Background:

Many healthcare providers screen patients for substance use with evidence-based tools, such as the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) and Drug Abuse Screening Test (DAST-1). This is the start of Screening, Brief Intervention, and Referral to Treatment (SBIRT) services where brief interventions and referrals are made based on screening results. Responses to screening differ based on the method used, such as healthcare-provider-administered interview and self-screens. The best screening method may be unique to each individual's background, and thus methodology may play a role in providing equitable care. We compare positive screening rates for substance use through healthcare team-member-administered and self-administered screening processes with subgroup analysis by gender, age, and race/ethnicity. Simultaneously, we pilot a tool for self-administered brief intervention and referral to treatment ("SelfBIRT").

Methods:

Screening for alcohol and drug use took place at community events using the AUDIT-C and DAST-1. Participants were randomly assigned to use the electronic "SelfBIRT" REDCap self-screen (via tablet or a QR code) or be screened by a team member. Demographics collected include age, gender, and race/ethnicity. For the self-screen arm, a positive AUDIT-C or DAST-1 screen automatically triggered a full self-screen with the AUDIT and DAST-10, followed by appropriate resources. Logistic regression and stratified analysis were used to analyze the data within demographic subgroups.

Results:

At the pre-determined interim analysis point, 41 individuals were screened. Those who self-screened had 1.89 (95% CI: 0.16-22.79) times the odds of screening positive for alcohol compared to those screened by a team member; this is not a statistically significant difference. No individuals screened positive for drug use.

Conclusions:

No differences in sensitivity of healthcare-provider administered screenings and self-screenings have been detected thus far, including demographic analysis. More data is necessary to conclusively determine the effectiveness of SelfBIRT in the community.

Background: OUD affects approximately 2.1 million people in the US. Nationally, opioid-related overdose deaths amount to over 100,000 yearly, over 2000 of which occurred in Massachusetts. While the CDC recommends medications for opioid use disorder (MOUD), including buprenorphine and methadone, as the gold standard of treatment, only 25% of eligible persons receive medication treatment. Historically, regulation of these medications has created access barriers, especially for marginalized populations. Although the Mainstreaming Addiction Treatment Act and other regulations have improved access, barriers to treatment persist, especially for methadone.

Methods: This analysis examined the policy landscape for MOUD, and the impact of potential policy solutions using the CDC Policy Analytical Framework and the Racial Equity in Policy (REAP) Framework. Policy recommendations were assessed for public health impact, political and operational feasibility, economic and budgetary considerations, and health equity impact.

Results: Two policy options are recommended to improve the update of medication treatment for OUD: 1) state regulation of insurance coverage for methadone under the federal 2024 SAMHSA/HHS final ruling; and 2) the incorporation of methadone management in primary care. Removing insurance barriers that impact patients’ ability to receive extended take-home doses of methadone, and access to methadone in non-OTP settings, would improve treatment uptake and reduce overdoses. Due to current laws, the first option is more feasible than the second, however international experience provides models for the latter’s adoption.

Conclusion: Addressing OUD requires a multifaceted policy approach that must integrate federal, state, and institutional levels. Potential policy change in MA may be applicable nationally. Policy solutions can remove the structural barriers to MOUD to enact successful, safe, and efficacious change.

The United States is dealing with the drug overdose crisis that has intensified over the past decade and is compounded by the emergence of new threats particularly xylazine, a veterinary sedative increasingly found in illicit drug supplies. This study investigates the prevalence of xylazine in El Paso, Texas, a U.S.-Mexico border city where its impact remains poorly understood. We employed wastewater analysis to detect xylazine and examine its potential correlation with fentanyl use over a 14-month period (June 2023 to July 2024). Our results show that xylazine was detected in wastewater samples from three of the four treatment plants serving the city. The prevalence of xylazine was heterogeneous, with the highest detection rate of 29% observed in one sewershed. All samples on xylazine-positive days also tested positive for norfentanyl, a fentanyl metabolite, demonstrating the widespread fentanyl consumption. Notably, sewersheds with higher xylazine detection exhibited significantly higher fentanyl loads, suggesting a community-level association between the two substances' use. Spatial mapping of registered veterinary clinics across sewersheds further indicates that veterinary clinics might not be the sole contributor to xylazine detected in wastewater. This study provides the first evidence of xylazine in Texas wastewater and highlights the urgent need for enhanced monitoring and targeted public health interventions to mitigate the growing threat of xylazine, particularly in border communities affected by the opioid crisis.

Aim: After legalizing recreational cannabis in New York State (NYS), further restrictions were placed on derived psychoactive cannabis products (DPCP), legalizing only Delta-9 THC. With this restriction in place, there are still questions as to the awareness and use of the derived products outside of Delta-9 THC.

Methods: Participants were recruited from a commercial database of young adults (18-25 years) in NYS via e-mail to participate. Data was collected from a self-administered, web-based survey including items on cannabis use patterns. Separate logistic regression models examined the relationship between awareness of DPCP (Delta-4 THC, Delta-8 THC, Delta-10 THC, THC-O), lifetime use of DPCP, current use of DPCP (past 30 days) and current cannabis use status. All models controlled for sex at birth, race, relationship status, age, and cigarette/e-cigarette use.

