Lisham Ashrafioun

Synthetic cannabinoid use among patients in residential substance use disorder treatment: Prevalence, motives, and correlates

BACKGROUND The abuse of synthetic cannabinoids has emerged as a public health concern over the past few years, yet little data exist characterizing the use of synthetic cannabinoids, particularly among patients seeking substance use disorder (SUD) treatment. In a sample of patients entering residential SUD treatment, we examined the prevalence of and motivations for synthetic cannabinoid use, and examined relationships of synthetic cannabinoid use with other substance use and demographic characteristics. METHODS Patients (N=396; 67% male, 75% White, Mage=34.8) completed self-report screening surveys about lifetime prevalence of synthetic cannabinoid use, route of administration, and motives for use. RESULTS A total of 150 patients (38%) reported using synthetic cannabinoids in their lifetimes, primarily by smoking (91%). Participants chose multiple motives for use and the most commonly endorsed included curiosity (91%), feeling good/getting high (89%), relaxation (71%), and getting high without having a positive drug test (71%). Demographically, those who used synthetic cannabinoids were younger and more were White. They had higher rates of other substance use and higher scores on measures of depression and psychiatric distress. CONCLUSIONS Lifetime synthetic cannabinoid use was relatively common in SUD patients and many of those who used it reported doing so because they believed it would not result in a positive drug test. Further research is needed to characterize the extent of synthetic cannabinoid use among SUD treatment samples, and to establish understanding of the longitudinal trajectories of synthetic cannabinoid use in combination with other substance use, psychiatric distress, and treatment outcomes.

Prescription Opioid Use among Patients Seeking Treatment for Opioid Dependence

Objective:This study was designed to assess nonmedical prescription opioid use among a sample of opioid dependent participants. Methods:A cross-sectional survey was conducted with a convenience sample of patients hospitalized for medical management of opioid withdrawal. We collected data related to participant demographics, socioeconomic characteristics, the age of first opioid use, types of opioids preferred, and routes of administration. We also asked participants to describe how they first began using opioids and how their use progressed over time. Results:Among the 75 participants, the mean age was 32 years (SD: ±11, range: 18–70 years), 49 (65%) were men, 58 (77%) considered themselves to be “white,” 55 (74%) had a high school diploma or equivalent, and 39 (52%) were unemployed. All of these participants considered themselves to be “addicted.” Thirty-one (41%) felt that their addiction began with “legitimate prescriptions,” 24 (32%) with diverted prescription medications, and 20 (27%) with “street drugs” from illicit sources; however, 69 (92%) had reported purchasing opioids “off the street” at some point in time. Thirty-seven (49%) considered heroin to be their current preferred drug, and 43 (57%) had used drugs intravenously. Conclusions:We found that many treatment-seeking opioid-dependent patients first began using licit prescription drugs before obtaining opioids from illicit sources. Later, they purchased heroin, which they would come to prefer, because it was less expensive and more effective than prescription drugs.

Locomotor activity in a novel environment predicts both responding for a visual stimulus and self-administration of a low dose of methamphetamine in rats.

There is evidence that visual stimuli used to signal drug delivery in self-administration procedures have primary reinforcing properties, and that drugs of abuse enhance the reinforcing properties of such stimuli. Here, we explored the relationships between locomotor activity, responding for a visual stimulus, and self-administration of methamphetamine (METH). Rats were classified as high or low responders based on activity levels in a novel locomotor chamber and were subsequently tested for responding to produce a visual stimulus followed by self-administration of a low dose of METH (0.025 mg/kg/infusion) paired with the visual stimulus. High responder rats responded more for the visual stimulus than low responder rats indicating that the visual stimulus was reinforcing and that operant responding for a visual stimulus has commonalities with locomotor activity in a novel environment. Similarly, high responder rats responded more for METH paired with a visual stimulus than low responder rats. Because of the reinforcing properties of the visual stimulus, it was not possible to determine if the rats were responding to produce the visual stimulus, METH or the combination. We speculate that responding to produce sensory reinforcers may be a measure of sensation seeking. These results indicate that visual stimuli have unconditioned reinforcing effects which may have a significant role in acquisition of drug self-administration, a role that is not yet well understood.

