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    Research News Roundup: July 15, 2021

    Pills to Powder: A 17-Year Transition from Prescription Opioids to Heroin among US Adolescents Followed into Adulthood

    Journal: Journal of Addiction Medicine, 2021, doi: 10.1097/ADM.0000000000000741

    Authors: Sean Esteban McCabe, Carol J Boyd, Rebecca J Evans-Polce, Vita V McCabe, John E Schulenberg & Philip T.Veliz

    Objectives: To examine the longitudinal relationships between US adolescents’ prescription opioid use and misuse and any subsequent heroin use in adulthood.

    Methods: Nationally representative samples of adolescents from 25 independent cohorts were surveyed via self-administered questionnaires and followed from ages 18 to 35 (n = 11,012). Adolescents were divided into 5 subgroups based on survey responses at age 18: no lifetime exposure to prescription opioids (population controls), medical prescription opioid use without a history of nonmedical misuse (medical use only), medical use followed by nonmedical misuse, nonmedical misuse followed by medical use, and nonmedical misuse only. These 5 subgroups were compared on their risk for any heroin use through age 35 (1993–2017). Adolescents who reported lifetime heroin use at age 18 were excluded.

    Results: Adolescents who reported nonmedical prescription opioid misuse followed by medical use or nonmedical misuse only had greater odds of any heroin use in adulthood than population controls. More recent cohorts of adolescents who reported nonmedical misuse or medical use only (compared to older cohorts) had greater odds of any heroin use in adulthood relative to population controls. Nearly 1 in 3 adolescents in recent cohorts who reported nonmedical prescription opioid misuse transitioned to any heroin use.
    Conclusions: There is increased risk for heroin use among adolescents who initiated nonmedical misuse or adolescents prescribed opioids in more recent cohorts. These findings indicate historical variation and reinforce the critical role of vigilant monitoring and drug screening to detect high-risk individuals who would benefit from an intervention to reduce later heroin use.

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

    The Role of Social Isolation in Opioid Addiction

    Journal: Social Cognitive and Affective Neuroscience, 2021, doi: 10.1093/scan/nsab029

    Author: Nina C Christie

    Abstract: Humans are social animals: social isolation hurts people both psychologically and physically. Strong, positive social bonds help people to live longer and healthier lives compared with their more isolated peers. Opioid use disorder is associated with feelings of social isolation, an increased risk of suicide and, at the community level, lower social capital. I propose a psychobiological mechanistic explanation that contributes to the association between opioid use and social isolation. The endogenous opioid system plays a central role in the formation and maintenance of social bonds across the life span and has been investigated primarily through the framework of the brain opioid theory of social attachment. In primates, maternal-infant bonding and social play are both impaired by the administration of naltrexone (an opioid antagonist), and in humans, the chronic use of opioids appears to be particularly (relative to other drugs) corrosive to close relationships. Social isolation may play a role in the development and exacerbation of opioid use disorder. Taken together, work on the brain’s opioid system suggests a possible mechanistic basis for bidirectional causal links between social isolation and opioid use disorder. Evaluation of this hypothesis would benefit from longitudinal psychosocial and neuropsychopharmacological investigations.

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

    Patterns of Combustible and Electronic Cigarette Use during Pregnancy and Associated Pregnancy Outcomes

    Journal: Scientific Reports, 2021, doi: 10.1038/s41598-021-92930-5

    Authors: Annette K Regan & Gavin Pereira

    Abstract: Although pregnant smokers may perceive electronic cigarettes (e-cigarettes) as safe alternatives to smoking combustible cigarettes, few studies have evaluated perinatal e-cigarette use and its associated health effects. We analyzed data from the Pregnancy Risk Assessment Monitoring System (PRAMS, 2016–2018) for 16,022 women who recently gave birth and reported smoking combustible cigarettes prior to pregnancy. Using average marginal predictive values from multivariable logistic regression to produce adjusted prevalence ratios (aPRs), we estimated the prevalence of combustible cigarette smoking during pregnancy and adverse birth outcomes associated with e-cigarette use. In total, 14.8% of smoking women reported using e-cigarettes prior to pregnancy. There was no association between e-cigarette use prior to pregnancy and combustible cigarette smoking during pregnancy (aPR 0.95; 95% CI 0.88, 1.02); however, e-cigarette use during pregnancy was associated with higher prevalence of combustible cigarette smoking during pregnancy (aPR 1.65; 95% CI 1.52, 1.80). In this sample, we did not observe evidence to support reduced risk of preterm birth, small-for-gestational age and low birthweight compared to combustible cigarette smoking during pregnancy. The prevalence of LBW was higher for those who used e-cigarettes, even exclusively, compared to women who quit smoking cigarettes entirely. These results suggest that e-cigarettes should not be considered a safe alternative to combustible cigarette smoking during pregnancy.