Results: Of the 2776 participants who answered questions about DPCP, Delta-8 THC had the highest positive responses for both awareness (41.3%) and lifetime use (57.9%) when compared to other DPCP. However, among those with awareness of THC-O, the prevalence of current DPCP use is 10.7%, which is higher than that of other DPCP. Current cannabis users have higher odds of lifetime use of Delta-8 THC (AOR = 3.83, p < 0.001), Delta-10 THC (AOR = 3.99, p < 0.001) and THC-O (AOR = 3.12, p < 0.001) compared to non-current users. Current cannabis users have higher odds of current DPCP use, specifically for Delta-8 THC (AOR = 5.08, p < 0.001) and THC-O (AOR = 3.13, p = 0.03) as compared to non-current cannabis users.

Conclusion: Current cannabis users have higher odds of using DPCP, indicating that DPCP users are likely using these products in addition to cannabis, rather than as a substitution to cannabis use. Further research is recommended to better understand patterns of DPCP use and co-use with other substances.

Introduction: Opioid overdose is a significant problem in Virginia state, with a significant increase in morbidity and mortality rates due to opioid overdose and exacerbated by the COVID-19 pandemic. During a pandemic, opioid-related deaths increase, due to isolation, disorders in healthcare access, and increased access to synthetic opioids like fentanyl. This study aims to provide a detailed epidemiological overview of opioid overdose in Virginia to inform public health measures and targeted interventions.

Methods: A retrospective analysis of data from the Virginia Department of Health, including emergency department visits, mortality rates, and naloxone administration reports from 2018 – 2023. Geographic disparities, trends during the pandemic and post-COVID-19, community-level risk factors, and the impact of the REVIVE prevention program in Virginia were assessed.

Results: From 2018 to 2023, Virginia identified a 32% rise in opioid-related overdose deaths, with the highest burden in Southwest and Central Virginia, and especially among Black communities from rural areas. During the peak of the COVID-19 pandemic (2020-2021), synthetic opioids contributed to over 75% of fatalities. The usage of synthetic opioids caused over 70% of fatalities. The main demographic groups at risk were predominantly male population among the 25-40-year-old Black population. However, these resources and access to treatment for opioid use disorder (OUD) remain inadequate in rural areas in Virginia.

Discussion: The study findings highlight the need for equitable healthcare access to OUD, screening and prevention programs, and increased educational initiatives across Virginia. While Virginia state programs have shown positive results in expanding naloxone access, addressing systemic barriers to OUD is important.

Conclusion: The opioid crisis in Virginia, compounded by the COVID-19 pandemic, provides valuable insights for managing overlapping public health emergencies. As opioid overdose rates decline after the pandemic, there is an urgent need to sustain preventive efforts and prepare for future epidemics and pandemics.

As medical cannabis legalization expands in the United States, more parents and people of child-bearing age are becoming medical cannabis patients. This analysis applies the theory of role strain to explore how parents navigate being a medical cannabis patient in Pennsylvania. 24 semi-structured qualitative interviews with parents from an ongoing registry study of medical cannabis patients were analyzed using an a priori codebook and complemented by codes to capture emergent themes. Additionally, memo-writing was utilized to refine the analysis and validate findings. Parents described their cannabis use as supportive of their parental role through the reduction of physical and psychological symptoms, improvements to mood, and increased patience with children. However, participants also reported that fear of legal consequences and stigma around their medical cannabis use put strain on their role as parents. The medical cannabis patient role both supports and strains the parental role depending on context and situation. Results indicate a need for more research among parents who are medical cannabis patients, especially along lines of identity and factors such as race, ethnicity, gender, and socioeconomic status.

Background: Opioid misuse represents a rapidly escalating public health crisis globally, with a particularly alarming surge in tramadol abuse across West Africa. Notably, “seizures of tramadol in West Africa account for up to 77% of all tramadol seized globally.” This study aimed to determine the prevalence and factors associated with tramadol use disorder among high school and college students in the Sunyani Municipality, Ghana.

Methods: A cross-sectional, web-based descriptive survey was conducted from January to August 2021, using a structured questionnaire with a simple random sample of 500 students. Data were analyzed descriptively and with Chi-squared tests. Online focus groups explored in-depth perspectives, with thematic analysis employed.

Results: Among 500 student respondents (Mean age = 27.14 ± 7.3 years; 70% male), 10.8% (95% CI [8.08, 13.52]) reported tramadol use in the past year, exceeding prior estimates for the region. Specifically, 3.2% obtained tramadol without a prescription, and 3.0% used it for non-medical reasons. Chi-squared analysis revealed a significant gender disparity, with males 65.6% more likely to use tramadol compared to females (χ2(1, N=500) = 4.234, p = 0.0396). Tramadol use correlated with self-reported pain/discomfort, sleep difficulties, and anxiety/depression (p < 0.05 for all). Qualitative findings from focus groups highlighted key motivating factors such as peer influence, ease of access, and perceived enhancement of physical and cognitive performance.

