Category: From Newswise – Substance Abuse

Newswise — Researchers have identified a strong association between prevalence of prescription stimulant therapy for attention-deficit/hyperactivity disorder (ADHD) and rates of prescription stimulant misuse (taken in a way other than as directed by a clinician) by students in middle and high schools. The study, which appeared today in JAMA Network Open, highlights the need for assessments and education in schools and communities to prevent medication-sharing among teens. This is especially important considering non-medical use of prescription stimulants among teens remains more prevalent than misuse of any other prescription drug, including opioids and benzodiazepines.

Supported by the National Institute on Drug Abuse (NIDA) at the National Institutes of Health and the U.S. Food and Drug Administration, the study used data collected between 2005 and 2020 by the Monitoring the Future (MTF) study. MTF is a large, multicohort survey of legal and illicit drug use among American adolescents in eighth, 10^th, and 12^th grade, also funded by NIDA.

“The drug supply has rapidly changed, and what looks like medications – bought online or shared among friends or family members – can contain fentanyl or other potent illicit substances that can result in overdoses. It’s important to raise awareness of these new risks for teens,” said NIDA Director Nora Volkow, M.D. “It’s also essential to provide the necessary resources and education to prevent misuse and support teens during this critical period in their lives when they encounter unique experiences and new stressors.”

Stimulant therapy is an evidence-based treatment for ADHD, but it can also be harmful if used without prescription or guidance from clinicians. Prolonged stimulant misuse can lead to several detrimental health effects including cardiovascular conditions, depressed mood, overdoses, psychosis, anxiety, seizures, and stimulant use disorder.

Previous studies have shown that more than half of adolescents who misuse prescription stimulants get the medication for free from friends or relatives. While diagnoses of ADHD and prescribing of stimulant therapy for ADHD have increased significantly in the United States over the past 20 years, few studies have looked at the relationship between stimulant therapy and prescription stimulant misuse in schools. This is the first large, national study to examine prevalence of prescription stimulant misuse and factors correlating with prevalence among students in eighth, 10^th, and 12^th grade across the U.S.

Researchers at the University of Michigan examined both school- and individual-level characteristics associated with prescription stimulant misuse. Across 231,141 student participants surveyed at 3,284 secondary schools, the school-level prevalence of nonmedical use varied from 0% to over 25% of students. Schools with a greater number of students (12% or higher) reporting prescription stimulant therapy for ADHD tended to have the highest percentages of their student body reporting prescription stimulant misuse (8% of total student body). By comparison, schools with fewer students (0 to 6% of student body) reporting stimulant therapy for ADHD were associated with lower rates of prescription stimulant misuse (4 to 5% of student body).

Other features of schools that were associated with increased rates of misuse included having a higher proportion of parents with higher levels of education, being located in non-Northeastern regions and in suburban areas, having a higher proportion of non-Hispanic white students, and showing “medium-level” (10-19% of total student body) binge drinking. However, the association between school prevalence of stimulant therapy for ADHD and prescription stimulant misuse remained strong when accounting for prevalence of other types of substance use and numerous other individual- and school-level sociodemographics.

Recent research from this team expands on the associations found in this study, including a study that suggested teens with a history of taking both stimulant or non-stimulant medications for ADHD are at high risk for prescription stimulant misuse, as well as cocaine and methamphetamine use. The researchers note that it is important to interpret these results as associations, not causations, and that the primary goal of these kinds of studies is to inform effective preventative and support strategies for teens.

“The key takeaway here is not that we need to lessen prescribing of stimulants for students who need them, but that we need better ways to store, monitor, and screen for stimulant access and use among youth to prevent misuse,” said study author Sean Esteban McCabe, Ph.D. “There’s variation in stimulant misuse across different schools, so it’s important to assess schools and implement personalized interventions that work best for each school. It’s also critical to treat and educate teens on prescription stimulants as the medications they are intended to be and limit their availability as drugs of misuse.”

With sadness, NIDA shares that study author and NIDA grantee Dr. John E. Schulenberg passed away in February. Dr. Schulenberg was a member of the Monitoring the Future study’s leadership team for 32 years and has made immense contributions to addiction science that will be remembered and honored.

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For more information on substance and mental health treatment programs in your area, call the free and confidential National Helpline 1-800-662-HELP (4357) or visit www.FindTreatment.gov. 

Reference: SE McCabe, et al. Prescription stimulant medical and nonmedical use among US secondary school students (2005–2020). JAMA Network Open. DOI: 10.1001/jamanetworkopen.20238707 (2023).

