Publications

@article{pmid32359667c,

title = {The impact of naturalistic cannabis use on self-reported opioid withdrawal},

author = {Cecilia L Bergeria and Andrew S Huhn and Kelly E Dunn},

doi = {10.1016/j.jsat.2020.108005},

issn = {1873-6483},

year  = {2020},

date = {2020-06-01},

journal = {J Subst Abuse Treat},

volume = {113},

pages = {108005},

abstract = {OBJECTIVES: Four states have legalized medical cannabis for the purpose of treating opioid use disorder. It is unclear whether cannabinoids improve or exacerbate opioid withdrawal. A more thorough examination of cannabis and its impact on specific symptoms of opioid withdrawal is warranted.nnMETHOD: Two hundred individuals recruited through Amazon Mechanical Turk with past month opioid and cannabis use and experience of opioid withdrawal completed the survey. Participants indicated which opioid withdrawal symptoms improved or worsened with cannabis use and indicated the severity of their opioid withdrawal on days with and without cannabis.nnRESULTS: 62.5% (n = 125) of 200 participants had used cannabis to treat withdrawal. Participants most frequently indicated that cannabis improved: anxiety, tremors, and trouble sleeping. A minority of participants (6.0%, n = 12) indicated cannabis worsened opioid withdrawal, specifically symptoms of yawning, teary eyes, and runny nose. Across all symptoms, more participants indicated that symptoms improved with cannabis compared to those that indicated symptoms worsened with cannabis. Women reported greater relief from withdrawal with cannabis use than men.nnDISCUSSION: These results show that cannabis may improve opioid withdrawal symptoms and that the size of the effect is clinically meaningful. It is important to note that symptoms are exacerbated with cannabis in only a minority of individuals. Prospectively designed studies examining the impact of cannabis and cannabinoids on opioid withdrawal are warranted.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32267192,

title = {Evaluating the co-use of opioids and cannabis for pain among current users using hypothetical purchase tasks},

author = {Cecilia L Bergeria and Sean B Dolan and Matthew W Johnson and Claudia M Campbell and Kelly E Dunn},

doi = {10.1177/0269881120914211},

issn = {1461-7285},

year  = {2020},

date = {2020-06-01},

journal = {J Psychopharmacol},

volume = {34},

number = {6},

pages = {654--662},

abstract = {BACKGROUND: Cannabinoids may potentiate opioid analgesia and therefore could be used to reduce reliance on opioids for analgesia.nnAIMS: The current study evaluated whether the concurrent availability of cannabis influences opioid consumption using a behavioral economic demand framework.nnMETHODS: An online survey assessed cannabis and opioid use frequency and dependence measures, pain severity, and demand for both cannabis and opioids alone and when concurrently available using hypothetical purchase tasks. Adults reporting current use of opioids for pain management and past 30-day cannabis exposure (=155) completed two hypothetical purchase tasks in which only grams of cannabis or units of participants' index opioids were available for purchase, and two hypothetical tasks in which both were concurrently available and the price of one drug increased whereas the other was kept constant. Paired-sample -tests compared the demand of each drug alone with when it was available concurrently with an alternative.nnRESULTS: Demand intensity was significantly reduced and demand elasticity was significantly increased for both cannabis and opioids when the alternate commodity was available, although the reductions in cannabis consumption were more pronounced than they were for opioid consumption in the presence of the alternate commodity.nnCONCLUSIONS: These data provide behavioral economic evidence that cannabis access may modestly reduce demand for opioids in persons who have pain. Additional clinical studies that evaluate the analgesic effects of cannabis and cannabis-opioid effects on pain are warranted.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32359667,

title = {The impact of naturalistic cannabis use on self-reported opioid withdrawal},

author = {Cecilia L Bergeria and Andrew S Huhn and Kelly E Dunn},

doi = {10.1016/j.jsat.2020.108005},

issn = {1873-6483},

year  = {2020},

date = {2020-06-01},

journal = {J Subst Abuse Treat},

volume = {113},

pages = {108005},

abstract = {OBJECTIVES: Four states have legalized medical cannabis for the purpose of treating opioid use disorder. It is unclear whether cannabinoids improve or exacerbate opioid withdrawal. A more thorough examination of cannabis and its impact on specific symptoms of opioid withdrawal is warranted.nnMETHOD: Two hundred individuals recruited through Amazon Mechanical Turk with past month opioid and cannabis use and experience of opioid withdrawal completed the survey. Participants indicated which opioid withdrawal symptoms improved or worsened with cannabis use and indicated the severity of their opioid withdrawal on days with and without cannabis.nnRESULTS: 62.5% (n = 125) of 200 participants had used cannabis to treat withdrawal. Participants most frequently indicated that cannabis improved: anxiety, tremors, and trouble sleeping. A minority of participants (6.0%, n = 12) indicated cannabis worsened opioid withdrawal, specifically symptoms of yawning, teary eyes, and runny nose. Across all symptoms, more participants indicated that symptoms improved with cannabis compared to those that indicated symptoms worsened with cannabis. Women reported greater relief from withdrawal with cannabis use than men.nnDISCUSSION: These results show that cannabis may improve opioid withdrawal symptoms and that the size of the effect is clinically meaningful. It is important to note that symptoms are exacerbated with cannabis in only a minority of individuals. Prospectively designed studies examining the impact of cannabis and cannabinoids on opioid withdrawal are warranted.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32247649,

title = {Pharmacodynamic effects of vaporized and oral cannabidiol (CBD) and vaporized CBD-dominant cannabis in infrequent cannabis users},

author = {Tory R Spindle and Edward J Cone and Elia Goffi and Elise M Weerts and John M Mitchell and Ruth E Winecker and George E Bigelow and Ronald R Flegel and Ryan Vandrey},

doi = {10.1016/j.drugalcdep.2020.107937},

issn = {1879-0046},

year  = {2020},

date = {2020-06-01},

journal = {Drug Alcohol Depend},

volume = {211},

pages = {107937},

abstract = {INTRODUCTION: The use and availability of oral and inhalable products containing cannabidiol (CBD) as the principal constituent has increased with expanded cannabis/hemp legalization. However, few controlled clinical laboratory studies have evaluated the pharmacodynamic effects of oral or vaporized CBD or CBD-dominant cannabis.nnMETHODS: Eighteen healthy adults (9 men; 9 women) completed four, double-blind, double-dummy, drug administration sessions. Sessions were separated by ≥1 week and included self-administration of 100 mg oral CBD, 100 mg vaporized CBD, vaporized CBD-dominant cannabis (100 mg CBD; 3.7 mg THC), and placebo. Study outcomes included: subjective drug effects, vital signs, cognitive/psychomotor performance, and whole blood THC and CBD concentrations.nnRESULTS: Vaporized CBD and CBD-dominant cannabis increased ratings on several subjective items (e.g., Like Drug Effect) relative to placebo. Subjective effects did not differ between oral CBD and placebo and were generally higher for CBD-dominant cannabis compared to vaporized CBD. CBD did not increase ratings for several items typically associated with acute cannabis/THC exposure (e.g., Paranoid). Women reported qualitatively higher ratings for Pleasant Drug Effect than men after vaporized CBD and CBD-dominant cannabis use. CBD-dominant cannabis increased heart rate compared to placebo. Cognitive/psychomotor impairment was not observed in any drug condition.nnCONCLUSIONS: Vaporized CBD and CBD-dominant cannabis produced discriminable subjective drug effects, which were sometimes stronger in women, but did not produce cognitive/psychomotor impairment. Subjective effects of oral CBD did not differ from placebo. Future research should further elucidate the subjective effects of various types of CBD products (e.g., inhaled, oral, topical), which appear to be distinct from THC-dominant products.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32267192c,

title = {Evaluating the co-use of opioids and cannabis for pain among current users using hypothetical purchase tasks},

author = {Cecilia L Bergeria and Sean B Dolan and Matthew W Johnson and Claudia M Campbell and Kelly E Dunn},

doi = {10.1177/0269881120914211},

issn = {1461-7285},

year  = {2020},

date = {2020-06-01},

journal = {J Psychopharmacol},

volume = {34},

number = {6},

pages = {654--662},

abstract = {BACKGROUND: Cannabinoids may potentiate opioid analgesia and therefore could be used to reduce reliance on opioids for analgesia.nnAIMS: The current study evaluated whether the concurrent availability of cannabis influences opioid consumption using a behavioral economic demand framework.nnMETHODS: An online survey assessed cannabis and opioid use frequency and dependence measures, pain severity, and demand for both cannabis and opioids alone and when concurrently available using hypothetical purchase tasks. Adults reporting current use of opioids for pain management and past 30-day cannabis exposure (=155) completed two hypothetical purchase tasks in which only grams of cannabis or units of participants' index opioids were available for purchase, and two hypothetical tasks in which both were concurrently available and the price of one drug increased whereas the other was kept constant. Paired-sample -tests compared the demand of each drug alone with when it was available concurrently with an alternative.nnRESULTS: Demand intensity was significantly reduced and demand elasticity was significantly increased for both cannabis and opioids when the alternate commodity was available, although the reductions in cannabis consumption were more pronounced than they were for opioid consumption in the presence of the alternate commodity.nnCONCLUSIONS: These data provide behavioral economic evidence that cannabis access may modestly reduce demand for opioids in persons who have pain. Additional clinical studies that evaluate the analgesic effects of cannabis and cannabis-opioid effects on pain are warranted.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32359667d,

title = {The impact of naturalistic cannabis use on self-reported opioid withdrawal},

author = {Cecilia L Bergeria and Andrew S Huhn and Kelly E Dunn},

doi = {10.1016/j.jsat.2020.108005},

issn = {1873-6483},

year  = {2020},

date = {2020-06-01},

journal = {J Subst Abuse Treat},

volume = {113},

pages = {108005},

abstract = {OBJECTIVES: Four states have legalized medical cannabis for the purpose of treating opioid use disorder. It is unclear whether cannabinoids improve or exacerbate opioid withdrawal. A more thorough examination of cannabis and its impact on specific symptoms of opioid withdrawal is warranted.nnMETHOD: Two hundred individuals recruited through Amazon Mechanical Turk with past month opioid and cannabis use and experience of opioid withdrawal completed the survey. Participants indicated which opioid withdrawal symptoms improved or worsened with cannabis use and indicated the severity of their opioid withdrawal on days with and without cannabis.nnRESULTS: 62.5% (n = 125) of 200 participants had used cannabis to treat withdrawal. Participants most frequently indicated that cannabis improved: anxiety, tremors, and trouble sleeping. A minority of participants (6.0%, n = 12) indicated cannabis worsened opioid withdrawal, specifically symptoms of yawning, teary eyes, and runny nose. Across all symptoms, more participants indicated that symptoms improved with cannabis compared to those that indicated symptoms worsened with cannabis. Women reported greater relief from withdrawal with cannabis use than men.nnDISCUSSION: These results show that cannabis may improve opioid withdrawal symptoms and that the size of the effect is clinically meaningful. It is important to note that symptoms are exacerbated with cannabis in only a minority of individuals. Prospectively designed studies examining the impact of cannabis and cannabinoids on opioid withdrawal are warranted.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32359668,

title = {Impact of methadone treatment initiated in jail on subsequent arrest},

author = {Sharon M Kelly and Robert P Schwartz and Kevin E O'Grady and Shannon G Mitchell and Tiffany Duren and Anjalee Sharma and Jerome H Jaffe},

doi = {10.1016/j.jsat.2020.108006},

issn = {1873-6483},

year  = {2020},

date = {2020-06-01},

journal = {J Subst Abuse Treat},

volume = {113},

pages = {108006},

abstract = {BACKGROUND: There are limited data from randomized trials about the impact of starting methadone treatment in jail on subsequent arrest after release for adults with opioid use disorder (OUD).nnMETHODS: Official arrest records were obtained for 212 participants with OUD who were enrolled in a three-group randomized controlled trial of initiating methadone treatment in jail either with or without patient navigation vs. enhanced treatment-as-usual in Baltimore, Maryland. Participants treated for opioid withdrawal in jail were assigned to: 1) interim methadone (IM) with patient navigation (PN; IM + PN); 2) IM without PN (IM); or 3) enhanced treatment-as-usual (ETAU). Participants in both IM groups were able to continue treatment at a community-based methadone treatment program with counseling upon release, while ETAU participants received overdose information and a city-wide treatment assessment/referral number. Likelihood of arrest, time to first subsequent arrest, and severity of arrest charges in the 12 months following release were examined for: 1) combined IM + PN and IM groups compared to ETAU; and 2) IM + PN compared to IM.nnRESULTS: Within 12 months of release from the index incarceration, 50.5% of the sample had been arrested. The majority of arrest charges (71%) were for low-level, nonviolent crimes. On an intention-to-treat basis, there were no significant differences between the combined IM + PN and IM groups vs. ETAU or IM + PN vs. IM in the likelihood of arrest, time to first subsequent arrest, or severity of arrest charges.nnCONCLUSION: Initiating IM with or without PN during pretrial detention did not have a significant effect on subsequent arrest during a 12-month post-release follow-up compared to not starting methadone maintenance during detention, despite the high rate of methadone treatment entry in the community following release. This finding may be attributable to the considerable attrition from treatment in the community or other systematic factors. Additional interventions may be needed to reduce the likelihood of subsequent arrest.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32267192b,

title = {Evaluating the co-use of opioids and cannabis for pain among current users using hypothetical purchase tasks},

author = {Cecilia L Bergeria and Sean B Dolan and Matthew W Johnson and Claudia M Campbell and Kelly E Dunn},

