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Background: Overdose death rates for Hispanic people rose 2010-2022. Opioid overdose rates grew faster among Hispanic people than non-Hispanic White people ("White"). Medication for opioid use disorder (MOUD) is an effective but underutilized intervention for decreasing overdose risk. The Affordable Care Act ("ACA") should have increased MOUD use, but insurance and behavioral health reforms differed by state. We examined to what extent MOUD use increased post-ACA implementation and differed for Hispanic people (overall and by heritage group) compared to White people who used opioids ("clients")., Methods: We analyzed first annual ambulatory care episodes (TEDS-A, 2009-2019) for working-age Hispanic (N= 76,591) and White (N=444,753) clients. We categorized Hispanic clients by heritage group (Puerto Rican, Mexican, or Other Hispanic). We grouped states by Medicaid expansion status (California, Other Expansion States, and Non-Expansion States). We used logistic regression to compare the odds of MOUD use pre/post ACA within racial/heritage groups, and, separately, between racial/heritage groups using pre-ACA White clients as a reference group. We used linear probability difference-in-differences to confirm changes in MOUD use between Hispanic and White clients., Results: Among Hispanic clients in ambulatory care, MOUD use was lowest in the Non-Expansion States and highest in California. Nationally, only Puerto Rican and Other Hispanic heritage clients had higher odds of MOUD post-ACA compared to pre-ACA. Nationally and in Other Expansion States, Hispanic and White clients had similar increases in MOUD use post-ACA., Conclusions: MOUD use among Hispanic clients rose post-ACA, but differences remained between Hispanic heritage groups and between states., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: The opioid crisis within the United States has been widely studied; however, some gaps within the literature still exist. There is limited information on trends in opioid misuse as it relates to income among a national sample of Black Women. Given the recent increase in opioid overdose deaths in Black Americans and the vulnerability of women who misuse opioids, research in this population is important., Objective: The objective of this study is to evaluate trends of past year opioid misuse (PYOM) among Black women by income over the study period., Methods: A cross-sectional study among adult aged Black women captured in the National Survey on Drug Use and Health (NSDUH) from 2015 to 2019 was conducted. Descriptive statistics for all study variables was conducted. Weighted logistic regression analyses were conducted to evaluate predictors of PYOM. A stratified analysis was also conducted to examine possible differences between income strata on predictors of PYOM., Results: A total of 15,196 Black women were included in the study (16,008,921 weighted visits). Among the women included, 41.5% were age 50+, 57.7% were unemployed, 63.8% reported very good/good health, 59.5% had past year alcohol use, 44.1% had never been married, 39.1% received government assistance, and 90.1% resided in a metro area. An estimated 3.14% of Black women reported PYOM. Findings from the regression analysis showed that Black women who were between 18 and 25, had past year major depressive episode, had alcohol use, illicit drug use, and who received government assistance had significantly greater odds of PYOM. Those reporting an excellent general health rating and higher education had significantly lower odds of PYOM. Income was not associated with PYOM in this study., Conclusion: Overall, income was not found to be a significant predictor of PYOM. However, income was found to modify the effects of major depressive episode and alcohol use on PYOM, especially among Black women who reported earning ≥$75,000/year. These findings suggest that high-earning Black women may be just as at risk for opioid misuse as low-earning Black women. Further studies are warranted to explore these effects among other gender/racial groups to determine if this trend is unique to Black women., (Copyright © 2024 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Purpose: Identifying predictors of opioid overdose following release from prison is critical for opioid overdose prevention., Methods: We leveraged an individually linked, state-wide database from 2015-2020 to predict the risk of opioid overdose within 90 days of release from Massachusetts state prisons. We developed two decision tree modeling schemes: a model fit on all individuals with a single weight for those that experienced an opioid overdose and models stratified by race/ethnicity. We compared the performance of each model using several performance measures and identified factors that were most predictive of opioid overdose within racial/ethnic