Factors associated with history of non-fatal overdose among opioid users in the Swedish criminal justice system

BACKGROUND: Overdose (OD) is a common cause of death in opioid users. Also, many current opioid users report a history of non-fatal OD. The present study aimed to identify factors associated with a history of non-fatal OD. METHODS: A sample of 7085 Swedish criminal justice clients with alcohol or drug misuse was assessed, using the Addiction Severity Index. Subjects reporting use of opioids during the 30 days prior to incarceration were included (n=1113). Relevant variables of misuse pattern, heredity, psychiatric symptoms and previous criminal charges were analysed in a logistic regression model. RESULTS: A history of non-fatal OD was reported by 55% (n=604). The estimated contribution to the variance in OD history was 25% for variables describing misuse pattern, compared to 10% for psychiatric symptoms, 8% for heredity, and 8% for previous criminal charges. The final model included the following variables: history of injection drug use (OR 3.28), history of heroin use (OR 2.87), history of suicide attempt (OR 1.92), history of tranquilliser use (OR 1.91), being born in Sweden or other Nordic countries (OR 1.74), difficulty in controlling violent behaviour (OR 1.68), and paternal alcohol problems (OR 1.57). CONCLUSIONS: Suicide attempts and difficulty in controlling violent behaviour were associated with history of non-fatal OD, independent of variables of misuse pattern. This may indicate a possible association with impulse control disturbances, and may have clinical applications. Country of birth and heredity of alcohol problems also had some influence. As expected, severity of misuse most strongly contributed to history of non-fatal OD.     

Associations between polysubstance use and psychiatric problems in a criminal justice population in Sweden

Background

Polysubstance use is common in substance users, and may complicate their clinical course. This study, in a criminal justice setting in Sweden, examines the association between the number of concurrently used substance types and psychiatric symptoms during 30 days before incarceration, while controlling for background variables such as family history (drug and alcohol problems, psychiatric problems, criminality), demographic data and history of emotional, physical or sexual abuse.

Methods

The data material comprised 5659 criminal justice clients reporting a substance use problem, examined with the Addiction Severity Index. Variables were compared in a multinomial regression analysis, comparing clients reporting one (n = 1877), two (n = 1408), three (n = 956), four (n = 443) and five or more (n = 167) substance types.

Results

The 30-day prevalence of most psychiatric symptoms included in the study (depression, anxiety, cognitive problems, hallucinations, difficulty controlling violent behaviour, suicidal ideation, suicide attempts) was higher in individuals with a higher number of concurrent substance types used. In multinomial regression analysis, while controlling for background variables, these associations remained for concurrent suicidal ideation, cognitive problems, hallucinations and violent behaviour, with the latter two being associated with the higher numbers of substance types. Binge alcohol drinking, tranquilizers, opioids and the number of substance types reported were associated with several of the psychiatric symptoms.

Conclusions

In the present criminal justice setting in Sweden, the use of multiple substance types and concurrent psychiatric symptoms appear to be associated, and a sub-group reporting particularly high numbers of concurrent substance types are particularly likely to report potentially severe psychiatric problems.     

Factors associated with early initiation of disease-modifying drug treatment in newly-diagnosed patients with multiple sclerosis

Objective: To examine the time to first disease-modifying drug (DMD) treatment and to identify factors associated with early DMD initiation in newly-diagnosed patients with MS.

Methods: This retrospective cohort study included newly-diagnosed patients with MS from a US administrative claims database, aged 18–65 years, with a first MS diagnosis (ICD-9-CM code: 340.xx) between January 1, 2007 and June 30, 2013 (index date), continuous eligibility for 12 months pre- and 24 months post-index, and initiated DMD treatment within 2 years. Time to first DMD within 24 months post-index was evaluated. A logistic regression model predicted earlier initiation of DMD treatment (within 60 days of MS diagnosis).

Results: In total, 37.4% of patients initiated DMD treatment within 2 years of MS diagnosis and were included in the primary analysis (n?=?7,124). Mean (standard deviation [SD]) time from MS diagnosis to first DMD was 112.6 (148.3) days (median?=?51); 30.7% received first DMD in <30 days, 55.1% in <60 days, and 18.5% not until ≥180 days after diagnosis. Logistic regression found that younger age; not living in the Northeast; diagnoses of balance disorders, numbness, and optical neuritis; the absence of musculoskeletal diagnoses; and a neurologist visit or MRI within 90 days before diagnosis were associated with DMD initiation within 60 days.

