humulene and Opioid-Related-Disorders

Cannabis use in the United States is growing at an unprecedented pace. Most states in the United States have legalized medical cannabis use, and many have legalized nonmedical cannabis use. In this setting, health care professionals will increasingly see more patients who have questions about cannabis use, its utility for medical conditions, and the risks of its use. This narrative review provides an overview of the background, pharmacology, therapeutic use, and potential complications of cannabis.

Topics: Adult; Cachexia; Cannabis; Endocannabinoids; Female; Health Personnel; Humans; Legislation, Drug; Male; Medical Marijuana; Nausea; Neurobiology; Opioid-Related Disorders; Seizures; Severity of Illness Index; Somatoform Disorders; Spasm; Stress Disorders, Post-Traumatic; United States

The idea that cannabis is a 'gateway drug' to more harmful substances such as opioids is highly controversial, yet has substantially impacted policy, education and how we conceptualize substance use. Given a rise in access to cannabis products and opioid-related harm, the current study aimed to conduct the first systematic review and meta-analysis on the likelihood of transitioning from cannabis use to subsequent first-time opioid use, opioid use disorders (OUD), dependence or abuse.. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, pubMed/MEDLINE, Scopus, EMBASE, PsychINFO, Cochrane Central Register of Controlled Trials and Informit Health Collection were searched for full-text articles assessing the likelihood of transitioning from cannabis to subsequent opioid use, and from opioid use to OUD, abuse or dependence given prior cannabis use. Analysis of subpopulations within studies were discussed narratively, and E-values were calculated to assess the potential influence of unmeasured confounding.. Six studies provided relevant data from the United States, Australia and New Zealand between 1977 and 2017, a total sample of 102 461 participants. Random-effects analysis of the adjusted pooled effect size indicates that the likelihood of transitioning from cannabis to opioid use, relative to non-cannabis users, is odds ratio (OR) = 2.76, 95% confidence interval (CI) = 2.26-3.36, whereas the likelihood of transitioning from opioid use to OUD, abuse or dependence given prior cannabis use is OR = 2.52, 95% CI = 1.65-3.84. While the evidence was determined to be of low quality with moderate risk of bias, E-values suggest that these findings are robust against unmeasured confounding.. A systematic review and meta-analysis found that while people who use cannabis are disproportionately more likely to initiate opioid use and engage in problematic patterns of use than people who do not use cannabis, the low quality of the evidence must be considered when interpreting these findings.

Topics: Analgesics, Opioid; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Opioid-Related Disorders

Several meta-analyses of observational studies have addressed the association between risk and protective factors and cannabis/cocaine/opioid use disorders, but results are conflicting. No umbrella review has ever graded the credibility of this evidence (not significant/weak/suggestive/highly suggestive/convincing). We searched Pubmed-MEDLINE/PsycInfo, last search September 21, 2020. We assessed the quality of meta-analyses with the AMSTAR-2 tool. Out of 3,072 initial references, five were included, providing 19 associations between 12 putative risk/protective factors and cannabis/cocaine/opioid use disorders (cases: 4539; N = 1,118,872,721). While 84 % of the associations were statistically significant, none was convincing. One risk factor (smoking) had highly suggestive evidence for association with nonmedical use of prescription opioid medicines (OR = 3.07, 95 %CI:2.27 to 4.14). Convincing evidence emerged in sensitivity analyses on antisocial behavior and cannabis use disoder (OR 3.34, 95 %CI 2.53-4.41). Remaining associations had weak evidence. The quality of meta-analyses was rated as moderate in two (40 %), low in one (20 %), and critically low in two (40 %). Future research is needed to better profile risk/protective factors for cannabis/cocaine/opioid use disorders disorders informing preventive approaches.

Topics: Cannabis; Cocaine; Humans; Meta-Analysis as Topic; Observational Studies as Topic; Opioid-Related Disorders; Protective Factors; Risk Factors

Topics: Analgesics, Opioid; Cannabis; Humans; Opioid-Related Disorders; Retrospective Studies; Urinalysis

Despite high rates of cannabis use during medication-based treatment of opioid use disorder (MOUD), uncertainty remains around how cannabis influences treatment outcomes. We sought to investigate the relationship between cannabis use during MOUD and a number of patient outcomes. We searched seven databases for original peer-reviewed studies documenting the relationship between cannabis use and at least one primary outcome (opioid use, treatment adherence, or treatment retention) among patients enrolled in methadone-, buprenorphine-, or naltrexone-based therapy for OUD. In total, 41 articles (including 23 methadone, 7 buprenorphine, 6 naltrexone, and 5 mixed modalities) were included in this review. For each primary outcome area, there was a small number of studies that produced findings suggestive of a supportive or detrimental role of concurrent cannabis use, but the majority of studies reported that cannabis use was not statistically significantly associated with the outcome. No studies of naltrexone treatment demonstrated significantly worse outcomes for cannabis users. We identified methodological shortcomings and future research priorities, including exploring the potential role of adjunct cannabis use for improving opioid craving and withdrawal during MOUD. While monitoring for cannabis use may help guide clinicians towards an improved treatment plan, cannabis use is unlikely to independently threaten treatment outcomes.

Topics: Buprenorphine; Cannabis; Humans; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders

Cannabis use has become increasingly common in the U.S. in recent years, with legalization for medical and recreational purposes expanding to more states. With this increase in use and access, providers should be prepared to have more conversations with patients about use. This review provides an overview of cannabis terminology, pharmacology, benefits, harms, and risk mitigation strategies to help providers engage in these discussions with their patients. Current evidence for the medical use of cannabis, cannabis-related diagnoses including cannabis use disorder (CUD) and withdrawal syndromes, and the co-use of opioids and cannabis are discussed. It is crucial that providers have the tools and information they need to deliver consistent, evidence-based assessment, treatment, prevention and harm-reduction, and we offer practical guidance in these areas.

Topics: Cannabis; Communication; Drug Administration Routes; Humans; Marijuana Abuse; Medical Marijuana; Opioid-Related Disorders; Primary Health Care; Professional-Patient Relations; Substance Withdrawal Syndrome; Synthetic Drugs; United States

In 2016, the actuality for addictions in this edition addresses four points. Social neurosciences of addiction are of great importance regarding the vulnerabilities for addiction and for the recovery. Deep brain stimulation is emerging in the therapeutic panel coming from the clinical neurosciences for the addictions. Novelties in opioid agonists for the treatment of opiates dependence, with the apparition in the Swiss market of release morphine and of levomethadone. Cannabis and prison, a pilot study for the maintenance of abstinence in prison.. En 2016, l’actualité des addictions pour ce numéro concerne quatre points. Les neurosciences sociales de l’addiction, qui ont une grande importance en termes de vulnérabilité pour l’addiction mais aussi pour le rétablissement. La stimulation cérébrale profonde qui fait son apparition dans l’éventail thérapeutique issu des neurosciences cliniques pour les addictions. Les nouveautés du traitement agoniste opioïde de la dépendance aux opiacés avec l’apparition dans le marché suisse de la morphine retard puis de la lévométhadone. Des algorithmes sont proposés pour orienter le prescripteur. Cannabis et prison, une étude pilote pour le maintien de l’abstinence en prison.

Topics: Behavior, Addictive; Cannabis; Humans; Neurosciences; Opioid-Related Disorders; Prisons; Substance-Related Disorders

Marijuana is becoming legal in an increasing number of states for both medical and recreational use. Considerable controversy exists regarding the public health impact of these changes. The evidence for the legitimate medical use of marijuana or cannabinoids is limited to a few indications, notably HIV/AIDS cachexia, nausea/vomiting related to chemotherapy, neuropathic pain, and spasticity in multiple sclerosis. Although cannabinoids show therapeutic promise in other areas, robust clinical evidence is still lacking. The relationship between legalization and prevalence is still unknown. Although states where marijuana use is legal have higher rates of use than nonlegal states, these higher rates were generally found even prior to legalization. As states continue to proceed with legalization for both medical and recreational use, certain public health issues have become increasingly relevant, including the effects of acute marijuana intoxication on driving abilities, unintentional ingestion of marijuana products by children, the relationship between marijuana and opioid use, and whether there will be an increase in health problems related to marijuana use, such as dependence/addiction, psychosis, and pulmonary disorders. In light of this rapidly shifting legal landscape, more research is urgently needed to better understand the impact of legalization on public health.

Topics: Automobile Driving; Cannabis; Cognition Disorders; Dronabinol; Humans; Illicit Drugs; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Opioid-Related Disorders; Prevalence; Psychotic Disorders; Public Health; United States

This article reviews neuropsychological performance in frequent users of cocaine, (meth)amphetamines, ecstasy, opiates, alcohol, and cannabis. We searched the scientific literature published in the last five years, focusing on studies that required at least 2 weeks of abstinence from drug use, and included a control group. All substances of abuse, except cannabis, were associated with sustained deficits in executive functioning, especially inhibition. In addition, verbal memory decrements were consistently found in cocaine, (meth)amphetamines and ecstasy users, but not in heroin or cannabis users. More specific executive functioning deficits were reported depending on the substance of abuse. Cocaine was associated with diminished cognitive flexibility, whereas (meth)amphetamines were associated with worse cognitive planning functions compared to controls. Opiate studies showed lower scores on verbal fluency in opiate dependent subjects compared to controls. Working memory and visuospatial abilities were compromised in alcohol abusers. In ecstasy users, inconsistent findings have been reported across neuropsychological domains, with the exception of inhibition and verbal memory. There was little evidence for sustained cognitive impairments in adult abstinent cannabis users. Recognition of neuropsychological problems related to different substances can help to select subjects that will benefit most from treatment. Furthermore, a better understanding of the neuropsychological impairments in drug abusing individuals could help to explain the remitting course of substance abuse disorders and to improve psychological interventions.

Topics: Alcoholism; Amphetamine-Related Disorders; Cannabis; Central Nervous System Stimulants; Cocaine; Cocaine-Related Disorders; Drug Users; Hallucinogens; Heroin Dependence; Humans; Marijuana Abuse; Memory Disorders; Methadone; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; Neuropsychological Tests; Opioid-Related Disorders; Psychomotor Performance; Recognition, Psychology; Substance-Related Disorders; Verbal Behavior

Cannabis is the most widely consumed illicit drug in the United States. Its use, particularly in early initiates, is associated with subsequent development of other drug and alcohol use disorders.. The authors examined the prevalence of cannabis use and the association between cannabis use and aberrant opioid-related behaviors in patients prescribed chronic opioid therapy for persistent pain.. PubMed was queried for studies of chronic opioid therapy in which aberrant opioid-related behaviors were quantitatively examined and in which cannabis use data (as determined by cannabinoid-positive urine drug tests) were extricable from that of other substances of abuse.. The prevalence of cannabis use among patients prescribed chronic opioid therapy in these studies ranged from 6.2% to 39%, compared with 5.8% in the general United States population. Furthermore, cannabis use in chronic opioid patients shows statistically significant associations with present and future aberrant opioid-related behaviors.. Cannabis use is prevalent in patients prescribed chronic opioid therapy and is associated with opioid misuse. Further research is necessary to clarify the strength and the nature of the association between cannabis use and opioid misuse, and to address additional questions about the consequences of cannabis use in the context of chronic opioid therapy.

Topics: Analgesics, Opioid; Cannabis; Chronic Disease; Comorbidity; Drug Prescriptions; Humans; Marijuana Abuse; Opioid-Related Disorders; Pain, Intractable; Prevalence; United States

Very little addiction treatment research has been done concerning smoking cessation, illicit drugs, or even alcohol abuse in liver transplant patients. Our data suggest that a surprising number of patients who are awaiting a liver transplant for alcohol-related end-stage liver disease will return to drinking before transplantation. We found that motivational enhancement therapy afforded no marked benefit over treatment as usual for drinking, smoking, mood, or general health outcomes in alcoholics awaiting liver transplantation. Stably abstinent methadone-maintained opiate-dependent patients should not be tapered off methadone; are generally good candidates for liver transplant; show low relapse rates into illicit use of opiates; and may be at risk for more medical complications than their counterparts. Pre- and posttransplantation smoking rates are high and cause marked morbidity and mortality. Transplant teams should encourage smoking cessation treatments.Marijuana use in liver transplant recipients is not uncommon, and apart from the risk of developing aspergillosis, additional health risks have not yet been identified.

Topics: Alcoholism; Analgesics, Opioid; Behavior, Addictive; Cannabis; Humans; Liver Diseases; Liver Transplantation; Opioid-Related Disorders; Pain Management; Tobacco Use Disorder

Topics: Cannabis; Cocaine; Humans; Lung Diseases; Narcotics; Opioid-Related Disorders; Substance-Related Disorders

When a patient presents a neurological disorder, it is important to consider drugs is a possible cause. The risk to suffer neurological complications by drugs is unknown. It is difficult to calculate the number of drug addicts or the number of occasional drug users. It is important take into account that some patients are using more than one drug. The acute use of cannabis induces important changes in cognition and psychomotor performance. No signs of neurotoxicity were found in chronic marihuana users. Some "designer drugs" can induce neurotoxicity. MDMA, that have hallucinogenic activity, is a neurotoxin in animals. MPTP kill dopaminergic neurons in the substantia nigra, inducing Parkinson's disease. Volatile substances containing toluene or n-hexane are usually abused by young people. They can produce neurological damage when are used chronically (p. ex. cerebral atrophy or peripheral neuropathies).

Topics: Cannabis; Designer Drugs; Humans; Nervous System Diseases; Opioid-Related Disorders; Phenethylamines; Solvents; Substance-Related Disorders

Self-report measures are important in substance use assessment, yet they are susceptible to reporting errors. Urine drug screens (UDS) are often considered a more valid alternative. However, collecting in-person UDS may not always be feasible, contributing to the need to understand factors that influence the validity of self-reported substance use.. In this secondary analysis of data from 295 women with co-occurring PTSD and substance use disorders (SUD) who participated in a clinical trial testing behavioral interventions, we examined concordance and discordance between self-reported drug use and associated UDS results. Generalized linear mixed models were used to examine the impact of treatment type and participant characteristics on the associations between self-reported drug use and UDS results.. Findings revealed higher disagreement between self-report and UDS for opioids and sedatives (ranging from.77 to.90) and lower disagreement rates for cannabis and cocaine (ranging from.26 to.33). Treatment type was not a significant moderator of the associations between self-report and UDS across all drugs. Among those with a positive opioid UDS, those who reported employment in the past three years were more likely to self-report no opioid use compared to their counterparts without employment in the past three years.. Findings add to the literature that supports the validity of self-reported cannabis and cocaine use. The greater discrepancies between self-report and UDS test results of opioids and sedatives suggest adjunctive UDS may be required, although a variety of factors other than inaccurate self-report may be associated with this discrepancy.