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About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

About substance use disorders: Substance use disorders are chronic, treatable conditions from which people can recover. In 2021, over 46 million people in the United States had at least one substance use disorder. Substance use disorders are defined in part by continued use of substances despite negative consequences. They are also relapsing conditions, in which periods of abstinence (not using substances) can be followed by a return to use. Stigma can make individuals with substance use disorders less likely to seek treatment. Using preferred language can help accurately report on substance use and addiction. View NIDA’s online guide.

NIH…Turning Discovery Into Health^®

Newswise — COLUMBUS, Ohio – About one in five cases of child abuse and neglect is committed by both mothers and fathers, but nearly all the research attention has been focused on when just one parent is involved.

A new study that aimed to shine a light on risk factors for mistreatment coming from both parents found some surprising results.

For example, mothers and fathers who were substance users had lower odds of both being involved in physical or sexual abuse. Couples in which at least one of the parents was a prior abuse perpetrator also had lower odds of physical abuse.

These and other results suggest that the factors that predict when both parents will be involved in specific types of maltreatment are not always obvious, said Joyce Lee, lead author of the study and assistant professor of social work at The Ohio State University.

“We need more nuanced ways of understanding and addressing multiple risk factors within the family to prevent child maltreatment involving both mothers and fathers,” Lee said.

The issue is important because previous research suggests that child maltreatment perpetrated by mothers and fathers is more severe than maltreatment committed by one parent alone.

“That’s alarming, but also not surprising. Two parents can have more of a harmful impact on a child if they are both involved with maltreatment,” Lee said.

The research was published online recently in the journal Children.

The study involved data from the National Child Abuse and Neglect Data System, which is a federally sponsored project of the Children’s Bureau at the U.S. Department of Health and Human Services.

The final sample included 6,996 families from 11 states in which biological mother-father pairs were identified as co-perpetrating maltreatment against a child that led to involvement in the foster care system.

Results showed that about 93% of the maltreatment cases involved neglect, followed by 14% physical abuse, 2% sexual abuse and 1% emotional abuse.

The findings related to physical abuse contradict the results of previous research that suggested parental substance use and housing insecurity were risk factors for child physical abuse.

“Parents who are intoxicated from alcohol or drugs, as well as those struggling to find adequate housing, may not have the bandwidth for any type of parenting – even harsh parenting linked to physical abuse,” Lee said.

But those same risk factors were linked to higher odds of both parents participating in neglect, she said. 

“There seems to be differences in how family characteristics are linked to acts of omission, such as neglect, versus acts of commission, such as physical abuse,” Lee said.

The fact that having a parent who was a prior perpetrator was linked to lower odds of both parents being involved in physical abuse suggests that additional services provided to parents and increased monitoring of these families may mitigate the risk of maltreatment recurrence, she said.

Results also showed that intimate partner violence in a couple relationship was linked to higher odds of both parents participating in child neglect.

In cases of sexual abuse, disability and medical conditions among parents were linked with higher odds of mothers and fathers being co-involved, while parental substance use was linked with lower odds of sexual abuse.

Intimate partner violence was the only factor in the study linked to the emotional abuse of children.

The study also found, somewhat surprisingly, that economic insecurity and parental mental health problems were not risk factors for any type of maltreatment. That is inconsistent with other research, and Lee said more research is needed to determine if those factors truly aren’t linked to both parents being involved in maltreatment.

Lee said the results suggest a critical need for programs and policies to address the presence of a prior perpetrator in the family, parental substance use, disability and medical conditions, inadequate housing, and intimate partner violence in families.

But the results suggest a nuanced approach, because efforts to reduce maltreatment may not have an equal impact on all the various types.

“For example, interventions that aim to prevent intimate partner violence may help prevent emotional abuse and neglect, but not help prevent physical or sexual abuse,” she said.

“We really need to have a comprehensive assessment and treatment of risk factors so that we can stop all types of child maltreatment by both parents.”

Co-authors of the study were Susan Yoon and Angelise Radney of Ohio State, Keunhye Park of Michigan State University, Stacey Shipe of Binghamton University, and Garrett Pace of the University of Nevada Las Vegas.

Newswise — مدينة روتشستر، بولاية مينيسوتا —  قد يكون لاستخدام الأدوية أفيونية المفعول التي تُصرف بوصفة طبية تأثير سلبي على الوظائف الإدراكية لدى البالغين الأكبر سنًا، وذلك وفقًا لدراسة حديثة أجرتها مايو كلينك، نُشرت في مجلة الجمعية الأمريكية لطب الشيخوخة. استخدمت الدراسة السكانية الرصدية بيانات من دراسة مايو كلينك للشيخوخة، وهي مبادرة بحثية تدرس الانحدار الإدراكي لدى كبار السن منذ ما يقرب من 20 عامًا. 