doi = {10.1177/0269881120914211},

issn = {1461-7285},

year  = {2020},

date = {2020-06-01},

journal = {J Psychopharmacol},

volume = {34},

number = {6},

pages = {654--662},

abstract = {BACKGROUND: Cannabinoids may potentiate opioid analgesia and therefore could be used to reduce reliance on opioids for analgesia.nnAIMS: The current study evaluated whether the concurrent availability of cannabis influences opioid consumption using a behavioral economic demand framework.nnMETHODS: An online survey assessed cannabis and opioid use frequency and dependence measures, pain severity, and demand for both cannabis and opioids alone and when concurrently available using hypothetical purchase tasks. Adults reporting current use of opioids for pain management and past 30-day cannabis exposure (=155) completed two hypothetical purchase tasks in which only grams of cannabis or units of participants' index opioids were available for purchase, and two hypothetical tasks in which both were concurrently available and the price of one drug increased whereas the other was kept constant. Paired-sample -tests compared the demand of each drug alone with when it was available concurrently with an alternative.nnRESULTS: Demand intensity was significantly reduced and demand elasticity was significantly increased for both cannabis and opioids when the alternate commodity was available, although the reductions in cannabis consumption were more pronounced than they were for opioid consumption in the presence of the alternate commodity.nnCONCLUSIONS: These data provide behavioral economic evidence that cannabis access may modestly reduce demand for opioids in persons who have pain. Additional clinical studies that evaluate the analgesic effects of cannabis and cannabis-opioid effects on pain are warranted.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32359667b,

title = {The impact of naturalistic cannabis use on self-reported opioid withdrawal},

author = {Cecilia L Bergeria and Andrew S Huhn and Kelly E Dunn},

doi = {10.1016/j.jsat.2020.108005},

issn = {1873-6483},

year  = {2020},

date = {2020-06-01},

journal = {J Subst Abuse Treat},

volume = {113},

pages = {108005},

abstract = {OBJECTIVES: Four states have legalized medical cannabis for the purpose of treating opioid use disorder. It is unclear whether cannabinoids improve or exacerbate opioid withdrawal. A more thorough examination of cannabis and its impact on specific symptoms of opioid withdrawal is warranted.nnMETHOD: Two hundred individuals recruited through Amazon Mechanical Turk with past month opioid and cannabis use and experience of opioid withdrawal completed the survey. Participants indicated which opioid withdrawal symptoms improved or worsened with cannabis use and indicated the severity of their opioid withdrawal on days with and without cannabis.nnRESULTS: 62.5% (n = 125) of 200 participants had used cannabis to treat withdrawal. Participants most frequently indicated that cannabis improved: anxiety, tremors, and trouble sleeping. A minority of participants (6.0%, n = 12) indicated cannabis worsened opioid withdrawal, specifically symptoms of yawning, teary eyes, and runny nose. Across all symptoms, more participants indicated that symptoms improved with cannabis compared to those that indicated symptoms worsened with cannabis. Women reported greater relief from withdrawal with cannabis use than men.nnDISCUSSION: These results show that cannabis may improve opioid withdrawal symptoms and that the size of the effect is clinically meaningful. It is important to note that symptoms are exacerbated with cannabis in only a minority of individuals. Prospectively designed studies examining the impact of cannabis and cannabinoids on opioid withdrawal are warranted.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Lister2020,

title = {Opioid prescribing and opioid-overdose deaths in Michigan: Urban-rural comparisons and changes across 2013–2017},

author = {Jamey J. Lister and Jennifer D. Ellis and Miyoung Yoon},

doi = {10.1016/j.abrep.2019.100234},

issn = {2352-8532},

year  = {2020},

date = {2020-06-00},

journal = {Addictive Behaviors Reports},

volume = {11},

publisher = {Elsevier BV},

keywords = {Psychiatry and Mental health},

pubstate = {published},

tppubtype = {article}

}

@article{Lister2019,

title = {A systematic review of rural-specific barriers to medication treatment for opioid use disorder in the United States},

author = {Jamey J. Lister and Addie Weaver and Jennifer D. Ellis and Joseph A. Himle and David M. Ledgerwood},

doi = {10.1080/00952990.2019.1694536},

issn = {1097-9891},

year  = {2020},

date = {2020-05-03},

journal = {The American Journal of Drug and Alcohol Abuse},

volume = {46},

number = {3},

pages = {273--288},

publisher = {Informa UK Limited},

keywords = {Clinical Psychology, Medicine (miscellaneous), Psychiatry and Mental health},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31225625,

title = {Potential Moderating Effects of Sex/Gender on the Acute Relative Reinforcing and Subjective Effects of Reduced Nicotine Content Cigarettes in Vulnerable Populations},

author = {Joanna M Streck and Danielle R Davis and Raina D Pang and Stacey C Sigmon and Janice Y Bunn and Cecilia L Bergeria and Jennifer W Tidey and Sarah H Heil and Diann E Gaalema and John R Hughes and Maxine L Stitzer and Ellaina Reed and Stephen T Higgins},

doi = {10.1093/ntr/ntz098},

issn = {1469-994X},

year  = {2020},

date = {2020-05-01},

journal = {Nicotine Tob Res},

volume = {22},

number = {6},

pages = {878--884},

abstract = {INTRODUCTION: Reports in relatively healthy smokers suggest men are more sensitive than women to the subjective effects of reduced nicotine content cigarettes (RNCCs). We know of no reports examining sex differences in the relative reinforcing effects of RNCCs, an important outcome in assessing smoking's addiction potential. The aim of the present study is to address this gap by examining sex/gender differences on reinforcing effects while examining whether sex differences in subjective effects are discernible in vulnerable populations.nnMETHODS: Secondary analysis of a within-subject, double-blinded experiment examining acute effects of cigarettes varying in nicotine content (0.4, 2.4, 5.2, 15.8 mg/g) among 169 adult smokers with psychiatric conditions or socioeconomic disadvantage. Effects of dose, sex, and their interaction were examined on reinforcing (concurrent-choice and Cigarette Purchase Task [CPT] testing), and subjective effects (Cigarette Evaluation Questionnaire [CEQ] and craving/withdrawal ratings).nnRESULTS: Reducing nicotine content decreased the relative reinforcing effects of smoking in concurrent-choice and CPT testing (p's < .05) with no significant effects of sex nor dose × sex/gender interactions. Reducing nicotine content decreased CEQ ratings with only a single significant effect of sex (higher Psychological Reward scores among women than men, p = .02) and no significant dose × sex/gender interactions. Results on craving/withdrawal paralleled those on the CEQ.nnCONCLUSIONS: Reducing nicotine content decreases the addiction potential of smoking independent of sex in populations highly vulnerable to smoking and addiction, with no indication that women are less sensitive to subjective effects of RNCCs or would benefit less from a policy reducing the nicotine content of cigarettes.nnIMPLICATIONS: A policy reducing the nicotine content of cigarettes has the potential to reduce the addiction potential of smoking across men and women who are especially vulnerable to smoking, addiction, and tobacco-related adverse health impacts.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31989411,

title = {The Hotel Room Purchase Task: Effects of Gender and Partner Desirability on Demand for Hypothetical Sex in Individuals with Disordered Cocaine Use and Controls},

author = {Sean B Dolan and Patrick S Johnson and Matthew W Johnson},

doi = {10.1007/s10508-020-01634-w},

issn = {1573-2800},

year  = {2020},

date = {2020-05-01},

journal = {Arch Sex Behav},

volume = {49},

number = {4},

pages = {1251--1262},

abstract = {Hypothetical purchase tasks allow for rapid assessment of behavioral economic demand for numerous commodities and are useful in evaluating reinforcer pathologies, such as substance and behavioral addiction. Currently, there is not a task for evaluating demand for sex without requiring implicit engagement in sex work. The current study used a novel purchase task with hotel rooms for sex as the hypothetical commodity to assess demand for sex in individuals with disordered cocaine use, a population that frequently engages in risky sexual behavior. Adults meeting criteria for cocaine abuse or dependence (13 males, ten females) and noncocaine-using controls (eight males, three females) chose hypothetical sexual partners from a series of photographs and endorsed two partners with whom they would most and least like to have sex. Participants then completed the hotel purchase task for both partners, wherein they reported how many nights at a hotel room, at prices from $10 to $1280 per night, they would purchase in a year. Demand intensity was significantly greater and demand elasticity was significantly lower for the most preferred relative to the less preferred partner. Males demonstrated significantly greater intensity and lesser elasticity for sex than females. Demand metrics did not differ between the cocaine and control group. This task may serve as a useful measure of demand for sex without requiring implicit hypothetical engagement in sex work. Future studies exploring the relation between task performance and other characteristics such as sexual dysfunction, in addition to acute substance administration effects, may further determine the task's clinical utility.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32086373,

title = {Abstinence-contingent wage supplements to promote drug abstinence and employment: a randomised controlled trial},

author = {August F Holtyn and Forrest Toegel and Shrinidhi Subramaniam and Brantley P Jarvis and Jeannie-Marie Leoutsakos and Michael Fingerhood and Kenneth Silverman},

doi = {10.1136/jech-2020-213761},

issn = {1470-2738},

year  = {2020},

date = {2020-05-01},

journal = {J Epidemiol Community Health},

volume = {74},

number = {5},

pages = {445--452},

abstract = {BACKGROUND: Poverty, unemployment and substance abuse are inter-related problems. This study evaluated the effectiveness of abstinence-contingent wage supplements in promoting drug abstinence and employment in unemployed adults in outpatient treatment for opioid use disorder.nnMETHODS: A randomised controlled trial was conducted in Baltimore, MD, from 2014 to 2019. After a 3-month abstinence initiation and training period, participants (n=91) were randomly assigned to a usual care control group that received employment services or to an abstinence-contingent wage supplement group that received employment services plus abstinence-contingent wage supplements. All participants were invited to work with an employment specialist to seek employment in a community job for 12 months. Abstinence-contingent wage supplement participants could earn training stipends for working with the employment specialist and wage supplements for working in a community job, but had to provide opiate and cocaine-negative urine samples to maximise pay.nnRESULTS: Abstinence-contingent wage supplement participants provided significantly more opiate and cocaine-negative urine samples than usual care control participants (65% vs 45%; OR=2.29, 95% CI 1.22 to 4.30, p=0.01) during the 12-month intervention. Abstinence-contingent wage supplement participants were significantly more likely to have obtained employment (59% vs 28%; OR=3.88, 95% CI 1.60 to 9.41, p=0.004) and lived out of poverty (61% vs 30%; OR=3.77, 95% CI 1.57 to 9.04, p=0.004) by the end of the 12-month intervention than usual care control participants.nnCONCLUSION: Abstinence-contingent wage supplements can promote drug abstinence and employment.nnTRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT02487745.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Carr2020,

title = {Development and Validation of the Recognizing Addictive Disorders Scale: A Transdiagnostic Measure of Substance-Related and Other Addictive Disorders},

author = {Meagan M. Carr and Karen K. Saules and Jennifer D. Ellis and Angela Staples and David M. Ledgerwood and Tamara M. Loverich},

doi = {10.1080/10826084.2020.1797806},

issn = {1532-2491},

year  = {2020},

date = {2020-03-03},

journal = {Substance Use & Misuse},

volume = {55},

number = {13},

pages = {2194--2204},

publisher = {Informa UK Limited},

keywords = {Environmental and Occupational Health, Health (social science), Medicine (miscellaneous), Psychiatry and Mental health, Public Health},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32298998,

title = {Pharmacodynamic dose effects of oral cannabis ingestion in healthy adults who infrequently use cannabis},

author = {Nicolas J Schlienz and Tory R Spindle and Edward J Cone and Evan S Herrmann and George E Bigelow and John M Mitchell and Ronald Flegel and Charles LoDico and Ryan Vandrey},

doi = {10.1016/j.drugalcdep.2020.107969},

issn = {1879-0046},

year  = {2020},

date = {2020-03-01},

journal = {Drug Alcohol Depend},

volume = {211},

pages = {107969},

abstract = {BACKGROUND: Prior controlled cannabis research has mostly focused on smoked cannabis and predominantly included frequent cannabis users. Oral cannabis products ("edibles") make up a large and growing segment of the retail cannabis market. This study sought to characterize the pharmacodynamic effects of oral cannabis among infrequent cannabis users.nnMETHODS: Seventeen healthy adults who had not used cannabis for at least 60 days completed four experimental sessions in which they consumed a cannabis-infused brownie that contained 0, 10, 25, or 50 mg THC. Subjective effects, vital signs, cognitive/psychomotor performance, and blood THC concentrations were assessed before and for 8 h after dosing.nnRESULTS: Relative to placebo, the 10 mg THC dose produced discriminable subjective drug effects and elevated heart rate but did not alter cognitive/psychomotor performance. The 25 and 50 mg THC doses elicited pronounced subjective effects and markedly impaired cognitive and psychomotor functioning compared with placebo. For all active doses, pharmacodynamic effects did not manifest until 30-60 min after ingestion, and peak effects occurred 1.5-3 h post-administration. Blood THC levels were significantly correlated with some pharmacodynamic drug effects, but were substantially lower than what is typically observed after cannabis inhalation.nnCONCLUSION: Ingestion of oral cannabis dose-dependently altered subjective drug effects and impaired cognitive performance. Unlike inhaled forms of cannabis for which acute effects occur almost immediately, effects of oral cannabis were considerably delayed. In an era of legalization, education about the time course of drug effects for cannabis edibles is needed to facilitate dose titration and reduce acute overdose incidents.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31682266,

title = {Urinary Pharmacokinetic Profile of Cannabinoids Following Administration of Vaporized and Oral Cannabidiol and Vaporized CBD-Dominant Cannabis},

author = {Tory R Spindle and Edward J Cone and David Kuntz and John M Mitchell and George E Bigelow and Ronald Flegel and Ryan Vandrey},

