Drug and alcohol dependence
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Drug Alcohol Depend · Apr 2021
"Doctor and pharmacy shopping": A fading signal for prescription opioid use monitoring?
The term "doctor and pharmacy shopping" colloquially describes patients with high multiple provider episodes (MPEs)-a threshold count of distinct prescribers and/or pharmacies involved in prescription fulfillment. Opioid-related MPEs are implicated in the global opioid crisis and heavily monitored by government databases such as U.S. state prescription drug monitoring programs (PDMPs). We applied a widely-used MPE definition to examine U.S. trends from a large, commercially-insured population from 2010 to 2017. Further, we examined the proportion of enrollees identified as "doctor shoppers" with evidence of a cancer diagnosis to examine the risk of false positives. ⋯ Opioid "shopping" flags are a long-standing but rapidly fading PDMP signal. To avoid unintended consequences, such as identifying legitimate medical encounters requiring high healthcare utilization or opioid treatment, while maintaining vigilance, more nuanced and sophisticated approaches are needed.
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Drug Alcohol Depend · Apr 2021
Behavioral economic demand in opioid treatment: Predictive validity of hypothetical purchase tasks for heroin, cocaine, and benzodiazepines.
Behavioral economics provides a framework in which to understand choice and motivation in the field of substance use disorders. Hypothetical purchase tasks (HPT), which indicate the amount or probability of purchasing substances at different prices, have been suggested as a clinical tool that can help predict future substance use and identify targets for intervention. ⋯ This report provides evidence that demand assessment is predictive of future substance use and could help guide treatment planning at intake. These results also demonstrated that the ZBEn model provides good fits to consumption data and allows for sensitive statistical analyses.
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Drug Alcohol Depend · Apr 2021
Alcohol and cigarette smoking consumption as genetic proxies for alcohol misuse and nicotine dependence.
To investigate the role of consumption phenotypes as genetic proxies for alcohol misuse and nicotine dependence. ⋯ Our study suggests that cigarette smoking consumption, which can be easily measured in the general population, may be good a genetic proxy for nicotine dependence, whereas alcohol consumption is not a direct genetic proxy of alcohol misuse.
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Drug Alcohol Depend · Apr 2021
Pharmacists' nonprescription syringe dispensing perceptions and behaviors: A three-state descriptive analysis.
One approach to increasing the reach of syringe programs in rural areas could be through provision of syringes at community pharmacies. This study evaluated relationships between state-specific syringe policies, pharmacy, and pharmacist characteristics and pharmacists' nonprescription syringe dispensing behaviors in a 3- state Appalachian region at high risk for HIV and HCV transmission. ⋯ Significant differences in pharmacists' perceptions and behaviors were noted across state lines with North Carolina pharmacists reporting more engagement in syringe dispensing as compared to pharmacists in Tennessee and Virginia. Policy allowing pharmacists to dispense syringes to people who inject drugs appears to foster some but not all pharmacist engagement in this harm reduction intervention.
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Drug Alcohol Depend · Apr 2021
ReviewThe phenomics and genetics of addictive and affective comorbidity in opioid use disorder.
Opioid use disorder (OUD) creates significant public health and economic burdens worldwide. Therefore, understanding the risk factors that lead to the development of OUD is fundamental to reducing both its prevalence and its impact. ⋯ In this review, we describe the prevalence and clinical significance of addictive and affective comorbidities as risk factors for OUD development as a basis for rational opioid prescribing and OUD treatment and to improve efforts to prevent the disorder. We also review the genetic variants that have been associated with OUD and other addictive and affective disorders to highlight targets for future study and risk assessment protocols.