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Background: This paper reports on recruiting strategies in a study which aimed to examine the mechanism of intranasal oxytocin on cue-induced opiate craving and attentional bias in males using heroin in addition to substitute opiates from four UK community drug treatment services. Methods: Recruitment took place during and post-COVID-19 periods of social distancing and lockdowns. Caseworkers obtained consent to contact from interested service users before an initial telephone screen. People were then scheduled for in-person screens, typically within seven days of the initial telephone call. Subsequent visits took place within 30 days of the previous visit. Each visit lasted one hour and participants received one £20 voucher per completed visit. Results: Thirty participants were randomized from 113 referrals. We were unable to contact 36% (n = 41) of people. Of those eligible to start the study (n = 44), 68% (n = 30) agreed to start the study, retaining 82% (n = 24) to completion. Factors which positively influenced recruitment were having a research presence on site, the cultivation of relationships and demonstrating respect and gratitude toward the participants. Conclusions: These results support the feasibility of recruiting males currently using heroin in addition to substitute opiates utilizing a person-first approach with service users and staff. [ABSTRACT FROM AUTHOR]

Objective: The study's objectives were (i) demonstrating the trends of sociodemographic, substance use, and clinical characteristics of pregnant women admitted to substance use treatment facilities from 2011 to 2018 and (ii) mining their patterns of association of polysubstance use. Methods: We used the Treatment Episode Data Set – Admissions (TEDS-A) of pregnant women between 2011 and 2018. The Cochran–Armitage test was employed to test the trend, and Market Basket Analysis (MBA) was used for mining association rules to identify polysubstance use patterns. Results: Over the years, some cohorts consistently showed majority admissions. Among these, age (30–39 years), education (12 or more years), injection as a route, and medication-assisted opioid therapy showed a significantly increasing trend. Admissions increased significantly with heroin (66%) and methamphetamine (46%) and decreased between 23% and 43% with alcohol, marijuana/hashish, cocaine/crack, other opiates/synthetics, and benzodiazepines. Basket analysis revealed some patterns of polysubstance co-occurrence consistent over the years. For instance, the co-occurrences of {alcohol, marijuana/hashish} or {methamphetamine, marijuana/hashish} were the most common. Conclusions: The findings on trends and long-run polysubstance use patterns may help to find pregnant women's most vulnerable cohorts for effective interventions to minimize the health risk for them and their fetuses. [ABSTRACT FROM AUTHOR]

Background: Individuals with disabilities are more likely to use substances and have cardiovascular disease (CVD) than individuals without disabilities. CVD is associated with drug use, which increases the risk for poor CVD outcomes. Our aim was to test the association between CVD and lifetime drug use (LDU) among those with vision loss (VL) and/or hearing loss (HL) and assess if disability type moderated this association. Methods: Multivariable logistic regression incorporating complex survey design was used to estimate adjusted odds ratios (AOR) using data from NHANES 2013–2018. Results: Although not quite statistically significant (p ≥.05), the magnitude of effect modification was large. The effect was positive among those with VL (AOR = 1.55, 95% confidence interval (CI) = 0.73, 3.30) or HL (AOR = 1.69, 95% CI = 0.56, 5.11), but among those with both CVD was associated with 75% lower odds of LDU (AOR = 0.25, 95% CI = 0.06, 1.05). After adjusting for multiple comparisons, the CVD effect was significantly different between those with VL versus both VL and HL (p <.05), and nearly significantly different between those with HL versus both (p ≥.05). Conclusions: Additional research could focus on the relationship between CVD and LDU among persons with sensory disabilities. [ABSTRACT FROM AUTHOR]

Background: Previous non-fatal overdose may increase risk of overdose fatality for women reentering the community following incarceration, but pre-incarceration overdose experiences are understudied. This study describes the prevalence and correlates of non-fatal overdose prior to jail among women with opioid use disorder (OUD). Methods: Women (N = 700) were randomly selected from eight Kentucky jails, screened for OUD, and interviewed as part of the NIDA-funded Kentucky Justice Community Opioid Innovation Network (JCOIN) trial. Descriptive statistics were used to examine women's prior overdose experiences, while bivariate analyses and logistic regression were used to identify correlates of overdose in the 90 days prior to jail. Results: Analyses found that 55.4% of women had overdosed in their lifetime, and 21.4% overdosed in the 90 days prior to jail. Of those who overdosed in the 90 days prior to jail, heroin (80.7%) was the most-commonly used drug prior to overdose, 35.2% received emergency, medically-attended services post-overdose, and 92.4% were administered naloxone – primarily by acquaintances. Overdosing in the 90 days prior to jail was positively correlated with identifying as a sexual minority, being from an urban community, childhood victimization, as well as recent heroin, fentanyl, and injection drug use. Conclusions: Findings indicate that prior overdose is common among jailed women with OUD, and although naloxone was often administered, few women received medically-attended services post-overdose. Results highlight the importance of distributing naloxone to community members and women reentering the community from jail, and suggest additional research is needed to understand factors inhibiting medical care following an overdose. [ABSTRACT FROM AUTHOR]

Background: Substance use carries a wide range of negative consequences, impacting both the individual using the substances and others. In recent years, there have been multiple efforts to assess the harm caused by drugs and to rank them, with each taking a distinctive approach to the matter. Objectives: This study seeks to introduce a new model for assessing the harm index and ranking of drugs. Methods: This prospective study involved the evaluation of 277 male drug users, assessing substance use harm on four separate occasions throughout the span of 1 year. Various aspects of harm were quantified through the utilization of the Duke Health Profile (DUKE) and the Addiction Severity Index (ASI) questionnaire. The pharmaceutical properties of each drug were incorporated into the study. The relationship between the combined variables in a mixed statistical model was determined at a significance level of.05 using the Rsoftware. This procedure facilitated the establishment of models and the definition of harm index ranges for each substance. Result: The results indicated that heroin had the highest harm index at 71.2 (95% CI69.6–72.8), while pure methadone scored the lowest at 36.5 (95% CI31.7–41.7), along with methadone combined with methamphetamine, which scored 35 (95% CI33–37.1). Conclusion: The variables utilized in this study can help estimate the approximate harm index range for both traditional and novel substances. Furthermore, the harm model designed in this study has the capability to predict the extent of harm to a drug user. [ABSTRACT FROM AUTHOR]

Background: Although substance use rates among adolescents have decreased, drug overdose deaths among adolescents have increased since 2020, driven largely by illegally made fentanyl (IMF). This study explores substance use patterns and characteristics of adolescents who were assessed for substance use disorder (SUD) treatment to inform prevention and response strategies. Methods: A convenience sample of adolescents aged 10–18 years assessed for SUD treatment from September 2017 to December 2021 was analyzed using the Comprehensive Health Assessment for Teens. The percentage of lifetime and past 30-day substance use was examined. Adolescent characteristics (e.g., demographics, history of overdoses or hospital visits due to drug/alcohol use) were analyzed by lifetime substances used. Results: Among 5,377 assessments, most were male (58.7%), aged 16–18 years (50.5%), non-Hispanic White (43.1%), enrolled in school (87.3%), and living with their parent(s) (72.4%). The most commonly reported lifetime substances used were marijuana (68.0%), alcohol (54.2%), and prescription opioid misuse (13.6%). The most common past 30-day substance use combination was alcohol and marijuana (35.6%). The percentage of assessments indicating past-year overdoses or hospital visits due to drug/alcohol use was greatest among those who reported lifetime use of IMF (24.0%), followed by heroin (21.4%) and cocaine (15.3%). Overall, 2.3% reported lifetime IMF use and 0.6% thought IMF was causing them the most problems. Conclusions: Findings inform opportunities to address substance use and increased IMF-involved overdose among adolescents. Continued overdose prevention and response strategies such as evidence-based education campaigns, naloxone distribution and harm reduction efforts, and evidence-based SUD treatment expansion are needed. [ABSTRACT FROM AUTHOR]

