Changes in opioid prescribing in veterans with headache during the COVID-19 pandemic: A regression discontinuity in time analysis.

OBJECTIVE: To determine changes in opioid prescribing among veterans with headaches during the coronavirus disease of 2019 (COVID-19) pandemic by comparing the stay-at-home phase (March 15 to May 30, 2020) and the reopening phase (May 31 to December 31, 2020). BACKGROUND: Opioid prescribing for chronic pain has declined substantially since 2016; however, changes in opioid prescribing during the COVID-19 pandemic among veterans with headaches remain unknown. METHODS: This retrospective cohort study utilized regression discontinuity in time and difference-in-differences design to analyze veterans aged ≥18 years with a previous diagnosis of headache disorders and an outpatient visit to the Veterans Health Administration (VHA) during the study period. We measured the weekly number of opioid prescriptions, the number of days supplied, the daily dose in morphine milligram equivalents (MMEs), and the number of prescriptions with ≥50 morphine equivalent daily doses (MEDD). RESULTS: A total of 81,376 veterans were analyzed with 589,950 opioid prescriptions. The mean (SD) age was 51.6 (13.5) years, 57,242 (70.3%) were male, and 53,464 (65.7%) were White. During the pre-pandemic period, 323.6 opioid prescriptions (interquartile range 292.1-325.8) were dispensed weekly, with an median (IQR) of 24.1 (24.0-24.4) days supplied and 31.8 (31.2-32.5) MMEs. Transition to stay-at-home was associated with a 7.7% decrease in the number of prescriptions (incidence rate ratio [IRR] 1.077, 95% confidence interval [CI] 0.866-0.984) and a 9.8% increase in days supplied (IRR 1.098, 95% CI 1.078-1.119). Similar trends were observed during the reopening period. Subgroup analysis among veterans on long-term opioid therapy also revealed 1.7% and 1.4% increases in days supplied during the stay-at-home (IRR 1.017, 95% CI 1.009-1.025) and reopening phase (IRR 1.014, 95% CI 1.007-1.021); however, changes in the total number of prescriptions, MME/day, or the number of prescriptions >50 MEDD were insignificant. CONCLUSION: Prescription opioid access was maintained for veterans within VHA during the pandemic. The de-escalation of opioid prescribing observed prior to the pandemic was not seen in our study.

Not Just Service Attendance: Associations of Religious Community Social Connections with Alcohol Use among Black Adults Header: Religious Community Social Connections and Alcohol Use among Black Adults.

Background: Religious involvement is a well-documented protective factor against alcohol use among Black adults, but the extent to which social connections to the religious community can explain those effects remains largely unknown. The current study was designed to capture contributions of religious community support and demands - independent of religious service attendance - to alcohol use among three age cohorts of Black adults. Methods: Data were drawn from 18- to 65-year-old Black participants in the National Survey of American Life (n = 4,462; 29.4% Afro Caribbean, 70.6% African American; 63.20% female). Ordinal logistic regression analyses, conducted separately for each age cohort (18-29, 30-44, and 45-65), were used to model frequency of alcohol use as a function of religious community support and demands in two stages: (1) prior to and (2) after accounting for religious service attendance. Results: Religious community support accounted for differences in alcohol use frequency over and above religious service attendance (in Stage 2 models) for adults aged 30-44 (OR = 0.85, CI: 0.74-0.96) and 45-65 (OR = 0.77, CI: 0.64-0.93) but not 18-29 (OR = 0.85, CI: 0.71-1.03). The association of religious community demands with alcohol use frequency was specific to the age 30-44 cohort in both stage models (Stage 2: OR = 1.33, CI: 1.06-1.68). Conclusions: Study findings suggest that in addition to attending religious services regularly, developing supportive social connections to the religious community may reduce risk for frequent drinking among Black adults, particularly during middle adulthood, when demands from the religious community may increase risk.

Profiles of substance use related protective and risk factors and their associations with alcohol and tobacco use initiation among black adolescents.

