Assessing experts' perspectives on challenges in substance misuse prevention, harm reduction, and treatment to shape funding priorities in New York State.

BACKGROUND: Drug overdose is a leading cause of death and opioid-related deaths increased by more than 300% from 2010 to 2020 in New York State. Experts holding a range of senior leadership positions from across New York State were asked to identify the greatest challenges in substance misuse prevention, harm reduction, and treatment continuum of care. Expert input was used to shape funding priorities. METHOD: Individual semi-structured interviews of sixteen experts were conducted in April and May 2023. Experts included academics, medical directors, leaders of substance misuse service agencies, administrators of a state agency, a county mental health commissioner, the president of a pharmacy chain, and a senior vice president of an addiction-related national non-profit. Zoom interviews were conducted individually by an experienced qualitative interviewer and were recorded, transcribed, and coded for content. An initial report, with the results of the interviews organized by thematic content, was reviewed by the research team and emailed to the expert interviewees for feedback. RESULTS: The research team identified five major themes: 1. Siloed and fragmented care delivery systems; 2. Need for a skilled workforce; 3. Attitudes towards addiction (stigma); 4. Limitations in treatment access; and 5. Social and drug related environmental factors. Most experts identified challenges in each major theme; over three-quarters identified issues related to siloed and fragmented systems and the need for a skilled workforce. Each expert mentioned more than one theme, three experts mentioned all five themes and six experts mentioned four themes. CONCLUSIONS: Research, educational, and programmatic agendas should focus on identified topics as a means of improving the lives of patients at risk for or suffering from substance use-related disorders. The results of this project informed funding of pilot interventions designed to address the identified care challenges.

Differences in prescribing patterns of opioid dependence drugs among patients with primary alcohol use problems and opioid use disorders within New York State by social determinant factors, 2005-2018.

BACKGROUND: The increase in alcohol use problems and opioid use disorder (OUD) highlights the need for research on effective medication treatments for patients with dual diagnoses. OBJECTIVES: This study analyzed trends and social disparities in prescribing OUD medications for patients who initially had alcohol use problems and later received their first OUD diagnosis. METHODS: This study utilized merged data from the New York State Office of Addiction Services and Supports and the Medicaid to analyze individuals aged 18 and older who initially had primary alcohol use problems and later had OUD for the first time between 2005 and 2018. It examined the rates of new buprenorphine and naltrexone prescriptions across various demographic and socioeconomic groups. RESULTS: Among 27,029 clients, the average rate of new buprenorphine was 64.23 per 1,000 clients (95% CI [61.30, 67.15]), with upward trends. The 18-35 age group had the highest buprenorphine utilization (111.48 per 1,000 clients), and highest increase rates compared to other age groups. The White non-Hispanic group had the highest rates of buprenorphine (119.23 per 1000 clients) and showed larger increase over time compared to other race/ethnicity groups. Disabled patients showed slower increasing rates of buprenorphine compared to other groups. Upward trends were observed in naltrexone. All observed differences were statistically significant (P<0.05). CONCLUSIONS: Trends showed increased use of OUD medications, with varying rates of buprenorphine utilization across different ages, races, and employment statuses. Despite this, the rates of receiving new buprenorphine remained low, suggesting a need for innovative methods to expand access to treatments.

Trends in Prescribing Opioids, Benzodiazepines, and Both Among Adults with Alcohol Use Disorder in New York State.