Topics: Analgesics, Opioid; Cannabis; Cocaine; Female; Humans; Hypnotics and Sedatives; Opioid-Related Disorders; Self Report; Stress Disorders, Post-Traumatic; Substance Abuse Detection; Substance-Related Disorders

Conflictual evidence exists regarding the effects of cannabis use on the outcomes of opioid agonist therapy (OAT). In this exploratory analysis, we examined the effect of recent cannabis use on opioid use, craving, and withdrawal symptoms, in individuals participating in a trial comparing flexible buprenorphine/naloxone (BUP/NX) take-home dosing model to witnessed ingestion of methadone.. We analyzed data from a multi-centric, pragmatic, 24-week, open label, randomized controlled trial in individuals with prescription-type opioid use disorder (n = 272), randomly assigned to BUP/NX (n = 138) or methadone (n = 134). The study measured last week cannabis and opioid use via timeline-follow back, recorded at baseline and every two weeks during the study. Craving symptoms were measured using the Brief Substance Craving Scale at baseline, and weeks 2, 6, 10, 14, 18 and 22. The study measured opioid withdrawal symptoms via Clinical Opiate Withdrawal Scale at treatment initiation and weeks 2, 4, and 6.. The mean maximum dose taken during the study was 17.3 mg/day (range = 0.5-32 mg/day) for BUP/NX group and 67.7 mg/day (range = 10-170 mg/day) in the methadone group. Repeated measures generalized linear mixed models demonstrated that cannabis use in the last week (mean of 2.3 days) was not significantly associated with last week opioid use (aβ ± standard error (SE) = -0.06 ± 0.04; p = 0.15), craving (aβ ± SE = -0.05 ± 0.08, p = 0.49), or withdrawal symptoms (aβ ± SE = 0.09 ± 0.1, p = 0.36). Bayes factor (BF) for each of the tested models supported the null hypothesis (BF < 0.3).. The current study did not demonstrate a statistically significant effect of cannabis use on outcomes of interest in the context of a pragmatic randomized-controlled trial. These findings replicated previous results reporting no effect of cannabis use on opioid-related outcomes.

Topics: Analgesics, Opioid; Bayes Theorem; Buprenorphine; Buprenorphine, Naloxone Drug Combination; Cannabis; Humans; Methadone; Narcotic Antagonists; Opiate Substitution Treatment; Opioid-Related Disorders; Substance Withdrawal Syndrome

Chronic, non-cancer pain impacts approximately 50 million adults in the USA (20%), approximately 25% of whom receive chronic prescription opioids for pain despite limited empirical efficacy data and strong dose-related risk for opioid use disorder and opioid overdose. Also despite lack of efficacy data, there are many reports of people using cannabis products to manage chronic pain and replace or reduce chronic opioids. Here we describe the protocol for a randomised trial of the effect of cannabis, when added to a behavioural pain management and prescription opioid taper support programme, on opioid utilisation, pain intensity and pain interference.. This is a pragmatic, single-blind, randomised, wait-list controlled trial that aims to enrol 250 adults taking prescription opioids at stable doses of ≥25 morphine milligram equivalents per day for chronic non-cancer pain who express interest in using cannabis to reduce their pain, their opioid dose or both. All participants will be offered a weekly, 24-session Prescription Opioid Taper Support group behavioural pain management intervention. Participants will be randomly assigned in 1:1 ratio to use cannabis products, primarily from commercial cannabis dispensaries or to abstain from cannabis use for 6 months. Coprimary outcomes are change in prescription monitoring programme-verified opioid dose and change in Pain, Enjoyment, General Activity scale scores. Secondary outcomes include quality of life, depression, anxiety, self-reported opioid dose and opioid and cannabis use disorder symptoms. All other outcomes will be exploratory. We will record adverse events.. This study has ethical approval by the Massachusetts General Brigham Institutional Review Board (#2021P000871). Results will be published in peer-reviewed journals and presented at national conferences.. NCT04827992.

Topics: Adult; Analgesics, Opioid; Cannabinoid Receptor Agonists; Cannabis; Chronic Pain; Drug Tapering; Humans; Opioid-Related Disorders; Pragmatic Clinical Trials as Topic; Prescriptions; Quality of Life; Randomized Controlled Trials as Topic; Single-Blind Method

The main question addressed by this paper is whether DSM-IV substance dependence diagnoses obtained from two different instruments (the semi-structured WHO Schedules for Clinical Assessment in Neuropsychiatry, SCAN and the highly structured WHO Composite International Diagnostic Interview--Substance Abuse Module, SAM) are as consistent as diagnoses obtained from a single instrument (SAM) administered twice. Such comparisons of results from the two different instruments provide some measure of validity of the lay-administered SAM and of the underlying diagnostic concepts. Chance-corrected concordance was estimated using the kappa coefficient for SAM/SCAN (test/validation) and SAM/SAM (test/retest) comparisons. Analyses of agreement between SAM and SCAN for DSM-IV dependence diagnoses indicated good agreement for alcohol and cocaine, and fair agreement for opiates and cannabis. SAM/SAM (test/retest) agreement was excellent for alcohol and opiate dependence, good for cocaine dependence, and fair for cannabis dependence. Agreement on individual dependence criteria was generally consistent with overall diagnostic agreement though more variable. Notable was the poor agreement for cannabis criteria in the SAM/SCAN protocol. This may indicate that the dependence syndrome is less applicable to cannabis, while the consistency of agreement for alcohol, opiate, and cocaine dependence criteria supports the validity of these dependence syndromes. Finally, these data indicate that both the clinical (SCAN) and non-clinical (SAM) interviews can be used effectively for a variety of substances and dependence diagnoses.

Topics: Adolescent; Adult; Cannabis; Cocaine; Female; Humans; Male; Narcotics; Opioid-Related Disorders; Psychiatric Status Rating Scales; Reproducibility of Results; Substance-Related Disorders

The purpose of this study was to examine the influence of preoperative marijuana use on postoperative opioid use during the first three postoperative days (POD 1-3) after surgery, and on expectations of pain control, resiliency, and quality-of-life scores.. All patients presenting to a single institution undergoing elective hand or upper extremity outpatient surgery were asked to complete pre- and postoperative questionnaires. Preoperative questionnaires collected information on demographics, marijuana use, tobacco use, procedure type, self-assessed health, pain control expectations, and EuroQol-5D (EQ-5D) scores. At the first postoperative visit, patients self-reported opioid consumption from POD 1-3. Multivariate linear regression analysis was used to determine which patient characteristics were predictive of greater postoperative opioid consumption during POD 1-3.. Self-reported marijuana users were younger, less healthy, and more likely to use tobacco compared to non-users. Marijuana users and non-users were comparable in their use of pain medication (including non-opioids), rates of chronic pain diagnoses, and self-reported pain tolerance. EQ-5D scores were lower in marijuana users than non-users (0.64 vs. 0.72). Marijuana users and non-users were prescribed comparable quantities of opioids during the first 14 days after surgery (176 ± 148 vs 115 ± 87). Multiple linear regression analysis revealed that lower preoperative EQ-5D scores, rather than marijuana use, were associated with increased opioid consumption during POD 1-3.. Preoperative marijuana use was not independently associated with increased opioid use during POD 1-3 after elective hand and upper extremity surgery; instead, an association with lower preoperative EQ-5D scores was identified.. II, prospective cohort study.

Topics: Analgesics, Opioid; Cannabis; Hand; Humans; Opioid-Related Disorders; Pain, Postoperative; Prospective Studies; Self Report; Upper Extremity

The recreational and medical use of cannabis is being legalized worldwide. Its use has been linked to an increased risk of developing opioid use disorders. As opioids continue to be prescribed after total hip arthroplasty (THA), the influence that preoperative cannabis use may have on postoperative opioid consumption remains unknown. The purpose of this study was to assess the relationship between preoperative cannabis use and opioid utilization following primary THA.. We identified all patients over the age of 18 who underwent unilateral, primary THA for a diagnosis of osteoarthritis at a single institution from February 2019 to April 2021. Our cohort was grouped into current cannabis users (within 6 months of surgery) and those who reported never using cannabis. One hundred and fifty-six current users were propensity score matched 1:6 with 936 never users based on age, sex, BMI, history of chronic pain, smoking status, history of anxiety/depression, ASA classification and type of anesthesia. Outcomes included inpatient and postdischarge opioid use in morphine milligram equivalents.. Total inpatient opioid utilization, opioids refilled, and total opioids used within 90 postoperative days were similar between the groups.. In propensity score matched analyses, preoperative cannabis use was not independently associated with an increase in inpatient or outpatient, 90-days opioid consumption following elective THA.

Topics: Adult; Aftercare; Analgesics, Opioid; Arthroplasty, Replacement, Hip; Cannabis; Humans; Middle Aged; Opioid-Related Disorders; Pain, Postoperative; Patient Discharge; Retrospective Studies

Illicit substance use is common among people entering prisons, as is returning to substance use after release from prison. We aimed to assess the predictive validity of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for returning to substance use after release from prison.. A longitudinal design with baseline survey conducted between 2008 and 2010 in the 6 weeks before expected prison release and up to three follow-up surveys in the 6 months after release.. Prisons in Queensland, Australia.. A total of 1054 adults within 6 weeks of expected release from prison.. The ASSIST was used to assess problematic use of cannabis, methamphetamine, heroin and other non-prescribed opioids in the 3 months before incarceration. Post-incarceration substance use was measured at 1, 3 and 6 months after release. We calculated the area under the receiver operating characteristic curve (AUROC) and the optimal ASSIST cut-off score for each substance, using Youden's index (J).. Forty-one per cent (n = 434) of the cohort reported any substance use during follow-up: 33% (n = 344) used cannabis, 20% (n = 209) methamphetamine, 10% (n = 109) heroin and 9% (n = 97) illicit other opioids. The optimal ASSIST cut-off score was ≥ 4 for heroin, methamphetamine and cannabis and ≥ 1 for other opioids. Using these cut-offs, the AUROC was highest for heroin in predicting both any use (AUROC = 0.82) and weekly use (AUROC = 0.88) in the past 4 weeks. AUROCs for other drugs ranged from 0.73 to 0.79.. The ASSIST shows promise as an accurate and potentially scalable tool that may be useful for predicting a return to substance use after release from prison and could inform service delivery. The substantial rates of returning to substance use after release from prison suggest that prison serves to interrupt rather than cease substance use.

Topics: Adult; Analgesics, Opioid; Cannabis; Heroin; Humans; Methamphetamine; Opioid-Related Disorders; Prisoners; Prisons; Smoking

The opioid epidemic is a significant public health concern, particularly among adults with chronic pain. There are high rates of cannabis co-use among these individuals and co-use is related to worse opioid-related outcomes. Yet, little work has examined mechanisms underlying this relationship. In line with affective processing models of substance use, it is possible that those who use multiple substances do so in a maladaptive attempt to cope with psychological distress.. We tested whether, among adults with chronic lower back pain (CLBP), the relation between co-use and more severe opioid-related problems would occur via the serial effects of negative affect (anxiety, depression) and more coping motivated opioid use.. After controlling for pain severity and relevant demographics, co-use remained related to more anxiety, depression, and opioid-related problems (but not more opioid use). Further, co-use was indirectly related to more opioid-related problems via the serial effect of negative affect (anxiety, depression) and coping motives. Alternative model testing found co-use was not indirectly related to anxiety or depression via serial effects of opioid problems and coping.. Results highlight the important role negative affect may play in opioid problems among individuals with CLBP who co-use opioid and cannabis.

Topics: Adult; Affect; Analgesics, Opioid; Cannabinoid Receptor Agonists; Cannabis; Hallucinogens; Humans; Opioid-Related Disorders

Little is known about the prospective relationship between cannabis use and pain reliever misuse. This study examined associations of non-medical and medical cannabis use with onset of non-medical pain reliever misuse among young adults in Washington State (WA), where non-medical cannabis is legal.. Data were from a cohort-sequential study of adults 18-25 residing in WA. Four annual surveys were used from cohorts recruited in 2014, 2015, and 2016. Participants who had not reported non-medical pain reliever misuse at baseline were included in discrete time survival analyses (N = 4,236). Odds ratios (ORs) were estimated for new onset of non-medical pain reliever misuse in any given follow-up year over the course of three years according to baseline non-medical and medical cannabis use.. When included separately in models, non-medical and medical cannabis use at baseline were associated with increased risk of non-medical pain reliever misuse adjusting for demographic characteristics as well as past year cigarette use and alcohol use (non-medical OR = 5.27; 95 % CI: 3.28, 8.48; medical OR = 2.21; 95 % CI: 1.39, 3.52). Including both forms of use in the model, associations of non-medical and medical cannabis use with non-medical pain reliever misuse onset remained (non-medical OR = 4.64; 95 % CI: 2.88, 7.49; medical OR = 1.65; 95 % CI: 1.04, 2.62).. Despite claims that cannabis use may reduce opioid use and related harms, findings suggest that cannabis use, including medical use, may not be protective, but instead may increase risk for non-medical pain reliever misuse.

Topics: Analgesics, Opioid; Cannabis; Humans; Medical Marijuana; Opioid-Related Disorders; Pain; Prescription Drug Misuse; Prospective Studies; Young Adult

Assess associations between social networks and urban American Indian/Alaska Native emerging adults' alcohol, cannabis, and opioid use and intentions.. Having a higher proportion of network members engaging in regular cannabis and heavy alcohol use (but not other drugs) was associated with more frequent cannabis use and stronger cannabis use intentions. Participants with higher proportions of members engaging in heavy alcohol use, regular cannabis use, or other drug use and who did not engage in traditional practices were more likely to report cannabis use and greater intentions to use cannabis and drink alcohol. In contrast, participants with higher proportions of network members engaging in traditional practices and who did not report heavy alcohol use, regular cannabis use, or other drug use were less likely to report intentions to use cannabis or drink alcohol.. Findings emphasize what many studies have shown among various racial/ethnic groups-having network members who use substances increases the chance of use. Findings also highlight that traditional practices may be an important part of the prevention approach for this population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Topics: Adolescent; Adult; American Indian or Alaska Native; Analgesics, Opioid; Cannabis; Ethanol; Female; Humans; Indians, North American; Male; Opioid-Related Disorders; Protective Factors; Social Networking; United States; Young Adult

As the literature grows on opioid use, the impact of simultaneous cannabis use has hitherto been mostly unexplored. In this study, we assessed the effects of cannabis use on postoperative opioid utilization in opioid-naive patients undergoing single level fusions of the lumbar spine.. Using an all-payer claims database, the medical records of 91 million patients were analyzed to identify patients who had undergone single level lumbar fusions between January 2010 and October 2020. Rates of opioid utilization at 6 months following index procedure (morphine milligram equivalents/day), the development of opioid use disorder (OUD), and the rates of opioid overuse were assessed.. Following examination of 87,958 patient records, 454 patients were matched and distributed equally into cannabis user and noncannabis user cohorts. At 6 months following index procedure, cannabis users were equal to nonusers in their rates of prescribed opioid utilization (49.78%, P > 0.99). Cannabis users used smaller daily dosages compared to nonusers (51.1 ± 35.05 vs. 59.72 ± 41, P = 0.003). On the other hand, the proportion of patients diagnosed with OUD was found to be significantly higher among patients using cannabis (18.94% vs. 3.96%, P < 0.0001).. Compared to noncannabis users, opioid-naive patients who are cannabis users undergoing lumbar spinal fusions are at a higher risk of developing opioid dependence following surgery, despite having decreased daily dosages of opioids overall. Further studies should explore the factors associated with the development of OUD and the details of concurrent marijuana use to effectively treat pain while limiting the potential for abuse.

Topics: Analgesics, Opioid; Cannabis; Humans; Opioid-Related Disorders; Pain, Postoperative; Retrospective Studies

Substance use disorder prevention programs are most effective when matched appropriately to the baseline risk of the population. Individuals who misuse opioids often have unique risk profiles different from those who use other substances such as alcohol or cannabis. However, most substance use prevention programs are geared toward universal audiences, neglecting key inflection points along the continuum of care. The HEAL Prevention Cooperative (HPC) is a unique cohort of research projects that represents a continuum of care, from community-level universal prevention to indicated prevention among older adolescents and young adults who are currently misusing opioids or other substances. This paper describes the theoretical basis for addressing opioid misuse and opioid use disorder across the prevention continuum, using examples from research projects in the HPC.