وجد الفريق البحثي أن 70% من المشتركين تلقوا وصفة طبية واحدة على الأقل من عقاقير أفيونية المفعول على مدار 7.5 عامًا في المتوسط. وتم ربط كل وصفة بحدوث انحدارات في الأداء الإدراكي، خاصة في الذاكرة واللغة والانتباه. كما أن من تلقوا العقاقير أفيونية المفعول كانت لديهم احتمالية أكبر للإصابة بالاختلال المعرفي المعتدل (MCI) بنسبة 20%، وهي حالة انحدار إدراكي تفوق الأعراض الطبيعية المصاحبة للتقدم في العمر.

تقول نفيسة وارنر، دكتورة الطب، اختصاصي التخدير وطب الألم: “من المهم ذكر هذه المعلومات أثناء عملية اتخاذ القرار المشتركة بين المرضى وخبراء الرعاية الصحية بشأن أفضل أساليب إدارة الألم”.

وبخلاف مسؤوليات الرعاية السريرية، فإن دكتورة وارنر تشارك بكثرة في الأبحاث السريرية، التي يدعمها المعهد الوطني للشيخوخة، كما أنها كانت باحثة في برنامج كيرن لتقديم الرعاية الصحية في مركز روبرت دي وباتريشيا إي كيرن لعلوم تقديم الرعاية الصحية التابع لمايو كلينك. يدرب برنامج كيرن لتقديم الرعاية الصحية الزملاء الحاصلين على الدكتوراه وأعضاء هيئة التدريس الناشئين في مجال أبحاث الخدمات الصحية.

يُعتبر الشعور بالألم شائعًا بين البالغين الأكبر سنًا، حيث يعاني أكثر من نصف البالغين 65 عامًا أو أكثر من الألم في أغلب الأيام. يقترح مؤلفو الدراسة أنه عند التفكير في وصف العقاقير أفيونية المفعول للبالغين الأكبر سنًا، يجب أن يكون العلاج مصممًا خصيصًا لكل مريض على حدة من خلال تقييم المخاطر والفوائد، وإجراء متابعة سريرية عن كثب.

يؤمن الباحثون أن نتائج دراستهم قد ينتج عنها تطوير استراتيجيات علاجية أكثر فاعلية للبالغين الأكبر سنًا، والمساعدة في تخفيف الأثر السلبي للعقاقير أفيونية المفعول المصروفة بوصفة طبية على الوظائف الإدراكية.

ويشيرون إلى أن الآليات التي من خلالها تسبب العقاقير أفيونية المفعول الانحدار الإدراكي ليست مفهومة بشكل كامل. السؤال الرئيسي هنا هل الروابط المُلاحظة بين العقاقير أفيونية المفعول المصروفة بوصفة طبية والانحدار الإدراكي تشير إلى وجود علاقة سببية، أم أن هذه العقاقير هل محض مؤشر إلى وجود حالات أخرى ترتبط بالخلل الإدراكي.

تقول دكتورة وارنر: “بالرغم من أن هذه البيانات مقنعة، فإنها لا تثبت وجود رابط سببي بين العقاقير أفيونية المفعول المصروفة بوصفة طبية وبين الانحدار الإدراكي”. “لكن ثمة رابط واضح بين العقاقير أفيونية المفعول والانحدار الإدراكي طويل المدى، مما يفرض مناقشة هذا الأمر عند التفكير في إعطاء شخص بالغ عقاقير أفيونية المفعول تُصرف بوصفة طبية”.

وتضيف دكتورة وارنر أنه عند اتخاذ أي قرار علاجي يجب مراعاة أكثر ما يهم المريض، مثل صحته وأهدافه الحياتية وتفضيلات الرعاية لديه.   

تقول دكتورة ورانر: “عندما نقرر المضي قدمًا في وصف علاج أفيوني المفعول، فمن المهم تحسين العوامل الأخرى التي قد تقي من الانحدار الإدراكي، مثل: النوم وممارسة التمارين الرياضية وترسيخ العلاقات الاجتماعية”.

لمعرفة المزيد من الأخبار عن أبحاث مايو كلينك، يُرجى زيارة Discovery’s Edge.

