Preliminary Evidence of the Association between Time on Buprenorphine and Cognitive Performance among Individuals with Opioid Use Disorder Maintained on Buprenorphine: A Pilot Study.

People on buprenorphine maintenance treatment (BMT) commonly present cognitive deficits that have been associated with illicit drug use and dropout from buprenorphine treatment. This study has compared cognitive responses to the Stroop Task and the Continuous Performance Task (CPT) among individuals on BMT, with recent drug use, and healthy controls and explored the associations between cognitive responses and drug use, craving, and buprenorphine use among participants on BMT. The participants were 16 individuals on BMT and 23 healthy controls. All participants completed a 60 min laboratory session in which they completed the Stroop Task and the CPT, a saliva drug test, a brief clinical history that collected substance-use- and treatment-related information, and the Opioid Craving Scale. The results showed that the BMT participants presented more commission errors (MBMT participants = 2.49; Mhealthy controls = 1.38; p = 0.048) and longer reaction times (MBMT participants = 798.09; Mhealthy controls = 699.09; p = 0.047) in the Stroop Task than did the healthy controls. More days on buprenorphine were negatively associated with reaction time in the CPT (-0.52) and the number of commission errors (-0.53), simple reaction time (-0.54), and reaction time correct (-0.57) in the Stroop Task. Neither drug use nor craving was significantly associated with the results for the cognitive tasks. Relative to the control participants, the BMT individuals performed worse in terms of longer reaction times and more commission errors in the Stroop Task. Within the BMT participants, longer times on buprenorphine were associated with better cognitive results in terms of faster reaction times for both tasks and lower commission errors for the Stroop Task.

Racial/Ethnic Patterns in Opioid Dispensing among Medicaid-Funded Young Children.

Racial differences in opioid dispensing for diseases of the respiratory system (RESP) and injury (INJURY) outpatient visits among patients ≤ 3 years old were examined. Outpatient claims data of South Carolina Medicaid children were analyzed over three three-year periods. The variable of interest was the triennial rate of dispensed opioid prescriptions per 1000 visits for RESP and INJURY diagnoses across racial/ethnic groups. Overall, dispensed opioid prescription rates related to RESP declined for all racial/ethnic categories. White children had the highest dispensing rate for RESP indications in the first period (5.6), followed by Black (4.5), and Hispanic (4.1). The likelihood of White children being prescribed opioids was higher than Blacks, and this was persistent over the studied time (rate ratios from 1.24 to 1.22, respectively). Overall opioid dispensing rates related to injury declined during the studied time. Hispanics had the highest dispensing rate for INJURY (20.1 to 14.8 to 16.1, respectively) followed by White (16.1 to 13.1 to 10.4, respectively). Relative differences in the dispensing rates across groups increased over time (Hispanics vs. White: rate ratios from 1.25 to 1.55, Hispanics vs. Black: from 1.52 to 2.24, and White vs. Black: from 1.24 to 1.44, respectively). There are considerable differences in the dispensing rates across racial/ethnic groups, especially in injury-related prescribing.

Harm reduction and recovery services support (HRRSS) to mitigate the opioid overdose epidemic in a rural community.

BACKGROUND: Rural areas in the United States (US) are ravaged by the opioid overdose epidemic. Oconee County, an entirely rural county in northwest South Carolina, is likewise severely affected. Lack of harm reduction and recovery resources (e.g., social capital) that could mitigate the worst outcomes may be exacerbating the problem. We aimed to identify demographic and other factors associated with support for harm reduction and recovery services in the community. METHODS: The Oconee County Opioid Response Taskforce conducted a 46-item survey targeting a general population between May and June in 2022, which was mainly distributed through social media networks. The survey included demographic factors and assessed attitudes and beliefs toward individuals with opioid use disorder (OUD) and medications for OUD, and support for harm reduction and recovery services, such as syringe services programs and safe consumption sites. We developed a Harm Reduction and Recovery Support Score (HRRSS), a composite score of nine items ranging from 0 to 9 to measure level of support for placement of naloxone in public places and harm reduction and recovery service sites. Primary statistical analysis using general linear regression models tested significance of differences in HRRSS between groups defined by item responses adjusting for demographic factors. RESULTS: There were 338 survey responses: 67.5% were females, 52.1% were 55 years old or older, 87.3% were Whites, 83.1% were non-Hispanic, 53.0% were employed, and 53.8% had household income greater than US$50,000. The overall HRRSS was relatively low at a mean of 4.1 (SD = 2.3). Younger and employed respondents had significantly greater HRRSS. Among nine significant factors associated with HRRSS after adjusting for demographic factors, agreement that OUD is a disease had the greatest adjusted mean difference in HRSSS (adjusted diff = 1.22, 95% CI=(0.64, 1.80), p < 0.001), followed by effectiveness of medications for OUD (adjusted diff = 1.11, 95%CI=(0.50, 1.71), p < 0.001). CONCLUSIONS: Low HRRSS indicates low levels of acceptance of harm reduction potentially impacting both intangible and tangible social capital as it relates to mitigation of the opioid overdose epidemic. Increasing community awareness of the disease model of OUD and the effectiveness of medications for OUD, especially among older and unemployed populations, could be a step toward improving community uptake of the harm reduction and recovery service resources critical to individual recovery efforts.

Healthcare Utilization and Smoking among South Carolina's Long-Term Uninsured.

Cigarette smoking and tobacco-related health conditions have continued to rise among persons of low social economic status. This study explored the association between healthcare utilization and smoking among the long-term uninsured (LTU). The sample consisted of South Carolina residents who had been without healthcare insurance for at least 24 months. Multivariable logistic regression was used to estimate differences in the likelihood of delaying healthcare due to cost and/or not filling a needed prescription between smokers and non-smokers. Among LTU, smoking was a significant predictor of delaying healthcare at the 10% level (AOR = 1.36, 95% CI = 0.99-1.86); the sensitivity analysis strengthened this association at the 5% level (AOR = 1.43, 95% CI = 1.06-1.93). Smoking was a significant predictor of not filling needed prescriptions (AOR = 1.44, 95% CI = 1.06-1.96). While neglected healthcare utilization was common among the LTU, this problem was more severe among smokers. The wider gap in access to healthcare services among the LTU, especially LTU who smoke, warrants further attention from the research community and policy makers.

Predictive value of clinical symptoms for COVID-19 diagnosis in young adults.

Objective: Assessment of predictive values of clinical symptoms for COVID-19 diagnosis in young adults. Participants: Nonresidential university students (ages 18-25) participating in surveillance testing and mandatory symptom survey between 9/9/2020 and 11/25/2020. Methods: Retrospective study of test results and symptom survey data. Results: Among 6,489 individuals, 288 (4.4%) tested positive for COVID-19, 90 (31.3%) of whom reported symptoms. COVID-19 prevalence among individuals reporting and not reporting symptoms was 17.2% and 3.3%, respectively. The four symptoms with highest positive predictive values (PPVs) were smell/taste loss (PPV = 38.5%), chills (PPV = 31.5%), muscle/joint pain (PPV = 26.0%), and fever (PPV = 25.9%). Conclusions: Institutions should emphasize COVID-19 risk for highly predictive symptoms in public health messaging to inform individuals on when to seek testing or self-isolation. However, low COVID-19 diagnostic accuracy of clinical symptoms and the high pre-symptomatic/asymptomatic rate (69%) highlight the limitations of voluntary testing strategies employed by higher education institutions during the original strain of SARS-CoV-2.