Topics: Adolescent; Analgesics, Opioid; Cannabis; Continuity of Patient Care; Humans; Opioid-Related Disorders; Prescription Drug Misuse; Young Adult

Topics: Analgesics, Opioid; Cannabinoid Receptor Agonists; Cannabis; Chronic Pain; Humans; Opioid-Related Disorders; Risk Assessment

Topics: Analgesics, Opioid; Cannabis; Chronic Pain; Humans; Opioid-Related Disorders; Risk Assessment

Laws liberalizing access to medical marijuana are associated with reduced opioid analgesic use among adults, but little is known about the impact of such policies on adolescents and young adults.. This retrospective cohort study used 2005 to 2014 claims from MarketScan® Commercial database, which covers all 50 states and Washington D.C. The sample included 195,204 adolescent and young adult patients (aged 12-25) who underwent one of 13 surgical procedures.. Of the 195,204 patients, 4.8% had prolonged opioid use. Several factors were associated with a higher likelihood of prolonged opioid use, including being female (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], 1.21-1.33), longer hospital stay (aOR, 1.04; 95% CI, 1.02-1.06), greater days of index opioid supply (8-14 days: aOR, 1.39, 95% CI, 1.33-1.45; greater than 14 days: aOR, 2.42, 95% CI, 2.26-2.59), rural residence (aOR, 1.07; 95% CI, 1.01-1.14), and cholecystectomy (aOR, 1.16; 95% CI, 1.08-1.25). There was not a significant association of medical marijuana dispensary laws on prolonged opioid use (aOR, 0.98; 95% CI, 0.81-1.18).. Medical marijuana has been suggested as a substitute for opioids, but our results focusing on adolescents and young adults provide new evidence that this particularly vulnerable population does not exhibit reductions in prolonged use of opioids after surgery when they have legal access to medical marijuana. These findings are the first to demonstrate potentially important age differences in sustained use of opioids, and point to the need for prescriber oversight and management with this vulnerable population.

Topics: Adolescent; Analgesics, Opioid; Cannabis; Female; Humans; Male; Medical Marijuana; Opioid-Related Disorders; Retrospective Studies; United States; Young Adult

Treatment outcomes for individuals with substance use disorders (SUDs) are variable and more individualized approaches may be needed. Cross-validated, machine-learning methods are well-suited for probing neural mechanisms of treatment outcomes. Our prior work applied one such approach, connectome-based predictive modeling (CPM), to identify dissociable and substance-specific neural networks of cocaine and opioid abstinence. In Study 1, we aimed to replicate and extend prior work by testing the predictive ability of the cocaine network in an independent sample of 43 participants from a trial of cognitive-behavioral therapy for SUD, and evaluating its ability to predict cannabis abstinence. In Study 2, CPM was applied to identify an independent cannabis abstinence network. Additional participants were identified for a combined sample of 33 with cannabis-use disorder. Participants underwent fMRI scanning before and after treatment. Additional samples of 53 individuals with co-occurring cocaine and opioid-use disorders and 38 comparison subjects were used to assess substance specificity and network strength relative to participants without SUDs. Results demonstrated a second external replication of the cocaine network predicting future cocaine abstinence, however it did not generalize to cannabis abstinence. An independent CPM identified a novel cannabis abstinence network, which was (i) anatomically distinct from the cocaine network, (ii) specific for predicting cannabis abstinence, and for which (iii) network strength was significantly stronger in treatment responders relative to control particpants. Results provide further evidence for substance specificity of neural predictors of abstinence and provide insight into neural mechanisms of successful cannabis treatment, thereby identifying novel treatment targets. Clinical trials registation: "Computer-based training in cognitive-behavioral therapy web-based (Man VS Machine)", registration number: NCT01442597 . "Maximizing the Efficacy of Cognitive Behavior Therapy and Contingency Management", registration number: NCT00350649 . "Computer-Based Training in Cognitive Behavior Therapy (CBT4CBT)", registration number: NCT01406899 .

Topics: Cannabis; Cocaine; Cocaine-Related Disorders; Cognitive Behavioral Therapy; Humans; Male; Opioid-Related Disorders; Substance-Related Disorders; Treatment Outcome

Accumulating evidence has indicated that cannabis substitution is often used as a harm reduction strategy among people who use unregulated opioids (PWUO) and people living with chronic pain. We sought to investigate the association between cannabis use to manage opioid cravings and self-reported changes in opioid use among structurally marginalized PWUO.. The data were collected from a cross-sectional questionnaire administered to PWUO in Vancouver, Canada. Binary logistic regression was used to analyze the association between cannabis use to manage opioid cravings and self-reported changes in unregulated opioid use.. A total of 205 people who use cannabis and opioids were enrolled in the present study from December 2019 to November 2021. Cannabis use to manage opioid cravings was reported by 118 (57.6%) participants. In the multivariable analysis, cannabis use to manage opioid cravings (adjusted Odds Ratio [aOR] = 2.13, 95% confidence interval [CI]: 1.07, 4.27) was significantly associated with self-reported reductions in opioid use. In the sub-analyses of pain, cannabis use to manage opioid cravings was only associated with self-assessed reductions in opioid use among people living with moderate to severe pain (aOR = 4.44, 95% CI: 1.52, 12.97). In the sub-analyses of males and females, cannabis use to manage opioid cravings was only associated with self-assessed reductions in opioid use among females (aOR = 8.19, 95% CI: 1.20, 55.81).. These findings indicate that cannabis use to manage opioid cravings is a prevalent motivation for cannabis use among PWUO and is associated with self-assessed reductions in opioid use during periods of cannabis use. Increasing the accessibility of cannabis products for therapeutic use may be a useful supplementary strategy to mitigate exposure to unregulated opioids and associated harm during the ongoing drug toxicity crisis.

Topics: Analgesics, Opioid; Cannabis; Chronic Pain; Craving; Cross-Sectional Studies; Drug-Related Side Effects and Adverse Reactions; Female; Hallucinogens; Humans; Male; Opioid-Related Disorders

Individuals with an Opioid Use Disorder (OUD) have increased rates of cannabis use in comparison to the general population. Research on the short- and long-term impacts of cannabis use in OUD patients has been inconclusive. A genetic component may contribute to cannabis cravings.. Identify genetic variants associated with cannabis use through Genome-wide Association Study (GWAS) methods and investigate a Polygenic Risk Score (PRS). In addition, we aim to identify any sex differences in effect size for genetic variants reaching or nearing genome-wide significance in the GWAS.. The study outcomes of interest were: regular cannabis use (yes/no) (n = 2616), heaviness of cannabis use (n = 1293) and cannabis cravings (n = 836). Logistic and linear regressions were preformed, respectively, to test the association between genetic variants and each outcome, regular cannabis use and heaviness of cannabis use. GWAS summary statistics from a recent large meta-GWAS investigating cannabis use disorder were used to conduct PRS's. Findings are limited to a European ancestry sample.. No genome-wide significant associations were found. Rs1813412 (chromosome 17) for regular cannabis use and rs62378502 (chromosome 5) for heaviness of cannabis use were approaching genome-wide significance. Both these SNPs were nominally significant (p<0.05) within males and females, however sex did not modify the association. The PRS identified statistically significant association with cannabis cravings. The variance explained by all PRSs were less than 1.02x10-2.. This study provides promising results in understanding the genetic contribution to cannabis use in individuals living with OUD.

Topics: Cannabis; Female; Genetic Predisposition to Disease; Genome-Wide Association Study; Humans; Male; Multifactorial Inheritance; Opioid-Related Disorders; Risk Factors

Opioid use disorder (OUD) poses significant public health problems that have increased dramatically, resulting in high rates of morbidity and mortality.. To minimize the risk of an opioid epidemic in Israel and be prepared, we evaluated physicians' objective knowledge, level of stigma, and approach to prescribing opioids, risk factors, and identification of patients with substance use disorder (SUD), as well as their knowledge about opioid maintenance treatment (OMT) for OUD.. Anonymous computerized questionnaires were distributed nationally to physicians by the Israel Medical Association. Knowledge, stigma, and approach were scored.. Of only 249 responders, 58.6% prescribe opioids, 32.1% prescribe cannabis, and 18.5% daily encounter patients with SUD. Logistic regression found the high knowledge group had daily encounters with SUD (Odds Ratio (OR) = 3.5, 95% CI 1.7-7.1) and were familiar with OMT (OR = 10.1, 95% CI 3.5-29.0). The high stigma group was characterized by physicians who prescribe opioids (OR = 1.7, 95% CI 1.0-2.9), but who self-reported having limited knowledge regarding OMT (OR = 2, 95% CI 1.1-3.7). The high approach group was characterized by those who prescribe opioids (OR = 11.7, 95% CI 4.9-28), prescribe cannabis (OR = 2.1, 95% CI 1.0-4.3), self-report having limited knowledge regarding OMT (OR = 11.2, 95% CI 1.4-89) and self-report identifying SUD (OR = 32.5, 95% CI 4.1-260).. High stigma was most evident among physicians who prescribe opioids but, importantly, who had limited knowledge specifically regarding OMT. Gaps in knowledge and approach were observed. An educational intervention is highly recommended to reduce stigma and increase referrals of patients for OMT, the most effective treatment for opioid use disorder.

Topics: Analgesics, Opioid; Cannabis; Hallucinogens; Humans; Opiate Substitution Treatment; Opioid-Related Disorders; Physicians; Self Report

Initial use of drugs such as tobacco and alcohol may lead to subsequent more problematic drug use-the 'gateway' hypothesis. However, observed associations may be due to a shared underlying risk factor, such as trait impulsivity. We used bidirectional Mendelian randomization (MR) to test the gateway hypothesis.. Our main method was inverse-variance weighted (IVW) MR, with other methods included as sensitivity analyses (where consistent results across methods would raise confidence in our primary results). MR is a genetic instrumental variable approach used to support stronger causal inference in observational studies.. Genome-wide association summary data among European ancestry individuals for smoking initiation, alcoholic drinks per week, cannabis use and dependence, cocaine and opioid dependence (n = 1749-1 232 091).. Genetic variants for exposure.. We found evidence of causal effects from smoking initiation to increased drinks per week [(IVW): β = 0.06; 95% confidence interval (CI) = 0.03-0.09; P = 9.44 × 10. Bidirectional Mendelian randomization testing of the gateway hypothesis reveals that smoking initiation may lead to increased alcohol consumption, cannabis use and cannabis dependence. Cannabis use may also lead to smoking initiation and opioid dependence to alcohol consumption. However, given that tobacco and alcohol use typically begin before other drug use, these results may reflect a shared risk factor or a bidirectional effect for cannabis use and opioid dependence.

Topics: Alcohol Drinking; Cannabis; Genome-Wide Association Study; Humans; Marijuana Abuse; Mendelian Randomization Analysis; Nicotiana; Opioid-Related Disorders; Polymorphism, Single Nucleotide; Smoking

The endocannabinoid system has been implicated in physiological processes fundamental to pain, giving plausibility to the hypothesis that cannabis may be used as a substitute or complement to prescription opioids in the management of chronic pain. We examined the association of medical cannabis licensure with likelihood of prescription opioid receipt using administrative records.. This study linked registry information for medical cannabis licensure with records from the prescription drug monitoring program from April 1, 2016 to March 31, 2019 to create a population-based, retrospective cohort in Rhode Island. We examined within-person changes in receipt of any opioid prescription and receipt of an opioid prescription with a morphine equivalent dose of 50 mg or more, and of 90 mg or more.. The sample included 5,296 participants with medical cannabis license. Medical cannabis licensure was not associated with the odds of filling any opioid prescription (OR: 0.99; 95% CI: 0.94-0.1.05) or the odds of filling a prescription with a morphine equivalent dose of 50 mg or more (OR: 0.93; 95% CI: 0.84-1.04) and 90 mg or more (OR: 0.99; 95% CI: 0.86-1.15).. Medical cannabis licensure was not associated with subsequent cessation and reduction in prescription opioid use. Re-scheduling of cannabis will allow for the conduct of randomized controlled trials to determine the efficacy of medical cannabis as an alternative to prescription opioid use or a complement to the use of lower doses of prescription opioids in patients with chronic pain.

Topics: Analgesics, Opioid; Cannabinoid Receptor Agonists; Cannabis; Chronic Pain; Cohort Studies; Hallucinogens; Humans; Medical Marijuana; Morphine; Opioid-Related Disorders; Prescriptions; Retrospective Studies

Risk factors for accidental drug poisonings in children are poorly understood, including the association with maternal substance use. This study seeks to determine whether maternal substance use disorders before birth are associated with the future risk of accidental drug poisonings in young children.. This study was a longitudinal cohort analysis of 1,032,209 children aged <5 years between 2006 and 2020 in Quebec, Canada. The main exposure included maternal substance use disorders before or during pregnancy. The outcome was hospitalization for drug poisonings before age 5 years, including opioids, cannabis, sedatives/hypnotics, stimulants, and other drugs. Adjusted Cox proportional hazards regression was used to compute hazard ratios and 95% CIs for the association of substance use disorders with child drug poisonings during 4,523,003 person-years of follow-up. Analyses were conducted in 2020.. Hospitalization rates for drug poisoning before age 5 years were greater for children of mothers with substance use disorders versus no substance use disorder (84.8 vs 20.7 per 100,000 person-years). Maternal substance use disorders before birth were associated with 2.28 times the risk of future drug poisonings in children (95% CI=1.63, 3.20). The association was stronger for maternal opioid use disorders (hazard ratio=4.16, 95% CI=2.38, 7.27) than other drug use disorders. Associations with child poisonings were stronger between age 1 and 2 years (hazard ratio=3.26, 95% CI=2.09, 5.10) and for poisonings involving opioids, cannabis, and sedative/hypnotic drugs.. Maternal substance use disorders before childbirth may be markers of future risk of drug poisonings in young children.

Topics: Accidents; Analgesics, Opioid; Cannabis; Child; Child, Preschool; Cohort Studies; Female; Humans; Opioid-Related Disorders; Pregnancy; Substance-Related Disorders

Marijuana and opioids are commonly used illicit drugs in the United States and their use continues to rise. Cannabis use disorder (CUD) and Opioid use disorder (OUD) are associated with adverse effects on public health and postoperative outcomes. However, their impact on vascular surgery, specifically infrainguinal bypass repair (IIB). is not well described in the literature. Therefore, our study aimed to assess perioperative outcomes in patients with CUD and OUD who underwent IIB.. A retrospective analysis of the National Inpatient Sample database for the years 2005 to 2018 was performed. Using the International Classification of Diseases Clinical Modification, Ninth and Tenth revisions, patients who were diagnosed with peripheral artery disease and underwent IIB repair.were identified. Our primary outcome was the comparison of rates of in-hospital complications between the groups, and the secondary outcomes included analysis of total hospital charges and length of stay. A 1:1 propensity score matching (PSM) CUD and OUD patients to their control groups without the disease was conducted using the nearest-neighbor method. The matching was based on select patient demographics and comorbidities included in our analyses.. A total of 190,794 patients were identified: 972 patients with CUD and 682 patients with OUD. In the matched cohorts, patients with a diagnosis of CUD had a higher incidence of in-hospital cardiac complications (adjusted Odds Ratio [aOR], 1.76; 95% Confidence Interval [CI], 0.99-3.12) and acute kidney injury (AKI) (aOR, 1.51; CI, 1.09-2.08). Additionally, total hospital charges and mean length of stay were higher in the CUD group (P < 0.001). Those with OUD had a higher incidence of postoperative respiratory complications (aOR, 1.92; CI, 1.23-2.99), sepsis (aOR, 2.39; CI, 1.32-4.34), infection (aOR, 3.55; CI, 1.16-10.84), AKI (aOR, 2.11; CI,1.47-3.04), major amputations (aOR, 1.69; CI, 1.07-2.69), along with higher total charges and mean length of stay (P < 0.001).. Both CUD and OUD have increased incidence of postoperative complications following IIB. The OUD group had generally worse outcomes compared to patients with CUD. Both were associated with a substantial increase in total hospital charges and length of hospital stay. A further prospective study is warranted to provide better insight on the effects of substance use disorders on the procedure's short- and long-term outcomes.

