BACKGROUND: The number of opioid-related deaths in the United States has more than tripled over the past 7 years, with a steep increase beginning at the same time as the COVID-19 pandemic. There is an urgent need for novel treatment options that can help alleviate the individual and social effects of refractory opioid use disorder (OUD). Deep brain stimulation (DBS), an intervention that involves implanting electrodes in the brain to deliver electrical impulses, is one potential treatment. Currently in clinical trials for many psychiatric conditions, including OUD, DBS\'s use for psychiatric indications is not without controversy. Several studies have examined ethical issues raised by using DBS to counter treatment-resistant depression, obsessive-compulsive disorder, and eating disorders. In contrast, there has been limited literature regarding the use of DBS for OUD.
OBJECTIVE: This study aims to gain empirical neuroethical insights into public perceptions regarding the use of DBS for OUD, specifically via the analysis of web-based comments on news media stories about the topic.
METHODS: Qualitative thematic content analysis was performed on 2 Washington Post newspaper stories that described a case of DBS being used to treat OUD. A total of 292 comments were included in the analysis, 146 comments from each story, to identify predominant themes raised by commenters.
RESULTS: Predominant themes raised by commenters across the 2 samples included the hopes and expectations with treatment outcomes, whether addiction is a mental health disorder, and issues related to resource allocation. Controversial comments regarding DBS as a treatment method for OUD seemingly decreased when comparing the first printed newspaper story to the second. In comparison, the number of comments relating to therapeutic need increased over time.
CONCLUSIONS: The general public\'s perspectives on DBS as a treatment method for OUD elucidated themes via this qualitative thematic content analysis that include overarching sociopolitical issues, positions on the use of technology, and technological and scientific issues. A better understanding of the public perceptions around the use of DBS for OUD can help address misinformation and misperceptions about the use of DBS for OUD, and identify similarities and differences regarding ethical concerns when DBS is used specifically for OUD compared to other psychiatric disorders.

Sexualized substance use or \"chemsex\" may contribute to the HIV epidemic among men who have sex with men (MSM) in Thailand. Specific patterns of chemsex use may be associated with different HIV/STI transmission risks. We examined typologies and correlates of sexualized substance use among a sample of high-risk MSM (n = 532) who had attended a private sex party or circuit party in the past three years using latent class analysis. Multinomial regression was used to adjust for variables associated with the 3-class latent class model. We identified a 3-class model as the best fitting model, which included: (1) \"negligible sexualized substance users\" (36.7%), who had never engaged in chemsex in the past six months; (2) \"sexualized substance users\" (13.9%), who had a high level of sexualized alcohol use and a wide range of other substances before or during sex in the past six months; and (3) \"exclusive chemsex users\" (49.4%), who predominantly used crystal methamphetamine, amyl nitrite, and erectile dysfunctional drugs before or during sex in the past six months. Compared to negligible sexualized substance users, exclusive chemsex users were more likely to be HIV-positive, more likely to have six or more sexual partners in the past six months, less likely to have condom use at last anal intercourse, and more likely to have provided sex work. Relative to negligible sexualized substance users, sexualized substance users reported more frequent online sex-seeking behaviors. These subgroups of Thai MSM have unique substance use patterns and HIV-related risk profiles, underscoring the importance of targeted HIV prevention strategies.

UNASSIGNED: To explore the ramifications of the COVID-19 pandemic on Mental Health and Substance Use.
UNASSIGNED: Relevant literature examining the correlation between COVID-19 and mental health/substance use was reviewed, and findings were summarized.
UNASSIGNED: Specific mechanisms regarding COVID-19\'s effects on the brain are unclear, but preliminary studies and biomarkers have been suggested in the literature. Numerous studies demonstrated COVID-19 has immediate and lingering neuropsychiatric impacts on affected patients. Psychiatric disorders and substance abuse increased during the COVID-19 pandemic due to biological and psychosocial factors, with a significant burden on individuals and societies worldwide, particularly in the United States.
UNASSIGNED: COVID-19 has shown us that underlying causes of mental health and substance abuse problems are more complicated than we have appreciated. Neuroinflammation and psychosocial stresses impact mental health and substance use. These factors need to be explored further for a better understanding and intervention.