doi = {10.1093/jat/bkz080},

issn = {1945-2403},

year  = {2020},

date = {2020-03-01},

journal = {J Anal Toxicol},

volume = {44},

number = {2},

pages = {109--125},

abstract = {Cannabis products in which cannabidiol (CBD) is the primary chemical constituent (CBD-dominant) are increasingly popular and widely available. The impact of CBD exposure on urine drug testing has not been well studied. This study characterized the urinary pharmacokinetic profile of 100-mg oral and vaporized CBD, vaporized CBD-dominant cannabis (100-mg CBD; 3.7-mg ∆9-THC) and placebo in healthy adults (n = 6) using a within-subjects crossover design. Urine specimens were collected before and for 5 days after drug administration. Immunoassay (IA) screening (cutoffs of 20, 50 and 100 ng/mL) and LC-MS-MS confirmatory tests (cutoff of 15 ng/mL) for 11-nor-9-carboxy-∆9-tetrahydrocannabinol (∆9-THCCOOH) were performed; urine was also analyzed for CBD and other cannabinoids. Urinary concentrations of CBD were higher after oral (mean Cmax: 776 ng/mL) versus vaporized CBD (mean Cmax: 261 ng/mL). CBD concentrations peaked 5 h after oral CBD ingestion and within 1 h after inhalation of vaporized CBD. After pure CBD administration, only 1 out of 218 urine specimens screened positive for ∆9-THCCOOH (20-ng/mL IA cutoff) and no specimens exceeded the 15-ng/mL confirmatory cutoff. After inhalation of CBD-dominant cannabis vapor, nine samples screened positive at the 20-ng/mL IA cutoff, and two of those samples screened positive at the 50-ng/mL IA cutoff. Four samples that screened positive (two at 20 ng/mL and two at 50 ng/mL) confirmed positive with concentrations of ∆9-THCCOOH exceeding 15 ng/mL. These data indicate that acute dosing of pure CBD will not result in a positive urine drug test using current federal workplace drug testing guidelines (50-ng/mL IA cutoff with 15-ng/mL confirmatory cutoff). However, CBD products that also contain ∆9-THC may produce positive urine results for ∆9-THCCOOH. Accurate labeling and regulation of ∆9-THC content in CBD/hemp products are needed to prevent unexpected positive drug tests and unintended drug effects.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31311321,

title = {Demographic and sexual risk predictors of delay discounting of condom-protected sex},

author = {Mary M Sweeney and Meredith S Berry and Patrick S Johnson and Evan S Herrmann and Steven E Meredith and Matthew W Johnson},

doi = {10.1080/08870446.2019.1631306},

issn = {1476-8321},

year  = {2020},

date = {2020-03-01},

journal = {Psychol Health},

volume = {35},

number = {3},

pages = {366--386},

abstract = { Sexual delay discounting describes the decreased likelihood of condom-protected sex if a condom is not immediately available, which can be quantitatively summarised using the Sexual Delay Discounting Task (SDDT). The present studies determined the extent to which condom use likelihood as assessed by the SDDT is associated with self-reported sexual risk behaviours and demographics in two online samples of adults.  Study 1 ( = 767) assessed demographics, sexual risk behaviour, and delay discounting, and examined relations between these variables using correlation and regression. Study 2 ( = 267) examined whether real-world instances of unprotected sex because a condom was not immediately available predicted greater sexual discounting.  Sexual delay discounting, condom use.  Both studies observed significant positive relations between sexual delay discounting and self-reported sexual risk behaviours, and found that males tended to show greater sexual discounting. In Study 2, 46% of the sample self-reported having unprotected sex because a condom was not immediately available, and these individuals showed significantly greater sexual delay discounting.  These results extend prior findings by demonstrating that delay is a critical variable underlying real-life sexual risk behaviour among non-clinical samples. The SDDT is an ecologically valid measure of these processes.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31475622,

title = {Potential for limited reinforcing and abuse-related subjective effects of intranasal oxytocin},

author = {Sean B Dolan and Meredith S Berry and Patrick S Johnson and Matthew W Johnson},

doi = {10.1177/0269881119867607},

issn = {1461-7285},

year  = {2020},

date = {2020-03-01},

journal = {J Psychopharmacol},

volume = {34},

number = {3},

pages = {336--347},

abstract = {BACKGROUND: There has been growing interest in using oxytocin as a pharmacotherapy for psychiatric disorders, including substance use disorder. Limited data exist regarding oxytocin's reinforcing efficacy, which is a necessary consideration for novel pharmacotherapies, especially in substance-using populations.nnAIMS: This study aimed to determine the potential reinforcing effects of intranasally administered oxytocin by assessing behavioral economic demand and subjective effects.nnMETHODS: Healthy adults ( = 23) participated in a double-blind, repeated-measures, laboratory study wherein they received intranasal oxytocin (40 IU) or placebo in a randomized order across two sessions. Participants completed drug purchasing tasks at the conclusion of both sessions. Throughout both sessions, subjective and physiological effects were assessed.nnRESULTS: Demand-curve analysis of purchasing tasks revealed greater median purchasing for oxytocin relative to placebo. Physiological and subjective effects did not significantly differ between oxytocin and placebo. However, a nonsignificant trend was observed for moderately greater drug liking for oxytocin relative to placebo. There was a significant, positive correlation between the difference in drug liking (between oxytocin and placebo) and the difference in lowest-price purchasing (between oxytocin and placebo).nnCONCLUSIONS: These data suggest the potential for limited reinforcing and abuse-related subjective effects of intranasal oxytocin. Given the small sample, the greater drug liking of oxytocin compared to placebo, and the positive relation between demand and drug liking, it is possible that oxytocin may produce reinforcing effects in some participants. Therefore, additional studies of oxytocin reinforcement are warranted.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31958677,

title = {Relationship between cannabis use frequency and major depressive disorder in adolescents: Findings from the National Survey on Drug Use and Health 2012-2017},

author = {Natalie Gukasyan and Eric C Strain},

doi = {10.1016/j.drugalcdep.2020.107867},

issn = {1879-0046},

year  = {2020},

date = {2020-03-01},

journal = {Drug Alcohol Depend},

volume = {208},

pages = {107867},

abstract = {BACKGROUND: Cannabis use and major depressive disorder (MDD) are common and often co-morbid in adolescents, but the nature and directionality of the relationship between these two conditions remains obscure.nnMETHODS: We examined results from the National Survey on Drug Use and Health. Weighted demographics were compared between adolescents with a history of cannabis use (N = 14,873) and never users (N = 73,079). Weighted logistic regression controlling for demographic variables and other substance use was used to determine the relationship between cannabis use frequency and MDD.nnRESULTS: Adolescents with any history of cannabis use had significantly higher rates of lifetime and past year MDD, MDD with severe role impairment, and past year suicide attempt (p < 0.001). Comparing use frequency groups in the adjusted model revealed that heavy users (weekly or greater use) had significantly lower predicted prevalence of lifetime and past year MDD, and past year MDD with severe role impairment compared to light users and those who used cannabis >1 year ago. Rates of reported past year suicide attempt did not differ significantly by cannabis use frequency.nnCONCLUSIONS: Adolescents with any cannabis use history have significantly higher rates of MDD. However, the directionality between frequency of use and MDD is counter to what was expected.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid15072805,

title = {Relative bioavailability of different buprenorphine formulations under chronic dosing conditions},

author = {Eric C Strain and David E Moody and Kenneth B Stoller and Sharon L Walsh and George E Bigelow},

doi = {10.1016/j.drugalcdep.2003.11.008},

issn = {0376-8716},

year  = {2004},

date = {2004-04-01},

journal = {Drug Alcohol Depend},

volume = {74},

number = {1},

pages = {37--43},

abstract = {BACKGROUND: Buprenorphine is an approved medication for the treatment of opioid dependence. Three sublingual formulations have been used at various times during its development-a solution containing alcohol, tablets containing buprenorphine alone, and tablets containing buprenorphine plus naloxone. This study compared the relative buprenorphine bioavailability of these different formulations.nnMETHODS: Outpatient volunteers (N = 10) were maintained for 14 days of daily administration on each formulation; the dose of buprenorphine (8 mg) was constant across formulations. Blood samples were collected and tested for buprenorphine and norbuprenorphine concentrations after 7 and 14 days maintenance on each formulation. Serial samples were collected before and for 6 h after a daily dose of each formulation.nnRESULTS: Peak buprenorphine concentrations (C(max)) and area under the curve (AUC) for the 6h interval (AUC(0-6)) were highest for the solution and lowest for buprenorphine alone tablets; values for combination tablets were more similar to those for solution. Differences between formulations were less pronounced at day 14 than day 7. There was considerable between-subject variability in concentrations produced.nnCONCLUSIONS: These results suggest there may be greater bioavailability of buprenorphine/naloxone versus buprenorphine alone tablets, and that the bioavailability of buprenorphine from the former is very similar to that seen with solution after 2 weeks of stabilization on each formulation.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid15764421,

title = {Safety and efficacy of L-tryptophan and behavioral incentives for treatment of cocaine dependence: a randomized clinical trial},

author = {Hendrée E Jones and Rolley E Johnson and George E Bigelow and Kenneth Silverman and Tim Mudric and Eric C Strain},

doi = {10.1080/10550490490512753},

issn = {1055-0496},

year  = {2004},

date = {2004-01-01},

journal = {Am J Addict},

volume = {13},

number = {5},

pages = {421--437},

abstract = {L-tryptophan(ie, tryptophan)has shown promise as a pharmacotherapy in cocaine addiction treatment. Abstinent contingent voucher incentives have shown efficacy in abstinence initiation and maintenance for treatment of cocaine dependence. The present study evaluated these two approaches singly and in combination in a relapse prevention+treatment design. A double-blind, parallel-group, placebo-controlled design was used. Cocaine-dependent patients(N=199) were stratified and randomized to one of four groups: tryptophan+contingent vouchers, tryptophan+non-contingent vouchers, placebo+contingent vouchers, and placebo+non-contingent vouchers. The study included residential stabilization (4-9 days), where patients achieved initial cocaine abstinence; outpatient treatment evaluation(16 weeks), where patients received medication, vouchers, and urine testing thrice weekly; and disposition. Main outcomes were retention in treatment, urinalysis, self-reported drug use, and self-reported side effects. Tryptophan did not significantly prevent relapse to cocaine use or attenuate cocaine use after relapse. Contingent vouchers significantly increased the time to cocaine relapse and produced less cocaine use relative to non-contingent vouchers. Results demonstrate the sensitivity of this methodology for detecting decreases in cocaine use, as evidenced by significant changes of the contingent voucher conditions; this suggests that tryptophan's lack of efficacy was not due to model insensitivity for detecting significant differences in cocaine use. This study also showed that contingent vouchers were effective in the novel experimental model of relapse prevention.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid12738351,

title = {Buprenorphine: how to use it right},

author = {Rolley E Johnson and Eric C Strain and Leslie Amass},

doi = {10.1016/s0376-8716(03)00060-7},

issn = {1879-0046},

year  = {2003},

date = {2003-05-01},

journal = {Drug Alcohol Depend},

volume = {70},

number = {2 Suppl},

pages = {S59--S77},

abstract = {The unique pharmacology of buprenorphine at the mu-opioid receptor (i.e. high affinity, low intrinsic activity and slow dissociation) results in buprenorphine having: (1) a good safety profile, (2) low physical dependence, and (3) flexibility in dose scheduling. Early studies assessed the effectiveness of buprenorphine for the treatment of opioid dependence using a sublingual solution formulation. More recently, a combination tablet (buprenorphine/naloxone in a 4:1 ratio) has been assessed with the goal of decreasing diversion and abuse. Controlled studies with buprenorphine solution, buprenorphine mono-tablet, and buprenorphine/naloxone combination tablet have uniformly demonstrated the effectiveness of buprenorphine for opioid dependence treatment and the combination tablet appears to decrease (but not eliminate) abuse potential. There is general agreement across studies regarding buprenorphine induction and maintenance dose schedules. The clinical effects of buprenorphine and buprenorphine/naloxone are similar and most patients can be treated initially with and maintained on a daily buprenorphine/naloxone dose of 4:1-24:6 mg. Dosing is possible on a less-than-daily schedule; however, multiples of the daily-dose should be administered to cover the increased interval between doses. If buprenorphine withdrawal is indicated, gradual dose reduction is recommended over a rapid dose reduction or abrupt cessation. Both tablet formulations are approved by the US FDA for opioid dependence treatment as Schedule III narcotics and are, therefore, available for use in office-based practice. The buprenorphine plus naloxone combination product should provide additional safeguards for use in office-based practice by decreasing risk of diversion, and office-based treatment should expand the availability of services to opioid dependent patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid12732405,

title = {Single versus multiple drug focus in substance abuse clinical trials research: the devil is in the details},

author = {Eric C Strain},

doi = {10.1016/s0376-8716(03)00035-8},

issn = {0376-8716},

year  = {2003},

date = {2003-05-01},

journal = {Drug Alcohol Depend},

volume = {70},

number = {2},

pages = {131--134},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid12719364,

title = {Review: there is insufficient evidence for naltrexone maintenance treatment in opioid dependence},

author = {Eric C Strain},

doi = {10.1136/ebmh.6.2.57},

issn = {1362-0347},

year  = {2003},

date = {2003-05-01},

journal = {Evid Based Ment Health},

volume = {6},

number = {2},

pages = {57},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid12653813,

title = {Evaluation of the effects of lofexidine and clonidine on naloxone-precipitated withdrawal in opioid-dependent humans},