A Clinical Trial Comparing Tapering Doses of Buprenorphine With Steady Doses for Chronic Pain and Coexistent Opioid Addiction

Objectives:Effective strategies are needed to manage individuals with chronic noncancer pain and coexistent opioid addiction. This study compared opioid discontinuation and opioid replacement protocols. Methods:We planned to enroll 60 individuals into an open-label trial who had been treated with opioids for chronic noncancer pain, and who also had opioid addiction. Participants were randomly assigned to one of the two 6-month treatment protocols of buprenorphine/naloxone sublingual tablets: (1) tapering doses for opioid weaning or “detoxification” (active comparator group) or (2) steady doses for opioid replacement (experimental group). They were followed up monthly for the study outcomes: completion of the 6-month treatment protocol and self-reported pain control, physical functioning, alcohol consumption, and illicit drug use. Results:Enrollment was terminated after enrolling 12 participants because none of the 6 assigned to receive tapering doses could successfully complete the protocol (5 were given steady doses and 1 was admitted to an inpatient chemical dependency treatment program), whereas of the 6 assigned to receive steady doses, 5 completed the protocol (1 withdrew). This difference between the 2 treatment conditions was significant (P = 0.015). Of the 10 participants who completed the 6-month follow-up, 8 reported improved pain control and physical functioning and 5 used alcohol and/or illicit drugs. Conclusions:We conclude that during 6 months, these participants with chronic pain and coexistent opioid addiction were more likely to adhere to an opioid replacement protocol than an opioid weaning protocol and that opioid replacement therapy with steady doses of buprenorphine/naloxone is associated with improved pain control and physical functioning.

Methods of assessing craving to gamble: a narrative review.

Although the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) does not explicitly list craving as a diagnostic criterion for pathological gambling, theories of disordered gambling and research on relapse precipitants suggest that cravings--among other factors--provoke and maintain episodes of gambling. Assessment of craving to gamble is complicated by questions regarding (a) the emotional, cognitive, behavioral, and physiological components of such craving; (b) the degree to which craving is viewed as an acute and fluctuating experience or as a relatively stable preoccupation with or inclination to gamble; (c) the threshold separating mild desire from pathological craving to gamble; and (d) the degree to which disordered gamblers are aware of, and able to report on, their experience of craving. Our literature search revealed various self-report methods that could be used to assess craving to gamble, including single-item rating scales, multi-item questionnaires, and application of the think-aloud procedure. In addition, psychophysiological reactivity (e.g., heart rate, brain activation) to gambling-related stimuli and reaction time (RT) tasks (e.g., gambling Stroop, Lexical Salience Task) may serve as proxy measures of subjective craving to gamble. Although researchers have assessed elements of reliability and validity of many measures, most require additional evaluation to examine their predictive and construct validity and their utility across different modes of gambling. The field would also benefit from further research to develop and evaluate additional self-report and proxy measures.

A Randomized Trial of Two Behavioral Interventions to Improve Outcomes Following Inpatient Detoxification for Alcohol Dependence

ABSTRACT Participants (n = 150), undergoing inpatient alcohol detoxification, were randomized into 3 groups: treatment as usual (TAU), motivation enhancement therapy (MET), or peer-delivered 12-step facilitation (P-TSF). The main outcome was the initiation of any type of subsequent rehabilitation service (i.e., professional treatment or self-help) within 30 and 90 days of discharge. At the 30-day follow-up interview, there was no significant difference among the groups in the rate of initiation of any type of subsequent care (82%, 74%, and 82%, respectively, p = 0.617); however, the MET group had significantly more patients initiate subsequent inpatient treatment by the 90-day follow-up interview compared to the P-TSF group (31% and 61%, respectively, p = 0.007) and a greater proportion of MET participants completed subsequent inpatient treatment compared to both the TAU and P-TSF groups. There were no differences in drinking-related outcomes. MET during inpatient detoxification may help patients initiate subsequent inpatient rehabilitation treatment.

Prevalence and correlates of suicidal ideation and suicide attempts among veterans in primary care referred for a mental health evaluation.