Social connectedness and related relational constructs can facilitate recovery in adults with substance use disorder (SUD). To date, there is a lack of research differentiating music therapy interventions as measured by the group relationship among peers within an inpatient detoxification setting for adults with SUD. The purpose of this study was to compare three commonly used group music therapy interventions in adults with SUD by measuring the group relationship Participants (N = 103) were adults with SUD hospitalized on an inpatient detoxification unit. The researcher cluster-randomized participants to one of three single-session group music therapy conditions: lyric analysis (LA), recreational music therapy (RMT), or songwriting (SW). Participants completed pre- and posttest measures of the group relationship. All conditions had favorable mean group relationship changes from pre- to posttest. There were significant between-group differences in the positive bonding relationship and positive working relationship subscales between the SW and RMT conditions. There was a significant between-group difference in the negative relationship scale between the RMT and both the LA and SW conditions. Despite the temporal limitations of single-session therapy common on detoxification units, this study has clinical implications because of the relevance of social connectedness and group relationships among adults with SUD. As the SW condition outperformed the RMT condition in all three group relationship subscales and has support regarding other SUD-related constructs, SW may constitute an ideal intervention in adult detoxification settings. Implications, limitations, and suggestions for future research are provided. [ABSTRACT FROM AUTHOR]

The article focuses on the challenges of addressing co-occurring disorders among US military veterans, emphasizing the complexity of mental health and substance use issues that arise from combat experiences and post-service struggles. Topics include the increased prevalence of PTSD and substance use disorders among veterans, the barriers veterans face in accessing Veterans Administration services, and the effectiveness of treatment models that integrate peer support and case management.

Opioid misuse continues to cause significant harm. To investigate current research, we conducted a scoping literature review of disease spread models of opioid misuse from January 2000 to December 2022. In total, 85 studies were identified and examined for the opioids modeled, model type, data sources used and model calibration and validation. Most of the studies (58%, 49) only modeled heroin; the next largest categories were prescription opioids and unspecified opioids which accounted for 9% (8) each. Most models were theoretical compartmental models (57) or applied compartmental models (21). Previously published research was the most used data source (38), and a majority of the model validation involved the researchers setting initial conditions to verify theoretical results (30). To represent typical opioid use more accurately, multiple opioids need to be incorporated into the disease spread models, and applying different modeling techniques may allow other insights into opioid misuse spread. [ABSTRACT FROM AUTHOR]

Background: Family Dependency Treatment Court (FDTC) is a problem-solving court for parents who have child welfare involvement and designed to address parental substance misuse by providing treatment and wrap-around services, with the goal of reunifying parents with their children. Objectives: This study aimed to identify different classes of FDTC parents and compare how child placement outcomes differ by class. Parental characteristics and permanent placement outcomes for 354 parents participating in a Central Florida FDTC were assessed using administrative data. An exploratory latent class analysis was conducted to classify parents. Results: Results revealed three distinct classes of FDTC participants: 1) co-occurring issues, 2) racial/ethnic minority participants, and 3) prescription opioid, meth, and heroin users. Regression analyses showed that parents with co-occurring issues were over two times more likely to achieve permanency (OR = 2.05, p <.05), and were two times less likely to terminate their parental rights (TPR) compared to the other two classes. Conclusions: Implications for tailoring FDTC procedures to parents' individual needs, combating racial/ethnic disparities in access to services and placement outcomes, and improved child welfare and placement outcomes are discussed. [ABSTRACT FROM AUTHOR]

Background: Societal beliefs about the seriousness of different addictions were assessed in the United Kingdom (UK). Methods: An online panel, conducted in 2021 and sampled to be representative of the UK general population 18 years and over (N = 1499), was conducted and asked participants their views regarding the seriousness of different societal problems, including various addictive behaviors. Results: Cannabis was ranked as the least serious of the addictive behaviors. Other illicit drug use (cocaine, amphetamine, heroin) was rated as the most serious of addictive behaviors. None of the addictive behaviors were rated as being as serious a problem to society as environmental damage, violent crime, poverty, and the COVID-19 pandemic. Conclusions: Ratings of cannabis use were not as expected and stand in contrast to the current UK policy on cannabis use. In addition, the UK policy on alcohol consumption contrasts with societal concerns about alcohol use. [ABSTRACT FROM AUTHOR]

Methamphetamine overdose can cause severe psychological and physical health issues including psychosis, heart attack, and death. People who use methamphetamine (PWUM) who experience methamphetamine overdose symptoms (MOS) are advised to seek emergency healthcare; however, factors related to seeking care are not well characterized. This study used data from the 2021 Washington State Syringe Services Program (SSP) Health Survey, a cross-sectional survey administered to participants at 21 SSPs in Washington (N = 955). Participants answered questions related to substance use including emergency department/room (ER) utilization for methamphetamine use and whether they experienced psychological and physical MOS. Using Poisson regression, we assessed the association between ER utilization for methamphetamine use, non-fatal opioid overdose, and other key covariates among PWUM who experienced MOS. Methamphetamine use in the last three months was reported by 86% of participants. Among PWUM, 31% reported psychological MOS, 19% reported physical MOS, and 37% reported ≥1 MOS in the prior three months. Non-fatal opioid overdose (adjusted prevalence ratio [APR] = 2.04, 95% CI = 1.38–3.03), main drug of goofball (heroin and methamphetamine combined) (APR = 1.98, 95% CI = 1.34–2.92) and recent blood infection/sepsis (APR = 2.07, 95% CI = 1.24–3.46) were associated with ER utilization for MOS. Among people who use SSPs in Washington State, methamphetamine use remains high, and MOS are common. Recent non-fatal opioid overdose was positively associated with ER utilization for methamphetamine use among PWUM who experienced MOS. Patients in the ER for MOS should be screened for opioid use disorder and linked with harm reduction supplies like naloxone and medications for opioid use disorder. [ABSTRACT FROM AUTHOR]

This research analyzes the police departments' unconventional approach to fighting heroin by offering treatment instead. Police departments implement a program, the Safe Passages, that allows an individual addicted to heroin to enter the police department without fear of arrest or questioning. A qualitative research design was used for this study that was centered on new initiatives that have been enacted by leaders in law enforcement in order to combat the heroin epidemic. This study analyzed the Safe Passages program in police departments in Will County: the overall cost of the program, information dissemination to the public, and the impact it has had on communities. Data was collected through in-depth interviews, and also available documentation that illustrated whether or not initiatives, such as the Safe Passages program, have been looked at as successful in certain communities. This qualitative study found three themes that emerged: heroin addiction was a problem in communities, the costs associated with the Safe Passages program, and the challenges, such as lack of recent participation and poor advertising, and effects the Safe Passages program has had on communities where the program was implemented. The Safe Passages program is designed for intervention to assist police departments in combating the root problem of heroin addiction. The majority of respondents felt that Safe Passages program had made a positive impact in their communities, and they would encourage other police departments to utilize this program. [ABSTRACT FROM AUTHOR]

Opioid withdrawal symptoms are a highly salient and consequential health condition experienced by people who use opioids (PWUO). This study utilized qualitative interviews to explore opioid withdrawal experiences and consequences among PWUO in Los Angeles County, USA. Semi-structured qualitative interviews were conducted with 22 PWUO (aged 27–63 years) between May 2021 and May 2022. Participants self-reported opioid and injection drug use in the last 30 days. We employed an inductive thematic approach to systematically code and synthesize textual interview data. Participants experienced withdrawal symptoms frequently, with many going to great lengths to avoid them. Withdrawal pain was described as incapacitating and interfered with PWUO's ability to sustain regular employment and ensure stable housing. Avoiding withdrawal was described as influential in driving decisions to continue using opioids. Mechanisms for managing withdrawal included using other substances to the point of sedation. PWUO who transitioned from heroin to fentanyl use revealed more frequent, painful, and faster onset of withdrawal symptoms. Adverse withdrawal experiences and fear of precipitated withdrawal from buprenorphine were barriers to treatment initiation and continuation. Withdrawal symptoms among PWUO increase health risk. Improved strategies to treat opioid withdrawal are urgently needed. Solutions such as safe supply and intentional opioid withdrawal interventions (educational trainings, withdrawal comfort kits) are needed to improve withdrawal management and reduce opioid-related harm. [ABSTRACT FROM AUTHOR]

