Journal: Neuroradiology, 2024, doi: 10.1148/radiol.240514
Authors: Saloni Mehta, Hannah Peterson, Jean Ye, Ahmad Ibrahim, Gul Saeed, Sarah Linsky, … Dustin Scheinost
Abstract:
Background: Structural and functional MRI studies have revealed brain alterations associated with opioid use disorder (OUD). However, previous research has been limited by small sample sizes, few female participants, and single-modality analyses.
Purpose: To identify structural and functional brain alterations in individuals with OUD using whole-brain data-driven methods to analyze T1-weighted MRI and resting-state functional MRI (rsfMRI).
Materials and Methods: This secondary analysis of the Collaboration Linking Opioid Use Disorder and Sleep study compared participants with OUD (data collection February 2021 to February 2023) receiving methadone treatment with healthy control participants (data collection February 2018 to May 2023). T1-weighted MRI and rsfMRI were analyzed using tensor-based morphometry and intrinsic connectivity distribution, respectively. Primary outcome measures included regional brain volumes and functional connectivity. Voxel-wise linear regression was used to assess group differences, with family-wise error correction. Pearson partial correlations were used to examine structure-function relationships.
Results: Compared with healthy control participants (n = 105; median age, 27 years [IQR, 23–37 years]; 58 female), participants with OUD (n = 103; median age, 37 years [IQR, 31.5–46 years]; 62 male) showed smaller volumes (corrected P < .05) in the thalamus (β = −17.42 [95% CI: −26.56, −8.27]) and right medial temporal lobe (β = −8.02 [95% CI: −12.25, −3.78]). Larger volumes (corrected P < .05) were seen in the brainstem (pons and medulla, β = 15.21 [95% CI: 7.03, 23.40]; midbrain, β = 13.04 [95% CI: 6.61, 19.47]) and cerebellum (right, β = 14.96 [95% CI: 7.25, 22.67]; left, β = 14.88 [95% CI: 7.32, 22.43]). An interaction between sex and group was found for medial prefrontal cortex volume (β = −19.38, corrected P < .05), with female participants having smaller volumes than male participants in the OUD group. Increased functional connectivity (corrected P < .05) was noted in the thalamus (β = 0.50 [95% CI: 0.25, 0.75]), right medial temporal lobe (β = 0.43 [95% CI: 0.21, 0.66]), right cerebellum (β = 0.46 [95% CI: 0.21, 0.71]), and brainstem (β = 0.48 [95% CI: 0.22, 0.74]) in the OUD group. Structure and function were positively correlated in the cerebellum (Pearson r = 0.32 [95% CI: 0.17, 0.44], P < .001) and brainstem (Pearson r = 0.23 [95% CI: 0.09, 0.37], P = .002).
Conclusion: Individuals with OUD showed overlapping structural and functional brain alterations in opioid receptor–dense regions compared with healthy control participants.
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Journal: Journal of Research on Adolescence, 2024, doi: 10.1111/jora.13025
Authors: Lucinda Okine, & Jennifer B. Unger
Abstract:
Substance use among youth is associated with adverse consequences and may increase vulnerability to addiction and psychiatric disorders later in life. Sociocultural factors such as discrimination have been associated with substance use, while positive cultural resources, such as enculturation and familism, have demonstrated protective outcomes. However, few studies have highlighted how family factors influence substance use among Latinx youth during their transition from adolescence to young adulthood. This study used longitudinal data to explore the associations between sociocultural factors, family factors, childhood adversity, and substance use among Latinx youth. The data were from a longitudinal study of acculturation and substance use among Latinx youth in Southern California (n = 1257, 52.1% female, mixed socioeconomic status). The average age was 14.5 (SD = 0.39). Data collection began in 2005 and ended in 2016. Hierarchical regression models showed that discrimination was associated with higher problematic alcohol susceptibility. Childhood adversity was associated with higher odds of tobacco, alcohol, and marijuana use. Parental communication was associated with lower odds of problematic alcohol and marijuana use. To promote youth well-being, preventive efforts should prioritize reducing childhood adversity and discrimination, while fostering positive family relationships. Overall, our findings suggest the need for interventions targeting various systemic levels to effectively address substance use among Latinx youth.
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Journal: Journal of Substance Use & Addiction Treatment, 2024, doi: 10.1016/j.josat. 2024.209511
Authors: Brian Chan, Ryan Cook, Ximena Levander, Katharina Wiest, Kim Hoffman, Kellie Pertl, … Stephen A. Martin
Abstract:
Introduction: At the beginning of the COVID-19 pandemic, federal agencies permitted telehealth initiation of buprenorphine treatment for opioid use disorder (OUD) without in-person assessment. It remains unclear how telehealth-only buprenorphine treatment impacts time to discontinuation and patient reported treatment outcomes.
