Background: Canada continues to face an opioid epidemic with 5,368 opioid apparent related deaths occurring between January and September of 2021. Methadone Maintenance Treatment (MMT), a form of Medication Assisted Treatment used to treat Opioid Use Disorder (OUD), has been reported to decrease opioid cravings and opioid use, however, individual differences exist in the effective dose of methadone. Further, individuals living with an OUD have higher rates of substance use including cannabis. A genetic component has been suggested to exist for both cannabis use and MMT outcomes, however inconsistent findings have been reported. Methods: Knowledge synthesis and primary genetic association studies were conducted. A protocol was prepared for the planning of a systematic review for Genome-Wide Association Studies (GWASs) of cannabis use. The full systematic review was then conducted, providing an assessment of the literature and a description of studies quality. A GWAS and Polygenic Risk Score (PRS) was then conducted for cannabis use and MMT outcomes, separately, in Europeans only. The top Single Nucleotide Polymorphisms (SNPs) were then analyzed separately by sex and sex interactions were conducted. Results: The systematic review included 6 studies, identifying 96 genetic variants associated with cannabis use. The GWASs for both cannabis use and MMT outcomes did not identify any significant results. A significant PRS was found for regular cannabis use and methadone dose. No sex-specific results were identified. Discussion: This thesis summarised the evidence on the genetics of cannabis use as well as employed GWASs and PRSs to investigate cannabis use and MMT outcomes within a European population. We were able to highlight gaps within the genetic literature of cannabis and MMT outcomes as well as identify areas of interest for future research. / Dissertation / Doctor of Philosophy (PhD) / Cannabis use rates in Canada are increasing, with Opioid Use Disorder (OUD) patients having high rates of cannabis use despite inconsistent findings on the impacts. To combat the opioid crisis, Methadone Maintenance Treatment (MMT) is utilized to reduce opioid cravings and use. However, individuals on MMT are likely to use other substances, including cannabis. This thesis explores the genetic literature on cannabis use and conducts a Genome-Wide Association Study (GWAS) and a Polygenetic Risk Score (PRS). The GWAS investigates genetic variants throughout the whole genome associated with a trait, while the PRS creates a genetic weight risk score. GWAS and PRS methods were used to investigate cannabis use and MMT outcomes within Europeans with OUD. While no significant GWAS results were found, a statistically significant PRS was found for regular cannabis use and methadone dose, suggesting each respective score can estimate an individual’s risk of that trait.