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نبذة عن مايو كلينك
مايو كلينك هي مؤسسة غير ربحية تلتزم بالابتكار في الممارسات السريرية والتعليم والبحث وتوفير التعاطف والخبرة لكل مَن يحتاج إلى الاستشفاء والرد على استفساراته. لمعرفة المزيد من أخبار مايو كلينك، تفضَّل بزيارة شبكة مايو كلينك الإخبارية.

Newswise — BOSTON – New research from Boston Medical Center concluded that offering medications to treat opioid addiction in jails and prisons leads to a decrease in overdose deaths. Published in JAMA Network Open, the study also found that treating opioid addiction during incarceration is cost-effective in terms of healthcare costs, incarceration costs, and deaths avoided.

Overdoses kill more than 100,000 people per year in America and this number continues to increase every year. People with addiction are more likely to be incarcerated than treated, with those from communities of color who use drugs more likely to be incarcerated than White people. Most prisons and jails in the United States discontinue medications for opioid use disorder (MOUD) upon incarceration, even if taken stably prior to incarceration, and do not initiate MOUD prior to release. Patients often suffer withdrawal symptoms while incarcerated and the post incarceration period is a time of very high-risk for overdose death.

“Offering medications for opioid addiction for incarcerated individuals saves lives. Specifically, offering all three medications—buprenorphine, methadone, and naltrexone—is the most effective at saving lives and is more cost-effective,” said lead author Avik Chatterjee, MD, primary care and addiction medicine physician at Boston Medical Center and Boston Healthcare for the Homeless and assistant professor of medicine at Boston University Chobanian & Avedisian School of Medicine. “We hope our study supports policy change at the state and federal level, requiring treating opioid use disorder with medications among people who are incarcerated.”

The study modeled the impact of MOUD access during and upon release from incarceration on population-level overdose mortality and OUD-related treatment costs in Massachusetts using three different strategies: 1) no MOUD provided during incarceration or upon release, 2) offer only extended-release naltrexone (XR-NTX) upon release from incarceration, and 3) offer all three MOUD at intake.

Among 30,000 incarcerated people with OUD, offering no MOUD was associated with 40,927 MOUD treatment starts over a 5-year period and 1,259 overdose deaths after 5 years. Over 5 years, offering XR-NTX at release led to 10,466 additional treatment starts and 40 fewer overdose deaths. In comparison, offering all three MOUD at intake led to 11,923 additional treatment starts, compared to offering no MOUD, and 83 fewer overdose deaths. Among everyone with OUD in MA, “XR-NTX only” averted 95 overdose deaths over 5 years—a 0.9% decrease in state-level overdose mortality, while the all-MOUD strategy averted 192 overdose deaths—a 1.8% decrease.

In this simulation modeling study, researchers found that offering any MOUD to incarcerated individuals with OUD would prevent overdose deaths and offering all three MOUD would prevent more deaths and save money.

Researchers believe that a treatment-based approach is more appropriate than an incarceration-based one for treating addiction. Proactively offering treatment during incarceration can save lives and is a cost-effective health intervention, while also supporting the dignity of people who are incarcerated.

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About Boston Medical Center

Boston Medical Center is a leading academic medical center with a deep commitment to health equity and a proud history of serving all who come to us for care. BMC provides high-quality healthcare and wrap around support that treats the whole person, extending beyond our physical campus into our vibrant and diverse communities. BMC is advancing medicine, while training the next generation of healthcare providers and researchers as the primary teaching affiliate of Boston University Chobanian & Avedisian School of Medicine. BMC is a founding member of Boston Medical Center Health System, which supports patients and health plan members through a value based, coordinated continuum of care.

BYLINE: Sydney Kern

Newswise — While legal cannabis products in the United States are required to report THC potency levels on their packaging those levels aren’t necessarily accurate, which can have important implications for cannabis consumers. According to a new study from the University of Northern Colorado’s Department of Biological Sciences, researchers Mitchell McGlaughlin and Anna Schwabe found that the THC potency values reported on the packaging of cannabis samples from dispensaries across Colorado’s Front Range are substantially over-reported.  

In their research, “Uncomfortably High: Testing Reveals Inflated THC Potency on Retail Cannabis Labels,” published in the journal PLOS ONE on April 12, 2023, the authors analyzed THC potency in 23 samples from 10 dispensaries throughout the Colorado Front Range and compared the results to the THC potency reported on the packaging. Approximately 70% of the samples they collected and had analyzed by a third-party lab were found to be inflated by at least 15%, confirming that consumers are often being misled about the product they are buying. According to the authors, the lack of accurate reporting of THC potency can have impacts on medical patients controlling dosage, recreational consumers expecting an effect aligned with price and trust in the industry as a whole.