Conclusions: In this population of patients initiating DMD treatment within 2 years of MS diagnosis, mean time to first DMD was 112.6 days. Identifying factors associated with delayed treatment may provide better understanding of the reasons for delay, leading to improved disease management.     

Drug user treatment within a criminal justice context

This paper summarizes what is known, and what is uncertain, about strategies what exploit the coercive potential of the criminal justice system to get problem drug users to get treatment for their dependency. It considers the links between problem drug use and crime, the characteristics of effective treatment for problem drug users, the effectiveness of coerced treatment, and the practical obstacles in bridging the gap between criminal justice and treatment services. It draws on experience in Britain, though it is also informed by the English-language research literature, especially that carried out in the United States.     

Factors associated with regular marijuana use among high school students: a long-term follow-up study

The present study investigated whether several behavioral and psychosocial factors measured during early adolescence predicted regular marijuana use 6 years later in a sample of high school students. As part of a school-based survey. 7th-grade students (N = 1,132) reported levels of alcohol, tobacco, and marijuana use, and were assessed on several domains of psychosocial functioning potentially relevant in the etiology of marijuana use. When students were followed-up in the 12th-grade, 14% smoked marijuana on a regular basis (once or more per month). Findings indicated that early cigarette smoking, alcohol use, and alcohol intoxication predicted later regular marijuana use. For boys, early marijuana use increased the odds for later regular marijuana use. Cigarette smoking by friends and siblings during early adolescence also increased the likelihood of later monthly marijuana use. The findings suggest that early prevention programs for adolescent alcohol, tobacco, and/or other drug use may have important preventive effects in terms of potentially more serious levels of marijuana involvement later in adolescence and early adulthood.     

Research on naltrexone in the criminal justice system

Many parolees and probationers are opioid abusers, and substance abuse is a leading factor for the revocation of probation, parole, and other alternatives to incarceration. The opioid antagonist naltrexone would appear to be an excellent treatment for opioid abuse and dependence in this population and the authors sought to systematically review this literature. Using the PubMed database, the authors identified large bodies of criminal justice (CJS) and naltrexone literature. The search terms used in both searches were crosschecked to identify all articles that involved research on naltrexone in the CJS. Only two articles were identified. The lack of research on naltrexone in the criminal justice system highlights the need for more research on naltrexone in our overburdened CJS.     

Drug treatment aftercare in the criminal justice system: a systematic review

Drug treatment aftercare is frequently cited as necessary for individuals served within the criminal justice system. The purposes of this article are to review how much is actually known about aftercare and to highlight issues in studying the role of aftercare. We begin with a review of the literature, looking at how aftercare is defined within the criminal justice system outcome literature and the findings on aftercare for offenders who received initial treatment from in-prison substance use treatment programs. We continue with a discussion of how substance use treatment provided within the federal system, drug use patterns, and responses to drug use create methodological difficulties in adequately assessing the effectiveness of aftercare services. Taking into account both the previous research on aftercare and the issues encountered in attempting to evaluate the federal aftercare services, we concluded that the claim of certainty about aftercare effectiveness is not well substantiated and that the precise nature of aftercare services needed is not well understood. We conclude with a discussion of the methodological and substantive issues that need to be addressed in future research. Issues identified include the need to address self-selection bias and to disentangle offender behavior from the effects of criminal justice system policies. Research is also needed to identify the most effective type and intensity of aftercare.     

Factors associated with smokeless tobacco cessation in an Appalachian population

Identifying factors associated with successful tobacco quit attempts may help in the development and targeting of effective cessation strategies. This paper aims to describe factors associated with smokeless tobacco (ST) cessation and compares the results to findings in the smoking cessation literature. Prospective data on 116 men aged 19 to 70 and participating in a ST cessation program were used to examine correlates of successful ST cessation at 1-year post-intervention. Controlling for age, level of education (p=0.002) and daily coffee consumption (p=0.005) had significant independent associations with successful cessation. No ST use variables were significant predictors of cessation success. In a multivariable logistic regression model three factors were significantly associated with cessation: education (p=0.010), coffee consumption (p=0.019), and age (p=0.029). Factors associated with successful ST cessation in this sample are consistent with predictors of smoking cessation reported in the literature. Based on its widespread use and the strength of its association with successful quitting, the role of caffeine consumption in ST cessation merits further study.     

