Medical-surgical patients with untreated hazardous drinking: Randomized controlled trial of the DO-MoST intervention to improve health outcomes over 12-month follow-up.

INTRODUCTION: High prevalence and harmful consequences of hazardous drinking among medical-surgical patients underscore the importance of intervening with drinking to improve patients' health. This study evaluated a novel intervention, "Drinking Options - Motivate, Shared Decisions, Telemonitor" (DO-MoST). METHODS: In a randomized design, 155 medical-surgical patients with untreated hazardous drinking were assigned to enhanced usual care or DO-MoST, and followed 3, 6, and 12 months later. We conducted intent-to-treat and per-protocol analyses. RESULTS: For the primary outcome, percent days of alcohol abstinence in the past 30 days, intent-to-treat analyses did not find superior effectiveness of DO-MoST. However, per-protocol analyses found abstinence increased between 3 and 12 months among participants assigned to DO-MoST who engaged with the intervention (n=46). Among DO-MoST-assigned participants who did not engage (n=27), abstinence stayed stable during follow-up. Group comparisons showed an advantage on abstinence for Engaged compared to Non-Engaged participants on change over time. Intent-to-treat analyses found that DO-MoST was superior to usual care on the secondary outcome of physical health at 12 months; per-protocol analyses found that Engaged DO-MoST-assignees had better physical health at 12 months than Non-Engaged DO-MoST-assignees. DO-MoST-assignees had lower odds of receiving substance use care during follow-up than usual care-assignees. DISCUSSION: Patients engaged in DO-MoST showed a greater degree of abstinence and better physical health relative to the non-engaged or usual care group. DO-MoST may be a source of alcohol help in itself rather than only a linkage intervention. Work is needed to increase DO-MoST engagement among medical-surgical patients with untreated hazardous drinking.

Acceptability and feasibility of a mobile behavioral economic health intervention to reduce alcohol use in adults in rural areas.

Background: At-risk alcohol use is associated with increased adverse health consequences, yet is undertreated in healthcare settings. People residing in rural areas need improved access to services; however, few interventions are designed to meet the needs of rural populations. Mobile interventions can provide feasible, low-cost, and scalable means for reaching this population and improving health, and behavioral economic approaches are promising. Methods: We conducted a pilot randomized controlled trial focused on acceptability and feasibility of a mobile behavioral economic intervention for 75 rural-residing adults with at-risk alcohol use. We recruited participants from a large healthcare system and randomized them to one of four virtually-delivered conditions reflecting behavioral economic approaches: episodic future thinking (EFT), volitional choice (VC), both EFT and VC, or enhanced usual care control (EUC). The intervention included a telephone-delivered induction session followed by two weeks of condition-consistent ecological momentary interventions (EMIs; 2x/day) and ecological momentary assessments (EMAs; 1x/day). Participants completed assessments at baseline, post-intervention, and two-month follow-up, and provided intervention feedback. Results: All participants completed the telephone-delivered session and elected to receive EMI messages. Average completion rate of EMAs across conditions was 92.9%. Among participants in active intervention conditions, 89.3% reported the induction session was helpful and 80.0% reported it influenced their future drinking. We also report initial alcohol use outcomes. Discussion: The behavioral economic intervention components and trial procedures evaluated here appear to be feasible and acceptable. Next steps include determination of their efficacy to reduce alcohol use and public health harms.

Development and Pilot Testing of an Experimental Cannabis Marketplace: Toward Evaluating the Impact of Cannabis Policy on Consumer Choices.