Substance use in people with HIV (PWH) negatively impacts antiretroviral therapy (ART) adherence. However, less is known about this in the current treatment era and the impact of specific substances or severity of substance use. We examined the associations of alcohol, marijuana, and illicit drug use (methamphetamine/crystal, cocaine/crack, illicit opioids/heroin) and their severity of use with adherence using multivariable linear regression in adult PWH in care between 2016 and 2020 at 8 sites across the US. PWH completed assessments of alcohol use severity (AUDIT-C), drug use severity (modified ASSIST), and ART adherence (visual analogue scale). Among 9400 PWH, 16% reported current hazardous alcohol use, 31% current marijuana use, and 15% current use of ≥1 illicit drugs. In multivariable analysis, current methamphetamine/crystal use, particularly common among men who had sex with men, was associated with 10.1% lower mean ART adherence (p < 0.001) and 2.6% lower adherence per 5-point higher severity of use (ASSIST score) (p < 0.001). Current and more severe use of alcohol, marijuana, and other illicit drugs were also associated with lower adherence in a dose-dependent manner. In the current HIV treatment era, individualized substance use treatment, especially for methamphetamine/crystal, and ART adherence should be prioritized. [ABSTRACT FROM AUTHOR]

The opioid epidemic has created unprecedented challenges in the United States (US), including hundreds of thousands of lives lost to overdose in the past five years. Expansion of prevention and treatment for opioid use disorder (OUD) is urgently needed, as evidence-based strategies exist but many remain unable to access life-saving services. To inform school health and mental health providers, educators and school administrators about the causes and consequences of the US opioid epidemic and to provide practical solutions for engineering multi-tiered systems of support for children and families affected by the epidemic, including through opioid misuse, OUD, and opioid overdose. We review the literature on the history of and current challenges associated with the opioid epidemic in the US. The collateral damage of OUD is pervasive, impacting children and families across the US. We found no health education programs focusing on this topic in US schools, underscoring a critical need and cogent practice/policy avenue. Schools are uniquely positioned to respond to the opioid epidemic, but school health and mental health providers, educators, and other professionals who work in schools must have accurate knowledge of the opioid epidemic, understand the challenges it is causing for children and families, and be familiar with best practices in prevention and treatment. This review provides a succinct overview of the history of the opioid epidemic, examines its impacts on children and families, and provides a call to action for schools to partner in our national response. The US opioid epidemic has caused broad devastation in homes, schools, and communities across the country. Increases in mental health disorders and isolation associated with the COVID-19 pandemic have only worsened the epidemic. School health and mental health providers, along with educators and school administrators, can play a critical role in delivering prevention messages, providing screening and linkage to evidence-based services, and offering psychosocial support for children and families impacted by opioid misuse and opioid use disorder (OUD). Decreasing the stigma surrounding the opioid epidemic is also critical, and school professionals/educators are well-positioned to play a key role in stigma reduction efforts in schools and communities. There is a critical absence of health education programs in the US focusing on this topic, underscoring the need for the development and expansion of such programs. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) [ABSTRACT FROM AUTHOR]

ATS dependence in Malaysia is growing tremendously across multiracial Malaysian groups, increasing concerns among public health experts and the community. This study highlighted the chronicity of ATS dependence and factors associated with ATS use. Interviewer-administered questionnaires were administered using ASSIST 3.0. A total of N = 327 multiracial people who use ATS were enrolled in this study. The study findings show that 190/327 (58.1%) respondents were ATS dependent. Malays reported the highest number of ATS-dependent (55.8%), followed by Bajau (21.6%) and Kadazan-Dusun (16.8%) ethnic. Across all races, three factors were significantly associated with the ATS dependence: respondents who had a lifetime history of needle sharing aOR = 0.023 (95% CI: 0.003, 0.183) and a lifetime history of heroin use aOR = 0.192 (95% CI: 0.093, 0.396) were at a reduced odd of ATS dependent. Meanwhile, being married reduced the likelihood of becoming dependent on ATS with aOR = 0.378 (95% CI: 0.206, 0.693) compared to being single or divorced. This study revealed that the use of ATS among multiracial Malaysians is alarmingly high, including those in detention centers. Comprehensive harm reduction strategies are urgently needed to prevent the spreading of infectious diseases and other negative health consequences associated with ATS use. [ABSTRACT FROM AUTHOR]

Adolescent substance use continues to be a global concern. Research has shown that two consistent predictors of this behavior are self-control and peer substance use. The objective of this study was to determine if these two variables interact to affect the frequency of substance use among young people. The analysis utilized three years of data from the Second International Self-Report Delinquency study (2005-2007) (ISRD-2), which gathered information from youth, ages 12-17, residing in 30 nations (n = 72,206). Illicit substance use included cannabis, ecstasy, stimulants, and other substances. A zero-inflated negative binomial model that adjusts for selection effects was estimated to predict the frequency of substance use. The results showed that adolescents with low self-control who associated with substance using peers tended to be the most frequent substance users. Yet, youth with higher levels of selfcontrol were likely to report no or low frequency use regardless of the number of their friends who used illicit substances. Self-control affects substance use among adolescents and can attenuate the influence of peer substance use. Research using longitudinal data is needed to disentangle changes in self-control, peer substance use, and one's own substance use. [ABSTRACT FROM AUTHOR]

AbstractThe sources of seized heroin can provide information on its manufacture and distribution. Using ultra-high-performance liquid chromatography with tandem mass spectrometry (UPLC-MS/MS), 15 neutral/acidic characteristic target substances in illicit heroin products were determined. The analysis of these samples was completed by combining mathematical and statistical analysis. In all, 38 heroin samples from different cities were characterized by combining case information, relevant subgroups, and principal component analysis (PCA) results. The samples were initially classified using principal component analysis (PCA). The Pearson distance was used to calculate the correlation between samples in each group separately, and r > 0.98 was selected as the threshold value to screen out 11 groups with strong correlations. It was surmised from the case information that the origin or processing methods of heroin seized from different cities may differ. This study applies correlation analysis to relate the seized heroin from different cases to the same upline or network, providing insight for the investigation. [ABSTRACT FROM AUTHOR]

AbstractRationaleObjectivesResultsConclusionThe opioid crisis in North America has recently seen a fourth wave, which is dominated by drug-related deaths due to the combined use of illicitly manufactured fentanyl [IMF] and stimulants such as cocaine and methamphetamine.A systematic review addressing the question why drug users combine opioids and stimulants and why the combination results in such a high overdose mortality: from specific and dangerous pharmacokinetic or pharmacodynamic interactions or from accidental poisoning?Motives for the combined use include a more intensive high or rush when used at the same time, and some users have the unfounded and dangerous belief that co-use of stimulants will counteract opioid-induced respiratory depression. Overdose deaths due to combined (intravenous) use of opioids and stimulants are not likely to be caused by specific pharmacokinetic or pharmacodynamic interactions between the two drugs and it is unlikely that the main cause of overdose deaths is due to accidental poisoning.The unexpectedly high overdose rates in this population could not be attributed to accidental overdosing or pharmacokinetic/pharmacodynamic interactions. The most likely explanation for the high rate of drug-related deaths in opioid-cocaine co-users is careless overdosing with either cocaine, opioid(s) or both, probably facilitated by the high level of preexisting impulsivity in these co-users and a further acute increase in impulsivity following cocaine use. The primary corollary is that cocaine users should avoid IMF use in the same time window. In addition, IMF users should refrain from cocaine use to avoid impulsive IMF overdosing. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsConsuming opioid agonists is a risk factor for cardiovascular disease particularly in intravenous heroin users. The monthly injectable extended-release opioid antagonist, naltrexone (XR-NTX) is an effective treatment for opioid use disorder. The impact of opioid receptor blockade through XR-NTX on blood pressure, a critical risk factor for cardiovascular morbidity, has not yet been characterized.The study evaluated the change in blood pressure during XR-NTX treatment among 14 patients who predominately used intravenous heroin and 24 patients who used prescription oral opioids, all with opioid use disorder. Blood pressure was measured in each patient immediately before the first XR-NTX injection and ∼two weeks after the first injection. The change in diastolic and systolic pressure was compared between the heroin users and the prescription opioids users using analysis of variance.XR-NTX treatment was associated with significant decreases in diastolic blood pressure in the heroin group, but not in the prescription opioids group. Systolic blood pressure values in the heroin users showed a decline at trend level only.Further research is warranted to replicate our findings and to determine whether XR-NTX effect is relatively specific to blood pressure or generalizes to other components of metabolic syndrome. Distinguishing between heroin and prescription opioid users could shed light on the unique clinical and pharmacological profiles of opioid drugs, particularly regarding their cardiovascular safety. This information can be useful in developing personalized therapeutic strategies based on the route of opioid administration. [ABSTRACT FROM AUTHOR]