Racism is embedded in the fabric of society at structural, disciplinary, hegemonic, and interpersonal levels, working as a mechanism that drives health disparities. In particular, stigmatized views of substance use get entangled with racialization, serving as a tool to uphold oppressive systems. While national health institutions have made commitments to dismantle these systems in the United States, anti-racism has not been integrated into biomedical research practice. The ways in which substance use researchers use and interpret race data-without engaging in structural racism as a mechanism of health inequity-can only be described as inadequate. Drawing upon concepts from the Public Health Critical Race praxis, QuantCrit, and an anti-racism research framework, we recommend a set of guidelines to help biomedical researchers conceptualize and engage with race more responsibly in substance use research.

Numerous cities are experimenting with pre-booking diversion programs that allow police officers to divert community members to supportive services in instances that would otherwise result in arrest and prosecution. These programs aim to decrease harmful involvement with the criminal justice system while reducing crime and public disorder. Although previous research has explored the experiences of people receiving diversion referrals and of police officers initiating them, none have examined the perspectives of community members who can offer crucial insights into planning, evaluation, and implementation barriers. We administered a survey to 293 people living in four police districts where the Philadelphia Police Department operates a pre-booking diversion program. The survey explored residents\' perspectives on the program as well as their broader views on associated issues like decriminalization of substance use, sex work, and minor theft. Bivariate χ2 tests and multivariate logistic regression examined differences in responses between subgroups. Perspectives were diverse and varied based on demographic attributes of the respondents as well as on district level attributes, like crime patterns. Most surveyed community members perceived pre-booking diversion to be a valuable tool for improving the experiences and outcomes of policing. However, residents living in areas with more crime and with more public disorder held significantly less positive perspectives. Their skepticism may reflect the possibility that pre-booking diversion and similar reforms are necessary but not sufficient to transforming individual health and public safety in some areas.

OBJECTIVE: The COVID-19 pandemic has had unprecedented and deteriorating effects on the mental health of adolescents and young adults. Various studies have described changes regarding substance abuse, but findings are conflicting.
METHODS: We conducted a cross-sectional online survey on nicotine, alcohol, and illicit drug use.
METHODS: From March to May 2023, 502 participants aged 14-24 from a community-based sample completed the questionnaire.
RESULTS: We found a general trend of declining or stable substance use during the first 2 years of the pandemic; however, in the third year (i.e., 2022), substance use returned to pre-pandemic levels or exceeded it. Compared with young adults (age 19-24), adolescents\' (age 14-18) use increased more clearly. Participants who scored above the cut-off on screening measures for problematic substance use showed a more pronounced increase in the use of cigarettes and illicit drugs but not of alcohol. Higher alcohol consumption during lockdowns was associated with increased likelihood of current problematic alcohol (odds ratio [OR]: 3.03) and cannabis use (OR: 2.60). Furthermore, individuals who reported increased usage of one psychotropic substance during lockdowns were more likely to have increased their use of other substances as well (OR: 2.66-4.87).
CONCLUSIONS: Although not optimally generalizable due to the retrospective online format and convenience sampling, our results support the notion that special attention ought to be paid to certain subgroups such as younger people and those who already exhibit problematic substance use during the pandemic. Following up on post-pandemic trends in substance use is crucial for developing prevention measures and targeted interventions.
UNASSIGNED: ZIEL: Die COVID-19-Pandemie hatte nie dagewesene negative Auswirkungen auf die psychische Gesundheit von Jugendlichen und jungen Erwachsenen. In verschiedenen Studien wurden Veränderungen des Substanzmissbrauchs beschrieben, aber die Ergebnisse sind widersprüchlich.
METHODS: Es wurde eine Online-Querschnittserhebung zum Konsum von Nikotin, Alkohol und illegalen Drogen bei Jugendlichen durchgeführt.
METHODS: Von März bis Mai 2023 füllten 502 Teilnehmende im Alter von 14–24 Jahren aus einer Bevölkerungsstichprobe den Fragebogen aus.
UNASSIGNED: Es stellte sich eine allgemeine Tendenz zu abnehmendem oder stabilem Substanzkonsum während der ersten 2 Jahre der Pandemie heraus, im dritten Jahr (d. h. 2022) kehrte der Substanzkonsum allerdings auf ein Niveau wie vor der Pandemie zurück oder überstieg es sogar. Im Vergleich zu jungen Erwachsenen (Alter: 19–24 Jahre) stieg der Konsum bei Jugendlichen deutlicher an (Alter: 14–18 Jahre). Teilnehmer mit Werten oberhalb des Grenzwerts bei Screening-Parametern für problematischen Substanzgebrauch wiesen einen deutlicheren Anstieg bei dem Konsum von Zigaretten und illegalen Drogen, nicht aber von Alkohol auf. Ein höherer Alkoholkonsum während der Lockdowns ging mit einer erhöhten Wahrscheinlichkeit für aktuellen problematischen Alkohol- (Odds Ratio [OR]: 3,03) und Cannabiskonsum (OR: 2,60) einher. Außerdem war es bei Personen, die einen erhöhten Konsum einer psychotropen Substanz während der Lockdowns angegeben hatten, wahrscheinlicher, dass sie ihren Konsum anderer Substanzen ebenfalls gesteigert hatten (OR: 2,66–4,87).
UNASSIGNED: Auch wenn die vorliegenden Ergebnisse nicht optimal zu verallgemeinern sind, da ein retrospektives Online-Format und eine Gelegenheitsstichprobe angewendet wurden, unterstützen sie die Auffassung, dass bestimmten Untergruppen besondere Aufmerksamkeit geschenkt werden sollte, wie jüngeren Leuten und Personen, die bereits während der Pandemie einen problematischen Substanzgebrauch aufgewiesen haben. Die laufende Beobachtung postpandemischer Tendenzen beim Substanzkonsum junger Menschen ist von entscheidender Bedeutung für die Entwicklung von Präventionsmaßnahmen und gezielten Interventionen.