BACKGROUND: Alcohol use disorder (AUD) is a highly prevalent public health problem that contributes to opioid- and benzodiazepine-related morbidity and mortality. Even though co-utilization of these substances is particularly harmful, data are sparse on opioid or benzodiazepine prescribing patterns among individuals with AUD. OBJECTIVE: To estimate temporal trends and disparities in opioid, benzodiazepine, and opioid/benzodiazepine co-prescribing among individuals with AUD in New York State (NYS). DESIGN/PARTICIPANTS: Serial cross-sectional study analyzing merged data from the NYS Office of Addiction Services and Supports (OASAS) and the NYS Department of Health Medicaid Data Warehouse. Subjects with a first admission to an OASAS treatment program from 2005-2018 and a primary AUD were included. A total of 148,328 subjects were identified. MEASURES: Annual prescribing rates of opioids, benzodiazepines, or both between the pre- (2005-2012) and post- (2013-2018) Internet System for Tracking Over-Prescribing (I-STOP) periods. I-STOP is a prescription monitoring program implemented in NYS in August 2013. Analyses were stratified based on sociodemographic factors (age, sex, race/ethnicity, and location). RESULTS: Opioid prescribing rates decreased between the pre- and post-I-STOP periods from 25.1% (95% CI, 24.9-25.3%) to 21.3% (95% CI, 21.2-21.4; P <.001), while benzodiazepine (pre: 9.96% [95% CI, 9.83-10.1%], post: 9.92% [95% CI, 9.83-10.0%]; P =.631) and opioid/benzodiazepine prescribing rates remained unchanged (pre: 3.01% vs. post: 3.05%; P =.403). After I-STOP implementation, there was a significant decreasing trend in opioid (change, -1.85% per year, P <.0001), benzodiazepine (-0.208% per year, P =.0184), and opioid/benzodiazepine prescribing (-0.267% per year, P <.0001). Opioid, benzodiazepine, and co-prescription rates were higher in females, White non-Hispanics, and rural regions. CONCLUSIONS: Among those with AUD, opioid prescribing decreased following NYS I-STOP program implementation. While both benzodiazepine and opioid/benzodiazepine co-prescribing rates remained high, a decreasing trend was evident after program implementation. Continuing high rates of opioid and benzodiazepine prescribing necessitate the development of innovative approaches to improve the quality of care.

A cohort of patients in New York State with an alcohol use disorder and subsequent treatment information - A merging of two administrative data sources.

OBJECTIVE: Despite the high prevalence of alcohol use disorder (AUD) in the United States, limited research is focused on the associations among AUD, pain, and opioids/benzodiazepine use. In addition, little is known regarding individuals with a history of AUD and their potential risk for pain diagnoses, pain prescriptions, and subsequent misuse. Moreover, the potential risk of pain diagnoses, prescriptions, and subsequent misuse among individuals with a history of AUD is not well known. The objective was to develop a tailored dataset by linking data from 2 New York State (NYS) administrative databases to investigate a series of hypotheses related to AUD and painful medical disorders. METHODS: Data from the NYS Office of Addiction Services and Supports (OASAS) Client Data System (CDS) and Medicaid claims data from the NYS Department of Health Medicaid Data Warehouse (MDW) were merged using a stepwise deterministic method. Multiple patient-level identifier combinations were applied to create linkage rules. We included patients aged 18 and older from the OASAS CDS who initially entered treatment with a primary substance use of alcohol and no use of opioids between January 1, 2003, and September 23, 2019. This cohort was then linked to corresponding Medicaid claims. RESULTS: A total of 177,685 individuals with a primary AUD problem and no opioid use history were included in the dataset. Of these, 37,346 (21.0%) patients had an OUD diagnosis, and 3,365 (1.9%) patients experienced an opioid overdose. There were 121,865 (68.6%) patients found to have a pain condition. CONCLUSION: The integrated database allows researchers to examine the associations among AUD, pain, and opioids/benzodiazepine use, and propose hypotheses to improve outcomes for at-risk patients. The findings of this study can contribute to the development of a prognostic prediction model and the analysis of longitudinal outcomes to improve the care of patients with AUD.

Parent Alcohol Use and Problems in Children's Alcohol-Related Learning and Subsequent Alcohol Use.

Background: Alcohol cognitions can emerge early in life and have lasting associations with alcohol use behavior. Observational learning theories suggest that witnessing alcohol use and its consequences may be an important mechanism underlying early development of alcohol cognitions. Parents are among the earliest contributors to children's alcohol-related learning, although findings regarding the association of parental alcohol use and problems with children's alcohol-related beliefs and attitudes are considerably mixed. This study tested associations of parent alcohol use and problems with adolescent alcohol expectancies, motives, and subsequent alcohol use to help clarify this literature. Methods: Families (N = 227) comprising family alcohol use disorder cases and demographically matched controls were recruited as part of a longitudinal investigation on child development. Parents reported on their alcohol use and problems at seven assessments throughout the index adolescents' childhood, and adolescents reported on their own alcohol expectancies in 6th grade, alcohol motives in 8th grade, and alcohol use in 12th grade. Results: Father alcohol problems and mother alcohol use were linked to more positive and less negative child alcohol expectancies, respectively. However, these cognitions did not contribute unique variance in adolescent alcohol use after accounting for additional risks included in the model. Conclusions: Findings highlight the need for future research aimed at modeling broader and potentially indirect sources of parent influences on adolescent alcohol-related learning and subsequent drinking behavior.

