Anna Eisenberg

Trends and regional variation in opioid overdose mortality among Veterans Health Administration patients, fiscal year 2001 to 2009.

Objectives:Opioid-related mortality has increased in the United States in the past decade. The purpose of this study was to examine trends and regional variation in opioid prescribing and overdose rates in a national health system, the Veterans Health Administration. Materials and Methods:Annual cohorts of Veterans Health Administration patients were identified on the basis of medical records, and overdose mortality was determined from National Death Index records. State-level prescribing and overdose rates were mapped to provide information on regional variability. Results:There were significant increases between 2001 and 2009 in the rate of overdoses associated with nonsynthetic opioids (&bgr;=0.53, 95% confidence interval, 0.35, 0.70) and methadone (&bgr;=0.63, 95% confidence interval, 0.37, 0.90) but not synthetic/semisynthetic opioids. State-level overdose rates had a moderate correlation with the average proportion of patients in that state receiving opioids (r=0.29). Discussion:The present study demonstrates that the increases in prescription opioid overdoses observed in the general population are also found in the patient population of a national health system and provides further evidence of the population-level association between trends in opioid prescribing and opioid overdose deaths. There is substantial regional variation in both opioid prescribing and opioid-related overdose rates, and these data can inform region-specific overdose prevention strategies and opioid policy.

Butch tops and femme bottoms? Sexual positioning, sexual decision making, and gender roles among young gay men.

Gender and power are theoretical constructs linked to discussions of sexual transmission of HIV/AIDS among heterosexual couples. Despite the fact that HIV rates are rising among young men who have sex with men in the United States, work examining the role of gender in sexual decision making of young men who have sex with men remains in its infancy. Through qualitative interviews with 34 young gay men (YGM), the authors seek to contribute to the literature in this area by focusing on the ways that YGM understand and enact sexual positions during anal sex. The authors’ results highlight the diversity of YGM’s sexual preferences, as well as the high degree of sexual fluidity. Ideas of gender appear to inform part of this process; however, YGM critiqued conventional gender norms and emphasized the centrality of relationships (i.e., casual vs. romantic) in their sexual decision making. The authors discuss the importance of considering gender and interpersonal factors when designing HIV/AIDS prevention messages for YGM.

Butch Tops and Femme Bottoms? Constructions of Masculinity by Young Men Who Have Sex with Men Seeking Partners Online

Gender and power are theoretical constructs linked to discussions of sexual transmission of HIV/AIDS among heterosexual couples. Despite the fact that HIV rates are rising among young men who have sex with men in the United States, work examining the role of gender in sexual decision making of young men who have sex with men remains in its infancy. Through qualitative interviews with 34 young gay men (YGM), the authors seek to contribute to the literature in this area by focusing on the ways that YGM understand and enact sexual positions during anal sex. The authors’ results highlight the diversity of YGM’s sexual preferences, as well as the high degree of sexual fluidity. Ideas of gender appear to inform part of this process; however, YGM critiqued conventional gender norms and emphasized the centrality of relationships (i.e., casual vs. romantic) in their sexual decision making. The authors discuss the importance of considering gender and interpersonal factors when designing HIV/AIDS prevention messages for YGM.

Achieving Safety: Safer Sex, Communication, and Desire Among Young Gay Men

Conceptualizations of safer sex practices among young gay men (YGM) are frequently structured around communication between partners and the subsequent utilization or absence of condoms in a sexual encounter. Drawing on a sample of 34 in-depth interviews with YGM, ages 18 to 24, the authors explore the ways in which conceptualizations and definitions of safer sex are discussed and enacted. Placing attention on their safer sex practices, the authors analyze the conversations that do and do not occur among YGM and their partners, including the strategies (e.g., negotiated safety, condom communication and negotiation) that are commonly perceived as most useful by YGM. The authors provide recommendations regarding how to craft safer sex messages for YGM by considering their competing demands.

“A Safe Way to Explore” Reframing Risk on the Internet Amidst Young Gay Men’s Search for Identity

Internet use provides a vital opportunity for sexual-minority youth to learn about sexual desires and pursue partnerships otherwise publically stigmatized. Researchers, however, have portrayed the Internet as an inherently risky venue for HIV or sexually transmitted infection (STI) transmission among young gay men (YGM). We therefore investigated how YGM use the Internet during adolescence and emerging adulthood. In the course of 34 in-depth, semistructured interviews with a sample of self-identified YGM, 18 to 24 years of age, we inquired about initial experiences of online dating. We found that YGM benefit online through exploration of their sexual identities, while simultaneously encountering and negotiating sources of risk. In examining YGM’s perceptions of risk, we hope to reach a greater understanding of the opportunities for HIV prevention and health promotion among YGM.