• First study to do apples-to-apples comparison of residential treatment use among Medicaid enrollees across several states
• Nine states represent 14.9 million people (20% of all Medicaid enrollees)

Newswise — CHICAGO — Approximately 7 million adults in the U.S. are living with opioid use disorder (OUD). Yet a new Northwestern Medicine study that measured residential treatment use among Medicaid enrollees across nine states found only 7% of enrollees with OUD received residential treatment, an integral part of the recovery process for many.

“Given the worsening opioid crisis, that number seems low,” said corresponding author Lindsay Allen, a health economist and assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine. “We’re probably leaving effective treatment for millions on the table.”

Additionally, usage across the nine states varied widely, the study found, with some states providing residential treatment for only 0.3% of their Medicaid enrollees with OUD, and others providing up to 14.6%. The contrast in usage could be attributable to differences in insurance coverage by state, supply of facilities, and the characteristics of the states’ populations, Allen said.

“It’s disconcerting that these rates range so drastically,” Allen said. “We don’t know the ‘right’ number of people that need residential care, but it’s clearly more than what is being used.” 

The findings will be published after 9 a.m. (ET) April 12 in the Journal of Substance Use and Addiction Treatment. Results from this large nine-state study add context to the ongoing national conversation around OUD treatment and policy, providing a baseline for future research.

‘One of the best treatments for severe substance use’

Residential treatment centers are 24-hour, live-in facilities (sometimes referred to as “rehab”) that provide structured support, which can include individual and/or group therapy and medication for opioid use disorder, such as methadone and buprenorphine. 

“Residential treatment – as long as it is evidence based – is one of the best treatments for those with severe substance use,” Allen said. “It helps move people into meaningful long-term recovery, which saves lives and reduces the need for costly health care in the long term.” 

Prior to this paper, researchers struggled to make lateral comparisons of treatment use across states because state Medicaid programs define and reimburse for residential treatment differently. This is the first study to provide an apples-to-apples comparison of how many Medicaid enrollees with OUD across several states are receiving residential treatment. The scientists used a distributed research network, which standardized the nine states’ Medicaid data. 

Why state Medicaid data matters in OUD treatment

Medicaid provides health coverage to low-income people and is one of the largest payers for health care in the U.S. As more Medicaid agencies begin covering residential OUD treatment, it is important to capture use of residential OUD treatment across state Medicaid populations for benchmarking purposes and to help guide policy decisions, Allen said. 

Because Medicaid is a state-run program, any plans to increase residential treatment rates are up to the state, itself. However, there are several federal mechanisms (such as a Section 1115 waiver) that states can use to reimburse (and sometimes get federal financial assistance for) the care, Allen said. 

The nine states that took part in this study — Delaware, Kentucky, Maryland, Michigan, North Carolina, Ohio, Pennsylvania, Virginia and West Virginia — represent 14.9 million people (20% of all Medicaid enrollees). Results from each state were de-identified due to confidentiality agreements with the state partners. 

Funding for this study was provided by the National Institute on Drug Abuse of the National Institutes of Health (grant 5R01DA048029).

Newswise — A new study shows promise for reducing risky drinking among Army National Guard members over the long term, potentially improving their health and readiness to serve.

The number of days each month that Guard members said they had been binge-drinking dropped by up to half, according to the new findings by a University of Michigan team published in the journal Addiction.

The drop happened over the course of a year among Guard members who did multiple brief online education sessions designed for members of the military, and among those who did an initial online education session followed by supportive phone calls every few months with veteran peers trained to talk about alcohol use.

In addition to less binge drinking, the study also showed that both approaches led to lower scores on a scale that measures risky drinking habits. Those who got the peer phone calls over the year also had a reduction on a score that measures alcohol-related impacts on their lives. Those who were randomly assigned to receive no support beyond a pamphlet saw no decline by the end of the year on any of the measures.

“This is the first study of its kind to show the effectiveness of a relatively inexpensive e-health intervention for hazardous alcohol use in a component of our nation’s Army reserves,” says Frederic Blow, Ph.D., lead author of the study and the director of the University of Michigan Addiction Center. “With risky drinking threatening the health and readiness of those who serve, we hope this approach could be useful in other National Guard units and beyond.”

Focusing on those most at risk

The randomized controlled trial, called Mission Strong, grew out of previous work that showed the power of tailored education and peer support in reducing risking drinking among veterans who receive care at Veterans Affairs medical centers.

