- Email: [email protected]
Risks associated with nonmedical prescription opioid use: Transition to heroin use and drug injection, overdose and hepatitis C
Abstracts / Drug and Alcohol Dependence 156 (2015) e102–e182
and fewer percent days smoking (8% fewer, p < .03) across 1, 3, and 6 months after CV started. Only 2% more had point-prevalence abstinence in CV versus NV from 1 to 12 months (ns). No differences in substance use were seen. Conclusions: Within-treatment effects are stronger than in a prior study using with CV without NRT but effects are minimal after vouchers end. Implications for voucher treatment include investigating effects when combined with stronger smoking medications. Smoking treatment did not harm SUD recovery. Financial support: This research was supported by a grant from the National Institute on Drug Abuse (R01DA013995), and a Senior Research Career Scientist Award from the Department of Veterans Affairs. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.384 Are medical marijuana users different than recreational marijuana users? Silvia S. Martins 2 , Julian Santaella 1 , Lauren R. Pacek 3 , Katherine Keyes 2 , Magdalena Cerda 2 , Deborah S. Hasin 2 , Sandro Galea 2 1
Columbia University, New York, NY, United States Epidemiology, Columbia University, New York City, NY, United States 3 Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States 2
Aims: To describe the profiles of recreational versus medical marijuana users. Methods: Data came from the 2013 U.S. National Survey on Drug Use and Health 54,981 respondents aged 12 and older. Respondents were asked about past-year marijuana use (MU) recreationally and/or as prescribed by a doctor. Using weighted multinomial logistic regression, we compared respondents who were non-MU, recreational MU, medical MU, and recreational+medical MU on demographic characteristics, living in a state with or without medical marijuana laws (MMLs), psychiatric disorders, substance use, and perceived risk of drug use. Results: Of the US population 12 years and older, 11.5% were past-year recreational MU, 0.7% were past-year medical MU, and 0.4% were medical/recreational MU. States with MMLs versus those without such laws had higher prevalence of recreational MU (13.1% vs. 10.8%, p<0.001), medical MU (1.7% vs. 0.2%, p<0.001) and recreational+medical MU (0.7% vs. 0.3%, p<0.001). Compared to recreational MU, medical users, and recreational+medical MU were more likely to be 18 and older vs. 12-17, to have past-year anxiety disorder and to be past-month alcohol abstainers, and less likely to be Asian vs. non-Hispanic White, adjusted for all other covariates. Past-year major depressive episodes were significantly associated with medical/recreational use vs. recreational-only MU in states without MMLs. Recreational, medical and recreational+medical MU were less likely than non-users to perceive great risk in using marijuana weekly. Recreational users were less likely than non-users to perceive great risk in daily heavy drinking. Similar associations were found in analyses stratified by state MML. Conclusions: Medical MU users report more psychiatric comorbidity and lower levels of alcohol use compared to those of recreational users. All MU subgroups have lower levels of perceived risk of MU compared to non-users. Financial support: NIDA grant R01DA037866 (PI: Martins). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.385
e141
Age of cigarette smoking onset is associated with impulsive responding on a smoking Go/NoGo task Yasmin Mashhoon, Stacey Farmer, Jennifer Betts, Scott Lukas Behavioral Psychopharmacology Research Lab, McLean Hospital, Belmont, MA, United States Aims: Initiation of cigarette smoking during adolescence coincides with structural and cognitive neuromaturation. Thus, early onset smokers (EOS; <16 yrs) may be at unique risk of altered normal executive function development relative to late onset smokers (LOS; >16 yrs). This study investigated differential effects of age of smoking onset on response impulsivity and inhibitory control using a novel smoking Go/NoGo task (Luijten et al., 2011). Methods: Adult EOS (n=6) and LOS (n=10) in acute nicotine withdrawal and adult non-smokers (NS;n=10) were shown Smoking or Non-Smoking images with either a blue (Go) or yellow (NoGo) frame. Participants were instructed to respond to blueframed Go trials quickly and accurately, and withhold responding for yellow-framed NoGo trials. Each Smoking and Non-Smoking image was shown 3 times as a Go stimulus and once as a NoGo stimulus. Results: EOS and LOS exhibited more Go errors (p<0.01) and a greater false alarm rate (p<0.01) than NS. EOS and LOS showed lower overall Go response accuracy (p<0.01), and EOS also exhibited lower Smoking Go accuracy (p<0.03), than NS. EOS and LOS exhibited lower Smoking NoGo accuracy (p<0.02), and LOS also showed lower Non-Smoking NoGo accuracy (p<0.02), than NS. Smoking Go accuracy and Non-Smoking NoGo accuracy were each correlated with age of smoking onset (p<0.01) and daily cigarettes smoked (p<0.02). Conclusions: EOS had difficulty responding accurately to Smoking Go stimuli, suggesting that these distracting images disrupted attention to task demands. In contrast, LOS had difficulty withholding responses to both Smoking and Non- Smoking NoGo stimuli, indicating greater impulsivity and deficits in inhibitory control, regardless of category. Collectively, preliminary findings suggest age of smoking onset differentially impacts task-related attention and response inhibition, thus individualized cognitive approaches may improve executive function in smokers in treatment programs. Financial support: K01DA034028 (YM). