Nyaradzo Longinaker

Recent trends in treatment admissions for prescription opioid abuse during pregnancy.

Prescription opioid abuse is a significant and costly public health problem among pregnant women in the United States. We investigated recent trends in substance abuse treatment admissions for prescription opioids during pregnancy using the Treatment Episodes Data Set. From 1992 to 2012 the overall proportion of pregnant admissions remained stable at 4%; however, admissions of pregnant women reporting prescription opioid abuse increased substantially from 2% to 28% especially in the south. Demographic characteristics of pregnant opioid admissions changed from 1992 to 2012 with younger, unmarried White non-Hispanic women, criminal justice referrals, and those with a psychiatric co-morbidity becoming more common (p<0.01). About a third received medication assisted therapy despite this being the standard of care for opioid abuse in pregnancy. While substance abuse treatment centers have increased treatment volume to address the increase in prescription opioid dependence among pregnant women, targeting certain risk groups and increasing utilization of medication assisted therapy should be emphasized.

Women-Centered Drug Treatment Services and Need in the United States, 2002–2009

OBJECTIVES We examined options and need for women-centered substance use disorder treatment in the United States between 2002 and 2009. METHODS We obtained characteristics of facilities from the National Survey of Substance Abuse Treatment Services and treatment need data from the National Survey on Drug Use and Health. We also examined differences in provision of women-centered programs by urbanization level in data from the National Center for Health Statistics 2006 Rural-Urban County Continuum. RESULTS Of the 13 000 facilities surveyed annually, the proportion offering women-centered services declined from 43% in 2002 to 40% in 2009 (P < .001). Urban location, state population size, and Medicaid payment predicted provision of such services as trauma-related and domestic violence counseling, child care, and housing assistance (all, P < .001). Prevalence of women with unmet need ranged from 81% to 95% across states. CONCLUSIONS Change in availability of women-centered drug treatment services was minimal from 2002 to 2009, even though need for treatment was high in all states.

Cord Blood Vγ2Vδ2 T Cells Provide a Molecular Marker for the Influence of Pregnancy-Associated Malaria on Neonatal Immunity

BACKGROUND Plasmodium falciparum placental infection primes the fetal immune system and alters infant immunity. Mechanisms leading to these outcomes are not completely understood. We focused on Vγ2Vδ2 cells, which are part of the immune response against many pathogens, including P. falciparum. These unconventional lymphocytes respond directly to small, nonpeptidic antigens, independent of major histocompatibility complex presentation. We wondered whether placental malaria, which may increase fetal exposure to P. falciparum metabolites, triggers a response by neonatal Vγ2Vδ2 lymphocytes that can be a marker for the extent of fetal exposure to malarial antigens. METHODS Cord blood mononuclear cells were collected from 15 neonates born to mothers with P. falciparum infection during pregnancy (8 with placental malaria) and 25 unexposed neonates. Vγ2Vδ2 cell phenotype, repertoire, and proliferative responses were compared between newborns exposed and those unexposed to P. falciparum. RESULTS Placental malaria-exposed neonates had increased proportions of central memory Vγ2Vδ2 cells in cord blood, with an altered Vγ2 chain repertoire ex vivo and after stimulation. CONCLUSION Our results suggest that placental malaria affects the phenotype and repertoire of neonatal Vγ2Vδ2 lymphocytes. Placental malaria may lower the capacity for subsequent Vγ2Vδ2 cell responses and impair the natural resistance to infectious diseases or the response to pediatric vaccination.

Effect of criminal justice mandate on drug treatment completion in women.

Abstract Background: Drug and alcohol abuse among women is a growing problem in the United States. Drug treatment is an effective way to manage the psychological, biological, financial, and social cost of drug abuse. Prior research has identified criminal justice referrals or coercion as a predictor of treatment completion among men but questions remain about the same effect in women. Objectives: This study uses the Treatment Episodes Datasets Discharge 2006–2008 (TEDS-D) to explore the association between coercion and treatment completion among women. Methods: Analysis compared primary treatment episodes of coerced women to those who entered treatment voluntarily. A logistic model of the odds of treatment success was performed controlling for race/ethnicity, age, education, employment, primary substance of abuse, number of substances reported at admission, referral source, treatment setting, and treatment duration. Results: 582 671 primary treatment episodes were analyzed comparing women with coercion referrals (n = 196 660) to those who entered treatment voluntarily (n = 390 054). Results of multivariable logistic modeling showed that coerced women had better odds of completion or transfer than women who entered voluntarily. However, this association was modified by treatment setting with better odds in ambulatory (OR = 1.49 [1.47, 1.51]) than in inpatient (OR = 1.06 [1.03, 1.10]) and worst outcomes in detoxification (OR = 0.89 [0.84, 0.96]). Conclusion: These results dispute the broad effectiveness of legal mandates across all drug treatment settings among women. They show the need for further recognition of female-specific characteristics that can affect motivation and treatment success to better inform healthcare and judicial policies on drug treatment services for women.