Introduction: The legal landscape of recreational cannabis production and consumption is rapidly expanding, driving a need to inform empirically supported cannabis regulatory policy. A behavioral economic framework integrating economic constructs (e.g., price, substitutability) with psychology and decision-making sciences, has previously been applied to tobacco regulatory sciences through the use of experimental marketplaces. However, experimental marketplaces have not yet been applied to understand cannabis choice behaviors or study ways to minimize risks from use. Herein, we describe the development and initial feasibility testing of an Experimental Cannabis Marketplace (ECM). The ECM can serve as an experimental platform relevant to evaluating the impact of regulatory policies on cannabis choices and use behavior. Methods: The ECM was designed to resemble an online cannabis dispensary. Adults aged 21 and older with past month cannabis use and past month purchase from a recreational dispensary were recruited online. To test the feasibility and acceptability of the ECM, 62 people completed the ECM shopping task and provided feedback on the ECM prototype. Participants also reported about their typical purchases from real-world dispensaries. Results: Nearly all participants rated the ECM as very (80.65%) or somewhat (16.13%) easy to navigate, and rated task instructions as at least mostly clear (100%). The majority (75.81%) said cannabis products available in the ECM were mostly the same or exactly the same as at their typical dispensary. Participant purchase choices in actual dispensary purchases closely matched ECM purchases, with 88% of product choices in typical real-world cannabis dispensaries matching the ECM products purchased. Discussion: Initial testing of the ECM indicates it is an acceptable and feasible tool for understanding cannabis purchasing and choice behavior. These preliminary findings suggest that the ECM mimics cannabis dispensary settings with people making similar choices to those made in the real world.

Methamphetamine use among American Indians and Alaska Natives in the United States.

BACKGROUND: Recent trends show methamphetamine use is increasing in the United States. American Indian and Alaska Native (AI/AN) communities face health disparities compared to the population overall, including some of the highest rates of illegal drug use. Herein, we examined the prevalence of methamphetamine use among AI/ANs and characteristics associated with methamphetamine use among AI/AN people. METHODS: We examined past-year methamphetamine use from 2015 to 2019 between AI/ANs and the general non-institutionalized U.S. population using the National Survey of Drug Use and Health. Then, we identify potential subgroups of AI/AN people at elevated risk of methamphetamine use across factors including demographic, social determinants, mental health, and co-occurring substance use. RESULTS: A total of 214,505 people, aged 18 or older, were surveyed between 2015 and 2019; 3,075 (0.55%) identified as AI/AN. An estimated 26.2 out of every 1000 AI/ANs used methamphetamine compared to 6.8 out of every 1000 in the general U.S. POPULATION: Compared to methamphetamine use in the general population, AI/AN methamphetamine use tends to cluster in rural areas and among those with low income. AI/ANs who use methamphetamine were more likely to be male, middle-aged, low income, have severe mental illness, and misuse other substances than AI/AN people who did not use methamphetamine. DISCUSSION: AI/ANs experience a disproportionate amount of methamphetamine use in the U.S. To address this disparity, multifaceted, broad prevention, harm reduction, and treatment efforts are needed that leverage cultural strengths to mitigate the consequences of methamphetamine use.

Prevalence of cannabis use among individuals with a history of cancer in the United States.

BACKGROUND: Patients with cancer have played a key role in advocating for legal access to cannabis, but little is known about links between cancer and cannabis use or cannabis-related beliefs. The authors used data from a national survey to study these relationships. METHODS: Nationally representative data collected by the National Survey on Drug Use and Health from 2015 to 2019 were acquired. Patterns of cannabis use and cancer history were examined and tested within age group subpopulations via domain analysis using survey weights. RESULTS: Data for 214,505 adults, including 4741 individuals (3.8%) with past (>1 year ago) cancer diagnosis and 1518 individuals (1.2%) with recent (≤1 year ago) cancer diagnosis, were examined. Cannabis use was less common in those with past (8.9%; 95% CI, 8.0%-9.8%) or recent (9.9%; 95% CI, 6.9%-11.1%) cancer diagnosis than in those without a history of cancer (15.9%; 95% CI, 15.7%-16.1%). However, when analyses were stratified by age group, those 18 to 34 years of age were more likely to report past cannabis use, and those 35 to 49 years of age were more likely to report past or recent cannabis use if they had a history of cancer. Younger patients felt that cannabis was more accessible and less risky if they had a history of cancer. CONCLUSIONS: Patients with cancer were less likely to report cannabis use, but there were different cannabis perceptions and use patterns by age. Age should be considered in studies of cannabis and cancer, and policy initiatives may be needed to aid provision of quality information on cannabis risk to those with cancer. LAY SUMMARY: Cannabis (marijuana) use is increasing in the United States, but we do not have much information on the relationship between cannabis use and cancer. We studied information from a representative group of people and found that younger patients generally reported more past and/or recent cannabis use if they had been diagnosed with cancer whereas older individuals did not. Beliefs about cannabis risk and accessibility differed by age. Clinical trials to study cannabis should account for patient age, and accurate information about cannabis should be provided to help patients with cancer make decisions about cannabis use.