Background: Polydrug use has been implicated in driving a "fourth wave" of the overdose crisis in North America, specifically through concurrent use of stimulants and opioids, especially fentanyl. In France, however, heroin has historically been and remains the easiest-to-access opioid, accounting for most drug treatment demand. Whether similar polydrug use is increasing in Western Europe remains understudied, despite severe health implications and potential inadequate public health responses. Methods: We take advantage of a nation-wide dataset containing information on all patients serviced in treatment centers in France from 2010 to 2020. We conduct Poisson regression to determine the main predictors of stimulant use among people who use heroin (PWUH) and opioids (PWUO) generally. Results: Heroin remains the primary opioid within drug treatment in France. A decreasing number of out-patients seeking treatment for heroin use has been accompanied by an increasing trend of stimulant use over time, most commonly with powder cocaine. Our results suggest a significant increase of crack cocaine use among the most vulnerable PWUH. Concurrent use of stimulants among PWUH was positively associated with use of alcohol, cannabis, unprescribed psychotropics and hallucinogens, and negatively with tobacco. Similar results were found for all in-treatment PWUO. Conclusions: Our results uncover heterogeneity in the profiles of PWUH that should be fully acknowledged to ensure better efficiency in substance use clinical practices and policy, while simultaneously drawing attention to trends in concurrent opioid-stimulant use outside North America. We advocate for an extension of the generalized risk framework and its implementation in prevention programs. [ABSTRACT FROM AUTHOR]

Fentanyl test strips (FTS) are a harm reduction method for people to test their drugs for fentanyl. Ideal points for FTS distribution have not been identified. Many people who use drugs have frequent contact with the Emergency Department (ED). We piloted FTS distribution in two urban hospital EDs. Between June-December 2021 in Philadelphia, PA, patients with past 30-day drug use completed a survey about drug use, fentanyl attitudes, and FTS; then offered FTS and a brief training. Survey data were analyzed using SPSS for bivariate statistics. Patients (n = 135) were primarily White (68.1%) and male (72.6%). Participants regularly interacted with substance use (57.8%) and benefits coordination (49.6%) services. The most common drugs used were heroin/fentanyl (68.9%), crack cocaine (45.2%) and cannabis (40.0%). Most (98.5%) had heard of fentanyl though few (18.5%) had ever used FTS. Across most drug types, participants were concerned about fentanyl. All accepted FTS training and distribution. Few (9.6%) were somewhat or very concerned about having FTS if stopped by police and this number varied by race (7.6% of White people were somewhat or very concerned, compared to 12.8% of Black people). Most participants were already engaged in risk reduction practices. FTS are a widely desired harm reduction tool to facilitate informed decision-making, and non-harm reduction locations are potentially feasible and acceptable distribution sites. Given regular contact with EDs and social services across the sample, FTS should be offered at non-harm reduction locations that come into frequent contact with people who use drugs. [ABSTRACT FROM AUTHOR]

This study explores the intentions and experiences of individuals seeking abstinence from heroin use through voluntary rehabilitation, as well as challenges to achieving a positive outcome. This study used semi-structured interviews with 37 individuals (22 female) who used heroin and utilized rational choice theory to guide data analysis. This study found that participants tried both medical and non-medical treatment methods but faced structural and personal barriers that hindered their efforts. While ceasing heroin use would presumably benefit their health and family relationships, individuals perceived the physical, psychological, and social costs of abstinence as outweighing the potential benefits and ultimately resumed heroin use. More targeted voluntary rehabilitation programs addressing specific structural and personal barriers are therefore recommended to benefit Chinese people seeking abstinence from drug use. [ABSTRACT FROM AUTHOR]

Background: As opioid overdoses continue rising, interventions are needed to expand naloxone carriage, an opioid overdose reversal agent. Use of fentanyl test strips (FTS) might promote naloxone carriage. This study examines the relationship between FTS use, perceived overdose risk, and naloxone carriage in Wisconsin, United States. Methods: In a survey of people who use drugs (n = 341) in southern Wisconsin, respondents were asked about FTS use, perceived overdose risk, and how often they (1) have naloxone, (2) have more than one dose of naloxone, and (3) the number of naloxone doses possessed currently. Likert responses were mapped to an integer scale. Ordinal and linear multivariable regression examined the relationship between FTS use and study outcomes while adjusting for respondent characteristics. Results: Most respondents were male (59.6%), identified heroin as their drug of choice (70.7%) and reported intravenous use (87.9%). In unadjusted models, FTS use was associated with more often having naloxone (OR: 2.10; p = 0.005), more often having multiple naloxone doses (OR: 2.98; p < 0.001), and possessing a greater number of naloxone doses (dose count difference: 2.85; p = 0.001). In adjusted models, FTS use was associated with more often having multiple naloxone doses (OR: 2.29; p = 0.005) and possessing a greater number of naloxone doses (dose count difference: 2.25, p = 0.020). Conclusions: Individuals who use FTS more often carry multiple doses relative to individuals who do not use FTS. Given that naloxone carriage is critical for reducing opioid overdose risk, expanding FTS use may offer a strategy to reduce opioid overdose rates via improved naloxone carriage. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the prevalence and pattern of traffic offenses associated with driving under the influence of drugs (DUID) in 31 provinces of mainland China. Traffic offenses were extracted from the nationally representative court file disclosure website. Drivers convicted of traffic offenses associated with DUID were included. The monthly percentage change (MPC) in rates was estimated by fitting negative binomial regression models to assess the time trends. Moran's I was used to determine the correlations of DUID-related rates among surrounding provinces. In total, 896 individuals convicted of DUID offenses were identified (April 2007 to March 2022). Of these, 769 individuals were involved in traffic crashes, and they killed 629 people. Regarding the types of drugs, 638 used amphetamine-type stimulants (ATS; methamphetamine, 3,4-methylenedioxymethamphetamine, amphetamine, and tenamfetamine), 104 used ketamine, 104 used opioids (heroin, morphine, methadone, codeine, and tramadol), 20 used caffeine, 4 used tetrahydrocannabinol, and 1 used gamma-hydroxybutyric acid. The offense trends among overall drug users (MPC, −1.1; p <.001) declined from 2014 to 2020. The trends also decreased for DUID-related traffic crashes (−1.5; p <.001) and deaths (−1.7; p <.001) during the same period. Except in three provinces, ATS-related offense rates were higher than opioid-related offense rates. Ketamine-related offense rates showed a significant positive correlation among the surrounding provinces (Moran's I, 0.22; p <.01), and South China had the highest ketamine-related offense rates. In the sample, the case fatality rate was 70.7%, which was a strong indicator of underreporting, and most minor DUID-related offenses could not be captured by Chinese court files. The frequency of drug screening tests for people should be increased. The traffic police in Qinghai, Tibet, and Xinjiang should always be equipped with fast screening test kits for drugs, which could increase the possibility of identifying DUID offenders. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore HIV risk perceptions and to examine the factors associated with the perceptions of HIV risk among people who inject drugs in Saveh, Iran. In this cross-sectional survey, 272 people who inject drugs in Saveh were recruited using a convenience snowball sampling method between April 2020 and May 2021. Two classes of HIV risk perception (high versus low) were identified using logistic regression to determine factors associated with individual HIV risk perception. Study participants were categorized as having a low (n = 181, 66.5%) or high (n = 91, 33.5%) risk perception for becoming infected with HIV. The odds of categorizing as high risk for HIV was significantly greater in participants who reported: injecting their drugs more than 2 times per day (AOR = 2.4, p <.05); receptive syringe sharing (AOR = 3.1, p <.05) and as HIV positive (AOR = 3.9, p <.05). Participants who smoked heroin (AOR = 0.4, p <.05) and who had received any psychosocial intervention in the previous 3 months (AOR = 0.3, p <.05) were less likely to perceive being at high for HIV risk. Interventional programs should focus on improving the perceptions of people who inject drugs toward HIV risk and reducing their HIV risk behaviors through increased HIV self-assessments. [ABSTRACT FROM AUTHOR]