Insufficient attention to protective and risk factors of particular salience for Black youth (e.g., racial identity and racial discrimination) in population-based substance use studies has left gaps in our understanding of alcohol and tobacco use development in Black adolescents. The current study aimed to capture the clustering of such understudied factors and their collective influence on alcohol and tobacco use initiation among Black adolescents. Data were drawn from The National Survey of American Life (n = 1,170; age range = 13-17; 6.9% Afro Caribbean, 93.1% African American; 50.0% female). Latent profile analysis applied to 11 indicators representing family, community, and individual level protective and risk factors revealed (1) High Vulnerability (high risk, low protective factors; 17.5%), (2) Moderate Vulnerability (moderate on both; 63.2%), and (3) Low Vulnerability (high protective, low risk factors; 19.3%) classes. Classes differed significantly by religious community support, school bonding, quality of relationship with mother, religious involvement, and interpersonal trauma. Relative to Class 2, Class 1 had higher odds of alcohol (OR = 1.518, CI:1.092-2.109) and tobacco use (OR = 1.998, CI:1.401-2.848); Class 3 had lower odds of alcohol (OR = 0.659, CI:0.449-0.968) but not tobacco use (OR = 0.965, CI:0.611-1.523). Findings suggest that alcohol and tobacco use initiation among Black adolescents is shaped by the collective influence of community and family level support, with commonly experienced risk factors such as non-interpersonal trauma distinguishing liability to a lesser degree. The equally modest prevalence of tobacco use among low and moderate vulnerability classes further indicates that fostering these connections may be especially effective in reducing tobacco use risk.

Correspondence Between Retrospective and Momentary Self-Reported Posttraumatic Stress Disorder Symptoms: Evidence for Peak and End Effects in Veterans.

Validated retrospective self-report symptom rating scales are recommended for posttraumatic stress disorder (PTSD) screening and treatment. However, such reports may be affected by a respondent's most intense ("peak") or most recent ("end") symptoms. The present study evaluated the correspondence between PTSD symptoms assessed using a standard past-month retrospective rating scale and recorded by ecological momentary assessment (EMA) over the same period and tested hypotheses that retrospective scores would be predicted by peak and end-period momentary symptoms. Male U.S. veterans (N = 35) who served post-9/11 completed the PTSD Symptom Checklist for DSM-5 (PCL-5) at baseline and 1 month later. For 28 days during the intervening period, they received quasi-randomly timed text prompts to complete a modified version of the PCL-5 at that moment. Using multiple regression modeling, controlling for the number of completed EMAs and time (days) since the last EMA, we assessed the predictability of follow-up retrospective PCL-5 scores by (a) the mean of all momentary scores and (b) peak and last-day momentary scores. Retrospective PCL-5 scores were closest to peak scores, d = -0.31, and substantially higher than overall mean, d = 0.99, and last-day momentary scores, d = 0.94. In the regression model, peak symptom experiences and last-day momentary symptoms uniquely predicted follow-up PCL-5 scores over and above significant prediction by overall mean momentary symptom scores. In sum, participants' self-reported past-month PTSD symptom severity did not simply reflect an average over time. Additional questioning is needed to understand peak and recent symptom periods reflected in these estimates.

Combination of parent-child closeness and parent disapproval of teen sex predicts lower rates of sexual risk for offspring.

Effective parenting processes during offspring's adolescence can reduce sexual risk behavior for those offspring in emerging adulthood. Few studies consider how mothers' and fathers' parenting processes cluster together and predict emerging adults' risky sexual behavior. In this study, we used latent profile analysis (LPA) to identify patterns of teens' perceptions of their residential mothers' and fathers' closeness, disapproval of teen sex, monitoring/presence at home and communication. Using data from waves one and three of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we identified four parenting classes: high disapproval/high closeness (54%), high disapproval/low closeness (7%), low disapproval/high closeness (15%) and moderate disapproval/high closeness (24%). Emerging adults within the high disapproval/high closeness class had lower rates of sexual risk behavior than other classes. These findings show benefits of authoritative parenting styles, and suggest parenting processes should be considered in combination, rather than as independent predictors of risk outcomes.