Discussion/Conclusion: This study unearthed a high prevalence of tramadol use disorder among students in the Sunyani Municipality, linked to modifiable factors. Given the documented cognitive and physiological risks associated with tramadol, these findings underscore the urgent need for targeted, evidence-based interventions, including public health education, stricter regulation of access, and community-based support programs.

Background: Despite recent legislation in Texas aimed at controlling prescription opioids to reduce overdose mortality, opioid-related deaths have continued to rise. The widespread prevalence of fentanyl, as reported by the Texas Department of State Health Services, significantly contributes to these trends. This study examines opioid-related mortality rates across Texas from 2019 to 2023 and evaluates the impact of prescription control measures. By analyzing opioid dispensing data and mortality trends at the county and public health region levels, the study aims to assess the effectiveness of these interventions, particularly in rural areas more vulnerable to the opioid crisis.

Methods: This study analyzed opioid overdose mortality data from the Texas Department of State Health Services (2019-2023) across all 254 Texas counties. Mortality rates were compared between state-defined public health regions, with a focus on rural counties. Opioid dispensing data from the CDC for the same period was compiled and aggregated by public health regions, then mapped to county-level mortality data to evaluate the relationship between opioid dispensing and mortality rates.

Results: The study revealed significant regional disparities in opioid-related mortality across Texas. Urban counties exhibited a strong negative correlation between opioid prescription control measures and overdose deaths, suggesting that these interventions may be ineffective in urban areas. In contrast, rural counties demonstrated a higher proportion of suppressed or incomplete mortality data, likely due to limited access to medical examiners and challenges in reporting. This highlights the need for standardized and comprehensive reporting protocols.

Conclusion: This study highlights the discrepancies in the effectiveness of opioid prescription control measures in Texas, particularly between urban and rural areas. Despite a decline in opioid dispensing rates, opioid-related mortality continues to rise, especially in rural regions. Improved data collection and targeted interventions are crucial to addressing the opioid crisis in these vulnerable areas.

Substance use presents significant risks among pregnant individuals, with 10.1 newborns per 1,000 hospital births diagnosed with neonatal abstinence syndrome in 2022 in Maryland. Pregnancy introduces unique challenges for people who use drugs (PWUD), influencing their substance use behaviors, treatment, and birth outcomes. While studies have examined substance use during pregnancy, few studies have explored how pregnancy fits within broader life course substance use patterns. This study examined how pregnancy, as a life event, shapes substance use patterns among PWUD.

We conducted a secondary analysis of qualitative data from the 2019 Maryland Statewide Ethnographic Assessment of Drug Use and Services, which included qualitative interviews with 314 PWUD across 18 Maryland counties. We used a thematic trajectory analysis approach focused on 25 transcripts detailing PWUD experiences with pregnancy and life course substance use patterns. This approach examined pregnancy’s role in: substance use trajectories, shaping cessation, relapse, or continued use.

Pregnancy was frequently viewed as a turning point, with many individuals attempting to reduce or quit substance use after learning of their pregnancy. However, the ability to sustain change was shaped by cumulative trauma histories, socioeconomic conditions, and access to care. While pregnancy offered the potential for positive transformation, it also intersected with structural and emotional challenges that could reinforce substance use patterns. Pregnancy, as a distinct life event, interacts with past experiences and future uncertainties, shaping long-term substance use trajectories.

Pregnancy is a complex and often transformative experience for PWUD, deeply influenced by broader life circumstances. Public health interventions should address the cumulative structural and psychosocial factors that shape substance use decisions during pregnancy to more effectively support individuals through this critical time.

Background:

Tobacco use is influenced by intersecting cultural, social, and structural factors, especially in immigrant communities. Arab Americans in California’s Central Valley remain understudied in tobacco control research. This qualitative study explores tobacco use patterns within this population.

Methods:

Fifteen in-depth interviews were conducted with Arab American adults of varied ages, socioeconomic backgrounds, education levels, and smoking histories. The Social Ecological Model and Intersectionality guided analysis.

Results:

Tobacco use was shaped by multiple, interacting levels. Individually, participants acknowledged health risks but often downplayed harms, especially related to hookah. Socially, peer pressure and cultural acceptance encouraged initiation and continuation. At the community level, hookah use was seen as a normalized, even celebrated, cultural practice. Participants noted a lack of tobacco prevention efforts targeting Arab Americans. While policy restrictions on public smoking were recognized, they were often disregarded in culturally specific environments. Intersectional analysis revealed that overlapping identities and structural inequities further shaped smoking behaviors and access to cessation resources.

Conclusions:

Culturally nuanced public health strategies are needed to address tobacco use in Arab American communities. Findings point to the value of community-specific interventions that consider social norms, cultural identity, and systemic barriers to prevention and cessation.