Topics: Acute Kidney Injury; Cannabis; Female; Humans; Male; Opioid-Related Disorders; Postoperative Complications; Prospective Studies; Retrospective Studies; Treatment Outcome; United States; Vascular Surgical Procedures

A growing body of research has reported on the potential opioid-sparing effects of cannabis and cannabinoids, but less is known about specific mechanisms. The present research examines cannabis-related posts in two large online communities on the Reddit platform ("subreddits") to compare mentions of naturalistic cannabis use by persons self-identifying as actively using opioids versus persons in recovery. We extracted all posts mentioning cannabis-related keywords (e.g., "weed", "cannabis", "marijuana") from December 2015 through August 2019 from an opioid use subreddit and an opioid recovery subreddit. To investigate how cannabis is discussed at-scale, we identified and compared the most frequent phrases in cannabis-related posts in each subreddit using term-frequency-inverse document frequency (TF-IDF) weighting. To contextualize these findings, we also conducted a qualitative content analysis of 200 random posts (100 from each subreddit). Cannabis-related posts were about twice as prevalent in the recovery subreddit (n = 908; 5.4% of 16,791 posts) than in the active opioid use subreddit (n = 4,224; 2.6% of 159,994 posts, p < .001). The most frequent phrases from the recovery subreddit referred to time without using opioids and the possibility of using cannabis as a "treatment." The most frequent phrases from the opioid subreddit referred to concurrent use of cannabis and opioids. The most common motivations for using cannabis were to manage opioid withdrawal symptoms in the recovery subreddit, often in conjunction with anti-anxiety and GI-distress "comfort meds," and to enhance the "high" when used in combination with opioids in the opioid subreddit. Despite limitations in generalizability from pseudonymous online posts, this examination of reports of naturalistic cannabis use in relation to opioid use identified withdrawal symptom management as a common motivation. Future research is warranted with more structured assessments that examines the role of cannabis and cannabinoids in addressing both somatic and affective symptoms of opioid withdrawal.

Topics: Analgesics, Opioid; Cannabinoid Receptor Agonists; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Narcotics; Opioid-Related Disorders; Social Media; Social Support; Substance Withdrawal Syndrome

Cannabis use during methadone treatment may negatively impact treatment outcomes. The aim of this study was to determine the prevalence and pattern of cannabis use among patients attending a methadone treatment clinic in Nairobi, Kenya.. This was a retrospective study of 874 patients on methadone therapy at a methadone maintenance treatment clinic in Nairobi, Kenya from December 2014 to November 2018. Data on sociodemographic characteristics and drug use patterns based on urine drug screens was collected from patient files. Data was analyzed using Statistical Package for the Social Sciences (SPSS) for windows version 23.0.. Point prevalence of cannabis use was 85.8% (95% CI, 83.3 - 88.0) at baseline and 62.7% (95% CI, 59.5 - 65.8) during follow-up. A pattern of polysubstance use was observed where opioids, cannabis and benzodiazepines were the most commonly used drugs. The mean age of the patients was 35.3 (SD 9.0) years with the majority being male, unemployed (76%), (51.4%) had reached primary level of education, and (48.5%) were divorced or separated. University education was associated with reduced risk for cannabis use OR = 0.1 (95% CI, 0.02-0.8, p = 0.031).. Cannabis use is prevalent among patients attending a methadone treatment clinic in Kenya, suggesting need for targeted interventions to address the problem of cannabis use during methadone treatment.

Topics: Adult; Cannabis; Female; Humans; Kenya; Male; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders; Prevalence; Retrospective Studies

This study examined whether polygenic risk scores (PRS) for lifetime cannabis and alcohol use were associated with misusing opioids, and whether sex differences existed in these relations in an urban, African-American sample.. Data were drawn from three cohorts of participants (N = 1,103; 45% male) who were recruited in first grade as part of a series of elementary school-based, universal preventive intervention trials conducted in a Mid-Atlantic region of the U.S. In young adulthood, participants provided a DNA sample and reported on whether they had used heroin or misused prescription opioids in their lifetime. Three substance use PRS were computed based on prior GWAS: lifetime cannabis use from Pasman et al. (2018), heavy drinking indexed via maximum number of drinks from Gelernter et al. (2019), and alcohol consumption from Kranzler et al. (2019).. Higher PRS for lifetime cannabis use, greater heavy drinking, and greater alcohol consumption were associated with heightened risk for misusing opioids among the whole sample. Significant sex by PRS interactions were also observed such that higher PRS for heavy drinking and alcohol consumption were associated with a greater likelihood of opioid misuse among males, but not females.. Our findings further elucidate the genetic contributions to misusing opioids by showing that the genetics of cannabis and alcohol consumption are associated with lifetime opioid misuse among young adults, though replication of our findings is needed.

Topics: Adult; Alcohol Drinking; Analgesics, Opioid; Black or African American; Cannabis; Female; Hallucinogens; Humans; Male; Opioid-Related Disorders; Prescription Drug Misuse; Risk Factors; Young Adult

Recent prevalence estimates of cannabis use among individuals receiving medication treatment for OUD (MOUD) are lacking, and no study has characterized cannabis route of administration (cROA) in this population. These knowledge gaps are relevant because cannabis' effects and health outcomes vary by cROA and the availability and perceptions of cROA (e.g., vaping devices) are changing.. The Vaping In Buprenorphine-treated patients Evaluation (VIBE) cross-sectional survey assessed the prevalence and correlates of cannabis use and cROA among adults receiving buprenorphine MOUD from 02/20 to 07/20 at five community health centers in Massachusetts, a state with legal recreational and medical cannabis use.. Among the 92/222 (41%) respondents reporting past 30-day cannabis use, smoking was the most common cROA (75%), followed by vaping (38%), and eating (26%). Smoking was more often used as a single cROA vs. in combination others (p = 0.01), whereas vaping, eating, and dabbing were more often used in combination with another cROA (all p < 0.05). Of the 39% of participants reporting multiple cROA, smoking and vaping (61%), and smoking and eating (50%), were the most prevalent combinations. Nonwhite race (vs. white) and current cigarette smoking (vs. no nicotine use) were associated with past 30-day cannabis use in multiple logistic regression.. Prevalence of past 30-day cannabis use among individuals receiving buprenorphine MOUD in Massachusetts in 2020 was nearly double the prevalence of cannabis use in Massachusetts' adult general population in 2019 (21%). Our data are consistent with state and national data showing smoking as the most common cROA.

Topics: Adult; Analgesics; Buprenorphine; Cannabis; Cross-Sectional Studies; Hallucinogens; Humans; Marijuana Smoking; Opioid-Related Disorders; Prevalence

To examine whether young adult opioid misuse reflects a general tendency toward substance use and is influenced by general substance use risk or whether it is a different phenomenon from other drug use.. At ages 23 (2016) and 26 (2019), a panel of young adults (n = 3794 to 3833) in the United States self-reported their past-month substance use (opioid misuse, heavy drinking, cigarettes, cannabis) and substance-specific risk factors (perceptions of harm; approval of use; and use of each substance by friends and romantic partners). Structural equation models examined non-opioid and opioid-specific associations between latent risk and substance use factors.. Opioid misuse and opioid-specific risk factors shared significant variance with latent substance use and latent substance use risk, respectively, which were strongly associated. A statistically significant residual correlation between opioid-specific risk and opioid misuse remained.. Young adult opioid misuse reflects a general tendency toward substance use and is strongly predicted by risk for substance use. Opioid-specific risk factors play only a small independent role. Existing evidence-based substance use interventions may be effective in preventing opioid misuse among young adults.

Topics: Adult; Analgesics, Opioid; Cannabis; Hallucinogens; Humans; Opioid-Related Disorders; Prescription Drug Misuse; Risk Factors; United States; Young Adult

Topics: Analgesics; Analgesics, Opioid; Cannabis; Humans; Medical Marijuana; Opioid-Related Disorders

Topics: Analgesics; Analgesics, Opioid; Cannabis; Hallucinogens; Humans; Opioid-Related Disorders

Despite a rapid expansion of cannabis use for pain management, how cannabis and prescription opioids are co-used and whether co-use improves analgesia and promotes reduction of opioid use in the daily lives of individuals with chronic pain is poorly understood. Based upon ecological momentary assessment (EMA), the present study examined 1) how pain and use of opioids and/or cannabis in the previous moment is associated with individuals' choice of opioids and/or cannabis in the next moment, 2) the effects of co-use on pain severity and pain relief, and 3) whether daily total opioid consumption differs on days when people only used opioids versus co-used. Adults with chronic pain (N = 46) using both opioids and cannabis who were recruited online completed a 30-day EMA. Elevated pain did not increase the likelihood of co-use in subsequent momentary assessments. Switching from sole use of either opioids and cannabis to co-use was common. Neither co-use nor sole use of either cannabis or opioids were associated with reductions in pain in the next moment. However, participants reported the highest daily perceived pain relief from co-use compared to cannabis and opioid use only. Post hoc analysis suggested recall bias as a potential source of this discrepant findings between momentary versus retrospective assessment. Lastly, there was no evidence of an opioid-sparing effect of cannabis in this sample. The present study shows preliminary evidence on cannabis and opioid co-use patterns, as well as the effects of co-use on pain and opoid dose in the real-world setting. PERSPECTIVE: This article presents the overall patterns and effects of co-using cannabis and prescription opioids among individuals with chronic pain employing ecological momentary assessment. There were conflicting findings on the association between co-use and analgesia. Co-use was not associated with a reduction in daily opioid consumption in this sample.

Topics: Adult; Analgesics, Opioid; Cannabinoid Receptor Agonists; Cannabis; Chronic Pain; Humans; Opioid-Related Disorders; Prescriptions; Retrospective Studies

Topics: Alcoholism; Benzodiazepines; Cannabis; Cocaine; COVID-19; Hallucinogens; Humans; Opioid-Related Disorders; Retrospective Studies; Substance-Related Disorders

Topics: Adult; Aged; Analgesics; Analgesics, Opioid; Cannabis; Cross-Sectional Studies; Female; Hallucinogens; Humans; Male; Medical Marijuana; Middle Aged; Opiate Alkaloids; Opioid-Related Disorders; Pain; Quality of Life; Young Adult

Topics: Analgesics, Opioid; Cannabis; Humans; Marijuana Abuse; Mindfulness; Opioid-Related Disorders; Pain

Borderline personality disorder (BPD) and substance use disorders (SUDs) commonly co-occur across various settings. However, little research has examined how BPD features relate to specific types of SUDs. This study examined whether BPD features assessed shortly after incarceration were differentially related to symptoms of dependence on alcohol, cannabis, cocaine, and opioids experienced in the 12 months prior to incarceration among 510 people recently incarcerated in jail. Follow-up multigroup analyses evaluated whether gender or race moderated the relation of BPD features to the four SUDs. Using structural equational modeling, the relationships of BPD features were compared to each of the four preincarceration dependence symptoms. BPD features were significantly related to dependence on each of the four substances, but the link between BPD features and cocaine dependence was stronger than BPD's association with alcohol, cannabis, or opioid dependence. These findings generalized across men and women and across White and Black people.

Topics: Analgesics, Opioid; Borderline Personality Disorder; Cannabis; Cocaine; Female; Humans; Jails; Male; Opioid-Related Disorders; Prisoners; Substance-Related Disorders

Substance use disorders (SUDs) are increasing in the obstetric population, vary with demographic characteristics, and are associated with adverse pregnancy outcomes. Cannabis use disorder and opioid use disorder are two of the most common SUDs during pregnancy.. This study had two objectives. The first objective was to assess trends in any SUD diagnosis during delivery hospitalizations from 2000 to 2018 by maternal age, ZIP code income quartile, and hospital location and teaching status. The second objective was to determine risk for adverse pregnancy outcomes during delivery hospitalizations specifically in the presence of cannabis and opioid use disorder diagnoses.. We conducted a serial cross-sectional analysis of the 2000-2018 National Inpatient Sample. Delivery hospitalizations to women aged 15-54 years with substance use disorder diagnoses were identified. SUD included (i) cannabis use disorder; (ii) opioid use disorder; (iii) alcohol use disorder; and (iv) other drug use disorder. We used joinpoint regression to estimate the average annual percent change (AAPC) in any substance use disorder diagnoses with 95% confidence intervals (CIs) by (i) ZIP code income quartile, (ii) hospital location and teaching status, and (iii) maternal age. We used unadjusted and adjusted log-linear regression to evaluate the relationship between cannabis use disorder and opioid use disorder several adverse maternal outcomes. We report unadjusted and adjusted risk ratios (aRRs) as measures of effect.. From 2000 to 2018, trends analyses broadly demonstrated increasing risk for SUD across demographic categories. In trends analyses stratified by ZIP code-income quartile, the proportion of deliveries with any SUD diagnosis increased across each income quartile with significant increases in the lowest income quartile (AAPC 4.6%, 95% CI 0.4%, 8.9%), second lowest quartile (AAPC 6.3%, 95% CI 5.3%, 7.4%), second highest quartile (AAPC 5.4%, 95% CI 4.1%, 6.8%), and highest quartile (AAPC 4.4%, 95% CI 2.1%, 6.8%). A larger increasing AAPC for SUD was present for deliveries in rural hospitals (AAPC 12.3%, 95% CI 9.8%, 14.9%) as compared to teaching (AAPC 5.7%, 95% CI 5.2%, 6.3%) and non-teaching urban hospitals (AAPC 7.0%, 95% CI 5.9%, 8.1%). By maternal age group, there was a significant larger AAPC for SUD for women aged 15-19 years (AAPC 8.5%, 95% CI 6.6%, 10.4%), 20-24 years (AAPC 9.0%, 95% CI 6.9%, 11.1%) and 25-29 years (AAPC 9.8%, 95% CI 9.1%, 10.6%) than women ≥30 years of age. Cannabis use disorder was associated with increased adjusted risk for preterm delivery (aRR 1.44, 95% CI 1.43, 1.45) and abruption and antepartum hemorrhage (aRR 1.77, 95% CI 1.75, 1.80). Opioid use disorder was associated with risk for non-transfusion severe maternal morbidity (aRR 1.73, 95% CI 1.67, 1.79), preterm delivery (aRR 1.75, 95% CI 1.74, 1.77), and abruption and antepartum hemorrhage (aRR 2.15, 95% CI 2.11, 2.19).. While substance use disorders are increasing in pregnancy across rural and urban settings, age groups, and income quartiles, several populations are associated with higher increased risks and trends. These findings support that SUDs are likely to continue to be of public health significance in diverse geographic and demographic settings.