Brief Counseling for Veterans with Musculoskeletal Disorder, Risky Substance Use, and Service Connection Claims.

OBJECTIVE: High proportions of post-9/11 veterans have musculoskeletal disorders (MSDs), but engaging them in care early in their course of illness has been challenging. The service connection application is an ideal point of contact for referring veterans to early interventions for their conditions. DESIGN: Among MSD claimants who reported risky substance use, we pilot-tested a counseling intervention targeting pain and risky substance use called Screening Brief Intervention and Referral to Treatment-Pain Module (SBIRT-PM). Veterans were randomly assigned in a 2:1:1 ratio to SBIRT-PM, Pain Module counseling only, or treatment as usual (TAU). METHODS: Participants assigned to either counseling arm were offered a single meeting with a study therapist with two follow-up telephone calls as needed. Participants completed outcome assessments at four and 12 weeks after randomization. RESULTS: Of 257 veterans evaluated, 101 reported risky substance use and were randomized. Counseling was attended by 75% of veterans offered it and was well received. VA pain-related services were used by 51% of participants in either of the pain-focused conditions but only by 27% in TAU (P < 0.04). Starting with average pain severity ratings of 5.1/10 at baseline, only minimal changes in mean pain severity were noted regardless of condition. Self-reported risky substance use was significantly lower over time in the SBIRT-PM condition relative to the two other conditions (P < 0.02). At week 12, proportions of veterans reporting risky substance use were 0.39, 0.69, and 0.71 for the SBIRT-PM, Pain Module counseling, and TAU conditions, respectively. CONCLUSIONS: SBIRT-PM shows promise as a way to engage veterans in pain treatment and reduce substance use.

Parenting Practices and Emerging Adult Sexual Health: The Role of Residential Fathers.

Emerging adulthood is a developmental period with high rates of sexual risk behavior. Effective parenting practices can reduce the likelihood of this behavior, but most research on the protective effects of parenting focuses on mothers. Research is needed to assess the role of paternal parenting in regards to their children's sexual risk behavior, particularly for children of teen mothers, who show a greater likelihood of risky sexual behaviors than those with older mothers. We investigated associations between residential fathers' parenting processes-communication, disapproval of teen sexual behavior, parental presence, and closeness-during adolescence and sexual risk behaviors reported by their children in emerging adulthood. Using multiple group structural equation modeling with data from 7399 participants at Wave I and Wave III of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we examined whether and how residential fathers' parenting relates to their children's sexual risk behavior independent of mothers' parenting processes, and whether these associations differ across children's sex and for children of teen and older mothers. We found that adolescents' perceptions of higher father disapproval of teen sexual behavior predicted lower levels of sexual risk behavior during emerging adulthood with no significant differences across emerging adults' sex or for children of teen relative to older mothers. Our findings suggest that teens' relationships with their fathers during adolescence are important for their future sexual health, despite a general understanding of emerging adulthood as a period characterized by independence and separation from parents. Additionally, our results suggest that even though children of teen mothers show greater likelihood of risky sexual behaviors than those of older parents, the processes through which fathers can support teens' sexual health may be similar.

Impulsivity interacts with momentary PTSD symptom worsening to predict alcohol use in male veterans.