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

    Brief Original Report: Does Smoking Status Provide Information Relevant to Screening for other Substance Use among US Adults?

    Journal: Preventive Medicine Reports, 2021, doi: 10.1016/j.pmedr.2021.101483

    Authors: Maria R Khan, Kaoon Bana, Ellen C Caniglia, Jennifer E Edelman, Julie Gaither, Stephen Crystal, Natalie E Chichetto, Kailyn E Young, Janet Tate, Amy C. Justice & R. Scott Braithwaite

    Abstract: We assessed whether tobacco screening provides clinically meaningful information about other substance use, including alcohol and other drug use, potentially facilitating targeting of screening for substance use. Using data from the Veterans Aging Cohort Study survey sample (VACS; N = 7510), we calculated test performance characteristics of tobacco use screening results for identification of other substance use including sensitivity, specificity, positive-likelihood-ratio (+LR = [sensitivity/(1-specificity)]: increase in odds of substance use informed by a positive tobacco screen), and negative-likelihood-ratio (-LR: [(1-sensitivity)/specificity]: reduction in odds of substance use informed by a negative tobacco screen). The sample was 95% male, 75% minority, and 43% were current and 33% were former smokers. Never smoking, versus any history, indicated an approximate four-fold decrease in the odds of injection drug use (-LR = 0.26), an approximate 2.5-fold decrease in crack/cocaine (-LR = 0.35) and unhealthy alcohol use (-LR = 0.40), an approximate two-fold decrease in marijuana (-LR = 0.51) and illicit opioid use (-LR = 0.48), and an approximate 30% decrease in non-crack/cocaine stimulant use (-LR = 0.75). Never smoking yielded more information than current non-smoking (never/former smoking). Positive results on tobacco screening were less informative than negative results; current smoking, versus former/never smoking, provided more information than lifetime smoking and was associated with a 40% increase in the odds of non-crack/cocaine stimulant use (+LR = 1.40) and opioid use (+LR = 1.44), 50% increase in marijuana use (+LR = 1.52) and injection drug use (+LR = 1.55), and an 80–90% increase in crack/cocaine use (+LR = 1.93) and unhealthy alcohol use (+LR = 1.75). When comprehensive screening for substance use is not possible, tobacco screening may inform decisions about targeting substance use screening.

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

    Race/Ethnicity Differences in Risk and Protective Factors for Marijuana use among U.S. Adolescents

    Journal: BMC Public Health, 2021, doi: doi: 10.1186/s12889-021-11159-z

    Author: Meen Hye Lee, Yeoun Soo Kim-Godwin & Hyungjo Hur

    Background: Little is known about how race and ethnicity influence marijuana-specific risk and protective factors in U.S. adolescents. We examined differences in risk and protective factors of marijuana use (MU) and their associations with MU by race/ethnicity.

    Methods: The present study used data from the 2015–2019 National Survey on Drug Use and Health. A total of 68,263 adolescents (aged 12 to 17 years) were divided into seven subgroups by race/ethnicity (White, Hispanic, Black, Asian, Native American, Native Hawaiian/Pacific Islander (NH/PI), and mixed race). Marijuana-specific risk and protective factors (RPFs) were examined, including perceived availability of marijuana, adolescents’ perceived risk of MU and perceived disapproval of parents, peers, and close friends. Past-month, past-year, and lifetime MU were used as MU outcomes to examine the associations with RPFs as well as with race/ethnicity.

    Results: Overall, 6.85, 12.67, and 15.52% of the sample reported past-month, past-year, and lifetime MU respectively. Weighted adjusted logistic regression analyses revealed that mixed race adolescents reported the greatest perceived availability of marijuana, whereas Black and Asian adolescents had less access compared to White adolescents. The adolescents’ perception of parental disapproval of MU was the lowest for Native American adolescents and highest for Asian adolescents. Mixed race adolescents experienced lower peer and close friend disapproval of MU while Black and Asian adolescents had higher. The MU risk perception was lower in most groups including Black, Hispanic, Native American, and mixed race adolescents, but not in Asian adolescents. Native American adolescents scored the highest on all MU outcomes, whereas Asian adolescents scored the lowest. Perceived availability of marijuana was associated with higher MU in all MU outcomes. Lower disapproval MU perceptions and lower MU risk perceptions were also associated with greater MU.

    Conclusion: These findings suggest there is considerable heterogeneity of marijuana risk and protective factors and MU across race/ethnicity among U.S. adolescents.

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


    July 2021