Research News Roundup: October 7, 2021

    Cooling E-cigarette Flavors and the Association with E-cigarette Use Among a Sample of High School Students

    Journal: PLoS One, 2021, doi:10.1371/journal.pone.0256844

    Authors: Danielle R. Davis, Meghan E. Morean, Krysten W. Bold, Deepa Camenga, Grace Kong, Asti Jackson, Patricia Simon & Suchitra Krishnan-Sarin


    Introduction: E-liquid flavor is typically presented by flavor category (e.g. menthol, mint, fruit, dessert). Cooling sensations produced by flavor additives such as menthol enhance appeal of e-cigarettes among youth, but not all e-liquids that produce cooling sensations are labeled as menthol. Sensory experiences produced by flavors may allow for a new way to capture e-cigarette flavor use. This study aims to examine use of flavors that produce cooling sensations among youth and its association with e-cigarette use behaviors.

    Methods: A 2019 survey of high school students (n = 4875) examined use of e-cigarette flavors that produced cooling sensations (cooling flavors) among past 30-day e-cigarette users. E-cigarette use behaviors (flavor use, nicotine use, frequency of use) were examined between those who did and did not use cooling flavors. A binary logistic regression was used to examine associations between vaping frequency, nicotine (vs. non-nicotine) use, and vaping cooling flavors while controlling for demographics, number of flavors vaped in the past month, and vaping age of onset.

    Results: 51.6% (n = 473/916) of the analytic sample endorsed vaping cooling flavors. There were no demographic differences by vaping cooling flavors. Vaping cooling flavors was associated with vaping more frequently (AOR:1.04,95% CI:1.03,1.05) and vaping nicotine (AOR:2.37,95% CI:1.53,3.67).

    Conclusion: Vaping cooling flavors was associated with greater nicotine vaping and frequency of e-cigarette use. Assessing sensory experience, such as cooling, in addition to flavor category may more fully capture e-cigarette flavor use and its impacts on youth e-cigarette use behaviors.

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

    Use of Non–prescribed Buprenorphine in the Criminal Justice System: Perspectives of Individuals Recently Released from Incarceration

    Journal: Journal of Substance Abuse Treatment, 2021, doi:10.1016/j.jsat.2021.108349

    Authors: Jan Gryczynski, Joshua D. Lee, Kristi Dusek, Ryan McDonald, Anjalee Sharma, Mia Malone, Laura B. Monico, Anna Cheng, Angela DeVeaugh-Geiss & Howard D. Chilcoat


    Buprenorphine, an effective treatment for opioid use disorder (OUD), remains underutilized in many U.S. jails and prisons. However, use of non–prescribed (i.e., diverted) buprenorphine has been reported in these settings. The current study examined non–prescribed buprenorphine use experiences in correctional and community contexts. The study conducted face-to-face interviews with 300 adults with OUD/opioid misuse and recent incarceration, recruited in Baltimore, MD, and New York, NY (n = 150 each). Illicit/non–prescribed opioid use during incarceration was reported by 63% of participants; 39% reported non–prescribed buprenorphine. Non–prescribed buprenorphine was considered the most widely available opioid in jails/prisons in both states (81% reported “very” or “somewhat” easy to get). The average price of non–prescribed buprenorphine in jail/prison was ~10× higher than in the community (p < 0.001). Participants were more likely to endorse getting high/mood alteration as reasons for using non–prescribed buprenorphine during incarceration, but tended to ascribe therapeutic motives to use in the community (e.g., self-treatment; p < 0.001). Multivariable logistic regression analyses showed that different individual-level characteristics were associated with history of non–prescribed buprenorphine use during incarceration and in the community. Use of non–prescribed buprenorphine during incarceration was associated with younger age (p = 0.006) and longer incarceration history (p < 0.001), while use of non–prescribed buprenorphine in the community was associated with MD recruitment site (p = 0.001), not being married (p < 0.001), prior buprenorphine treatment experience (p < 0.001), and housing situation (p = 0.01). These findings suggest that different dynamics and demand characteristics underlie the use of non–prescribed buprenorphine in community and incarceration contexts, with implications for efforts to expand OUD treatment in correctional settings.

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

    Analysis of State Cannabis Laws and Dispensary Staff Recommendations to Adults Purchasing Medical Cannabis

    Journal: JAMA Network Open, 2021, doi: 10.1001/jamanetworkopen.2021.24511

    Authors: Jessica S. Merlin, Andrew Althouse, Robert Feldman, Julia Arnsten, Hailey W. Bulls, Jane M. Liebschutz, Shannon M. Nugent, Steven R. Orris, Rebecca Rohac, Joanna L. Starrels, Benjamin J. Morasco & Devan Kansagara


