Category: From Newswise – Substance Abuse

Newswise — Whether they’re using it for recreational or medical reasons, a sizable percentage of people in their 50s and older have smoked, eaten, drunk or applied to their skin at least one form of cannabis in the past year, a new poll shows.

In all, 21% of people age 50 and older said they used a form of cannabis that contains the psychoactive compound THC at least once in the past year, according to new findings from the University of Michigan National Poll on Healthy Aging. The poll report focuses on use of cannabis products with psychoactive amounts of THC, not CBD-only products.

More than half of those who used a cannabis product did so frequently: 12% of adults aged 50 and older said they did so at least once a month. Those aged 50 to 64, and those who are in fair or poor physical health, or in lower income households were more likely to report using cannabis at least monthly. 

As for the reasons older adults use cannabis, many cited sleep (68%), help with pain (63%) or mental health (53%), and/or to relax or feel good (81%).

The poll also reveals potential risky behaviors related to cannabis use. 

Among those who use cannabis at least once a year, 20% said they had driven a vehicle within two hours of consumption; many experts recommend waiting two or even three times that long. And the rate of such driving was even higher – 27% – among those who use cannabis at least once a month. 

In addition, nearly half of older adults who use cannabis products at least monthly had not discussed their use with their health care provider. And more than 20% reported at least one sign of potential dependence on cannabis.

The poll is based at the U-M Institute for Healthcare Policy and Innovation, and supported by AARP and Michigan Medicine, U-M’s academic medical center. 

Erin E. Bonar, Ph.D., a U-M addiction psychologist who worked with the poll team on the report, says the findings suggest a need for action at the policy, clinical and community levels to identify those who may need treatment for cannabis addiction and to discourage driving or other risky behaviors after consumption. 

“With some form of cannabis use now legalized in 38 states and on the ballot this November in several others, and the federal rescheduling process under way, cannabis use is likely to grow,” she said. “But as this poll shows, it is not risk-free, and more attention is needed to identify and reduce those risks.”

Bonar is a member of IHPI, the U-M Addiction Center and the U-M Injury Prevention Center as well as a professor in the Medical School Department of Psychiatry. 

In addition to the national poll report, the team compiled data for Michigan adults age 50 and older compared with those in other states; a summary is available at https://michmed.org/JYJer and an interactive data visualization is available at https://michmed.org/4e2KW. 

Cannabis potency and addiction: Views of all older adults

The poll team also asked all older adults – including those who don’t use cannabis – about their views of cannabis. The results suggest a need for more public awareness efforts, Bonar says. 

People in their 50s and beyond may have familiarity with cannabis from decades ago, whether through direct use or indirect knowledge during a time when it was illegal for any use in all states. Because of this, the poll team asked whether they believe cannabis is stronger today than it was 20 to 30 years ago.

The vast majority – 79% — of older adults said they thought this was true. But Bonar notes that this means 21% aren’t currently aware of the major increases in THC levels found in cannabis available today, compared with levels in the 1990s and before. 

Meanwhile, 72% of all older adults said they believe people can become addicted to cannabis. But, Bonar notes, this means more than a quarter of older adults aren’t currently aware that research has shown conclusively that cannabis addiction is real and can affect someone’s life and health just as addiction to other substances can. 

Importance of discussing with health care providers 

For those who use cannabis, especially those who use it often, poll director Jeffrey Kullgren, M.D., M.P.H., M.S. says the poll findings show the importance of communicating with their health care provider about their use. 

In all, 56% of those who use cannabis with THC at least monthly said they had spoken with their regular health care provider about their use. Most of them said they had brought the topic up. 

Talking openly with a provider about use could help identify risky drug interactions, and spot those experiencing signs of cannabis dependence or addiction. 

In all, 22% of those who use cannabis at least monthly said in the past year they had had to use more cannabis to feel the effect they wanted, and 21% said using the same amount of cannabis had less of an effect on them than it had before, while 17% said they had increased the amount or frequency of their cannabis use. Another sign of potential addiction – strong desires or cravings to use cannabis with THC – was reported by 13% of those who use cannabis at least monthly.

“Even if your doctor, nurse practitioner or pharmacist doesn’t ask if you’re using cannabis products, it’s important to offer this information, no matter whether you’re using it to address a physical or mental health concern, or simply for pleasure,” says Kullgren, a primary care physician at the VA Ann Arbor Healthcare System and associate professor of internal medicine at U-M. “Many prescription medications and over-the-counter drugs, as well as alcohol, can interact with cannabis and cause unexpected or unwanted effects. And there are only a few conditions where we have good evidence of a medical benefit from cannabis, though this could change with time.”