author = {Sharon L Walsh and Eric C Strain and George E Bigelow},

doi = {10.1046/j.1360-0443.2003.00372.x},

issn = {0965-2140},

year  = {2003},

date = {2003-04-01},

journal = {Addiction},

volume = {98},

number = {4},

pages = {427--439},

abstract = {AIMS: To examine the efficacy of lofexidine, an alpha2 adrenergic agonist, to suppress opioid withdrawal symptoms in opioid-dependent humans under in-patient laboratory conditions by using a naloxone challenge procedure.nnDESIGN: Randomized, within-subject, cross-over design with drug administration taking place under double-blind and triple-dummy conditions.nnSETTING: A 14-bed in-patient hospital research unit dedicated to the conduct of behavioral pharmacology studies.nnPARTICIPANTS: Eight healthy adult volunteers (two female/six male) with histories of polysubstance abuse and current physical dependence on opioids.nnINTERVENTION: Participants were stabilized onto methadone and maintained on 30 mg/day, p.o. throughout the study. Oral placebo, lofexidine (0.4, 0.8 and 1.6 mg, p.o.) and clonidine (0.1 and 0.2 mg, p.o.) were each tested as pre-treatments once in combination with each of three intramuscular naloxone doses (0, 0.1 and 0.3 mg, i.m.) during 18 separate experimental sessions.nnMEASUREMENTS: An array of physiological indices (e.g. heart rate, blood pressure, pupil diameter) as well as a number of subjective and observer-rating scales sensitive to opioid withdrawal effects.nnFINDINGS: As expected, lofexidine and clonidine both produced dose-related decreases in blood pressure and heart rate but few subjective effects; naloxone increased opioid withdrawal signs and symptoms in a dose- and time-dependent fashion. Although both lofexidine and clonidine reduced the cardiovascular response to naloxone challenge, close inspection of the data reveal that this occurred only to the extent that baseline physiological parameters were reduced, while neither drug significantly modified the overall magnitude of the response to naloxone. Moreover, neither lofexidine nor clonidine suppressed the subjective discomfort of opioid withdrawal or significantly reduced other autonomic signs of opioid withdrawal, such as lacrimation or rhinorrhea.nnCONCLUSIONS: These data suggest that lofexidine is well tolerated even at supratherapeutic acute doses. However, its failure to modify most signs and symptoms of opioid withdrawal suggest that its effective use in spontaneous withdrawal will require concomitant medications for improved therapeutic response.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid12069411,

title = {A liquid chromatographic-electrospray ionization-tandem mass spectrometric method for determination of buprenorphine, its metabolite, norbuprenorphine, and a coformulant, naloxone, that is suitable for in vivo and in vitro metabolism studies},

author = {David E Moody and Matthew H Slawson and Eric C Strain and John D Laycock and Alan C Spanbauer and Rodger L Foltz},

doi = {10.1006/abio.2002.5673},

issn = {0003-2697},

year  = {2002},

date = {2002-07-01},

journal = {Anal Biochem},

volume = {306},

number = {1},

pages = {31--39},

abstract = {A liquid chromatographic-electrospray ionization-tandem mass spectrometric method has been developed and validated for determination of the antiabuse medication, buprenorphine, its primary metabolite, norbuprenorphine, and a proposed coformulant, naloxone. The method uses deuterated internal standards and a simple liquid-liquid extraction. Mass spectrometry employed selected reaction monitoring of the transitions of m/z 468 to 396 for buprenorphine, 472 to 400 for [2H4]buprenorphine, 414 to 101 for norbuprenorphine, 423 to 110 for [2H9]norbuprenorphine, 328 to 310 for naloxone, and 345 to 327 for its internal standard, [2H3]naltrexone. The method was accurate and precise across the dynamic range of 0.1 to 10 ng/ml. All analytes were stable in human plasma stored at room temperature for up to 24 h and after three freeze-thaw cycles. Reconstituted extracts were stable at -20 degrees C for up to 3 days. In human subjects receiving a sublingual tablet of 8 mg buprenorphine and 2 mg naloxone, buprenorphine and norbuprenorphine were detected for up to 24 h with respective maximum concentrations at 1 and 1.5 h. Maximal concentrations ranged from 2.2 to 2.8 and 1.5 to 2.4 ng/ml for buprenorphine and norbuprenorphine, respectively (i.e., approximately 6 nM). The method detected norbuprenorphine formation in human liver microsomes incubated with 5-82 nM buprenorphine, which encompasses the therapeutic plasma concentration range. When cDNA-expressed P450s were incubated with 21 nM buprenorphine, norbuprenorphine formation was detected for P450s 3A4, as previously described, but also for 3A5, 3A7, and 2C8. Buprenorphine utilization generally exceeded norbuprenorphine formation, suggesting that P450s 2C18, 2C19, 2D6, and 2E1 may also be involved in buprenorphine metabolism to other products. These results suggest this method is suitable for both in vivo and in vitro studies of buprenorphine metabolism to norbuprenorphine.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid12047729,

title = {Outpatient treatment entry and health care utilization after a combined medical/substance abuse intervention for hospitalized medical patients},

author = {Thomas P O'Toole and Eric C Strain and Gary Wand and Mary E McCaul and Matthew Barnhart},

doi = {10.1046/j.1525-1497.2002.10638.x},

issn = {0884-8734},

year  = {2002},

date = {2002-05-01},

journal = {J Gen Intern Med},

volume = {17},

number = {5},

pages = {334--340},

abstract = {CONTEXT: Drug-abusing patients utilize extensive amounts of health services resources, yet the acute medical hospitalization has typically not been used effectively to engage patients in substance abuse treatment.nnOBJECTIVES: To assess the effect of an integrated substance abuse/acute medical care day hospital (DH) intervention.nnDESIGN AND SETTING: Prospective, consecutive chart review of patients referred to a day hospital program from the medicine service at an urban tertiary care teaching hospital. From the referral cohort, a comparison group receiving usual care was identified.nnPARTICIPANTS: One hundred twenty adult medicine inpatients with active substance abuse and self-identified motivation to enter treatment.nnMAIN OUTCOME MEASURES: Outpatient substance abuse treatment entry and post-intervention health services utilization.nnRESULTS: Following DH treatment, 50.6% entered further outpatient substance abuse treatment (vs 2.4% comparison patients; P <.001). There was a significant increase in ambulatory medical visits for DH patients (pre-6 month 0.49 vs post-6 month 3.46; P <.001), greater than the change noted for comparison patients. However, there was no difference noted in pre-post hospitalization or emergency department utilization following the DH intervention.nnCONCLUSIONS: A DH program for substance abusing hospitalized medicine patients that introduces substance abuse treatment during treatment for an acute medical illness does appear to improve outpatient substance abuse treatment entry and ambulatory care utilization after hospital discharge.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid12479251,

title = {Assessment and treatment of comorbid psychiatric disorders in opioid-dependent patients},

author = {Eric C Strain},

doi = {10.1097/00002508-200207001-00003},

issn = {0749-8047},

year  = {2002},

date = {2002-01-01},

journal = {Clin J Pain},

volume = {18},

number = {4 Suppl},

pages = {S14--S27},

abstract = {The purpose of this article is to provide a review of the prevalence, assessment, and treatment of common psychiatric disorders found among patients with opioid dependence. Dependence on opioids can include both persons who are physically dependent on opioids and persons who fulfill the criteria for a syndrome of opioid dependence, such as that found in the Diagnostic and Statistical Manual, fourth edition (DSM-IV). The latter grouping of persons typically abuse illicit opioids, and prevalence of comorbid conditions and approaches in diagnosis and treatment have been studied in these patients. High rates of other psychiatric disorders--both other substance-use disorders as well as non-substance-use psychiatric disorders--have been reported. The most common non-substance-use psychiatric disorders are depressive, anxiety, and personality disorders. When evaluating and planning treatment of opioid-dependent patients with concurrent psychiatric symptoms, it is important to determine if such symptoms are independent of the substance use or substance induced. In the former case, treatment should follow routine clinical practice, whereas in the latter case, treatment stability in substance use should be the first therapeutic step. The presence of a pain condition can further complicate assessment and treatment, as either pain itself or treatments used for pain may produce symptoms that overlap with psychiatric disorders.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid11772479,

title = {Voucher-based reinforcement of opiate abstinence during methadone detoxification},

author = {Elias Robles and Maxine L Stitzer and Eric C Strain and George E Bigelow and Kenneth Silverman},

doi = {10.1016/s0376-8716(01)00160-0},

issn = {0376-8716},

year  = {2002},

date = {2002-01-01},

journal = {Drug Alcohol Depend},

volume = {65},

number = {2},

pages = {179--189},

abstract = {Methadone detoxification is often used in the treatment of opiate dependence. This procedure, however, is frequently associated with continued opiate use, and high rates of attrition and relapse. In this study, a 90-day methadone detoxification was enhanced by adding voucher-based reinforcement of opiate abstinence before, during and after the dose tapering schedule. After 4 weeks of standard methadone maintenance (baseline), subjects were randomized to either the abstinence (n=26), or attendance reinforcement (n=22) condition. During the remaining 22 weeks of the study, the abstinence reinforcement group could receive vouchers with monetary value three times per week for providing opiate-negative urine specimens, while subjects in the attendance reinforcement group received vouchers of equal value for attending the clinic, regardless of urinalysis results. Methadone maintenance continued during weeks 5-10, dose tapering was implemented during weeks 11-23, and during weeks 24-26 the voucher schedule remained in effect but no medication was provided. Fifty percent of clients in both groups completed dose tapering, and 40% completed the vouchers-only phase. Subjects in the abstinence as compared with the attendance reinforcement group had lower rates of opiate use during the maintenance and detoxification phases, and longer periods of opiate abstinence during the detoxification phase. Cocaine use was also lower in the abstinence than the attendance reinforcement group during the maintenance and detoxification phases. In addition, abstinence as compared with attendance reinforcement subjects reported significantly fewer intravenous injections during the detoxification phase. Voucher-based reinforcement procedures could be useful for successfully transitioning patients into opiate antagonist therapy, or drug-free treatments.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid11862344,

title = {Blockade of hydromorphone effects by buprenorphine/naloxone and buprenorphine},

author = {Eric C Strain and Sharon L Walsh and George E Bigelow},

doi = {10.1007/s002130100920},

issn = {0033-3158},

year  = {2002},

date = {2002-01-01},

journal = {Psychopharmacology (Berl)},

volume = {159},

number = {2},

pages = {161--166},

abstract = {RATIONALE: Buprenorphine is an opioid agonist-antagonist used in the treatment of opioid dependence. Naloxone has been combined with buprenorphine to decrease the parenteral abuse potential of buprenorphine. This addition of naloxone may also confer further opioid blockade efficacy.nnOBJECTIVES: To test the opioid blockade efficacy of sublingual buprenorphine/naloxone versus buprenorphine alone and determine whether: (1) the blockade efficacy of buprenorphine/naloxone varies between the time of expected maximal and minimal effects of naloxone, (2) the blockade efficacy of buprenorphine/naloxone and buprenorphine varies as a function of maintenance dose level, and (3) there are adaptive changes over time associated with repeated daily dosing of buprenorphine/naloxone and buprenorphine.nnMETHODS: Residential subjects ( n=6) were maintained on different double-blind dose levels of buprenorphine/naloxone (4/1, 8/2, 16/4, 32/8 mg) and buprenorphine (32 mg) for 6-day periods and challenged with parenteral doses of hydromorphone (12 mg) in laboratory sessions.nnRESULTS: There was no evidence of additional opioid blockade efficacy conferred by combining naloxone with buprenorphine. Higher doses of buprenorphine/naloxone provided greater blockade of hydromorphone effects. Changes over time associated with repeated daily dosing of buprenorphine/naloxone and buprenorphine were minimal.nnCONCLUSIONS: The addition of naloxone to buprenorphine may deter the parenteral abuse of buprenorphine/naloxone, but it does not enhance the therapeutic efficacy of buprenorphine. The blockade efficacy of buprenorphine/naloxone is dose related; however, doses up to 32/8 mg buprenorphine/naloxone provide only partial blockade when subjects receive a high dose of an opioid agonist.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid11561074,

title = {Enadoline and butorphanol: evaluation of kappa-agonists on cocaine pharmacodynamics and cocaine self-administration in humans},

author = {S L Walsh and B Geter-Douglas and E C Strain and G E Bigelow},

issn = {0022-3565},

year  = {2001},

date = {2001-10-01},

journal = {J Pharmacol Exp Ther},

volume = {299},

number = {1},

pages = {147--158},

abstract = {Preclinical studies have demonstrated that kappa-opioid agonists can attenuate the neurochemical and behavioral effects of cocaine that are related to its reinforcing efficacy, suggesting that kappa-agonists may serve as pharmacotherapies for cocaine dependence. This 8-week inpatient study examined the ability of enadoline, a selective and high-efficacy kappa-agonist, and butorphanol, a mixed agonist with intermediate efficacy at both mu- and kappa-receptors, to reduce the direct pharmacodynamic effects and self-administration of intravenous cocaine in humans (n = 8). Acute doses of intramuscular enadoline (20, 40, and 80 microg/kg), butorphanol (1.5, 3, and 6 mg/70 kg) and placebo were examined separately as pretreatments during each of three test sessions with cocaine in a constrained random order. A cocaine dose-effect session (0, 20, and 40 mg cocaine i.v., 1 h apart) examined direct pharmacodynamic interactions on subjective and physiological indices; self-administration sessions examined choice behavior for cocaine (40 mg i.v. for six trials) versus money 1) in the presence of a sample cocaine dose with money choices presented in ascending value, and 2) in the absence of a sample dose with money choices presented in descending values. Enadoline (80 microg/70 kg) significantly (p < 0.05) reduced some of the positive subjective effects of cocaine (e.g., ratings of "high"), while butorphanol failed to modify subjective responses. Both agents were safely tolerated in combination with cocaine without adverse physiological responses. Cocaine self-administration was significantly greater across all pretreatment conditions when the sample dose was given and ascending money choices were used. Enadoline and butorphanol failed to modify cocaine self-administration. These data suggest that these kappa-agonists may be safely administered in the presence of cocaine but do not produce significant attenuation of cocaine's direct effects or self-administration under these acute dosing conditions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid11594439,