The Influence of Drinking Buddies: A Longitudinal Investigation of Drinking Motivations and Drinking Behaviors in Emerging Adults.

Background: Heavy alcohol consumption and frequent alcohol use are associated with many adverse social and physical consequences. The different motivations underlying why people drink predict different patterns of alcohol consumption. A drinking buddy (i.e. a friend with whom a person drinks alcohol) influences a person's drinking via social learning, leading to escalations in drinking over time. Purpose: Few studies have investigated drinking motives among peers and none have studied whether the drinking motives of a drinking buddy can influence another person's drinking behavior; we sought to fill that gap. Method: Same-sex drinking buddies (N = 174; 66.1% female) were assessed once monthly for four months using self-report questionnaires. Participants were on average 18.66 years-old (SD = 1.17). Results: Indistinguishable actor-partner interdependence models using multilevel path analysis were conducted, with each drinking motive predicting drinking frequency and quantity, respectively. There were significant actor effects for social, enhancement, conformity, and coping motives; moreover, the enhancement, social, and coping-anxiety motives of the drinking buddy influenced the individual's drinking frequency across the four months of the study. Conversely, only the enhancement motives of the buddy predicted drinking quantity in the individual when averaged across time. Sex was not a significant moderator of these effects. Importance: When targeting risky drinking behavior in a therapeutic context, assessing and addressing a person's reasons for drinking, as well as their drinking buddy's reasons for drinking, may reduce the risk of escalations in either friend's drinking frequency over time.

Does state self-control depletion predict relationship functioning and partner aggression? An ecological momentary assessment study of community couples.

Intimate relationship functioning depends upon the ability to accommodate one's partner and to inhibit retaliatory and aggressive impulses when disagreements arise. However, accommodation and inhibition may be difficult when self-control strength is weak or depleted by prior exertion of self-control. The present study considered whether state self-control depletion prospectively predicts male and female self-reports of anger with partner and arguing with partner. Consistent with the I3 Model (Finkel, 2014, Adv Exp Soc Psychol, 49, 1-104), we also considered whether the association between elevated anger and arguing (i.e., instigation) and partner aggression was stronger when state self-control (i.e., inhibition) was depleted or among people high in negative urgency. In this ecological momentary assessment (EMA) study, heavy drinking married and cohabiting heterosexual couples (N = 191) responded to three randomly signaled reports each day for 30 days. Depletion predicted anger and arguing with partners both cross-sectionally and prospectively for men and women. However, after controlling for prior levels of anger and arguing, these effects were diminished, and supplemental analyses revealed that anger and arguing with partner predicted subsequent depletion. Anger and arguing were strongly associated with concurrent reports of partner aggression perpetration and victimization (verbal and/or physical). However, neither state self-control depletion nor negative urgency moderated these effects. Overall, results suggest a modest impact of depletion on daily couple functioning as well as a potential cyclical effect of arguing on depletion.

A dyadic approach to attachment anxiety and avoidance, marital conflict, and drinking.

In this research, we integrate attachment theory and dyadic methodology to examine how attachment anxiety and avoidance might interact with marital conflict to influence alcohol consumption, drinking motives, and alcohol-related problems in a sample of 280 married and cohabiting couples over 3 years. Both husband and wife attachment anxiety were related to higher levels of own drinking to cope and alcohol-related problems. Additionally, both husband and wife reports of marital conflict were associated with own alcohol-related problems. For wives, significant interactions between anxiety and marital conflict suggested that anxiety was more strongly associated with alcohol consumption, coping, and problems at higher levels of conflict. For husbands, significant interactions between avoidance and conflict indicated that avoidance was more strongly associated with coping and problems at lower levels of conflict. This research suggests two main patterns of attachment and alcohol use, both exacerbated by marital conflict and different for husbands and wives.

Reforming medical education admission and training in low- and middle-income countries: who gets admitted and why it matters.

Recent studies reveal public-sector healthcare providers in low- and middle-income countries (LMICs) are frequently absent from work, solicit informal payments for service delivery, and engage in disrespectful or abusive treatment of patients. While extrinsic factors may foster and facilitate these negative practices, it is not often feasible to alter the external environment in low-resource settings. In contrast, healthcare professionals with strong intrinsic motivation and a desire to serve the needs of their community are less likely to engage in these negative behaviors and may draw upon internal incentives to deliver a high quality of care. Reforming medical education admission and training practices in LMICs is one promising strategy for increasing the prevalence of medical professionals with strong intrinsic motivation.