groups and across models., Results: We found that out of 44,246 prison releases in Massachusetts between 2015-2020, 2237 (5.1%) resulted in opioid overdose in the 90 days following release. The performance of the two predictive models varied. The single weight model had high sensitivity (79%) and low specificity (56%) for predicting opioid overdose and was more sensitive for White non-Hispanic individuals (sensitivity = 84%) than for racial/ethnic minority individuals., Conclusions: Stratified models had better balanced performance metrics for both White non-Hispanic and racial/ethnic minority groups and identified different predictors of overdose between racial/ethnic groups. Across racial/ethnic groups and models, involuntary commitment (involuntary treatment for alcohol/substance use disorder) was an important predictor of opioid overdose., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Joshua A. Barocas reports financial support was provided by National Institutes of Health. Prasad Patil, Kristina Yamkovoy, Samantha K. Nall, Pallavi Aytha Swathi, Lauren Brinkley-Rubinstein reports financial support was provided by National Institutes of Health. Laura F. White, Prasad Patil, Yanjia Zhang reports financial support was provided by National Institute of General Medical Sciences. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To characterize racial/ethnic differences in past-year prescription opioid misuse and heroin use., Methods: Data on 1,117,086 individuals age 12 and older were from the 1999-2018 National Survey on Drug Use and Health. We compared relative prevalences across 6 racial/ethnic groups for prescription opioid misuse analyses and 4 racial/ethnic groups for heroin analyses. Unadjusted and gender- and age-adjusted prevalences are reported for 5 time periods (1999-2002, 2003-2006, 2007-2010, 2011-2014, 2015-2018). Survey-weighted Poisson regression models with robust variance were used to estimate risk ratios by race/ethnicity and to test for time trends., Results: Prescription opioid misuse was significantly higher among non-Hispanic White individuals than among Black, Hispanic, and Asian individuals across all time periods, yet was highest among Native American individuals in every time period. The relative difference between White and both Hispanic and Asian individuals significantly widened over time, whereas the gap between Black and White individuals significantly decreased. Early in the study period, heroin use was highest among Black and Hispanic individuals. Heroin use among White individuals first surpassed all other groups in 2007-2010 and continued to steadily increase, more than doubling from 1999-2002 to 2015-2018., Conclusions: While heroin use has risen among all racial/ethnic groups, the demographics of heroin use have changed significantly in the past two decades such that prevalence is now highest among White individuals. Opioid prevention and treatment initiatives should both be informed by the changing demographics of heroin use and seek to reduce opioid-related harms and expand treatment access equitably for all racial/ethnic groups., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Mental health diagnoses (MHD) are common among those with opioid use disorders (OUD). Methadone/buprenorphine are effective medication-assisted treatment (MAT) strategies; however, treatment receipt is low among those with dual MHDs. Medicaid expansions have broadly increased access to OUD and mental health services over time, but MAT uptake may vary depending on multiple factors, including MHD status, state Medicaid expansion decisions, and race/ethnicity and gender. Examining clinical and policy approaches to promoting MAT uptake may improve services among marginalized groups., Methods: MAT treatment discharges were identified using the Treatment Episodes Dataset-Discharges (TEDS-D; 2014-2017) (n = 1,400,808). We used multivariate logistic regression to model MAT receipt using interactions and adjusted for several potential confounders., Results: Nearly one-third of OUD treatment discharges received MAT. Dual MHDs in both expansion and non-expansion states were positively associated with MAT uptake over time. Dual MHDs were negatively associated with MAT receipt only among American Indian/Alaska Native women residing in Medicaid expansion states (aOR = 0.58, 95 % CI = 0.52-0.66, p < 0.0001)., Conclusion: Disparities in MAT utilization are nuanced and vary widely depending on dual MHD status, Medicaid expansion, and race/ethnicity/gender. Medicaid is beneficial but not a universal treatment panacea. Clinical decisions to initiate MAT are dependent on multiple factors and should be tailored to meet the needs of high-risk, historically disadvantaged clients., Competing Interests: Declaration of Competing Interest There is no conflict declared by any author., (Published by Elsevier B.V.)