title = {Enadoline, a selective kappa opioid agonist: comparison with butorphanol and hydromorphone in humans},

author = {S L Walsh and E C Strain and M E Abreu and G E Bigelow},

doi = {10.1007/s002130100788},

issn = {0033-3158},

year  = {2001},

date = {2001-09-01},

journal = {Psychopharmacology (Berl)},

volume = {157},

number = {2},

pages = {151--162},

abstract = {RATIONALE: The availability of the highly selective and specific kappa opioid agonist enadoline provides an opportunity to explore the function of kappa receptors in humans and their potential utility as a target for substance abuse pharmacotherapy development.nnOBJECTIVES: The purpose of this study was to characterize the pharmacodynamic effects of enadoline, a selective kappa agonist, and to compare it with butorphanol, a mixed mu/kappa agonist, and hydromorphone, a mu agonist, in humans.nnMETHODS: Pilot evaluation (n=3) served to establish intramuscular doses of enadoline (20, 40, 80, and 160 microg/70 kg), butorphanol (1.5, 3, 6, and 12 mg/70 kg), and hydromorphone (1.5, 3, and 6 mg/70 kg) of comparable activity. These acute doses were examined under double-blind, placebo-controlled and constrained randomized conditions with a minimum of 72 h between tests in volunteers with polysubstance abuse histories (n=6). Physiological and subject- and observer-rated measures were collected 30 min before and for 4 h after administration.nnRESULTS: Enadoline significantly increased measures of sedation, confusion and dizziness, produced visual distortions and feelings of depersonalization, and increased urinary output. The highest dose (160 microg/70 kg) was not tolerated and led to psychotomimetic effects. Hydromorphone produced prototypic mu opioid effects including respiratory depression, miosis, and euphoria. Butorphanol was most similar to hydromorphone and shared few effects with enadoline.nnCONCLUSIONS: These results are discussed with respect to the potential use and safety of kappa agonists for clinical indications.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid11351930,

title = {Effects of buprenorphine/naloxone in opioid-dependent humans},

author = {K B Stoller and G E Bigelow and S L Walsh and E C Strain},

doi = {10.1007/s002130000637},

issn = {0033-3158},

year  = {2001},

date = {2001-03-01},

journal = {Psychopharmacology (Berl)},

volume = {154},

number = {3},

pages = {230--242},

abstract = {RATIONALE: Buprenorphine is a partial mu opioid agonist under development as a sublingual (SL) medication for opioid dependence treatment in the United States. Because buprenorphine may be abused, tablets combining buprenorphine with naloxone in a 4:1 ratio have been developed to reduce that risk. Low doses of injected buprenorphine/naloxone have been tested in opioid-dependent subjects, but higher doses (more than 2 mg of either medication) and direct comparisons to SL buprenorphine/naloxone have not been examined.nnOBJECTIVES: To assess and compare the effects of intramuscular (i.m.) versus SL buprenorphine/naloxone in opioid-dependent volunteers.nnMETHODS: Opioid-dependent volunteers were maintained on 40 mg per day of oral hydromorphone while on a residential research ward. After safety testing in two pilot subjects, participants (n = 8) were tested with both i.m. and SL buprenorphine/naloxone (1/0.25, 2/0.5, 4/1, 8/2, 16/4 mg); i.m. hydromorphone (10 mg) and naloxone (0.25 mg); both i.m. and SL buprenorphine alone (8 mg); and placebo. Test sessions were twice per week; dosing was double-blind.nnRESULTS: Intramuscular buprenorphine/naloxone produced dose-related increases on indices of opioid antagonist effects. Effects were consistent with naloxone-precipitated withdrawal, and were short-lived. As withdrawal effects dissipated, euphoric opioid agonist effects from buprenorphine did not appear. Sublingual buprenorphine/naloxone produced neither opioid agonist nor antagonist effects.nnCONCLUSIONS: Intramuscular injection of buprenorphine/naloxone precipitates withdrawal in opioid dependent persons; therefore, the combination has a low abuse potential by the injection route in this population. Sublingual buprenorphine/naloxone by tablet is well tolerated in opioid dependent subjects, and shows neither adverse effects (i.e., precipitated withdrawal) nor a high abuse potential (i.e., opioid agonist effects).},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid11444154,

title = {Gradual dose taper following chronic buprenorphine},

author = {A B Becker and E C Strain and G E Bigelow and M L Stitzer and R E Johnson},

doi = {10.1080/105504901750227778},

issn = {1055-0496},

year  = {2001},

date = {2001-01-01},

journal = {Am J Addict},

volume = {10},

number = {2},

pages = {111--121},

abstract = {This paper describes the time course of withdrawal and relapse in opioid-dependent volunteers (n = 8) who completed a gradual outpatient buprenorphine dose taper (28 days). Compliance with treatment was very high, as evidenced by clinic attendance (96-100%). Urinalysis showed that 6 of the 8 volunteers had relapsed to opiates by the end of the dose taper, even though reports of withdrawal were generally low. Relapse may have been triggered by a desire to re-experience the drug's positive subjective effects, craving, or low motivation to remain drug-free. A longer taper combined with an expanded range of treatments may improve prognosis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid11058673,

title = {A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence},

author = {R E Johnson and M A Chutuape and E C Strain and S L Walsh and M L Stitzer and G E Bigelow},

doi = {10.1056/NEJM200011023431802},

issn = {0028-4793},

year  = {2000},

date = {2000-11-01},

journal = {N Engl J Med},

volume = {343},

number = {18},

pages = {1290--1297},

abstract = {BACKGROUND: Opioid dependence is a chronic, relapsing disorder with important public health implications.nnMETHODS: In a 17-week randomized study of 220 patients, we compared levomethadyl acetate (75 to 115 mg), buprenorphine (16 to 32 mg), and high-dose (60 to 100 mg) and low-dose (20 mg) methadone as treatments for opioid dependence. Levomethadyl acetate and buprenorphine were administered three times a week. Methadone was administered daily. Doses were individualized except in the group assigned to low-dose methadone. Patients with poor responses to treatment were switched to methadone.nnRESULTS: There were 55 patients in each group; 51 percent completed the trial. The mean (+/-SE) number of days that a patient remained in the study was significantly higher for those receiving levomethadyl acetate (89+/-6), buprenorphine (96+/-4), and high-dose methadone (105+/-4) than for those receiving low-dose methadone (70+/-4, P<0.001). Continued participation was also significantly more frequent among patients receiving high-dose methadone than among those receiving levomethadyl acetate (P=0.02). The percentage of patients with 12 or more consecutive opioid-negative urine specimens was 36 percent in the levomethadyl acetate group, 26 percent in the buprenorphine group, 28 percent in the high-dose methadone group, and 8 percent in the low-dose methadone group (P=0.005). At the time of their last report, patients reported on a scale of 0 to 100 that their drug problem had a mean severity of 35 with levomethadyl acetate, 34 with buprenorphine, 38 with high-dose methadone, and 53 with low-dose methadone (P=0.002).nnCONCLUSIONS: As compared with low-dose methadone, levomethadyl acetate, buprenorphine, and high-dose methadone substantially reduce the use of illicit opioids.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid10928310,

title = {Effects of buprenorphine versus buprenorphine/naloxone tablets in non-dependent opioid abusers},

author = {E C Strain and K Stoller and S L Walsh and G E Bigelow},

doi = {10.1007/s002130050066},

issn = {0033-3158},

year  = {2000},

date = {2000-03-01},

journal = {Psychopharmacology (Berl)},

volume = {148},

number = {4},

pages = {374--383},

abstract = {RATIONALE: Buprenorphine is an opioid agonist-antagonist under development in the United States as a sublingual medication for treatment of opioid dependence. Buprenorphine may be abused; therefore, tablets combining buprenorphine with naloxone have been developed with the intent of reducing the abuse risk in people physically dependent upon opioids. The characteristics and abuse potential of buprenorphine and buprenorphine/naloxone tablets in non-dependent opioid abusers have not been determined. Non-parenteral abuse of opioids such as buprenorphine may be more likely in people who have less severe substance abuse disorders (e.g., are not physically dependent upon opioids).nnOBJECTIVES: To assess the abuse potential of sublingual buprenorphine and buprenorphine/naloxone tablets in non-dependent opioid abusers.nnMETHODS: Subjects (n=7) were tested with sublingual buprenorphine (4, 8, 16 mg), sublingual buprenorphine/naloxone (1/0.25, 2/0.5, 4/1, 8/2, 16/4 mg), as well as intramuscular hydromorphone as an opioid agonist control (2, 4 mg) and placebo in laboratory sessions conducted twice per week. Dosing was double-blind and double-dummy.nnRESULTS: The higher doses of both buprenorphine and buprenorphine/naloxone produced similar opioid agonist-like effects. The onset of these effects was slowed, consistent with the sublingual route of administration, and the magnitude of effects was moderate. There was no evidence to suggest the addition of naloxone attenuated buprenorphine's opioid agonist effects in this population when buprenorphine was delivered by the sublingual route.nnCONCLUSIONS: These results suggest that sublingual buprenorphine and buprenorphine/naloxone may both be abused by opioid users who are not physically dependent upon opioids.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid10359462,

title = {Psychosocial treatments for cocaine dependence: rethinking lessons learned},

author = {E C Strain},

doi = {10.1001/archpsyc.56.6.503},

issn = {0003-990X},

year  = {1999},

date = {1999-06-01},

journal = {Arch Gen Psychiatry},

volume = {56},

number = {6},

pages = {503--504},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid10086434,

title = {Moderate- vs high-dose methadone in the treatment of opioid dependence: a randomized trial},

author = {E C Strain and G E Bigelow and I A Liebson and M L Stitzer},

doi = {10.1001/jama.281.11.1000},

issn = {0098-7484},

year  = {1999},

date = {1999-03-01},

journal = {JAMA},

volume = {281},

number = {11},

pages = {1000--1005},

abstract = {CONTEXT: Methadone hydrochloride treatment is the most common pharmacological intervention for opioid dependence, and recent interest has focused on expanding methadone treatment availability beyond traditional specially licensed clinics. However, despite recommendations regarding effective dosing of methadone, controlled clinical trials of higher-dose methadone have not been conducted.nnOBJECTIVE: To compare the relative clinical efficacy of moderate- vs high-dose methadone in the treatment of opioid dependence.nnDESIGN: A 40-week randomized, double-blind clinical trial starting in June 1992 and ending in October 1995.nnSETTING: Outpatient substance abuse treatment research clinic at the Johns Hopkins University Bayview Campus, Baltimore, Md.nnPARTICIPANTS: One hundred ninety-two eligible clinic patients.nnINTERVENTION: Daily oral methadone hydrochloride in the dose range of 40 to 50 mg (n = 97) or 80 to 100 mg (n = 95), with concurrent substance abuse counseling.nnMAIN OUTCOME MEASURES: Opioid-positive urinalysis results and retention in treatment.nnRESULTS: By intent-to-treat analysis through week 30 patients in the high-dose group had significantly lower rates of opioid-positive urine samples compared with patients in the moderate-dose group (53.0% [95% confidence interval [CI], 46.9%-59.2%] vs 61.9% [95% CI, 55.9%-68.0%]; P = .047. These differences persisted during withdrawal from methadone. Through day 210 no significant difference was evident between dose groups in treatment retention (high-dose group mean retention, 159 days; moderate-dose group mean retention, 157 days). Nineteen (33%) of 57 patients in the high-dose group and 11 (20%) of 54 patients in the moderate-dose group completed detoxification.nnCONCLUSIONS: Both moderate- and high-dose methadone treatment resulted in decreased illicit opioid use during methadone maintenance and detoxification. The high-dose group had significantly greater decreases in illicit opioid use.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33156180c,

title = {Provider Continuity in the Prescribing of Buprenorphine/Naloxone Within Medicare Part D},

author = {Justin C Strickland and Andrew S Huhn and Cecilia L Bergeria and Eric C Strain and Kelly E Dunn},

doi = {10.1097/ADM.0000000000000765},

issn = {1935-3227},

journal = {J Addict Med},

volume = {15},

number = {4},

pages = {325--333},

abstract = {OBJECTIVES: Efforts to improve buprenorphine access for opioid use disorder have focused on increasing the number of waivered providers. However, it is unknown how efforts to increase initial prescribing result in a sustained pool of prescribers. We examine the prevalence of year-to-year provider-level buprenorphine prescribing, and provider- and state-level factors associated with provider continuity.nnMETHODS: Providers prescribing buprenorphine/naloxone within the Medicare Part D claims database were evaluated from 2013 to 2017 with prescriber continuity measured as prescriptions made in consecutive years from the same provider (N = 14,222 unique providers; 6670 in 2013).nnRESULTS: The number of providers prescribing buprenorphine/naloxone within Medicare Part D increased from 2013 to 2017. The majority of providers prescribed buprenorphine/naloxone to 10 or fewer beneficiaries. Approximately 84% of providers prescribing buprenorphine/naloxone in 1 year prescribed it in the following year. Continuous prescribing from 2013 to 2017 was 59.4%, which was 86% the rate of a comparator chronic health medication (ie, lisinopril). Survival analyses indicated that female providers (adjusted hazard ratios [AHR] = 1.30, P < 0.001) and clinical neuroscience specialties such as psychiatry (AHR = 1.21, P < 0.001) exhibited greater discontinuation rates, whereas those with higher buprenorphine/naloxone beneficiary loads (AHR = 0.50, P < 0.001) and in states with a greater increase in overdose mortality rates (AHR = 0.88, P < 0.05) showed lower discontinuation rates.nnCONCLUSIONS: These data support evidence that providers who begin prescribing buprenorphine continue prescribing, although short of maximum capacity. Efforts to help providers become waivered, understand the impact of overdose fatalities in their area, and prescribe to multiple patients are likely to generate an enduring positive contribution to the number of treated patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33560698,