BACKGROUND: Globally, one in two children experience violence; experiences which may lead to later risky behaviors such as substance use. In low- and middle-income countries (LMICs), however, the association between childhood violence and substance use remains underexplored.
OBJECTIVE: This study assessed the association between childhood violence and substance use among LMIC youth.
METHODS: Data from the Violence Against Children and Youth Surveys (VACS) in eight LMICs (2017-2019) were analyzed, comprising 33,408 children and young adults (ages 13-24).
METHODS: Exposure variables included the experience of childhood violence (physical, sexual, emotional) and polyvictimization (experience of two or more types). Outcomes were current smoking and past-month alcohol and drug use. Multivariable logistic regressions with country-fixed effects were estimated. Stratified analyses were performed based on participant\'s sex and age, and effect modification analyses examined whether associations differ by the presence of peer support.
RESULTS: Childhood physical violence was the most prevalent type of violence (40.7 %), and about 10 % of the participants experienced polyvictimization. All types of violence increased the odds of smoking, binge drinking, and drug use, and polyvictimization elevated the risk substantially. Stronger associations were observed in young women with a history of childhood sexual violence (current smoking aOR: 1.5, 95 % CI: 1.2-1.9; binge-drinking aOR: 2.1, 95 % CI: 1.7-2.5; and drug-use aOR: 2.3, 95 % CI: 1.5-3.5) compared to young men. Additionally, the associations between childhood sexual violence and substance use were more pronounced among adolescents (current smoking aOR: 1.7, 95 % CI: 1.2-2.2; binge-drinking aOR: 2.3, 95 % CI: 1.8-2.9; and drug-use aOR: 2.4, 95 % CI: 1.5-3.9), relative to young adults. Lack of peer support significantly increased the likelihood of drug use.
CONCLUSIONS: Childhood violence prevention programs can reduce substance use in LMICs, and they should take into account the survivor\'s sex and age. Our findings suggest that peer support can mitigate risky behaviors among the survivors of childhood violence.

