Concurrent use of alcohol and sedatives among persons prescribed chronic opioid therapy: prevalence and risk factors

Taking opioids with other central nervous system (CNS) depressants can increase risk of oversedation and respiratory depression. We used telephone survey and electronic health care data to assess the prevalence of, and risk factors for, concurrent use of alcohol and/or sedatives among 1,848 integrated care plan members who were prescribed chronic opioid therapy (COT) for chronic noncancer pain. Concurrent sedative use was defined by receiving sedatives for 45+ days of the 90 days preceding the interview; concurrent alcohol use was defined by consuming 2+ drinks within 2 hours of taking an opioid in the prior 2 weeks. Some analyses were stratified by substance use disorder (SUD) history (alcohol or drug). Among subjects with no SUD history, 29% concurrently used sedatives versus 39% of those with an SUD history. Rates of concurrent alcohol use were similar (12 to 13%) in the 2 substance use disorder strata. Predictors of concurrent sedative use included SUD history, female gender, depression, and taking opioids at higher doses and for more than 1 pain condition. Male gender was the only predictor of concurrent alcohol use. Concurrent use of CNS depressants was common among this sample of COT users regardless of substance use disorder status. PERSPECTIVE: Risks associated with concurrent use of CNS depressants are not restricted to COT users who abuse those substances. And, the increased risk of concurrently using CNS depressants is not restricted to opioid users with a prior SUD history. COT requires close monitoring, regardless of substance use disorder history.     

Multiple risk factors: prevalence and correlates of alcohol,tobacco and other drug (ATOD) use among university students in Egypt

Abstract

There is a lack of research on Alcohol, Tobacco and Other Drug (ATOD) use in the Eastern Mediterranean region (EMR). We assessed four ATOD behaviors (risk factors; smoking, alcohol consumption behavior, one’s own illicit drug/s use, friend’s illicit drug/s use), two mental health indicators (depressive symptoms, perceived stress), two socio-demographic features (gender, age) and two policy variables (agree with smoking and alcohol bans at university). A self-administered questionnaire was completed by 3258 students at 11 faculties of Assiut University in Egypt (2009–2010). As for ATOD individual risk factors, about 8.8% of the participants smoked cigarettes (occasionally or daily), 3.8% reported “high frequency” alcohol use (a few times each week, every day and a few times each day), 4.5% had ever used illicit drugs, and 15.3% had a friend who used illicit drug/s. For ATOD multiple risk factors, 28.5% of the sample reported any ATOD risk factor, and 8.7% of the sample reported ≥2 risk factors, and the frequencies were significantly higher among males. Depressive symptoms were positively associated with illicit drug/s use and with having a friend/s who use illicit drug/s. Smoking was positively associated with one’s illicit drug/s use, but negatively associated with having a friend who use illicit drug/s. Higher frequency of alcohol use was positively associated with illicit drug/s use. Age and perceived stress were not associated with any of ATOD variables. These findings contribute to lack of research on ATOD use across the EMR, and provide a platform for planning prevention/intervention policies.     

Problems and concerns of patients receiving chronic opioid therapy for chronic non-cancer pain

The value of chronic opioid therapy (COT) for chronic non-cancer pain (CNCP) patients is determined by a balance of poorly understood benefits and harms. Traditionally, this balance has been framed as the potential for improved pain control versus risks of iatrogenic addiction, drug diversion, and aberrant drug-related behaviors. These potential harms are typically defined from the providers’ perspective. This paper seeks to clarify difficulties with the long-term use of opioids for CNCP from the patients’ perspective. We used the Prescribed Opioids Difficulties Scale (PODS) to assess current problems and concerns attributed to opioid use by 1144 adults receiving COT. Subjects were grouped into low (56.9%), medium (25.6%) and high (17.5%) PODS scorers. Among patients with high PODS scores, 64% were clinically depressed and 78% experienced high levels of pain-related interference with activities, compared to 28% depressed and 60% with high interference with activities among those with low PODS scores. High levels of opioid-related problems and concerns were not explained by differences in pain intensity or persistence. Patients with medium to high PODS scores were often concerned about their ability to control their use of opioid medications, but prior substance abuse diagnoses and receiving excess days supply of opioids were much less common in these patients than depression and pain-related interference with activities. These results suggest two types of potential harm from COT attributed by CNCP patients to opioids: psychosocial problems that are distinct from poor pain control and opioid control concerns that are distinct from opioid misuse or addiction.     

