Benzodiazepine and Stimulant Prescriptions Before Overdose in Youth

Greta Bushnell, Hillary Samples, Tobias Gerhard, Diane P. Calello, Mark Olfson 2022

In 2019, 4777 youth died of a drug overdose in the United States. Seven-hundred and twenty-seven youth died of overdoses involving benzodiazepines (BZDs) and 902 from overdoses involving psychostimulants. Opioid-related overdose deaths frequently involve other substances, and in youth, stimulants and BZDs are the most commonly involved substances. Overdoses can involve prescription drugs accessed through medical prescriptions or through illicit means. Among persons aged 18 to 25 years, 5.8% report past-year prescription stimulant misuse and 3.8% prescription BZD misuse…


Culture: The missing link in health research

M. Kagawa Singer, W. Dressler, S. George, Claudia R. Baquet, Ronny A. Bell, Linda Burhansstipanov, Nancy J. Burke, Suzanne Dibble, William Elwood, Linda Garro, Clarence C. Gravlee, Peter Guarnaccia, Michael L. Hecht, Jeffrey Henderson, Dan Hruschka, Roberto Lewis-Fernández, Robert Like, Charles Mouton, Hector F. Myers, J. Bryan Page, Rena Pasick, Bernice Pescosolido, Nancy Schoenberg, Bradley Stoner, Gregory Strayhorn, Laura Szalacha, Joseph Trimble, Thomas S. Weisner, David Williams 2022

Abstract: Culture is essential for humans to exist. Yet surprisingly little attention has been paid to identifying how culture works or developing standards to guide the application of this concept in health research. This paper describes a multidisciplinary effort to find consensus on essential elements of a definition of culture to guide researchers in studying how cultural processes influence health and health behaviors…


Feeling anxious yet? Interpreting findings on drug safety from large healthcare databases

Greta A. Bushnell, Daniel Horton, Tobias Gerhard 2022

In this issue of Clinical and Translational Science, Yun-Han Wang and colleagues report on a potential link between treatment with proton pump inhibitors (PPIs) and incident depression and anxiety disorders in children. The proposed mechanism between PPI use and anxiety and depression is related to the “microbiota-gut-brain axis.”…


Risks for Anaphylaxis With Intravenous Iron Formulations: A Retrospective Cohort Study

Chintan V. Dave, Gary M. Brittenham, Jeffrey Carson, Soko Setoguchi 2022

BACKGROUND: The risks for anaphylaxis among intravenous (IV) iron products currently in use have not been assessed. OBJECTIVE: To compare risks for anaphylaxis among 5 IV iron products that are used frequently. DESIGN: Retrospective cohort study using a target trial emulation framework. SETTING: Medicare fee-for-service data with Part D coverage between July 2013 and December 2018…


Commentary on Lo-Ciganic et al. The importance of evidence-based clinical and policy approaches to reduce opioid harms

Hillary Samples 2022

The overdose epidemic remains an urgent public health concern, with recent estimates indicating that deaths in the United States have surged to over 100 000 per year, predominantly attributed to opioids. Responses to growth in opioid-involved mortality over time have emphasized opioid prescribing regulations or restrictions, including a proliferation of state laws aimed at reducing harm by limiting exposure to opioids…


Comparative Risk of Alzheimer Disease and Related Dementia among Medicare Beneficiaries with Rheumatoid Arthritis Treated with Targeted Disease-Modifying Antirheumatic Agents

Rishi J. Desai, Vijay R. Varma, Tobias Gerhard, Jodi Segal, Mufaddal Mahesri, Kristyn Chin, Daniel B. Horton, Seoyoung C. Kim, Sebastian Schneeweiss, Madhav Thambisetty 2022

Importance: Cytokine signaling, including tumor necrosis factor (TNF) and interleukin (IL)-6, through the Janus-kinase (JAK)-signal transducer and activator of transcription pathway, was hypothesized to attenuate the risk of Alzheimer disease and related dementia (ADRD) in the Drug Repurposing for Effective Alzheimer Medicines (DREAM) initiative based on multiomics phenotyping. Objective: To evaluate the association between treatment with tofacitinib, tocilizumab, or TNF inhibitors compared with abatacept and risk of incident ADRD…


2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis

Karen B. Onel, Daniel B. Horton, Daniel J. Lovell, Susan Shenoi, Carlos A. Cuello, Sheila T. Angeles-Han, Mara L. Becker, Randy Q. Cron, Brian M. Feldman, Polly J. Ferguson, Harry Gewanter, Jaime Guzman, Yukiko Kimura, Tzielan Lee, Katherine Murphy, Peter A. Nigrovic, Michael J. Ombrello, C. Egla Rabinovich, Melissa Tesher, Marinka Twilt, Marisa Klein-Gitelman, Fatima Barbar-Smiley, Ashley M. Cooper, Barbara Edelheit, Miriah Gillispie-Taylor, Kimberly Hays, Melissa L. Mannion, Rosemary Peterson, Elaine Flanagan, Nadine Saad, Nancy Sullivan, Ann Marie Szymanski, Rebecca Trachtman, Marat Turgunbaev, Keila Veiga, Amy S. Turner, James T. Reston 2022