The current process at the federal level to change how cannabis is listed on the schedule of controlled substances may free more researchers to do studies of cannabis-derived products in clinical trials involving human volunteers. Right now, such research is very limited because of federal restrictions. 

The poll report is based on findings from a nationally representative survey conducted by NORC at the University of Chicago for IHPI and administered online and via phone in February and March 2024 among 3,379 adults ages 50 and older. The sample was subsequently weighted to reflect the U.S. and Michigan populations. Read past National Poll on Healthy Aging reports and about the poll methodology.

Broadcast quality interview and B-roll footage are available at https://michmed.org/NrGeW 

BYLINE: Tracy DeStazio

Newswise — Since the COVID-19 pandemic, rates of chronic absenteeism have nearly doubled across the nation for students in kindergarten through grade 12.

This increase was tied to the mode of instruction during the early years of the pandemic. In particular, schools that employed virtual learning as the primary teaching mode during the 2020-21 school year experienced a greater increase in chronic absenteeism in the following year. That increase was significantly greater in school districts with higher levels of poverty, according to new research from the University of Notre Dame.

William Evans, the Keough-Hesburgh Professor of Economics and co-founder of Notre Dame’s Wilson Sheehan Lab for Economic Opportunities, co-authored the study with current undergraduate student Kathryn Muchnick and 2024 graduate Olivia Rosenlund. Their work was recently published in the scientific journal JAMA Network Open.

The study analyzed data for two years from more than 11,000 school districts across the United States and found that chronic absenteeism rates increased from 16 percent in 2018-19 to nearly 30 percent in the 2021-22 school year. Students whose schools had full virtual instruction during the pandemic had chronic absenteeism rates that were nearly 7 percentage points higher than those schools that were fully in person, according to the research.

A student is considered chronically absent if he or she misses at least 10 percent of the instructional days in any given school year. That equates to more than three weeks of absences during a 180-day academic year.

As reported in the study, chronic absenteeism has been shown to lead to lower test scores, reduced social and educational interactions, lower rates of high school graduation and increased substance use. The increase in chronic absenteeism began to occur as public schools in the U.S. were attempting to return to pre-pandemic modes of in-person teaching.

Previous studies have indicated that moving away from in-person instruction during the 2020-21 school year to online teaching methods reduced student achievement and educational development, adversely affected children’s mental well-being and decreased school enrollment.

“We’ve learned a lot from the pandemic,” Evans said, “and a lot of work has gone into researching what effects virtual learning has had on students. It’s really difficult when you disrupt their educational experience by going remote.”

Both of Evans’ co-authors were high school students during the pandemic, giving them a uniquely personal perspective on the study’s results. Rosenlund said that when she entered the end of her senior year with fully virtual classes, she and her classmates “definitely had lower motivation to learn during that time compared to when class was fully in person.”

Muchnick added, “The shift in student motivation after online learning [back to in-person] was palpable.”

The research also indicated that chronic absenteeism rates hit at-risk students and school districts with the highest levels of poverty the hardest. Those school districts saw chronic absenteeism soar more than 10 percentage points higher among students who had participated in fully remote instruction, versus in-person learning.

“There is growing evidence that those in the most precarious situations were the ones that were really hurt the most by virtual instruction,” Evans said. “The districts with higher levels of poverty had higher rates of chronic absenteeism already, and they were much more aggressive at using virtual learning during COVID. So you took a vulnerable population, used this method of delivery for educational instruction, and the outcomes for these children are substantially worse.”

Households with lower incomes or fewer resources were less likely to have reliable or high-speed internet service and had far less access to quality computers or technology, making for a less-than-ideal virtual learning environment. “It was pretty detrimental for those kids who were most at risk in the first place,” Evans added, “and now they’ve been pushed further behind as a result of these policies.”

Although the study did not specifically explore the reasons behind the drop in school attendance, it did offer several possible explanations. First, roughly 10 to 20 percent of students were experiencing post-COVID-19 symptoms and may have elected not to go to school for medical and health reasons. Second, there was a corresponding increase in teacher absences and substitute teacher shortages that made students less compelled to go to school. Third, a greater occurrence of mental health issues, which is often coupled with an increased preoccupation with social media, may have kept students at home. Finally, following the pandemic, parents appear to be more willing to allow their children to miss school for a variety of reasons.

With the worst of the pandemic behind us, many parents, school teachers and administrators believe that virtual instruction is here to stay and will continue as a major component of K-12 education, potentially being used as a substitute for in-person teaching under certain circumstances, such as snow days.