Differences between cancer patients and others who use medicinal Cannabis.

BACKGROUND: Cancer patients have been at the forefront of policy discussions leading to legalization of medical Cannabis (marijuana). Unfortunately, Cannabis use among those with cancer is poorly understood. METHODS: A diverse group of patients seeking certification for medical Cannabis in the state of Michigan were surveyed at the time of their presentation to medical dispensaries. The survey assessed demographics, employment/disability, pain, physical functioning, mental health, mode of Cannabis use, and frequency/amount of Cannabis use. Chi-square and t-tests were performed to compare those who did and did not endorse cancer diagnosis. RESULTS: Analysis of data from 1485 adults pursuing medical Cannabis certification, including 72 (4.8%) reporting a cancer diagnosis, indicated that those with cancer were older [mean age 53.4 years (SD = 10.5) vs. 44.7 years (SD = 13.0); p<0.001] than those without cancer. They also differed regarding employment status (p<0.001; working: 20.8% vs. 46.2%; disabled: 44.4% vs. 26.5% for those with vs. those without cancer, respectively). Those with cancer used less Cannabis (p = 0.033 for quantity used) and used Cannabis less often (p = 0.032 for frequency of use); they less frequently endorsed smoking Cannabis (80% vs 91%; p = 0.015). There was a non-significant trend to increased edible use in those with cancer (57% vs. 44%; p = 0.052). CONCLUSIONS: Patients with cancer who are seeking medical Cannabis are different from those seeking medical Cannabis without cancer, and they report using Cannabis differently. Further research to characterize the patterns and consequences of Cannabis use in cancer patients is needed.

Progression of cannabis withdrawal symptoms in people using medical cannabis for chronic pain.

BACKGROUND AND AIMS: Research from cohorts of individuals with recreational cannabis use indicates that cannabis withdrawal symptoms are reported by more than 40% of those using regularly. Withdrawal symptoms are not well understood in those who use cannabis for medical purposes. Therefore, we prospectively examined the stability of withdrawal symptoms in individuals using cannabis to manage chronic pain. DESIGN, SETTING, PARTICIPANTS: Using latent class analysis (LCA) we examined baseline cannabis withdrawal to derive symptom profiles. Then, using latent transition analysis (LTA) we examined the longitudinal course of withdrawal symptoms across the time points. Exploratory analyses examined demographic and clinical characteristics predictive of withdrawal class and transitioning to more or fewer withdrawal symptoms over time. A cohort of 527 adults with chronic pain seeking medical cannabis certification or re-certification was recruited between February 2014 and June 2015. Participants were recruited from medical cannabis clinic waiting rooms in Michigan, USA. Participants were predominantly white (82%) and 49% identified as male, with an average age of 45.6 years (standard deviation = 12.8). MEASUREMENTS: Baseline, 12-month and 24-month assessments of withdrawal symptoms using the Marijuana Withdrawal Checklist-revised. FINDINGS: A three-class LCA model including a mild (41%), moderate (34%) and severe (25%) symptom class parsimoniously represented withdrawal symptoms experienced by people using medical cannabis. Stability of withdrawal symptoms using a three-class LTA at 12 and 24 months ranged from 0.58 to 0.87, with the most stability in the mild withdrawal class. Younger age predicted greater severity and worsening of withdrawal over time. CONCLUSIONS: Adults with chronic pain seeking medical cannabis certification or re-certification appear to experience mild to severe withdrawal symptoms. Withdrawal symptoms tend to be stable over a 2-year period, but younger age is predictive of worse symptoms and of an escalating withdrawal trajectory.

Prevalence of suicide ideation, planning and attempts among Supplemental Nutrition Assistance Program participants in the United States.