Readiness to change alcohol and illicit drug use among a sample of emergency department patients

Objective: This study sought to (1) provide estimates of alcohol and illicit drug use, alone and in combination, among a sample of adult emergency department patients and (2) examine readiness to change.

Methods: Consecutive emergency department patients ≥18 years of age from a large regional hospital in Camden, NJ, were enrolled from May to December 2005. Patients provided information on alcohol and illicit drug use, as well as on interest in quitting each of these substance classes.

Results: Of the 1549 subjects surveyed, 98 (6%) indicated weekly use of both alcohol and illicit drugs, and 58 (4%) indicated problems associated with use of both substance classes. Problem users of illicit drugs felt that quitting drugs was more important, that they were more ready and that they were more confident in quitting than problem users of alcohol.

Conclusion: Problem use of multiple substances was relatively common in this emergency department sample. A substantial proportion of problem users of both substance classes were highly motivated to quit the use of one, but not the other, substance class. Further longitudinal and clinical trial research is needed to study the implications of multiple substance use, motivation to change and cessation.     

Management of chronic noncancer pain in depressed patients

Many patients with chronic noncancer pain present with comorbid depression, which can greatly complicate the treatment of pain. Chronic pain and depression each increase the risk of licit and illicit substance abuse, including the abuse of opioids, and of suicide. Patients attempting suicide may overdose on opioids, which are commonly perceived as potentially harmful, or acetaminophen, an agent that is believed to be safe but is actually the leading cause of liver failure in the United States. Opioids, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs) have the potential to interact with antidepressants, and their adverse effects may be exacerbated by alcohol use, which is also common in patients with depression. Topical NSAIDs, capsaicin, and lidocaine provide effective analgesia for several pain conditions. These agents limit systemic drug exposure, reducing the risk of systemic adverse events without risk of accidental or deliberate overdose. However, use of topical agents is generally limited to localized pain syndromes and therefore does not substantially eliminate the need for systemic analgesics in those patients with diffuse persistent pain, central sensitization, and opioid-responsive pain. This review will discuss the challenges associated with treating chronic pain in depressed patients and will provide recommendations for optimizing treatment.     

The feasibility of substance misuse screening in referrals from Accident and Emergency to an inner-city fracture clinic: results from a pilot study

Objectives To assess the prevalence of problem drinking, excessive alcohol consumption and illicit drug use among patients referred to a fracture clinic from Accident and Emergency (A&E). Design Prospective self-completion questionnaire study. Setting An inner-city outpatient fracture clinic in South London. Subjects New referrals from an A&E department ( n = 73). Outcome measurements The AUDIT questionnaire was used to assess problem drinking, while the subjects' report of weekly alcohol consumption was used to identify excessive alcohol consumption. Illicit drug use was measured with the substance misuse section of the Maudsley Addiction Profile (MAP). Results Forty-one per cent of the sample scored over 8 (a positive AUDIT result), indicating problem drinking. This was significantly associated with male gender and with not being married. Twenty-three per cent of the sample consumed above recommended weekly limits of alcohol consumption. The only illicit drug that was used by any of the subjects over the month preceding interview was cannabis: 19% of the patients had used cannabis at least weekly over the month preceding interview. Cannabis use was associated with a positive AUDIT result and with belonging to a white non-UK ethnic group. Conclusions The rates of problem drinking resemble those found in the small number of previous fracture clinic studies and in A&E and orthopaedic in-patient population studies. A high incidence of cannabis use was also found in this patient group and this is the first study of drug use among fracture clinic attendees in the UK. Fracture clinics present an under-utilized opportunity to screen, engage and deliver brief interventions for the treatment of drug and alcohol problems.     

Associations of age at cannabis first use and later substance abuse with mental health and depression in young men

Purpose: This study aimed to determine if the associations between age at cannabis first use and mental health and depression persist after controlling for the misuse of cannabis, other illicit drugs, alcohol and cigarettes.

Methods: Baseline data from an ongoing cohort study on substance use risk factors were used (N?=?5521). The association between age at cannabis first use and the frequency of cannabis use was assessed using a Cox proportional hazard model. Associations with other illicit drug use, alcohol dependence, nicotine dependence, mental health and depression were tested using linear regressions and logistic regressions.

