Objective: It is well established that adolescents and young adults are increasingly vulnerable to the effects of early opioid exposures, with the emergency department (ED) playing a critical role in such introduction. Our objective was to identify predictors of ED opioid administration (ED-RX) and prescribing at discharge (DC-RX) among adolescent and young adults using a machine learning approach.

Methods: We conducted a secondary analysis of ED visit data from the National Hospital Ambulatory Medical Care Survey from 2014 to 2018. Visits where patients were aged 10 to 24 years were included. Predictors of ED-RX and DC-RX were identified via machine learning methods. Separate weighted logistic regressions were performed to determine the association between each predictor, and ED-RX and DC-RX, respectively.

Results: There were 12,693 ED visits identified within the study time frame, with the majority being female (58.6%) and White (70.7%). Approximately 12.3% of all visits were administered an opioid during the ED visit, and 11.5% were prescribed one at discharge. For ED-RX, the strongest predictors were fracture injury (odds ratio [OR], 5.24; 95% confidence interval [CI], 3.73-7.35) and Southern geographic region (OR, 3.01; 95% CI, 2.14-4.22). The use of nonopioid analgesics significantly reduced the odds of ED-RX (OR, 0.46; 95% CI, 0.37-0.57). Fracture injury was also a strong predictor of DC-RX (OR, 5.91; 95% CI, 4.24-8.25), in addition to tooth pain (OR, 5.47; 95% CI, 3.84-7.69).

Conclusions: Machine learning methodologies were able to identify predictors of ED-RX and DC-RX, which can be used to inform ED prescribing guidelines and risk mitigation efforts among adolescents and young adults.

Abstract: E-cigarettes, or electronic cigarettes, are electronic nicotine delivery systems that are marketed as a healthier alternative to tobacco cigarettes. There has been an exponential increase in their use among youth since their introduction to the United States market in 2007. With increased use and popularity, there has been an increase in calls to poison control centers regarding liquid nicotine toxicity in children and adolescents. Recent US Food and Drug Administration and other federal regulations of e-cigarettes have attempted to limit availability to youth. This article reviews trends in e-cigarette use among youth, the background and mechanism of action of e-cigarettes, liquid nicotine toxicity, management of liquid nicotine toxicity, and recent policy updates regarding e-cigarettes.

Non-medical prescription use of opioids (NMPUO) is a public health concern worldwide. Recently, tramadol misuse is increasing, but the systematic research of misuse of this specific opioid is limited. This study set out to assess the relationship between tramadol use and completion of treatment for substance use among adolescents and adults ≤25 years in an outpatient clinical setting. A retrospective cohort study of treatment outcome, expressed as “completion” or “non-completion” of treatment, was conducted in treatment-seeking adolescents with problematic substance use (n=335). Data was extracted from Ung-DOK interviews, a semi-structured assessment instrument designed for adolescents with substance abuse. The study included all treatment-seeking patients at an out-patient facility in 2014-2017. A total of 26% (n=88) were tramadol users (life-time prevalence). Twenty percent (n=66) of all treatments were non-completed. Tramadol users were significantly more likely than non-users to drop out of treatment (35% vs 15%, p<0.001). In multivariate logistic regression, tramadol use and age 18 and above were factors significantly associated with non-completion. Tramadol use was statistically significantly associated with non-completion of treatment. Further research addressing treatment needs and treatment completion among tramadol users is needed.

Aims
Much research indicates that an individual’s personality impacts the initiation and escalation of substance use and problems in youth. The acquired-preparedness model suggests that personality influences substance use by modifying learning about substances, which then affects substance use. The current study used longitudinal data to test whether automatic cannabis-related cognitions (memory associations and outcome expectancy liking) mediate the relationship between four personality traits with later cannabis use.

Methods
The study focused on initiation of use in a sample of adolescents who had not previously used (n = 670).

Results
A structural equation model supported a full mediation effect and the hypothesis that personality affects cannabis use in youth by influencing automatic memory associations and outcome expectancy liking. Further findings from the same model also indicated a mediation effect of these cognitions in the relationship between age and cannabis use.