BACKGROUND The Veterans Health Administration has made concerted efforts to increase mental health services offered in primary care. However, few studies have evaluated correlates of suicidal ideation and suicide attempt in veterans in primary care-mental health integration (PCMHI). The purpose of the present study is to examine associations between suicidal ideation and suicide attempts as dependent variables and demographic and clinical factors as the independent variables. METHODS Veterans (n=3004) referred from primary care to PCMHI were contacted for further assessment, which included past-year severity of suicidal thoughts (none, low, high) and attempts using the Paykel Suicide Scale, mental health disorders, and illicit drug use. Multinomial logistic regression models were used to identify correlates of suicidal ideation and suicide attempts. RESULTS Thoughts of taking ones life was endorsed by 24% of participants and suicide attempts were reported in 2%. In adjusted models, depression, psychosis, mania, PTSD and generalized anxiety disorder were associated with high severity suicidal ideation, but not suicide attempt. Illicit drug use was not associated with suicidal ideation, but was the only variable associated with suicide attempt. LIMITATIONS The study was cross-sectional, focused on one clinical setting, and the suicide attempt analyses had limited power. CONCLUSIONS PCMHI is a critical setting to assess suicidal ideation and suicide attempt and researchers and clinicians should be aware that the differential correlates of these suicide-related factors. Future research is needed to identify prospective risk factors and assess the utility of follow-up care in preventing suicide.

Nonmedical use of pain medications in dental patients

Abstract Background: Substance use is overrepresented in dental clinics that provide affordable care and dental clinics provide potential access to opioid analgesics. Research is needed to better understand prescription opioid misuse in this population. Objective: The purpose of this study was to assess the prevalence and correlates of the misuse of prescription opioids in adults seeking dental care from a low-cost dental training clinic. Methods: Patients were recruited from a university school’s dentistry patient emergency and admission services clinic. Patients (n = 369) within the waiting area of the clinic completed a self-report questionnaire about their nonmedical use of prescription pain medications, medication diversion and use of substances. Results: Approximately 37.9% (140/369) of those who completed the study survey reported at least some nonmedical use of pain medications within the past 30 days. Use was associated with diversion of medication, and use of tobacco, marijuana, and sedatives. Conclusions: Within this sample from a dental clinic, nonmedical use of prescription pain medications was more common than in the general population. This suggests that dental clinics may be an appropriate setting for provider education and patient-based intervention strategies to reduce nonmedical use of pain medications.

Characteristics of substance use disorder treatment patients using medical cannabis for pain

BACKGROUND This study was designed to assess the prevalence and correlates of self-reported medical cannabis use for pain in a substance use disorder (SUD) treatment program. METHOD Participants (n=433) aged 18 years and older were recruited from February 2012 to July 2014 at a large residential SUD treatment program. They completed a battery of questionnaires to assess demographics, usual pain level in the past three months (using the 11-point Numeric Rating Scale for pain), depression (using the Beck Depression Inventory), previous types of pain treatments, and lifetime and past-year use of substances (using the Addiction Severity Index). Using both adjusted and unadjusted logistic regression models, we compared those who reported medical cannabis use for pain with those who did not report it. RESULTS Overall, 15% of the sample (n=63) reported using medical cannabis for pain in the past year. After adjusting for age, medical cannabis use for pain was significantly associated with past-year use of alcohol, cocaine, heroin, other opioids, and sedatives, but was not associated with usual pain level or depression. It was also associated with past year treatment of pain using prescription pain relievers without prescriptions. CONCLUSIONS These results indicate that medical cannabis use for pain is relatively common and is associated with more extensive substance use among SUD patients. Future work is needed to develop and evaluate strategies to assess and treat individuals who report medical cannabis for pain in SUD treatment settings.

Exploratory Studies in Sensory Reinforcement in Male Rats: Effects of Methamphetamine

Understanding sensory reinforcement and the effects of stimulant drugs on sensory reinforcers is potentially important for understanding their influence on addiction processes. Experiment 1 explored the reinforcing properties of a visual stimulus and the effects of methamphetamine (METH) on responding maintained by a visual reinforcer (VRF) in male rats. Snout poke responses to the active alternative produced the VRF according to variable interval (VI) schedules of reinforcement, and responses to an inactive alternative had no programmed effect. Experiment 2 explored the effects of METH on choice between the VRF and a water reinforcer (H2ORF) using concurrent VI schedules in male rats. In Experiment 1, response-contingent onset of the VRF produced an increase in both the relative frequency and absolute rate of active responding. The rate of both active and inactive responding declined across the 40-min test sessions. METH did not differentially enhance active responding for the VRF. Instead, METH nondifferentially increased the rate of responding and attenuated the within-session decline of responding. In Experiment 2, METH differentially increased the rate of responding for the VRF relative to the H2ORF. The results of these exploratory experiments indicate that the reinforcing effects of the VRF were weak and transient. In addition, METH treatment increased responding, and the specificity of the enhancement of METH was dependent upon the testing conditions. Potential explanations of these differences, such as novelty and reinforcer type, are discussed.