BACKGROUND: Posttraumatic stress disorder (PTSD) is prevalent among veterans who served post-9/11, and co-occurs with problem alcohol and substance use. Studies using ecological momentary assessment have examined the temporal association between time-varying PTSD symptoms and alcohol use. Results suggest individual differences in these associations. OBJECTIVES: We tested hypotheses that alcohol use measured by momentary assessment would be explained by acute increases in PTSD symptoms, and the PTSD-alcohol association would be moderated by trait impulsivity. METHODS: A sample of 28 male post-9/11-era veterans who reported past-month PTSD symptoms and risky alcohol use were enrolled. On a quasi-random schedule, participants completed three electronic assessments daily for 28 days measuring past 2-h PTSD symptoms, alcohol, and substance use. At baseline, trait impulsivity was measured by the Barratt Impulsiveness Scale. Past-month PTSD symptoms and alcohol use were measured. Using three-level hierarchical models, number of drinks recorded by momentary assessment was modeled as a function of change in PTSD symptoms since last assessment, controlling for lag-1 alcohol and substance use and other covariates. A cross-level interaction tested moderation of the within-time PTSD-alcohol association by impulsivity. RESULTS: A total of 1,522 assessments were completed. A positive within-time association between PTSD symptom change and number of drinks was demonstrated. The association was significantly moderated by impulsivity. CONCLUSION: Results provide preliminary support for a unique temporal relationship between acute PTSD symptom change and alcohol use among veterans with trait impulsiveness. If replicated in a clinical sample, results may have implications for a targeted momentary intervention.

Financial Capability: Clinicians' Assessment of Beneficiaries With Dual Diagnoses.

OBJECTIVE: Adults with mental health disorders whose ability to work is sufficiently impeded are entitled to financial supports from the Social Security Administration. Beneficiaries determined to be incapable of managing these funds are supposed to be assigned a representative payee to assist beneficiaries in meeting their needs. However, patterns of payee assignment suggest that payee assignment is impacted by factors other than those the Social Security Administration instructs clinicians to consider. In this study, we tested the association between clinicians' judgments of their clients' financial capability and hypothesized predictors (demographic characteristics, psychiatric diagnosis, recent alcohol and other substance use, self-rated money mismanagement, recent homelessness, and provider characteristics). We posited that predictors might act indirectly on capability judgment via their impact on beneficiaries' money management. METHODS: Altogether, 261 people receiving intensive mental health care who did not have payees or fiduciaries were enrolled after providing written informed consent. These beneficiaries completed in-person assessment interviews, reporting demographic characteristics, treatment history, substance use, and homelessness. Mental health clinicians identified by the beneficiaries were enrolled in the study and asked to judge their clients' financial capability with standard Social Security instructions for determining capability. Bivariate associations between hypothesized predictors and clinicians' determinations of incapability were tested. In multivariate probit regression models, incapability determination was modeled as a function of all beneficiary and clinician characteristics that had significant bivariate associations with the outcome. RESULTS: Providers identified 24% of their clients as financially incapable. Determinations of financial incapability were unrelated to any beneficiary or provider demographic characteristics but were positively associated with money mismanagement, homelessness, and having a psychotic disorder. Alcohol use and other substance use were only significantly associated with capability determinations indirectly through their effects on money mismanagement. CONCLUSIONS: Providers' judgments of beneficiaries' capability to manage their funds were associated with factors that were consistent with Social Security Administration guidelines and were, importantly, not associated with personal characteristics. This finding suggests that guidelines can be fairly applied by clinicians and that reported inconsistencies in payee assignment are accounted for by other factors. The Social Security Administration is currently considering other approaches to standardize capability determinations.

Gender moderates the relationship between impulsivity and sexual risk-taking in a cocaine-using psychiatric outpatient population.

Adults who abuse substances are at increased risk for contracting sexually transmitted infections, including HIV. Within this population, sexual risk behaviors have been associated with increased impulsivity. Studies in non-clinical populations showing gender-related differences in sexual decision-making and casual sexual partnering suggest impulsivity has a greater influence on men than women, but these differences have not been documented in substance-using patients. In a sample of 89 adults with recent cocaine use and receiving outpatient psychiatric treatment, we tested the hypothesis that gender moderates the effect of impulsivity on sexual risk-taking. Using logistic regression modeling, we tested the main and gender-moderated effects of task-related impulsivity on the probability of having a casual sexual partner and multiple sexual partners. Results confirmed a significant gender-by-impulsivity interaction; men who were more impulsive on a continuous performance task had significantly higher rates of sexual risk-taking than less impulsive men, but women's impulsivity was unrelated to these outcomes. Impulsive men were over three times as likely as less impulsive men to have a recent casual partner. Implications of these results and suggestions for future research are discussed.