Prenatal Risk and Infant Regulation: Indirect Pathways via Fetal Growth and Maternal Prenatal Stress and Anger.

Pathways from maternal tobacco, marijuana, stress, and anger in pregnancy to infant reactivity and regulation (RR) at 9 months of infant age were examined in a low-income, diverse sample beginning in the first trimester of pregnancy, with fetal growth and postnatal stress/anger as potential mediators, and infant sex as a moderator. Participants were 247 dyads (173 substance-exposed infants). There were no direct effects of prenatal risk on RR and no moderation by sex. However, there were significant indirect effects on RR via poor fetal growth and higher postnatal anger. The study adds to the sparse literature on joint effects of tobacco and marijuana, and highlights the role of fetal growth and maternal anger as important pathways from prenatal risk to infant RR.

Etiology of Teen Dating Violence among Adolescent Children of Alcoholics.

Family processes in early life have been implicated in adolescent involvement in teen dating violence, yet the developmental pathways through which this occurs are not well understood. In this study, etiological pathways from parental psychopathology and marital conflict in infancy to involvement in dating violence in late adolescence were examined in a sample of children at high-risk due to parental alcohol problems. Families (N = 227) recruited when the child was 12 months of age were assessed at 12-, 24-, 36-months, kindergarten, 6th, 8th, and 12th grades. Slightly more than half of the children were female (51%) and the majority were of European American descent (91%). Parental psychopathology in infancy was indirectly associated with teen dating violence in late adolescence via low maternal warmth and self-regulation in early childhood, externalizing behavior from kindergarten to early adolescence, and sibling problems in middle childhood. Marital conflict was also indirectly associated with teen dating violence via child externalizing behavior. Maternal warmth and sensitivity in early childhood emerged as an important protective factor and was associated with reduced marital conflict and increased child self-regulation in the preschool years as well as increased parental monitoring in middle childhood and early adolescence. Family processes occurring in the preschool years and in middle childhood appear to be critical periods for creating conditions that contribute to dating violence risk in late adolescence. These findings underscore the need for early intervention and prevention with at-risk families.

Perfectionistic Concerns, Social Negativity, and Subjective Well-Being: A Test of the Social Disconnection Model.

Partner-specific perfectionistic concerns (PC) include concern over mistakes, self-criticism, and socially prescribed perfectionism as it pertains to one's partner. The social disconnection model proposes that PC influences well-being indirectly through interpersonal problems. Thus, we hypothesized that social negativity (expressed anger, hostility, and rejection) would mediate the relationship between dyadic PC and subjective well-being. Data from 203 romantic dyads (92.1% heterosexual) were collected using self-report surveys and a four-wave, 4-week longitudinal design. Participants were predominantly female (53.1%), young (M = 22.69 years), and Caucasian (82.3%). Data were analyzed using an actor-partner interdependence model with multilevel structural equation modeling. There were significant actor effects at the between-subjects and within-subjects levels, and significant partner effects for the relationship between PC and social negativity at the within-subject level. Social negativity mediated the relationships between PC and both negative affect and life satisfaction. However, positive affect was more weakly related to PC and social negativity. The social disconnection model was supported. PC was positively associated with one's own social negativity and evoked hostile behaviors from one's partner. Hostile, rejecting behaviors reduced the well-being of the actor, but not the partner. Results suggest perfectionism may be best understood within an interpersonal context.

Similarity in romantic couples' drinking motivations and drinking behaviors.