Topics: Adult; Cannabis; Child; Cross-Sectional Studies; Demography; Female; Hemorrhage; Humans; Infant, Newborn; Marijuana Abuse; Opioid-Related Disorders; Pregnancy; Premature Birth

Public health concerns regarding opioids and marijuana have implications for their medical use. This study examined use motives and perceived barriers in relation to opioid and marijuana use and interest in use among US adult cancer survivors. Self-administered surveys were distributed using social media to assess use motives and perceived barriers among participants living with cancer. Overall, 40.9% of cancer survivors reported current (past 30-day) use of opioids, 42.5% used marijuana, and 39.7% used both. The most common use motives for either/both drugs were to cope with pain and stress/anxiety (>70%). Highest-rated barriers to using either/both drugs were missing symptoms of worsening illness and not wanting to talk about their symptoms. Controlling for sociodemographics, binary logistic regression indicated that current opioid use was associated with reporting greater barriers to use (OR = 1.17, p = .011; Nagelkerke R-square = .934) and that current marijuana use was associated with reporting greater barriers to use (OR = 1.37, p = .003; Nagelkerke R-square = .921). Cancer survivors report various use motives and barriers to use regarding opioids and marijuana. While use motives and barriers for both drugs were similar, these constructs were differentially associated with use and interest in use across drugs. Understanding patients' perceptions about opioids and marijuana is an essential component to effectively manage symptoms related to a cancer diagnosis and improve quality of life for cancer survivors.

Topics: Adult; Analgesics, Opioid; Cancer Survivors; Cannabis; Humans; Motivation; Neoplasms; Opioid-Related Disorders; Quality of Life

Amid the opioid epidemic and evolving legal and social changes with marijuana, little is known about substance use among pregnant and postpartum people living with HIV.. To evaluate trends in marijuana, alcohol, and opioid use during pregnancy and the first year postpartum among US people living with HIV and the differences in substance use based on marijuana legalization status.. Data from the Surveillance Monitoring for Antiretroviral Toxicities (SMARTT) study of the Pediatric HIV/AIDS Cohort Study were analyzed. SMARTT-enrolled, pregnant people living with HIV at 22 US sites from January 1, 2007, to July 1, 2019, with self-reported substance use data available in pregnancy, 1 year postpartum, or both were assessed.. Calendar year and state marijuana legalization status.. The prevalence of any use of each of the following substances was calculated by calendar year, separately for pregnancy and postpartum: marijuana, alcohol, opioid, and concomitant alcohol and marijuana. Log binomial models were fit using general estimating equations to evaluate the mean annual change, accounting for repeat pregnancies. The study also evaluated differences in substance use by state recreational or medical marijuana legalization status.. Substance use data were available for 2926 pregnancies from 2310 people living with HIV (mean [SD] age, 28.8 [6.1] years; 822 [28.1%] Hispanic, 1859 [63.5%] non-Hispanic Black, 185 [6.3%] White, 24 [0.8%] of more than 1 race, 24 [0.8%] of other race or ethnicity [individuals who identified as American Indian, Asian, or Native Hawaiian or other Pacific Islander], and 12 [0.4%] with unknown or unreported race or ethnicity). Between 2007 and 2019, marijuana use during pregnancy increased from 7.1% to 11.7%, whereas alcohol and opioid use in pregnancy were unchanged. Postpartum alcohol (44.4%), marijuana (13.6%), and concomitant alcohol and marijuana (10.0%) use were common; marijuana use increased from 10.2% to 23.7% from 2007 to 2019, whereas postpartum alcohol use was unchanged. The adjusted mean risk of marijuana use increased by 7% (95% CI, 3%-10%) per year during pregnancy and 11% (95% CI, 7%-16%) per year postpartum. Postpartum concomitant alcohol and marijuana use increased by 10% (95% CI, 5%-15%) per year. Differences in substance use were not associated with recreational legalization, but increased marijuana use was associated with medical marijuana legalization.. In this cohort study, opioid use among pregnant people living with HIV remained stable, whereas marijuana use during pregnancy and postpartum increased over time and in states with legalized medical marijuana. These patterns of increasing marijuana use among pregnant and postpartum people living with HIV suggest that enhanced clinical attention is warranted, given the potential maternal and child health implications of substance use.

Topics: Adult; Alcohol Drinking; Analgesics, Opioid; Cannabis; Cohort Studies; Female; HIV Infections; Humans; Marijuana Smoking; Opioid-Related Disorders; Postpartum Period; Pregnancy; Pregnancy Complications; Young Adult

With the growing public interest in the potential therapeutic benefits of cannabis and cannabinoids in the treatment of opioid use disorder (OUD), some states have now either added or proposed to add OUD as an indication for their state's medical marijuana program. However, these initiatives are based on weak evidence which at present do not support the listing of cannabis or cannabinoids as a treatment for OUD. Nevertheless, studying the potential therapeutic applications of carefully chosen components of cannabis or cannabinoids to treat specific aspects of OUD is not without scientific merit. Given the high rates of treatment discontinuation among those taking medications for OUD, interventions that further improve clinical outcomes are especially needed. The potential therapeutic applications of cannabis and cannabinoids in the treatment of OUD are worthy of further study, but it should be conducted with the same rigor that we expect of all pharmaceutical products. Until we have more research to show their efficacy, policy makers and clinicians should refrain from portraying cannabis and cannabinoids as evidence-based treatments for OUD.

Topics: Cannabinoids; Cannabis; Humans; Medical Marijuana; Opioid-Related Disorders

Ecological studies have suggested that Cannabis legalization might have led to a decrease in opioid overdose deaths. Such studies do not provide information about whether individuals are substituting Cannabis for opioids at different points in time. The current study assessed the magnitude of the daily association between Cannabis and opioid use in individual adults with and without pain who use non-medical opioids.. Prospective cohort study.. The greater New York area and a suburban inpatient addiction program.. Adults with problem substance use who use non-medical opioids, recruited from May 2016-June 2019. The analytical sample included 13 271 days of observation among 211 participants (64% male, 41% white, 78% unmarried, 80% unemployed, mean age 43 years).. Participants completed interviewer- and self-administered computerized surveys, and then responded to an interactive voice response (IVR) system daily for the following 90 days. The main exposures, Cannabis use and pain, were defined as responding affirmatively to the IVR question: 'Did you use Cannabis yesterday?' and endorsing moderate or severe pain at baseline, respectively. The main outcome, non-medical or illicit opioid use during 90-day follow-up, was defined as responding affirmatively to IVR question: 'Did you use heroin yesterday?' or 'Did you use prescription opioids more than prescribed or without a prescription yesterday?'.. The mean IVR completion rate was 70%. The unadjusted odds ratio (aOR) indicating same-day use of Cannabis and opioids was 2.00 [95% confidence interval (CI) = 1.54-2.59]. Controlling for demographic characteristics, recruitment method, opioid types at baseline and pain, the aOR was 1.86 (95% CI = 1.44-2.41). A test of interaction between pain and Cannabis use to determine if the association of Cannabis with opioid use differed between people with moderate-to-severe pain and less-than-moderate pain was inconclusive.. Among US adults with problem substance use who use non-medical opioids, the odds of opioid use appear to be approximately doubled on days when Cannabis is used. This relationship does not appear to differ between people with moderate or more severe pain versus less than moderate pain, suggesting that Cannabis is not being used as a substitute for illegal opioids.

Topics: Adult; Analgesics, Opioid; Cannabis; Humans; Infant, Newborn; New York; Opioid-Related Disorders; Prospective Studies; United States

Cannabis motivations have been studied extensively among patients of medicinal cannabis dispensaries, but less is known about motivations in community samples of opioid-using people who inject drugs. Our objective is to describe cannabis use motivations associated with self-treatment of physical pain, emotional issues, and as an opioid substitute.. Data come from 6-month follow-up interviews with people who inject drugs who participated in a study on the efficacy of an injection initiation prevention intervention in Los Angeles and San Francisco, California from 2016-18. The analytic sample consists of 387 people who inject drugs who reported past-month cannabis use. We developed multivariable logistic regression models by reported cannabis use motivations: physical pain relief, emotional problems, and opioid substitute.. The most common cannabis use motivations reported by people who inject drugs was to "get high," relieve physical pain and emotional problems, and reduce opioid use. In separate multivariate models, using cannabis for physical pain relief was associated with higher odds of using cannabis as a substitute for opioids; cannabis for emotional problems was associated with being diagnosed with depression; and cannabis as a substitute for opioids was associated with non-prescribed, non-injection methadone use.. People who inject drugs reported using cannabis for health-related motivations. This motivation aligns with health needs and suggests the acceptability of cannabis use for health reasons in this population. Studies to determine the medical effectiveness of cannabis products for these common health and mental health needs among people who inject drugs are needed.

Topics: Adult; Analgesics; Analgesics, Opioid; Cannabis; Female; Humans; Injections; Intention; Logistic Models; Los Angeles; Male; Marijuana Smoking; Medical Marijuana; Middle Aged; Motivation; Opioid-Related Disorders; Pain; Pain Management; San Francisco; Substance Abuse, Intravenous

Despite medicalization and legalization of marijuana use, factors influencing demand for marijuana among persons living with HIV (PLWH) are incompletely understood. This knowledge gap undermines effective clinical management and policies. This study used demand curve simulation methods to address these issues.. Marijuana-using PLWH (N = 119) completed experimental tasks to simulate amount of marijuana purchasing/use across different costs (money or time), and likelihood of reselling marijuana or marijuana therapeutic-use registration card in relation to profits. Additional simulations assessed purchasing of marijuana relative to other drug and non-drug goods.. Simulated marijuana use decreased as money and time costs increased. Consumption was greater for participants with more severe Cannabis Use Disorder (CUD) and anxiety, intermediate pain levels, and past 90-day opioid use. Whereas few participants chose to sell their registration card, marijuana resale (diversion) steeply increased with profit. Likelihood of seeking marijuana therapeutic-use certification decreased in relation to registration card money cost, having to visit more physicians to get a signature, and delay to receiving the card, and increased with duration of certification. Participants who reported recent opioid use were more likely to seek certification. Consumption of several commodities assessed was independent of marijuana.. Simulated marijuana use was related to participants' clinical profile (CUD, anxiety and pain symptoms, recent opioid use), and unrelated to purchasing other goods. Likelihood of seeking marijuana therapeutic-use registration was affected by several types of costs and recent opioid use. Participants were unlikely to divert registration cards. We discuss clinical and policy implications of these findings.

Topics: Adult; Anxiety; Cannabis; Female; Hallucinogens; HIV Infections; Humans; Male; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Medical Marijuana; Opioid-Related Disorders; Pain; Surveys and Questionnaires

Vaping behaviour has increased in popularity and is particularly important to examine how it effects health outcomes in vulnerable populations, including those with opioid use disorder (OUD). With polysubstance use including cigarette and cannabis use being highly prevalent in the OUD population and cannabis/nicotine increasingly being consumed by vaping, vaping may have an important contribution to health outcomes in these individuals. The primary objective of this review is to systematically assess the literature related to patients with OUD and the effects vaping has shown on their physical and mental health.. A systematic search of databases including MEDLINE, Embase, PsycINFO, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Cochrane Clinical Trials Registry, the National Institutes for Health Clinical Trials Registry and the WHO International Clinical Trials Registry Platform from inception to 31 December 2020 will be conducted. Identified citations will be screened by two reviewers to determine eligibility at the title and abstract level, and then at the full text and data extraction phases. Any disagreements in inclusion will be resolved through unblinded discussion by these reviewers, with any remaining disagreements being resolved by a third reviewer. Data collection from eligible studies will be conducted according to the data extraction form tested prior to abstraction. Included studies will be examined for quality and bias and will be meta-analysed where applicable. This protocol is reported in keeping with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines.. The results for this review will be disseminated through publications in peer-reviewed journals, posters and presentations at scientific conferences. Additionally, we are collaborating with the Canadian Addiction Treatment Centre clinics to help disseminate the findings for this review. As this is a systematic review, no ethics approval is needed.. CRD42020178441.

Topics: Canada; Cannabis; Humans; Meta-Analysis as Topic; Opioid-Related Disorders; Outcome Assessment, Health Care; Research Design; Systematic Reviews as Topic; Vaping

Topics: Analgesics, Opioid; Cannabis; Humans; Medical Marijuana; Opioid Epidemic; Opioid-Related Disorders; United States

Given efforts to reduce opioid use, and because marijuana potentially offers a lower-risk alternative for treating chronic pain, there is interest in understanding the public health impact of marijuana legalization on opioid-related outcomes.. Assess the impact of recreational and medical marijuana legalization on opioid utilization among patients receiving pharmacotherapy for pain.. Retrospective claims-based study of commercially insured patients continuously eligible for pharmacy and medical benefits from July 8, 2014 to June 30, 2017. Index pain prescription period was defined between January 8, 2015 and June 30, 2015, and longer-term opioid use examined during 2-year follow-up. Marijuana state policy on July 1, 2015, was assigned: none; medical only; or medical and recreational.. Patients aged 18-62 without cancer diagnosis.. Patient receiving (1) opioid at index; (2) > 7 days' supply of index opioid; (3) opioid during follow-up; and (4) ≥ 90 days' opioid supply during follow-up. Multivariable regression assessed associations between opioid utilization and state marijuana policy, adjusting for age, gender, overall disease burden, mental health treatment, concomitant use of benzodiazepine or muscle relaxant, and previous pain prescription.. Of 141,711 patients, 80,955 (57.1%) resided in states with no policy; 56,494 (39.9%) with medical-only; and 4262 (3.0%) with medical and recreational. Patients in states with both policies were more likely to receive an index opioid (aOR = 1.72, 95% CI = 1.61-1.85; aOR = 1.90, 95% CI = 1.77-2.03; P < 0.001) but less likely to receive > 7 days' index supply (aOR = 0.84, 95% CI = 0.77-0.91; aOR = 0.76, 95% CI = 0.70-0.83; P < 0.001) than patients in states with no policy or medical-only, respectively. Those in states with both policies were more likely to receive a follow-up opioid (aOR = 1.87, 95% CI = 1.71-2.05; aOR = 2.20, 95% CI = 2.01-2.42; P < 0.001) than those in states with no policy or medical-only, respectively, and more likely to receive ≥ 90 cumulative follow-up opioid days' supply (aOR = 1.18, 95% CI = 1.07-1.29; P < 0.001) than those in states with no policy.. Our analysis does not support the supposition that access to marijuana lowers use of chronic opioids for pain.

