Evidence of the Emergence of Illicit Benzodiazepines from Online Drug Forums

Journal: European Journal of Public Health, 2022, doi: 10.1093/eurpub/ckac161

Authors: Abeed Sarker, Mohammed Ali Al-Garadi, Yao Ge, Nisha Nataraj, Londell McGlone, Christopher M. Jones & Steven A. Sumner


Illicit or ‘designer’ benzodiazepines are a growing contributor to overdose deaths. We employed natural language processing (NLP) to study benzodiazepine mentions over 10 years on 270 online drug forums (subreddits) on Reddit. Using NLP, we automatically detected mentions of illicit and prescription benzodiazepines, including their misspellings and non-standard names, grouping relative mentions by quarter. On a collection of 17 861 755 posts between 2012 and 2021, we searched for 26 benzodiazepines (8 prescription; 18 illicit), detecting 173 275 mentions. The rate of posts about both prescription and illicit benzodiazepines increased consistently with increases in deaths involving both drug classes, illustrating the utility of surveillance via Reddit.

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Low Barrier Medication for Opioid Use Disorder at a Federally Qualified Health Center: A Retrospective Cohort Study

Journal: Addiction Science & Clinical Practice, 2022, doi: 10.1186/s13722-022-00342-1

Authors: Jamie Carter, Zhen Li, Hillary Chen, Melissa Greiner, Christopher Bush, Debanjan Bhattacharya, Stephanie Poley, Nidhi Sachdeva, Jane Carolyn Crowder & Jacob Feigal


Background: Medication for opioid use disorder (MOUD) reduces mortality, but few patients access MOUD. At a Federally Qualified Health Center (FQHC), we implemented a low barrier model of MOUD, including same-day MOUD initiation and a harm reduction philosophy.

Objective: To investigate whether low barrier MOUD improved retention in care compared to traditional treatment.

Design and participants: Retrospective cohort study of patients with at least one visit seeking MOUD at the FQHC during a historical control period (3/1/2018-3/31/2019) and a low barrier intervention period (11/1/2019-7/31/2020).

Main measures: Primary outcomes were any MOUD prescription within 6 months of the index visit and 3- and 6-month retention in treatment without care gap, with care gap defined as 60 consecutive days without a visit or prescription. Secondary outcomes were all-cause hospitalization and emergency department visit within 6 months of the index visit.

Key results: Baseline characteristics were similar between the intervention (n = 113) and control (n = 90) groups, except the intervention group had higher rates of uninsured, public insurance and diabetes. Any MOUD prescription within 6 months of index visit was higher in the intervention group (97.3% vs 70%), with higher adjusted odds of MOUD prescription (OR = 4.01, 95% CI 2.08-7.71). Retention in care was similar between groups at 3 months (61.9% vs 60%, aOR = 1.06, 95% CI 0.78-1.44). At 6 months, a higher proportion of the intervention group was retained in care, but the difference was not statistically significant (53.1% vs 45.6%, aOR 1.27, 95% CI 0.93-1.73). There was no significant difference in adjusted odds of 6-month hospitalization or ED visit between groups.

Conclusions: Low barrier MOUD engaged a higher risk population and did not result in any statistically significant difference in retention in care compared with a historical control. Future research should determine what interventions improve retention of patients engaged through low barrier care. Primary care clinics can implement low barrier treatment to make MOUD accessible to a broader population.

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Patterns of Health Care Use 5 Years after an Intervention Linking Patients in Addiction Treatment with a Primary Care Practitioner

Journal: JAMA Network Open, 2022, doi: 10.1001/jamanetworkopen.2022.41338

Authors: Esti Iturralde, Constance M. Weisner, Sara R. Adams, Felicia W. Chi, Thekla B. Ross, Sarah F. Cunningham, Murtuza Ghadiali, Asma H. Asyyed, Derek D. Satre, Cynthia I Campbell & Stacy A. Sterling


Importance: Substance use disorders are associated with high rates of emergency department (ED) use and challenges engaging with primary care services.

Objective: To examine 5-year health care engagement and utilization outcomes for participants in the LINKAGE trial, given previously reported associations of LINKAGE with improved care engagement in the short term.