Diamorphine Assisted Treatment (DAT) is a treatment offer for individuals with Opioid Dependency (OD), who have failed to benefit from standard treatment model (Opioid Substitution Therapy [OST]). In the Middlesbrough DAT service, self-administered injectable synthetic heroin (diacetylmorphine) is offered to participants, twice daily under the supervision of medical staff in a controlled and safe environment. This case report evidences outcomes from the first operational DAT service in England outside of a research trial. Descriptive quantitative data from participants who engaged within the first year of operation of DAT (n=14) is presented detailing engagement, harm reduction, and psychosocial outcomes, and criminality of the cohort. The DAT service was associated with high engagement, a large reduction in positive toxicology screens for street heroin, reduced homelessness, increased engagement with psychosocial interventions and a substantial reduction of criminal offences. Poly-drug use (specifically the consumption of street tablets) impacted treatment engagement for a proportion of the sample. We present this work as an example of bottom-up policy making within the context of UK drug treatment and implications for practice discussed. [ABSTRACT FROM AUTHOR]

Drug use among university students have major health risks and economic losses. It poses great threat to social, economic, political, and security of societies. To identify the prevalence of drug use among Tanta University students and some determinants and problems associated with it. A representative sample of 7445 students from all faculties of Tanta University were recruited to fill in a pre-structured questionnaire sheet including data related to drug use and problems associated with it. The most commonly used substance tranquilizers during lifetime represented 8.4% while hashish was reported by 4.5%, bhang by 1.6% and Tramadol by 3%. Concerning current use, tobacco smoking was reported by 12.1% of males and 0.8% of females with a total prevalence of 4.9%. Concerning the current drug used, the first ranked were tranquilizers (3.3%), followed by hashish (1.9%) then alcohol (1.8%). Theoretical faculties showed higher prevalence of drug use compared to medical and practical ones except for tranquilizers which were significantly higher in medical faculties. Tobacco is the most commonly used substance followed by tranquilizers besides alcohol and cannabis. Male students use drugs more than females. Preventive services should be directed toward university students to combat these phenomena. [ABSTRACT FROM AUTHOR]

Background Opioid use disorder (OUD) is a heterogeneous disorder. However, there is a lack of deep phenotyping investigations focusing on important psychological constructs such as resilience that may impact OUD. The present study aimed to investigate the relationship between trait resilience and the five-factor model of personality (FFM) among individuals with opioid use disorder (OUD). We also explored whether the FFM and trait resilience form specific phenotypes associated with psychological functioning. Methods This secondary analysis of an epigenetic study included participants of African ancestry (n = 72), an understudied population, who met DSM-5 criteria for OUD. Participants completed measures to assess personality traits, trait resilience, current and previous drug use, and psychological functioning (depression, anxiety, and stress). Results Linear regression revealed a significant relationship between resilience (CD-RISC-25 score) and the FFM, R2 = 0.56, F(5,62) = 15.7, p<.001. Further, a two-cluster classification emerged as the optimal solution from the cluster analysis. Cluster 1 (n = 33, 45.8% of the sample) showed lower resilience (CD-RISC-25 score: M = 58.6, SD = 11.2) compared to Cluster 2 (n = 35, 48.6%; CD-RISC-25 score: M = 76.1, SD = 11.9). The “High-Resilience Cluster” (Cluster 2) was characterized by higher FFM traits of: Extraversion, Openness, Agreeableness, and Conscientiousness, and lower Neuroticism versus Cluster 1. Multivariate analysis of variance revealed statistically significant differences between the two resilience clusters concerning other psychological symptoms, Λ = 0.732, F(4, 50) = 7.05, p < 0.003. Conclusions These findings suggest associations between the FFM and trait resilience among individuals with OUD. Two distinct “resilience phenotypes” emerged, with high-resilience individuals displaying less stress, anxiety, and depressive symptoms. Results highlight the clinical importance of resilience as a potential target for intervention in people with OUD. [ABSTRACT FROM AUTHOR]

The purpose of this qualitative study is to characterize the impacts of the COVID-19 pandemic on drug use experiences among persons who use illicit opioids (PWUO) in Arizona. Between 12/2020 and 05/2021, interviews were conducted via Zoom with 22 PWUO from across Arizona. Participants were recruited through Craigslist and social media ads, referrals by a local harm reduction organization, and other participants. The interviews were transcribed and analyzed using NVivo. Participants were 25–51 years of age, 36% were female, and 55% non-Hispanic White. Most reported past month use of heroin, and/or counterfeit (pressed) non-pharmaceutical fentanyl (NPF) pills. Nearly all reported changes in their drug use during the pandemic. Participants discussed profound negative impacts of social isolation with escalating mental health problems, boredom, and ease of hiding drug use from others, leading to increases in drug use. Loss of daily routines, employment difficulties, and challenges of accessing treatment due to COVID-19 restrictions were also driving factors for increased drug use. The growing availability of NPF pills during the pandemic led many individuals to transition from heroin to more frequent NPF pill use. The results emphasize the need for quality behavioral care services with an increased focus on economic and social support systems. [ABSTRACT FROM AUTHOR]

This study aimed to understand contributing factors of stigma toward people with opioid use disorder (OUD). We conducted a randomized factorial survey with Masters in Social Work (MSW) students (n = 70). Students received four vignettes describing a person with OUD, yielding a total of 275 vignettes for analysis. We tested whether stigma differed according to the characteristics of people with OUD. We found significantly more stigmatizing attitudes toward people with OUD who 1) inject heroin versus use oxycodone and 2) do not always take buprenorphine as prescribed versus always takes buprenorphine as prescribed. These findings indicate the need for MSW training that destigmatizes heroin use and inconsistent medication usage. [ABSTRACT FROM AUTHOR]

