The mechanisms by which opioids affect progression of human immunodeficiency virus type 1 (HIV-1) infection are not well-defined. HIV-1 gp120 is important in the apoptotic death of uninfected, bystander T cells. In this study, we show that co-treatment of human peripheral blood mononuclear cells (PBMC) with HIV-1 gp120/morphine synergistically induces apoptosis in PBMC. Co-treatment of murine splenocytes from μ opiate receptor knockout mice with gp120/morphine resulted in decreased apoptosis when compared to splenocytes from wild type mice. Co-treatment of human PBMC or murine splenocytes with gp120/morphine led to decreased expression of β-arrestin 2, a protein required for opioid-mediated signaling. The role of β-arrestin 2 was confirmed in Jurkat lymphocytes, in which 1) over-expression of β-arrestin 2 inhibited gp120/morphine-induced apoptosis and 2) RNA interference of β-arrestin 2 expression enhanced gp120/morphine-induced apoptosis. These data suggest a novel mechanism by which HIV-1 gp120 and opioids induce lymphocyte cell death.

Substance abuse among gays and lesbians may be considered a "neglected area" of drug use research in criminology and criminal justice. In the current study, we seek to address the lack of scientific inquiry on substance use among lesbians, gays, and bisexuals by drawing from an availability sample of 179 lesbian, gay, and bisexual (LGB) adults to examine substance use patterns as well as the relationship of self-esteem with problems associated with using alcohol and drugs. Results showed consistency in the frequency of tobacco, alcohol, marijuana, and cocaine use in the past year; however, more gay and bisexual men than gay and bisexual women reported problems stemming from substance use.

Denna studie syftar till att, utifrån ett praktikerperspektiv, undersöka droganvändning blandungdomar i åldersintervallet 13–19 år i Västerbottens län. Studien undersöker vilka drogersom är populära bland ungdomar ur ett praktikerperspektiv, ungdomars inställning till drogeroch droganvändning samt hur den visar sig enligt praktiker, hur praktiker resonerar meduppdrag att arbeta drogförebyggande mot ungdomar och droganvändning samt vilka insatserungdomar som använder droger erbjuds. För att besvara studiens frågeställningar och syftegenomfördes tre kvalitativa semistrukturerade intervjuer med praktiker som arbetarpreventivt med studiens målgrupp. Resultatet visar att droger som ecstasy, kokain ochcannabis är de mest populära drogerna vilket verkar grunda sig i en liberal inställning tilldroger samt att man exponeras för cannabis i flertalet olika sammanhang, exempelvis media.Inställningen till droger är liberal i jämförelse med tidigare generationer och i synnerhetinställningen till cannabis är liberal. Ungdomars droganvändning har dock inte ökat ochdärmed kan inte ungdomars inställning till droger kopplas samman med konsumtion.Praktikerna arbetar förebyggande gällande ungdomars droganvändning genom att exempelvisföreläsa och informera om droganvändning, erbjuda kurser till föräldrar, samverkan medandra aktörer för att gemensamt kunna förebygga och begränsa ungdomars droganvändning.Insatser som erbjuds till ungdomar som använder droger är samtal, olika program ochmetoder som bland annat haschavvänjningsprogram och återfallsprevention samt drogtester iform av urinprovstagning.

Objective: To estimate the prevalence of mental health service use among US adults, examine the associations of mental health service use with health insurance coverage, mental health problems and drug use, and detect health disparities. Methods: This was a cross-sectional study with 5,434 adults receiving mental health service out of 37,424 adult respondents from the 2013 National Survey on Drug Use and Health. Weighted univariate and multiple logistic regression analyses were used to estimate the associations of potential factors with mental health service use. Results: The overall prevalence of mental health services use was 14.7%. Our results showed that being female, aging, having a major depressive episode, serious psychological distress, and illicit drug or alcohol abuse/dependence were positively associated with mental health service use; whereas being African American, Asian or Hispanic ethnicity, married, and having any form of insurance were negatively associated with mental health service use. Stratified analysis by insurance types showed that Medicaid/CHIP, CHAMPUS, and other insurance were positively associated with mental health service use. Conclusions: Health insurance coverage, mental health problems, and drug abuse or dependence were associated with mental health service use in US adults. Furthermore, adults with different insurances had disparities in access of mental health service.