“It’s going to be really difficult to put the genie back in the bottle in this context,” Evans said.

Finding a balance of how to use virtual learning in a way that does not negatively impact the students’ overall educational experience will be crucial, according to the researchers.

Rosenlund added, “It’s disheartening that students are still suffering from the negative effects of online learning. I hope that we can consider its implications more carefully going forward.”

The researchers suggest that educators and policymakers examine the evidence when establishing policies and practices related to online learning, particularly for those communities supporting at-risk students, in order to achieve equitable outcomes for all students.

“I think we need to take a more holistic approach in thinking about how to deal with these pandemics in the future,” Evans said.

Contact: Tracy DeStazio, associate director of media relations, 574-631-9958 or [email protected]

Newswise — Certain concepts have a demonstrated basis for aiding recovery from dangerous alcohol or substance use, according to an analysis of scientific literature since 1990. Self-efficacy (a belief in one’s ability to achieve a goal), social support, and managing cravings are among the treatment elements best supported by evidence. Effective treatment for alcohol use disorder (AUD) and other substance use disorders (SUDs) depends on understanding how human behaviors change and incorporating that knowledge into clinical practice. An ongoing research effort continues to investigate varying treatment approaches and how they relate to recovery outcomes, but those findings have not been well synthesized into a useful format. For the new review published in Alcohol: Clinical & Experimental Research, researchers from around the USA reviewed published studies, identified the treatment elements best supported by data, and evaluated their potential as key factors in behavior change. The researchers drew on existing study design criteria for validating conclusions about treatment elements.

The researchers explored reviews of studies published between 2008 and 2023 involving AUD and SUD treatments and the effects on substance use and related outcomes in adults. Three constructs involved in treatment were the most well-supported by data from 11 studies: self-efficacy, social support, and craving (coping skills, also well-supported, did not suit the current review process). They then reviewed 48 studies published between 1990 and 2023 that focused on one or more of these three concepts in adults’ recovery, and that met rigorous methodology standards. The 48 studies used varied research designs, participant samples, and contexts.

The analyzed studies provided support for self-efficacy, social support, and craving as factors that likely influence people’s behaviors in treatment or recovery. The researchers called for these three constructs to be incorporated into AUD and SUD treatment and clinical training. Such an approach could improve recovery interventions, inform new treatments and clinical training, help clinicians align patients with approaches likely to work for them, and hone community-based recovery programs.

The researchers called for additional research on how these three concepts drive behavior change and for mining existing science to identify other evidence-based approaches. They recommended several directions for future research. These included expanding the examined outcomes to other manifestations of mental and physical health and experimenting with key elements of treatment to generate direct evidence of associations between those constructs and outcomes. Investigating the roles of context (such as policies, incentives, social norms, and settings) and combinations of influences could improve outcomes across varied real-world situations. Specifying how behavioral change occurs—such as the relevant neurological and biological pathways—is a critical gap that needs to be addressed.

From alcohol and other drug (AOD) treatment mediator to mechanism to implementation: A systematic review and the cases of self-efficacy, social support, and craving. S. Maisto, D. Moskal, M. Firkey, B. Bergman, B. Borsari, K. Hallgren, J. Houck, M. Villarosa-Hurlocker, B. Kiluk, A. Kuerbis, A. Reid, M. Magill.

ACER-24-6054.R1

Newswise — Article title: Oxygen fluctuations in the brain and periphery induced by intravenous fentanyl: effects of dose and drug experience

Authors: Shinbe Choi, Michael R. Noya, Eugene A. Kiyatkin

From the authors: “We report that fentanyl’s effects are highly dose-dependent, drawing attention to the importance of better characterization to adequately respond in emergent cases of illicit fentanyl misuse.”

This study is highlighted as one of August’s “best of the best” as part of the American Physiological Society’s APSselect program.

BYLINE: Greg Bruno

Newswise — Mom always said, “Choose your friends wisely.” Now a study led by a Rutgers Health professor shows she was onto something: Their traits can rub off on you – especially ones that are in their genes.

The genetic makeup of adolescent peers may have long-term consequences for individual risk of drug and alcohol use disorders, depression and anxiety, the groundbreaking study has found.

“Peers’ genetic predispositions for psychiatric and substance use disorders are associated with an individual’s own risk of developing the same disorders in young adulthood,” said Jessica E. Salvatore, an associate professor of psychiatry at the Rutgers Robert Wood Johnson Medical School and lead author of the study published in the American Journal of Psychiatry. “What our data exemplifies is the long reach of social genetic effects,” Salvatore said.

