Browsing by Subject "Drug Users"

Now showing 1 - 6 of 6

Open Access
Mortality among heroin users and users of other internationally regulated drugs: A 27-year follow-up of users in the Epidemiologic Catchment Area Program household samples.
(Drug and alcohol dependence, 2015-11) Lopez-Quintero, Catalina; Roth, Kimberly B; Eaton, William W; Wu, Li-Tzy; Cottler, Linda B; Bruce, Martha; Anthony, James C
In contrast to research on more restricted samples of drug users, epidemiological studies open up a view of death rates and survivorship of those who have tried heroin a few times, with no acceleration toward sustained use patterns often seen in treatment and criminal justice samples. At their best, epidemiological estimates of heroin effects on risk of dying are not subject to serious selection biases faced with more restricted samples.Data are from 7207 adult participants aged 18-48 years in United States Epidemiologic Catchment Area Program field surveys, launched in 1980-1984. US National Death Index (NDI) records through 2007 disclosed 723 deaths. NDI enabled estimation of heroin-associated risk of dying as well as survivorship.Estimated cumulative mortality for all 18-48 year old participants is 3.9 deaths per 1000 person-years (95% confidence interval, CI=3.7, 4.2), relative to 12.4 deaths per 1000 person-years for heroin users (95% CI=8.7, 17.9). Heroin use, even when non-sustained, predicted a 3-4 fold excess of risk of dying prematurely. Post-estimation record review showed trauma and infections as top-ranked causes of these deaths.Drawing strengths from epidemiological sampling, standardized baseline heroin history assessments, and very long-term NDI follow-up, this study of community-dwelling heroin users may help clinicians and public health officials who need facts about heroin when they seek to prevent and control heroin outbreaks. Heroin use, even when sporadic or non-sustained, is predictive of premature death in the US, with expected causes of death such as trauma and infections.
Open Access
Persistent Bacillus cereus Bacteremia in 3 Persons Who Inject Drugs, San Diego, California, USA.
(Emerging infectious diseases, 2016-09) Schaefer, Gabrielle; Campbell, Wesley; Jenks, Jeffrey; Beesley, Cari; Katsivas, Theodoros; Hoffmaster, Alex; Mehta, Sanjay R; Reed, Sharon
Bacillus cereus is typically considered a blood culture contaminant; however, its presence in blood cultures can indicate true bacteremia. We report 4 episodes of B. cereus bacteremia in 3 persons who inject drugs. Multilocus sequence typing showed that the temporally associated infections were caused by unrelated clones.
Open Access
Reported lifetime aberrant drug-taking behaviors are predictive of current substance use and mental health problems in primary care patients.
(Pain Med, 2008-11) Fleming, Michael F; Davis, James; Passik, Steven D
BACKGROUND: The aim of this report is to determine the frequency of aberrant drug behaviors and their relationship to substance abuse disorders in a large primary sample of patients receiving opioids for chronic pain. METHODS: The data utilized for this report was obtained from 904 chronic pain patients receiving opioid therapy from their primary care physician. A questionnaire was developed based on 12 aberrant drug behaviors reported in the clinical literature. The diagnosis of a current substance use disorder was determined using Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition(DSM-IV) criteria. RESULTS: The average duration of chronic pain in the sample was 16 years and for opioid therapy, 6.4 years. Of the patients, 80.5% reported one or more lifetime aberrant drug behaviors. The most frequent behaviors reported included early refills (41.7%), increase dose without physician consent (35.7%), and felt intoxicated from opioids (32.2%). Only 1.1% of subjects with 1-3 aberrant behaviors (N = 464, 51.2%) met DSM-IV criteria for current opioid dependence compared with 9.9% of patients with four or more behaviors (N = 264, 29.3%). Persons with positive urine toxicology tests for cocaine were 14 times more likely to report four or more behaviors than no behaviors (14.1% vs 1.1%). A logistic model found that subjects who reported four or more aberrant behaviors were more likely to have a current substance use disorder (odds ratio [OR] 10.14; 3.72, 27.64), a positive test for cocaine (odds ratio [OR] 3.01; 1.74, 15.4), an Addiction Severity Index (ASI) psychiatric composite score >0.5 (OR 2.38; 1.65, 3.44), male gender (OR 2.08: 1.48, 2.92), and older age (OR 0.69; 0.59, 0.81) compared with subjects with three or fewer behaviors. Pain levels, employment status, and morphine equivalent dose do not enter the model. CONCLUSIONS: Patients who report four or more aberrant drug behaviors are associated with a current substance use disorder and illicit drug use, whereas subjects with up to three aberrant behaviors have a very low probability of a current substance abuse disorder. Four behaviors--oversedated oneself, felt intoxicated, early refills, increase dose on own--appear useful as screening questions to predict patients at greatest risk for a current substance use disorders.
Open Access
Subtypes of nonmedical opioid users: results from the national epidemiologic survey on alcohol and related conditions.
(Drug and alcohol dependence, 2010-11) Wu, Li-Tzy; Woody, George E; Yang, Chongming; Blazer, Dan G
To identify subtypes of nonmedical opioid users, gender variations in psychiatric disorders, and quality of life in a representative sample of adults.Analyses of data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093). Latent class analysis (LCA) and multinomial logistic regression procedures examined subtypes of nonmedical opioid users.Approximately 5% (n=1815) of adults used nonmedical opioids. LCA identified four subtypes: opioid-marijuana users (33%), opioid-other prescription drug users (9%), opioid-marijuana-hallucinogen users (28%), and opioid-polydrug users (30%). Subtypes were distinguished by race/ethnicity, gender, familial substance abuse, personal history of substance abuse treatment, and patterns of psychiatric disorders. Whites and men had increased odds of being in the opioid-polydrug and opioid-marijuana-hallucinogen subtypes. The opioid-other prescription drug use subtype had disproportionately affected women who were characterized by high rates of mood/anxiety disorders and low quality of life. Across all subtypes, women and men had similarly problematic substance use disorders; however, women had more major depression and disability in the mental health domain.The generally high prevalence of psychiatric disorders among nonmedical opioid users, particularly women, underscores the need for comprehensive assessment and coordinated delivery of services to match needs with treatment, as well as continued monitoring of trends in opioid use and related problems.
