Wellness Check: Addictions

2 Minute Medicine is pleased to announce that we are launching Wellness Check, a new series dedicated to exploring new research evidence focused on wellness. Each week, we will report on articles examining different aspects of wellness, including (but not limited to) nutrition, sleep, reproductive health, substance use and mental health. This week, we explore the latest evidence-based updates in addictions.

Co-occurring substance use disorders are common in pregnant women

1. Approximately 7% of pregnant women were diagnosed with at least one substance use disorder at delivery.

2. Many patients had co-occurring substance use disorders, the most common of which was tobacco and cannabis use disorders.

Evidence Rating Level: 2 (Good)

In the past decade, research has demonstrated an increase in substance use in pregnancy, including opioid, amphetamine, and cannabis use. Each of these substances are associated with adverse fetal outcomes, including growth restriction and preterm birth. Multiple substance use disorders (SUDs) may exacerbate this issue. Thus, it is important to understand the prevalence of polysubstance abuse amongst pregnant women.

This study was a nationally representative stratified sample from the National Inpatient Sample (NIS) administered by the United States (US) Agency of Healthcare Research and Quality. Participants were included if they were aged 15-44 and had a hospital delivery between 2007 and 2016 (weighted N=38 million). Patients were excluded if they did not have a delivery hospitalization. Information about substance use disorders was collected through the diagnosis codes recorded from NIS.

This study showed that overall, 7.3% of women were diagnosed with at least one SUD, including tobacco, cannabis, opioid, amphetamine, alcohol, sedative, or cocaine. Co-occurring SUDs were also common, the most common combination being tobacco and cannabis. Those who used sedatives had an 83.7% chance of using at least one other substance. This study was limited in its use of diagnosis codes to categorize SUD (which likely underestimated the true prevalence of SUDs). Furthermore, there was limited information to differentiate whether these substances were prescribed and misused versus illicit substance use. Despite these limitations, this study encourages further study on the effect of multiple substances on pregnancy outcomes.

Sexually transmitted and blood-borne infections may be prevalent amongst patients with substance use disorder

1. Patients initiating care at one substance use disorder clinic had high rates of HCV and several other sexually transmitted infections.

2. Comprehensive infection prevention, screening and treatment may be helpful at such facilities.

Evidence Rating Level: 2 (Good)

Compared to the general United States of America (USA) population, people with active substance use disorder (SUD) have higher rates of sexually transmitted as well as blood-borne infections. Some causes of this include needle sharing and riskier sexual behaviors. Many persons with SUD use low barrier to access programs (LBAPs) to obtain medication for their treatment of addiction. LBAPs may thus be an effective avenue to screen and treat for these infections among this population.

This study was a retrospective, cross-sectional chart review of all new patients at an LBAP in Boston, Massachusetts, USA who presented from Jan 1, 2017 to September 20, 2017. Participants were included in the data if they were a new patient or had not received care for at least 4 weeks (n=393). Minors and those who did not complete a full intake form were excluded. Patients recorded a substance use history and completed an intake laboratory panel, which included blood and urine tests related to sexually transmitted and blood-borne infections.

In this study, high baseline rates of HIV (2.3%), HCV (38.4%), and chronic HBV (0.5%) were noted amongst patients. In addition, 61 new, active infections of HIV, HCV, HBS, syphilis, gonorrhea, and chlamydia were also found through screening across 55 unique patients. Finally, many patients were identified to not be vaccinated (and thuss not immune) to HBV or HAV. However,  this study was limited, especially its focus on one clinic in an urban setting, which may not be generalizable. Nonetheless, this study suggests that LBAPs may be a good way to screen, and potentially even treat certain infections amongst those with SUD.

Online mutual help for alcohol use recovery may have decreased during COVID-19 pandemic

1. In this study, engagement with StopDrinking (a popular mutual help group) decreased during the COVID-19 pandemic.

2. This may signal problematic alcohol trends in the broader population.

Evidence Rating Level: 3 (Average)

The COVID-19 pandemic and social distancing restrictions have had a huge psychological impact on many people. In particular, those who are recovering from alcohol or other substance use disorders found themselves unable to attend face-to-face mutual help groups (MHG), such as Alcoholics Anonymous. However, online MHGs have proliferated in recent years and may serve as a valuable resource for these people.

This study collected publicly available “StopDrinking” (an online MHG) user data from the Reddit Application Programming Interface from February 19, 2018 to April 30, 2020. The platform itself contains almost 256,000 subscribers, one of the largest online MHGs. All posts were included, with an average of 18,575 engagements per week. No qualitative information about the posts themselves were included. Models were trained on the pre-COVID data to predict user engagement, and these values were compared with actual engagement during periods of social distancing.

The data showed that contrary to expectations, engagement in the StopDrinking MHG was much lower than expected in the early weeks of social distancing. In late April, the engagement had further decreased and was similar to pre-social distancing levels. Reasons for this lack of engagement could include other life demands such as childcare or increased problematic alcohol use.  However, this study was limited in its reliance on only one forum and its focus on engagement rather than the qualitative aspects of each post. Despite these limitations, this study encourages further study on the role of online MHGs in alcohol recovery and how online MHGs may be better utilized in the future.

Image: PD

©2021 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.