Nitazenes are potent synthetic opioids and N-desethyl isotonitazene, a metabolite of isotonitazene, has emerged as a drug in its own right. This is an observational case series of patients with suspected or declared substance use who were admitted to hospitals in the Sandwell and West Birmingham National Health Service Trust between July and October 2023. All patients were found on toxicological screening to have been exposed to N-desethyl isotonitazene. Twenty presentations involving 19 patients who tested positive for N-desethyl isotonitazene were included in the study. In 19 presentations, multiple substances were detected on toxicological screening. The number of patients testing positive for other substances were: 19 for cocaine and its main metabolite benzoylecgonine, 13 for morphine, 11 for the heroin-specific metabolite 6-monoacetylmorphine, ten for xylazine, eight for gabapentinoids (pregabalin and/or gabapentin), seven for methadone and/or the metabolite, 2-ethylidene-1, 5-dimethyl-3, 3-diphenylpyrrolidine, six for benzodiazepines and five for the synthetic cannabinoid MDMB-4en-PINACA. Only one patient had no other substances detected apart from N-desethyl isotonitazene. This patient presented with coma, miosis, bradypnoea and hypercapnia and responded to naloxone. In this cohort, the median concentration of N-desethyl isotonitazene was 1.53 µg/L (n = 14; range 0.59–5.48) in whole blood and 27.75 µg/L (n = 16; range 0.51–91.53) in urine. The majority of the patients in this cohort presented with features typical of an opioid overdose, which is unsurprising as they were all experienced users of diamorphine. Although these features are also consistent with the known effects of N-desethyl isotonitazene, in only one case is it possible to attribute the patient's features to N-desethyl isotonitazene toxicity alone. This case series highlights the need for toxicovigilance in the illicit drug market as patterns of substance misuse evolve and novel psychoactive substances continue to emerge. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionLeaves derived from the Kratom (Mitragyna speciosa) tree have been traditionally ingested for their curative properties by diverse groups of the population including people who use drugs (PWUDs) in Southeast Asia. This study investigated the motives for using kratom among drug-dependent adolescents.Eighty adolescents who were undergoing mandatory drug rehabilitation volunteered to participate in this mixed-method, cross-sectional study. All respondents answered a semi-structured questionnaire while a few were interviewed in-depth.The majority were males (70%, n = 56/80). The respondents’ mean age at admission was 18.2 years (SD = 1.40), and 65% were between 14 and 18 years old. Sixty-three percent (n = 50/80) had used crystal methamphetamine alone, while the rest had co-used crystal methamphetamine with heroin. About three-fifths (60%, n = 48/80) had a history of kratom use. Kratom was commonly used for many perceived benefits such as increasing energy, reducing crystal methamphetamine intake, intensifying euphoria, easing heroin withdrawal, as a heroin substitute and reducing heroin use. In addition, the multivariate analysis indicated that higher odds of kratom use were associated with those who were employed, used only crystal methamphetamine, were recent drug users, and had no prior incarceration history.While kratom was being used for its multifold perceived benefits, it also functions as a means to self-treat withdrawal from illicit drug use among drug-dependent adolescents. [ABSTRACT FROM AUTHOR]

Using the Arizona State Unintentional Drug Overdose Reporting System (AZ-SUDORS), the study aims to identify the social and drug characteristics of illicitly manufactured fentanyl (IMF)-related overdose deaths. The data include drug overdose deaths from July 1, 2019 to June 30, 2020. Decedents were categorized into four groups by types of opioids detected: (1) IMF-positive; (2) heroin-positive (negative for IMF); (3) pharmaceutical opioid-positive (negative for heroin or IMF); (4) nonopioid. Bivariate statistics were used to compare differences between IMF and other groups. Among 2,029 decedents, 77.8% tested positive for opioids. The IMF group included 57.9%, the heroin group included 9.5%, the pharmaceutical opioid group 10.5%, and the nonopioid group 22.2%. The IMF group was younger (mean age 35.0), more likely to be from a large urban area (78.2%), and with a greater proportion of ethnic/racial minorities (48.6%), compared to the other three groups. The IMF group was less likely to test positive for methamphetamine (24.9%), compared to heroin (63.7%) or pharmaceutical opioid groups (34.0%), but more likely to test positive for cannabis (31.3%), compared to the other three groups. Our data show disproportionate IMF impacts on younger persons and ethnic minorities. Interventions need to be tailored to account for distinct psychosocial profiles associated with IMF use. [ABSTRACT FROM AUTHOR]

Sexual and gender minorities (SGMs) often deal with discrimination which can result in maladaptive coping like substance misuse, yet few studies have examined the association between everyday discrimination and various types of substance misuse among SGMs or whether there is heterogeneity in substance misuse or this relationship by SGM identity. Data from 1316 adult SGMs in the United States were recruited from Reddit between February and March 2022. SGM identities (sexual minorities assigned male at birth (AMAB), sexual minorities assigned female at birth (AFAB), gender minorities AMAB, gender minorities AFAB), everyday discrimination, depressive symptoms, marijuana and alcohol misuse, over-the-counter drug misuse, prescription drug misuse, and heroin use were measured, along with demographics. Multivariable logistic regressions examined relationships between everyday discrimination and each substance misuse outcome, adjusting for SGM identity, race/ethnicity, age, income, and depressive symptoms. Interaction terms between everyday discrimination and SGM identities were added to each model to test for moderation. In fully adjusted models, with each additional unit of everyday discrimination score, there were significantly increased odds of substance misuse for all outcomes. SGM by everyday discrimination interactions was significant for alcohol misuse, over-the-counter drug misuse, and heroin use, with the association between everyday discrimination and substance misuse stronger among gender minorities. Substance misuse varied by SGM identity. Everyday discrimination was associated with substance misuse, but there was heterogeneity in this relationship between SGM identity and substance. Substance use disorder treatment and prevention among SGMs should consider heterogeneity by SGM identity and substance. [ABSTRACT FROM AUTHOR]

Illegal drugs are becoming a public health problem in African cities. In 2021, Bombé, a new drug of unknown composition, caused an outbreak of neuro-psychiatric symptoms in Kinshasa. Bombé was rumored to be based on ground catalytic exhausts stolen from cars. The chemical composition of six samples of Bombé obtained from different neighborhoods in Kinshasa was determined by triple quad liquid chromatography-mass spectrometry/mass spectrometry with confirmation by quadrupole time-of-flight mass spectrometry. Metals were determined by inductively coupled plasma-mass spectrometry, and polycyclic aromatic hydrocarbons were measured by gas chromatography-mass spectrometry. Analysis of the Bombé samples revealed that it contained heroin (2–12% of the total area under the curve of the samples) and opioid derivatives, plus paracetamol (33–72%), caffeine (17–26%), and also benzodiazepines (5/6 samples) and cyproheptadine (2/6 samples). The concentrations of neurotoxic metals were unremarkable. The median (range) concentrations of manganese and lead were 9.4 µg/g (range 3–334 μg/g) and 0.36 µg/g (range 0.1–3.12 μg/g), respectively. All polycyclic aromatic hydrocarbons were below the level of detection (<0.10 µg/g). Thanks to international collaboration, Bombé was documented to be a heroin-based drug and its alleged origin from catalytic exhausts was not substantiated. The local human expertise and technical capacity for undertaking toxicological analyses should be increased in Africa. [ABSTRACT FROM AUTHOR]

The nation's opioid epidemic requires a paradigm shift in the way patients with co-occurring opioid use disorder are treated during episodes of acute pain. Patients are often introduced to prescription opioids after an extremity fracture or sprain or resulting from musculoskeletal back, abdominal, or dental pain. Opioid naive patients who receive their first opioid prescription on discharge from the emergency department may be more likely to develop chronic opioid use compared to patients receiving non-opioid pain medications. This case report will highlight one patient's journey including initial prescription opioid use, escalation into illicit opioids, entry to a recovery and treatment program, discussions with her physician about alternative therapies, and barriers to satisfactory pain relief. A shared decision-making model will be explored. [ABSTRACT FROM AUTHOR]

In this paper, we investigated a new heroin–cocaine epidemic model which incorporates spatial heterogeneity and nonlinear incidence rate. The main project of this paper is to explore the threshold dynamics in terms of the basic reproduction number $ \mathcal {R}_0 $ R 0 , which was defined by applying the next-generation operator. The threshold type results shown that if $ \mathcal {R}_0 \lt 1 $ R 0 < 1 , then the drug-free steady state is globally asymptotically stable. If $ \mathcal {R}_0 \gt 1 $ R 0 > 1 , then heroin–cocaine spread is uniformly persistent. Furthermore, the globally asymptotic stability of the drug-free steady state has been established for the critical case of $ \mathcal {R}_0=1 $ R 0 = 1 by analysing the local asymptotic stability and global attractivity. [ABSTRACT FROM AUTHOR]