    Over the last decade, cannabis has become more accessible through the proliferation of dispensaries in states that have legalized its use. Most patients using cannabis for medical purposes report getting advice from dispensaries, yet there has been little exploration of frontline dispensary staff practices. To describe the practices of frontline dispensary workers who interact with customers purchasing cannabis for medical purposes and assess whether dispensary practices are associated with medicalization of state cannabis laws (degree to which they resemble regulation of prescription or over-the-counter drugs) and statewide adult use. This nationwide cross-sectional survey study was conducted from February 13, 2020, to October 2, 2020, using an online survey tool. Potential respondents were eligible if they reported working in a dispensary that sells tetrahydrocannabinol-containing products and interacting with customers about cannabis purchases. Participant responses to questions about formulating customer recommendations and talking to customers about risks. The 434 survey responses from 351 unique dispensaries were most often completed by individuals who identified as budtenders (40%), managers (32%), and pharmacists (13%). Most respondents reported basing customer recommendations on the customer’s medical condition (74%), the experiences of other customers (70%), the customer’s prior experience with cannabis (67%), and the respondent’s personal experience (63%); fewer respondents relied on clinician input (40%), cost (45%), or inventory (12%). Most respondents routinely advised customers about safe storage and common adverse effects, but few counseled customers about cannabis use disorder, withdrawal, motor vehicle collision risk, or psychotic reactions. A higher state medicalization score was significantly associated with using employer training (odds ratio, 1.41; 95% CI, 1.18-1.67) and physician or clinician input (odds ratio, 1.23; 95% CI, 1.05-1.43) as a basis for recommendation. Medicalization score was not associated with counseling about cannabis risks. This survey study provides insight into how frontline dispensary staff base cannabis recommendations and counsel about risks. The findings may have utility for clinicians to counsel patients who purchase cannabis, customers who want to be prepared for a dispensary visit, and policy makers whose decisions affect cannabis laws.

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

    Cannabis in Homes with Children: A Survey on Use, Storage, and Attitudes

    Journal: West J Emerg Med, 2021, doi: 10.5811/westjem.2021.5.49057

    Authors: Alex Gimelli, Anusha Deshpande, Julia N. Magana & Aimee Moulin


    Introduction: The recent legalization of cannabis in California has the potential to affect cannabis prevalence in households with children. This eventuality, combined with suboptimal cannabis storage practices, could lead to adverse effects such as unintentional pediatric ingestion, which occurred in Colorado after legalization. Our objective was to assess prevalence and storage practices of cannabis in households with children, and attitudes on use and storage education in a state that has legalized cannabis.

    Methods: We administered electronic surveys to 401 adults in a pediatric emergency department in California. Participants were excluded if they were not English- or Spanish-speaking or did not live in a household with children <18 years old. They answered questions regarding cannabis use, storage, and attitudes on cannabis storage education. We used convenience sampling and analyzed data using descriptive statistics.

    Results: Research assistants approached 558 participants of whom 401 completed the survey. Three participants did not respond regarding past or current cannabis use, and 14.5% (58/401) reported cannabis use in their home in the prior six months. Both users and non-users rated safe storage of high importance in homes with children. Only 44.8% of home users (26/58) reported that their cannabis was both locked and hidden. Among home users, the most common source of storage advice was friends and family (21/58, 36.2%), and 45% of home users (26/58) received no storage information whatsoever. Most cannabis users (53/67, 79.1%) and non-users (241/330, 73%) reported that they would feel comfortable receiving cannabis education from their primary care provider.

    Conclusion: Cannabis is used and stored in homes with children; however, safe storage is not clearly defined in California, and storage education is lacking. Healthcare providers in primary care and the emergency department may play an important role in educating the public about cannabis use and safe storage.

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

    Patients' Perceptions of Telehealth Services for Outpatient Treatment of Substance Use Disorders during the COVID-19 Pandemic

    Journal: The American Journal on Addictions, 2021, doi:10.1111/ajad.13207

    Authors: Dawn E. Sugarman, Alisa B. Busch, R. Kathryn McHugh, Olivera J. Bogunovic, Catherine D. Trinh, Roger D. Weiss & Shelly F. Greenfield


    Background and Objectives: The rapid scale-up of telehealth services for substance use disorders (SUDs) during the COVID-19 pandemic presented a unique opportunity to investigate patient experiences with telehealth. This study examined patient perceptions of telehealth in an outpatient SUD treatment program offering individual therapy, group therapy, and medication management.

    Methods: Two hundred and seventy adults receiving SUD outpatient treatment were eligible to complete a 23-item online survey distributed by clinicians; 58 patients completed/partially completed the survey. Data were summarized with descriptive statistics.

    Results: Participants were predominately male, White, and well-educated. The majority (86.2%) were “very satisfied” or “satisfied” with the quality of telehealth care. “Very satisfied” ratings were highest for individual therapy (90%), followed by medication management (75%) and group therapy (58%). Top reasons for liking telehealth included the ability to do it from home (90%) and not needing to spend time commuting (83%). Top reasons for disliking telehealth were not connecting as well with other members in group therapy (28%) and the ability for telehealth to be interrupted at home or work (26%).

    Discussion and Conclusions: Telehealth visits were a satisfactory treatment modality for most respondents receiving outpatient SUD care, especially those engaging in individual therapy. Challenges remain for telehealth group therapy.

    Scientific Significance: This is the first study examining patients’ perceptions of telehealth for outpatient SUD treatment during the COVID-19 pandemic by treatment service type. Importantly, while many participants found telehealth more accessible than in-person treatment, there was variability with respect to the preferred mode of treatment delivery.

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


    October 2021