Background: Opioid use disorder (OUD), prescription opioid misuse, and increased heroin use are major public health crises in the US. Excessive non-medical use of prescription opioids and illicit drugs can alter the brain, disrupt mental health, and increase the risk of blood-borne illnesses and bacterial infections. The CDC reported that opioids caused nearly 70% of the 67,367 overdose deaths in 2018. Rural areas have high prescription and illicit drug use rates, limited resources, and unique challenges. There is an emerging need to understand rural residents' perspectives on OUD and substance use disorder (SUD) in their community in order to implement efforts. A community-based participatory research (CBPR) approach addresses the need for a systematic participatory solutions, and reduces community opposition and promotes sustainable, culturally appropriate interventions that can reduce the health-related harms caused by substance abuse. Methods: Two studies were conducted using CBPR principles to address the opioid crisis in a rural Southern Virginia community. Study I aimed to provide insight into community members' perceptions, knowledge, and experiences with OUD/SUD to inform community-led strategies. Study II assessed whether a virtual community platform with a Nominal Group Technique (NGT) can build consensus around Comprehensive Harm Reduction (CHR) in the same rural Southern Virginia community. Study II used the Community Readiness Model (CRM) and assessment tool. Stakeholder focus groups were conducted by a participatory research team, EM, as part of a larger project using the Stakeholder Engagement in quEstion Development (SEED) method. To assess the community's readiness to implement CHR using the CRM, Study II used semi-structured qualitative interviews with key stakeholders. The results of the readiness assessment were then used to inform a virtual community forum with members of a drug-free coalition. On the basis of CRM interview themes and findings, the forum used the NGT consensus-building technique. Results: The primary themes identified in the analysis of the community stakeholder focus groups conducted for Study I included the importance of family dynamics and social networks as risk and resiliency factors, addressing hopelessness as a preventive strategy, the need for holistic approaches to treatment, childhood exposure resulting in intergenerational substance use, the needs of overburdened healthcare providers, the expansion of long-term rehabilitation programs, and the need for judicial reform towards those with OUD. Comprehensive methods to address OUD's complexity require specific and well-defined strategies. Understanding the factors that contribute to OUD in rural communities should be the first step in developing actions. The overall community readiness score for Study II was 4.07, indicating the community is still in the pre-planning stage for bring CHR to the community. The majority of key informants believe that leaders and community members recognize the problem of SUD/OUD harms and that something should be done to improve and integrate harm reduction efforts. The forum had 12 attendees. The community forum produced 13 topics and a list of action priorities that at least 80% of participants agreed on. The two areas of high priority included: (1) raising awareness of secondary harms of SUD/OUD and available resources to assist the community, and (2) reducing the stigma associated with CHR and appeal to people's sense of humanity in order to create an environment conducive to understanding and increase buy-in around CHR. Implications: Both studies show rural stakeholders can help curb the drug epidemic. Their knowledge of internal community dynamics and needs allows them to prioritize actions to improve health outcomes. In addition, Study II demonstrated the effectiveness of the CR Model in determining community readiness to adopt CHR and the value of a virtual community forum in conjunction with an NGT process in fostering stakeholder consensus. / Doctor of Philosophy / Background: Opioid use disorder (OUD), prescription opioid misuse, and rising heroin use are major public health crises in the US. Taking too many prescription opioids or illegal drugs can be harmful. This can alter the brain, cause stress, and increase the risk of blood-borne illnesses and infections. Opioids caused nearly 70% of the 67,367 overdose deaths in 2018, according to the Centers for Disease Control and Prevention. Rural areas have high prescription and illicit drug use rates, limited resources, and unique issues. There is an emerging need to understand rural residents' perspectives on OUD and substance use disorder (SUD) in their community in order to implement efforts. Thus, this research which is based on the principles of Community-Based Participatory Research (CBPR) was conducted to help address this need. To reduce the health-related harms caused by substance abuse, CBPR promotes sustainable, culturally applicable interventions. Methods: Two studies used CBPR to address the opioid crisis in rural Southern Virginia. The goal of Study I was to gain insight into community members' perspectives, knowledge, and experiences to inform community-led action. For the first study, a community-research team, EM, conducted group discussions with community members as part of a larger project that used a participatory approach to unite the community in actions to address OUD in their community. Study II used the Community Readiness Model (CRM) and an assessment tool to determine community readiness for comprehensive harm reduction (CHR). The study also wanted to see how a virtual community platform with a consensus building process could help build agreement around CHR. In Study II, key stakeholders were interviewed to assess the community's readiness for CHR. Then a virtual community forum with members of a drug-free coalition was held. The forum got responses and put them in order based on themes and results from CRM interviews. Results: We learned from the first study, family dynamics, social networks, hopelessness, intergenerational substance use, and healthcare provider needs all influence risk and resilience. Long-term rehab programs should be expanded, and the justice system should treat OUD differently. Detailed methods to address OUD's complexity require specific and well-defined strategies. Understanding what causes OUD in rural communities should be the first step in finding solutions. Study II found that the community is still in the pre-planning stage, with a score of 4.07 out of 9, indicating that leaders and community members recognize that the harms associated with OUD are a problem and something should be done to improve and incorporate harm reduction efforts. The results of the community forum also show a list of important topics on which at least 80% of participants agreed. The two areas of high importance were: (1) raising awareness of secondary harms and available resources to help the community, and (2) lowering the stigma associated with CHR to make it easier for people to understand, but be deliberate in appealing to people's sense of humanity to get them to buy into CHR. Conclusions: Both studies show that people who live in rural areas can help solve the local drug problem. Their understanding of how needs change within a community gives us a unique way to improve health outcomes. Study II found that using CRM and a virtual consensus-building process can aid stakeholders in reaching an agreement on how to address issues. Study II also showed how useful it is to use a virtual community forum and an NGT process to figure out if a community is ready for CHR.

No description available.

Aims: Untreated opioid use disorder (OUD) is associated with overdose, premature death and infectious disease, including human immunodeficiency virus (HIV) and Hepatitis C (HCV). While prior studies have shown that educational interventions are associated with improvements in HIV and HCV knowledge and reductions in risk behaviors, those examined to date have typically been time- and resource-intensive. We recently developed an HIV+HCV Education intervention which aims to improve HIV and HCV knowledge in a single visit using an automated iPad platform. In this project, we examined its ability, using a within-subject evaluation, to improve knowledge of HIV and HCV transmission and risks among adults with OUD. Methods: Participants were 25 adults with OUD who were enrolled in a 12-week randomized trial evaluating the efficacy of an Interim Buprenorphine Treatment (IBT) for reducing illicit opioid use while awaiting entry into community-based opioid treatment. Participants completed a baseline HIV+HCV knowledge assessment (Pre-Test) followed by corrective feedback, both administered via iPad. They then completed an interactive HIV flipbook and animated HCV video, also on iPad, followed by a second administration of the knowledge assessment (Post-Test). Finally, to evaluate whether any changes in knowledge persisted over time, the HIV+HCV assessment was administered again at 4 and 12 weeks following study intake. Results: At baseline (Pre-Test), participants answered 69% and 65% of items correctly on the HIV and HCV assessments, respectively. After completing the educational intervention, participants answered 86% of items correctly on both the HIV and HCV assessments (p’s<.001). These improvements in knowledge also persisted throughout the three-month study, with scores at Week 4 and 12 timepoints significantly greater than baseline (p’s<.001). Conclusion: An HIV+Hepatitis Education intervention delivered via a portable, automated iPad platform may produce significant and persistent improvements in HIV and HCV knowledge among adults with OUD. These data provide additional support for the use of mobile educational interventions for enhancing HIV and HCV knowledge in individuals at elevated risk for infectious disease. Support: This trial was supported by NIDA R34 DA3730385 (Sigmon) with additional support by NIDA T32 DA007242 (Higgins).