BACKGROUND: Research suggests that enhancement, conformity, social, coping-with-anxiety, and coping-with-depression drinking motives are linked to specific drinking outcomes in a theoretically expected manner. Social learning theory suggests that people who spend more time together emulate each other's behavior to acquire reinforcing outcomes. The present study sought to integrate drinking motives theory and social learning theory to investigate similarity in drinking behaviors and drinking motives in romantic couples. We hypothesized that couples would be more similar than chance in their drinking behaviors and motives. We also hypothesized that demographics reflecting time around and interactions with romantic partners (e.g., days spent drinking together) would positively correlate with similarity in drinking behaviors and motivations. METHODS: The present study tested hypotheses in 203 romantic couples. Participants completed a Timeline Follow-Back measure and the Modified Drinking Motives Questionnaire-Revised to track their alcohol use and drinking motives. Similarity profiles were calculated using McCrae's (J Pers Assess. 2008;90:105-109) coefficient of profile agreement, rpa. RESULTS: Couples were more similar in their drinking behavioral and motivational profiles than could be explained by chance. Days spent drinking together and days with face-to-face contact predicted increased similarity in drinking behavior profiles, but not similarity in drinking motives profiles. CONCLUSIONS: Results are partially consistent with social learning theory and suggest that social influences within couples could be important intervention targets to prevent escalations in drinking.

Modelling the multidimensional niche by linking functional traits to competitive performance.

Linking competitive outcomes to environmental conditions is necessary for understanding species' distributions and responses to environmental change. Despite this importance, generalizable approaches for predicting competitive outcomes across abiotic gradients are lacking, driven largely by the highly complex and context-dependent nature of biotic interactions. Here, we present and empirically test a novel niche model that uses functional traits to model the niche space of organisms and predict competitive outcomes of co-occurring populations across multiple resource gradients. The model makes no assumptions about the underlying mode of competition and instead applies to those settings where relative competitive ability across environments correlates with a quantifiable performance metric. To test the model, a series of controlled microcosm experiments were conducted using genetically related strains of a widespread microbe. The model identified trait microevolution and performance differences among strains, with the predicted competitive ability of each organism mapped across a two-dimensional carbon and nitrogen resource space. Areas of coexistence and competitive dominance between strains were identified,and the predicted competitive outcomes were validated in approximately 95% of the pairings. By linking trait variation to competitive ability, our work demonstrates a generalizable approach for predicting and modelling competitive outcomes across changing environmental contexts.

Levetiracetam, Calcium Antagonism, and Bipolar Disorder.

Hyperactive intracellular calcium ion (Ca) signaling in peripheral cells has been a reliable finding in bipolar disorder. Some established mood stabilizing medications, such as lithium and carbamazepine, have been found to normalize elevated intracellular Ca concentrations ([Ca]i) in platelets and lymphocytes from bipolar disorder patients, and some medications the primary effect of which is to attenuate increased [Ca]i have been reported to have mood stabilizing properties.Hyperactive intracellular Ca signaling has also been implicated in epilepsy, and some anticonvulsants have calcium antagonist properties. This study demonstrated that levetiracetam, an anticonvulsant that has been shown to block N and P/Q-type calcium channels in animal studies does not alter elevated [Ca]i in blood platelets of patients with bipolar disorder. Review of published clinical trials revealed no controlled evidence of efficacy as a mood stabilizer.This study underscores the possibility that pharmacologic actions of a medication in animals and normal subjects may not necessarily predict its pharmacologic or clinical effects in actual patients. Effects of treatments on pathophysiology that is demonstrated in clinical subtypes may be more likely to predict effectiveness in those subtypes than choosing medications based on structural similarities to established treatments.

Correlates of ever having used electronic cigarettes among older adolescent children of alcoholic fathers.

INTRODUCTION: Few studies have examined predictors of ever having used electronic cigarettes (or e-cigarettes) among older adolescents. This study examined correlates of ever having used e-cigarettes among adolescent children of alcoholic fathers. METHODS: Participants were 136 adolescents (50.7% male, 89.4% European American) from an ongoing longitudinal case-control study of children of alcoholic fathers. Adolescents reported on their mother's and father's parenting during middle adolescence (MA; M age = 13.8) and completed measures of their own, as well as their peers', substance use during late adolescence (LA; M age = 17.0). Parents completed measures of their own substance use at the MA assessment. RESULTS: More than one third (36.9%) of the participants reported ever using e-cigarettes. Parental monitoring during MA (odds ratio [OR] = 0.85, p < .05), lifetime use of cigarettes (OR = 3.88, p < .01), alcohol use (OR = 7.72, p < .05), marijuana use (OR = 4.07, p < .01), and peer substance use (OR = 1.34, p < .05) during LA were each uniquely associated with ever having used e-cigarettes. Ever having used e-cigarettes also was associated with more frequent current cigarette use (ß = .38, p < .05), alcohol use (ß = .30, p < .01), and marijuana use (ß = .31, p < .05). CONCLUSIONS: Results suggest that ever having used e-cigarettes in LA is a risk marker for substance use. Interventions to promote parental monitoring may be effective in curbing use of e-cigarettes and other substances in LA.

