Stimulant use and opioid-related harm in patients on long-term opioids for chronic pain.

BACKGROUND: There is lack of clarity regarding the impact of and optimal clinical response to stimulant use among people prescribed long-term opioid therapy (LTOT) for pain. OBJECTIVE: To determine if a positive urine drug test (UDT) for stimulants was associated with subsequent opioid-related harm or discontinuation of LTOT. DESIGN: Retrospective cohort study. PATIENTS: People living with and without HIV living in a major metropolitan area with public insurance, prescribed LTOT for chronic, non-cancer pain (n=600). MAIN MEASURES: UDT results from January 2012 to June 2019 were evaluated against 1) opioid-related emergency department (ED) visits (oversedation, constipation, infections associated with injecting opioids, and opioid seeking) or death in each 90-day period following a UDT, using logistic regression, and 2) LTOT discontinuation. RESULTS: There were no opioid overdose deaths within 90 days following a stimulant-positive UDT. A stimulant-positive UDT was not statistically significantly associated with opioid-related ED visits within 90 days (adjusted odds ratio [aOR] 1.39; 95% CI=0.88-2.21). Stimulant-positive UDT was independently associated with subsequent discontinuation of LTOT within 90 days (aOR 2.96; 95% CI=2.13 - 4.12). Living with HIV was independently associated with decreased odds of LTOT discontinuation (aOR 0.65; 95% CI 0.43 - 0.99). CONCLUSIONS: Despite no association between a stimulant-positive UDT and subsequent opioid-related harm, there was an association with subsequent LTOT discontinuation, with heterogeneity across clinical groups. Detection of stimulant use should result in a discussion of substance use and risk, rather than reflex LTOT discontinuation.

Prevalence of Chronic Multisymptom Illness/Gulf War Illness Over Time Among Millennium Cohort Participants, 2001 to 2016.

OBJECTIVE: Chronic multisymptom illness/Gulf War illness (CMI/GWI) is the defining illness of the 1990 to 1991 Gulf War. However, few studies have examined changes over time in CMI/GWI prevalence. METHODS: Prevalence of CMI/GWI over time was compared between three groups of military personnel (9110 Gulf War veterans, 36,019 era personnel, 31,446 non-era personnel) enrolled in the Millennium Cohort Study. Post hoc analyses were conducted among participants with no reported mental and physical health conditions (N = 30,093). RESULTS: CMI/GWI prevalence increased substantially over the study period among all groups. Gulf War veterans had the highest prevalence of CMI/GWI across the study period. This finding persisted after excluding participants with mental and physical health conditions. CONCLUSIONS: Gulf War veterans' increased risk of CMI/GWI persisted across the study period, highlighting the continued importance of screening and improving treatment options among this population.

Deportation Worry, Cardiovascular Disease Risk Factor Trajectories, and Incident Hypertension: A Community-Based Cohort Study.

Background Worry about deportation has been associated with cardiovascular disease risk factors in cross-sectional research. No research has evaluated this association longitudinally or examined the association between deportation worry and incident cardiovascular disease outcomes. Methods and Results We used data from an ongoing community-based cohort of 572 women primarily of Mexican origin. We estimated associations between self-reported deportation worry and: (1) trajectories of blood pressure, body mass index, and waist circumference with linear mixed models, and (2) incident hypertension with Cox proportional hazards models. Nearly half (48%) of women reported "a lot," 24% reported "moderate," and 28% reported "not too much" deportation worry. Higher worry at baseline was associated with nonlinear systolic blood pressure and mean arterial pressure trajectories. For example, compared with not too much worry, a lot of worry was associated with a faster initial increase (ß, interaction with linear year term: 4.10; 95% CI, 1.17-7.03) followed by a faster decrease in systolic blood pressure (ß, interaction with quadratic year term: -0.80; 95% CI, -1.55 to -0.06). There was weak evidence of an association between deportation worry and diastolic blood pressure and no association with body mass index, waist circumference, or pulse pressure trajectories. Among 408 women without baseline hypertension, reporting a lot (hazard ratio, 2.17; 95% CI, 1.15-4.10) and moderate deportation worry (hazard ratio, 2.48; 95% CI, 1.17-4.30) were each associated with greater risk of incident hypertension compared with reporting not too much worry. Conclusions Deportation worry may contribute to widening disparities in some cardiovascular disease risk factors and outcomes over time.

Health Status of Gulf War and Era Veterans Serving in the US Military in 2000.

OBJECTIVE: This research describes Gulf War and era veterans enrolled in the Millennium Cohort Study, who were sampled from US military personnel serving in 2000, and compares health characteristics of this sample to a Department of Veterans Affairs study sampled from the complete population. METHODS: Demographics characteristics of this sample were described. Self-reported health characteristics were compared between the two studies. RESULTS: Gulf War and era veterans in the Millennium Cohort were generally healthier than in the VA study; they had fewer medical conditions and mental health disorders and better self-reported health. In both studies, Gulf War veterans had poorer health outcomes than era veterans. CONCLUSION: The Millennium Cohort Study is a unique resource for examining the long-term health effects of Gulf War deployment, particularly comparing deployed and nondeployed personnel and examining illnesses with long latencies.

Distribution and Within-Family Specificity of Quantitative Autistic Traits in Patients with Neurofibromatosis Type I.

OBJECTIVE: To examine the distribution of quantitative autistic traits (QATs) in an independent neurofibromatosis type I (NF1) sample, the relationships between QAT, sex, and attention deficit hyperactivity disorder (ADHD) symptomatology, and to explore evidence for QAT mutational specificity within families. STUDY DESIGN: Age-appropriate versions of the Social Responsiveness Scale, second edition and the Conners Adult ADHD Rating Scales were completed for 103 patients with NF1 from the Washington University Neurofibromatosis Center. RESULTS: Patients with NF1 exhibited a pathologically shifted unimodal distribution for QAT. Forty-four percent of the subjects exhibited a QAT burden at or above 1 SD from the population mean; 13% scored at or above the extreme first percentile of the general population distribution. Elevations in ADHD symptomatology exhibited a distinct bimodal distribution; however, mean ADHD index scores were equivalent in patients who had been diagnosed in the community with ADHD compared with those who had not. We observed striking within-family associations for QAT, reflected by an Social Responsiveness Scale, second edition intraclass correlation of 0.77 in pairings of first degree relatives with NF1. CONCLUSIONS: Impairments in reciprocal social behavior and attention affect a large proportion of patients with NF1 throughout life and are often clinically unrecognized. Further exploration of genotype-phenotype correlation is strongly warranted for the purpose of gaining insights into mechanisms by which specific mutational variations in the NF1 gene may influence autistic trait severity.