Background: American Indian (AI) youth have disproportionately high rates of both heroin and other opioid misuse and recently have seen a large increase in negative outcomes due to opioid misuse. To address the dearth of research on within-group risk factors for heroin and other opioid misuse in AI adolescents, the goal of the present study is to explore the influence of peer, family, and school factors on opioid use among AI youth., Methods: Participants (n = 3498, 49.5 % female, M age  = 14.8) were drawn from a large school-based sample of AI youth living on or near reservations, across six geographic regions, between 2009 and 2013. Participants completed a self-report questionnaire regarding substance use and related factors. Multilevel logistic regression was utilized to examine the role of peer, family, and school-related factors on past-month and lifetime heroin and other opioid misuse., Results: Greater peer substance use (OR = 1.14, p<0.001), lower family disapproval of use (OR = .98, p = 0.01), and lower school performance (OR = .90, p = 0.01) were associated with greater likelihood of lifetime opioid misuse. Greater peer substance use (OR = 1.05, p<0.001) and lower family disapproval of use (OR = .99, p = 0.04) were associated with greater likelihood of past month opioid misuse. Greater peer substance use was the only variable significantly related to greater likelihood of lifetime (OR = 1.15, p<0.001) or past month heroin use (OR = 1.02, p = 0.047)., Conclusions: Findings highlight the need for interventions and offer potential factors to consider in developing interventions for heroin and/or other opioid misuse among AI adolescents., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Research on adolescent heroin use has focused on national surveillance, access, prevalence of use, and overdose deaths, however, to our knowledge, no study has examined local-level differences in the prevalence of adolescent heroin use in the context of nonmedical prescription opioid (NMPO) use. This study characterizes heroin and NMPO use among US high school students in select urban areas by sex and race/ethnicity., Methods: Data are from 21 urban school districts that participate in CDC's Local Youth Risk Behavior Surveillance System. We describe 2017 prevalence estimates (and 95 % confidence intervals) of lifetime heroin and NMPO use among youth stratified by sex and race/ethnicity (i.e., White, Black, Hispanic/Latino)., Results: The highest estimates of heroin use were in Baltimore, MD (7.6 %), Shelby County, TN (6.3 %), and Duval County, FL (6.1 %), whereas NMPO use was highest in Duval County, FL (18.1 %), Cleveland, OH (18.0 %), and Shelby County, TN (16.8 %). Heroin use was higher among boys than girls, especially among Hispanic/Latino boys in Duval County (12.3 %) and Black boys in Baltimore (10.9 %). NMPO use was highest among Hispanic/Latino girls (21.3 %) and White girls (19.9 %) in Duval County., Discussion: While some cities and subpopulations with high levels of adolescent heroin use also had elevated levels of NMPO use, others did not, illustrating the complexities of this opioid epidemic., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Death from fentanyl-related overdose is now a leading cause of mortality among US adults. We sought to characterize fentanyl preference among street-based people who use drugs (PWUD)., Methods: Cross-sectional surveys were administered to PWUD (N = 308) who illicitly used heroin or prescription opioids in the prior six months. Recruitment occurred in 2017 in three US east coast cities with high overdose mortality: Baltimore, Boston, and Providence. Our main outcome was preference for fentanyl (yes/no); exposures included sociodemographics, drug use, and overdose history. Pearson's χ2, Shapiro-Wilk-Mann rank-sum tests, and tiered log-binomial regression determined sociodemographic and exposure-related factors associated with fentanyl preference., Results: Preference for nonmedical use of fentanyl was reported by 27% (n = 83) of the sample. Fentanyl preference was associated with non-Hispanic white race (adjusted risk ratio (ARR) = 1.68, 95% confidence interval (CI):1.18-2.40), daily illicit drug use (aRR = 2.2, CI:1.71-2.87), and overdose ≥1 year ago (aRR = 1.33, CI:1.18-1.50). Age (in decades; aRR = 0.77, CI:0.61-0.98) and overdose <1 year ago (aRR = 0.92, CI:0.87-0.97) were associated with a decreased likelihood of preference. In our model excluding sociodemographics, initiating opioid use with non-prescribed opioids was associated with fentanyl preference (aRR = 1.48, CI:1.26-1.73)., Conclusion: In three cities with high levels of opioid use and overdose, a quarter of street based PWUD reported preferring fentanyl. An opioid use age cohort effect and disproportionate access to prescription opioids by race could be contributing to preference. Frequency of opioid use, not route of administration, was associated with preference. Our data demonstrate the need to consider preferences for fentanyl when targeting services and interventions for PWUD., (Copyright © 2019 The Author(s). Published by Elsevier B.V. All rights reserved.)