The U-M team had also done a previous survey that showed that nearly a third of Michigan Army National Guard members who had deployed as part of their service showed signs of risky drinking. Other research has shown that National Guard members who have deployed have higher rates of risky drinking than active duty members of other branches of the military who have deployed.

The Mission Strong study involved members of 41 Michigan Guard units who took surveys about their alcohol use during one of their monthly drill weekends. Of the 2,746 screened, 832 (30%) scored high enough to be considered to have hazardous alcohol use.

“We’re so grateful for the cooperation and ongoing engagement by the Michigan Army National Guard, which is working to improve the health and readiness of its members and made it possible for us to do a study that could help many other Guard units nationwide,” says senior author Lara Coughlin, Ph.D., an addiction psychologist and researcher at U-M and Addiction Center member who also sees patients at U-M Addiction Treatment Services.

The 739 Guard members who agreed to be randomly assigned to one of the three groups had an average age of 28, and 16% were women. While the majority were white and not of Hispanic backgrounds, 12% were Hispanic and 10% were Black. Just over 10% used cannabis despite the fact that it is against National Guard policy and was not generally legal in Michigan at the time of the study.

On mental health surveys, 10% reported they had had thoughts of suicide, 19% had moderate to severe depression, and nearly 5% had a score high enough to qualify for a diagnosis of post-traumatic stress disorder.

The study focused on National Guard members because of the unique nature of their service as citizen soldiers, who live in the community and work or study most of the time but drill regularly and are available to be called up for service to the state or nation.  

Among those in the study, 84% were employed full or part time, and 49% had ever been deployed as part of their Guard service.  Just over half had an enlisted rank of private or corporal, with most of the rest having higher enlisted ranks; 6% were officers.

By the end of a year, 550 of them had completed all three follow-up surveys, including 142 who had taken part in three phone calls from peers, 120 who had completed three follow-up web-based sessions, and the remainder who had only received the information pamphlet at the drill weekend and completed three follow-up surveys. All received a small amount of money for participating, to compensate them for their time.

Binge-drinking was defined as six or more drinks in one sitting by men, and four or more by women. Their overall hazardous alcohol use level was measured using the AUDIT scale and the consequences of their drinking habits in their lives – from relationships and finances to risk-taking and accidents — was measured using the SIP survey.

Results of the study

At the start of the study, participants reported binge-drinking four to five days a month. By the end, those in the peer-support group had gone from 5.2 days to 2.6 days on average, while those in the online education only group had gone from 4.2 days to 2.8 days on average. Those in the third group were still binge-drinking 4 days a month by the end of the study period.

On the AUDIT scale of risky drinking, those who received the peer calls had a 3.6-point reduction over the course of the year on average, while those who received online-only contacts had a nearly three-point drop – both considered significantly larger than the two-point drop among those who only received a pamphlet and follow-up surveys. At the start of the study, the average score for all three groups was above 9, indicating hazardous drinking; by the end the average score for the two groups that received the tailored online education had dropped below the hazardous threshold while the group that received no online education was still at hazardous levels.

On the SIP scale of the impacts of alcohol on a person’s life, those who received peer calls were the only ones to have a significant change from the start of the study to the end.

In addition to Coughlin, who is an assistant professor of psychiatry, and Blow, who is a professor of psychiatry in the U-M Medical School, the study’s authors are Maureen Walton, Ph.D., Mark Ilgen, Ph.D., and Kristen Barry, Ph.D. of the Addiction Center and Department of Psychiatry; Heather Walters of VA Ann Arbor Healthcare System; Lynn Massey of the U-M Injury Prevention Center; statistician Rosalinda Ignacio of the U-M School of Public Health; and Richard McCormick, Ph.D., of Case Western Reserve University.

Blow, Coughlin, Ilgen, Walton and Barry are also members of the U-M Injury Prevention Center and Institute for Healthcare Policy and Innovation.

The study was funded by the National Institute on Alcohol Abuse and Alcoholism (AA023122)

Details about the Mission Strong study are available via its listing on Clinicaltrials.gov (NCT02181283)

Peer- and web-based interventions for risky drinking among US National Guard members: Mission Strong randomized controlled trial, Addiction, 2023. https://doi.org/10.1111/add.16172

Newswise — The relationship between alcohol use and burn injuries is a negative one in multiple ways. Not only are about 50% of adults who sustain burn injuries intoxicated at the time of injury, suggesting that alcohol use may have contributed to the incident, but alcohol use among burn-injured patients is associated with more severe complications, delayed recovery, and increased morbidity and mortality. 