Topics: Analgesics, Opioid; Cannabis; Chronic Pain; Humans; Opioid-Related Disorders; Retrospective Studies; United States

With the ongoing opioid crisis and policy changes regarding legalization of cannabis occurring around the world, it is necessary to consider cannabis use in the context of opioid use disorder (OUD) and its treatment. We aimed to examine (1) past-month cannabis use in patients with OUD, (2) self-reported cannabis-related side effects and craving, and (3) the association between specific characteristics of cannabis use and opioid use during treatment in cannabis users.. Participants receiving pharmacological treatment for OUD (n = 2315) were recruited from community-based addiction treatment clinics in Ontario, Canada, and provided information on past-month cannabis use (self-report). Participants were followed for 3 months with routine urine drug screens in order to assess opioid use during treatment. We used logistic regression analysis to explore (1) the association between any cannabis use and opioid use during treatment, and (2) amongst cannabis-users, specific cannabis use characteristics associated with opioid use. Qualitative methods were used to examine responses to the question: "What effect does marijuana have on your treatment?".. Past-month cannabis use was reported by 51% of participants (n = 1178). Any cannabis use compared to non-use was not associated with opioid use (OR = 1.03, 95% CI 0.87-1.23, p = 0.703). Amongst cannabis users, nearly 70% reported daily use, and half reported experiencing cannabis-related side effects, with the most common side effects being slower thought process (26.2%) and lack of motivation (17.3%). For cannabis users, daily cannabis use was associated with lower odds of opioid use, when compared  with occasional use (OR = 0.61, 95% CI 0.47-0.79, p < 0.001) as was older age of onset of cannabis use (OR = 0.97, 95% CI 0.94, 0.99, p = 0.032), and reporting cannabis-related side effects (OR = 0.67, 95% CI 0.51, 0.85, p = 0.001). Altogether, 75% of cannabis users perceived no impact of cannabis on their OUD treatment.. Past-month cannabis use was not associated with more or less opioid use during treatment. For patients who use cannabis, we identified specific characteristics of cannabis use associated with differential outcomes. Further examination of characteristics and patterns of cannabis use is warranted and may inform more tailored assessments and treatment recommendations.

Topics: Aged; Analgesics, Opioid; Cannabis; Hallucinogens; Humans; Ontario; Opiate Substitution Treatment; Opioid-Related Disorders

Topics: Adolescent; Adult; Analgesics, Opioid; Cannabis; Child; Cohort Studies; Heroin; Humans; Opioid-Related Disorders; Prescription Drug Misuse; Young Adult

As the legalization of recreational cannabis becomes more widespread, its impact on individuals with substance use disorders must be studied. Amidst an ongoing opioid crisis, Canada's legalization of recreational cannabis in October 2018 provides an important setting for investigation. We examined changes to cannabis use patterns in patients receiving medication-assisted treatment (MAT) for opioid use disorder (OUD) following legalization.. This study includes cross-sectional data from 602 participants recruited 6 months pre-legalization and 788 participants recruited 6 months post-legalization, providing information on cannabis use. Regression analysis was used to estimate the association between legalization and cannabis use patterns. We collected longitudinal urine drug screens (UDSs) detecting cannabis-metabolites for 199 participants recruited pre-legalization and followed prospectively post-legalization. Conditional logistic regression was used to assess the association between legalization and UDS results.. Past-month cannabis use was self-reported by 54.8 and 52.3% of participants recruited pre- and post-legalization, respectively. Legalization was not associated with changes in any measured cannabis characteristics: cannabis use (OR 0.91, 95% CI 0.73-1.13), days of use/month (B -0.42, 95% CI - 2.05-1.21), money spent, or cannabis source. There was no association between legalization and prevalence of cannabis use on UDS (OR 1.67, 95% CI 0.93-2.99) or percentage of cannabis-positive UDSs (OR 1.00, 95% CI 0.99-1.01). Participants overwhelmingly reported that legalization would have no impact on their cannabis use (85.7%).. Amongst patients treated for OUD, no significant change in cannabis use was observed following legalization; however, high rates of cannabis use are noted.

Topics: Canada; Cannabis; Cross-Sectional Studies; Humans; Legislation, Drug; Opioid-Related Disorders

The opioid overdose epidemic in Canada and the United States has become a public health crisis - with exponential increases in opioid-related morbidity and mortality. Recently, there has been an increasing body of evidence focusing on the opioid-sparing effects of medical cannabis use (reduction of opioid use and reliance), and medical cannabis as a potential alternative treatment for chronic pain. The objective of this study is to assess the effect of medical cannabis authorization on opioid use (oral morphine equivalent; OME) between 2013 and 2018 in Alberta, Canada.. All adult patients defined as chronic opioid users who were authorized medical cannabis by their health care provider in Alberta, Canada from 2013 to 2018 were propensity score matched to non-authorized chronic opioid using controls. A total of 5373 medical cannabis patients were matched to controls, who were all chronic opioid users. The change in the weekly average OME of opioid drugs for medical cannabis patients relative to controls was measured. Interrupted time series (ITS) analyses was used to assess the trend change in OME during the 26 weeks (6 months) before and 52 weeks (1 year) after the authorization of medical cannabis among adult chronic opioid users.. Average age was 52 years and 54% were female. Patients on low dose opioids (< 50 OME) had an increase in their weekly OME per week (absolute increase of 112.1 OME, 95% CI: 104.1 to 120.3); whereas higher dose users (OME > 100), showed a significant decrease over 6 months (- 435.5, 95% CI: - 596.8 to - 274.2) compared to controls.. This short-term study found that medical cannabis authorization showed intermediate effects on opioid use, which was dependent on initial opioid use. Greater observations of changes in OME appear to be in those patients who were on a high dosage of opioids (OME > 100); however, continued surveillance of patients utilizing both opioids and medical cannabis is warranted by clinicians to understand the long-term potential benefits and any harms of ongoing use.

Topics: Adult; Alberta; Analgesics, Opioid; Cannabis; Female; Humans; Male; Medical Marijuana; Middle Aged; Opioid-Related Disorders; United States

Persons with severe opioid or cocaine use disorders are particularly vulnerable to morbidity and mortality. Heaviest use of mu-opioid receptor agonists and cocaine typically commences in early adulthood and is preceded by substantial adolescent exposure to cannabis and/or alcohol. Little information exists on the age trajectories of exposure to cannabis or alcohol in persons diagnosed with severe opioid or cocaine use disorders, compared to persons diagnosed with other substance use disorders (unrelated to opioids or cocaine).. This observational study had n = 854 volunteers (male = 581, female = 273; ≥18 years of age at the time of interview) and examined the ages of onset of heaviest use of cannabis and alcohol in persons diagnosed by DSM-IV criteria with opioid dependence (OD), both opioid and cocaine dependence (OD + CD) and cocaine dependence (CD). These age trajectory measures were compared to persons with other substance use disorders (primarily cannabis and alcohol use disorders, termed "Any Other Diagnoses").. Unadjusted survival analyses showed persons diagnosed with either OD + CD or CD had earlier onset of heaviest use of cannabis (mean ages of 16.2 and 17.8, respectively) compared to the "Any Other Diagnoses" reference group (mean age = 19.5). A multivariate logistic regression showed that later onset of heaviest use of cannabis was associated with lower odds of being in the OD + CD or CD groups, when compared to the reference group.. Persons diagnosed with severe cocaine use disorders or dual opioid and cocaine use disorders exhibit a pattern of heavy and especially early adolescent exposure to cannabis, compared to persons with other substance use disorders.

Topics: Adolescent; Adult; Age of Onset; Alcoholism; Analgesics, Opioid; Cannabis; Cocaine; Humans; Marijuana Abuse; Opioid-Related Disorders; Substance-Related Disorders; Young Adult

Psychoactive substance use may be risky for adults with functional impairments. This study investigates cannabis use and prescription opioid and tranquilizer/sedative (mis)use among adults aged ≥50 years reporting functional impairments in the U.S.. This cross-sectional analysis of adults aged ≥50 years from the 2015-2019 cohorts of the National Survey on Drug Use and Health estimates the prevalence of past-year medical and nonmedical cannabis use and prescription opioid and tranquilizer/sedative use and misuse according to the number of functional impairments reported. The adjusted odds of medical and nonmedical use or misuse of each substance in relation to any impairment, the number of impairments, and specific impairments were estimated using logistic regression. Analyses were conducted in December 2020.. Compared with those reporting no impairments, those reporting any impairment were more likely to report the use of cannabis and the (mis)use of prescription opioids and tranquilizers/sedatives (all p<0.05). Prevalence of (mis)use increased for each drug as the number of impairments increased (all p<0.001). Having any impairment was associated with increased odds for medical cannabis use (AOR=2.28, 95% CI=1.57, 3.30) but not for nonmedical use and with increased odds for misuse of prescription opioids (AOR=1.62, 95% CI=1.38, 1.91) and tranquilizers/sedatives (AOR=1.59, 95% CI=1.20, 2.11). Impaired thinking was associated with increased odds for the use and misuse of each substance, and impaired ability to do errands was associated with increased odds for prescription opioid misuse (AOR=1.34, 95% CI=1.01, 1.78).. Prescription drug misuse is linked to functional impairments among adults aged ≥50 years and may pose a potential risk for this vulnerable population.

Topics: Aged; Analgesics, Opioid; Cannabis; Cross-Sectional Studies; Humans; Opioid-Related Disorders; Prescription Drug Misuse; Prescription Drugs; Prescriptions; Prevalence; United States

Illicit drug use contributes to substantial morbidity and mortality. Drug scheduling, a legal measure in drug enforcement, is often structured as a hierarchy based on addiction tendency, abuse trends, and harm, but may lack data-driven evidence when classifying substances. Our study aims to measure addiction tendency and use trends based on real-world data. We used the open access database of National Police Agency, Ministry of the Interior in Taiwan and analyzed all daily criminal cases of illicit drugs from 2013 to 2017 and monthly illicit drug enforcement data from the same database from 2002 to 2017. We hypothesized that repeat and frequent use despite legal consequence may be a reflection of addictive behavior, and empirical mode decomposition was applied in analysis to calculate addiction tendency indices and intrinsic 15-year use trends. Our analysis showed heroin has the highest addiction index, followed by methamphetamine. 3,4-Methyl enedioxy methamphetamine, marijuana, and ketamine had lower addictive propensities. This result is consistent with most drug scheduling hierarchies. 15-year use trends of substances were consistent with previous epidemiological studies.

Topics: Amphetamine-Related Disorders; Anesthetics, Dissociative; Cannabis; Central Nervous System Stimulants; Crime; Databases, Factual; Hallucinogens; Heroin; Humans; Illicit Drugs; Ketamine; Marijuana Abuse; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Opioid-Related Disorders; Psychiatric Status Rating Scales; Substance-Related Disorders; Taiwan

Borderline personality disorder and substance use disorder co-occur at a high rate. However, little is known about the mechanisms driving this association. This study examined substance use motives for 3 common substance use disorders among 193 individuals in substance use disorder treatment. We found that the coping motive consistently mediated the relationship between borderline personality and alcohol, cannabis, and prescription opioid use disorders. For this substance use disorder treatment sample, our findings support the self-medication model of substance use, and that interventions aimed at coping-related substance use would be helpful among these patients. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Topics: Adaptation, Psychological; Adolescent; Adult; Aged; Alcohol Drinking; Borderline Personality Disorder; Cannabis; Female; Humans; Male; Middle Aged; Motivation; Opioid-Related Disorders; Substance-Related Disorders; Young Adult

This population-based study showed that maternal opioid plus marijuana use during pregnancy was associated with increased odds of prematurity and low birth weight but lower odds of neonatal abstinence syndrome and prolonged hospitalization compared with opioid exposure without marijuana use. Further research should evaluate the biologic mechanisms responsible for these outcomes.

Topics: Adolescent; Adult; Analgesics, Opioid; Cannabis; Child; Data Collection; Databases, Factual; Female; Hospitalization; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Male; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Massachusetts; Neonatal Abstinence Syndrome; Opioid-Related Disorders; Outcome Assessment, Health Care; Pregnancy; Pregnancy Complications; Young Adult

Topics: Analgesics, Opioid; Cannabis; Humans; Opioid-Related Disorders

Cannabis use in some individuals can meaningfully introduce

Topics: Adolescent; Adolescent Development; Animals; Behavior, Addictive; Brain; Cannabis; Comorbidity; Disease Models, Animal; Executive Function; Gene Expression; Humans; Long-Term Potentiation; Marijuana Use; Mental Disorders; Mice; Opioid-Related Disorders; Young Adult

Medical marijuana laws (MMLs) can impact marijuana and opioid use, but the relationship between MMLs and other drugs, such as prescription stimulants, remains unexamined. Because lesbian, gay and bisexual (LGB) individuals report higher levels of prescription stimulant use than heterosexuals, we explored the relationship between MMLs and past-year medical and non-medical stimulant use by sexual identity and gender.. We pooled 2015-2017 National Survey on Drug Use and Health data for adults (n = 126 463), and used survey-weighted multinomial logistic regression to estimate odds of past-year (a) medical prescription stimulant use, (b) non-medical prescription stimulant use and (c) non-medical versus medical stimulant use. We stratified by gender, adjusted for sociodemographic characteristics, and tested the interaction between MML state residence and sexual identity.. Bisexual men had higher medical (6.4% versus 4.1%; aROR=1.93[1.29-2.88]) and non-medical stimulant use 6.6% versus 2.4%; aROR=2.23[1.44-3.44]) than heterosexual men. Bisexual women had higher non-medical stimulant use (6.8% versus 1.6%; aROR=1.54[1.23-2.93] than heterosexual women. Female (aROR=0.70[0.62-0.78]) and male (aROR=0.74[0.66-0.82]) heterosexuals in MML states had lower odds of medical stimulant use than in non-MML states. Bisexual men in MML states had lower odds of medical (aROR=0.36[0.21-0.61]) and non-medical stimulant use (aROR=0.48[0.29-0.81]) than bisexual men in non-MML states. Similar patterns emerged for bisexual women's non-medical use (aROR=0.57[0.40-0.81]).. Prescription stimulant use was higher in non-MML states for most LGB subgroups. MMLs may differentially impact stimulant use, primarily for bisexual men and women. States enacting MMLs should consider potential impacts on drugs other than marijuana, especially among LGB populations.

Topics: Adult; Bisexuality; Cannabis; Female; Humans; Male; Medical Marijuana; Opioid-Related Disorders; Prescriptions; United States

Although much of the attention surrounding the opioid epidemic has focused on rural and suburban Whites and prescription opioids, heroin overdoses among urban Blacks are on the rise. While some argue that legalization of cannabis will combat the epidemic, there are concerns it ignores the shift in the epidemic and could increase vulnerability to opioid misuse. The goal of this study is to examine the association between cannabis use from adolescence to young adulthood with opioid misuse in a primarily urban Black cohort.. Data are from a study of 580 youth (87 % Black and 71 % low SES) residing in Baltimore City followed from ages 6-26. Cannabis trajectories were identified between ages 14-26 using group-based trajectory modeling. Logistic regressions were conducted to examine the impact of trajectories on opioid misuse in young adulthood adjusting for individual, neighborhood and peer factors. Opioid misuse was defined as using heroin or narcotics or painkillers without a prescription between ages 19-26.. Four cannabis trajectories were identified: Low/Non-Users (59.7 %), Adolescent Onset Limited (19.5 %), Young Adult Onset (10.8 %), and Adolescent Onset Chronic (10.0 %). Adolescent Onset Chronic cannabis users had the highest rate of opioid misuse (44.8 %) followed by Adolescent Onset Limited (18.8 %), Young Adult Onset (14.8 %) and Low/Non-Users (8.3 %). Prevalences were significantly higher for Adolescent Onset groups relative to Low/Non-Users even after adjustment for individual, neighborhood and peer factors.. Adolescent onset cannabis use is associated with opioid misuse in young adulthood among urban Blacks even after adjustment for socioecological factors associated with opioid misuse.

