This study examined the state of the literature on the effectiveness of medication assisted treatment (MAT; methadone, buprenorphine, naltrexone) delivered in prisons and jails on community substance use treatment engagement, opioid use, recidivism, and health risk behaviors following release from incarceration. Randomized controlled trials (RCTs) and quasi-experimental studies published through December 2017 that examined induction to or maintenance on methadone (n=18 studies), buprenorphine (n=3 studies), or naltrexone (n=3 studies) in correctional settings were identified from PsycINFO and PubMed databases. There were a sufficient number of methadone RCTs to meta-analyze; there were too few buprenorphine or naltrexone studies. All quasi-experimental studies were systematically reviewed. Data from RCTs involving 807 inmates (treatment n = 407, control n = 400) showed that methadone provided during incarceration increased community treatment engagement (n=3 studies; OR = 8.69, 95% CI = 2.46; 30.75), reduced illicit opioid use (n=4 studies; OR = 0.22, 95% CI = 0.15; 0.32) and injection drug use (n=3 studies; OR = 0.26, 95% CI = 0.12; 0.56), but did not reduce recidivism (n=4 studies; OR = 0.93, 95% CI = 0.51; 1.68). Data from observational studies of methadone showed consistent findings. Individual review of buprenorphine and naltrexone studies showed these medications were either superior to methadone or to placebo, or were as effective as methadone in reducing illicit opioid use post-release. Results provide the first meta-analytic summary of MATs delivered in correctional settings and support the use of MATs, especially with regard to community substance use treatment engagement and opioid use; additional work is needed to understand the reduction of recidivism and other health risk behaviors.

Patients with Fanconi anemia (FA) have increased risk for head and neck squamous cell carcinoma (HNSCC). We sought to determine the prevalence of undiagnosed FA and FA carriers in patients with HNSCC and an age cutoff for FA genetic screening. Screening germline DNA from 417 HNSCC patients under age 50 revealed 194 FA gene variants in 185 patients (44%). The variant spectrum was comprised of 183 nonsynonymous point mutations, nine indels, one large deletion, and one synonymous variant predicted to effect splicing. 108 patients (26%) had at least one rare variant predicted to be damaging, and 57 (14%) had at least one rare variant predicted to be damaging and previously reported. Fifteen patients carried two rare variants, or an X-linked variant, in an FA gene. Overall, we did not identify an age cutoff for FA screening among young HNSCC patients, as there were no significant differences in mutation rates when patients were stratified by age, tumor site, ethnicity, smoking status, or human papillomavirus status. However, we observed an increased burden, or mutation load, of FA gene variants in FANCD2, FANCE, and FANCL in our HNSCC patient cohort relative to the 1000 Genomes population. FANCE and FANCL, components of the core complex, are known to be responsible for the recruitment and ubiquitination, respectively, of FANCD2, a critical step in the FA DNA repair pathway. FA germline functional variants offer a novel area of study in HNSCC tumorigenesis, and the increased mutation burden of critical genes indicates the importance of the FA pathway in HNSCC.

Background Individuals who report more depressive symptoms consistently demonstrate higher rates of nicotine dependence and less successful smoking cessation than do individuals who report fewer depressive symptoms. Nicotine withdrawal and smoking urges are two potential factors that may account for the differences observed between these two groups. This study assessed whether elevated depression symptoms among nicotine dependent smokers are associated with changes in withdrawal and urges to smoke when undergoing smoking cessation treatment. Method Data on 81 nicotine dependent smokers were collected as part of a smoking cessation randomized trial that compared standard and contingency management treatment across one baseline week and four treatment weeks. Linear mixed model analyses were conducted with high and low depression scores predicting changes in withdrawal and urge ratings from a baseline week and four treatment weeks. Results Participants with elevated depression symptoms reported more intense nicotine withdrawal and smoking urges throughout treatment. Further, participants with greater depressive symptoms exhibited an increase in smoking urges at the start of treatment, compared with a gradual decline in urges among participants with fewer depressive symptoms. Conclusions Smokers with elevated depressive symptoms experience significantly elevated discomfort during smoking cessation efforts in the form of increased withdrawal and craving. This discomfort has the potential to make quitting smoking more difficult. Clinical Trial Identifier: NCT00865254.

The present findings suggest that current negative mood can be a response to the accumulated burden of heroin-use consequences, particularly in the presence of high trait impulsivity.

Background and Purpose Human papillomavirus (HPV)-positive oropharyngeal cancers represent a distinct clinical entity with more favorable prognosis than HPV-negative oropharyngeal cancers. However, among patients with HPV-positive oropharyngeal carcinomas, those with a significant smoking history have a much worse prognosis. Recently, imaging characteristics of oropharyngeal cancers were identified as markers of poor prognosis. The purpose of this study was to determine whether nodal imaging characteristics differ between smokers and never/light smokers with HPV-positive oropharyngeal cancer. Materials and Methods Review of 130 pretreatment CT examinations of HPV-positive oropharyngeal cancers in smokers (>10 pack-years) and never/light smokers (≤10 pack-years) matched for T stage and tumor subsite was performed with the reviewing radiologist blinded to HPV status, smoking history, and clinical stage. An additional 24 pretreatment CT examinations of patients with HPV-negative oropharyngeal cancers were also reviewed in a blinded fashion. Imaging characteristics of metastatic nodal disease were compared using chi-square testing (Fisher exact testing where appropriate) and McNemar chi-square testing for the matched-pair analysis. Results As expected, those with HPV-positive oropharyngeal cancer were more likely to be younger, male, non-Hispanic white, never/former smokers, and never drinkers than those with HPV-negative oropharyngeal cancer. Furthermore, the HPV-positive oropharyngeal cancers were more likely to be in the tonsil, smaller T-category, higher N-category, poorly differentiated, tonsil primaries, smaller T-category, higher N-category, and poorly differentiated than HPV-negative oropharyngeal cancers. However, among the HPV-positive oropharyngeal cancers, we could identify no obvious difference in the pretreatment imaging characteristics of paired smokers and never/light smokers. Conclusions Among patients with HPV-positive oropharyngeal cancer, no imaging characteristics were identified to correlate with the critical prognostic feature smoking status. Cystic and necrotic nodal metastases, as described previously, were more common among patients with HPV-positive than HPV-negative oropharyngeal cancers. While cystic nodal metastases were more common among never/light smokers with HPV-positive oropharyngeal cancer than smokers with HPV-positive oropharyngeal cancer; however, because these results did not reach statistical significance, we conclude that imaging results cannot serve as a surrogate for an HPV-driven phenotype.