Assessing men with opioid use disorder for testosterone deficiency after the development of symptoms.

OBJECTIVE: Individuals with opioid use disorder (OUD) have reduced life expectancy and inferior outcomes when treated for depression, diabetes, and fractures. Their elevated risk of testosterone deficiency may contribute to all of these relationships, however few individuals prescribed opioids are evaluated with testosterone assays. The purpose of this study is to determine whether patients with opioid use disorder are evaluated for testosterone deficiency after development of a symptom that may merit investigation, such as erectile dysfunction (ED). METHOD: We conducted a retrospective longitudinal cohort study that utilized data from a national database called TriNetX. Patients were eligible for inclusion if they were 20 to 90 years of age, male, and diagnosed with erectile dysfunction. We utilized descriptive statistics and logistic regression to address study aims. RESULTS: Testosterone testing was uncommon for all patients with ED. Among 20,658 patients, it was assessed in 11.2% with OUD and 15.1% without OUD. Among those screened, 40% individuals with OUD and ED had testosterone deficiency. Odds of screening those with OUD were lower than matched controls (RR 0.74). CONCLUSIONS: Individuals with OUD are at increased risk of testosterone deficiency than the general population, but nearly 90% are not evaluated for this condition even after development symptoms. That 40% of individuals assessed were classified as testosterone deficient suggests endocrine disorders may be contributing to increased fracture risk, chronic pain, and severe depression commonly encountered in patients with OUD. Addressing this care gap may reduce morbidity and mortality associated with opioid use disorder.

Interventions Addressing Cannabis Use During Pregnancy: A Systematic Review.

OBJECTIVES: The prevalence of cannabis use among pregnant women is increasing in the United States and places mothers and infants at risk of multiple adverse health outcomes. Given the uncertainty expressed by providers regarding how to approach cannabis use during pregnancy and the growing need for a systematic endeavor to curb use in this population, the aim of this study is to conduct a systematic review of interventions focused on reduction in cannabis use during pregnancy. METHODS: We conducted a systematic search of MEDLINE, PsycINFO, CINAHL, Web of Science, SCOPUS, and Cochrane Library to identify studies of interventions that target individuals that engaged in cannabis use during pregnancy. We included studies if they were randomized controlled trials, controlled studies, feasibility studies, pilot studies, as well as observational studies. The primary diagnostic outcome of interest is reduction in cannabis use. RESULTS: We identified 9 studies for inclusion with sample sizes ranging from 15 to 658 pregnant people. Interventions involved brief counseling, cognitive behavioral therapy (CBT), motivational interviewing (MI), motivational enhancement therapy + cognitive behavioral therapy (MET-CBT), computer-delivered psychotherapy, and psychoeducation. The interventions that were effective primarily used MI, CBT, and/or MET. There was just 1 study that implemented a home intervention and one that explored computer-based psychotherapy. CONCLUSIONS: The studies uncovered through this systematic review suggest that interventions involving CBT and/or MI demonstrate promise for decreasing cannabis use during pregnancy. There is a tremendous need for high-quality studies focused on this population, and the potential for remote and computer-based interventions should be explored more fully.

Psychiatric comorbidity and order of condition onset among patients seeking treatment for chronic pain and opioid use disorder.

BACKGROUND: The study objective was to compare psychiatric comorbidity among patients seeking treatment for chronic pain and opioid use disorder (OUD) by order of condition onset (i.e., "Pain First," "OUD First," "Same Time"). METHODS: Data from 170 patients entering two clinical trials of treatments for current comorbid chronic pain and OUD conducted between March 2009 and July 2013 were compared by order of condition onset. The Structured Clinical Interview for DSM-IV-TR Axis I Disorders and the Diagnostic Interview for DSM-IV Personality Disorders (Axis II) were performed by doctoral-level providers using a standardized training protocol. Age of onset group differences on specific diagnostic variables were examined using multinomial logistic regression. RESULTS: Fifty-two percent were in the "Pain First" group (n = 89), 35 % in the "OUD First" group (n = 59), and 13 % in the "Same Time" group (n = 22). Compared with the Pain First group, the Same Time group was less likely to report heroin (vs. prescription opioids) as the primary drug used (OR = 0.20, 95 % CI = 0.06-0.72) or meet criteria for an Axis II disorder (OR = 0.24, 95 % CI = 0.07-0.83). Compared with the Pain First group, the OUD First group was more likely to meet criteria for a current nonopioid substance use disorder (OR = 3.20, 95 % CI = 1.22-8.40). CONCLUSIONS: Our findings regarding differences in psychiatric comorbidity associated with order of condition onset indicate that varying pathways may exist for the emergence of chronic pain and OUD; further research should investigate potential treatment implications.

Pain catastrophizing and pain acceptance are associated with pain severity and interference among methadone-maintained patients.

OBJECTIVE: The present study examined whether pain catastrophizing and pain acceptance, two important targets of psychosocial interventions for chronic pain, are uniquely associated with pain severity and pain interference among patients on methadone maintenance treatment (MMT). METHOD: A total of 133 MMT patients who reported experiencing some pain during the previous week completed a battery of self-report measures. Multiple regression was used to test whether pain catastrophizing and pain acceptance are related to pain severity and pain interference above and beyond covariates including demographics, emotional distress, and current methadone dose. RESULTS: Both pain acceptance and catastrophizing were significantly associated with pain severity and pain interference while controlling for covariates. CONCLUSIONS: Consistent with previous literature on patients with chronic pain but without opioid use disorder, our findings suggest that both pain catastrophizing and pain acceptance are potentially important intervention targets among MMT patients with co-occurring opioid use disorder and chronic pain.

Electronic cigarette and tobacco use in individuals entering methadone or buprenorphine treatment.

BACKGROUND: Although smoking is prevalent among populations with opioid use disorder (OUD), few studies have examined electronic cigarette (EC) use in individuals seeking opioid agonist therapy (OAT). The aim of this study was to evaluate the prevalence and correlates of EC use among individuals seeking OAT. METHODS: 782 patients seeking OAT for OUD completed surveys assessing current and past EC use, reasons for use, current and past cigarette smoking, nicotine dependence, psychiatric distress, trauma, and pain. Bivariate and multivariate models evaluated correlates of daily EC use, past-30-day EC use, and current cigarette smoking. RESULTS: 6% of patients reported daily EC use, 18% reported past-30-day use, 62% reported EC use history, and 85% reported current cigarette smoking. 46% reported using ECs to quit or cut down smoking. In multivariate analyses, daily EC use was associated with higher odds of being a former smoker (OR 21; CI 1.7-273) and lower odds of ever smoking more than 100 cigarettes (OR 0.07; CI 0.01-0.32), while EC use in the past 30 days was associated with lower odds of being Caucasian (OR 0.55; CI 0.34-0.89), ever smoking more than 100 cigarettes (OR 0.13; CI 0.02-0.67), and history of chronic pain (OR 0.59; CI 0.38-0.90), and higher odds of reporting psychiatric distress (OR 1.5; CI 1.1-2.2). CONCLUSIONS: EC use is common among people with OUD who smoke cigarettes. Those with daily use had higher odds of being former smokers than current smokers. Interventions using ECs may be effective to help reduce harms and mortality in OUD.