Aim: To determine whether extended-release injectable naltrexone (XR-NTX), incentives for opiate abstinence, and their combination reduce opiate use compared to a usual care control and whether the combination reduces opiate use compared to either treatment alone., Design: Randomized 2 × 2 single-site controlled trial conducted from November 2012 through May 2016. After a detoxification and oral naltrexone induction, participants were assigned to a Usual Care, Abstinence Incentives, XR-NTX, or XR-NTX plus Abstinence Incentives group for a six-month intervention period., Setting: A model therapeutic workplace where participants could work on automated computer programs that targeted job-skills training for 4 h every weekday for 24 weeks and earn about $10 per hour., Participants: 84 heroin-dependent adults who were unemployed and medically approved for naltrexone. Most participants were male (71.4%), African American (80.1%), and cocaine dependent (71.4%)., Measurements: The primary outcome measure was the percentage of urine samples negative for opiates that were collected at once weekly assessments (24 per participant) that were not part of the intervention and for which participants were paid $10 for completing., Intervention: Participants who attended the workplace provided thrice-weekly urine samples. Abstinence Incentives participants had to provide opiate-free urine samples to maintain maximum pay. XR-NTX participants received one injection every 4 weeks and were required to take injections in order to work and to maintain maximum pay. Usual Care participants were not offered XR-NTX and opiate urinalysis results did not affect pay., Findings: A large percentage (65 of 149; 43.6%) of individuals failed the induction protocol required for randomization and to be eligible to receive XR-NTX. When missing urine samples were considered positive, there was no significant interaction between XR-NTX and Abstinence Incentives. XR-NTX plus Abstinence Incentives participants provided significantly more opiate-negative samples (81.3%, SD 39.0%) than XR-NTX participants (64.5%, SD 47.9%; aOR 10.4, 95% CI 1.3-85.5; P = .030). When urine samples were not replaced, there was a significant interaction between XR-NTX and Abstinence Incentives (aOR 77.0, 95% CI 1.3-4432;P = 0.036); XR-NTX plus Abstinence Incentives participants provided significantly more opiate-negative samples (99.6%, SD 0.1%) than XR-NTX participants (85.0%, SD 35.7%; aOR 147.6, 95% CI 6.3-3472; P = 0.002), Abstinence Incentives participants (91.9%, SD 27.3%; aOR 121.7, 95% CI 4.8-3067; P =0.004), and Usual Care participants (78.7%, SD 41.0%; aOR 233.4, 95% CI 9.4-5814; P <.001). No other group differences were significant., Conclusion: XR-NTX plus incentives for opiate abstinence increased opiate abstinence, but XR-NTX alone did not. XR-NTX can promote opiate abstinence when it is combined with incentives for opiate abstinence in a model therapeutic workplace., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: More than half of patients hospitalized annually receive an opioid during their inpatient hospitalization, which may serve as a first opioid exposure. Although recent research addresses outpatient opioid prescribing following delivery, little is known regarding the extent to which opioids are used during the postpartum hospitalization following vaginal delivery., Objective: Our objectives were as follows: (1) to describe the use of opioids during the last 24 hours of postpartum hospitalization in women following vaginal delivery and (2) to identify patient and provider characteristics associated with the use of opioids during this time period., Study Design: This is a retrospective case-control study of women who underwent vaginal delivery at a single tertiary care center from Dec. 1, 2015, to Nov. 30, 2016. Inpatient, pharmacy, and administrative records were queried for clinical and inpatient prescriber data. Opioid use during the last 24 hours of the postpartum hospitalization was determined. Significant factors on bivariable analysis were assessed in multivariable hierarchical logistic regression with random effects to identify patient and provider factors associated with any opioid use. A subgroup analysis of women who underwent an uncomplicated vaginal delivery, defined as lack of intrapartum, postpartum, or neonatal complications, was performed., Results: In this cohort of 9038 women after a vaginal delivery, almost a quarter (n = 2242, 24.8%) utilized opioids during the last 24 hours of the