Conclusion
The findings of the study support the acquired-preparedness model where personality influences automatic associations in the context of dual-processing theories of substance use.

Background
Individuals with a family history of alcohol and other substance use disorders (FH+) are several times more likely to develop alcohol problems compared to individuals with no such family histories (FH–). Here we sought to evaluate associations of early life adversity (ELA) with two key risk-related FH+ phenotypic characteristics: increased antisocial and depressive tendencies.

Methods
We examined data from 1187 FH+ and FH– young adults (average age 23.6 years old) with and without personal histories of substance use disorders. Antisocial tendencies were evaluated with the Socialization scale of the California Personality Inventory (CPI-So), while depressive tendencies were evaluated with the Beck Depression Inventory II (BDI).

Results
In general, being FH+, having a personal substance use disorder history, and experiencing greater levels of ELA were associated with lower CPI-So scores (indicating more antisocial tendencies) and higher BDI scores (indicating more depressive tendencies).

Conclusions
These results suggest that ELA is linked to increased antisocial and depressive tendencies observed in FH+ persons. Given that FH+ individuals are disproportionately exposed to ELA, this increased exposure may be a major contributor to these and other risk-related characteristics commonly present in FH+ individuals. Additional studies are needed to evaluate the impact of ELA on risk-related phenotypic characteristics, including prospective studies in early childhood and mechanistic studies evaluating pathways by which ELA exerts its effects on FH phenotypic characteristics.

Background: Opioid misuse and addiction have become a national crisis. New pain management guidelines call for the use of multimodal analgesia to manage acute pain. In hospital settings, a clinical decision aid that emphasizes multimodal analgesia may improve nurses' use of this opioid-sparing strategy.

Purpose: This integrative review was conducted to provide nurses with evidence-based information on the opioid-sparing benefits of multimodal analgesia.

Methods: A literature search was conducted using several electronic databases and Google Scholar. These initial searches yielded 136 articles of interest. Twenty-eight were selected for retrieval and in-depth appraisal; of these, 13 met all inclusion criteria.

Results: Of the 13 reviewed studies, six were randomized controlled trials, six were retrospective cohort or population-based studies, and one was a qualitative study. Overall, the findings provided strong evidence that multimodal analgesia is effective in managing acute pain in surgical patients while reducing opioid requirements. Several studies also found that multimodal analgesia was associated with shorter hospital lengths of stay.

Conclusions: With the appropriate tools and education, nurses can make the transition from traditional opioids to multimodal analgesia strategies. In so doing, they can have a significant positive impact on the opioid epidemic. Hospital leaders must address nursing practice regarding the use of opioids alone versus multimodal analgesia for the management of acute pain. Clinical decision tools such as the Michigan Opioid Safety Score may help nurses adopt new acute pain management guidelines. Further research regarding nursing practice and the opioid epidemic is needed.

Patients with cancer are living longer, and many experience pain secondary to tumor invasion or as a consequence of cancer-directed therapies. Opioid use disorders and associated morbidity and mortality have increased with dramatic rise during the SARS-CoV-2 pandemic. National and international stakeholders have developed clinical practice guidelines in an effort to curb opioid misuse and overdose-related death. However, to ensure that patients with cancer do not experience barriers to adequate pain management, most of these guidelines are not intended for patients with cancer-related pain or for those receiving palliative or hospice care. Oncology, palliative, and hospice care providers are increasingly tasked with the management of severe disease-related pain in the setting of coexisting opioid use disorder without research on the most effective risk and harm reduction strategies to guide care.

Clinicians should be familiar with addiction medicine and chronic pain literature and be able to incorporate some of these best practices. This case study reviews the management of severe cancer-related pain in a patient with co-occurring opioid use disorder, utilizing many of the best practices in available clinical practice guidelines for the management of chronic non-cancer-related pain.