Objectives This study was undertaken to confirm that patient reports on buprenorphine medication-assisted therapy in for-profit buprenorphine clinics in our community were personally costly. We contacted all 17 for-profit clinics in our community and confirmed the patient reports that a significant financial payment of ≤$100 was required for each visit. We also found that tapering of buprenorphine dosage in pregnancy was offered by several of the clinics. Methods A telephone survey was conducted with the 17 for-profit buprenorphine clinics located in the Johnson City, Tennessee area. The clinic representative who answered the telephone was asked questions regarding patient costs for therapy and availability of tapering programs for pregnant women. Results Patient reports that the for-profit clinics are costly were confirmed. None of the clinics accepted insurance reimbursement of any type. The most common weekly costs were $100 per visit. A majority of clinics offered biweekly or monthly visits at significantly increased rates. Clinic representatives stated that a majority of clinics would consider buprenorphine tapering programs for pregnant women. Conclusions The high cost of for-profit clinics is a barrier for patient access to medication-assisted therapy with buprenorphine. Tapering of buprenorphine dosage in pregnant women has penetrated buprenorphine management practice in our community. Further research is needed to determine whether elimination of cost barrier would have a positive effect on the rates of neonatal abstinence syndrome.

Submitted in fulfillment of the requirements of the degree of Master of Education in the Department of Educational Psychology & Special Education at the University of Zululand, 2007. / The aim of this study was to investigate the effect of cannibas use on the adolescent's development. This was achieved by means of a literature study and an emprical investigation. The literature study found that the use of cannabis by the adolescent affects his physical, psychological (cognitive and affective), social and normative development.

Opioid overdose deaths in the United States have been steadily increasing for decades. Initially, these deaths were driven by overdoses from prescription opioids. Strict limits were placed on opioid prescriptions to decrease the supply of available opioids. Instead, this prompted a shift toward the illicit opioid market, causing an increase in heroin-related overdoses. Fentanyl, a synthetic opioid that is more potent than heroin, has become commonplace in the illicit supply of opioids. The illicit opioid market is unregulated and unpredictable, and there is no way to know exactly what is in a bag sold as heroin or “dope”. Illicit drug use has been historically dealt with as a crime rather than a public health issue in the United States. Recently, harm reduction has been offered as an alternative to this punitive approach. Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Naloxone distribution and syringe service programs are examples of currently utilized harm reduction strategies in the United States. While these programs are necessary to improve the quality of life of people who use illicit drugs, the rates of death from overdose are continuing to increase. These strategies do not protect people from the toxic and unpredictable drug supply. Safe supply is a relatively new concept, but there have been some small-scale implementations of this practice in Canada. Safe supply refers to a legal and regulated supply of drugs with mind and body-altering properties that traditionally have been accessible only through the illicit drug market. This is a necessary strategy to combat the alarming rise in overdose mortality. In this paper, I will analyze the ethics of this strategy using a principalism approach. This analysis concludes that safe supply is ethically sound, and it should be a part of our approach to the overdose epidemic. Safe supply promotes autonomy, prevents harms, advances well-being, and upholds justice for people who use drugs. / Urban Bioethics

The purpose of this investigation focused on determining the effects of a physical conditioning program on physical fitness and health attitudes on inpatient adolescent male substance abusers during and following participation in a six week fitness program. The fitness measures chosen for this study were the 1 1/2 mile run, skinfold, sit-and-reach, and grip strength. The first four of these measures make up the AAHPERD test battery (AAHPERD, 1980). The Health Attribution Test (Lawlis and Lawlis, 1980) was administered to determine health locus of control.