postpartum hospitalization. In a multivariable analysis, several patient characteristics were associated with increased odds of opioid use during the last 24 hours of admission, including higher body mass index, history of smoking and substance abuse, use of regional analgesia, vaginal birth after cesarean delivery, major laceration, postpartum hemorrhage, and infectious complication. Even after adjusting for these characteristics, greater use of acetaminophen (adjusted odds ratio, 0.81, 95% confidence interval, 0.77-0.85) and analgesia orders written by an advanced practitioner (adjusted odds ratio, 0.46, 95% confidence interval, 0.29-0.73) remained associated with decreased odds of using an opioid. The same 2 factors remained associated with less opioid use (acetaminophen doses [adjusted odds ratio, 0.86, 95% confidence interval, 0.81-0.92] and analgesia orders written by an advanced practitioner [adjusted odds ratio, 0.52, 95% confidence interval, 0.30-0.89]) when only women who had an uncomplicated vaginal delivery were analyzed., Conclusion: In a large cohort, nearly one-quarter of women use opioid analgesia during the last 24 hours of inpatient hospitalization following vaginal delivery. Although patient factors account for some of the variation in inpatient opioid use, both use of acetaminophen and having had postpartum orders written by an advanced practitioner were independently associated with lower odds of inpatient opioid use., (Copyright © 2018. Published by Elsevier Inc.)

Background and Aims: Perceived stigma is related to the beliefs that members of stigmatized group have about the stigmatizing attitudes present in society. We present the data on perceived stigma in alcohol and opioid users seeking treatment., Methods: This study was conducted at a tertiary care de-addiction facility with recruitment of patients with substance use disorders (alcohol and opioid use). Perceived stigma was assessed using Perceived Stigma of Substance Abuse Scale (PSAS)., Results: The study included 201 participants, majority of whom were males (99.5%), educated up to 10 th std. (65.7%), with mean duration of substance use of 11.4 years. Opiates were the primary substance of abuse in the majority (83.6%) with ever-injecting drug use present in a considerable proportion (29.4%). The mean perceived stigma scale score was 21.23 ± 3.03. The perceived stigma was higher in patients from rural background, but was not associated with age, educational status, current living situation, duration of substance use and injecting drug use., Conclusion: Stigma remains an important issue among patients with alcohol and opioid use disorders. Perceived stigma could affect participation in society and health seeking behavior in substance using population, thus needs further exploration., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: The present study examined racial/ethnic disparities in initial treatment episode completion for adult clients reporting opioids as their primary problem substance in large US metropolitan areas., Methods: Data were extracted from the 2013 TEDS-D dataset (Treatment Episode Dataset-Discharge) for the 42 largest US metropolitan statistical areas (MSAs). Fixed effects logistic regression controlling for MSA was used to estimate the effect of race/ethnicity on the likelihood of treatment completion. The model was repeated for each individual MSA in a stratified design to compare the geographic variation in racial/ethnic disparities, controlling for gender, age, education, employment, living arrangement, treatment setting, medication-assisted treatment, referral source, route of administration, and number of substances used at admission., Results: Only 28% of clients completed treatment, and the results from the fixed effects model indicate that blacks and Hispanics are less likely to complete treatment compared to whites. However, the stratified analysis of individual MSAs found only three of the 42 MSAs had racial/ethnic disparities in treatment completion, with the New York City (NYC) MSA largely responsible for the disparities in the combined sample. Supplementary analyses suggest that there are greater differences between whites and minority clients in the NYC MSA vs. other cities on characteristics associated with treatment completion (e.g., residential treatment setting)., Conclusion: This study underscores the need for improving treatment retention for all opioid using clients in large metropolitan areas in the US, particularly for minority clients