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.386 Risks associated with nonmedical prescription opioid use: Transition to heroin use and drug injection, overdose and hepatitis C Pedro Mateu-Gelabert, Honoria Guarino, Lauren Jessell, Cassandra Syckes, Samuel R. Friedman Institute for Infectious Disease Research, National Development and Research Institutes, Inc, New York, NY, United States Aims: To elucidate drug use trajectories among young nonmedical prescription opioid (PO) users and the risks associated with such trajectories (heroin use, overdose, drug injection and Hepatitis C infection). Methods: New York City young adults (N=109) were recruited via respondent-driven sampling for an ongoing epidemiological survey to assess drug use patterns and overdose experiences. Eligible participants were ages 18-29 and had used POs nonmedically and/or heroin in the past 30 days. Participants were also tested on-site for HCV antibodies.
e142
Abstracts / Drug and Alcohol Dependence 156 (2015) e102–e182
Results: Participants were 31% female, 16% Latino, 82% White and 14% other races (mean age=23.3 years). Regarding education, 23% did not complete high school, 35% received a high school diploma/GED and 42% attended or graduated college. Most participants (86%) initiated PO use in their teens (mean age=16.2 years). For 88% of participants, PO initiation led to regular (1 or more times/week) PO use by 18 years old on average, and 62% experimented with PO injection (mean age at first PO injection=18.5 years). Ninety-seven percent of participants also used heroin (mean age at heroin initiation=18.4 years) and 90% injected heroin (mean age at first heroin injection=19.8 years). Thirty one participants (29%) tested positive for HCV antibodies. Most participants (56%) had experienced overdose (3.7 overdoses per participant on average); about two thirds of these required emergency personnel response and/or hospitalization. Conclusions: For many youth, early PO initiation led to longterm opioid use, heroin use, drug injection and repeated overdose. Drug injection carries a serious risk of HCV infection. There is a pressing need to develop innovative prevention programs to help younger teens avoid initiating nonmedical PO use and to assist current PO users in preventing escalation of opioid use, drug injection and HCV infection. Financial support: Supported by NIDA grant# R01DA035146. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.387 Non-medical prescription opioid use and commercial sex work among adults in residential substance use treatment Alexis K. Matusiewicz 1,2,3 , Amy S. Bohnert 1,2,3 , Erin E. Bonar 2 , Mark Ilgen 1,2,3 1
VA Center for Clinical Management Research, Ann Arbor, MI, United States 2 Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States 3 VA Ann Arbor Healthcare System, Ann Arbor, MI, United States Aims: High rates of substance use have been documented among individuals involved in commercial sex work (CSW) and a significant proportion of adults seeking substance use treatment report prior CSW. Little is known about the relationship between CSW and non-medical prescription opioid use (NMPOU), as research in this area was conducted before the escalation NMPOU in the US. The aims of this study were to describe the prevalence of recent CSW in a large residential substance use treatment center; and examine the association between NMPO use and CSW after controlling for demographic and clinical risk factors. Methods: Participants were 504 adults recruited from a residential treatment center between 2009-2013. Participants completed self-report measures of CSW, NMPOU, substance use and psychiatric symptoms. Bivariate and multivariate logistic regressions were used to examine the relationship between CSW and NMPOU, before and after adjusting for demographic and clinical correlates of CSW. Results: Results indicated that 14% (n = 71) of participants engaged in CSW in the previous month. NMPOU use was more common in those with a history of CSW (84% of sex workers vs. 54% of non-sex workers; OR = 4.48, p <.05). In the multivariate model, CSW was associated with female gender, ethnic minority status, global psychiatric symptom severity and cocaine use. After controlling for these factors, NMPOU remained significantly more common in those who engaged in CSW (OR = 2.39, p <.05).