Sex Differences in Substance Abuse Treatment Adherence in the United States

Background and Aims:There are sex differences regarding the frequency and patterns, barriers to care, and consequences of drug abuse. However, it is unclear if and how these factors influence substance abuse treatment (SAT) adherence. This study investigates whether sex is an independent predictor of SAT adherence controlling for treatment modality using national-level data. Design:Analysis used secondary cohort data comparing adherent and nonadherent SAT discharges by sex. Further comparisons examined the influence of SAT modality (ambulatory, rehabilitation, or detoxification) controlling for demographic characteristics using logistic regression. Setting:Data were obtained from the Treatment Episodes Data Set—Discharges, 2006 to 2008, a publicly available deidentified administrative data set that tracks admissions into all SAT facilities that receive federal funding. Participants:To maintain independence, this study was limited to first-time Treatment Episodes Data Set—Discharges episodes. Measurements:The primary outcome was defined dichotomously as adherence to SAT (completed or transferred to another program) and nonadherence (all other reasons for discharge). Findings:From 2006 to 2008 there were 1,779,248 primary SAT episodes (66% male). A total of 61% of these ended in adherence with minimal differences observed between sexes in adjusted analyses (odds ratio, 1.01; 95% confidence interval: 1.00, 1.01). However, this association was modified by treatment modality with female detoxification therapy episodes exhibiting lower odds of adherence compared with males (odds ratio, 0.90; 95% confidence interval: 0.88, 0.92). Conclusions:Although sex does not generally seem to be a determinant of SAT adherence, women in detoxification may be a subpopulation at higher risk of treatment attrition.

155 Association of smoking with narcotic overdose death following trauma injury admission

Purpose Due to psychosocial risk factors, injury severity, and post-injury exposure to narcotic analgesics, trauma patients may be at higher risk for narcotic abuse. This study examines overdose risk and modifiable risk factors that could affect mortality of trauma patients due to narcotic overdose. Methods Trauma injury patients older than 18 years of age who were discharged alive from a Level I Trauma Centre between January 1997 and December 2008 were linked to the National Death Index. Patients who were alive at least 30 days after discharge with no pre-existing alcohol or drug use disorders were included in this study. Chi-squared tests and unadjusted Odds Ratios were used to compare death due to overdose based on the following patient risk factors: demographic, tobacco use, injury mechanism and type, drug urine screen, and blood alcohol level. Cox Proportional Hazard results will be presented forthcoming. Results This study included a total of 46 504 patients. Thirty-one percent (31%) of patients were smokers at the time of admission and we observed 187 narcotic overdose deaths over the follow-up period. Preliminary results indicated that smoking was significantly associated with mortality due to narcotic overdose (OR 2.13, 95% CI 1.73–3.08). After restricting analyses to patients with no positive drug or alcohol test, we observed an increase in risk of narcotic overdose mortality among smokers (OR 3.92, 95% CI 2.40–6.41). Conclusion Preliminary results suggest that smoking status is associated with narcotic overdose death, which was higher after the exclusion of patients who tested positive for drugs or alcohol on admission. The association of smoking with narcotic overdose death following trauma admission may be due to differences in injury healing or psychosocial features that predispose smokers to developing addiction. Significance and Contributions This research informs further narcotic overdose prevention efforts by identifying smoking as risk factor.

Availability of Women-Centered Drug Treatment Services in the United States [1]

AIMS: Women who receive gender-specific drug treatment services have improved outcomes. We investigated how the availability of women-centered services has changed over time, geographic variation, and whether treatment availability corresponds to need. We hypothesized that, although treatment availability has increased over time, there are still disparities between treatment need and available services. METHODS: The National Survey of Substance Abuse Treatment Services was used to describe treatment availability from 2002 to 2010. Facilities with specific programs for women were contrasted with programs without these services. Treatment need was captured from the National Survey of Drug Use and Health 2002–2009. Services were compared over time and by geographic variation using STATA 11 and ArcGIS 10.2. RESULTS: There was a decline over time in specific programs reported for women (38% in 2002 compared with 32% in 2010, P<.001). There was an increase in facilities providing transportation (35–38%) and domestic violence counseling (33–36%) and a decline in peripartum and postpartum services. Facilities that reported specific programs for women were more likely to report trauma-related counseling, child care, housing assistance, and domestic violence counseling (P<.001 for all). There was a decline in women-centered services across a geographic gradient, from 41% in urban areas to 20% in small, non–urban-adjacent regions (P<.001). Availability of treatment services was not proportional to need (P<.001). CONCLUSION: There has been minimal change in women-centered services in drug treatment facilities over time. Marked geographic disparities exist for all components of women-centered care, and the availability of treatment services does not match treatment need nationwide.