in those localities where disparities exist, and for better understanding the geographic context for treatment outcomes., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Prescription drug misuse, especially opioid misuse, has become a public health crisis in the US. While much research attention has been focused on prescription drug misuse, a number of notable gaps in the literature remain. The current research addresses one of these gaps by examining racial/ethnic variation in prescription opioid misuse among adults., Methods: We use data from the 2015 NSDUH to identify correlates of prescription opioid misuse among Black respondents aged 18 and older. The NSDUH defines prescription drug misuse as the use of prescription drugs in any way a doctor did not direct respondents to use them, including (a) without a prescription of their own; (b) in greater amounts, more often, or longer than told to use; or (c) in any other way a doctor did not tell respondents to use the drug., Results: Findings indicate that Black respondents have a very similar prevalence rate of prescription opioid misuse compared to White respondents. A number of factors (i.e., gender, socioeconomic status, educational attainment) were significantly correlated with prescription opioid misuse only among Black respondents. In addition, many factors (i.e., depression, general health, other illicit drug use, being approached by a drug dealer) were significantly associated with prescription opioid misuse among both Black and White respondents., Conclusions: The current research identified a number of unique correlates of prescription opioid misuse among Black adults. To more effectively deal with the current public health crisis, research must identify risk factors among various groups within the population., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: As resources are deployed to address the opioid overdose epidemic in the USA, it is essential that we understand the correlates of more frequent opioid injections-which has been associated not only with HIV and HCV transmission, but also with overdose risk-to inform the development and targeting of effective intervention strategies like overdose prevention and naloxone distribution programs. However, no studies have explored how characteristics of opioid use partnerships may be associated within injection frequency with opioid partnerships., Methods: Using baseline data from a trial of a behavioural intervention to reduce overdose among opioid users in San Francisco, CA, we calculated assortativity among opioid use partnerships by race, gender, participant-reported HIV- and HCV-status, and opioids used using Newman's assortativity coefficient (NC). Multivariable generalized estimating equations linear regression was used to examine associations between individual- and partnership-level characteristics and injection frequency within opioid use partnerships., Results: Opioid use partnerships (n=134) reported by study participants (n=55) were assortative by race (NC=0.42, 95%CI=0.33-0.50) and participant-reported HCV-status (NC=0.42, 95%CI=0.31-0.52). In multivariable analyses, there were more monthly injections among sexual/romantic partnerships (β=114.4, 95%CI=60.2-168.7, p<0.001), racially concordant partnerships reported by white study participants (β=71.4, 95%CI=0.3-142.5, p=0.049), racially discordant partnerships reported by African American study participants (β=105.7, 95%CI=1.0-210.5, p=0.048), and partnerships in which either member had witnessed the other experience an overdose (β=81.8, 95%CI=38.9-124.6, p<0.001)., Conclusion: Social segregation by race and HCV-status should potentially be considered in efforts to reach networks of opioid users. Due to higher injection frequency and greater likelihood of witnessing their partners experience an overdose, individuals in sexual/romantic opioid use partnerships, white individuals in racially homogenous partnerships, and African American individuals in heterogeneous partnerships may warrant focused attention as part of peer- and network-based overdose prevention efforts, as well as broader HIV/HCV prevention strategies. Developing and targeting overdose prevention education programs that provide information on risk factors and ways to identify overdose, as well as effective responses, including naloxone use and rescue breathing, for more frequently injecting networks may help reduce opioid morbidity and mortality in these most at risk groups., (Copyright © 2016. Published by Elsevier B.V.)