Objective: To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are also provided…


Benzodiazepine and Stimulant Prescriptions Before Overdose in Youth

Greta Bushnell, Hillary Samples, Tobias Gerhard, Diane P. Calello, Mark Olfson 2022

In 2019, 4777 youth died of a drug overdose in the United States.1 Seven-hundred and twenty-seven youth died of overdoses involving benzodiazepines (BZDs) and 902 from overdoses involving psychostimulants.2 Opioid-related overdose deaths frequently involve other substances, and in youth, stimulants and BZDs are the most commonly involved substances.3 Overdoses can involve prescription drugs accessed through […]


2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Recommendations for Nonpharmacologic Therapies, Medication Monitoring, Immunizations, and Imaging

Karen B. Onel, Daniel B. Horton, Daniel J. Lovell, Susan Shenoi, Carlos A. Cuello, Sheila T. Angeles-Han, Mara L. Becker, Randy Q. Cron, Brian M. Feldman, Polly J. Ferguson, Harry Gewanter, Jaime Guzman, Yukiko Kimura, Tzielan Lee, Katherine Murphy, Peter A. Nigrovic, Michael J. Ombrello, C. Egla Rabinovich, Melissa Tesher, Marinka Twilt 2022

Objective: To provide recommendations for the management of juvenile idiopathic arthritis (JIA) with a focus on nonpharmacologic therapies, medication monitoring, immunizations, and imaging, irrespective of JIA phenotype…


Use of Medication for Opioid Use Disorder among US Adolescents and Adults with Need for Opioid Treatment, 2019

Pia M. Mauro, Sarah Gutkind, Erin M. Annunziato, Hillary Samples 2022

Importance: Medication for opioid use disorder (MOUD) is the criterion standard treatment for opioid use disorder (OUD), but nationally representative studies of MOUD use in the US are lacking. Objective: To estimate MOUD use rates and identify associations between MOUD and individual characteristics among people who may have needed treatment for OUD…


Non–prescribed buprenorphine preceding treatment intake and clinical outcomes for opioid use disorder

Arthur Robin Williams, Christine M. Mauro, Tianshu Feng, Amanda Wilson, Angelo Cruz, Mark Olfson, Stephen Crystal, Hillary Samples, Lisa Chiodo 2022

Objective: Successful retention on buprenorphine improves outcomes for opioid use disorder (OUD); however, we know little about associations between use of non–prescribed buprenorphine (NPB) preceding treatment intake and clinical outcomes. Methods: The study conducted observational retrospective analysis of abstracted electronic health record (EHR) data from a multi-state nationwide office-based opioid treatment program. The study observed a random sample of 1000 newly admitted patients with OUD for buprenorphine maintenance (2015–2018) for up to 12 months following intake. We measured use of NPB by mandatory intake drug testing and manual EHR coding…


Psychosocial and behavioral therapy in conjunction with medication for opioid use disorder: Patterns, predictors, and association with buprenorphine treatment outcomes

Hillary Samples, Arthur Robin Williams, Stephen Crystal, Mark Olfson 2022

Introduction: Current evidence indicates that buprenorphine is a highly effective treatment for opioid use disorder (OUD), though premature medication discontinuation is common. Research on concurrent psychosocial and behavioral therapy services and related outcomes is limited. The goal of this study was to define patterns of OUD-related psychosocial and behavioral therapy services received in the first 6 months after buprenorphine initiation, identify patients’ characteristics associated with service patterns, and examine the course of buprenorphine treatment, including the association of therapy with medication treatment duration…


Pandemic vaccine testing: Combining conventional and challenge studies

Tobias Gerhard, Brian L. Strom, Nir Eyal 2022

Abstract: Early into COVID, human challenge trials were considered, but usually as alternatives to conventional randomized controlled trials. Instead, assessment of authorized COVID vaccines, of further COVID vaccines, and of vaccines …


Longitudinal analysis of the prevalence and correlates of heavy episodic drinking and self-reported opioid use among a national cohort of patients with HIV

Benjamin J. Oldfield, Yu Li, Rachel Vickers-Smith, Declan T. Barry, Stephen Crystal, Kirsha S. Gordon, Robert D. Kerns, Emily C. Williams, Brandon D.L. Marshall, E. Jennifer Edelman 2022

Background: Heavy episodic drinking (HED) is a risk factor for opioid-related overdose and negatively impacts HIV disease progression. Among a national cohort of patients with HIV (PWH), we examined sociodemographic and clinical correlates of concomitant HED and self-reported opioid use. Methods: We used data collected from 2002 through 2018 from the Veterans Aging Cohort Study, a prospective cohort including PWH in care at eight US Veterans Health Administration sites. HED was defined as consuming six or more drinks at least once in the year prior to survey collection. We examined the relationship between HED and self-reported opioid use and created a 4-level composite variable of HED and opioid use…


Opioid overdose survivors: Medications for opioid use disorder and risk of repeat overdose in Medicaid patients

