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    Research News Roundup: July 20, 2023

    Journal: JAMA Network Open, 2023, doi: 10.1001/jamanetworkopen.2023.22303

    Authors: Tara Gomes, Shaleesa Ledlie, Mina Tadrous, Muhammad Mamdani, J. Michael Paterson, & David N. Juurlink


    Importance: Opioid-related harms constitute a major public health crisis in the US, and this crisis has worsened during the COVID-19 pandemic.

    Objectives: To characterize the societal burden of unintentional opioid-related deaths in the US and describe changing mortality patterns during the COVID-19 pandemic.

    Design, setting, and participants: A serial cross-sectional study examined all unintentional opioid-related deaths in the US, evaluated annually from calendar years 2011 to 2021.

    Main outcomes and measures: The public health burden of opioid toxicity-related deaths was estimated in 2 ways. First, the proportion of all deaths that were attributable to unintentional opioid toxicity by year (2011, 2013, 2015, 2017, 2019, and 2021) and age group (15-19, 20-29, 30-39, 40-49, 50-59, and 60-74 years) were calculated, using age-specific estimates of all-cause mortality as the denominator. Second, the total years of life lost (YLL) due to unintentional opioid toxicity was estimated, overall and by sex and age group, for each year studied.

    Results: Among the 422 605 unintentional deaths due to opioid toxicity between 2011 and 2021, the median age of the individuals was 39 (IQR, 30-51) years, and 69.7% were male. The number of unintentional deaths due to opioid toxicity increased 289% over the study period, from 19 395 (2011) to 75 477 (2021). Similarly, the percentage of all deaths that were attributed to opioid toxicity increased from 1.8% in 2011 to 4.5% in 2021. By 2021, opioid toxicity was responsible for 10.2% of all deaths among those aged 15 to 19 years, 21.7% of deaths among those aged 20 to 29 years, and 21.0% of deaths among those aged 30 to 39 years. The YLL due to opioid toxicity increased 276% over the study period, from 777 597 in 2011 to 2 922 497 in 2021. While YLL plateaued between 2017 (7.0 YLL per 1000) and 2019 (7.2 YLL per 1000), it increased by 62.9% between 2019 and 2021 coincident with the COVID-19 pandemic, reaching 11.7 YLL per 1000 population. This relative increase was similar across all age groups and sexes with the exception of those aged 15 to 19 years, in whom the YLL nearly tripled, from 1.5 to 3.9 YLL per 1000 population.

    Conclusions and relevance: In this cross-sectional study, deaths due to opioid toxicity increased substantially during the COVID-19 pandemic. By 2021, 1 of every 22 deaths in the US was attributable to unintentional opioid toxicity, underscoring the urgent need to support people at risk of substance-related harm, particularly men, younger adults, and adolescents.

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

    Youth Patterns of Use of Electronic Nicotine Delivery Systems (ENDS), Population Assessment of Tobacco and Health (PATH) Waves 4-5.5

    Journal: Addictive Behaviors, 2023, doi: 10.1016/j.addbeh.2023.107783

    Authors: Arielle Selya, Saul Shiffman, & Michael J. Hannon


    Introduction: Youth use of electronic nicotine delivery systems (ENDS) is a continuing concern, making it important to assess evolving patterns, especially as non-tobacco, non-menthol (NTM) flavors were withdrawn for pod-based (but not disposable) ENDS in February 2020.

    Methods: Trends in past-30-day (P30D) ENDS use and smoking prevalence, usual device type, flavor (tobacco, mint/menthol, or fruit/sweet/other), and regular/last-used brand in PATH Waves 4 (2017), 4.5 (2018), 5 (2019), and 5.5 (2020) were examined. Shifts between 2019 and 2020 in flavor use for pods and disposables were examined.

    Results: P30D ENDS use peaked in 2019 at 8.6 % of all youth, subsequently declining by nearly half to 4.5 % in 2020. Meanwhile, P30D cigarette smoking declined to an all-time low (1.3 %) in 2020. Within this overall decline, consumption shifted to disposable ENDS, which increased nearly 10-fold (from 5.0 % to 49.2 % of P30D ENDS users). Relatedly, use of fruit/sweet/other flavors remained similar overall between 2019 and 2020 (approximately 75-80 % of P30D ENDS users), but the use of these flavors became concentrated in disposable ENDS in 2020 (a 12-fold increase from 4.4 % to 58.4 % of fruit/sweet/other-flavor users).

    Conclusions: PATH results show similar trends to other US national surveys in youth ENDS trends. The removal of non-tobacco, non-menthol flavors in pod-based ENDS (while remaining available in disposables) has likely driven youth towards disposable devices, resulting in continued high use of fruit/sweet/other flavors, which are now predominant in users of disposable ENDS. Wave 5.5 is uninformative regarding brand use because common disposable brands were not queried.

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

    A Review of Social Media Platform Policies that Address Cannabis Promotion, Marketing and Sales

    Journal: Substance Abuse Treatment, Prevention & Policy, 2023, doi: 10.1186/s13011-023-00546-x

    Authors: Carla J. Berg, Cassidy R. LoParco, Yuxian Cui, Alexandria Pannell, Grace Kong, Lynniah Griffith, Katelyn F. Romm, … Patricia A. Cavazos-Rehg


    Background: Cannabis marketing exposure via social media may impact use in youth and young adults. Most states with recreational cannabis lack policies regarding social media-based marketing. Thus, we examined such policies among prominent platforms, particularly those popular among youth and young adults.