Results: Participants using cannabis “almost every day” were on an average two years younger at cannabis first use than those using cannabis “once a month or less”. Age at cannabis first use was also associated with other illicit drug use, alcohol dependence and nicotine dependence. Associations with mental health and depression were substantially attenuated after adjustment for the misuse of cannabis and other substances.

Conclusions: These findings show that early cannabis onset is associated with later impairments in mental health and depression; however, these are largely explained by later substance abuse. Effective preventive measures are needed to delay cannabis onset and to avoid the progression from cannabis to using other drugs.     

Predictors of illicit drug use among a national sample of adolescents

Background: Rates of illicit drug use are increasing among adolescents. This study was guided by Jessor’s problem behavior theory and explored the conceptual domains of risk factors for adolescent illicit drug use. The purpose of the present study was to investigate whether sex, age, race/ethnicity, authoritarian parenting, negative school experiences, ever been treated for depression, or legal involvement predicted lifetime illicit drug use, past year illicit drug use, or past month illicit drug use among adolescents nationwide. Method: The present study was a secondary data analysis of the 2012 National Survey on Drug Use and Health including 17,399 youth from 12 to 17 years of age nationwide. Results: Among adolescents, 25.3% reported using illicit drugs in their lifetime, 18.9% reported past year use, and 10.1% reported past month use. Predictors of lifetime illicit drug use were age, race/ethnicity, ever been treated for depression, authoritarian parenting, negative school experiences, and legal involvement. Predictors of past year and past month illicit drug use were age, ever been treated for depression, authoritarian parenting, negative school experiences, and legal involvement. Conclusions: A global approach targeting all problem behavior theory systems may reduce illicit drug use among adolescents nationwide. Recommendations for future studies are included.     

Opioids and designer drugs

Despite the increasing use of other illicit drugs, opioid abuse, overdose, and the ensuing medical complications continue to pose management challenges for the emergency physician. Heroin use is increasing as abusers of cocaine seek a drug to prolong cocaine's effects while blunting the postcocaine depression. Clandestine chemists have created newer, more powerful compounds--designer drugs--whose potencies are many-fold that of the presently available opioids. Aggressive airway support and use of naloxone enable the emergency physician to salvage many of these patients, leaving the many medical complications of parenteral and inhalational use as the greatest management challenge.     

Unhealthy substance-use behaviors as symptom-related self-care in persons with HIV/AIDS

Unhealthy substance-use behaviors, including a heavy alcohol intake, illicit drug use, and cigarette smoking, are engaged in by many HIV-positive individuals, often as a way to manage their disease-related symptoms. This study, based on data from a larger randomized controlled trial of an HIV/AIDS symptom management manual, examines the prevalence and characteristics of unhealthy behaviors in relation to HIV/AIDS symptoms. The mean age of the sample (n = 775) was 42.8 years and 38.5% of the sample was female. The mean number of years living with HIV was 9.1 years. The specific self-reported unhealthy substance-use behaviors were the use of marijuana, cigarettes, a large amount of alcohol, and illicit drugs. A subset of individuals who identified high levels of specific symptoms also reported significantly higher substance-use behaviors, including amphetamine and injection drug use, heavy alcohol use, cigarette smoking, and marijuana use. The implications for clinical practice include the assessment of self-care behaviors, screening for substance abuse, and education of persons regarding the self-management of HIV.     

Predictors of Alcohol and Drug Problems in Rural African American Women

African American women report less alcohol and other drug (AOD) use than Caucasian women. However, health care professionals cannot afford to dismiss AOD use as significant problems for some African-American women. Although we know much more about AOD problems in women in general, we still lack information about AOD disorders and associated factors among rural African American women. Stepwise multiple regression was used to identify the best predictors of alcohol and drug problems among 142 rural African American women who took part in a study of risk factors for AOD disorders in rural women.     

Stress, coping, and alcohol expectancies in rural African-American women

African-American women report less alcohol and other drug (AOD) use compared with Caucasian women. However, health care professionals cannot afford to dismiss AOD use as a significant problem for some African-American women. Although we know much more about AOD problems in women in general, we still lack information on AOD disorders and associated factors among rural African-American women. This article focuses on examining rural African-American women (n=142) with and without AOD disorders on the following variables: stressors, uplifts, coping, and alcohol expectancies.