“Return to work or normal life can be impaired or delayed for burn-injured patients who use alcohol,” says Elizabeth Kovacs, PhD, vice chair of research and professor of GI, trauma, and endocrine surgery in the University of Colorado Department of Surgery. “Every organ of the body is affected by alcohol because it enters your bloodstream. If you look at the data on alcohol use and injury recovery, it affects everything from the cardiovascular system to the lungs, liver, and pancreas, and even fracture repair.” 

That’s primarily because alcohol in the body alters inflammatory responses, she says, making it harder for the immune system to do its job. 

“The immune system kills a germ by eating it, like a Pac-Man, and alcohol impairs the ability of that cell to eat the germ,” Kovacs says. “If you get a bacterial infection and your body can’t destroy it, then you’re going to have more bacteria, and things will only get worse.” 

The problem goes to the brain 

In a research study posted online in January in the journal Alcohol, Kovacs describes another possible issue caused by the combination of alcohol and burn injury: impaired cognitive function. Looking at data from patients at the University of Colorado Burn Center, Kovacs and her research team found a correlation between the presence of inflammation markers in the blood of intoxicated burn-injured patients and delirium during the course of hospitalization, as measured by the Confusion Assessment Method tool. 

“There are biomarkers that are associated with cognitive dysfunction in humans, which could be Parkinson’s, Alzheimer’s, or other conditions,” Kovacs says. “We’re trying to see if this patient population might have a change in the inflammatory milieu in the blood that would predict a higher incidence of delirium, confusion, and maybe even post-traumatic stress disorder later on.” 

Among those biomarkers is the cytokine CCL11, which recently was identified as an indicator of chronic traumatic encephalopathy, a progressive degenerative disease of the brain found in athletes and others with a history of repetitive brain trauma. 

“We’re trying to find early biomarkers of potential problems,” Kovacs says. “If we can come up with a panel of biomarkers that indicate that this patient may have more complications than one would expect, then maybe we can come up with more personalized therapies.” 

The role of the gut 

Kovacs, who has studied the link between alcohol and burn injury for more than two decades, has a theory as to why burn-injured patients who use alcohol have worse outcomes and are at higher risk for delirium — burn injuries to the skin cause the release of chemicals that make their way to other organs, most notably the gut. Because the gut and the brain are closely connected, impaired cognitive function can occur in burn-injured patients whose immune function is impaired by alcohol.  

“For people who sustain an injury where alcohol is a factor, we may be able to give them supplements that will improve their gut microbiome, and therefore their immune function, and that may help heal wounds faster and may yield less delirium,” she says. 

Be aware 

April is Alcohol Awareness Month, and Kovacs says her research is a timely reminder that alcohol use can have severe and unintended consequences. 

“There aren’t any real benefits of alcohol at any level of consumption,” she says. “It’s important to limit or moderate alcohol use. If every patient who comes into the emergency department is asked about their alcohol use, and we can get a realistic assessment of who is really using alcohol at a less healthy level, we might be able to decrease the amount of people who suffer from excessive alcohol use.” 

BYLINE: By Elizabeth Chapin

Newswise — LEXINGTON, Ky. (April 10, 2023) — University of Kentucky researchers are creating an innovative statewide surveillance system to inform prevention and response efforts aimed at reducing the burden of opioid use disorder in Kentucky.

The Rapid Actionable Data for Opioid Response in Kentucky (RADOR-KY) will use data from federal, state, and local sources to guide evidence-based practices aimed at preventing opioid overdoses in the Commonwealth. Phase one of the project is supported by a three-year $3.1 million grant from the National Institute on Drug Abuse (NIDA).

Driven by the COVID-19 pandemic and illegally manufactured fentanyl, drug overdose deaths in the U.S. increased to historic levels in 2021. Kentucky has been hit hard by the opioid epidemic. Overdose deaths reached an all-time high of 2,250, with 90% of those deaths involving an opioid.

Co-led by Svetla Slavova, Ph.D., associate professor in the College of Public Health, and Jeff Talbert, Ph.D., professor in the College of Medicine and College of Pharmacy, RADOR-KY will use a comprehensive set of data needed to effectively monitor and respond to the rapidly evolving opioid overdose crisis.

The system will use advanced algorithms to rapidly process data and help predict potential overdose surges using artificial intelligence.

“This unique, first-of-its-kind system will not only track and monitor overdose cases but use predictive analytics and dashboards for fast dissemination of analytical results to keep state agencies and local stakeholders on the frontlines of the opioid epidemic in Kentucky a step ahead,” said Slavova, who also serves as interim associate dean for research in the College of Public Health.