No description available.

Aims: Opioid use disorder (OUD) is associated with significant morbidity and mortality, and opioid agonist treatment (OAT) with methadone or buprenorphine represents the most efficacious treatment. However, data suggest that chronic administration of opioids may be associated with significant weight gain, possibly by altering an organism’s perception of and preference for sweet foods. The primary aim of this laboratory study was to rigorously examine sucrose subjective response among adults receiving OAT and a comparison sample without OUD. As secondary outcomes, we also sought to compare the groups on additional baseline characteristics that may influence subjective sucrose response and weight gain during treatment. Methods: Participants were 40 adults receiving treatment for OUD (OUD+) and a comparison sample of 40 adults without OUD (OUD-). All participants completed an initial screening visit that included questionnaires on eating behaviors, diet and nutrition, recent substance use, and measurement of body mass index. Eligible participants completed two, same-day outpatient laboratory sessions during which they sampled six experimenter-administered concentrations of sucrose solution (0, 0.1, 0.25, 0.5, 0.75, and 1.0M in distilled water) each three times under double-blind counterbalanced conditions. Following each exposure, participants rated the pleasantness and intensity of each sample using 100-point visual analog scales. Results: OUD+ participants rated sucrose solutions as less pleasant than OUD- participants (p<0.001). However, this effect was limited to the three lowest sucrose concentrations (0, 0.1, 0.25M), and at higher concentrations there were no group differences. There were no between-group differences on ratings of intensity (p=0.35). Given these baseline group differences in placebo (0M) responding, sucrose response was also examined in terms of change from baseline. In this analysis, there was a significant group effect, with a higher magnitude of change in pleasantness ratings and a lower magnitude of change in intensity ratings from 0M in OUD+ vs. OUD- participants (p’s<0.05). With regard to baseline characteristics that may influence sucrose response and eating behavior more generally, the OUD+ group had a higher prevalence of obesity, food insecurity, unhealthy eating behaviors, high sugar consumption, and nutrition knowledge deficits compared to the OUD- group (p’s<0.05). Conclusion: Data from preclinical and clinical research have suggested that opioid agonist medications may enhance subjective response to sweet flavors. In the present study, OUD+ participants exhibited a higher magnitude of change in pleasantness ratings from placebo compared to OUD- participants. However, this effect was largely driven by pronounced group differences in perceived pleasantness of essentially unsweet solutions. On the outcome of sucrose intensity, findings were more mixed with no consistent differences between OUD+ and OUD- participants. In contrast, group differences were far more pronounced in participants’ daily eating behaviors and nutrition knowledge, with OUD+ participants presenting with a consistently more severe profile. These data highlight the significant risk factors experienced by OUD+ individuals that extend beyond drug-related risks and may inform future scientific and clinical efforts to improve health outcomes in this vulnerable population.

INTRODUCTION: Despite rising hepatitis C virus (HCV) incidence in the United States in recent years among young adults, little data describe HCV testing in youth. My objective was to characterize the HCV care cascade in adolescents and emerging adults in a large US sample and to describe the association between diagnosed substance use disorders (SUDs) and HCV testing. METHODS: In this retrospective cohort study, I describe HCV care cascade outcomes for youth 13–21 years old seen at least once from 1/2012–9/2017 at an OCHIN-participating federally qualified health center. Using electronic health record data, I analyzed odds of HCV testing by number of concurrent diagnosed SUDs associated with HCV risk (those associated with injection or intranasal use: opioids, amphetamines, and cocaine). RESULTS: Among 269,124 youth who met inclusion criteria, (54.7% female, 62.5% non-white, mean age [SD] at testing 18.5 [2.2] years), 6812 (2.5%) were tested for HCV antibody, 122/6812 (1.8%) of those tested were anti-HCV positive, and of anti-HCV positive youth, 75.4% had additional diagnostic testing. Only 1 had documented HCV treatment. Each additional HCV risk-associated SUD was associated with higher odds of HCV testing, particularly in younger (OR 9.12, 95% CI 6.78, 12.4 in 13–15 year-olds, and OR 8.37, 95% CI 7.48, 9.36 in 16–18 year-olds) compared with older youth (OR 3.9, 95% CI 3.59, 4.24 in 19–21 year-olds). CONCLUSION: This study highlights important gaps in recommended HCV testing during the current opioid crisis. As the first step in the care cascade, addressing missed testing opportunities is critical for reducing hepatitis C burden. / 2020-09-28T00:00:00Z