Conclusions: Individuals engaged in sex work reported extremely high rates of NMPOU, and NMPOU was associated with sex work after adjusting for psychiatric symptoms and other substance use. Residential treatment provides a unique opportunity to address the complex psychosocial and psychiatric needs of substance users involved in CSW, but continued work is needed to develop interventions for this vulnerable group. Financial support: This research was a supported by DA029587 (MAI), DA03531 (ASBB) and DA036008 (EEB). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.388 Challenges to opioid treatment programs after hurricane sandy: Impact, preparedness, and recovery Harlan Matusow 1 , Ellen Benoit 2 , Andrew Rosenblum 1 1 Institute for Treatment and Services Research, National Development and Research Institutes, Inc., New York, NY, United States 2 Institute for Special Populations Research, NDRI, New York, NY, United States
Aims: To describe how Hurricane Sandy impacted opioid treatment programs (OTPs) and present recovery and disaster planning policy recommendations. Methods: Staff (via surveys), clients (via focus groups) and directors (via interviews) at nine OTPs in the NYC metro area shared their perspectives on how preparation for, and recovery from Hurricane Sandy was handled at their site. Results: Patients reported treatment disruptions such as transportation and communication problems, methadone dose reduction, suspension of psychiatric medication, and increased “pick-up” schedule. Some patients reported resumption of illicit opioid use due to difficulties obtaining methadone. Staff reported challenges in arranging guest-dosing, protocol for providing take home doses, responding to unanticipated problems with electricity and heat, and guests from other sites and states. Directors reported how local, state, and federal regulations helped or hampered continuity of care, administrative and fiscal challenges associated with changing caseloads, and long term effects of service disruption. There were also several occurrences of how stigma toward methadone maintenance (especially reported by patients) appeared to contribute to treatment disruption. Despite these multiple disruptions, there was also evidence that treatment continuity was sustained for most patients during this period. Conclusions: The consequences of Hurricane Sandy varied greatly based on program location and storm preparations. Data collected to date suggest that factors to assure treatment continuity during and after a catastrophic event should include better communication among OTPs and government authorities (e.g., DEA), transportation resources, and comprehensive and consistent emergency preparedness/recovery plans among OTPs. Financial support: Department of Health and Human Services, ASPR HITEP140014-01-00. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.389
and fewer percent days smoking (8% fewer, p < .03) across 1, 3, and 6 months after CV started. Only 2% more had point-prevalence abstinence in CV versus NV from 1 to 12 months (ns). No differences in substance use were seen. Conclusions: Within-treatment effects are stronger than in a prior study using with CV without NRT but effects are minimal after vouchers end. Implications for voucher treatment include investigating effects when combined with stronger smoking medications. Smoking treatment did not harm SUD recovery. Financial support: This research was supported by a grant from the National Institute on Drug Abuse (R01DA013995), and a Senior Research Career Scientist Award from the Department of Veterans Affairs. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.384 Are medical marijuana users different than recreational marijuana users? Silvia S. Martins 2 , Julian Santaella 1 , Lauren R. Pacek 3 , Katherine Keyes 2 , Magdalena Cerda 2 , Deborah S. Hasin 2 , Sandro Galea 2 1
Columbia University, New York, NY, United States Epidemiology, Columbia University, New York City, NY, United States 3 Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States 2