Treatment for opioid use disorder (OUD) with diacetylmorphine is an evidence-based form of drug treatment, but it is not available in the United States (US). Better understanding acceptability of treatment with injectable diacetylmorphine among people who use opioids (PWUO) in the US may expedite future initiatives designed to engage persons in this form of treatment should it become available. The purpose of this research is to examine factors associated with interest in treatment with injectable diacetylmorphine among a sample of PWUO in the US. Data are from a cross-sectional study of PWUO in Baltimore City, Maryland. Participants were given a brief description of treatment with injectable diacetylmorphine and then asked to rate their level of interest. We used Poisson regression with robust variance to assess factors associated with interest in treatment with injectable diacetylmorphine. The average age of participants was 48 years, 41% were women, and most (76%) identified as non-Hispanic, Black. The most commonly used substances were non-injection heroin (76%), opioid pain relievers (73%), and non-injection crack/cocaine (73%). Two-thirds of participants (68%) indicated interest in treatment with injectable diacetylmorphine. Factors significantly associated with interest in injectable diacetylmorphine treatment included: having at least a high school education (adjusted prevalence ratio [aPR]: 1.23; 95% confidence interval [CI]: 1.04–1.45), not having health insurance (aPR: 1.23; 95% CI: 1.06–1.44), having ever overdosed (aPR: 1.20; 95% CI: 1.01–1.42), and past utilization of medications for opioid use disorder (aPR: 1.22; 95% CI: 1.01–1.47). Recent non-injection cocaine use was inversely associated with interest in treatment with injectable diacetylmorphine (aPR 0.80; 95% CI: 0.68–0.94). The majority of participants reported interest in treatment with injectable diacetylmorphine. Given worsening trends in the addiction and overdose crisis in the US, treatment with injectable diacetylmorphine should be considered as another evidence-based option for treating OUD. Interest in treatment with injectable diacetylmorphine was high among a sample of people who use opioids in the United States. Factors associated with increased interest in treatment with injectable diacetylmorphine included having at least a high school education, having ever overdosed, and not having health insurance. Past utilization of medications for opioid use disorder was associated with interest in treatment with injectable diacetylmorphine. [ABSTRACT FROM AUTHOR]

To date, few studies have investigated the toxicological effects of the combined use of amphetamine and heroin in the heart. Hence, the aim of this study was to identify indicators for clinical evaluation and prevention of cardiac injury induced by the combined use of amphetamine and heroin. Four different groups were analyzed: (1) normal group (n＝25；average age＝35 ± 6.8); (2) heart disease group (n＝25；average age＝58 ± 17.2); (3) drug abusers (n = 27; average age = 37 ± 7.7); (4) drug abstainers (previous amphetamine-heroin users who had been drug-free for more than two weeks; n = 22; average age = 35 ± 5.6). The activity of MMPs, and levels of TNF-α, IL-6, GH, IGF-I, and several serum biomarkers were examined to evaluate the impact of drug abuse on the heart. The selected plasma biomarkers and classic cardiac biomarkers were significantly increased compared to the normal group. The zymography data showed the changes in cardiac-remodeling enzymes MMP-9 and MMP-2 among combined users of amphetamine and heroin. The levels of TNF-α and IL-6 only increased in the heart disease group. Growth hormone was increased; however, IGF-I level decreased with drug abuse and the level was not restored by abstinence. We speculated that the amphetamine-heroin users might pose risk to initiate heart disease even though the users abstained for more than two weeks. The activity change of MMP-9 and MMP-2 can be a direct reason affecting heart function. The indirect reason may be related to liver damage by drug abuse reduce IGF-1 production to protect heart function. [ABSTRACT FROM AUTHOR]

Abstract The etiology of addiction has not yet been fully elucidated. The ratio between the length of the second and fourth fingers (2D:4D ratio) has been linked with prenatal androgen concentrations, but also with addictive behvaiors. Aim: The present study aimed to evaluate the differences of 2D:4D ratio of individuals with cannabis and heroin addiction by examining them together with the control group. A total of sixty two male patients (33 opiate use disorder and 29 cannabis use disorder) with substance use disorder and the twenty-nine healthy controls were included in the present investigation. We obtained the lengths of 2D and 4D of the subjects by using sensitive calipers and calculated the 2D:4D. Heroin-addicted patients had lower 2D:4D ratio in in the right hand (significant difference between control group) (p < 0.001), there was no significant difference found between heroin-cannabis (p = 0.242) and control-cannabis 2D:4D ratios (p < 0.06). In the left hand, it was significant between the heroin-control groups (p < 0.037) and the cannabis-control groups (p < 0.023), while it was not significant between the heroin-cannabis groups (p = 1). In conclusion, we suggest that heroin-and cannabis addicted patients seem to have a lower ratio of 2D:4D compared to healthy control subjects. Our findings can be considered promising as to whether prenatal hormonal factors are important in the etiopathogenesis of addiction. [ABSTRACT FROM AUTHOR]

Background: Non-prescribed substance use (NPSU) during the treatment of opioid use disorder (OUD) is a recognized phenomenon. The use of non-prescribed substances is associated with discontinuing treatment and drop-out can occur within the early weeks of treatment, before benefit from treatment occurs. Recent developments in treatment include long-acting, slow-release depot buprenorphine injections. This article focuses on NPSU during the first month of treatment with depot buprenorphine, addressing the frequency with which it occurs, the substances used, and reasons for use. Methods: 70 semi-structured interviews (held at three time-points) were conducted with 26 patients initiating depot buprenorphine as part of a longitudinal qualitative study. Analysis prioritized content and framework analyses. Findings: 17/26 participants self-reported NPSU at various times during the first month of treatment. NPSU typically involved heroin, crack-cocaine and some use of benzodiazepines and/or cannabis. Participants' reasons for heroin use were connected to their subjective accounts of opioid withdrawal symptoms, the management of pain, and experimentation (to test the blockade effect of buprenorphine). Frequency of heroin use was typically episodic rather than sustained. Participants associated crack-cocaine use with stimulant-craving and social connections, and considered their use of this substance to be difficult to manage. Conclusions: Patients' initial engagement with treatment for OUD is rarely examined in qualitative research. This study highlights how NPSU amongst patients receiving new forms of such treatment continues to be a challenge. As such, shared decision-making (between providers and patients) regarding treatment goals and NPSU should be central to the delivery of depot buprenorphine treatment programmes. [ABSTRACT FROM AUTHOR]

Psychological factors play a critical role in the treatment of heroin addiction in women, especially in the prevention of relapse. However, little empirical research has explored how social support, active coping strategies, and openness to experience affect relapse tendency in Chinese women experiencing addiction. In a cross-sectional design, 467 Chinese women experiencing heroin addiction (aged 12–57 years) completed self-report measures of social support, active coping strategies, openness to experience, and relapse tendency. Then, the moderated mediation model was tested. The results show that active coping strategies completely mediated the relationship between social support and relapse tendency. Further, the mediated effect of active coping strategies on relapse tendency was moderated by openness to experience. Surprisingly, the role of social support for Chinese women experiencing addiction as an active coping strategy decreases as the level of openness to experience increases. Because this result seems to be different from results of existing research from Western cultures, we speculate that it may be related to the cultural background of Chinese collectivism. All in all, this study helps to better understand how social support acts on relapse tendencies. More importantly, the study of openness to experience provides some new ideas for addiction treatment and intervention in different cultural contexts. This will serve to sensitize researchers and professionals to the significance of cultural context and the bias of Western norms and values in many psychological measures. [ABSTRACT FROM AUTHOR]

