. The association between family/peer views towards tobacco use and smoking cessation was statisitcally significant for individuals with symptoms on the both internalizing and externalizing sub-scales (adjusted OR: 0.62, 95%CI: 0.42 – 0.92), but not for those reporting symptoms on a single sub scale.

    Our findings suggest that having family members or peers who hold neutral or positive views towards tobacco use may deter cessation efforts of people with mental health conditions who smoke. Efforts to modify these views are needed to improve quit rates in people with mental health conditions who smoke.

    To read the full text of the article, please visit the publisher’s website.

    Cannabinoid Content and Label Accuracy of Hemp-Derived Topical Products Available Online and at National Retail Stores

    Journal: JAMA Network Open, 2022, doi: 10.1001/jamanetworkopen.2022.23019

    Authors: Tory R. Spindle, Dennis J. Sholler, Edward J. Cone, Timothy P. Murphy, Mahmoud El Sohly, Ruth E. Winecker, Ronald R. Flegel, Marcel O. Bonn-Miller & Ryan Vandrey


    Importance: Products containing cannabinoids such as cannabidiol (CBD) have proliferated since 2018, when the Agriculture Improvement Act removed hemp (ie, cannabis containing <0.3% Δ9-tetrahydrocannabinol [THC]) from the US controlled substances list. Topical cannabinoid products can be purchased nationwide at retail stores and over the internet, yet research on these products is scarce.

    Objective: To evaluate the cannabinoid content (ie, CBD and THC) and label accuracy of topical cannabinoid products and to quantify their therapeutic and nontherapeutic claims.

    Design, setting, and participants: Product inclusion criteria included designation as hemp products, intended for topical or transdermal application, and purported to contain cannabinoids (eg, CBD). All unique products available at each retail store were purchased. Online products were identified via Google using relevant keywords (eg, hemp or CBD topical). Various products (eg, lotions and patches) were purchased from retail stores (eg, pharmacies, grocery stores, and cosmetic or beauty stores) in Baltimore, Maryland, and online. Data analysis was performed from March to June 2022.

    Main outcomes and measures: Labeled and actual total amounts of CBD and THC, measured via gas chromatography-mass spectrometry. Therapeutic and nontherapeutic claims and references to the US Food and Drug Administration were quantified.

    Results: A total of 105 products were purchased, 45 from retail locations and 60 online. Of the 89 products that listed a total amount of CBD on the label, 18% (16 products) were overlabeled (ie, contained >10% less CBD than advertised), 58% (52 products) were underlabeled (ie, contained >10% more CBD than advertised), and 24% (21 products) were accurately labeled. The median (range) percentage deviation between the actual total amount of CBD and the labeled amount was 21% (-75% to 93%) for in-store products and 10% (-96% to 121%) for online products, indicating that products contained more CBD than advertised overall. THC was detected in 37 of 105 products (35%), although all contained less than 0.3% THC. Among the 37 THC-containing products, 4 (11%) were labeled as THC free, 14 (38%) indicated they contained less than 0.3% THC, and 19 (51%) did not reference THC on the label. Overall, 28% of products (29 products) made therapeutic claims, 14% (15 products) made cosmetic claims, and only 47% (49 products) noted that they were not Food and Drug Administration approved.

    Conclusions and relevance: In a case series of topical cannabinoid products purchased online and at popular retail stores, products were often inaccurately labeled for CBD and many contained THC. These findings suggest that clinical studies are needed to determine whether topical cannabinoid products with THC can produce psychoactive effects or positive drug tests for cannabis.

    To read the full text of the article, please visit the publisher’s website.


    August 2022