Patients with cancer are living longer, and many experience pain secondary to tumor invasion or as a consequence of cancer-directed therapies. Opioid use disorders and associated morbidity and mortality have increased with dramatic rise during the SARS-CoV-2 pandemic. National and international stakeholders have developed clinical practice guidelines in an effort to curb opioid misuse and overdose-related death. However, to ensure that patients with cancer do not experience barriers to adequate pain management, most of these guidelines are not intended for patients with cancer-related pain or for those receiving palliative or hospice care. Oncology, palliative, and hospice care providers are increasingly tasked with the management of severe disease-related pain in the setting of coexisting opioid use disorder without research on the most effective risk and harm reduction strategies to guide care.

Clinicians should be familiar with addiction medicine and chronic pain literature and be able to incorporate some of these best practices. This case study reviews the management of severe cancer-related pain in a patient with co-occurring opioid use disorder, utilizing many of the best practices in available clinical practice guidelines for the management of chronic non-cancer-related pain.

En raison des répercussions qu’elle a sur la santé des familles et des générations futures, la consommation de substances psychoactives pendant la période périnatale est une préoccupation de santé publique pour l’ensemble de la population. Afin de cibler des stratégies de prévention et de promotion de la santé et du bien-être pour les Premières Nations et les Inuits, il est essentiel de comprendre les facteurs qui influencent la consommation de substances psychoactives chez les femmes autochtones en période périnatale. Cette synthèse analyse les facteurs qui émergent de la littérature scientifique sous la loupe des déterminants sociaux de la santé.

Les liens familiaux forts, le soutien social et la connexion à la communauté, aux valeurs traditionnelles et à la culture ressortent comme des facteurs de protection de la consommation de substances psychoactives pendant la période périnatale pour les femmes autochtones. Ces facteurs sont associés à l’environnement social et à la continuité culturelle, des déterminants sociaux de la santé des Autochtones.
Des conditions de vie difficiles (précarité d’emploi, faible niveau d’éducation et délocalisation fréquente) ainsi que la violence interpersonnelle vécue tendent à accroître la consommation de substances psychoactives des femmes autochtones avant, pendant et après la grossesse. Ces déterminants sociaux sont aussi influencés par les systèmes de santé et d’éducation, et les contextes historique et politique.
À la lumière des résultats des publications retenues, la relation entre le bien-être et la santé mentale et la consommation de substances psychoactives pendant la période périnatale doit être considérée. Les femmes autochtones déprimées sont plus susceptibles de consommer des substances psychoactives pendant la période périnatale.
Bien que peu d’études de cette synthèse abordent cet aspect, les traumatismes historiques vécus par les peuples autochtones ont des conséquences sur la santé et le bien-être des femmes et des communautés autochtones. Ils influencent notamment les comportements de consommation de substances psychoactives et les problèmes de dépendance. Certaines femmes attribuent leurs expériences négatives vécues en enfance aux traumatismes historiques vécus par les peuples autochtones.
L’arrêt ou la réduction de la consommation de substances psychoactives pendant la période périnatale est influencé par plusieurs déterminants sociaux. Améliorer les conditions de vie des peuples autochtones, bâtir des environnements sociaux favorables et assurer la continuité culturelle, et ce, en étroite collaboration avec les instances autochtones sont des avenues pour agir sur ces déterminants.

Objectives: Varenicline is a partial agonist at the [alpha]2[beta]4 and [alpha]6[beta]2 nAChR receptors and a full agonist at [alpha]7 receptors. Both [alpha]7 and [alpha]6[beta]2 receptors are implicated in the neural reward circuitry activated by cocaine use. A preliminary clinical trial suggested that varenicline treatment reduced cocaine use. This trial was intended to replicate and extend the findings of the previous trial.

Methods: This was a 12-week, double-blind, placebo-controlled clinical trial involving 156 subjects with DSM IV cocaine dependence. Subjects received up to 2 mg of varenicline or identical placebo daily along with weekly relapse prevention psychotherapy. The primary outcome measure was cocaine use measured by thrice-weekly urine drug screens. Additional outcome measures included end of study cocaine abstinence, cocaine craving, cocaine withdrawal symptom severity, cigarette use, and global improvement measure by the Clinical Global Improvement Scale.