BACKGROUND: Suicide represents a substantial public health problem in the U.S. Programs like the Supplemental Nutrition Assistance Program (SNAP)-which provides services for U.S. adults who are food insecure-could be an appropriate venue for suicide prevention strategies targeting high-risk individuals. METHODS: This cross-sectional study used multiple logistic regression to determine odds ratios (ORs) and 95% confidence intervals (CIs) for suicide ideation, planning and attempt among those who participated in SNAP vs. nonparticipants. The National Survey of Drug Use and Health provided a representative sample of U.S. adults for 2012-2018 (n = 288,730). RESULTS: SNAP participants were more likely than nonparticipants to have serious suicidal thoughts (crude OR=1.89; 95% CI=1.79-1.99), to have a plan for suicide (crude OR=2.35; 95% CI=2.16-2.56) or to attempt suicide (crude OR=2.89; 95% CI=2.54-3.29). Associations remained for those aged <50 in age-stratified analyses that accounted for survey year, demographics, socioeconomic status, self-rated health and mental health service use. LIMITATIONS: SNAP was assessed at the household level; thus, those who reported suicidal thoughts and/or behaviors may not personally interact with SNAP. CONCLUSION: Using a large, nationally-representative sample of U.S. adults, this study documented greater prevalence of suicide-related outcomes among those who participate in SNAP. Suicide prevention among SNAP participants may provide a unique means to reach individuals who are often hard to engage in other health services.

Efficacy of a Psychosocial Pain Management Intervention for Men and Women With Substance Use Disorders and Chronic Pain: A Randomized Clinical Trial.

Importance: Chronic pain is common in those with substance use disorders (SUDs) and predicts poorer addiction treatment outcomes. A critical challenge for addiction treatment is to develop effective methods to improve pain-related and substance use-related outcomes for those in treatment for SUDs. Objective: To examine the efficacy of an integrated behavioral pain management intervention (Improving Pain During Addiction Treatment [ImPAT]) for men and women with SUDs to treat pain, functioning, and substance use. Design, Setting, and Participants: In this randomized clinical trial, 8 sessions of ImPAT were compared with 8 sessions of a supportive psychoeducational control (SPC) condition for adults with pain treated at a large residential SUD treatment program. Follow-up occurred at 3, 6, and 12 months postbaseline. A total of 1372 adults were screened, including 960 men and 412 women, and 510 adults were randomized, including 264 men and 246 women. The goal was to recruit approximately equal numbers of men and women to examine results separately in men and women. A total of 470 of 510 participants (92.2%) completed at least 1 follow-up assessment. Data were collected from October 3, 2011, to January 14, 2016. Data were analyzed from February 1, 2016, to May 1, 2020. Interventions: ImPAT focused on how a psychosocial model of pain was associated with functioning and relapse prevention and provides skills to manage pain. SPC served as the active control condition and involved discussions of topics like nutrition and the course of addiction, which were intended to be relevant to the patient population and to have face validity but be distinct from the content of ImPAT. Main Outcomes and Measurements: The primary outcomes were pain intensity, pain-related functioning, and behavioral pain tolerance at 12 months. Secondary outcomes were frequency of alcohol and drug use over 12 months. Results: Of the 510 included participants, the mean (SD) age was 34.8 (10.3) years. A total of 133 men and 122 women were assigned to ImPAT, and a total of 131 men and 124 women were assigned to the SPC condition. Over 12 months of follow-up, randomization to the ImPAT intervention was associated with higher tolerance of pain among men, higher by a mean score of 0.11 (95% CI, 0.03 to 0.18; P = .004; Cohen d = 0.40) at 3 months and by 0.07 (95% CI, -0.01 to 0.19; P = .11; Cohen d = 0.25) at 12 months. Women receiving the ImPAT intervention experienced a reduction in pain intensity from 3 to 12 months, while women receiving the SPC condition experienced an increase in pain intensity, resulting in lower pain in the ImPAT condition by a mean score of 0.58 (95% CI, -0.07 to 1.22; P = .08; Cohen d = -0.22) at 12 months. No differences were found between the ImPAT and SPC conditions on alcohol or drug use. Conclusions and Relevance: Behavioral pain management is not typically included in addiction treatment, but the present results indicate that this type of intervention was associated with better pain-related outcomes, including pain tolerance in men and pain intensity in women. Improvements in substance use-related outcomes beyond that achieved by treatment as usual were not observed. Treatment programs should consider providing psychosocial pain management services to augment standard addiction treatment. Trial Registration: ClinicalTrials.gov Identifier: NCT01372267.