Factors associated with illegal substance use initiation among young students in Mexico City

Introduction and Aims. To assess risk factors for illegal substances use initiation in a cohort of Mexican high‐school teenage students. Design and Methods. Longitudinal study of a cohort of 10th grade students, with follow up at the time of their enrolment in college (3–4 year follow up). The associations of parental educational level, alcohol abuse in the family, employment status, experiences of physical and sexual aggression, sexual initiation, emotional distress and previous legal substance use at the baseline measurement, with the initiation of illegal substance use were explored. Results. The follow‐up analysis was carried out in 21 616 at‐risk students. The incidence of substance use initiation was 7%. Male gender (odds ratio 3.86, 95% confidence interval 3.45, 4.32), a higher father's education level, sexual initiation for women (odds ratio 2.67, 95% confidence interval 1.49, 4.79] and use of legal substances at baseline were associated with risk of substance use initiation. Discussion and Conclusions. The social circumstances surrounding adolescents influence their risk of illegal substance consumption. Although the complex network of factors affecting substance use requires further exploring, young people at risk can be identified and should receive preventive attention.[Bojorquez I, Fernández‐Varela H, Gorab A, Solís C. Factors associated with illegal substance use initiation among young students in Mexico City. Drug Alcohol Rev 2010]     

A case-linkage study of the relationship between drug misuse,crime, and psychosocial problems in a total criminal justice population

This study was designed to inform the development of new Criminal Justice Intervention Programmes for drug-using offenders by examining the complex inter-relationships of drug problems, drug crime and generic crime together with psychological and social problems. The study combined total population datasets for police and probation agencies with all drug agencies in one geographical area. It first examined associations between greater frequency of crime, drug crime and drug problems. It then examined associations between each of these factors and a range of psychological and social problems. There is a relationship between drug crime and drug problems and both are associated with increased frequency of crime. However, drugs and crime variables are mediated by a range of other social and psychological factors, which strongly influence the probability of drug problems and crime, indicating a need for caution in identifying simple cause-and-effect relationships between crime and drugs.     

Factors associated with initiation of ecstasy use among US adolescents: Findings from a national survey

AimsTo investigate adolescent pathways to ecstasy use by (1) examining how early onsets of smoking, drinking, and marijuana use are related to a child's risk of initiation of ecstasy use and (2) assessing the influence of other individual and parental factors on ecstasy use initiation.MethodsData on 6426 adolescents (12–17 years old at baseline) from the National Survey of Parents and Youth (NSPY), a longitudinal, nationally representative household survey of youth and their parents, were used in the analyses. Information on youth substance use, including ecstasy use, as well as familial and parental characteristics, was available.ResultsInitiation of ecstasy use is predicted by an adolescent's early initiation of smoking, drinking, or marijuana use. In particular, early initiation either of marijuana use, or of both smoking and drinking, increases a child's risk for ecstasy use initiation. Among the familial and parental variables, parent drug use emerged as significantly predictive of child initiation of ecstasy use; living with both parents and close parental monitoring, on the other hand, are negatively associated with ecstasy use initiation, and may be protective against it. At the individual level, sensation seeking tendencies and positive attitudes towards substance use, as well as close associations with deviant peers, are predictive of adolescent initiation of ecstasy use.ConclusionOur findings on the risk and protective factors for initiation of ecstasy use, especially with regard to factors that are modifiable, will be useful for prevention programs targeting youth use not only of ecstasy, but also of other drugs.     

The incremental inpatient costs associated with marijuana comorbidity

In this paper we examine the incremental cost of marijuana comorbidity for alcohol, mood and thought diagnoses in hospital settings. We use data from the 1993-2000 National Hospital Discharge Survey to examine the effect on length of stay and the 1995-2000 Florida Hospital Discharge Data to examine charges. General linear modeling (GLM) and propensity score methods are employed to deal with concerns stemming from the distribution of the dependent variables and statistically significant differences in the baseline characteristics of marijuana users versus non-users. Marijuana comorbidity is associated with longer length of stays and higher charges for patients suffering from a primary diagnosis of an alcohol problem. We also find higher average charges for patients suffering from mood disorders, though the finding is not robust across all model specifications. We do not find any significant effects for thought disorders. Findings from this study suggest that a marijuana comorbidity increases the cost of treating patients with alcohol problems and mood disorder diagnoses, implying that there may be real health consequences associated with marijuana abuse and dependence and more work considering this possibility is warranted.     