    Methods: In September-October 2022, 3 research team members extracted policies applying to the general community, advertising, and any specific content regarding drug-related content for 11 social media sites: Discord, Facebook, Instagram, Pinterest, Reddit, Snapchat, TikTok, Tumblr, Twitch, Twitter, and YouTube. Using inductive thematic analysis, they then dual-coded restrictions on cannabis-related content (e.g., paid advertising, unpaid promotion, sales). Descriptive analyses were conducted.

    Results: Ten (all except TikTok) referenced cannabis/marijuana, 7 (all except Discord, Instagram, TikTok, and YouTube) distinguished different cannabis-derived products, and 5 (Reddit, Snapchat, TikTok, Tumblr, Twitter) noted jurisdictional differences in cannabis regulations/legality. All prohibited sales, 9 (all except Snapchat and Tumblr) prohibited paid advertising, and 4 (Discord, Reddit, Snapchat, TikTok) prohibited unpaid promotion (e.g., user-generated content). All restricted underage access to cannabis-related content. However, policies varied and were ambiguous regarding how “promotion” was defined, whether/how jurisdictional differences in legality were addressed, how businesses may interact on social media, barriers implemented to inhibit the facilitation of sales, and enforcement protocols.

    Conclusions: Social media policies regarding cannabis marketing are ambiguous and may facilitate cannabis marketing, promotion, sales, and underage exposure, thus compounding concerns regarding insufficient governmental regulations. Greater specificity in social media cannabis-related policies and enforcement is needed.

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

    A Qualitative Examination of Social Identity and Stigma among Adolescents Recovering from Alcohol or Drug Use

    Journal: Addictive Behaviors Reports, 2023, doi: 10.1016/j.abrep.2023.100505

    Authors: Sophia H. Blyth, Kiefer Cowie, Jordan Jurinsky, & Emily A. Hennessy


    Introduction: Alcohol and other drug (AOD) use disorders are stigmatized conditions, but little is known about youth’s experience of this stigma, which may threaten their developing social identity and recovery process. This study investigates youth’s perceptions of AOD use-related stigma in the context of their social identity.

    Methods: This study uses data from 12 youth (ages 17–19) who were in recovery from problematic AOD use. Participants completed a Social Identity Mapping in Addiction Recovery (SIM-AR) exercise, in which they created a visual map of their social groups, and semi-structured interview, in which participants were asked about their experience creating their SIM-AR and reflections on their social network. SIM-AR data were descriptively analyzed, and interviews were thematically analyzed for instances of stigma.

    Results: Using stigmatizing terminology, participants expressed some stigmatizing attitudes towards themselves and others in their network who used substances and perceived both positive and negative reactions from those who knew about their disorder. Findings suggest that youth may experience some internalized stigma and perceive stigma from others in their social networks, which may be a barrier to the development of a healthy social identity and engagement in recovery supports.

    Conclusions: These findings should be considered when seeking to engage youth in treatment and recovery programming. Despite the small sample, the findings suggest the importance of considering how stigma may influence adolescents’ treatment and recovery experience in the context of their social environment.

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

    Cannabis Dispensary Staff Approaches to Counseling on Potential Contraindications to Cannabis Use: Insights from a National Self-Report Survey

    Journal: BMC Primary Care, 2023, doi: 10.1186/s12875-023-02095-5

    Authors: Deepika E. Slawek, Andrew D. Althouse, Robert Feldman, Julia H. Arnsten, Hailey W. Bulls, Jane M. Liebschutz, Shannon M. Nugent, …. Jessica S. Merlin


    Background: Legal cannabis is available in more than half of the United States. Health care professionals (HCPs) rarely give recommendations on dosing or safety of cannabis due to limits imposed by policy and lack of knowledge. Customer-facing cannabis dispensary staff, including clinicians (pharmacists, nurses, physician’s assistants), communicate these recommendations in the absence of HCP recommendations. Little is known about how dispensary staff approach individuals with complex medical and psychiatric comorbidities. Using responses from a national survey, we describe how cannabis dispensary staff counsel customers with medical and psychiatric comorbidities on cannabis use and examine whether state-specific cannabis policy is associated with advice given to customers.

    Methods: National, cross-sectional online survey study from February 13, 2020 to October 2, 2020 of dispensary staff at dispensaries that sell delta-9-tetrahydrocannabinol containing products. Measures include responses to survey questions about how they approach customers with medical and psychiatric comorbidities; state medicalization score (scale 0-100; higher score indicates more similarity to regulation of traditional pharmacies); legalized adult-use cannabis (yes/no). We conducted multiple mixed effects multivariable logistic regression analyses to understand relationships between state medicalization and dispensary employees’ perspectives.

    Results: Of 434 eligible respondents, most were budtenders (40%) or managers (32%), and a minority were clinicians (18%). State medicalization score was not associated with responses to most survey questions. It was associated with increased odds of encouraging customers with medical comorbidities to inform their traditional HCP of cannabis use (Odds ratio [OR]=1.2, 95% confidence interval [CI] 1.0-1.4, p=0.03) and reduced odds of recommending cannabis for individuals with cannabis use disorder (CUD) (OR=0.8, 95% CI 0.7-1.0, p=0.04). Working in a state with legalized adult-use cannabis was associated with recommending traditional health care instead of cannabis in those with serious mental illness (OR 2.2, 95% CI 1.1-4.7, p=0.04). Less than half of respondents believed they had encountered CUD (49%), and over a quarter did not believe cannabis is addictive (26%).

    Conclusions: When managing cannabis dosing and safety in customers with medical and psychiatric comorbidity, dispensary staff preferred involving individuals’ traditional HCPs. Dispensary staff were skeptical of cannabis being addictive. While state regulations of dispensaries may impact the products individuals have access to, they were not associated with recommendations that dispensary staff gave to customers. Alternative explanations for dispensary recommendations may include regional or store-level variation not captured in this analysis.

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