Stephen Crystal, Molly Nowels, Hillary Samples, Mark Olfson, Arthur Robin Williams, Peter Treitler 2022

Background: Patients with medically-treated opioid overdose are at high risk for subsequent adverse outcomes, including repeat overdose. Understanding factors associated with repeat overdose can aid in optimizing post-overdose interventions. Methods: We conducted a longitudinal, retrospective cohort study using NJ Medicaid data from 2014 to 2019. Medicaid beneficiaries aged 12–64 with an index opioid overdose from 2015 to 2018 were followed for one year for subsequent overdose. Exposures included patient demographics; co-occurring medical, mental health, and substance use disorders; service and medication use in the 180 days preceding the index overdose; and MOUD following index overdose. Results: Of 4898 individuals meeting inclusion criteria, 19.6% had repeat opioid overdoses within one year…


Non–prescribed buprenorphine preceding treatment intake and clinical outcomes for opioid use disorder

Arthur Robin Williams, Christine M. Mauro, Tianshu Feng, Amanda Wilson, Angelo Cruz, Mark Olfson, Stephen Crystal, Hillary Samples, Lisa Chiodo 2022

Objective: Successful retention on buprenorphine improves outcomes for opioid use disorder (OUD); however, we know little about associations between use of non–prescribed buprenorphine (NPB) preceding treatment intake and clinical outcomes. Methods: The study conducted observational retrospective analysis of abstracted electronic health record (EHR) data from a multi-state nationwide office-based opioid treatment program…


Cross-substance patterns of alcohol, cigarette, and cannabis use initiation in Black and White adolescent girls

Carolyn E. Sartor, Feifei Ye, Patricia Simon, Zu Wei Zhai, Alison E. Hipwell, Tammy Chung 2022

Characterizing variations in the timing of alcohol, cigarette, and cannabis use onset both among and between Black and White youth can inform targeted prevention. The current study aimed to capture cross-substance initiation patterns in Black and White girls and characterize these patterns with respect to substance use related socioeconomic, neighborhood, family, community, and individual level factors. Data were drawn from interviews conducted at ages 8 through 17 in an urban sample of girls (n = 2172; 56.86% Black, 43.14% White). Discrete-time multiple event process survival mixture modeling was used to identify patterns (i.e., classes) representing timing of alcohol, cigarette, and cannabis use initiation, separately by race. Class characteristics were compared using multinomial logistic regression. Among both Black and White girls, four classes, including abstainer and cross-substance early onset classes, emerged. Two classes characterized by mid-adolescence onset (Black girls) and variation in onset by substance (White girls) were also observed. Class differences centered around cannabis for Black girls (e.g., preceding or following cigarette use) and alcohol for White girls (e.g., (in)consistency over time in greater likelihood of initiation relative to cigarette and cannabis use). Several factors distinguishing the classes were common across race (e.g., externalizing behaviors, friends’ cannabis use); some were specific to Black girls (e.g., intentions to smoke cigarettes) or White girls (e.g., primary caregiver problem drinking). Findings underscore the need to recognize a more complex picture than a high-risk/low-risk dichotomy for substance use initiation and to attend to nuanced differences in markers of risky onset pathways between Black and White girls…


Climate Change, Health, and Health Care Systems: A Global Perspective

Soko Setoguchi, Desmond Leddin, Geoffrey Metz, M. Bishr Omary 2022

Many of us who have served in health care long enough witnessed a transition from cloth gowns, sheets, and reusable surgical trays to disposal plastic replacements decades ago. However, we have rarely connected a pair of gloves and equipment that were discarded after each use to melting ice caps and dying polar bears…


Does limited EMG denervation in early primary lateral sclerosis predict amyotrophic lateral sclerosis?

Anhar Hassan, Shivam O. Mittal, William T. Hu, Keith A. Josephs, Eric J. Sorenson, J. Eric Ahlskog 2022

Objective: We assessed whether a cohort of patients with primary lateral sclerosis (PLS) and limited electromyography (EMG) motor unit denervation changes evolve into amyotrophic lateral sclerosis (ALS) with prolonged follow-up. Methods: We initially ascertained all PLS patients diagnosed at Mayo Clinic-Rochester (1990–2016). Of 64 total cases, 43 had normal EMGs (“pure” PLS) during the first 4 years after symptom onset and were the focus of a prior publication, documenting absence of evolution to ALS…


Consent Requirements for Testing Health Policies: An Intercontinental Comparison of Expert Opinions

Astrid Berner-Rodoreda, Shannon McMahon, Nir Eyal, Puspita Hossain, Atonu Rabbani, Mrittika Barua, Malabika Sarker, Emmy Metta, Elia Mmbaga, Melkizedeck Leshabari, Daniel Wikler, Till Bärnighausen 2022

Abstract: Individual informed consent is a central requirement for clinical research on human subjects, yet whether and how consent requirements should apply to health policy experiments (HPEs) remains unclear. HPEs test and evaluate public health policies prior to implementation. We interviewed 58 health experts in Tanzania, Bangladesh and Germany on informed consent requirements for HPEs…


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