Electronic nicotine delivery systems emerged during the 2010s as a novel way to consume (i.e., vape) nicotine. Public health authorities became concerned that vaping could cause nicotine-naïve youth to begin using tobacco products and that a new generation of youth could become tobacco-dependent. Though millions of youth have vaped, authorities' fears about a new generation of youth tobacco dependence has not materialized. A more recent concern is nicotine vaping’s potential effects on cannabis use and the use of other substances. An increase in cannabis use among some adolescent groups and young adults could be because of nicotine vaping’s rise. Additionally, cannabis can be vaped, so transitioning from nicotine vaping to cannabis vaping may be easier than transitioning from nicotine vaping to other forms of cannabis use. Furthermore, nicotine product use was historically associated with later use of cannabis and other substances; this trend may be renewed with the advent of nicotine vaping. To date, most studies on the associations between nicotine vaping and cannabis/other substance use are cross-sectional, so more longitudinal evidence is needed. If evidence suggests that nicotine vaping does affect the use of cannabis and other substances, specifying a mechanism would help with developing potential interventions and with testing the validity of total effects. The overarching goal of this dissertation is to advance evidence of nicotine vaping's potential harmful effects on youth and young adults, which could be used to support interventions aimed at reducing the burden of nicotine vaping's outcomes. First, I conducted a systematic review in which I examined the extent to which confounding, measurement errors, and loss to follow-up could alternatively explain reported longitudinal effects of nicotine vaping on cannabis use or other substance use. I also identified studies that tested effect modification and mediation. This systematic review revealed that nicotine vaping likely increases the risk of subsequent cannabis use and other substance use for up to 24 months. It also revealed that some studies evaluated effect measure modification, while no study assessed mechanisms. These observations suggest that future studies should assess long-term effects on initiation and evaluate potential mechanisms. Second, I evaluated whether nicotine vaping affected the initiation of cannabis and other substances over a six-year period among adolescents as they age into adulthood. Results suggested that nicotine vaping had harmful effects on both outcomes over the six-year period. I also found evidence that nicotine vaping's harmful effects in later years appeared stronger than in earlier years; the absence of age effects suggest the absence of cohort effects. Furthermore, I found that effects appeared stronger among individuals who had a history of non-vaping tobacco product use than among individuals without a history of non-vaping tobacco product use, suggesting that tobacco use is key to nicotine vaping's harms. Finally, I evaluated possible mechanisms of the effects based on a theory that I developed from prior empirical literature and behavioral theory. I posited that nicotine vaping caused deviant peer affiliation, which caused conduct problems and subsequently, the outcomes. I found no evidence that three conduct problems (considered together) were mechanisms of the effects. Future studies of mechanisms can reveal potential intervention targets, lead to studies of other potential mechanisms, and help test the validity of total effects. This dissertation achieved its goal of advancing evidence that nicotine vaping may harm youth and young adults. Public health bodies tasked with addressing potential public health concerns about nicotine vaping products should consider evidence from this dissertation.

Purpose: We investigated the associations of early onset polysubstance use prior to age 18 with the prevalence of bronchitis among U.S. adults and tested whether the associations differ by gender. Methods: A total of 77,950 adults, of them 2,653 with bronchitis in the past year, were from the combined 2013 and 2014 National Survey on Drug Use and Health data. The variable cluster analysis was used to classify nine variables about substance use prior to age 18 (cigarettes, cigars, smokeless tobacco, marijuana, cocaine, heroin, methamphetamines, ecstasy, and phencyclidine). Weighted multivariate logistic regression analysis (MLR) was used to examine the associations with bronchitis. Results: Nine variables were divided into two clusters: early onset poly tobacco use (three tobacco use variables) and early onset poly drug use (six drug use variables). The overall prevalence of bronchitis was 3.8% (5.1% for females and 2.3% for males). MLR analysis showed that being female, elderly (ages 65 and above), obese, and early onset poly tobacco use were associated with increased odds of bronchitis (p < 0.05). Gender-stratified analyses showed that early-onset poly tobacco use was significantly associated with bronchitis only in males, whereas early onset poly drug use was associated with bronchitis only in females. Moreover, obesity and tobacco use in the past year revealed associations with bronchitis regardless of gender. Conclusions: Obesity, early onset poly tobacco use prior to age 18, and tobacco use in the past year were positively associated with bronchitis; furthermore, the associations of early onset polysubstance use with bronchitis differed by gender, which indicated that gender differences should be considered in developing effective prevention strategies.