Lead Story: Comparative Effectiveness Associated With Buprenorphine and Naltrexone in Opioid Use Disorder and Cooccurring Polysubstance Use

Comparative Effectiveness Associated With Buprenorphine and Naltrexone in Opioid Use Disorder and Cooccurring Polysubstance Use 🔓

JAMA Network Open

This comparative effectiveness study evaluated 179 280 individuals with opioid use disorder (OUD) using insurance claims. Individuals with OUD and co-occurring substance use disorders (SUDs) were less likely to receive buprenorphine and more likely to receive extended-release naltrexone than peers without polysubstance use; buprenorphine and extended-release naltrexone were comparable in their protective associations with drug- related poisonings in both populations. These findings suggest that individuals with co-occurring SUDs were less likely to receive buprenorphine despite buprenorphine’s association with protecting against overdose in this population.

 

Perceived effectiveness of objective elements of vaping prevention messages among adolescents 🔓

Tobacco Control

To date, no comprehensive analysis of vaping prevention message elements has been conducted. This study examined how objective features of vaping prevention messages predict adolescents’ perceptions of those messages. Items such as addiction, chemicals, and negative health symptoms/effects were associated with higher perceived message effectiveness (PME); the word ‘addiction’ was associated with higher PME only for non-users. Referencing lung effects increased PME for current users but not for non-users. Items such as industry targeting, environmental impact, and flavor themes were associated with lower PME, along with first-person language or the word ‘teen.’ Prevention messages that even moderately improve vaping-related outcomes have the potential to improve vaping prevention.

 

Survey of Barriers and Facilitators to Prescribing Buprenorphine and Clinician Perceptions on the Drug Addiction Treatment Act of 2000 Waiver 🔓

JAMA Network Open

As opioid-related deaths increase, methods to reduce barriers to prescribing buprenorphine are needed. What is unclear is whether removal of the X-waiver requirement for prescribing buprenorphine will be enough to increase access. This study was conducted to better understand key barriers/facilitators to prescribing beyond those related to the X-waiver process. A survey of Texas clinicians who received waiver training between March 2019 and February 2020 was distributed, with a follow-up survey later in the year assessing nine barriers to treatment. Complexity of X-waiver process, perceived lack of professional support and referral network, and getting started were found to be barriers to prescribing; supportive professional networks were a key facilitator. 

 

Prevalence and Correlates of Driving under the Influence of Stimulants: Evidence from a National Sample 

Addictive Behaviors

This study notes an increase in cocaine use over the last decade and even greater increase in the use of methamphetamine. Data on stimulant use and driving under the influence of stimulants (DUIS) was obtained from four years of the National Survey on Drug Use and Health (2016-2019). Among adults reporting stimulant use in the past year 28% reported DUIS and 56% for those who met DSM IV criteria for stimulant abuse/dependence. Odds of DUIS was lower among women (AOR 0.78). A majority of those reporting DUIS also reported driving under the influence of alcohol (53%) or cannabis (59%).  

 

Does it come from tobacco? Young adults’ interpretations of the term “tobacco-free nicotine” in a cross-sectional national survey sample 🔓

PLOS One

“Tobacco-free” nicotine (TFN) products are relatively new to the market. Although as of March 2022 they fall under FDA regulation as tobacco products, there is still concern about public understanding of these products and potential impact on nicotine product use, particularly among adolescents and young adults. In this study, the authors surveyed those 18-25 years of age to assess knowledge about tobacco products in general and TFN products in particular. Overall, young adults lack knowledge about nicotine-containing products, frequently incorrectly identifying the nicotine source for cigarettes (38.1%), smokeless tobacco (47.9%), e-cigarettes (53.4%) nicotine pouches (74.4%), and TFN (42.2%). Of particular concern, 17.1% of respondents believed TFN products did not contain nicotine or tobacco. FDA regulation around marketing of TFN products may be needed. 

 

Prevention, treatment and care of substance use disorders in times of COVID-19 🔓

World Psychiatry

In this editorial, The United Nations Office on Drugs and Crime (UNODC) – World Health Organization Informal Scientific Network (ISN) provides multiple recommendations for care of substance use disorders (SUDs). During the COVID-19 pandemic, persons with SUDs have fared worse than the general population, both in terms of risk of infection and worse outcomes with infection. One of the key public health principles is providing services to populations with increased vulnerabilities; this also benefits the entire population. Among the recommendations from the ISN are inclusion of mental health and SUD experts in COVID-19 task forces and development of strategies to ensure SUDs are treated like any other chronic medical condition during the pandemic and beyond. 

 

Can slogans prevent gambling harm?

The Lancet Public Health

This is a commentary on a study assessing the efficacy of a slogan used in a safer gambling campaign in the UK. The slogan “When the fun stops, stop” did not have the intended effect in this study of experienced gamblers. The author observes that a safer gambling campaign implies that there is a safe level of gambling which may not exist, for example with electronic gambling machines. A parallel is drawn with responsible drinking campaigns that have little impact on actual alcohol consumption. They also focus responsibility on the individual rather than providers and regulators. The author notes that experience with alcohol and tobacco has shown that advertising emphasizing the harms of use can discourage harmful use.  

 

The stigma of alcohol-related liver disease and its impact on healthcare 

Journal of Hepatology

This review summarizes the evidence on alcohol related liver disease (ALD) stigma in healthcare and its implications for people with ALD. Public stigma, self-stigma and structural stigma all contribute to increased illness burden of ALD, failure to or delay of seeking help, inferior healthcare, and negative health outcomes. Stigma can be experienced, but also anticipated and avoided, which all negatively impacts ALD healthcare. Blaming people with ALD for their condition is central to ALD stigma. Stigma affects ALD healthcare at all stages, from prevention, early detection and intervention, to allocation of scarce resources in liver transplantation. People with lived experience need to be empowered to lead action against the stigma of ALD.