Exploring Racial/Ethnic Disparities in Substance Dependence and Serious Psychological Distress among US Veterans.

OBJECTIVES: There are substantial racial/ethnic disparities in substance use and mental health among civilian populations, but few studies have examined these disparities in veterans using a nationally representative sample. Thus, we examined differences in substance dependence and serious psychological distress (SPD) by race/ethnicity among a national sample of US veterans. METHODS: We pooled cross-sectional data from the 2015-2019 waves of the National Survey on Drug Use and Health (N = 7,653 veterans aged 18-64 years). Regression models were utilized to examine racial/ethnic differences in DSM-IV substance dependence and SPD with a Benjamini-Hochberg correction applied. RESULTS: Compared to non-Hispanic White veterans: American Indian/Alaska Native veterans had significantly higher odds of past-year alcohol dependence (AOR = 2.55, 95% CI: 1.28, 5.08); Asian American veterans had significantly lower odds of past-year alcohol dependence (AOR = 0.12, 95% CI: 0.02, 0.62); non-Hispanic Black (AOR = 0.60, 95% CI: 0.48, 0.77), Hispanic (AOR = 0.47, 95% CI: 0.34, 0.65), and veterans of more than one race (AOR = 0.55, 95% CI: 0.36, 0.83) had significantly lower odds of past-month nicotine dependence; Asian American veterans had significantly lower odds of past-year illicit drug dependence (AOR = 0.05, 95% CI: 0.01, 0.35); and non-Hispanic Black veterans had significantly lower odds of past-year SPD (AOR = 0.69, 95% CI: 0.55, 0.85) after correction for multiple comparisons. CONCLUSION: Overall, racial/ethnic disparities in substance dependence and SPD among veterans are not as stark as in civilian populations, but some disparities remain.

Assessing the European impact of alcohol misuse and illicit drug dependence research: clinical practice guidelines and evidence-base policy.

BACKGROUND: Despite alcohol and illicit drug dependence being one of the most common diagnoses in Europe, there is heterogeneity of research evidence used in policy and practice. OBJECTIVE: We sought to (1) evaluate European research outputs on alcohol misuse and drug addiction in 2002-2018 in the Web of Science, (2) compare these with their burden of disease and (3) determine their impact in several ways. METHODS: A bibliometric research was undertaken including an assessment of the citation counts, the influence of research on members of national health advisory committees, and their contribution to the evidence base of clinical practice guidelines (CPGs). FINDINGS: There were 3201 analysed references cited in 28 CPGs across 11 European Countries on alcohol misuse and illicit drug abuse. Research conducted in the USA dominated both sets of CPGs, while many European countries were overcited relative to their research presence. The illicit drug research appeared to be adequate relative to the evidence of harm in Europe. However, alcohol misuse research appeared grossly inadequate to the harm it causes by a factor of 20. CONCLUSIONS: The volume of research on illicit drug addiction is commensurate to the European burden, whereas alcohol misuse is far below what is needed to curb a significant source of harm. CLINICAL IMPLICATIONS: The research asymmetries call for attention to the causes of the problem. Development of research-based solutions to a serious social harm is needed, including minimum pricing and collaborative work to harmonise efforts on disease management and treatment practices across European countries.

Identifying Priority Areas for Increasing the Supply of Medication-Assisted Treatments for Opioid Use Disorder: A Geospatial Approach.

BACKGROUND: The opioid epidemic has disproportionately affected several areas across the United States (US), with research indicating that these areas may be underserved and lack access to sufficient medication-assisted treatment (MAT) options. The objective of this study was to introduce a geospatial analytical framework for identifying sub-state priority areas to target federal allocation of MAT training and resources. METHODS: We used a geospatial analytical framework, which integrated multiple substance use measures and layers of geographic information. Measures included estimates of illicit drug dependence and unmet treatment need from the National Survey on Drug Use and Health (NSDUH), opioid-related admissions from the Treatment Episode Data Set: Admissions (TEDs-A), and Drug Enforcement Agency (DEA) waiver practitioner data from the Substance Abuse and Mental Health Services Administration (SAMHSA). Analyses included standard deviation outlier mapping, local indicators of spatial autocorrelation (LISA), and map overlays. RESULTS: We identified twenty-nine opioid dependence priority areas, eleven unmet treatment need priority areas, and seven low MAT capacity priority areas, located across the US, including southeastern Ohio, western Indiana, the District of Columbia, New England, and northern and southern California. CONCLUSIONS: This study identified several areas across the US that have unmet need for MAT. Targeting these areas will allow for the most effective deployment of cost-effective MAT resources to aid the greatest number of patients with opioid use disorders.