Introduction and background Opioid use disorder (OUD) is an epidemic in the U.S. OUD affects both the mother’s and infant’s health. Substance-exposed infants suffer from decreased health outcomes relative to non-exposed infants. Purpose The aim is to identify infant health outcomes when pregnant women are prescribed medication-assisted treatment (MAT) for OUD. Among pregnant women with OUD in the U.S., is medication-assisted therapy as compared to no therapy associated with decreased negative infant health outcomes? Literature review Five studies on OUD and infant outcomes in the U.S. were reviewed. CINAHL and PubMed were searched using terms opioid use disorder, pregnancy, and neonatal abstinence syndrome (NAS). The search was limited to the last five years and full text only. Of the 815 results, five articles were selected that focused on infant outcomes and prevention of NAS. Articles were excluded if the focus was solely on the maternal outcomes, cost, or unoriginal research. One meta-analysis was included that compared two types of MAT for pregnant women with OUD. Findings MAT is correlated with a shorter hospital stay and less severe NAS symptoms in infants. Conclusion and implications Rates of NAS and OUD have increased significantly in the US. Some of the increase may be attributed to the transition to ICD-10 codes. MAT for pregnant women with OUD is associated with better health outcomes for infants. Patient-centered care could help decrease negative health outcomes for both infants and women with OUD. Future study should focus on degrees of opioid exposure and related outcomes.

Research supports that social connection is important in both humans and animals. In humans, having a cohesive support/social network system and healthy attachments in childhood predict low risk of later addiction (i.e. substance use disorder), as does perceived support from a religious or other cohesive community. Moreover, personal characteristics such as identifying as religious or spiritual can predict low risk for addiction, but little is known about the intersection of neuroscience and religion/spirituality in this regard. Conversely, adverse childhood experiences (ACEs) have repeatedly been shown to predict later addiction. However, the role of the body’s neuro-hormonal responses, such as the endogenous opioid and oxytocin systems in this process merits further exploration, such as how the production or deprivation of endogenous opioids impact later substance use patterns. Existing research also provides evidence that individuals decrease pursuit of interpersonal connections and social bonds when they use substances that activate opioid receptors. This has been found with both substances of abuse and medications used to treat addiction (e.g., methadone, buprenorphine, naltrexone). Research has also demonstrated that addiction often results in situations of social isolation. However, it remains to be elucidated whether the substances of abuse physiologically meet that need for connection. Importantly, research across numerous fields indicates that intentionally increasing interpersonal connection may be an effective treatment for addiction. However, less is known about how specific characteristics of communities impact the quantity, quality, or effectiveness of care and support for a person with addiction [...] / https://dc.etsu.edu/etsu_books/1292/thumbnail.jpg

Introduction and Background: Between 1999 and 2014 the number of patients in the labor and delivery that were on medication for opioid use disorder (MOUD) quadrupled. The rate of unintended pregnancies in pregnant patients of mOUD is at a tremendous high due to inconsistencies in the use of reliable contraception in this population. Purpose Statement: To reduce the number of unintended pregnancies and infants born with neonatal abstinence syndrome there is a need for prevention and required education for men and women in medication-assisted facilities. Literature Review: Twenty research studies were reviewed and evaluated. These articles were found by utilizing PubMed, CINAHL, One Search, and Google Scholar. Most articles were discovered in the following Journals: Medical, Contraceptive, Preventative Medicine, Women's Health, Addiction, and Neonatal Nursing Journals. Findings: Through this research, we found there is a need for prevention services and required education onsite at the facility where patients are receiving medication for opioid addiction (mOUD). The following articles show the lack of contraceptive education, and misinformation about reproduction while on methadone or other medication-assisted drugs. Conclusion: The accessibility of having contraceptives onsite with required education for patients who are in treatment has been proven to be more effective and can decrease the number of unintended pregnancies or infants born with Neonatal Abstinence Syndrome. To be able to give better patient care for this specific demographic it is crucial that nurses are allowed to educate clients.