Research News Roundup: March 3, 2022

    Journal: BMC Emergency Medicine, 2022, doi: 10.1186/s12873-022-00573-0

    Authors: Leslie W. Suen, Thibaut Davy-Mendez, Kathy T. LeSaint, Elise D. Riley & Phillip O. Coffin


    Background: Drug-related emergency department (ED) visits are escalating, especially for stimulant use (i.e., cocaine and psychostimulants such as methamphetamine). We sought to characterize rates, presentation, and management of ED visits related to cocaine and psychostimulant use, compared to opioid use, in the United States (US).

    Methods: We used 2008–2018 National Hospital Ambulatory Medical Care Survey data to identify a nationally representative sample of ED visits related to cocaine and psychostimulant use, with opioids as the comparator. To make visits mutually exclusive for analysis, we excluded visits related to 2 or more of the three possible drug categories. We estimated annual rate trends using unadjusted Poisson regression; described demographics, presenting concerns, and management; and determined associations between drug-type and presenting concerns (categorized as psychiatric, neurologic, cardiopulmonary, and drug toxicity/withdrawal) using logistic regression, adjusting for age, sex, race/ethnicity, and homelessness.

    Results: Cocaine-related ED visits did not significantly increase, while psychostimulant-related ED visits increased from 2008 to 2018 (2.2 visits per 10,000 population to 12.9 visits per 10,000 population; p < 0.001). Cocaine-related ED visits had higher usage of cardiac testing, while psychostimulant-related ED visits had higher usage of chemical restraints than opioid-related ED visits. Cocaine- and psychostimulant-related ED visits had greater odds of presenting with cardiopulmonary concerns (cocaine adjusted odds ratio [aOR] 2.95, 95% CI 1.70–5.13; psychostimulant aOR 2.46, 95% CI 1.42–4.26), while psychostimulant-related visits had greater odds of presenting with psychiatric concerns (aOR 2.69, 95% CI 1.83–3.95) and lower odds of presenting with drug toxicity/withdrawal concerns (aOR 0.47, 95%CI 0.30–0.73) compared to opioid-related ED visits.

    Conclusion: Presentations for stimulant-related ED visits differ from opioid-related ED visits: compared to opioids, ED presentations related to cocaine and psychostimulants are less often identified as related to drug toxicity/withdrawal and more often require interventions to address acute cardiopulmonary and psychiatric complications.

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

    How Academic Medicine Can Help Confront the Opioid Crisis

    Journal: Academic Medicine, 2022, doi: 10.1097/ACM.0000000000004289

    Authors: Nora Volkow, Tom McLellan & Carlos Blanco


    The United States is in the midst of a devastating overdose and addiction crisis involving opioids as well as other drugs. Yet, despite the existence of effective treatments for opioid use disorder, only a minority of people who need treatment for this or other substance use disorders receive it. Besides the terrible human and economic costs of overdose deaths and the other health consequences of addiction, untreated substance use has wide-ranging impacts across health care. Academic medicine can help address this crisis by increasing the preparedness of the current and future clinical workforce to detect and treat substance misuse and addiction through increased attention to these topics in medical and nursing schools and in residency programs. In this commentary, the authors explore the barriers to treatment for substance misuse and addiction and the role of academic medicine in improving treatment outcomes through training, clinical care, health service delivery, and research.

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

    The Impact of the COVID-19 Pandemic on Drug Use Behaviors, Fentanyl Exposure, and Harm Reduction Service Support among People who Use Drugs in Rural Settings

    Journal: International Journal of Environmental Research and Public Health, 2022, doi: 10.3390/ijerph19042230

    Authors: Rebecca S. Bolinski, Suzan Walters, Elizabeth Salisbury-Afshar, Lawrence J. Ouellet, Wiley D. Jenkins, Ellen Almirol, Brent Van Ham, Scott Fletcher, Christian Johnson, John A. Schneider, Danielle Ompad & Mai T. Pho


    Background: The COVID-19 pandemic has worsened the opioid overdose crisis in the US. Rural communities have been disproportionately affected by opioid use and people who use drugs in these settings may be acutely vulnerable to pandemic-related disruptions due to high rates of poverty, social isolation, and pervasive resource limitations.

    Methods: We performed a mixed-methods study to assess the impact of the pandemic in a convenience sample of people who use drugs in rural Illinois. We conducted 50 surveys capturing demographics, drug availability, drug use, sharing practices, and mental health symptoms. In total, 19 qualitative interviews were performed to further explore COVID-19 knowledge, impact on personal and community life, drug acquisition and use, overdose, and protective substance use adaptations.

    Result: Drug use increased during the pandemic, including the use of fentanyl products such as gel encapsulated “beans” and “buttons”. Disruptions in supply, including the decreased availability of heroin, increased methamphetamine costs and a concomitant rise in local methamphetamine production, and possible fentanyl contamination of methamphetamine was reported. Participants reported increased drug use alone, experience and/or witness of overdose, depression, anxiety, and loneliness. Consistent access to harm reduction services, including naloxone and fentanyl test strips, was highlighted as a source of hope and community resiliency.

