Characteristics of patients with non-cancer pain and long-term prescription opioid use who have used medical versus recreational marijuana.

OBJECTIVE: Marijuana use is increasingly common among patients with chronic non-cancer pain (CNCP) and long-term opioid therapy (LTOT). We determined if lifetime recreational and medical marijuana use were associated with more frequent and higher dose prescription opioid use. DESIGN: Cross-sectional SUBJECTS: Eligible patients (n=1,037), who had a new period of prescription opioid use lasting 30-90 days, were recruited from two midwestern health care systems to a study of long-term prescription opioid use and mental health outcomes. The present cross-sectional analyses uses baseline data from this on-going cohort study. METHODS: Primary exposures were participant reported lifetime recreational and medical marijuana use versus no lifetime marijuana use. Prescription opioid characteristics included daily versus non-daily opioid use and ≥50 morphine milligram equivalent (MME) dose per day vs. <50 MME. Multivariate, logistic regression models estimated the association between lifetime recreational and medical marijuana use vs. no use and odds of daily and higher dose prescription opioid use, before and after adjusting for confounding. RESULTS: The sample was an average of 54.9 (SD±11.3) years of age, 57.3% identified as female gender, 75.2% identified as White, and 22.5% identified as Black race. Among all participants, 44.4% were never marijuana users, 21.3% were recreational only, 7.7% medical only and 26.6% were both recreational and medical marijuana users. After controlling for all confounders, lifetime recreational marijuana use, as compared to no use, was significantly associated with increased odds of daily prescription opioid use (OR=1.61; 95%CI:1.02-2.54). There was no association between lifetime recreational or medical marijuana use and daily opioid dose. CONCLUSION: Lifetime medical marijuana use is not linked to current opioid dose, but lifetime recreational use is associated with more than a 60% odds of being a daily prescription opioid user. Screening for lifetime recreational marijuana use may identify patients with chronic pain who are vulnerable to daily opioid use which increases risk for adverse opioid outcomes. Prospective data is needed to determine how marijuana use influences the course of LTOT and vice versa.

Analyzing the Effect of the 2022 Formula Shortage on Postpartum Parents' Feeding Decisions in an Urban Hospital Setting.

Introduction: In early 2022, more than 40% of the U.S. formula supply was out of stock due to product recalls and manufacturing plant shutdowns. While previous studies have explored parents' opinions on formula feeding in response to formula safety concerns and offered advice on adapting to the 2022 formula shortage, there is currently a lack of data assessing the relationship between the formula shortage and parents' feeding decisions. Our study aims to understand how new parents' feeding decisions were impacted in the aftermath of the 2022 formula shortage, in comparison to demographic factors and feeding methods with previous children. We hypothesized that parents may either exclusively breastfeed their new baby when they did not do so previously or breastfeed their new baby more frequently than they did previously due to the formula shortage. Methods: Ninety-nine postpartum parents were administered a Qualtrics survey during their admission at a private urban hospital in St. Louis, Missouri, and answered questions about demographics, feeding decisions with previous children, current feeding decisions, and how influential the formula shortage was on these decisions. Data was analyzed using chi-square and Fisher's exact tests. Results: There is a significant relationship between parents' feeding decisions for previous children and feeding decisions for their new baby (p < 0.0001) but no significant influence of the formula shortage on feeding decisions for their new baby (p = 0.80). Conclusion: When making feeding decisions for their newborn, parents were more influenced by decisions with previous children than by the formula shortage, which highlights the importance of supporting parents with breastfeeding, especially for their first child.

The gut microbiome and depression: a review.

BACKGROUND: Recent explorations into the gut microbiome of humans and animals reveal implications in chronic physical and mental health disorders. Relatively little is known regarding the relationship of gut microbiome and depression. In the current review, we reviewed existing scientific data related to the gut microbiome and healthy patients versus patients with depression. Additionally, scientific literature containing the utility of microbiome interventions to improve depression symptoms was reviewed. METHODS: A PubMed and Clinical Key literature search combined the key terms 'gut,' 'microbiome,' 'bacteria,' and 'depression' to identify studies investigating these relationships. RESULTS: 76 relevant articles were identified. Human and animal studies reviewed examined marked alterations in the dominant bacterial phyla in the gut of individuals with depression, the connection between leaky gut and neuroinflammation in depression, brain regulatory centers impacted by changes in the gut microbiome, and the benefits of the addition of a probiotic/prebiotic for gut and mental health. CONCLUSIONS: The current review confirmed the suspected direct communication between the gut microbiome, brain functioning, and depression. Additionally, studies suggest antibiotics disrupt the gut microbiome. There are important implications for psychiatrists in providing opportunities for intervention and enhancement of current treatments for individuals with depression.