Open Access
Trends and correlates of driving under the influence of alcohol among different types of adult substance users in the United States: a national survey study.
(BMC public health, 2019-05-04) Park, Ji-Yeun; Park, Ji-Yeun; Wu, Li-Tzy
BACKGROUND:Despite a decrease in driving under the influence of alcohol (DUIA) prevalence over the past decades, DUIA prevalence still remains high in the United States. To date, there is limited research examining whether different types of substance users have different trends in DUIA. This study sought to assess trends and variables associated with DUIA by substance use type. METHODS:National Survey on Drug Use and Health (NSDUH) is a cross-sectional, nationally representative population-based survey. By using the NSDUH 2008-2014, we performed the Joinpoint analysis to identify time trends of DUIA in each group of substance users (aged ≥18 years). Logistic regression analysis was used to explore association between substance use type and DUIA and to identify variables associated with DUIA. RESULTS:Adults who reported alcohol or drug use in the past year were classified into different groups based on past-year substance use status: alcohol use only (n = 141,521) and drug use regardless alcohol use. Drug users included prescription opioids only (n = 5337), marijuana only (n = 32,206), other single drug (n = 3789), prescription opioids-marijuana (n = 3921), multiple prescription drugs (n = 1267), and other multiple drugs (n = 18,432). The Joinpoint analysis showed that DUIA prevalence decreased significantly from 2008 to 2014 among alcohol only users (Average Annual Percent Change [AAPC] = - 2.8), prescription opioids only users (AAPC = -5.4), marijuana only users (AAPC = -5.0), prescription opioids-marijuana users (AAPC = -6.5), multiple prescription drug users (AAPC = -7.4), and other multiple drug users (AAPC = -3.2). Although the estimate was not statistically significant, other single drug users showed a decreasing trend (AAPC = -0.9). Substance use type was significantly associated with DUIA in the adjusted logistic regression. All drug use groups, relative to the alcohol only group, had elevated odds of DUIA, and the odds were especially elevated for the multiple drug use groups (prescription opioids-marijuana, adjusted odds ratio [AOR] = 2.71; multiple prescription drugs, AOR = 2.83; and other multiple drugs, AOR = 3.68). Additionally, younger age, male sex, being white, higher income, and alcohol abuse/dependence were positively associated with DUIA. CONCLUSIONS:DUIA prevalence decreased over time and the magnitude of this reduction differed by substance use type. DUIA interventions need to be tailored to substance use type and individual characteristics.
Open Access
Validation of the TAPS-1: A Four-Item Screening Tool to Identify Unhealthy Substance Use in Primary Care.
(Journal of general internal medicine, 2017-09) Gryczynski, Jan; McNeely, Jennifer; Wu, Li-Tzy; Subramaniam, Geetha A; Svikis, Dace S; Cathers, Lauretta A; Sharma, Gaurav; King, Jacqueline; Jelstrom, Eve; Nordeck, Courtney D; Sharma, Anjalee; Mitchell, Shannon G; O'Grady, Kevin E; Schwartz, Robert P
BACKGROUND:The Tobacco, Alcohol, Prescription Medication, and Other Substance use (TAPS) tool is a combined two-part screening and brief assessment developed for adult primary care patients. The tool's first-stage screening component (TAPS-1) consists of four items asking about past 12-month use for four substance categories, with response options of never, less than monthly, monthly, weekly, and daily or almost daily. OBJECTIVE:To validate the TAPS-1 in primary care patients. DESIGN:Participants completed the TAPS tool in self- and interviewer-administered formats, in random order. In this secondary analysis, the TAPS-1 was evaluated against DSM-5 substance use disorder (SUD) criteria to determine optimal cut-points for identifying unhealthy substance use at three severity levels (problem use, mild SUD, and moderate-to-severe SUD). PARTICIPANTS:Two thousand adult patients at five primary care sites. MAIN MEASURES:DSM-5 SUD criteria were determined via the modified Composite International Diagnostic Interview. Oral fluid was used as a biomarker of recent drug use. KEY RESULTS:Optimal frequency-of-use cut-points on the self-administered TAPS-1 for identifying SUDs were ≥ monthly use for tobacco and alcohol (sensitivity = 0.92 and 0.71, specificity = 0.80 and 0.85, AUC = 0.86 and 0.78, respectively) and any reported use for illicit drugs and prescription medication misuse (sensitivity = 0.93 and 0.89, specificity = 0.85 and 0.91, AUC = 0.89 and 0.90, respectively). The performance of the interviewer-administered format was similar. When administered first, the self-administered format yielded higher disclosure rates for past 12-month alcohol use, illicit drug use, and prescription medication misuse. Frequency of use alone did not provide sufficient information to discriminate between gradations of substance use problem severity. Among those who denied drug use on the TAPS-1, less than 4% had a drug-positive biomarker. CONCLUSIONS:The TAPS-1 can identify unhealthy substance use in primary care patients with a high level of accuracy, and may have utility in primary care for rapid triage.