Aims: To describe the profiles of recreational versus medical marijuana users. Methods: Data came from the 2013 U.S. National Survey on Drug Use and Health 54,981 respondents aged 12 and older. Respondents were asked about past-year marijuana use (MU) recreationally and/or as prescribed by a doctor. Using weighted multinomial logistic regression, we compared respondents who were non-MU, recreational MU, medical MU, and recreational+medical MU on demographic characteristics, living in a state with or without medical marijuana laws (MMLs), psychiatric disorders, substance use, and perceived risk of drug use. Results: Of the US population 12 years and older, 11.5% were past-year recreational MU, 0.7% were past-year medical MU, and 0.4% were medical/recreational MU. States with MMLs versus those without such laws had higher prevalence of recreational MU (13.1% vs. 10.8%, p<0.001), medical MU (1.7% vs. 0.2%, p<0.001) and recreational+medical MU (0.7% vs. 0.3%, p<0.001). Compared to recreational MU, medical users, and recreational+medical MU were more likely to be 18 and older vs. 12-17, to have past-year anxiety disorder and to be past-month alcohol abstainers, and less likely to be Asian vs. non-Hispanic White, adjusted for all other covariates. Past-year major depressive episodes were significantly associated with medical/recreational use vs. recreational-only MU in states without MMLs. Recreational, medical and recreational+medical MU were less likely than non-users to perceive great risk in using marijuana weekly. Recreational users were less likely than non-users to perceive great risk in daily heavy drinking. Similar associations were found in analyses stratified by state MML. Conclusions: Medical MU users report more psychiatric comorbidity and lower levels of alcohol use compared to those of recreational users. All MU subgroups have lower levels of perceived risk of MU compared to non-users. Financial support: NIDA grant R01DA037866 (PI: Martins). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.385
e141
Age of cigarette smoking onset is associated with impulsive responding on a smoking Go/NoGo task Yasmin Mashhoon, Stacey Farmer, Jennifer Betts, Scott Lukas Behavioral Psychopharmacology Research Lab, McLean Hospital, Belmont, MA, United States Aims: Initiation of cigarette smoking during adolescence coincides with structural and cognitive neuromaturation. Thus, early onset smokers (EOS; <16 yrs) may be at unique risk of altered normal executive function development relative to late onset smokers (LOS; >16 yrs). This study investigated differential effects of age of smoking onset on response impulsivity and inhibitory control using a novel smoking Go/NoGo task (Luijten et al., 2011). Methods: Adult EOS (n=6) and LOS (n=10) in acute nicotine withdrawal and adult non-smokers (NS;n=10) were shown Smoking or Non-Smoking images with either a blue (Go) or yellow (NoGo) frame. Participants were instructed to respond to blueframed Go trials quickly and accurately, and withhold responding for yellow-framed NoGo trials. Each Smoking and Non-Smoking image was shown 3 times as a Go stimulus and once as a NoGo stimulus. Results: EOS and LOS exhibited more Go errors (p<0.01) and a greater false alarm rate (p<0.01) than NS. EOS and LOS showed lower overall Go response accuracy (p<0.01), and EOS also exhibited lower Smoking Go accuracy (p<0.03), than NS. EOS and LOS exhibited lower Smoking NoGo accuracy (p<0.02), and LOS also showed lower Non-Smoking NoGo accuracy (p<0.02), than NS. Smoking Go accuracy and Non-Smoking NoGo accuracy were each correlated with age of smoking onset (p<0.01) and daily cigarettes smoked (p<0.02). Conclusions: EOS had difficulty responding accurately to Smoking Go stimuli, suggesting that these distracting images disrupted attention to task demands. In contrast, LOS had difficulty withholding responses to both Smoking and Non- Smoking NoGo stimuli, indicating greater impulsivity and deficits in inhibitory control, regardless of category. Collectively, preliminary findings suggest age of smoking onset differentially impacts task-related attention and response inhibition, thus individualized cognitive approaches may improve executive function in smokers in treatment programs. Financial support: K01DA034028 (YM). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.386 Risks associated with nonmedical prescription opioid use: Transition to heroin use and drug injection, overdose and hepatitis C Pedro Mateu-Gelabert, Honoria Guarino, Lauren Jessell, Cassandra Syckes, Samuel R. Friedman Institute for Infectious Disease Research, National Development and Research Institutes, Inc, New York, NY, United States Aims: To elucidate drug use trajectories among young nonmedical prescription opioid (PO) users and the risks associated with such trajectories (heroin use, overdose, drug injection and Hepatitis C infection). Methods: New York City young adults (N=109) were recruited via respondent-driven sampling for an ongoing epidemiological survey to assess drug use patterns and overdose experiences. Eligible participants were ages 18-29 and had used POs nonmedically and/or heroin in the past 30 days. Participants were also tested on-site for HCV antibodies.