Design, setting, and participants: In this post hoc analysis of a nonrandomized controlled trial, participants were assigned to the LINKAGE or usual care (UC) groups using a nonrandomized 3-month alternating off and on strategy over 30 months. Baseline through 5-year follow-up data were collected from April 2011 to October 2018. The trial was conducted at an urban outpatient addiction treatment clinic within a large health system among patients newly enrolled in addiction treatment. Data analysis was conducted from April 2021 to February 2022.

Intervention: The LINKAGE intervention included 6 group-based sessions emphasizing patient agency, skill, and motivation in navigating health care services as well as a facilitated telephone or email connection with a primary care practitioner. The UC group received medical education.

Main outcomes and measures: Substance use problem discussions with primary care practitioners (by patient self-report at 1-, 2-, and 5-year follow-up interview) and annual use of the electronic patient portal, primary care, and ED based on electronic health records.

Results: A total of 503 participants, with a mean (SD) age of 42 (12) years, 346 (69%) male participants and 37 (7%) African American, 34 (7%) Asian, and 101 (20%) Hispanic participants, were assigned to LINKAGE (252 participants) or UC (251 participants). Compared with UC participants, LINKAGE participants were significantly more likely to discuss substance use problems with a primary care practitioner at 1-year follow-up (risk ratio [RR], 1.30; 95% CI, 1.03-1.65; P = .03) and use the electronic patient portal at 1- and 2-year follow-up (eg, messaging clinicians at 2 years: RR, 1.24; 95% CI, 1.04-1.47; P = .02). The LINKAGE group had small, statistically significant 5-year annual increases in primary care use (RR, 1.03; 95% CI, 1.003-1.07; P = .03) and significant annual decreases in substance-related ED use (RR, 0.79; 95% CI, 0.64-0.97; P = .03), relative to UC. The LINKAGE group did not significantly differ from the UC group on other types of ED utilization.

Conclusions and relevance: In this study, a patient activation intervention embedded in outpatient addiction treatment was associated with sustained improvements in health care engagement beyond previously reported 6-month outcomes and with long-term improvements in health care use patterns.

Trial registration: ClinicalTrials.gov Identifier: NCT01621711.

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Loneliness and Alcohol-Related Problems among College Students Who Report Binge Drinking Behavior: The Moderating Role of Food and Alcohol Disturbance

Journal: International Journal of Environmental Research & Public Health, 2022, doi: 10.3390/ijerph192113954

Authors: Luke Herchenroeder, Stacy M. Post, Michelle L. Stock & Ellen W. Yeung


Loneliness and alcohol misuse are common among college students and pose a threat to public health. To better understand the longitudinal association between these public health concerns we examined food and alcohol disturbance (FAD; i.e., restricting one’s caloric intake prior to drinking) as a moderator in the association between loneliness and alcohol-related problems. Participants were 456 college students from a mid-sized university who engaged in past 30-day binge drinking. The majority of participants identified as being White (67.1%), female (78.1%), and reported a mean age of 19.61 (SD = 1.54) years. Participants completed two surveys (3 weeks apart) over the course of an academic semester. Analyses revealed a significant interaction between loneliness and FAD, such that loneliness (T1) significantly and positively predicted alcohol-related problems (T2), but only among individuals who engaged in relatively higher levels of FAD (T1). FAD may be an appropriate target for interventions aimed at reducing alcohol-related problems among college students experiencing loneliness.

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Alcohol’s Negative Emotional Side: The Role of Stress Neurobiology in Alcohol Use Disorder

Journal: Alcohol Research: Current Reviews, 2022, doi: 10.35946/arcr.v42.1.12

Author: Rajita Sinha

Abstract: This article reviews human research investigating neurobiological and psychological changes related to alcohol misuse that are associated with greater distress and stress-related alcohol craving and their role in predicting risk of binge drinking, relapse, and impact on treatment outcomes. The author presents the effects of stress and trauma on brain stress responses and their associations with resilient coping and describes the impact of binge and chronic alcohol use on brain and peripheral stress responses and their role in promoting alcohol craving and relapse risk. Specific clinical and biobehavioral markers of both risk of developing alcohol use disorder (AUD) and relapse are also reviewed. Finally, the article discusses recent findings on treatments that focus on reversing stress and craving disruptions related to chronic alcohol misuse to improve treatment outcomes.

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