Links between suicidal intent, polysubstance use, and medical treatment after non-fatal opioid overdose.

BACKGROUND: Suicidal thinking during non-fatal overdose may elevate risk for future completed suicide or intentional overdose. Long-term outcomes following an intentional non-fatal overdose may be improved through specific intervention and prevention responses beyond those designed for unintentional overdoses, yet little research has assessed suicidal intent during overdoses or defined characteristics that differentiate these events from unintentional overdoses. METHODS: Patients with a history of opioid overdose (n = 274) receiving residential addiction treatment in the Midwestern United States completed self-report surveys to classify their most recent opioid overdose as unintentional, actively suicidal (wanted to die), or passively suicidal (didn't care about the risks). We characterized correlates of intent using descriptive statistics and prevalence ratios. We also examined how intent related to thoughts of self-harm at the time of addiction treatment. RESULTS: Of opioid overdoses, 51 % involved suicidal intent (44 % passive and 7 % active). Active suicidal intent was positively associated with hospitalization. Active/passive intent (vs. no intent, aPR: 2.2, 95 % CI: 1.4-3.5) and use of ≥5 substances (vs. 1 substance, aPR: 3.6, 95 % CI: 1.2-10.6) at the last opioid overdose were associated with having thoughts of self-harm or suicide in the 2 weeks before survey completion in adjusted models. Participants who reported active/passive intent more commonly used cocaine or crack (27 %) with opioids during their last overdose relative to unintentional overdoses (16 %). CONCLUSIONS: Over half of opioid overdoses among individuals in addiction treatment involved some degree of suicidal thinking. Identifying patients most at risk will facilitate better targeting of suicide prevention and monitoring services.

A physician-pharmacist collaborative care model to prevent opioid misuse.

PURPOSE: Clinical pharmacists in primary care clinics can potentially help manage chronic pain and opioid prescriptions by providing services similar to those provided within their scope of practice to patients with diabetes and hypertension. We evaluated the feasibility and acceptability of a pharmacist-physician collaborative care model for patients with chronic pain. METHODS: The program consisted of an in-person pharmacist consultation and optional follow-up visits over 4 months in 2 primary care practices. Eligible patients had chronic pain and a long-term prescription for opioids or buprenorphine or were referred by their primary care physician (PCP). Pharmacist recommendations were communicated to PCPs via the electronic medical record (EMR) and direct communication. Mixed-methods evaluation included baseline and follow-up surveys with patients, EMR review of opioid-related clinical encounters, and provider interviews. RESULTS: Between January and October 2018, 47 of the 182 eligible patients enrolled, with 46 completing all follow-up; 43 patients (91%) had received opioids over the past 6 months. The pharmacist recommended adding or switching to a nonopioid pain medication for 30 patients, switching to buprenorphine for pain and complex persistent opioid dependence for 20 patients, and tapering opioids for 3 patients. All physicians found the intervention acceptable but wanted more guidance on prescribing buprenorphine for pain. Most patients found the intervention helpful, but some reported a lack of physician follow-up on recommended changes. CONCLUSION: The study demonstrated that comanagement of patients with chronic pain is feasible and acceptable. Policy changes to increase pharmacists' authority to prescribe may increase physician willingness and confidence to carry out opioid tapers and prescribe buprenorphine for pain.

Changes in urban and rural cigarette smoking and cannabis use from 2007 to 2017 in adults in the United States.