title = {Treatment Disruption and Childcare Responsibility as Risk Factors for Drug and Alcohol Use in Persons in Treatment for Substance Use Disorders During the COVID-19 Crisis},

author = {Andrew S Huhn and Eric C Strain and Jasmyne Jardot and Gavin Turner and Cecilia L Bergeria and Sandeep Nayak and Kelly E Dunn},

doi = {10.1097/ADM.0000000000000813},

issn = {1935-3227},

journal = {J Addict Med},

volume = {16},

number = {1},

pages = {e8--e15},

abstract = {OBJECTIVES: The novel 2019 coronavirus (COVID-19) crisis has caused considerable upheaval in the U.S. healthcare system. The current study examined patient-reported experiences in substance use disorder (SUD) treatment during the early stages of the COVID-19 crisis.nnMETHODS: Participants in SUD treatment were recruited via online crowdsourcing from April 14, 2020 to May 26, 2020, during the early stages of the COVID-19 crisis. Participants reported disruptions in SUD treatment, stress and anxiety caused by these disruptions on a 0-100 point visual analogue scale (VAS), stress associated with childcare responsibilities on a 0-100 VAS, current stress on the Perceived Stress Scale (PSS), anxiety symptoms on the Beck Anxiety Inventory (BAI), sleep disturbances on the Insomnia Severity Index (ISI), and whether they used drugs or alcohol during the COVID-19 crisis.nnRESULTS: Participants (N = 240) endorsed that at least 1 SUD treatment was switched to telemedicine (63.7%), had some appointments cancelled (37.5%), or was discontinued due to COVID-19 (29.6%). Participants who did versus did not endorse drug/alcohol use reported difficulty obtaining medications to treat their SUD (OR = 2.47, 95% CI, 1.17-5.22, χ2 = 5.98, P = .016), greater scores on VAS treatment-related stress (F1,197 = 5.70, P = .018) and anxiety (F1,197 = 4.07, P = .045), greater VAS stress related to childcare (F1,107 = 10.24, P = .002), and greater scores on the PSS (F1,235 = 19.27, P < .001), BAI (F1,235 = 28.59, P < .001), and ISI (F1,235 = 14.41, P < .001).nnCONCLUSIONS: Providers and public health officials should work to improve continuity and quality of care during the COVID-19 crisis, with special attention on addressing childcare difficulties and providing remote methods to improve stress, anxiety, and sleep for persons in SUD treatment.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33156180,

title = {Provider Continuity in the Prescribing of Buprenorphine/Naloxone Within Medicare Part D},

author = {Justin C Strickland and Andrew S Huhn and Cecilia L Bergeria and Eric C Strain and Kelly E Dunn},

doi = {10.1097/ADM.0000000000000765},

issn = {1935-3227},

journal = {J Addict Med},

volume = {15},

number = {4},

pages = {325--333},

abstract = {OBJECTIVES: Efforts to improve buprenorphine access for opioid use disorder have focused on increasing the number of waivered providers. However, it is unknown how efforts to increase initial prescribing result in a sustained pool of prescribers. We examine the prevalence of year-to-year provider-level buprenorphine prescribing, and provider- and state-level factors associated with provider continuity.nnMETHODS: Providers prescribing buprenorphine/naloxone within the Medicare Part D claims database were evaluated from 2013 to 2017 with prescriber continuity measured as prescriptions made in consecutive years from the same provider (N = 14,222 unique providers; 6670 in 2013).nnRESULTS: The number of providers prescribing buprenorphine/naloxone within Medicare Part D increased from 2013 to 2017. The majority of providers prescribed buprenorphine/naloxone to 10 or fewer beneficiaries. Approximately 84% of providers prescribing buprenorphine/naloxone in 1 year prescribed it in the following year. Continuous prescribing from 2013 to 2017 was 59.4%, which was 86% the rate of a comparator chronic health medication (ie, lisinopril). Survival analyses indicated that female providers (adjusted hazard ratios [AHR] = 1.30, P < 0.001) and clinical neuroscience specialties such as psychiatry (AHR = 1.21, P < 0.001) exhibited greater discontinuation rates, whereas those with higher buprenorphine/naloxone beneficiary loads (AHR = 0.50, P < 0.001) and in states with a greater increase in overdose mortality rates (AHR = 0.88, P < 0.05) showed lower discontinuation rates.nnCONCLUSIONS: These data support evidence that providers who begin prescribing buprenorphine continue prescribing, although short of maximum capacity. Efforts to help providers become waivered, understand the impact of overdose fatalities in their area, and prescribe to multiple patients are likely to generate an enduring positive contribution to the number of treated patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36731101,

title = {Cannabis Use Disorder Treatment Preferences: A Pilot Survey in Current Users of Cannabis},

author = {Joshua A Lile and Brian W Turner and David H Cox and Marcel O Bonn-Miller and Ned R Katz and Thomas P Shellenberg and William W Stoops and Justin C Strickland},

doi = {10.1097/ADM.0000000000001059},

issn = {1935-3227},

journal = {J Addict Med},

volume = {17},

number = {2},

pages = {e87--e93},

abstract = {OBJECTIVES: Highly effective treatments for cannabis use disorder (CUD) are lacking, and patient preferences have not been considered during treatment development. We therefore conducted an exploratory crowdsourced survey of individuals reporting current cannabis use and a willingness to cut down or quit their cannabis use, to determine their interest in various treatment aspects.nnMETHODS: Subjects (n = 63) were queried about their willingness to take medications as a function of type, route, and regimen and to participate in adherence monitoring. Subjects were also asked about their willingness to engage in behavioral/psychosocial interventions as a function of type, setting, and duration. Measures theorized to be associated with treatment preferences were also collected, including cannabis use variables, readiness to change, reduction or cessation goal, perceived cessation barriers, and medication use beliefs and behaviors.nnRESULTS: Survey responses indicated that efforts to develop CUD medications should focus on nonsynthetic compounds administered orally or by mouth spray no more than once per day to maximize patient acceptance. Remote adherence monitoring and one-on-one outpatient behavioral treatment approaches, especially contingency management, are also anticipated to enhance participation. Most subjects indicated a preference to reduce their cannabis use rather than quit.nnCONCLUSIONS: These data provide guidance for the development of CUD interventions based on the preferences of individuals interested in treatment for their cannabis use. Additional research is needed to confirm these results in a larger sample and determine if matching CUD patients with their preferred treatments improves success rates.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35220331b,

title = {Assessment of Kratom Use Disorder and Withdrawal Among an Online Convenience Sample of US Adults},

author = {Kirsten E Smith and Kelly E Dunn and Jeffrey M Rogers and Albert Garcia-Romeu and Justin C Strickland and David H Epstein},

doi = {10.1097/ADM.0000000000000986},

issn = {1935-3227},

journal = {J Addict Med},

volume = {16},

number = {6},

pages = {666--670},

abstract = {INTRODUCTION: Since 2007, kratom use in the United States has increased, centered around nonmedical self-treatment of pain, psychiatric, and substance use disorder symptoms. Reports of kratom withdrawal have emerged amidst description of therapeutic effects, yet we know little about disordered use. Our objective was to assess Diagnostic and Statistical Manual-5 substance use disorder for kratom ("kratom use disorder," KUD) and examine kratom withdrawal symptoms among those who ever used regularly. We also sought to identify clinical characteristics of respondents who qualified for current, remitted, or never KUD.nnMETHODS: Between April and May 2021, we re-recruited online respondents who reported lifetime kratom use on an unrelated survey into our cross-sectional kratom survey study, permitting a diverse sample of current and former kratom-using persons.nnRESULTS: A total of 129/289 (44.6%) evaluable surveys were obtained. Over half (52.7%) of respondents never met KUD diagnostic criteria; 17.8% were assessed remitted, and 29.5% met current (past-year) KUD threshold. For past-year KUD, severity was: 14.0% mild, 7.0% moderate, and 8.5% severe. Pain, psychiatric symptoms, and polydrug use were found across all groups. KUD symptoms reflected increased use, tolerance, withdrawal, unsuccessful quit attempts, and craving; 9.3% reported decreases in important social, occupational, or recreational activities because of use. Withdrawal symptoms were moderate and included gastrointestinal upset, restlessness, anxiety, irritability, fatigue/low energy, and craving.nnCONCLUSIONS: As assessed here, tolerance and withdrawal are primary KUD features rather than psychosocial impairments. As kratomis often used among persons with a myriad of health conditions, clinicians should be aware of and assess for kratom use and withdrawal.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35985027,

title = {Child Mental Health and Sleep Disturbances During the Early Months of the COVID-19 Pandemic in the United States},

author = {Lauren Dayton and Xiangrong Kong and Terrinieka W Powell and Janice Bowie and George Rebok and Justin C Strickland and Carl Latkin},

doi = {10.1097/FCH.0000000000000338},

issn = {1550-5057},

journal = {Fam Community Health},

volume = {45},

number = {4},

pages = {288--298},

abstract = {Many children have experienced unprecedented levels of stress as a result of the COVID-19 pandemic due to school closures, strained resources, and excess morbidity and mortality. The current study examines change in children's mental health and sleep during the early months of the US pandemic and identifies risk and protective factors. In May 2020, a total of 225 parents reported on the mental health and sleep of each child (N = 392 children) living in their household prior to the onset of the COVID-19 pandemic and about their functioning in the past month. McNemar's test examined change in mental health and sleep disturbance across developmental stage. Bivariate and multivariate generalized estimating equations examined predictors of change in mental health and sleep. Each age group showed a significant change in mental health and sleep outcomes, but the development of mental health problems was greater for older children. Parental caregiving strain (adjusted odds ratio [aOR] = 2.42; 95% confidence interval [CI], 1.11-5.27) was identified as a risk factor associated with children developing anxiety, and income loss was associated with developing sleep disturbances (aOR = 2.34; 95% CI, 1.06-5.17). Parental receipt of emotional support was identified as a protective factor for all child health outcomes. Policies and interventions that promote access to mental health services, provide financial safety nets, and strengthen social support networks for families are needed.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36201678,

title = {Perception of Resource Allocations to Address the Opioid Epidemic},

author = {Justin C Strickland and Grant Victor and Bradley Ray},

doi = {10.1097/ADM.0000000000000971},

issn = {1935-3227},

journal = {J Addict Med},

volume = {16},

number = {5},

pages = {563--569},

abstract = {OBJECTIVES: Despite billions of dollars spent on opioid policy initiatives, public knowledge of evidence-based policies to reduce opioid-related morbidity remain low. Consequences of this knowledge gap for support of initiatives remains understudied. Our objective was to evaluate how participants with and without lived experience allocate funding for initiatives to address the opioid epidemic. A secondary objective was to collect proof-of-concept data of an informational intervention designed to improve support for evidence-based policies.nnMETHODS: Participants (N = 284; 57.2% female) without lifetime nonmedical opioid use (n = 98) and those with lifetime use (past year [n = 81] or nonpast year [n = 105]) of nonmedical opioids were recruited. All participants reported how they would allocate funds to demand reduction, supply reduction, harm reduction, and treatment policies. Half of all participants were then randomized to a brief informational intervention designed to emphasize evidence-based harm reduction and treatment programs.nnRESULTS: Funding allocations were highest for policies related to community services and treatment and lowest for those related to harm reduction. Participants with lived experience allocated less to supply reduction policies. Participants (12%) who reallocated funds after information exposure increased funding to supervised consumption sites, dz = 0.77, naloxone distribution, dz = 0.85, syringe exchange programs, dz = 0.63, and medications for opioid use disorder access, dz = 0.70.nnCONCLUSIONS: This study illustrates how people with and without lived experience prioritize various policies to address the opioid epidemic and emphasize comparably low support for harm reduction policies. Proof-of-concept data suggest that brief informational interventions may increase funding support for harm reduction strategies, at least in a subset of people.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33156180d,

title = {Provider Continuity in the Prescribing of Buprenorphine/Naloxone Within Medicare Part D},

author = {Justin C Strickland and Andrew S Huhn and Cecilia L Bergeria and Eric C Strain and Kelly E Dunn},

doi = {10.1097/ADM.0000000000000765},

issn = {1935-3227},

journal = {J Addict Med},

volume = {15},

number = {4},

pages = {325--333},

abstract = {OBJECTIVES: Efforts to improve buprenorphine access for opioid use disorder have focused on increasing the number of waivered providers. However, it is unknown how efforts to increase initial prescribing result in a sustained pool of prescribers. We examine the prevalence of year-to-year provider-level buprenorphine prescribing, and provider- and state-level factors associated with provider continuity.nnMETHODS: Providers prescribing buprenorphine/naloxone within the Medicare Part D claims database were evaluated from 2013 to 2017 with prescriber continuity measured as prescriptions made in consecutive years from the same provider (N = 14,222 unique providers; 6670 in 2013).nnRESULTS: The number of providers prescribing buprenorphine/naloxone within Medicare Part D increased from 2013 to 2017. The majority of providers prescribed buprenorphine/naloxone to 10 or fewer beneficiaries. Approximately 84% of providers prescribing buprenorphine/naloxone in 1 year prescribed it in the following year. Continuous prescribing from 2013 to 2017 was 59.4%, which was 86% the rate of a comparator chronic health medication (ie, lisinopril). Survival analyses indicated that female providers (adjusted hazard ratios [AHR] = 1.30, P < 0.001) and clinical neuroscience specialties such as psychiatry (AHR = 1.21, P < 0.001) exhibited greater discontinuation rates, whereas those with higher buprenorphine/naloxone beneficiary loads (AHR = 0.50, P < 0.001) and in states with a greater increase in overdose mortality rates (AHR = 0.88, P < 0.05) showed lower discontinuation rates.nnCONCLUSIONS: These data support evidence that providers who begin prescribing buprenorphine continue prescribing, although short of maximum capacity. Efforts to help providers become waivered, understand the impact of overdose fatalities in their area, and prescribe to multiple patients are likely to generate an enduring positive contribution to the number of treated patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{doi:10.1177/00220426231165264,