Pathways to assignment of payees.

How clients come to be assigned representative payees and/or conservators to manage their funds is not well understood. We compared clients assigned a payee during a clinical trial of a money management-based intervention to those not assigned payees and examined antecedents to payee assignment. One year after randomization, significantly more clients assigned to the advisor teller money manager (ATM) money management intervention were assigned payees than participants in the control condition (10 of 47 vs. 2 of 43; p = .02); those assigned payees had lower baseline GAF scores and participated more in study therapies. Several ATM clients were assigned payees after third parties paid more attention to clients' finances, and others after having negotiated storage of their funds with the ATM money manager during the study. Assignment of payees appears to be influenced by whether third parties critically attend to how clients' manage funds and by clients' receptiveness to having a payee.

Financial motivation to work among people with psychiatric disorders.

BACKGROUND: Supported employment is an effective intervention for people with serious mental illnesses (SMI) but is underutilized. Clients' desire to work might be heightened by programs that provide counseling about managing one's funds, since money management helps people become more aware of the advantages of having money. AIM: To analyze the thoughts of recently homeless or hospitalized persons with SMI concerning their personal finances and employment. METHODS: We interviewed 49 people with SMI about their finances, reviewed transcripts and analyzed their baseline characteristics. RESULTS: Twenty of the 49 participants spontaneously expressed a desire to work in order to earn more money. Those who expressed a desire to work managed their money significantly better than those who did not. CONCLUSION: Discussion of finances, such as that fostered by money management programs, may promote engagement in vocational rehabilitation and working for pay.

Military sexual trauma-related posttraumatic stress disorder service-connection: Characteristics of claimants and award denial across gender, race, and compared to combat trauma.

The current study characterizes a cohort of veteran claims filed with the Veterans Benefits Administration for posttraumatic stress disorder secondary to experiencing military sexual trauma, compares posttraumatic stress disorder service-connection award denial for military sexual trauma-related claims versus combat-related claims, and examines military sexual trauma -related award denial across gender and race. We conducted analyses on a retrospective national cohort of veteran claims submitted and rated between October 2017-May 2022, including 102,409 combat-related claims and 31,803 military sexual trauma-related claims. Descriptive statistics were calculated, logistic regressions assessed denial of service-connection across stressor type and demographics, and odds ratios were calculated as effect sizes. Military sexual trauma-related claims were submitted primarily by White women Army veterans, and had higher odds of being denied than combat claims (27.6% vs 18.2%). When controlling for age, race, and gender, men veterans had a 1.78 times higher odds of having military sexual trauma-related claims denied compared to women veterans (36.6% vs. 25.4%), and Black veterans had a 1.39 times higher odds of having military sexual trauma-related claims denied compared to White veterans (32.4% vs. 25.3%). Three-fourths of military sexual trauma-related claims were awarded in this cohort. However, there were disparities in awarding of claims for men and Black veterans, which suggest the possibility of systemic barriers for veterans from underserved backgrounds and/or veterans who may underreport military sexual trauma.

Receipt of opioid use disorder treatments prior to fatal overdoses and comparison to no treatment in Connecticut, 2016-17.