The acute toxicity (sometimes called \"overdose\" or \"poisoning\") crisis has affected Canadians across all stages of life, including youth, adults and older adults. Our biological risks and exposures to substances change as we age. Based on a national chart review study of coroner and medical examiner data on acute toxicity deaths in 2016 and 2017, this analysis compares the burden of deaths and circumstances of death, locations of acute toxicity event and death, health history and substances contributing to death of people, by sex and life stage.
UNASSIGNED: La crise des intoxications aiguës (parfois appelées « surdoses » ou « empoisonnements ») touche la population canadienne à toutes les étapes de vie, que ce soit les jeunes, les adultes ou les aînés. Les risques biologiques et l’exposition aux substances changent avec l’âge. Cette analyse, fondée sur une étude nationale portant sur l’examen des dossiers des coroners et des médecins légistes sur les décès attribuables à une intoxication aiguë en 2016 et 2017, compare le fardeau des décès et les circonstances du décès, le lieu de l’intoxication aiguë et du décès, les antécédents en matière de santé et les substances qui contribuent au décès des personnes, selon le sexe et le stade de la vie.
This analysis reveals key differences in the characteristics of acute toxicity deaths by sex and life stage, and suggests potential intervention points for each group. Many people across demographics were alone while using substances before the acute toxicity event, and many were alone when they died. Youth, particularly female youth, more often died in circumstances where someone might have been available to help by calling 911 or administering first aid and naloxone. For the people who were in contact with health care prior to their death, about one-quarter (24%–28%) of adults and older adults sought assistance for reasons related to pain. Youth more often sought assistance for a nonfatal acute toxicity event (13%–14%) or for mental health (particularly female youth, 21%) than people in other life stages. Multiple substances contributed to most deaths, and both pharmaceutical and nonpharmaceutical substances were common causes of death for all life stages and sexes. There are demographic differences in the specific substances contributing to death.
Cette analyse présente les différences clés des caractéristiques des décès attribuables à une intoxication aiguë par sexe et stade de la vie, et propose des interventions possibles pour chaque groupe. Dans toutes les catégories démographiques, plusieurs personnes étaient seules au moment de consommer des substances avant l’intoxication aiguë, et plusieurs d’entre elles étaient seules au moment du décès. Les jeunes, et en particulier les jeunes femmes, sont décédées le plus souvent dans des circonstances où quelqu’un aurait pu être disponible pour aider en appelant le 911 ou en administrant les premiers soins et la naloxone. Parmi les personnes qui étaient en contact avec le système de santé avant leur décès, environ le quart (24 % à 28 %) des adultes et des aînés ont sollicité de l’aide pour des raisons liées à la douleur. Les jeunes ont plus souvent sollicité de l’aide pour une intoxication aiguë non mortelle (13 % à 14 %) ou pour des raisons liées à la santé mentale (en particulier les jeunes femmes, 21 %) que les personnes à d’autres stades de la vie. La polyconsommation de substances était en cause pour la plupart des décès, et les substances pharmaceutiques et non pharmaceutiques étaient toutes deux des causes courantes de décès pour tous les stades de la vie et les sexes. Il existe des différences démographiques en lien avec les substances spécifiques ayant contribué aux décès.