INTRODUCTION: Rural-urban differences in cigarette and cannabis use have traditionally shown higher levels of cigarette smoking in rural areas and of cannabis use in urban areas. To assess for changes in this pattern of use, we examined trends and prevalence of cigarette, cannabis, and co-use across urban-rural localities. METHODS: Urban-rural trends in current cigarette and/or cannabis use was evaluated using 11 cohorts (2007-2017) of the National Survey on Drug Use and Health (NSDUH; N = 397,542). We used logistic regressions to model cigarette and cannabis use over time, adjusting for demographics (age, gender, race/ethnicity, income, education), in addition to assessing patterns of cannabis use among cigarette smokers and nonsmokers. RESULTS: Despite decreases in cigarette smoking overall, between 2007 and 2017, the urban-rural disparity in cigarette smoking increased (AOR = 1.17), with less reduction in rural as compared to urban cigarette smokers. Cannabis use increased in general (AOR = 1.88 by 2017), with greater odds in urban than rural regions. Cannabis use increased more rapidly in non-cigarette smokers than smokers (AOR = 1.37 by 2017), with 219% greater odds of cannabis use in rural non-cigarette smokers in 2017 versus 2007. CONCLUSIONS: Rurality remains an important risk factor for cigarette smoking in adults and the fastest-growing group of cannabis users is rural non-cigarette smokers; however, cannabis use is currently still more prevalent in urban areas. Improved reach and access to empirically-supported prevention and treatment, especially in rural areas, along with dissemination and enforcement of policy-level regulations, may mitigate disparities in cigarette use and slow the increase in rural cannabis use.

The Role of Drugs in Alcohol Poisoning and Blackout Events: A Latent Class Analysis of a Residential Treatment Sample.

BACKGROUND: Alcohol can lead to fatal and nonfatal overdose (OD) through its neurobiological inhibitory effects when used alone or with other drugs. Little research has examined alcohol OD characteristics in the context of concomitant drug use. METHODS: This study utilized alcohol OD data (defined as alcohol poisoning, passing out, or blacking out) collected in a large residential addiction treatment facility (N = 660). Latent class analysis identified classes of alcohol OD events based on concomitant drug use at the time of OD. We evaluated correlates of alcohol OD classes, including depression, emergency medical services, and hospitalization, using latent class regression. RESULTS: Only 20% of alcohol ODs involved alcohol alone. Marijuana was the most commonly used drug during the most recent alcohol OD (43.2%), followed by sedatives (27.9%), cocaine or crack (25.9%), prescription opioids (26.1%), and heroin (20%). The final latent class model included 3 classes: no/low drug involvement (61%), moderate drug involvement (33%), and high drug involvement (6%). Relative to the no/low drug involvement class, participants admitted to the hospital were 6.4-fold more likely to be in the high drug involvement class (95% CI: 2.4 to 16.6) and 2.9-fold more likely to be in the moderate drug involvement class (95% CI: 1.2 to 7.2). Participants receiving emergency medical services were more likely to be in the high drug involvement class (aOR: 2.2, 95% CI: 2.2, 1.1 to 4.5) and less likely to be in the moderate drug involvement class (aOR 0.39, 95% CI: 0.2 to 0.96). CONCLUSIONS: Combining drug classes with alcohol prior to OD was common and associated with a higher likelihood of hospitalization. Overdose prevention efforts should address acute risks of alcohol ingestion with other drugs.

Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids.

Importance: Opioid-prescribing policies and guidelines aimed at reducing inappropriate opioid prescribing may lead physicians to stop prescribing opioids. Patients may thus encounter difficulties finding primary care practitioners willing to care for them if they take opioids. Objectives: To assess practitioner willingness to accept and continue prescribing opioids to new patients with pain and whether this willingness differs across payer types. Design, Setting, and Participants: This survey study used a simulated patient call audit method. A brief telephone survey was administered to all clinics followed by a call using a patient script simulating an adult patient with chronic pain who was taking long-term opioids. The patient had Medicaid or private insurance. Calls were made between June 22 and October 30, 2018, to 667 primary care clinics that served a general adult population in Michigan. Clinics that accepted both Medicaid and private insurance, took new patient appointments, and were successfully recontacted for the simulated call were eligible for the study. Main Outcomes and Measures: Prevalence of clinics' acceptance of new patients receiving prescription opioids overall and by clinic characteristics and insurance type. Results: Of the 194 eligible clinics, 94 (48.4%) were randomized according to insurance type to receive calls from research assistants posing as children of patients with Medicaid and 100 (51.5%) to receive calls from those with private insurance. Overall, 79 (40.7%) stated that their practitioners would not prescribe opioids to the simulated patient. Thirty-three clinics (17.0%) requested more information before making a decision. Compared with single-practitioner clinics, clinics with more than 3 practitioners were more likely (odds ratio [OR], 2.99; 95% CI, 1.48-6.04) to accept new patients currently taking opioids. No difference was found in access based on insurance status (OR, 0.92; 95% CI, 0.52-1.64) or whether the clinic offered medications for opioid use disorders (OR, 1.10; 95% CI, 0.45-2.69). Conclusions and Relevance: The findings suggest that access to primary care may be reduced for patients taking prescription opioids, which could lead to unintended consequences, such as conversion to illicit substances or reduced management of other medical comorbidities.