Background. We describe the prevalence of and changes in heroin use and injection drug use (IDU) among high school students in five large, urban school districts in the US (2005–2017); nearly three-fourths of the students were Black and/or Hispanic/Latino. Methods. Data are from the Centers for Disease Control and Prevention's "Youth Risk Behavior Survey" program, which includes biennial surveys in urban school districts. We pooled data across districts and survey years, and then generated weighted prevalence estimates (and 95% CIs) for any lifetime heroin use and IDU. Joinpoint regression modeling was used to estimate changes in prevalence over the study period. Results. Biennial prevalence estimates (2005–2017) for heroin use and IDU were above 1.8% for all seven timepoints. In 2017, prevalence of heroin use and IDU were 2.9% and 2.5%, respectively. Both heroin use and IDU were higher among boys than girls. There were statistically significant increases in heroin use and IDU among girls from 2005–2009, whereas changes over time were stable among boys. Conclusions. High school students in large, urban school districts may have higher rates of heroin use and IDU than US high school students in general, and there is little evidence of increases since 2009. This study suggests that adolescence may be a critical period for initiation of heroin use among adolescents in large urban school districts, the majority of whom are Black and/or Latino. Supplemental data for this article is available online at https://doi.org/10.1080/15332640.2021.1992327. [ABSTRACT FROM AUTHOR]

Abstract Background Methods Results Conclusion Non-judgmental language to refer to people who use drugs is replacing terms that can be stigmatizing. A study by Pivovarova and Stein found people in treatment for heroin use preferred person-first terms. Aim one of our study is to add to knowledge of term preferences among people in the US who use heroin by replicating the Pivovarova and Stein study with a sample of people who use heroin but are not in treatment. Aim two is to extend findings with insights from qualitative analysis.Our mixed method study replicated survey questions on what labels are preferred. Qualitative questions probed the meaning of terms and the impact of changing language. We recruited 206 participants between November 2019 and May 2021. We compare the results of the treatment sample with a not-in-treatment sample.Both similarities and differences were found in the quantitative analysis. The qualitative analysis revealed that only a third of our sample indicated that changes in language were helpful, while another third indicated that changing the terms did not result in changing attitudes towards people who use drugs.While stigmatizing language should be avoided, language is constantly evolving and subject to political trends. More emphasis is needed on changing attitudes toward people who use drugs. [ABSTRACT FROM AUTHOR]

Previous research showed that methadone maintenance treatment (MMT) is linked to impulsivity, with higher impulsivity levels being associated with for example, increased drug use. One aspect of impulsivity, most commonly studied in rodent research, is premature responding, the failure to wait for a starting signal. Premature responding is of high translational significance since it predicts the development of addiction-like behaviors in rodents. We assessed 45 MMT patients and 46 demographically matched (age, sex, education, and handedness) healthy volunteers (HVs) on premature responding alongside action and inhibition of instructed and intentional trials using the Intentional Hand Task (IHT). The results showed markedly enhanced premature responses in the MMT vs. the HV group, which correlated positively with methadone dosage in the MMT patients. Throughout the task, MMT patients were faster across all trial parts and less accurate in response to instructed trials compared to HVs. The increase in premature motor reactions during variable waiting periods alongside increased motion speed and lower accuracy might reflect a specific motor inhibition deficit in MMT, a subcomponent of impulsivity not previously assessed in MMT. Incorporating an experimentally defined measure of impulsivity, such as premature responding, into existing test batteries used by clinicians might enable more tailored treatments addressing the increased impulsivity levels and associated dysfunctional behaviors in MMT. [ABSTRACT FROM AUTHOR]

Despite a rapidly growing number of older cocaine users, the link between cocaine use and suicide attempt in older adults has not been examined. We examined associations between co-used other substances and (1) suspected suicide attempts versus other intentional misuse, and (2) major medical outcomes (major effect or death) of suspected suicide attempts and other intentional misuse. We used the 2015–2021 United States National Poison Data System (N = 5,191 cases age 50 and older). Descriptive statistics and generalized linear models for a Poisson distribution with a log link function were used to examine the study questions. Cocaine exposures steadily increased from 2015 through 2021. Over the seven years, 52.3% and 47.7% were suicide attempts and other intentional misuse cases, respectively. Co-use of alcohol (incidence rate ratios = 1.24, 95% confidence interval = 1.14–1.35) and psychotropic (e.g., antidepressants: incidence rate ratios = 1.37, 95% confidence interval = 1.24–1.53) and cardiovascular medications were associated with a higher likelihood of suicide attempt, but co-use of prescription opioids, heroin, or other illicit drugs was associated with a lower likelihood of suicide attempt compared to other intentional misuse. Prescription opioids and amfetamine were associated with a higher likelihood of major effect or death in both suicide attempts and intentional misuse and heroin use and injection use were associated with a higher likelihood of major effect/death among intentional misuse cases. These findings show that significant proportions of older cocaine users who attempted suicide also used psychotropic and cardiovascular medications. We suggest that healthcare providers screen for suicidal ideation among cocaine users, with special attention to an increased risk of suicide attempts among those who co-use cocaine with alcohol and psychotropic and other prescription medications. [ABSTRACT FROM AUTHOR]

Background: Examining opioid use profiles over time and related factors among young adults is crucial to informing prevention efforts. Objectives: This study analyzed baseline data (Fall 2018) and one-year follow-up data from a cohort of 2,975 US young adults (Mage=24.55, 42.1% male; 71.7% White; 11.4% Hispanic). Multinomial logistic regression was used to examine: 1) psychosocial correlates (i.e. adverse childhood experiences [ACEs], depressive symptoms, parental substance use) of lifetime opioid use (i.e. prescription use vs. nonuse, nonmedical prescription [NMPO] use, and heroin use, respectively); and 2) psychosocial correlates and baseline lifetime use in relation to past 6-month use at one-year follow-up (i.e. prescription use vs. nonuse and NMPO/heroin use, respectively). Results: At baseline, lifetime use prevalence was: 30.2% prescription, 9.7% NMPO, and 3.1% heroin; past 6-month use prevalence was: 7.6% prescription, 2.5% NMPO, and 0.9% heroin. Compared to prescription users, nonusers reported fewer ACEs and having parents more likely to use tobacco, but less likely alcohol; NMPO users did not differ; and heroin users reported more ACEs and having parents more likely to use cannabis but less likely alcohol. At one-year follow-up, past 6-month use prevalence was: 4.3% prescription, 1.3% NMPO, and 1.4% heroin; relative to prescription users, nonusers were less likely to report baseline lifetime opioid use and reported fewer ACEs, and NMPO/heroin users were less likely to report baseline prescription opioid use but more likely heroin use. Conclusions: Psychosocial factors differentially correlate with young adult opioid use profiles, and thus may inform targeted interventions addressing different use patterns and psychosocial risk factors. [ABSTRACT FROM AUTHOR]

Background: The neuroanatomy of craving, typically investigated using the functional magnetic resonance imaging (fMRI) drug cue reactivity (FDCR) paradigm, has been shown to involve the mesocorticolimbic, nigrostriatal, and corticocerebellar systems in several substances. However, the neuroanatomy of craving in heroin use disorder is still unclear. Objective: The current meta-analysis examines previous research on the neuroanatomy of craving in abstinent individuals with opioid use disorder (OUD). Method: Seven databases were searched for studies comparing abstinent OUD versus healthy controls on drug > neutral contrast interaction at the whole-brain level. Voxel-based meta-analysis was performed using seed-based d mapping with permuted subject images (SDM-PSI). Thresholds were set at a family-wise error rate of less than 5% with the default pre-processing parameters of SDM-PSI. Results: A total of 10 studies were included (296 OUD and 187 controls). Four hyperactivated clusters were identified with Hedges' g of peaks that ranged from 0.51 to 0.82. These peaks and their associated clusters correspond to the three systems identified in the previous literature: a) mesocorticolimbic, b) nigrostriatal, and c) corticocerebellar. There were also newly revealed hyperactivation regions including the bilateral cingulate, precuneus, fusiform gyrus, pons, lingual gyrus, and inferior occipital gyrus. The meta-analysis did not reveal areas of hypoactivation. Conclusion: Recommendations based on the functional neuroanatomical findings of this meta-analysis include pharmacological interventions such as buprenorphine/naloxone and cognitive-behavioral treatments such as cue-exposure combined with HRV biofeedback. In addition, research should utilize FDCR as pre- and post-measurement to determine the effectiveness and mechanism of action of such interventions. [ABSTRACT FROM AUTHOR]