Topics: Adolescent; Adult; Analgesics, Opioid; Black or African American; Cannabis; Child; Cohort Studies; Drug Overdose; Female; Heroin; Humans; Male; Marijuana Smoking; Motivation; Opioid-Related Disorders; Peer Group; Prescription Drug Misuse; Residence Characteristics; Young Adult

Prenatal use of cannabis and opioids are increasing and very concerning. Engagement and retention in comprehensive, perinatal substance use disorder (PSUD) care are associated with better outcomes for mothers and babies. We compared the characteristics and engagement in care among women with opioid use disorder who used cannabis late in pregnancy versus those who didn't.. The primary outcome, "overall engagement and retention in PSUD care" included: utilization of substance use treatment prenatally, negative screening/toxicology at delivery (excluding cannabis), and attendance at expected prenatal and postpartum visits. Cannabis use late in pregnancy was objectively assessed at delivery via maternal urine drug screen and/or neonatal meconium/cord toxicology. Between-group comparisons utilized chi square, t-test or Mann-Whitney. Associations were assessed using Spearman Rho and two multivariate, binary logistic regressions for cannabis use and the primary outcome.. 18.0% (85/472) consumed cannabis late in pregnancy. Women of color, younger women, and those diagnosed with concurrent cannabis use disorder were more likely to consume cannabis. Engagement and retention in PSUD care was not associated with cannabis use, but rather, with prescribed pharmacotherapy for psychiatric disorders. The use of prescribed buprenorphine+naloxone was associated with cannabis avoidance late in pregnancy.. Cannabis use late in pregnancy, compared to none, did not impact engagement and retention in our PSUD program. Adjunctive psychotropic medication and/or buprenorphine+naloxone prescription were associated with cannabis avoidance suggesting the use and interactions of pharmacotherapies in an opioid dependent population is complex. A shared decision-making process during PSUD care is warranted.

Topics: Analgesics, Opioid; Buprenorphine, Naloxone Drug Combination; Cannabis; Child; Female; Humans; Infant, Newborn; Opioid-Related Disorders; Perinatal Care; Pregnancy

Topics: Adult; Alcoholic Beverages; Cannabis; Commerce; Duration of Therapy; Female; Health Services Accessibility; Humans; Linear Models; Male; Medication Adherence; Methadone; Middle Aged; Opiate Substitution Treatment; Opioid-Related Disorders; Residence Characteristics; Spatial Analysis; Washington

More than 30 % of patients participating in an opioid maintenance program consume cannabis. This article describes the effects of additional cannabis use during an opioid maintenance treatment program.. Narrative literature research using online publication databases (MedLine, PubMed) RESULTS: The additional use of cannabis during an opioid maintenance treatment program may have negative side effects.. Cannabis use should be discussed with the patient. It is in principle not a reason for discontinuing an opioid maintenance treatment program.. Mehr als 30 % der Patienten in Opioidsubstitutionsbehandlung konsumieren zusätzlich Cannabis. In dem Artikel werden die Auswirkungen des Konsums von Cannabis im Rahmen einer Opioidsubstitutionsbehandlung dargestellt.. Narrative Literaturrecherche (Medline, PubMed) ERGEBNISSE: Der Konsum von Cannabis im Rahmen einer Opioidsubstitutionsbehandlung kann negative Folgen nach sich ziehen.. Der Konsum von Cannabis im Rahmen einer Substitutionsbehandlung sollte mit dem Patienten erörtert werden. Cannabiskonsum stellt grundsätzlich keinen Grund für den Abbruch einer Substitutionsbehandlung dar.

Topics: Analgesics, Opioid; Cannabis; Humans; Marijuana Smoking; Opioid-Related Disorders

Ecological research suggests that increased access to cannabis may facilitate reductions in opioid use and harms, and medical cannabis patients describe the substitution of opioids with cannabis for pain management. However, there is a lack of research using individual-level data to explore this question. We aimed to investigate the longitudinal association between frequency of cannabis use and illicit opioid use among people who use drugs (PWUD) experiencing chronic pain.. This study included data from people in 2 prospective cohorts of PWUD in Vancouver, Canada, who reported major or persistent pain from June 1, 2014, to December 1, 2017 (n = 1,152). We used descriptive statistics to examine reasons for cannabis use and a multivariable generalized linear mixed-effects model to estimate the relationship between daily (once or more per day) cannabis use and daily illicit opioid use. There were 424 (36.8%) women in the study, and the median age at baseline was 49.3 years (IQR 42.3-54.9). In total, 455 (40%) reported daily illicit opioid use, and 410 (36%) reported daily cannabis use during at least one 6-month follow-up period. The most commonly reported therapeutic reasons for cannabis use were pain (36%), sleep (35%), stress (31%), and nausea (30%). After adjusting for demographic characteristics, substance use, and health-related factors, daily cannabis use was associated with significantly lower odds of daily illicit opioid use (adjusted odds ratio 0.50, 95% CI 0.34-0.74, p < 0.001). Limitations of the study included self-reported measures of substance use and chronic pain, and a lack of data for cannabis preparations, dosages, and modes of administration.. We observed an independent negative association between frequent cannabis use and frequent illicit opioid use among PWUD with chronic pain. These findings provide longitudinal observational evidence that cannabis may serve as an adjunct to or substitute for illicit opioid use among PWUD with chronic pain.

Topics: Adult; Analgesics; Analgesics, Opioid; Canada; Cannabis; Chronic Pain; Female; Humans; Longitudinal Studies; Male; Marijuana Smoking; Medical Marijuana; Middle Aged; Opioid-Related Disorders; Pain; Pain Management; Prospective Studies

The prevalence of opioid-associated morbidity and mortality underscores the need for research on non-opioid treatments for chronic non-cancer pain (CNCP). Pain is the most common medical condition for which patients request medical cannabis. Limited research indicates that patients are interested in cannabis as a potential addition to or replacement for opioid medication. This analysis reports on CNCP patient and clinician perceptions about the co-use of cannabis and opioids for CNCP management.. We interviewed 23 clinicians and 46 CNCP patients, using semi-structured interview guides, from six safety-net clinics across the San Francisco Bay Area, and 5 key stakeholders involved in CNCP management. We used a modified grounded theory approach to code and analyze transcripts.. CNCP patients described potential benefits of co-use of cannabis and opioids for pain management and concerns about dosing and addictive potential. Patients reported seeking cannabis when unable to obtain prescription opioids. Clinicians stated that their patients reported cannabis being helpful in managing pain symptoms. Clinicians expressed concerns about the potential exacerbation of mental health issues resulting from cannabis use.. Clinicians are hampered by a lack of clinically relevant information about cannabis use, efficacy and side-effects. Currently no guidelines exist for clinicians to address opioid and cannabis co-use, or to discuss the risk and benefits of cannabis for CNCP management, including side effects. Cannabis and opioid co-use was commonly reported by patients in our sample, yet rarely addressed during clinical CNCP care. Further research is needed on the risks and benefits of cannabis and opioid co-use.

Topics: Analgesics, Opioid; Attitude of Health Personnel; Cannabinoids; Cannabis; Chronic Pain; Opioid-Related Disorders; Pain Management; Patients; Physicians; Primary Health Care; San Francisco

Topics: Cannabis; Ethanol; Health Surveys; Humans; International Classification of Diseases; Opioid-Related Disorders; Substance-Related Disorders

Topics: Analgesics, Opioid; Cannabis; Humans; Medical Marijuana; Opioid-Related Disorders; Physicians

Topics: Analgesics, Opioid; Cannabis; Humans; Medical Marijuana; Opioid-Related Disorders; Physicians

Topics: Cannabis; Humans; Medical Marijuana; Opioid-Related Disorders

Topics: Analgesics, Opioid; Cannabis; Humans; Medical Marijuana; Opioid-Related Disorders; United States

Topics: Analgesics, Opioid; Cannabis; Humans; Medical Marijuana; Opioid-Related Disorders; United States

Topics: Analgesics, Opioid; Cannabis; Hallucinogens; Humans; Medical Marijuana; Opioid-Related Disorders

Topics: Cannabis; Hallucinogens; Humans; Medical Marijuana; Opioid-Related Disorders

To determine the effect of clinical, socio-demographic, and contextual characteristics on treatment retention in an opioid treatment program (OTP).. A retrospective longitudinal review of 851 clients who received methadone at the only state-funded OTP in Spokane County, Washington between 2015 and 2017. A time variable (the number of days in treatment) and a status indicator (to distinguish between clients who dropped out or censored) worked together to define retention in treatment. Our hypothesized covariates included: area deprivation, distance to the OTP, availability of cannabis retail outlets, availability of on-premise and off-premise alcohol outlets, methadone dosage, age, gender, race, and years on treatment. Cox regression within the family of survival analysis was used to model time-to-event data in the presence of censored cases.. The median duration of retention was 394 (95%CI = 324-464) days. In the multivariable Cox regression, factors predicting treatment retention were area deprivation (HR = 1.79, 95%CI = 1.02-3.15, p = 0.04), age (HR=0.99, 95%CI=0.98-.99, p = 0.008), dosage of methadone (HR=0.98, 95%CI=0.98-0.98, p < 0.001), and the number of years on treatment (HR=1.12, 95%CI=1.06-1.18, p < 0.001).. The findings of this study showed age and methadone dosage were protective factors and area deprivation and years on treatment were risk factors for treatment retention. After dichotomizing methadone dosage, a unique finding of this study was that higher dosage of methadone did not lead to increasingly smaller HRs for dropping out of treatment. Considering that opioid use disorder is a chronic condition, efforts need to be made to target factors associated with retention.

Topics: Adult; Analgesics, Opioid; Cannabis; Commerce; Dose-Response Relationship, Drug; Ethanol; Female; Geography, Medical; Humans; Male; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders; Patient Compliance; Retrospective Studies; Socioeconomic Factors; Survival Analysis; Washington; Young Adult

Cannabis will soon become legalized in Canada, and it is currently unclear how this will impact public health. Methadone maintenance treatment (MMT) is the most common pharmacological treatment for opioid use disorder (OUD), and despite its documented effectiveness, a large number of patients respond poorly and experience relapse to illicit opioids. Some studies implicate cannabis use as a risk factor for poor MMT response. Although it is well established that substance-use behaviors differ by sex, few of these studies have considered sex as a potential moderator. The current study aims to investigate sex differences in the association between cannabis use and illicit opioid use in a cohort of MMT patients.. This multicentre study recruited participants on MMT for OUD from Canadian Addiction Treatment Centre sites in Ontario, Canada. Sex differences in the association between any cannabis use and illicit opioid use were investigated using multivariable logistic regression. A secondary analysis was conducted to investigate the association with heaviness of cannabis use.. The study included 414 men and 363 women with OUD receiving MMT. Cannabis use was significantly associated with illicit opioid use in women only (OR = 1.82, 95% CI 1.18, 2.82,. This is the largest study to date examining the association between cannabis use and illicit opioid use. Cannabis use may be a sex-specific predictor of poor response to MMT, such that women are more likely to use illicit opioids if they also use cannabis during treatment. Women may show improved treatment outcomes if cannabis use is addressed during MMT.

Topics: Adolescent; Adult; Aged; Cannabis; Female; Humans; Male; Marijuana Smoking; Methadone; Middle Aged; Ontario; Opiate Substitution Treatment; Opioid-Related Disorders; Sex Characteristics; Young Adult

There are limited data about the extent of DSM-5 substance use disorders (SUDs) among primary care patients.. This study analyzed data from a multisite validation study of a substance use screening instrument conducted in a diverse sample of 2000 adults aged ≥18 years recruited from five primary care practices in four states. Prevalence and correlates of 12-month DSM-5 SUDs were examined.. Overall, 75.5% of the sample used any substance, including alcohol (62.0%), tobacco (44.1%), or illicit drugs/nonmedical medications (27.9%) in the past 12 months (marijuana 20.8%, cocaine 7.3%, opioids 4.8%, sedatives 4.1%, heroin 3.9%). The prevalence of any 12-month SUD was 36.0% (mild disorder 14.2%, moderate/severe disorder 21.8%): tobacco 25.3% (mild 11.5%, moderate/severe 13.8%); alcohol 13.9% (mild 6.9%, moderate/severe 7.0%); and any illicit/nonmedical drug 14.0% (mild 4.0%, moderate/severe 10.0%). Among past 12-month users, a high proportion of tobacco or drug users met criteria for a disorder: tobacco use disorder 57.4% (26.1% mild, 31.3% moderate/severe) and any drug use disorder 50.2% (14.3% mild, 35.8% moderate/severe); a lower proportion of alcohol users (22.4%) met criteria for alcohol use disorder (11.1% mild, 11.3% moderate/severe). Over 80% of adults with opioid/heroin use disorder met criteria for a moderate/severe disorder. Younger ages, male sex, and low education were associated with increased odds of having SUD.. These findings reveal the high prevalence of SUDs in primary care and underscore the need to identify and address them.

Topics: Adult; Alcoholism; Cannabis; Diagnostic and Statistical Manual of Mental Disorders; Heroin; Humans; Hypnotics and Sedatives; Illicit Drugs; Opioid-Related Disorders; Prevalence; Primary Health Care; Substance-Related Disorders; Tobacco Use Disorder

To determine whether maternal and infant outcomes are associated with exposure to marijuana during the third trimester in a population of opioid dependent pregnant women maintained on buprenorphine.. This retrospective cohort study of 191 maternal-infant dyads exposed to buprenorphine during pregnancy examines a variety of variables including gestational age, birthweight, method of delivery, Apgar scores at one and five minutes, duration of infant hospital stay, peak neonatal abstinence syndrome (NAS) score, duration of NAS and incidence of pharmacologic treatment of NAS in infants exposed to marijuana during the third trimester as compared to infants not exposed to marijuana during the third trimester.. Analyses failed to support any significant relationship between marijuana use in the third trimester and a variety of maternal and infant outcomes. Two important variables - the likelihood of requiring pharmacologic treatment for NAS (27.6% in marijuana exposed infants vs. 15.7% in non-marijuana exposed infants, p=0.066) and the duration of infant hospital stay (7.7days in marijuana exposed infants vs. 6.6days in non-exposed infants, p=0.053) trended toward significance.. Preliminary results indicate that marijuana exposure in the third trimester does not complicate the pregnancy or the delivery process. However, the severity of the infant withdrawal syndrome in the immediate postnatal period may be impacted by marijuana exposure. Because previous study of prenatal marijuana exposure has yielded mixed results, further analysis is needed to determine whether these findings are indeed significant.

Topics: Analgesics, Opioid; Birth Weight; Buprenorphine; Cannabis; Female; Gestational Age; Humans; Infant; Infant, Newborn; Length of Stay; Marijuana Smoking; Neonatal Abstinence Syndrome; Opioid-Related Disorders; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third; Retrospective Studies; Substance Withdrawal Syndrome

With the non-medical use of prescription opioids increasingly becoming a method of abuse in Canada, the number of patients requiring methadone maintenance treatment (MMT) for opioid use disorder has increased dramatically. The rate of cannabis use in this population is disproportionately high (~50 %). Because its use is generally perceived as harmless, cannabis use is often not monitored during MMT. Current literature regarding the effects of cannabis use on MMT is conflicting, and the presence and nature of an association has not been clearly established. The primary objective of this review will be to conduct a systematic review of the literature and, if appropriate, a meta-analysis to determine whether there is an association between cannabis use and MMT outcomes. A secondary objective will be to perform subgroup analyses (by age, sex, method of cannabis measurement, and country) to determine whether cannabis use differentially influences MMT outcomes within these subgroups.. The search will be conducted on the following electronic databases using a predefined search strategy: MEDLINE, EMBASE, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Two authors (LZ and MB) will independently screen articles using predetermined inclusion/exclusion criteria and will extract data from included articles using a pilot-tested data extraction form. Disagreements at all stages of the screening process will be settled through discussion, and when consensus cannot be reached, a third author (ZS) will be consulted. An assessment of quality and risk of bias will be conducted on all included articles, and a sensitivity analysis will be used to compare results of studies with high and low risk of bias. We will perform random- and fixed-effects meta-analyses, if appropriate, with heterogeneity calculated using the I (2) statistic and formal evaluation of publication bias.. Results of this systematic review will elucidate the association between cannabis use and methadone maintenance treatment outcomes. We will provide evidence that will be useful to clinicians regarding whether monitoring cannabis use during MMT is advantageous for optimizing MMT outcomes.. PROSPERO CRD42015029372.