Background: Young people from the former Soviet Union (FSU) in the U.S. are engaging in opioid and injection drug use (IDU) in substantial numbers, paralleling nationwide trends. Yet opioid-using FSU immigrants face distinctive acculturation challenges, including perceived stigmatisation as drug users within their immigrant communities, which may exacerbate the negative health and psychosocial consequences of such use., Methods: This qualitative study draws on semi-structured interviews with 26 FSU immigrant young adults (ages 18-29) living in New York City who reported opioid use in the past month and/or were currently in treatment for opioid use disorder. Interviews probed youths' drug use histories, immigration/acculturation experiences, family and peer relationships, and service utilisation. Interviews or focus groups were also conducted with 12 FSU mothers of opioid-using youth and 20 service providers familiar with the FSU population. In a content-based thematic analysis, verbatim transcripts were coded for salient themes., Results: All three participant groups emphasized that stigma towards drug users within the FSU community is pervasive and acute, in contrast to the cultural acceptance of heavy drinking, and is rooted in punitive Soviet-era drug policies, fostering widespread ignorance about drugs and addiction. Young adults and service providers reported instances in which anticipation of community stigmatisation deterred youth from accessing drug treatment and harm reduction services. Similarly, stigma contributed to parents' failure to recognize early signs of their children's opioid problems and their reluctance to seek drug treatment for their children until opioid use had become severe. Young adults described how drug-use stigma is frequently internalized, leading to shame and loss of self-esteem., Conclusion: Findings indicate an urgent need for community-wide education about drugs within FSU immigrant communities, and suggest specific service modalities that may be less stigmatizing for youth, such as peer-delivered syringe exchange and harm reduction education, and technology-based interventions that can be accessed privately and discreetly., Competing Interests: This original article has not been submitted or published elsewhere in any form. All authors have contributed significantly to the work presented in this article, and all authors agree to the submission of this article to the International Journal of Drug Policy. The authors also have no conflicts of interests to declare. Thank you for considering this article for publication., (Published by Elsevier B.V.)

Background: Geographic and demographic variation in buprenorphine and methadone treatment use in U.S. cities has not been assessed. Identifying variance in opioid maintenance is essential to improving treatment access and equity., Purpose: To examine the differential uptake of buprenorphine treatment in comparison to methadone treatment between 2004 and 2013 in neighborhoods in New York City characterized by income, race and ethnicity., Methods: Social area (SA) analysis of residential zip codes of methadone and buprenorphine patients in NYC, which aggregated zip codes into five social areas with similar percentages of residents below poverty, identifying as Black non-Hispanic and as Hispanic, to examine whether treatment rates differed significantly among social areas over time. For each rate, mixed model analyses of variance were run with fixed effects for social area, year and the interaction of social area by year., Results: Buprenorphine treatment increased in all social areas over time with a significantly higher rate of increase in the social area with the highest income and the lowest percentage of Black, Hispanic, and low-income residents. Methadone treatment decreased slightly in all social areas until 2011 and then increased bringing rates back to 2004 levels. Treatment patterns varied by social area., Conclusions: Buprenorphine treatment rates are increasing in all social areas, with slower uptake in moderate income mixed ethnicity areas. Methadone rates have remained stable over time. Targeted investments to promote public sector buprenorphine prescription may be necessary to reduce disparities in buprenorphine treatment and to realize its potential as a public health measure., (Copyright © 2016. Published by Elsevier Ireland Ltd.)

Background: Treatment of opiate use disorders with methadone is complicated by wide interindividual variability in pharmacokinetics. To identify potentially contributing covariates in methadone pharmacokinetics, we used population pharmacokinetic modeling to estimate clearance (CL/F) and volume of distribution (V/F) for each methadone enantiomer in an ethnically diverse methadone maintained population., Methods: Plasma levels of the opiate-active R-methadone and opiate-inactive S-methadone were measured in 206 methadone maintained subjects approximately two and twenty-three hours after a daily oral dose of rac-methadone. A linear one-compartment population pharmacokinetic model with first-order conditional estimation with interaction (FOCE-I) was used to evaluate methadone CL/F and V/F. The influence of covariates on parameter estimates was evaluated using stepwise covariate modeling. Covariates included ethnicity, gender, weight, BMI, age, methadone dose, and 21 single nucleotide polymorphisms in genes implicated in methadone pharmacokinetics., Results: In the final model, for each enantiomer, Hmong ethnicity reduced