Results: End of study cocaine abstinence, measured by urine drug screens during the last 3 weeks of the trial, was not different between groups (8% in the varenicline treated subjects and versus 9% in placebo-treated subjects). Generalized estimating equations analysis of urine drug screen results showed no significant difference between groups in cocaine abstinence over the 12 weeks of the trial. There were no significant differences between the 2 groups in cocaine craving or cocaine withdrawal symptom severity. Varenicline was well-tolerated. There were no medication-associated serious adverse events.

Conclusions: Varenicline plus cognitive-behavioral therapy does not seem to be an efficacious treatment for cocaine dependence.

Objectives: To review the currently available evidence on transfer strategies from methadone to sublingual buprenorphine used in clinical trials and observational studies of medication for opioid use disorder treatment, and to consider whether any strategies yield better clinical outcomes than others.

Methods: Six medical and public health databases were searched for articles and conference abstracts. The Cochrane Central Register of Controlled Trials and the World Health Organization International Clinical Trials Registry Platform were used to identify unpublished trial results. Records were dually screened, and data were extracted and checked independently. Results were summarized qualitatively and, when possible, analyzed quantitatively.

Results: Eighteen studies described transfer from methadone to buprenorphine. Transfer protocols were extremely varied. Most studies reported successful rates of transfer, even among studies involving transfer from high methadone doses, although lower pretransfer methadone dose was significantly associated with higher rate of successful transfer. Precipitated withdrawal was not reported frequently. A range of innovative approaches to transfer from methadone to buprenorphine remains untested.

Conclusions: Few studies have used designs that enable comparison of different approaches to transfer patients from methadone to buprenorphine. Most international clinical guidelines provide recommendations consistent with the available evidence. However, clinical guidelines should be perceived as providing "guidance" rather than "protocols," and clinicians and patients need to exercise judgment when attempting transfers.

Outpatient parenteral antibiotic therapy (OPAT) refers to the monitored provision of intravenous antibiotics for complicated infections outside of a hospital setting, typically in a rehabilitation facility, an infusion center, or the home. Home-based OPAT allows for safe completion of prolonged courses of therapy while decreasing costs to the healthcare system, minimizing the risk of hospital-related infectious exposures for patients, and permitting patients to recover in a familiar environment. Amidst the COVID-19 pandemic, during which nursing facilities have been at the center of many outbreaks of the SARS-CoV-2 virus, completion of antimicrobial therapy in the home is an even more appealing option. Persons who inject drugs (PWID) frequently present with infectious complications of their injection drug use which require long courses of parenteral therapy. However, these individuals are frequently excluded from home-based OPAT on the basis of their addiction history. This commentary describes perceived challenges to establishing home-based OPAT for PWID, discusses ways in which this is discriminatory and unsupported by available data, highlights ways in which the COVID-19 pandemic has accentuated inequities in care, and proposes a multidisciplinary approach championed by Addiction specialists to increasing implementation of OPAT for appropriate patients with substance use disorders.

Objective: The objective of this study was to evaluate predictors of unplanned readmission to a specialized hospital addiction unit within less than 30 days, between 30 and 60 days and over 60 days post-discharge among individuals with a diagnosis of substance use disorder.

Methods: Cox proportional hazards regressions were used to test the effects of potential risk factors on time-to-onset for unplanned readmissions. The outcome (survival time) was the length of time to hospital readmission and the predictors were age, sex, duration of the first hospital stay, Health of Nation Outcome Scales score and Brief Symptom Check List.

Results: Of the 750 readmissions analyzed for the reported period 28.0% took place in less than 30 days, 12.0% between 30 and 60 days and 60.0% after 60 days of discharge. Length of the first hospitalization was a statistically significant predictor of readmission between 30 and 60 days and over 60 days but not for less than 30 days. A 10% increase in length of the first hospitalization, holding all other variables constant, was associated with a 5.0% decrease in unplanned readmissions occurring between 30 and 60 days and a 2.2% decrease in readmissions over 60 days post-discharge.