Topics: Analgesics, Opioid; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders; Research Design; Systematic Reviews as Topic; Treatment Outcome

Topics: Analgesics, Opioid; Biomedical Research; Cannabis; Chronic Pain; Humans; Neural Pathways; Neurons; Opioid-Related Disorders; Pain Management

Topics: Analgesics, Opioid; Cannabis; Complementary Therapies; Drug Overdose; Drug Prescriptions; Humans; Medical Marijuana; Opioid-Related Disorders; Pain; Pain Management; United States

Topics: Analgesics, Opioid; Canada; Cannabis; Drug Prescriptions; Humans; Opioid-Related Disorders; Practice Guidelines as Topic

Afghanistan leads global opium and cannabis production, amidst concerted efforts to improve the country's infrastructure. In this commentary, the evidence base for drivers of increased drug use in the context of deteriorating security is presented, government, donor, and civil society responses to date are described, and key areas for health policy response are summarized. Opiate use in Afghanistan shows disturbing trends: multiple substances are accessible at low cost and frequently used in combination, and injecting use has become more common. Pressures from both donor and governmental sectors have compromised innovations in programming. Further, civil unrest and resultant displacement have created challenges for programme implementation. Afghanistan urgently needs a well-funded, sustainable, comprehensive, and inclusive programme of drug dependency treatment, aftercare, and harm reduction services, as well as realistic, effective, and culturally salient primary prevention programmes. To date, drug dependence is not a prioritised issue, current programmes are under-resourced, and the continuum of care has a narrow scope generally limited to treatment. Unless this issue is addressed, the next generation of Afghans is poised to become a casualty of the opiate industry.

Topics: Afghanistan; Aftercare; Agriculture; Cannabis; Harm Reduction; Health Policy; Humans; Opioid-Related Disorders; Opium; Substance Abuse, Intravenous

This is a register-based cohort study of 20,581 individuals in treatment for illicit substance use disorders in Denmark between 1996 and 2006. All in all, 1441 deaths were recorded during 111,445 person-years of follow-up. Standardized mortality ratios (SMRs) associated with different primary substance types were calculated and Cox-regression analyses were performed in order to establish hazard ratios (HR) associated with injection drug use and psychiatric comorbidity. SMRs for primary users of specific substances were: cannabis: 4.9 (95% confidence interval (CI): 4.2-5.8), cocaine: 6.4 (CI: 3.9-10.0), amphetamine: 6.0 (CI: 4.2-8.3), heroin: 9.1 (CI: 8.5-9.8), and other opioids 7.7 (CI: 6.6-8.9). For MDMA ('ecstasy') the crude mortality rate was 1.7/1000 person-years (CI: 0.4-7.0) and the SMR was not significantly elevated. Injection drug use was associated with significantly increased hazard ratios in users of opioids and cocaine/amphetamine. Overall, psychiatric comorbidity was not associated with increased mortality (HR: 1.1 [CI: 0.9-1.2], p=.28), but an association was found specifically among cocaine/amphetamine users (HR: 3.6 [CI: 2.1-6.4], p<.001).

Topics: Adult; Amphetamine; Analgesics, Opioid; Cannabis; Cocaine; Cohort Studies; Denmark; Female; Follow-Up Studies; Humans; Male; Marijuana Abuse; N-Methyl-3,4-methylenedioxyamphetamine; Opioid-Related Disorders; Registries; Substance-Related Disorders; Treatment Outcome; Young Adult

Topics: Adult; Cannabis; Female; Humans; Male; Marijuana Abuse; Opioid-Related Disorders; Outpatients; Prevalence; Sleep Wake Disorders; Substance Withdrawal Syndrome; Surveys and Questionnaires

In the early twentieth century, the concept of “degeneration” helped to turn “drugs” into a problem of national importance in Mexico. By invoking this concept, Mexico's sanitary authorities secured provisions in the Constitution of 1917 which specifically authorized a newly constituted Department of Public Sanitation to lead a nation-wide campaign against drug abuse. That Department then inaugurated Mexico's modern war on drugs when, in 1920, it declared a law governing the import and distribution of the opiates, cocaine, and marijuana nationwide. This essay examines the idea of degeneration and how it came to play this crucial role in the foundation of Mexico's modern war on drugs.

Topics: Cannabis; Cocaine; Drug Industry; Government Regulation; History, 20th Century; Illicit Drugs; Law Enforcement; Mexico; Opioid-Related Disorders; Public Health; Public Policy; Social Conditions; Social Problems; Social Responsibility; Substance-Related Disorders

Fourteen states and the District of Columbia have legalized the use of cannabis for medical purposes. A small, high-quality literature supports the efficacy of medical cannabis for the treatment of neuropathic pain. The smoked botanical product, however, is associated with a number of adverse medical and psychiatric consequences. Furthermore, experimental data indicate that acute use of cannabis results in impairment of every important metric related to the safe operation of a motor vehicle. Epidemiological data show associations between recent cannabis use and both psychomotor impairment and motor vehicle crashes, associations that are strengthened by the concomitant use of alcohol and other central nervous system depressants. Finally, data from pain clinics reveals an unusually high prevalence of cannabis use in nearly all age groups and an association between cannabis use and opioid and other substance misuse. Based on available data and expert opinion, concomitant use of cannabis and opioids is an absolute contraindication to the operation of a motor vehicle. In patients who use cannabis and are prescribed opioids, heightened vigilance for opioid- and other substance-related problems is warranted. It is appropriate to refrain from prescribing opioids to individuals using medical cannabis if there is reasonable suspicion that the combination will pose a risk to the patient or others.

Topics: Accidents, Traffic; Alcohol Drinking; Analgesics, Opioid; Animals; Cannabis; Drug Interactions; Humans; Marijuana Smoking; Neuralgia; Opioid-Related Disorders; Phytotherapy; Substance-Related Disorders; United States

Topics: Cannabis; Humans; Marijuana Abuse; N-Methyl-3,4-methylenedioxyamphetamine; Opioid-Related Disorders

The aim of this study was the assessment of disorders after chronic intake of psychoactive drugs, like marijuana, amphetamine, ecstasy, cocaine and opiates. In 2002 in the Department of Clinical Toxicology detoxification unit were treated 117 chronic drug abusers. The 76 of them use the opiates predominantly, the next 41 persons (35 men, 6 women), were heavy abusers of psychostimulant drugs. In opiate abusers typical withdrawal signs and symptoms were observed. In the group of psychostimulants users, the mean time of marijuana use was 6 years, amphetamine--5 years. The cocaine was used rarely. Among 25 persons (61%) from these group the withdrawal syndrome were established. The excitation of neurovegetative system, depression, or psychomotor effects were observed. We concluded the necessity of estimation of neurobiological changes after using of psychostimulants and that more controlled research might uncover a clinically diagnosable withdrawal syndrome in human psychostimulants users.

Topics: Adolescent; Adult; Amphetamine; Amphetamine-Related Disorders; Cannabis; Cocaine; Cocaine-Related Disorders; Female; Hospitalization; Humans; Male; Marijuana Abuse; Middle Aged; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Opioid-Related Disorders; Poland; Psychotropic Drugs; Substance Abuse Treatment Centers; Substance Withdrawal Syndrome

To determine the mortality rate, during the first 2 years of life, in infants who were exposed to cocaine, opiate, or cannabinoid during gestation.. For a period of 11 months, a large group of infants were enrolled and screened at birth for exposure to cocaine, opiate, or cannabinoid by meconium analysis. Death outcome, within the first 2 years after birth, was determined in this group of infants using the death registry of the Michigan Department of Public Health.. A total of 2964 infants was studied. At birth, 44% of the infants tested positive for drugs: 30. 5% positive for cocaine, 20.2% for opiate, and 11.4% for cannabinoids. Compared to the drug negative group, a significantly higher percentage (P < .05) of the drug positive infants had lower weight and smaller head circumference and length at birth and a higher percent of their mothers were single, multigravid, multiparous, and had little to no prenatal care. Within the first 2 years of life, 44 infants died: 26 were drug negative (15.7 deaths per 1000 live births) and 18 were drug positive (13.7 deaths per 1000 live births). The mortality rate among cocaine, opiate, or cannabinoid positive infants were 17.7, 18.4, and 8.9 per 1000 live births, respectively. Among infants with birth weight

Topics: Birth Weight; Cannabinoids; Cannabis; Cocaine; Confidence Intervals; Data Interpretation, Statistical; Female; Humans; Infant; Infant Mortality; Infant, Newborn; Male; Meconium; Narcotics; Neonatal Screening; Odds Ratio; Opioid-Related Disorders; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Registries; Sudden Infant Death

Topics: Cannabis; Chronic Disease; Cocaine; Ethanol; Humans; Opioid-Related Disorders; Pain; Substance-Related Disorders

Topics: Adult; Alcoholism; Cannabis; Cocaine; Female; Humans; Interview, Psychological; Male; Opioid-Related Disorders; Substance-Related Disorders; Syndrome

Examinations of the birth order literature for drug and alcohol abuse reveals equivocal and contradictory findings, many of which are methodologically suspect. The findings based on the 12-year follow-up of the Drug Abuse Reporting Program (DARP) suggest that there is very little support for birth order differences among drug abusers for age of initial drug use, severity of drug use, achievement of abstinence, or alcohol consumption. Finally, it is suggested that birth position is probably not a strong hypothesis for further research. Methodological difficulties, the likelihood of very small effect sizes (if any), and the uncertain theoretical status of birth position all detract from the viability of such investigations.

Topics: Adult; Alcohol Drinking; Birth Order; Black or African American; Cannabis; Family Characteristics; Humans; Interview, Psychological; Male; Opioid-Related Disorders; Research; Substance-Related Disorders; Time Factors; White People

Studies have reported a positive relationship between alcohol consumption and general levels of affluence in society. The present paper suggests that drug use and abuse should also be related to affluence since, to some extent, alcohol and drugs are substitute products. Levels of drug abuse and levels of affluence, in society, change over time. Therefore, indicators of affluence (economic and health conditions) and various types of illicit drug abuse in five countries were examined for the period 1960-1975. The results of our investigation show that officially recorded measures of drug abuse, in each of five countries, were related to improvements in economic and health conditions.

Topics: Amphetamine; Canada; Cannabis; Health; Hong Kong; Humans; Opioid-Related Disorders; Socioeconomic Factors; Substance-Related Disorders; Sweden; United Kingdom; United States

Topics: Cannabis; Cocaine; Hallucinogens; Humans; Hypnotics and Sedatives; Opioid-Related Disorders; Substance-Related Disorders; United States

The paper provides an outline of a wide-ranging drug abuse control programme undertaken by the Government of the Socialist Republic of the Union of Burma with support and assistance from the United Nations. The components included law enforcement, crop substitution, measures for treatment and rehabilitation and a nationwide programme for drug education. The overall effort was co-ordinated by the Ministry of Home and Religious Affairs, through a Central Committee for Drug Abuse Control on which the Deputy Ministers of the Ministries concerned were members. Liaison between the executing Burmese agencies and the United Nations assisting organizations was effected through a small United Nations office established in Rangoon. The promising result of the programme has led to a further Agreement between the government and the United Nations for the continuation of the programme for a further five years from May 1981.

Topics: Agriculture; Cannabis; Drug and Narcotic Control; Health Education; Humans; Myanmar; Opioid-Related Disorders; Papaver; Plants, Medicinal; Substance-Related Disorders; United Nations

Topics: Adolescent; Adult; Age Factors; Alcohol Drinking; Black or African American; Cannabis; Cocaine; Educational Status; Hallucinogens; Heroin Dependence; Humans; Illicit Drugs; Male; Marijuana Abuse; New York City; Opioid-Related Disorders; Smoking; Student Dropouts; Substance-Related Disorders; Unemployment; United States; White People

An investigation was carried out as a case-finding study to estimate the scale of heavy drug abuse in Sweden. Just over 8200 persons were reported as heavy drug abusers, 80% of these as injecting. For the majority of those reported more than one type of drug was indicated. There was concurrent abuse of alcohol by a majority of the heavy drug abusers. After correction of non-response with a modified capture-recapture technique and for erroneous classification, the scale of heavy drug abuse was estimated at 10000 - 14000 persons.

Topics: Adult; Alcohol Drinking; Cannabis; Female; Humans; Male; Opioid-Related Disorders; Smoking; Substance-Related Disorders; Sweden

The drug habits for 78 confirmed opiate addicts were studied on eight scales from the Process Association Test of Addiction (PATA) for many drug names. Through cluster analysis eight stages of addiction were defined: "to be clean", "to learn about drugs", "to hustle", "to chip" (also "to be high"), to be psychologically dependent or "to need a shot", "to be hooked" "to kick a habit" and "to be in treatment". Associations stimulated by the words heroin and morphine were very similar over the eight stages of addiction in opiate addicts. The subjects were especially inclined to associate morphine and heroin with the most severe level of addiction, "to be hooked". Associations to both methadone and cocaine were elevated at the "hooked" stage, but in other respects associations to these drugs were opposite. Thus, associations to cocaine were focused on the stage of psychological dependence and the lower intermediate stage of addiction, "to chip" and "to be high", whereas associations to methadone suggested a turning away from addiction as indicated by avoidance associations ("to come down" and "to kick a habit") as well as associations to "treatment" and "to be clean". Marijuana, Benzedrine, "goofball" (barbiturates) and alcohol habits were prominent at an intermediate stage of addiction ("to chip" and "to be high"). Avoidance associations were common for Benzedrine and "goofballs" (also pentobarbital) but not for marijuana or alcohol. "Hustling" associations were frequent for marijuana but not for alcohol.

Topics: Adult; Alcoholism; Amphetamines; Barbiturates; Cannabis; Cocaine; Heroin Dependence; Humans; Male; Methadone; Morphine Dependence; Opioid-Related Disorders; Pentobarbital; Psychological Tests; Substance-Related Disorders

A treatment population of 1,544 drug/alcohol abusers at 10 combined treatment centers was studied to determine the various patterns of sequential use and their corresponding policy implications. Most of the persons who began their substance abuse with alcohol continued to use only alcohol. Alcoholics who did use another substance, either sequentially or concurrently, tended to select a drug other than opiates or marijuana. Although a majority of opiate users eventually became concurrent or sequential users of another substance, a sizable number remained mono-users. A miniscule number of the opiate users moved on to alcohol or marijuana. Most of the users initiated into regular use with marijuana eventually began to use a nonopiate, nonalcoholic substance. A majority of the users who started with a nonalcohol, nonopiate, nonmarijuana substance eventually used marijuana. Sequential and concurrent users in general were more similar to each other than to mono-users. The implications of the development of drug use typologies for direct treatment are discussed. Having identified target groups, the author then suggests policies for controlling substance abuse indirectly, such as those dealing with employment.

Topics: Adult; Alcoholism; Cannabis; Employment; Female; Humans; Male; Opioid-Related Disorders; Social Adjustment; Socioeconomic Factors; Substance-Related Disorders