OBJECTIVE: To determine the relative risk of death following exposure to treatments for OUD compared to no treatment. METHODS: In this retrospective cohort study we compiled and merged state agency data on accidental and undetermined opioid overdose deaths in 2017 and exposures to OUD treatment in the prior six months to determine incidence rates following exposure to different treatment modalities. These rates were compared to the estimated incidence among those exposed to no treatment to determine relative risk of death for each treatment exposure. RESULTS: Incidence rates for opioid poisoning deaths for those exposed to treatment ranged from 6.06±1.40 per 1000 persons exposed to methadone to 17.36±3.22 per 1000 persons exposed to any non-medication treatment. The estimated incidence rate for those not exposed to treatment was 9.80±0.72 per 1000 persons. With no exposure to treatment as referent, exposure to methadone or buprenorphine reduced the relative risk by 38% or 34%, respectively; the relative risk of non-medication treatments was equal to or worse than no exposure to treatment (RR = 1.27-1.77). PRINCIPAL CONCLUSIONS: Exposure to non-MOUD treatments provided no protection against fatal opioid poisoning whereas the relative risk was reduced following exposures to MOUD treatment, even if treatment was not continued. Population level efforts to reduce opioid overdose deaths need to focus on expanding access to agonist-based MOUD treatments and are unlikely to succeed if access to non-MOUD treatments is made more available.

Pain Care at Home to Amplify Function: Protocol Article.

Guidelines recommend strategies to optimize opioid medication safety, including frequent reassessment of the benefits and harms of long-term opioid therapy. Prescribers, who are predominantly primary care providers (PCPs), may lack the training or resources to implement these guideline-concordant practices. Two interventions have been designed to assist PCPs and tested within the Veterans Health Administration (VHA). Telemedicine Collaborative Management (TCM) provides primarily medication management support via care manager-prescriber teams. Cooperative Pain Education and Self-Management (COPES) promotes self-management strategies for chronic pain via cognitive behavior therapy techniques. Each intervention has been shown to improve prescribing and/or patient outcomes. The added value of combining these interventions is untested. With funding and central coordination by the Integrative Management of Chronic Pain and Opioid Use Disorder for Whole Recovery (IMPOWR) Network of the National Institutes of Health Helping to End Addiction Long-term (HEAL) Initiative, we will conduct a multisite patient-level randomized hybrid II effectiveness-implementation trial within VHA to compare TCM to TCM + COPES on the primary composite outcome of pain interference and opioid safety, secondary outcomes of alcohol use, anxiety, depression, and sleep, and other consensus IMPOWR Network measures. Implementation facilitation strategies informed by interviews with healthcare providers will target site-specific needs. The impact of these strategies on TCM implementation will be assessed via established formative and summative evaluation techniques. Economic analyses will evaluate intervention cost-effectiveness.

Prescription Opioid Dose Change Prior to Fatal Opioid-Detected Overdose.

BACKGROUND: The opioid overdose crisis continues within the U.S., and the role of prescribed opioids and prescribing patterns in overdose deaths remains an important area of research. This study investigated patterns of prescription opioids dispensed in the 12 months prior to opioid-detected overdose death in Connecticut between May 8th, 2016 and January 2nd, 2018, considering differences by demographic characteristics. METHODS: The sample included decedents who had an opioid dispensed within 30 days preceding death. Using multilevel modeling, we estimated the slope of change in mean morphine equivalent (MME) daily dose over 12 months prior to death, considering linear and quadratic effects of time. We estimated the main effects of age, sex, race, and ethnicity and their interactions with time on MME. A sensitivity analysis examined how excluding decedents who did not receive long-term (≥90 days) opioid therapy affected mean MME slopes. Secondary analysis explored differences by toxicology results. RESULTS: Among 1,580 opioid-detected deaths, 179 decedents had prescribed opioids dispensed within 30 days preceding death. Decedents' mean age was 47.3 years (±11.5), 65.5% were male, 81% White non-Hispanic, 9.5% Black non-Hispanic, and 9.5% Hispanic. In the time-only model, linear (ß=6.25, p<0.01) and quadratic (ß=0.49, p=0.02) effects of time were positive, indicating exponentially increasing dose prior to death. Linear change in MME was significantly attenuated in men compared to women (ß=-4.87, p=0.03); however, men were more likely to have non-prescription opioids in their toxicology results (p=0.02). Sensitivity analysis results supported primary findings. CONCLUSION: Rapid dose increases in dispensed opioids may be associated with opioid-detected overdose deaths, especially among women.