Factors associated with medication adherence and persistence of treatment for hypertension in a Medicaid population

BackgroundNon-adherence with antihypertensive therapy is a significant problem. Prior research has generally focused upon one drug or one drug class. Current information across multiple antihypertensive drug classes is limited.ObjectivesTo describe the initial treatment of recipients of Louisiana Medicaid with newly-diagnosed hypertension; evaluate differences in adherence and persistence rates among multiple antihypertensive drug classes; and test the association of drug classes, race, gender, age and comorbidity with adherence and persistence to drug therapy.MethodsIn a retrospective analysis of administrative claims data, initial therapy was described by type and drug class for 4544 Medicaid recipients with newly-diagnosed hypertension. Recipients were placed into cohorts based upon drug classes (diuretics, beta-blockers, angiotensin-II receptor blockers, angiotensin converting enzyme inhibitors, and calcium channel blockers). Persistence with drug therapy and Medication Possession Ratios (MPR) were calculated for 6-month and 12-month periods following diagnosis. Drug class and demographic variables were used as predictor variables in logistic regression analyses of persistence and MPR.ResultsRecipients in the study group were primarily female (66%) and Black (65%). Recipients initially were treated with monotherapy (33%), multiple drugs (11%), fixed combinations (8%) or no drugs (48%). After one year, 62% of recipients were not receiving drug therapy. Persistence rates by cohort ranged from 26% to 42% at 6-months following diagnosis, and 14%–28% at 12-months. The proportion of recipients by cohort with MPRs of 0.8 or above ranged from 43% to 60% at 6-months and 25%–42% at 12-months. Race, comorbidities, and initial drug therapy were significant predictors of both persistence and MPR.ConclusionsWithin this study group, adherence and persistence to medication therapy were less than optimal. Future efforts to improve compliance with medication therapy could be focused upon specific groups having poor adherence and/or persistence within the drug class cohorts analyzed in this study.     

Resilience against marijuana use initiation in low-income African American youth

IntroductionRecent increases in marijuana use among adolescents, in concert with decreases in perceptions of harm caused by marijuana use, documented associations of marijuana use with health problems and academic disengagement, and the increase in cannabis potency over the past two decades highlight the need for effective prevention and intervention efforts to delay and/or curb marijuana use among adolescents. The present study investigated the role of four promotive factors in the role of abstinence from marijuana use initiation.MethodsLow-income, urban, African American youth (N = 302; 54.6% female; M age = 12.05 years, SD = 1.57 years, Range = 10 to 16) participating in a larger study of stress and coping who had not initiated marijuana use at baseline were included in the sample. Goal directedness, emotion regulation, perceived support from mother, and religious coping, assessed at baseline, were evaluated for their contributions to marijuana use initiation two years later."ResultsBy time 3, 14.7% of the sample reported having initiated marijuana use. Univariate analyses indicated that abstainers were younger, better able to regulate their emotions, and marginally more likely to use religious coping. Logistic regression analysis was used to develop a best-fitting model describing abstinence from marijuana use; this model revealed age and emotion regulation as unique contributors to abstinence.ConclusionsEmotion regulation is a teachable skill, and is included in many school-based prevention and parenting programs. Recommendations to enhance the effectiveness of self-regulation interventions in African American youth are discussed.     

Agitation associated with aripiprazole initiation

Aripiprazole is a novel antipsychotic with a mechanism of action different from those of traditional first- and second-generation antipsychotics. We describe three patients with long histories of treatment for schizophrenia or schizoaffective disorder in whom conversion to aripiprazole was being attempted. After they started aripiprazole, their psychosis, agitation, anxiety, or aggression worsened. Although the cause of the increased agitation was unclear, it may have been related to long-term use of dopamine-blocking antipsychotics and resultant upregulation of postsynaptic dopamine receptors. The mechanism of partial dopamine agonism observed with aripiprazole may increase dopaminergic activity and worsen positive dopamine-associated symptoms, such as paranoia, agitation, and aggression. The treatment of schizophrenia is often a clinical challenge, particularly when patients have a long history of noncompliance and poor response. Clinicians face difficult decisions in finding an effective and well-tolerated regimen. These cases magnify some of the challenges and provide insight into the clinical implications of converting to therapies with different pharmacodynamic effects.