Daily associations among self-control, heavy episodic drinking, and relationship functioning: an examination of actor and partner effects.

An emerging literature suggests that temporary deficits in the ability to inhibit impulsive urges may be proximally associated with intimate partner aggression. The current study examined the experience of alcohol use and the depletion of self-control in the prediction of relationship functioning. Daily diary data collected from 118 heterosexual couples were analyzed using parallel multi-level Actor-Partner Interdependence Models to assess the effects of heavy episodic drinking and depletion of self-control across partners on outcomes of participant-reported daily arguing with and anger toward an intimate partner. Heavy episodic drinking among actors predicted greater arguing but failed to interact with either actor or partner depletion. We also found that greater arguing was reported on days of high congruent actor and partner depletion. Both actor and partner depletion, as well as their interaction, predicted greater partner-specific anger. The current results highlight the importance of independently assessing partner effects (i.e., depletion of self-control), which interact dynamically with disinhibiting actor effects, in the prediction of daily adverse relationship functioning. Results offer further support for the development of prospective individualized and couples-based interventions for partner conflict.

Characteristics of Patients Presenting at an Emergency Department for a Heroin Overdose vs Detoxification.

Purpose: This study compares substance use, treatment histories, and sociodemographic characteristics of patients presenting to an emergency department (ED) following a heroin overdose or seeking detoxification services for heroin and examines risk factors for a subsequent return to the ED for a substance-related problem. Methods: A convenience sample of patients presenting for an overdose or detoxification at an urban teaching ED was recruited for this study. During their ED visit, patients were interviewed regarding demographics, substance use experiences, and treatment history. Subsequently, a review of patient records for past and subsequent ED use was performed. Results: Patients requesting detox and those with an overdose were similar in terms of prior treatment. Both groups had similar extensive polysubstance histories. As a group, however, patients presenting for detox were more likely to report use of each of three substances (benzodiazepines, opioid pain medications, and heroin) more than three times per week, compared to those presenting for overdose. Detox patients had higher scores on the 3-item Alcohol Use Disorder Identification Test-C and the drug problems scale compared to overdose patients. Overall, 28% of the patients returned to the ED within 90 days for a drug-related issue, including 8% that returned for an overdose. Factors predictive of a return ED visit included ED visits for substance use in the previous year and recent frequent heroin use. Conclusion: Patients requesting detox were similar in most domains to those presenting following an overdose. Notably, overdose patients were less likely to use heroin more than three times per week compared to detox patients. Both groups were equally likely to return for an SUD reason within 3-months, however for both groups, previous ED visits and recent frequent heroin use predicted a return visit.

High-risk use of prescription opioids among patients treated for alcohol problems in New York State. A repeated cross-sectional study, 2005-2018.

Background: Patients with alcohol use disorder (AUD) and high-risk opioid use are at risk of serious complications. The purpose of this study was to estimate the prevalence of and factors associated with high-risk opioid use in patients with an alcohol use problem from 2005 to 2018. Methods: This repeated cross-sectional study analyzed data from first admissions for alcohol treatment (2005-2018) to the NYS Office of Addiction Services and Supports merged with Medicaid Claims Data. High-risk opioid use was defined as opioid dose ≥50 morphine mg equivalents (MME) per day; opioid prescriptions overlapping ≥7 days; opioids for chronic pain >90 days or opioids for acute pain >7 days. Results: Patients receiving ≥50 MME increased from 690 to 3226 from 2005 to 2010; then decreased to 2330 in 2018. From 2005-2011, patients with opioid prescriptions overlapping ≥7 days increased from 226 to 1594 then decreased to 892 in 2018. From 2005-2010, opioid use >7 days for acute pain increased from 133 to 970 and plateaued after 2010. From 2005-2018, patients who received opioids >90 days for chronic pain trended from 186 to 1655. White patients, females, age 36-55, patients with chronic and acute pain diagnoses had the highest rates of high-risk use. Conclusions: The prevalence of high-risk opioid use in patients with alcohol use problems increased from 2005 to 2011, and generally decreased after 2010. However, prevalence of opioids >90 days for chronic pain trended up from 2005 to 2018. High-risk opioid use among patients with AUD emphasizes the need to develop interventional strategies to improve patient care.