Conclusion: Length of the first hospitalization was found to be a protective factor of readmission between 30 and 60 days and over 60 days but not for less than 30 days post-discharge. The longer the duration of the first hospitalization, the less quickly patients were readmitted to hospital.

Objectif: L'objectif de cette etude etait d'evaluer les predicteurs de readmissions non planifiees dans une unite hospitaliere specialisee en addiction en moins de 30 jours, entre 30 et 60 jours et plus de 60 jours apres leur sortie chez les personnes ayant un diagnostic de trouble lie a l'utilisation de substances (TUS).

Methode: Les regressions des risques proportionnels de Cox ont ete utilisees pour tester les effets des facteurs de risques potentiels sur le temps relies aux readmissions non planifiees. Le pronostic (duree de survie) etait la duree jusqu'a la readmission a l'hopital et les verifiables etaient l'age, le sexe, la duree du premier sejour a l'hopital, le score des resultats du Health of Nation Outcome Scales (HoNOS-F) et la liste de controle des symptomes du Brief Symptom Check List (BSCL).

Resultats: Sur les 750 readmissions analysees pour la periode rapportee, 28,0% ont eu lieu en moins de 30 jours, 12,0% entre 30 et 60 jours et 60,0% apres 60 jours de conge. La duree de la premiere hospitalisation etait une variable predictive statistiquement significative pour les readmissions entre 30 et 60 jours et les plus de 60 jours, mais pas pour les moins de 30 jours. Une augmentation de 10% de la duree de la premiere hospitalisation, en maintenant toutes les autres variables constantes, a ete associee avec une diminution de 5,0% des readmissions imprevues survenant entre 30 et 60 jours et une diminution de 2,2% des readmissions plus de 60 jours apres la liberation.

Conclusions: La duree de la premiere hospitalisation s'est averee etre un facteur de protection contre une readmission entre 30 et 60 jours et au-dela de 60 jours mais pas pour les moins de 30 jours apres la liberation. Plus la duree de la premiere hospitalisation est longue, moins les patients sont readmis rapidement a l'hopital.

LGBTQ+ individuals are at increased risk of experiencing mental health concerns including depression and substance use. Understanding these mental health disparities has been an increasing focus for researchers, but there is still limited research on the relationship between religion and depression and substance use among LGBTQ+ individuals. In the current study, it was theorized that higher perceived parental religiosity influences current experiences of depression and alcohol and substance use/abuse through the mediator of the perceived familial stigma of sexuality (stigmatizing behaviors experienced in the home). Individuals (N = 427) who identified as gay/lesbian, queer, bisexual, pansexual, asexual, and/or demisexual were recruited for the study. Results showed that perceived parental religiosity was positively linked to both current reports of depression, alcohol use, and cannabis use. In line with predictions, perceived familial stigma of sexuality was found to fully mediate the relationships between perceived parental religiosity and depression and cannabis use and to partially mediate the relationship between perceived parental religiosity and alcohol use. Furthermore, there was a moderating effect of gender, showing that gay men experienced the strongest links between perceived parental religiosity and perceived familial stigma and between perceived familial stigma and depression, alcohol use, and cannabis use. The findings of this study implicate perceived familial stigma of sexuality as an important factor that could explain how perceived parental religiosity increases LGBTQ+ individuals' experiences of mental health concerns.

'' Les thérapies les plus efficaces en matière de prévention de la rechute rassemblées dans un programme''

Les addictions touchent plusieurs centaines de millions de personnes en Europe et constituent donc un problème de santé majeur. S'il est particulièrement complexe d'amener les personnes qui souffrent d'addictions à se soigner, de nombreux enjeux attendent les professionnels qui les accompagnent avec l'objectif d'améliorer leur qualité de vie.

En s'appuyant sur les principes théoriques et contextuels de la prévention, ce livre propose aux professionnels des séances individuelles ou en groupe dans lesquelles on retrouve:
- une base de psychoéducation;
- des techniques thérapeutiques;
- des vignettes cliniques;
- des conseils pour répondre aux difficultés rencontrées en cours de séance.