Socio-genomics – the influence of one person’s genotype on the observable traits of another – is an emerging field of genomics. Research suggests that peers’ genetic makeup may influence health outcomes of their friends. To test this, Salvatore and colleagues used Swedish national data to assess peer social genetic effects for several psychiatric disorders.

With an anonymized database of more than 1.5 million individuals born in Sweden between 1980 and 1998 to Swedish-born parents, the first step was to map individuals by location and by school during their teenage years. The researchers then used medical, pharmacy and legal registries documenting substance use and mental health disorders for the same individuals in adulthood.

Models were run to assess whether peers’ genetic predispositions predicted target individuals’ likelihood of experiencing substance abuse, major depression, and anxiety disorder in adulthood. Peers’ genetic predispositions were indexed with family genetic risk scores – personalized measures of genetic risk based on family history – for the same conditions.

Even when controlling for factors such as the target individuals’ own genetic predispositions and family socioeconomic factors, the researchers found a clear association between peers’ genetic predispositions and target individuals’ likelihood of developing a substance use or psychiatric disorder. The effects were stronger among school-based peers than geographically defined peers.

Within school groups, the strongest effects were among upper secondary school classmates, particularly those in the same vocational or college-preparatory track between ages 16 and 19. Social genetic effects for school-based peers were greater for drug and alcohol use disorders than major depression and anxiety disorder.

Salvatore said more research is needed to understand why these connections exist.

“The most obvious explanation for why peers’ genetic predispositions might be associated with our own well-being is the idea our peers’ genetic predispositions influence their phenotype, or the likelihood that peers are also affected by the disorder,” she said. “But in our analysis, we found that peers’ genetic predispositions were associated with target individuals’ likelihood of disorder even after we statistically controlled for whether peers were affected or unaffected.”

What is clear, Salvatore said, is what the findings mean for interventions.

“If we want to think about how to best address these socially costly disorders, we need to think more about network based and social interventions,” she said. “It’s not enough to think about individual risk.”

This research also underscores the importance of disrupting processes and risks that extend for at least a decade after attendance in school, Salvatore added. “Peer genetic influences have a very long reach,” she said.

Coauthors include Henrik Ohlsson, Jan Sundquist and Kristina Sundquist, from Lund University in Sweden; and Kenneth S. Kendler from the Virginia Institute for Psychiatric and Behavioral Genetics at Virginia Commonwealth University.

Newswise — A recent study reveals a troubling surge in opioid-related deaths across the Appalachian region, with rural areas suffering the highest rates. From 2018 to 2021, opioid-related fatalities steadily climbed in urban, suburban, and rural counties, underscoring an urgent call for targeted interventions and healthcare reforms to combat the epidemic’s devastating impact on these communities.

The study titled “Differences in Opioid-Related Deaths in the Appalachian Region in 2018-2021 by State and Rural-Urban County Classification” examines opioid-related death rates across different county classifications (urban, suburban, rural) within the Appalachian region from 2018 to 2021. The study was organized and funded by the Rothman Opioid Foundation. The study focuses on understanding how these death rates vary by geographic and demographic factors. Opioid-related deaths, on average and by population, have risen steadily in the Appalachian region from 2018 to 2021 across all geographic areas (urban/metropolitan, suburban, rural). Rural counties consistently showed the highest opioid-related deaths per population compared to urban/metropolitan and suburban areas.

“The results emphasize the need for targeted community and health system interventions to address the disproportionately high rate of opioid prescribing and deaths in the Appalachian region,” says Dr. Asif Iliyas, co-author of the study. He is President of The Rothman Institute Foundation for Opioid Research and Education (Rothman Opioid Foundation) in Philadelphia, a Professor of Orthopaedic Surgery at Thomas Jefferson University, and an Associate Dean of Clinical Research at the Drexel University College of Medicine in Pennsylvania.

Santiago Rengifo, Alice Wu, and Patrick Ioffreda are co-authors of the study. The complete study can be found at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10349683/.

About the Rothman Institute Foundation for Opioid Research and Education.

The Rothman Orthopaedic Foundation, for short, is a non-profit 501c3 organization dedicated to raising awareness of the ongoing opioid crisis, educating physicians and patients on safe opioid prescribing and use – respectively, and advising policymakers on sound opioid and pain management policy. Most importantly, the Rothman Opioid Foundation performs and supports the highest quality research on opioids and alternative pain modalities to yield findings that can better inform patients, physicians, and the greater healthcare community in the most evidenced-based pain management strategies while working to mitigate opioid abuse and addiction.