The Relationship Between Hearing Loss and Substance Use Disorders Among Adults in the U.S.

INTRODUCTION: Hearing loss is common and associated with poorer health and impeded communication. Little is known about the association between hearing loss and substance use disorders in the general population. The objective of this study was to assess substance use disorder prevalence among individuals with hearing loss, versus those without hearing loss, in a nationally representative sample of adults. METHODS: Two years (2015 and 2016) of National Survey on Drug Use and Health (unweighted N=86,186) were combined to compare substance use disorders among adults with and without self-reported hearing loss. Statistical analysis included descriptive frequencies, chi-square tests, and multiple logistic regressions. Analyses were performed in 2018. RESULTS: Hearing loss prevalence across all age groups was 5.2%. Among younger age groups, after adjusting for sociodemographics, hearing loss was independently associated with an increased likelihood of experiencing a substance use disorder (ages 18-34 years, AOR=1.34, 95% CI=1.10, 1.64 vs 35-49 years, AOR=1.87, 95% CI=1.39, 2.53). Hearing loss was also associated with a greater likelihood of a prescription opioid use disorder (AOR=2.85, 95% CI=1.86, 4.39) in the group aged 18-34 years and, for the group aged 35-49 years, hearing loss increased the likelihood of both an alcohol use disorder (AOR=1.87, 95% CI=1.39, 2.53) and a prescription opioid use disorder (AOR=1.99, 95% CI=1.01, 3.91). CONCLUSIONS: Hearing loss is independently associated with substance use disorders among those aged 49 years and younger; these associations are particularly pronounced for prescription opioid use disorders in the group aged 18-34 years. Given the concern of inappropriate use of prescription opioids, this information may have implications for healthcare providers' pain management for patients with hearing loss.

Randomized controlled trial of telephone monitoring with psychiatry inpatients with co-occurring substance use and mental health disorders.

Background Psychiatry inpatients frequently have co-occurring substance use and mental health disorders, which are related to poor post-discharge outcomes. Telephone monitoring is effective in specialty substance use disorder treatment settings in increasing continuing care and 12-step program utilization and improving substance use outcomes. This study examined the effectiveness of telephone monitoring among psychiatry inpatients with co-occurring substance use and mental health disorders. Methods This randomized controlled trial (n = 406) compared usual care to usual care plus telephone monitoring (one in-person session during the inpatient stay, followed by weekly telephone contact for three months post-discharge). Follow-ups were conducted at end-of-intervention (three months post-baseline) and nine and 15 months post-baseline (73% followed). Primary outcomes were number of days out of the past 30 of drinking alcohol, using drugs, and experiencing psychological problems. Secondary outcomes were outpatient substance use treatment, and 12-step group, utilization. Results Longitudinal modeling found that patients in both conditions improved over time on each primary outcome. Improvement was comparable between conditions on alcohol and drug use and psychological problems. Receipt of outpatient treatment decreased over the follow-up period and was not related to condition. Likelihood of attending 12-step group meetings did not change over follow-ups, and was not related to condition. Conclusions Improvement over time was evident regardless of condition assignment. Patients maintained attendance at 12-step groups from pre- to post-discharge. Short-term telephone monitoring in addition to usual care for patients with co-occurring substance use and mental health disorders may not be sufficiently intensive to achieve additional improvements on outcomes.

Use of non-pharmacological strategies for pain relief in addiction treatment patients with chronic pain.