Timeline historical review of income and financial transactions: a reliable assessment of personal finances.

The need for accurate and reliable information about income and resources available to individuals with psychiatric disabilities is critical for the assessment of need and evaluation of programs designed to alleviate financial hardship or affect finance allocation. Measurement of finances is ubiquitous in studies of economics, poverty, and social services. However, evidence has demonstrated that these measures often contain error. We compare the 1-week test-retest reliability of income and finance data from 24 adult psychiatric outpatients using assessment-as-usual (AAU) and a new instrument, the Timeline Historical Review of Income and Financial Transactions (THRIFT). Reliability estimates obtained with the THRIFT for Income (0.77), Expenses (0.91), and Debt (0.99) domains were significantly better than those obtained with AAU. Reliability estimates for Balance did not differ. THRIFT reduced measurement error and provided more reliable information than AAU for assessment of personal finances in psychiatric patients receiving Social Security benefits. The instrument also may be useful with other low-income groups.

Build a better mouse: directly-observed issues in computer use for adults with SMI.

Integrating information technology into healthcare has the potential to bring treatment to hard-to-reach people. Individuals with serious mental illness (SMI), however, may derive limited benefit from these advances in care because of lack of computer ownership and experience. To date, conclusions about the computer skills and attitudes of adults with SMI have been based primarily on self-report. In the current study, 28 psychiatric outpatients with co-occurring cocaine use were interviewed about their computer use and opinions, and 25 were then directly observed using task analysis and think aloud methods as they navigated a multi-component health informational website. Participants reported low rates of computer ownership and use, and negative attitudes towards computers. Self-reported computer skills were higher than demonstrated in the task analysis. However, some participants spontaneously expressed more positive attitudes and greater computer self-efficacy after navigating the website. Implications for increasing access to computer-based health information are discussed.

Acute Effects of Competitive Exercise on Risk-Taking in a Sample of Adolescent Male Athletes.

Exercise acutely reduces cravings for tobacco and alcohol, but the mechanism accounting for this relationship is not fully understood. To explore exercise's effects on general risk-taking, we compared the performances of 20 adolescent male athletes on the balloon analog risk task (BART) immediately after periods of exercise (playing tennis) and rest. Statistically significant risk-taking effects were observed post-exercise. The established attenuating effect of exercise on desire for substance use did not extend to impulses for other risk behaviors in this study. In future studies, the moderating effects of participant characteristics and type of risk behavior should be considered.

Delphi study to explore a new diagnosis for "ineffective" long-term opioid therapy for chronic pain.

ABSTRACT: A challenge in clinical, research, and policy spheres is determining whether and how to apply the Diagnostic and Statistical Manual-5 Opioid Use Disorder criteria to patients receiving long-term opioid therapy (LTOT) for the management of chronic pain. This study explored perspectives on the merits of creating a new diagnostic entity to characterize the problems that arise for certain patients prescribed LTOT and develop consensus on its definition and diagnostic criteria. We conducted 3 rounds of online surveys and held one discussion-based workshop to explore a new diagnostic entity and generate consensus with subject matter experts (n = 51) in pain and opioid use disorder, including a wide range of professional disciplines. The first survey included open-ended questions and rapid qualitative analysis to identify potential diagnostic criteria. Rounds 2 and 3 involved rating potential diagnostic criteria on a Likert-type scale to achieve consensus. The workshop was a facilitated conversation aimed at further refining criteria. Three-quarters of Delphi panelists were in favor of a new diagnostic entity; consensus was reached for 19 potential diagnostic criteria including benefits of LTOT no longer outweighing harms and a criterion related to difficulty tapering. A subgroup of expert panelists further refined the new diagnostic entity definition and criteria. Consensus on potential criteria for the new diagnostic entity was reached and further refined by a subgroup of experts. This Delphi study represents the opinions of a small group of subject matter experts; perspectives from other experts and additional stakeholder groups (including patients) are warranted.