RADOR-KY will use data from multiple sources, including the Kentucky Office of Vital Statistics, syndromic surveillance, emergency medical services, prescription drug monitoring, Medicaid claims and drug seizure records. It will also track measures related to evidence-based practices such as treatment for opioid use disorder, overdose education and the distribution of naloxone, a life-saving medication that rapidly reverses an opioid overdose.

The project will leverage the expertise of UK research centers including the Kentucky Injury Prevention and Research Center, the Center on Drug and Alcohol Research, and the Institute for Biomedical Informatics. It also builds upon the expertise and experience gained from UK’s work on the HEALing Communities Study (HCS).

“We’ve harnessed the power of our data processing capabilities at UK with the framework and experience gained from our work on the HEALing Communities Study, which has also shown that addressing this public health crisis requires working across disciplines,” said Talbert, who also directs the Institute for Biomedical Informatics.

“The HEALing Communities Study has been an exemplar of how a state and a university can work together and one of the deciding factors for receiving this award,” said HCS principal investigator Sharon Walsh, Ph.D., a professor in UK’s College of Medicine and College of Pharmacy and director for the Center on Drug and Alcohol Research.

Walsh leads the project’s substance use disorder team, which will advise on the content of evidence-based practices and state and local partners who are end users of the system.

Katherine Marks, Ph.D., a UK College of Medicine research assistant professor who serves as project director for the Kentucky Opioid Response Effort (KORE) within the Cabinet for Health and Family Services, is the project’s state government liaison.

Marks says RADOR-KY’s faster data processing, predictive analytics and inclusion of evidence-based practices will help the state take more strategic action.

“The opportunity for state and community partners to have readily available access to data so we can take action and evaluate how we’re doing in our response is a remarkable innovation,” said Marks. “This is a wonderful demonstration of the collaborative potential between the state and university expertise. It’s also yet another example of how UK is working as the University for Kentucky.” 

An end-user advisory group, including partners in state government and local communities, will also guide the development of RADOR-KY. To advance the efforts to mitigate the opioid epidemic across the U.S. the team also plans to share programming code and algorithms in a public repository.

This project is supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R01DA057605. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

As the state’s flagship, land-grant institution, the University of Kentucky exists to advance the Commonwealth. We do that by preparing the next generation of leaders — placing students at the heart of everything we do — and transforming the lives of Kentuckians through education, research and creative work, service and health care. We pride ourselves on being a catalyst for breakthroughs and a force for healing, a place where ingenuity unfolds. It’s all made possible by our people — visionaries, disruptors and pioneers — who make up 200 academic programs, a $501 million research and development enterprise and a world-class medical center, all on one campus.   

In 2022, UK was ranked by Forbes as one of the “Best Employers for New Grads” and named a “Diversity Champion” by INSIGHT into Diversity, a testament to our commitment to advance Kentucky and create a community of belonging for everyone. While our mission looks different in many ways than it did in 1865, the vision of service to our Commonwealth and the world remains the same. We are the University for Kentucky.  

BYLINE: Kali Chan

According to the Centers for Disease Control and Prevention (CDC) and The National Vital Statistics System, drug-related overdose deaths have been rising over the past two decades in the United States. In 2021, 106,699 drug overdose deaths occurred. Adults aged 65 and over experienced the largest percentage increase in drug overdose death rates from 2020 through 2021, with a 28% increase. 

On December 29, 2022, the Consolidated Appropriations Act of 2023 enacted a new one-time requirement which goes into effect as of June 27, 2023 for any Drug Enforcement Administration (DEA)-registered practitioner (except for veterinarians) to complete 8 hours of training “on the treatment and management of patients with opioid or other substance use disorders.”

Dr. Kevin Zacharoff, a chronic pain and substance use expert, Faculty Member, Clinical Instructor, and the Course Director of Pain and Addiction at the Renaissance School of Medicine at Stony Brook University, says “I support the decision to mandate education on this subject matter from the Drug Enforcement Administration. According to Senators Michael Bennet and Susan Collins in the MATE Act, a recent survey of clinicians revealed that only 1 in 4 of them received training on addiction during their medical education.”

Dr. Zacharoff, who is also the co-author of several books including of The PainEDU.org Manual : A Pocket Guide to Pain Management and Managing Chronic Pain with Opioids in Primary Care adds that “this is significant in that when Congress eliminated the X-Waiver 8-hour educational requirement to prescribe buprenorphine for opioid use disorder, it is being replaced with a one-time, 8-hour educational requirement for every DEA registrant.”

Interviews with Dr. Kevin Zacharoff can be conducted.