BACKGROUND: Multiple Canadian jurisdictions have reported a pattern of chronic pain among people who died from substance-related acute toxicity. This study examined the prevalence and characteristics of those with chronic pain using data from a national study of people who died of accidental acute toxicity.
METHODS: A cross-sectional analysis of accidental substance-related acute toxicity deaths that occurred in Canada between 1 January 2016 and 31 December 2017 was conducted. The prevalence of pain and pain-related conditions were summarized as counts and percentages of the overall sample. Subgroups of people with and without a documented history of chronic pain were compared across sociodemographic characteristics, health history, contextual factors and substances involved.
RESULTS: From the overall sample (n = 7902), 1056 (13%) people had a history of chronic pain while 6366 (81%) had no documented history. Those with chronic pain tended to be older (40 years and older), unemployed, retired and/or receiving disability supports around the time of death. History of mental health conditions, trauma and surgery or injury was significantly more prevalent among people with chronic pain. Of the substances that most frequently contributed to death, opioids typically prescribed for pain (hydromorphone and oxycodone) were detected in toxicology more often among those with chronic pain than those without.
CONCLUSIONS: Findings underscore the cross-cutting role of multiple comorbidities and unmanaged pain, which could compound the risk of acute toxicity death. Continued prioritization of harm reduction and regular patient engagement to assess ongoing needs are among the various opportunities for intervention.
BACKGROUND: Dans plusieurs provinces et territoires du Canada, on remarque que, souvent, les personnes qui décèdent d’une intoxication aiguë liée à une substance souffraient aussi de douleur chronique. Cette étude traite de la prévalence de la douleur chronique et des caractéristiques des personnes qui en sont atteintes en utilisant les données d’une étude nationale sur les décès par intoxication aiguë accidentelle.
UNASSIGNED: Nous avons réalisé une analyse transversale des décès par intoxication aiguë accidentelle liée à une substance qui ont eu lieu au Canada entre le 1er janvier 2016 et le 31 décembre 2017. Nous avons synthétisé, sous forme d’effectifs et de pourcentages, la prévalence de la douleur ainsi que des problèmes de santé liés à la douleur à partir de l’échantillon global. Nous avons effectué des comparaisons entre les personnes avec antécédents documentés de douleur chronique et les personnes sans antécédents documentés de douleur chronique, sur la base de différentes caractéristiques sociodémographiques, des antécédents médicaux, de facteurs contextuels et des substances consommées.
UNASSIGNED: Au sein de l’échantillon global (N = 7 902), 1 056 (13 %) personnes avaient des antécédents documentés de douleur chronique et 6 366 (81 %) n’en avaient pas. En général, les personnes souffrant de douleur chronique étaient plus âgées (40 ans et plus), n’avaient pas d’emploi et étaient à la retraite ou recevaient des prestations d’invalidité au moment de leur décès. Des antécédents de problèmes de santé mentale, de traumatisme et de chirurgie ou de blessure étaient beaucoup plus fréquents chez les personnes atteintes de douleur chronique. Parmi les substances le plus couramment en cause dans les décès, les opioïdes habituellement prescrits pour soulager la douleur (hydromorphone et oxycodone) ont été détectés plus souvent dans les analyses toxicologiques des personnes avec douleur chronique que dans les analyses des personnes sans douleur chronique.
CONCLUSIONS: Les résultats font ressortir le rôle transversal que jouent la présence concomitante de problèmes de santé et la douleur non traitée, cette dernière risquant d’accroître le risque de décès par intoxication aiguë. Continuer à prioriser la réduction des méfaits et mettre à contribution régulière des patients pour l’évaluation des besoins courants font partie des pistes d’intervention.
Between 2016 and 2017, at least one in ten of the people in Canada who died from an accidental acute toxicity had a documented history of chronic pain. People with chronic pain tended to be older and with no formal source of income. Mental health challenges, trauma and a previous surgery or injury were significantly more common among people with chronic pain than those without. Almost all individuals with chronic pain accessed health care services in the year before their death.
En 2016 et 2017, au moins une personne sur dix décédée d’une intoxication aiguë au Canada présentait des antécédents documentés de douleur chronique. En général, les personnes souffrant de douleur chronique étaient plus âgées et n’avaient pas de source officielle de revenus. Les antécédents de problèmes de santé mentale, de traumatisme et de chirurgie ou de blessure étaient nettement plus fréquents chez les personnes avec douleur chronique que chez celles sans douleur chronique. Presque toutes les personnes atteintes de douleur chronique avaient consulté des services de santé dans l’année précédant leur décès.

OBJECTIVE: To study the proportion and predictors of outpatient physician follow-up within 60 days of substance-related emergency department (ED) visits for Ontario youth.
METHODS: We examined administrative data on substance-related ED visits before and during the COVID-19 pandemic among youths aged 10-24 years in Ontario, Canada. Substance-related visits were identified using International Classification of Diseases-10-CA codes. We described demographic characteristics, receipt of mental health services in the year before the ED visit, disposition from the ED, and follow-up services within 60 days of the ED visit.
RESULTS: Between April 1, 2017, and May 31, 2021, 64,236 youth had at least one ED visit for substance use. Visits for alcohol were the most common (49%), followed by cannabis (32.3%). ED visits for all substances were more prevalent during the pandemic than prepandemic, except visits for alcohol. The receipt of follow-up physician care for substance use was low (33.2% prepandemic) but increased during the pandemic (41.7%; adjusted odds ratio 1.34, 95% CI 1.28, 1.39) and varied between substances. Mental health service history in the year before the substance-related ED visit had the strongest association with receipt of follow-up physician care within 60 days (adjusted odds ratio 6.86, 95% CI 6.57, 7.17).
CONCLUSIONS: Youth frequently do not receive physician follow-ups within two months of the substance-related ED visit, although higher follow-up proportions were seen during the pandemic after the implementation of virtual care. Further research is required to understand why follow-up is low and to examine interventions that can increase connection to care.