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Substance use, misuse and dependence: A PLOS Medicine special issue

PLOS

This week sees publication of the first research papers that will form part of PLOS Medicine's latest Special Issue, which is devoted to understanding the substantial challenges caused by substance use and misuse and seeking to inform responses in the health sector and beyond. Content for the special issue has been selected along with guest editors Margarita Alegria, Steffanie Strathdee and Alexander Tsai.

Substance use is a threat in almost all settings worldwide, and the resulting harms--including transmission of infectious diseases by injection drug use, deaths from overdose, and the complex issues caused by long-term dependence--pose serious problems not only for the people affected and their families but also for health providers, policymakers, those working in criminal justice systems and others.

The current epidemic of opioid use and the ensuing morbidity and mortality, notably the growing burden of overdose deaths, in the United States and other countries has been well recognized in recent years--with the US Centers for Disease Control and Prevention highlighting a daily toll of about 190 drug overdose deaths. In a research paper in the Special Issue, Yu-Jung Jenny Wei of the University of Florida, Gainesville, and co-authors report on documented opioid prescriptions in a cohort of 227,000 adults with a diagnosis of opioid use disorder or overdose in the United States during the period 2005-16. Efforts to curb use of prescription opioids are generally focused on people receiving 90 mg of morphine equivalents per day or more. However, the authors found that about 35% of study participants received no prescription opioids in the year before diagnosis of opioid use or overdose, and two thirds received opioids at a level below the recognized threshold for risk. They comment that programmes seeking to limit use of prescription opioids could be missing a growing proportion of people at risk of harm from opioid misuse.

In a second published study, Joel Hudgins of Boston Children's Hospital, and colleagues, report on prescription opioid use and misuse by adolescents and young adults, based on an analysis of the US National Survey on Drug Use and Health for 2015 and 2016. The authors found that 21% of adolescents (among about 28,000 participants aged 12-17 years) and around 32% of young adults (among about 28,000 participants aged 18-25 years) had used prescription opioids in the previous year, corresponding to an estimated 32.8 million people in the US population in aggregate. Opioid use was more common in women than in men, and opioid misuse was reported by 3.8% of adolescents and 7.8% of young adults. "Prevention and treatment efforts should take into account that greater than half of youths misusing prescription opioids obtain these medications through friends and relatives", the authors say.

In a nationwide study carried out in Sweden, James Kirkbride of University College London, and colleagues from the Karolinska Institute, Sweden, report on substance use disorders in refugee and non-refugee migrant groups. Although refugees are known to be at higher risk of post-traumatic stress disorder than people in the general population, for example, there has been less research on substance use. Data from more than 1.2 million people were included, including 17,700 refugees and 104,200 other migrants, with the Middle East and North Africa being the region of origin for the largest proportions of refugees and migrants. The researchers found that refugees were substantially less likely than Swedish-born individuals to have been diagnosed with a substance use disorder (adjusted hazard ratio 0.52 [95% CI 0.46-0.60]), as were non-refugee migrants (0.46, 0.43-0.49). Risks appeared to converge with those of the Swedish population over time, however, with differences less pronounced in people who had migrated at 0-6 years of age as compared with those migrating after 20 years of age.

Further research and commentary papers for the Special Issue will be published in the coming weeks, and we look forward to ongoing engagement in research focused on understanding and addressing the global crisis in substance use and misuse.

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Image Credit: Jacksoncam, Flickr

Research Article - Wei et al

Funding:

This project had no direct funding. Y-JJW is supported in part by a Mentored Research Scientist Award (K01AG054764), and RF is supported in part by an Academic Career Award (K07AG046371), both awards from the National Institute on Aging (NIA) (https://www.nia.nih.gov/). The funder had no role in study design, data collection and analysis,decision to publish, or preparation of the manuscript.

Competing Interests:

The authors have declared that no competing interests exist.

Citation:

Wei Y-JJ, Chen C, Fillingim R, Schmidt SO, Winterstein AG (2019) Trends in prescription opioid use and dose trajectories before opioid use disorder or overdose in US adults from 2006 to 2016: A cross-sectional study. PLoS Med 16(11): e1002941. https://doi.org/10.1371/journal.pmed.1002941

Author Affiliations:

Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, United States of America
College of Dentistry, University of Florida, Gainesville, Florida, United States of America
Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, United States of America
Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
Department of Epidemiology, College of Medicine and College of Public Health & Health Professions, University of Florida, Gainesville, Florida, United States of America

In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002941

Research Article - Hudgins et al

Funding:

FTB is supported by the Burroughs Wellcome Fund (https://www.bwfund.org/), grant number 1017627. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

The authors have declared that no competing interests exist.

Citation:

Hudgins JD, Porter JJ, Monuteaux MC, Bourgeois FT (2019) Prescription opioid use and misuse among adolescents and young adults in the United States: A national survey study. PLoS Med 16(11): e1002922. https://doi.org/10.1371/journal.pmed.1002922

Author Affiliations:

Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America
Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
Pediatric Therapeutics and Regulatory Science Initiative, Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, United States of America

In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002922

Research Article - Kirkbride et al

Funding:

This work was supported by a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust (http://www.wellcome.ac.uk) and the Royal Society (https://royalsociety.org/) (grant number: 101272/Z/13/Z to JBK), by a John Grace QC Scholarship from Mental Health Research UK (http://www.mentalhealthresearchuk.org.uk/) to JBK/JD, UCLH NIHR Biomedical Research Centre (https://www.uclh.nhs.uk/Research/BRC/) to SH, JD, and JBK, and by a UCL Overseas Research Scholarship (https://www.ucl.ac.uk) to JD. A-CH was supported by Folkhälsomyndigheten (Public Health Agency of Sweden) (https://www.folkhalsomyndigheten.se/) and FORTE (https://forte.se/en/), grant number 2017-00632. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

The authors have declared that no competing interests exist.

Citation:

Harris S, Dykxhoorn J, Hollander A-C, Dalman C, Kirkbride JB (2019) Substance use disorders in refugee and migrant groups in Sweden: A nationwide cohort study of 1.2 million people. PLoS Med 16(11): e1002944. https://doi.org/10.1371/journal.pmed.1002944

Author Affiliations:

Psylife Group, Division of Psychiatry, University College London, London, United Kingdom
Department of Psychosocial Science, University of Bergen, Bergen, Norway
Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden

In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002944

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