    Conclusions: The COVID-19 pandemic period was characterized by changing drug availability, increased overdose risk, and other drug-related harms faced by people who use drugs in rural areas. Our findings emphasize the importance of ensuring access to harm reduction services, including overdose prevention and drug checking for this vulnerable population.

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

    College Student E-Cigarette Users’ Knowledge about E-Cigarettes: Ingredients, Health Risks, Device Modifications, and Information Sources

    Journal: International Journal of Environmental Research and Public Health, 2022, doi: 10.3390/ijerph19041962

    Authors: Alison C. McLeish, Joy L. Hart & Kandi L. Walker


    Although college students represent a growing demographic of e-cigarette users, it is unclear how knowledgeable they are about the product they use. The lack of such knowledge could result in unsafe practices and greater health risks. Therefore, the purpose of the current study was to examine college student e-cigarette users’ knowledge about e-cigarette ingredients and health risks, how often they modify their devices, and whether they utilize reputable sources when searching for information regarding e-cigarettes. The participants were 183 undergraduate e-cigarette users (Mage = 19.98, SD = 1.98; 71.6% female; 85.8% White). Most participants correctly recognized that e-cigarettes increase the risk of cardiovascular disease and lung disease, but fewer than half recognized the increased risk of seizures and depression. Only one-third to one-half of participants correctly identified the toxic compounds commonly found in e-cigarettes, and most indicated that they would consult Google or a friend with questions about e-cigarettes. College student e-cigarette users are well-informed about many health risks associated with e-cigarettes. However, they are relatively unaware of the harmful substances in e-cigarettes and are seeking information from less reliable sources. Targeted public health campaigns educating college students about e-cigarettes, including where to seek reliable information, are needed.

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

    Association between Assistance with Medicaid Enrollment and Use of Health Care after Incarceration among Adults with a History of Substance Use

    Journal: JAMA Network Open, 2022, doi: 10.1001/jamanetworkopen.2021.42688

    Authors: Marguerite E. Burns, Steven Cook, Lars M. Brown, Laura Dague, Steve Tyska, Karla Hernandez Romero, Cici McNamara & Ryan P. Westergaard


    Importance: The transition from prison to community is characterized by elevated morbidity and mortality, particularly owing to drug overdose. However, most formerly incarcerated adults with substance use disorders do not use any health care, including treatment for substance use disorders, during the initial months after incarceration.

    Objective: To evaluate whether a prerelease Medicaid enrollment assistance program is associated with increased health care use within 30 days after release from prison.

    Design, Setting, and Participants: This retrospective cohort study included 16 307 adults aged 19 to 64 years with a history of substance use who were released from state prison between April 1, 2014, and December 31, 2016. The Wisconsin Department of Corrections implemented prerelease Medicaid enrollment assistance in January 2015. Statistical analysis was performed from January 1 to August 31, 2021.

    Exposure: A statewide Medicaid prerelease enrollment assistance program.

    Main Outcomes and Measures: The main outcome was Medicaid-reimbursed health care, associated with substance use disorders and for any cause, within 30 days of prison release, including outpatient, emergency department, and inpatient care. Mean outcomes were compared for those released before and after implementation of prerelease Medicaid enrollment assistance using an intention-to-treat analysis and person-level data from the Wisconsin Department of Corrections and Medicaid.

    Results: The sample included 16 307 individuals with 18 265 eligible releases (men accounted for 16 320 of 18 265 total releases, and 6213 of 18 265 releases were among Black individuals; mean [SD] age at release, 35.5 [10.7] years). The likelihood of outpatient care use within 30 days of release increased after implementation of enrollment assistance relative to baseline by 7.7 percentage points for any visit (95% CI, 6.4-8.9 percentage points; P < .001), by 0.7 percentage points for an opioid use disorder visit (95% CI, 0.4-1.0 percentage points; P < .001), by 1.0 percentage point for any substance use disorder visit (95% CI, 0.5-1.6 percentage points; P < .001), and by 0.4 percentage points for receipt of medication for opioid use disorder (95% CI, 0.2-0.6 percentage points; P < .001). There was no significant change in use of the emergency department (0.7 percentage points [95% CI, –0.15 to 1.4 percentage points]). The probability of an inpatient stay increased by 0.4 percentage points (95% CI, 0.03-0.7 percentage points; P = .03).

    Conclusions and Relevance: The results of this cohort study suggest that prerelease Medicaid enrollment assistance was associated with increased use of outpatient health care after incarceration and highlights the value of making this assistance universally available within correctional settings. More tailored interventions may be needed to increase the receipt of treatment for substance use disorders.

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


    March 2022