BACKGROUND AND OBJECTIVES: We examined use of non-pharmacological treatments for pain in addiction treatment patients. METHODS: Patients in addiction treatment with chronic pain (N = 501) were classified based on use of non-pharmacological pain treatments. Demographic and clinical correlates were compared. RESULTS: A total of 49% (N = 243) of patients used a non-pharmacological treatment in the past year versus 72% (N = 361) who used opioids. Non-pharmacological treatment users were more likely to use opioids and other pain medications. CONCLUSIONS: Non-pharmacological treatments are less commonly used than opioids by addiction treatment patients. SCIENTIFIC SIGNIFICANCE: Findings highlight the need to better understand pain treatment decision-making among addiction treatment patients. (Am J Addict 2017;26:564-567).

Comparison of four different nerve conduction techniques of the superficial fibular sensory nerve.

INTRODUCTION: There are many different nerve conduction study (NCS) techniques to study the superficial fibular sensory nerve (SFSN). We present reference distal latency values and comparative data regarding 4 different NCS for the SFSN. METHODS: Four different NCS techniques, Spartan technique, Izzo techniques (medial and intermediate dorsal cutaneous branches), and Daube technique, were performed on (114) healthy volunteers. A total of 108 subjects with 164 legs were included. RESULTS: The mean latency of the Spartan technique was longest (3.9 ± 0.3 ms) while the Daube technique was the shortest (3.6 ± 0.7 ms). The mean amplitude of the Daube technique displayed the highest (15.2 ± 8.2 µV) with the Spartan technique having the lowest (8.7 ± 4.2 µV). Among the absent sensory nerve action potentials (SNAPs), the Spartan technique was absent only twice (1.2%) and the Izzo Medial technique was absent more than the other techniques (2.9%). CONCLUSIONS: All 4 techniques were reliable methods for obtaining the superficial fibular nerve SNAP, present in 95% of individuals. Muscle Nerve 56: 458-462, 2017.

Suicidal ideation among young Afghanistan/Iraq War Veterans and civilians: Individual, social, and environmental risk factors and perception of unmet mental healthcare needs, United States, 2013.

Suicidal Ideation among Afghanistan/Iraq War Veterans remains a health concern. As young Veterans adjust to civilian life, new risk factors might emerge and manifest differently in this group versus those in the general population. We explored these differences. With 2013 National Survey on Drug Use and Health data, we examined differences in risk of past-year suicidal ideation between Veterans of the Afghanistan/Iraq War periods aged 18-34 years (N=328) and age-comparable civilians (N=23,222). We compared groups based on individual and socio-environmental risk factors as well as perceptions of unmet mental healthcare needs. We report adjusted rate ratios (aRRs); interaction terms tested for between-group differences. PY suicidal ideation rates for Veterans and civilians did not differ (52 versus 59 per 1,000, p=0.60) and both groups shared many risk factors. However, drug problems and perceived unmet mental health care needs were vastly stronger risk factors among Veterans versus civilians (interaction terms indicated that the aRRs were 3.8-8.0 times higher for Veterans versus civilians). Other differences were discovered as well. Past-year suicidal ideation rates did not differ by Veteran status among young adults. However, different risk factors per group were detected, which can inform Veteran suicide prevention efforts.

Comparing adults who use cannabis medically with those who use recreationally: Results from a national sample.

OBJECTIVES: Cannabis has been legalized for medical use in almost half of the states in the U.S. Although laws in these states make the distinction between medical and recreational use of cannabis, the prevalence of people using medical cannabis and how distinct this group is from individuals using cannabis recreationally is unknown at a national level. METHODS: Data came from the 2013 National Survey on Drug Use and Health (NSDUH). All adults endorsing past year cannabis use who reported living in a state that had legalized medical cannabis were divided into recreational cannabis use only and medical cannabis use. Demographic and clinical characteristics were compared across these two groups. RESULTS: 17% of adults who used cannabis in the past year used cannabis medically. There were no significant differences between those who used medically versus recreationally in race, education, past year depression and prevalence of cannabis use disorders. In adjusted analyses, those with medical cannabis use were more likely to have poorer health and lower levels of alcohol use disorders and non-cannabis drug use. A third of those who reported medical cannabis use endorsed daily cannabis use compared to 11% in those who reported recreational use exclusively. CONCLUSIONS: Adults who use medical and recreational cannabis shared some characteristics, but those who used medical cannabis had higher prevalence of poor health and daily cannabis use. As more states legalize cannabis for medical use, it is important to better understand similarities and differences between people who use cannabis medically and recreationally.