Misclassification of suicide deaths: examining the psychiatric history of overdose decedents

Objectives The intent of a death from overdose can be difficult to determine. The goal of this study was to examine the association of psychiatric diagnoses among overdose deaths ruled by a medical examiner as intentional, unintentional and indeterminate intent. Methods All Veterans Health Administration patients in Fiscal Year 1999 (n=3 291 891) were followed through Fiscal Year 2006. We tested the relative strength of association between psychiatric disorders among types of overdoses (categorised by intent) using multinomial models, adjusted for age, sex, Veterans Affairs priority status and Charlson comorbidity scores. Data were from National Death Index records and patient medical records. Results Substance use disorders (SUD) had a stronger association with indeterminate intent overdoses than intentional overdoses (adjusted OR (AOR)=1.80, 95% CI 1.47 to 2.22). SUDs also had a stronger association with unintentional overdoses than intentional (AOR=1.48, 95% CI 1.27 to 1.72), but the reverse was true for all other psychiatric disorders (except post-traumatic stress disorder). Conclusions Overdoses ruled indeterminate may be misclassified suicide deaths and are important to suicide surveillance and prevention efforts. Additionally, overdose deaths not classified as suicides may include some cases due to suicidal-like thinking without overt suicidal intent.

Perceived Risks and Protective Strategies Employed by Young Men Who Have Sex With Men (YMSM) When Seeking Online Sexual Partners

This study examined the perceptions of risk by young men who have sex with men (YMSM) regarding meeting sexual partners through the Internet. Fifty-four YMSM ages 18–29 who reported engaging in bareback sex (“intentional unprotected anal intercourse in high-risk contexts”) completed a structured assessment and a face-to-face interview. Participants reported using the Internet to meet sexual partners at least once per week, having had multiple sexual partners in the past 2 months (M = 10.50, SD = 9.25), and engaging in occasions of unprotected receptive (M = 5.35, SD = 6.76) and insertive (M = 5.06, SD = 10.11) anal intercourse. A third of the sample reported having had unprotected sex with a partner who was serodiscordant or of unknown serostatus. Despite the obvious HIV risks, the most commonly perceived risks included threats to physical safety and difficulties trusting a stranger. Risk reduction strategies included leaving information about partner and whereabouts with a friend, meeting in a public place, and screening partner through online chatting. Those YMSM who meet partners online may be at risk for physical violence in addition to HIV or sexually transmitted infections (STIs). Public health campaigns should increase awareness of safety concerns when meeting sexual partners online and support YMSMs self-protective actions.

Prescription opioid use among addictions treatment patients: Nonmedical use for pain relief vs. other forms of nonmedical use

BACKGROUND Differences between those who engage in nonmedical prescription opioid use for reasons other than pain relief and those who engage in nonmedical use for reasons related to pain only are not well understood. METHODS Adults in a residential treatment program participated in a cross-sectional self-report survey. Participants reported whether they used opioids for reasons other than pain relief (e.g., help sleep, improve mood, or relieve stress). Within those with past-month nonmedical opioid use (n=238), logistic regression tested differences between those who reported use for reasons other than pain relief and those who did not. RESULTS Nonmedical use of opioids for reasons other than pain relief was more common (66%) than nonmedical use for pain relief only (34%), and those who used for reasons other than pain relief were more likely to report heavy use (43% vs. 11%). Nonmedical use for reasons other than pain relief was associated with having a prior overdose (odds ratio [OR]=2.54, 95% CI: 1.36-4.74) and use of heroin (OR=4.08, 95% CI: 1.89-8.79), barbiturates (OR=6.44, 95% CI: 1.47, 28.11), and other sedatives (OR=5.80, 95% CI: 2.61, 12.87). Individuals who reported nonmedical use for reasons other than pain relief had greater depressive symptoms (13.1 vs. 10.5) and greater pain medication expectancies across all three domains (pleasure/social enhancement, pain reduction, negative experience reduction). CONCLUSIONS Among patients in addictions treatment, individuals who report nonmedical use of prescription opioids for reasons other than pain relief represent an important clinical sub-group with greater substance use severity and poorer mental health functioning.

Measuring Love: Sexual Minority Male Youths’ Ideal Romantic Characteristics

Research examining how sexual minorities characterize love within same-sex relationships is scarce. In this study, the authors examined the validity of Sternbergs triangular theory of love in a sample of sexual minority male youth (N = 447). To test the adequacy of the theory for our population, the authors examined the psychometric properties of the Triadic Love Scale (TLS) and tested whether the three underlying constructs of the theory (intimacy, passion, and commitment) emerged when participants were asked to consider their ideal relationship with another man. Using confirmatory factor analysis, the authors found support for the three-factor solution to characterize sexual minority male youths’ ideal romantic relationship, after minimizing item cross-loadings and adapting the content of the Passion subscale. The authors discuss the implications of their findings regarding the measurement of the TLS among sexual minority male youth and propose ways to enhance its measurement in future research.

Qualitative Evaluation of Suicide and Overdose Risk Assessment Procedures Among Veterans in Substance Use Disorder Treatment Clinics

The objective of this study was to examine risk assessment practices for suicide and unintentional overdose to inform ongoing care in substance use disorder clinics. Focus groups were conducted via telephone among a random sample of treatment providers (N = 19) from Veterans Health Administration substance use disorder clinics across the nation. Themes were coded by research staff. Treatment providers reported consistent and clear guidelines for risk assessment of suicide among patients. Unintentional overdose questions elicited dissimilar responses which indicated a lack of cohesion and uniformity in risk assessment practices across clinics. Suicide risk assessment protocols are cohesively implemented by treatment providers. Unintentional overdose risk, however, may be less consistently assessed in clinics.