title = {Risk Factors Associated with Simultaneous Use of Alcohol and Prescription Opioids Among Young Adults in Michigan},

author = {Guijin Lee and Emily Pasman and Jennifer D. Ellis and Marvin A. Solberg and Danielle Hicks and Elizabeth Agius and Stella M. Resko},

url = {https://doi.org/10.1177/00220426231165264},

doi = {10.1177/00220426231165264},

journal = {Journal of Drug Issues},

volume = {0},

number = {0},

pages = {00220426231165264},

abstract = { Purpose: Alcohol can have serious side effects alone and can enhance the side effects of prescription opioids in unpredictable and dangerous ways. This study aims to identify risk factors for simultaneous use of alcohol and prescription opioids among young adults. Methods: Demographic characteristics, substance use, mental well-being, other substance-related factors, and simultaneous use of alcohol and prescription opioids were utilized to run multiple logistic regression analysis (N = 1751; aged 18–25). Results: Mental well-being (OR = 0.971},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35220331,

title = {Assessment of Kratom Use Disorder and Withdrawal Among an Online Convenience Sample of US Adults},

author = {Kirsten E Smith and Kelly E Dunn and Jeffrey M Rogers and Albert Garcia-Romeu and Justin C Strickland and David H Epstein},

doi = {10.1097/ADM.0000000000000986},

issn = {1935-3227},

journal = {J Addict Med},

volume = {16},

number = {6},

pages = {666--670},

abstract = {INTRODUCTION: Since 2007, kratom use in the United States has increased, centered around nonmedical self-treatment of pain, psychiatric, and substance use disorder symptoms. Reports of kratom withdrawal have emerged amidst description of therapeutic effects, yet we know little about disordered use. Our objective was to assess Diagnostic and Statistical Manual-5 substance use disorder for kratom ("kratom use disorder," KUD) and examine kratom withdrawal symptoms among those who ever used regularly. We also sought to identify clinical characteristics of respondents who qualified for current, remitted, or never KUD.nnMETHODS: Between April and May 2021, we re-recruited online respondents who reported lifetime kratom use on an unrelated survey into our cross-sectional kratom survey study, permitting a diverse sample of current and former kratom-using persons.nnRESULTS: A total of 129/289 (44.6%) evaluable surveys were obtained. Over half (52.7%) of respondents never met KUD diagnostic criteria; 17.8% were assessed remitted, and 29.5% met current (past-year) KUD threshold. For past-year KUD, severity was: 14.0% mild, 7.0% moderate, and 8.5% severe. Pain, psychiatric symptoms, and polydrug use were found across all groups. KUD symptoms reflected increased use, tolerance, withdrawal, unsuccessful quit attempts, and craving; 9.3% reported decreases in important social, occupational, or recreational activities because of use. Withdrawal symptoms were moderate and included gastrointestinal upset, restlessness, anxiety, irritability, fatigue/low energy, and craving.nnCONCLUSIONS: As assessed here, tolerance and withdrawal are primary KUD features rather than psychosocial impairments. As kratomis often used among persons with a myriad of health conditions, clinicians should be aware of and assess for kratom use and withdrawal.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35914024,

title = {Effects of Early Life Trauma on Risks for Adult Opioid Use Disorder Are Mediated by Stress and Occur Independent of Depression and Anxiety},

author = {Kelly E Dunn and Gavin M Turner and Lynn M Oswald},

doi = {10.1097/ADM.0000000000001011},

issn = {1935-3227},

journal = {J Addict Med},

volume = {16},

number = {6},

pages = {709--715},

abstract = {OBJECTIVES: Adverse childhood experiences, or early life trauma (ELT), may be a potential risk factor for opioid use disorders (OUDs) that could be further influenced by depression, anxiety, and stress. The prevalence and strength of these associations are largely unknown.nnMETHODS: This study examined the association between current OUD severity and lifetime history of ELT, and the degree to which current depression, anxiety, and stress influenced this association, in persons (n = 310) with at least 1 lifetime exposure to opioids using an online survey.nnRESULTS: Ninety-three percent of respondents experienced at least 1 trauma in their lifetime, and 65% met the criteria for OUD. Early life trauma was largely unassociated with demographics but demonstrated an almost "dose-dependent" association among all forms of ELT (total, general, physical, emotional, sexual), whereby more ELT was associated with more severe current OUD. A multivariate mediation model found perceived stress to be a robust mediator of this association. Current psychiatric functioning did not significantly moderate the relationship between ELT and OUD, suggesting that ELT may impact OUD severity at varying levels of psychiatric functioning.nnCONCLUSIONS: These data support existing evidence that greater ELT may influence adult OUD severity and identify perceived stress as a potential mechanistic contributor to this association. Results are preliminary in nature but support continued research into mechanisms underlying the association between ELT and OUD, particularly conformational changes in the stress system resultant from ELT, and interventions to mitigate the impact of ELT on OUD development and/or develop trauma-informed OUD treatment approaches.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34619714,

title = {Integration of Patient-reported Outcomes Assessment Into Routine Care for Patients Receiving Residential Treatment for Alcohol and/or Substance Use Disorder},

author = {Cameron M Yi and Andrew S Huhn and J Gregory Hobelmann and John Finnerty and Bernadette Solounias and Kelly E Dunn},

doi = {10.1097/ADM.0000000000000927},

issn = {1935-3227},

journal = {J Addict Med},

volume = {16},

number = {4},

pages = {e240--e247},

abstract = {BACKGROUND: More than 3 million individuals receive treatment for alcohol use disorder (AUD) and/or substance use disorder each year, yet there exists no standardized method for measuring patient success in treatment. Quantifying a more comprehensive assessment of treatment outcomes could identify the relative efficacy of different treatment strategies for individuals with AUD/substance use disorders, and help patients to identify, in advance, appropriate treatment options.nnMETHODS: This study developed and embedded patient-reported outcome measures into the routine clinical operations of a residential treatment program. Surveys assessed demographics, drug use history, physical and mental health, and quality of life. Outcomes were assessed among participants at admission (n = 961) and in patients who completed the survey at time of discharge (n = 633).nnRESULTS: Past 30-day alcohol and/or opioid use at admission were correlated with worse self-reported physical and mental health, sleep, and quality of life, and greater negative affect and craving ( P s < 0.05). Previous history of treatment and/or withdrawal management were associated with worse self-reported physical and mental health, quality of life, and increased craving ( P s < 0.05). Physical and mental health improved across timepoints and was most pronounced when comparing persons receiving treatment for opioid use disorder versus AUD, wherein persons with opioid use disorder had worse physical health at all time points, and greater sleep disturbance and negative affect at discharge ( P s < 0.05).nnCONCLUSIONS: It is feasible to embed patient outcome monitoring into routine clinic operations, which could be used in the future to tailor treatment plans.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34816821,

title = {Evidence of Buprenorphine-precipitated Withdrawal in Persons Who Use Fentanyl},

author = {Neil B Varshneya and Ashish P Thakrar and J Gregory Hobelmann and Kelly E Dunn and Andrew S Huhn},

doi = {10.1097/ADM.0000000000000922},

issn = {1935-3227},

journal = {J Addict Med},

volume = {16},

number = {4},

pages = {e265--e268},

abstract = {OBJECTIVES: Buprenorphine can precipitate withdrawal in opioid-dependent persons with recent fentanyl use. However, the prevalence of this phenomenon is not clinically established. We sought to evaluate the incidence of buprenorphine-precipitated withdrawal in persons who use fentanyl.nnMETHODS: We collected self-report data on opioid withdrawal symptoms after buprenorphine use, and, as a comparator, after methadone use, in 1679 individuals seeking treatment for opioid use disorder across 49 addiction treatment centers in the United States.nnRESULTS: The odds of developing severe withdrawal symptoms significantly increased when taking buprenorphine within 24 hours after fentanyl use (OR = 5.202, 95% CI = 1.979-13.675, P = 0.001), and within 24 to 48hours after fentanyl use (OR = 3.352, 95% CI =1.237-9.089, P = 0.017). As expected, patients did not report significantly higher rates of withdrawal when taking methadone after fentanyl use. Of those who waited less than 24hours after fentanyl before using buprenorphine or methadone, 22.19% (n = 152 of 685) and 11.56% (n = 23 of 199), respectively, reported severe opioid withdrawal.nnCONCLUSIONS: This study supports previous anecdotal reports of buprenorphine-precipitated withdrawal from fentanyl. The odds of withdrawal symptoms significantly increased when taking buprenorphine after recent (within 48 hours) fentanyl use, however, this relationship was not observed in persons taking methadone, suggesting that this effect is specific to buprenorphine. Further research is urgently needed to describe the pharmacokinetics of non-medical fentanyl use to improve buprenorphine inductions strategies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33560698b,

title = {Treatment Disruption and Childcare Responsibility as Risk Factors for Drug and Alcohol Use in Persons in Treatment for Substance Use Disorders During the COVID-19 Crisis},

author = {Andrew S Huhn and Eric C Strain and Jasmyne Jardot and Gavin Turner and Cecilia L Bergeria and Sandeep Nayak and Kelly E Dunn},

doi = {10.1097/ADM.0000000000000813},

issn = {1935-3227},

journal = {J Addict Med},

volume = {16},

number = {1},

pages = {e8--e15},

abstract = {OBJECTIVES: The novel 2019 coronavirus (COVID-19) crisis has caused considerable upheaval in the U.S. healthcare system. The current study examined patient-reported experiences in substance use disorder (SUD) treatment during the early stages of the COVID-19 crisis.nnMETHODS: Participants in SUD treatment were recruited via online crowdsourcing from April 14, 2020 to May 26, 2020, during the early stages of the COVID-19 crisis. Participants reported disruptions in SUD treatment, stress and anxiety caused by these disruptions on a 0-100 point visual analogue scale (VAS), stress associated with childcare responsibilities on a 0-100 VAS, current stress on the Perceived Stress Scale (PSS), anxiety symptoms on the Beck Anxiety Inventory (BAI), sleep disturbances on the Insomnia Severity Index (ISI), and whether they used drugs or alcohol during the COVID-19 crisis.nnRESULTS: Participants (N = 240) endorsed that at least 1 SUD treatment was switched to telemedicine (63.7%), had some appointments cancelled (37.5%), or was discontinued due to COVID-19 (29.6%). Participants who did versus did not endorse drug/alcohol use reported difficulty obtaining medications to treat their SUD (OR = 2.47, 95% CI, 1.17-5.22, χ2 = 5.98, P = .016), greater scores on VAS treatment-related stress (F1,197 = 5.70, P = .018) and anxiety (F1,197 = 4.07, P = .045), greater VAS stress related to childcare (F1,107 = 10.24, P = .002), and greater scores on the PSS (F1,235 = 19.27, P < .001), BAI (F1,235 = 28.59, P < .001), and ISI (F1,235 = 14.41, P < .001).nnCONCLUSIONS: Providers and public health officials should work to improve continuity and quality of care during the COVID-19 crisis, with special attention on addressing childcare difficulties and providing remote methods to improve stress, anxiety, and sleep for persons in SUD treatment.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33156180b,

title = {Provider Continuity in the Prescribing of Buprenorphine/Naloxone Within Medicare Part D},

author = {Justin C Strickland and Andrew S Huhn and Cecilia L Bergeria and Eric C Strain and Kelly E Dunn},

doi = {10.1097/ADM.0000000000000765},

issn = {1935-3227},

journal = {J Addict Med},

volume = {15},

number = {4},

pages = {325--333},

abstract = {OBJECTIVES: Efforts to improve buprenorphine access for opioid use disorder have focused on increasing the number of waivered providers. However, it is unknown how efforts to increase initial prescribing result in a sustained pool of prescribers. We examine the prevalence of year-to-year provider-level buprenorphine prescribing, and provider- and state-level factors associated with provider continuity.nnMETHODS: Providers prescribing buprenorphine/naloxone within the Medicare Part D claims database were evaluated from 2013 to 2017 with prescriber continuity measured as prescriptions made in consecutive years from the same provider (N = 14,222 unique providers; 6670 in 2013).nnRESULTS: The number of providers prescribing buprenorphine/naloxone within Medicare Part D increased from 2013 to 2017. The majority of providers prescribed buprenorphine/naloxone to 10 or fewer beneficiaries. Approximately 84% of providers prescribing buprenorphine/naloxone in 1 year prescribed it in the following year. Continuous prescribing from 2013 to 2017 was 59.4%, which was 86% the rate of a comparator chronic health medication (ie, lisinopril). Survival analyses indicated that female providers (adjusted hazard ratios [AHR] = 1.30, P < 0.001) and clinical neuroscience specialties such as psychiatry (AHR = 1.21, P < 0.001) exhibited greater discontinuation rates, whereas those with higher buprenorphine/naloxone beneficiary loads (AHR = 0.50, P < 0.001) and in states with a greater increase in overdose mortality rates (AHR = 0.88, P < 0.05) showed lower discontinuation rates.nnCONCLUSIONS: These data support evidence that providers who begin prescribing buprenorphine continue prescribing, although short of maximum capacity. Efforts to help providers become waivered, understand the impact of overdose fatalities in their area, and prescribe to multiple patients are likely to generate an enduring positive contribution to the number of treated patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35220331c,