Methods: A longitudinal observational cohort study conducted September 2021 through March, 2023 enrolled participants with OUD initiating buprenorphine (≤ 45 days) with internet and phone access in Oregon and Washington. The intervention was a fully telehealth-only (THO) app versus treatment as usual (TAU) in office-based settings with some telehealth. We assessed self-reported buprenorphine discontinuation at 4-,12-, and 24-weeks. Generalized estimating equations (GEE) calculated unadjusted and adjusted relative risk ratios (RR) for discontinuation averaged over the study period. Secondary outcomes included change in the Brief Addiction Monitor (BAM) and the visual analogue craving scale. Generalized linear models estimated average within-group and between-group differences over time.
Results: Participants (n = 103 THO; n = 56 TAU) had a mean age of 37 years (SD = 9.8 years) and included 52 % women, 83 % with Medicaid insurance, 80 % identified as White, 65 % unemployed/student, and 19 % unhoused. There were differences in gender (THO = 54 % women vs. TAU = 44 %, p = .04), unemployed status (60 % vs 75 %, p = .02), and stable housing (84 % vs 73 %, p = .02). Rates of buprenorphine discontinuation were low in the THO (4 %) and TAU (13 %) groups across 24 weeks. In the adjusted analysis, the risk of discontinuation was 61 % lower in the THO group (aRR = 0.39, 95 % CI [0.17, 0.89], p = .026). Decreases occurred over time on the harms subscale of the BAM (within-group difference – 0.85, p = .0004 [THO], and – 0.68, p = .04 [TAU]) and cravings (within-group difference – 13.47, p = .0001 [THO] vs -7.65, p = .01 [TAU]).
Conclusions: A telehealth-only platform reduced the risk of buprenorphine discontinuation compared to office-based TAU. In-person evaluation to receive buprenorphine may not be necessary for treatment-seeking patients.
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Journal: Harm Reduction Journal, 2024, doi: 10.1186/s12954-024-01118-3
Authors: Michaela Pacheco, Abiodun Ologunowa, & Anita Jacobson
Abstract:
Background: An online mail order naloxone and harm reduction supply program was created by an interdisciplinary team at the University of Rhode Island College of Pharmacy and hosted on the university website (UNIV). The program was subsequently funded by the Rhode Island Department of Health (DOH) and added to the DOH website. This study compares demographic characteristics of the two populations submitting requests through the program’s distinct access points, UNIV and DOH, to those of populations at-risk for overdose.
Methods: This is a retrospective comparative analysis using voluntarily provided information from mail order request forms submitted through two websites from June 2020 through October 2023. The primary objective was to compare demographic characteristics of requesters through the two access points to those of individuals at-risk for experiencing or responding to an overdose. Descriptive statistics were used to characterize the two distinct populations. Chi-square tests were performed to determine if statistically significant differences in population demographics existed between access points. Odds ratios were estimated using a simple logistic regression model to assess the relationship between access point and demographic characteristic to determine if either access point had a greater likelihood of reaching individuals with at-risk demographics.
Results: A total of 5,783 (UNIV = 1662; DOH = 4121) mail order request forms were included in the analysis. Participants who completed requests through UNIV were more likely to be 44 years old or younger and/or reside in rural areas. Participants who submitted requests through DOH were more likely to reside in non-rural and/or low-income areas, and/or identify as gender minorities. Additionally, UNIV respondents were more likely to be first-time naloxone requesters while DOH respondents were more likely to have obtained and used naloxone before.
Conclusions: Results establish that different access points can reach different at-risk population subsets and support the use of multiple access points and advertising strategies to expand the reach of online mail order harm reduction programs
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Authors: Joy D. Scheidell, Teresa Chueng, Katrina Ciraldo, Belén Hervera, Sophia Dakoulas, Muthoni Mahachi, Alex S. Bennett, & Luther C. Elliott
Journal: Harm Reduction Journal, 2024, doi: 10.1186/s12954-024-01116-5
Abstract:
Background: People who use drugs are at elevated sexual and reproductive health risk but experience barriers to services. Syringe services programs (SSP) are an important venue to provide integrated health services. Few studies have examined SSP use within intersecting gender, racial, and ethnic groups, including by injection drug use (IDU), and differences in sexual and reproductive health among these groups.
Methods: Within a cohort study among people who use unprescribed opioids in New York City, we conducted a nested cross-sectional study from November 2021-August 2022 assessing sexual health with a survey (n = 120). The parent study measured baseline characteristics, and the cross-sectional study survey measured self-reported past-year SSP use and sexual and reproductive health. We estimated SSP use within gender, racial, and ethnic groups by IDU, and the prevalence of sexual and reproductive health outcomes by gender, race, ethnicity, and SSP use.
Results: Among men (n = 61) and women (n = 54), SSP use was disproportionately low among Black participants irrespective of IDU. Women reporting SSP use had a higher prevalence of multiple, new, sex trade, and/or casual sex partners, history of STI symptoms, and lack of effective STI prevention, although women who did not use SSP had non-negligible levels of risk with variation between racial and ethnic groups. Among men, sexual and reproductive health varied across racial and ethnic groups but not as clearly by SSP use.
Conclusions: SSP offer opportunity to address elevated STI risk among people who use drugs but may miss certain intersecting gender, race, and ethnic groups.
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