CL/F by approximately 30% and the rs2032582 (ABCB1 2677G>T/A) GG genotype was associated with a 20% reduction in CL/F. The presence of the rs3745274 minor allele (CYP2B6 515G>T) reduced CL/F by up to 20% for S-methadone only. A smaller effect of age was noted on CL/F for R-methadone., Conclusion: This is the first report showing the influence of the rs2032582 and rs3745274 variants on methadone pharmacokinetics rather than simply dose requirements or plasma levels. Population pharmacokinetics is a valuable method for identifying the influences on methadone pharmacokinetic variability., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To examine the prevalence and patterns of nonmedical use of prescription opioid analgesics and stimulants among student pharmacists., Design: Descriptive, nonexperimental, cross-sectional study., Setting: Private urban college of pharmacy in the United States in fall 2006., Participants: 1,538 PharmD students., Intervention: Online survey., Main Outcome Measures: Lifetime and past-year nonmedical prescription opioid and stimulant use., Results: Response rate for the survey was 62%. Lifetime prevalence of opioid misuse was 8%, and 5% of students had misused in the past year. Lifetime prevalence of stimulant misuse was 7%, and 5% had misused in the past year. Whites and fraternity or sorority members were more likely than their peers to have ever misused opioids. Past-year opioid misuse was more likely among whites, men, and low academic achievers compared with their peers. Lifetime stimulant misuse was more likely among students who were white, older, and fraternity or sorority members, while past-year misuse was more likely among whites and low academic achievers. Common motives for opioid misuse were to have fun, to relax, and to deal with chronic pain. Stimulants were used to improve concentration and academic performance. Friends were the most common source of prescription opioids and stimulants. Nonmedical prescription use was associated with greater likelihood of alcohol and other illicit substance use., Conclusion: The prevalence of prescription medication misuse among student pharmacists was lower than (opioids) or comparable with (stimulants) reported rates in college populations. Subgroups of students demonstrated higher rates of nonmedical use, including whites, students involved with fraternities or sororities, and low academic achievers. That friends were the primary source of misused medications indicates that diversion of prescription-only controlled substances likely occurs among student pharmacists. Nonmedical prescription medication use should be considered in the context of other substance use.

Issue: Inadequate pain management is a serious public health problem that affects a wide cross-section of Americans. Patients are often denied sufficient medication, because physicians lack training and fear scrutiny from federal and state regulatory agencies. In addition, even the state-financed system of care, Medicaid, has been increasingly denying payment for the best treatment for pain management. These factors are complicated by physician bias about various subgroups and poor physician-patient communication. Comprehensive patient assessment plays a crucial role in determining appropriate treatment and identifying potential abuse problems. Physicians must routinely document medications analgesic effects and screen for potential ill effects and drug abuse., Objective: To examine the prevalence of the undertreatment of pain, particularly among African Americans, and to recommend relevant proactive policy and practice changes to aid in eliminating this health problem., Consensus Process: In July 2002, the NMA convened the "Managing Pain: The Challenge in Underserved Populations: Appropriate Use versus Abuse and Diversion" Consensus Meeting in Washington, DC. The country's most renowned experts in the area of pain management and substance abuse reviewed substantial information regarding pain management and substance abuse including the following: --A draft summary paper on pain management and substance abuse that served as briefing material for consensus members; --Annotated bibliographies; --Articles on pain management and substance abuse; and --Key presentations on pain management and substance abuse.

This paper examines the association between DSM-IV alcohol dependence, drug use and DSM-IV drug/abuse dependence in a sample of White (n = 256), Black (n = 263) and Mexican American (n = 212) men consecutively admitted to five alcohol treatment programs in a Northern California county. Results show that drug use is higher among Blacks and Mexican Americans than among Whites. About 35% of the Whites 43% of the Blacks and 35% of the Mexican Americans are both alcohol and drug dependent. Among alcohol dependent individuals, about 44% of the Whites, 72% of the blacks and 52% of the Mexican Americans report using at least one drug other than alcohol once a week or more in the 12 months previous to the interview. The drug most frequently used by Whites is marijuana, followed by cocaine and amphetamines. The drug most frequently used by Blacks and Mexican Americans is cocaine, followed by marijuana. Severity of drug dependence is inversely related to severity of alcohol dependence among Whites. Alcohol treatment programs for Whites, Blacks and Mexican Americans must offer assessment, treatment matching and relapse prevention that takes into consideration this high prevalence of drug use and dependence.