e142
Abstracts / Drug and Alcohol Dependence 156 (2015) e102–e182
Results: Participants were 31% female, 16% Latino, 82% White and 14% other races (mean age=23.3 years). Regarding education, 23% did not complete high school, 35% received a high school diploma/GED and 42% attended or graduated college. Most participants (86%) initiated PO use in their teens (mean age=16.2 years). For 88% of participants, PO initiation led to regular (1 or more times/week) PO use by 18 years old on average, and 62% experimented with PO injection (mean age at first PO injection=18.5 years). Ninety-seven percent of participants also used heroin (mean age at heroin initiation=18.4 years) and 90% injected heroin (mean age at first heroin injection=19.8 years). Thirty one participants (29%) tested positive for HCV antibodies. Most participants (56%) had experienced overdose (3.7 overdoses per participant on average); about two thirds of these required emergency personnel response and/or hospitalization. Conclusions: For many youth, early PO initiation led to longterm opioid use, heroin use, drug injection and repeated overdose. Drug injection carries a serious risk of HCV infection. There is a pressing need to develop innovative prevention programs to help younger teens avoid initiating nonmedical PO use and to assist current PO users in preventing escalation of opioid use, drug injection and HCV infection. Financial support: Supported by NIDA grant# R01DA035146. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.387 Non-medical prescription opioid use and commercial sex work among adults in residential substance use treatment Alexis K. Matusiewicz 1,2,3 , Amy S. Bohnert 1,2,3 , Erin E. Bonar 2 , Mark Ilgen 1,2,3 1
VA Center for Clinical Management Research, Ann Arbor, MI, United States 2 Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States 3 VA Ann Arbor Healthcare System, Ann Arbor, MI, United States Aims: High rates of substance use have been documented among individuals involved in commercial sex work (CSW) and a significant proportion of adults seeking substance use treatment report prior CSW. Little is known about the relationship between CSW and non-medical prescription opioid use (NMPOU), as research in this area was conducted before the escalation NMPOU in the US. The aims of this study were to describe the prevalence of recent CSW in a large residential substance use treatment center; and examine the association between NMPO use and CSW after controlling for demographic and clinical risk factors. Methods: Participants were 504 adults recruited from a residential treatment center between 2009-2013. Participants completed self-report measures of CSW, NMPOU, substance use and psychiatric symptoms. Bivariate and multivariate logistic regressions were used to examine the relationship between CSW and NMPOU, before and after adjusting for demographic and clinical correlates of CSW. Results: Results indicated that 14% (n = 71) of participants engaged in CSW in the previous month. NMPOU use was more common in those with a history of CSW (84% of sex workers vs. 54% of non-sex workers; OR = 4.48, p <.05). In the multivariate model, CSW was associated with female gender, ethnic minority status, global psychiatric symptom severity and cocaine use. After controlling for these factors, NMPOU remained significantly more common in those who engaged in CSW (OR = 2.39, p <.05).
Conclusions: Individuals engaged in sex work reported extremely high rates of NMPOU, and NMPOU was associated with sex work after adjusting for psychiatric symptoms and other substance use. Residential treatment provides a unique opportunity to address the complex psychosocial and psychiatric needs of substance users involved in CSW, but continued work is needed to develop interventions for this vulnerable group. Financial support: This research was a supported by DA029587 (MAI), DA03531 (ASBB) and DA036008 (EEB). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.388 Challenges to opioid treatment programs after hurricane sandy: Impact, preparedness, and recovery Harlan Matusow 1 , Ellen Benoit 2 , Andrew Rosenblum 1 1 Institute for Treatment and Services Research, National Development and Research Institutes, Inc., New York, NY, United States 2 Institute for Special Populations Research, NDRI, New York, NY, United States
Aims: To describe how Hurricane Sandy impacted opioid treatment programs (OTPs) and present recovery and disaster planning policy recommendations. Methods: Staff (via surveys), clients (via focus groups) and directors (via interviews) at nine OTPs in the NYC metro area shared their perspectives on how preparation for, and recovery from Hurricane Sandy was handled at their site. Results: Patients reported treatment disruptions such as transportation and communication problems, methadone dose reduction, suspension of psychiatric medication, and increased “pick-up” schedule. Some patients reported resumption of illicit opioid use due to difficulties obtaining methadone. Staff reported challenges in arranging guest-dosing, protocol for providing take home doses, responding to unanticipated problems with electricity and heat, and guests from other sites and states. Directors reported how local, state, and federal regulations helped or hampered continuity of care, administrative and fiscal challenges associated with changing caseloads, and long term effects of service disruption. There were also several occurrences of how stigma toward methadone maintenance (especially reported by patients) appeared to contribute to treatment disruption. Despite these multiple disruptions, there was also evidence that treatment continuity was sustained for most patients during this period. Conclusions: The consequences of Hurricane Sandy varied greatly based on program location and storm preparations. Data collected to date suggest that factors to assure treatment continuity during and after a catastrophic event should include better communication among OTPs and government authorities (e.g., DEA), transportation resources, and comprehensive and consistent emergency preparedness/recovery plans among OTPs. Financial support: Department of Health and Human Services, ASPR HITEP140014-01-00. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.389