title = {Assessment of Kratom Use Disorder and Withdrawal Among an Online Convenience Sample of US Adults},

author = {Kirsten E Smith and Kelly E Dunn and Jeffrey M Rogers and Albert Garcia-Romeu and Justin C Strickland and David H Epstein},

doi = {10.1097/ADM.0000000000000986},

issn = {1935-3227},

journal = {J Addict Med},

volume = {16},

number = {6},

pages = {666--670},

abstract = {INTRODUCTION: Since 2007, kratom use in the United States has increased, centered around nonmedical self-treatment of pain, psychiatric, and substance use disorder symptoms. Reports of kratom withdrawal have emerged amidst description of therapeutic effects, yet we know little about disordered use. Our objective was to assess Diagnostic and Statistical Manual-5 substance use disorder for kratom ("kratom use disorder," KUD) and examine kratom withdrawal symptoms among those who ever used regularly. We also sought to identify clinical characteristics of respondents who qualified for current, remitted, or never KUD.nnMETHODS: Between April and May 2021, we re-recruited online respondents who reported lifetime kratom use on an unrelated survey into our cross-sectional kratom survey study, permitting a diverse sample of current and former kratom-using persons.nnRESULTS: A total of 129/289 (44.6%) evaluable surveys were obtained. Over half (52.7%) of respondents never met KUD diagnostic criteria; 17.8% were assessed remitted, and 29.5% met current (past-year) KUD threshold. For past-year KUD, severity was: 14.0% mild, 7.0% moderate, and 8.5% severe. Pain, psychiatric symptoms, and polydrug use were found across all groups. KUD symptoms reflected increased use, tolerance, withdrawal, unsuccessful quit attempts, and craving; 9.3% reported decreases in important social, occupational, or recreational activities because of use. Withdrawal symptoms were moderate and included gastrointestinal upset, restlessness, anxiety, irritability, fatigue/low energy, and craving.nnCONCLUSIONS: As assessed here, tolerance and withdrawal are primary KUD features rather than psychosocial impairments. As kratomis often used among persons with a myriad of health conditions, clinicians should be aware of and assess for kratom use and withdrawal.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33973924,

title = {Potential Value of the Insights and Lived Experiences of Addiction Researchers With Addiction},

author = {Samuel W Stull and Kirsten E Smith and Noel A Vest and Devin P Effinger and David H Epstein},

doi = {10.1097/ADM.0000000000000867},

issn = {1935-3227},

journal = {J Addict Med},

volume = {16},

number = {2},

pages = {135--137},

abstract = {People in remission from substance use disorders (SUDs) have a history of using their own experience (also referred to as "experiential knowledge" or "expertise") to support those in or seeking SUD remission. In recent years, people with this experiential knowledge are being incorporated into research protocols to better guide research questions and inform the real-world uptake of SUD treatments and recovery supports. In these research contexts, however, those with research expertise and addiction rarely speak freely about these overlapping perspectives. The aim of this commentary is to increase awareness regarding the existence of this group (addiction researchers with addiction) and to explore the possibility that their expertise may help advance addiction science while helping to reduce stigma.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34001777,

title = {The Use of Kratom (Mitragyna speciosa Korth.) Among People Who Co-use Heroin and Methamphetamine in Malaysia},

author = {Darshan Singh and Suresh Narayanan and Balasingam Vicknasingam and Walter C Prozialeck and Kirsten Elin Smith and Ornella Corazza and Jack E Henningfield and Oliver Grundmann},

doi = {10.1097/ADM.0000000000000876},

issn = {1935-3227},

journal = {J Addict Med},

volume = {16},

number = {2},

pages = {223--228},

abstract = {OBJECTIVES: Kratom (Mitragyna speciosa Korth.), an indigenous medicinal plant, has been widely used as a traditional remedy in Southeast Asia. However, its combined consumption with other substances has received scarce attention. This study investigates the use of kratom among adults with a history of using heroin and methamphetamine in Malaysia.nnMETHODS: A total of 332 patients who were mandated to undergo drug rehabilitation participated in this cross-sectional study. The study data were collected through face-to-face interviews using a semi-structured questionnaire.nnRESULTS: The majority were males (95%, n = 314/332) and Malays (98%, n = 325/332) with a mean age of 32.3 years (SD = 9.16). Over two thirds of the respondents used kratom to alleviate heroin withdrawal symptoms and to reduce methamphetamine intake; 59% used it as a substitute for heroin and methamphetamine. A similar proportion used kratom to reduce heroin intake (58%), while only 15% used it for its euphoric effects. Multivariate analysis showed that previous attendees of government rehabilitation programs had lower odds of using kratom as a heroin substitute.nnCONCLUSIONS: The potential of kratom to alleviate heroin withdrawal symptoms, and to reduce methamphetamine and heroin intake, among people who co-use heroin and methamphetamine warrants further research.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35861348,

title = {Opioid Use Disorder Treatment in the Fentanyl Era},

author = {Neil B Varshneya and Ashish P Thakrar and Eugene Lambert and Andrew S Huhn},

doi = {10.1097/ADM.0000000000001013},

issn = {1935-3227},

journal = {J Addict Med},

volume = {17},

number = {1},

pages = {118--119},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35861348b,

title = {Opioid Use Disorder Treatment in the Fentanyl Era},

author = {Neil B Varshneya and Ashish P Thakrar and Eugene Lambert and Andrew S Huhn},

doi = {10.1097/ADM.0000000000001013},

issn = {1935-3227},

journal = {J Addict Med},

volume = {17},

number = {1},

pages = {118--119},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34619714b,

title = {Integration of Patient-reported Outcomes Assessment Into Routine Care for Patients Receiving Residential Treatment for Alcohol and/or Substance Use Disorder},

author = {Cameron M Yi and Andrew S Huhn and J Gregory Hobelmann and John Finnerty and Bernadette Solounias and Kelly E Dunn},

doi = {10.1097/ADM.0000000000000927},

issn = {1935-3227},

journal = {J Addict Med},

volume = {16},

number = {4},

pages = {e240--e247},

abstract = {BACKGROUND: More than 3 million individuals receive treatment for alcohol use disorder (AUD) and/or substance use disorder each year, yet there exists no standardized method for measuring patient success in treatment. Quantifying a more comprehensive assessment of treatment outcomes could identify the relative efficacy of different treatment strategies for individuals with AUD/substance use disorders, and help patients to identify, in advance, appropriate treatment options.nnMETHODS: This study developed and embedded patient-reported outcome measures into the routine clinical operations of a residential treatment program. Surveys assessed demographics, drug use history, physical and mental health, and quality of life. Outcomes were assessed among participants at admission (n = 961) and in patients who completed the survey at time of discharge (n = 633).nnRESULTS: Past 30-day alcohol and/or opioid use at admission were correlated with worse self-reported physical and mental health, sleep, and quality of life, and greater negative affect and craving ( P s < 0.05). Previous history of treatment and/or withdrawal management were associated with worse self-reported physical and mental health, quality of life, and increased craving ( P s < 0.05). Physical and mental health improved across timepoints and was most pronounced when comparing persons receiving treatment for opioid use disorder versus AUD, wherein persons with opioid use disorder had worse physical health at all time points, and greater sleep disturbance and negative affect at discharge ( P s < 0.05).nnCONCLUSIONS: It is feasible to embed patient outcome monitoring into routine clinic operations, which could be used in the future to tailor treatment plans.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36201678b,

title = {Perception of Resource Allocations to Address the Opioid Epidemic},

author = {Justin C Strickland and Grant Victor and Bradley Ray},

doi = {10.1097/ADM.0000000000000971},

issn = {1935-3227},

journal = {J Addict Med},

volume = {16},

number = {5},

pages = {563--569},

abstract = {OBJECTIVES: Despite billions of dollars spent on opioid policy initiatives, public knowledge of evidence-based policies to reduce opioid-related morbidity remain low. Consequences of this knowledge gap for support of initiatives remains understudied. Our objective was to evaluate how participants with and without lived experience allocate funding for initiatives to address the opioid epidemic. A secondary objective was to collect proof-of-concept data of an informational intervention designed to improve support for evidence-based policies.nnMETHODS: Participants (N = 284; 57.2% female) without lifetime nonmedical opioid use (n = 98) and those with lifetime use (past year [n = 81] or nonpast year [n = 105]) of nonmedical opioids were recruited. All participants reported how they would allocate funds to demand reduction, supply reduction, harm reduction, and treatment policies. Half of all participants were then randomized to a brief informational intervention designed to emphasize evidence-based harm reduction and treatment programs.nnRESULTS: Funding allocations were highest for policies related to community services and treatment and lowest for those related to harm reduction. Participants with lived experience allocated less to supply reduction policies. Participants (12%) who reallocated funds after information exposure increased funding to supervised consumption sites, dz = 0.77, naloxone distribution, dz = 0.85, syringe exchange programs, dz = 0.63, and medications for opioid use disorder access, dz = 0.70.nnCONCLUSIONS: This study illustrates how people with and without lived experience prioritize various policies to address the opioid epidemic and emphasize comparably low support for harm reduction policies. Proof-of-concept data suggest that brief informational interventions may increase funding support for harm reduction strategies, at least in a subset of people.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34816821b,

title = {Evidence of Buprenorphine-precipitated Withdrawal in Persons Who Use Fentanyl},

author = {Neil B Varshneya and Ashish P Thakrar and J Gregory Hobelmann and Kelly E Dunn and Andrew S Huhn},

doi = {10.1097/ADM.0000000000000922},

issn = {1935-3227},

journal = {J Addict Med},

volume = {16},

number = {4},

pages = {e265--e268},

abstract = {OBJECTIVES: Buprenorphine can precipitate withdrawal in opioid-dependent persons with recent fentanyl use. However, the prevalence of this phenomenon is not clinically established. We sought to evaluate the incidence of buprenorphine-precipitated withdrawal in persons who use fentanyl.nnMETHODS: We collected self-report data on opioid withdrawal symptoms after buprenorphine use, and, as a comparator, after methadone use, in 1679 individuals seeking treatment for opioid use disorder across 49 addiction treatment centers in the United States.nnRESULTS: The odds of developing severe withdrawal symptoms significantly increased when taking buprenorphine within 24 hours after fentanyl use (OR = 5.202, 95% CI = 1.979-13.675, P = 0.001), and within 24 to 48hours after fentanyl use (OR = 3.352, 95% CI =1.237-9.089, P = 0.017). As expected, patients did not report significantly higher rates of withdrawal when taking methadone after fentanyl use. Of those who waited less than 24hours after fentanyl before using buprenorphine or methadone, 22.19% (n = 152 of 685) and 11.56% (n = 23 of 199), respectively, reported severe opioid withdrawal.nnCONCLUSIONS: This study supports previous anecdotal reports of buprenorphine-precipitated withdrawal from fentanyl. The odds of withdrawal symptoms significantly increased when taking buprenorphine after recent (within 48 hours) fentanyl use, however, this relationship was not observed in persons taking methadone, suggesting that this effect is specific to buprenorphine. Further research is urgently needed to describe the pharmacokinetics of non-medical fentanyl use to improve buprenorphine inductions strategies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33560698c,

title = {Treatment Disruption and Childcare Responsibility as Risk Factors for Drug and Alcohol Use in Persons in Treatment for Substance Use Disorders During the COVID-19 Crisis},

author = {Andrew S Huhn and Eric C Strain and Jasmyne Jardot and Gavin Turner and Cecilia L Bergeria and Sandeep Nayak and Kelly E Dunn},

doi = {10.1097/ADM.0000000000000813},

issn = {1935-3227},

journal = {J Addict Med},

volume = {16},

number = {1},

pages = {e8--e15},

abstract = {OBJECTIVES: The novel 2019 coronavirus (COVID-19) crisis has caused considerable upheaval in the U.S. healthcare system. The current study examined patient-reported experiences in substance use disorder (SUD) treatment during the early stages of the COVID-19 crisis.nnMETHODS: Participants in SUD treatment were recruited via online crowdsourcing from April 14, 2020 to May 26, 2020, during the early stages of the COVID-19 crisis. Participants reported disruptions in SUD treatment, stress and anxiety caused by these disruptions on a 0-100 point visual analogue scale (VAS), stress associated with childcare responsibilities on a 0-100 VAS, current stress on the Perceived Stress Scale (PSS), anxiety symptoms on the Beck Anxiety Inventory (BAI), sleep disturbances on the Insomnia Severity Index (ISI), and whether they used drugs or alcohol during the COVID-19 crisis.nnRESULTS: Participants (N = 240) endorsed that at least 1 SUD treatment was switched to telemedicine (63.7%), had some appointments cancelled (37.5%), or was discontinued due to COVID-19 (29.6%). Participants who did versus did not endorse drug/alcohol use reported difficulty obtaining medications to treat their SUD (OR = 2.47, 95% CI, 1.17-5.22, χ2 = 5.98, P = .016), greater scores on VAS treatment-related stress (F1,197 = 5.70, P = .018) and anxiety (F1,197 = 4.07, P = .045), greater VAS stress related to childcare (F1,107 = 10.24, P = .002), and greater scores on the PSS (F1,235 = 19.27, P < .001), BAI (F1,235 = 28.59, P < .001), and ISI (F1,235 = 14.41, P < .001).nnCONCLUSIONS: Providers and public health officials should work to improve continuity and quality of care during the COVID-19 crisis, with special attention on addressing childcare difficulties and providing remote methods to improve stress, anxiety, and sleep for persons in SUD treatment.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}