Co-Occurring Opioid Use and Depressive Disorders: Patient Characteristics and Co-Occurring Health Conditions

Tormohlen, Kayla N.; Mojtabai, Ramin; Seiwell, Anthony; McGinty, Emma E.; Stuart, Elizabeth A.; Tobin, Karin E.; Troiani, Vanessa

doi:10.1080/15504263.2021.1979349

Cited by 17 publications

(11 citation statements)

References 35 publications

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“…Last, our comorbid affective disorder screening measures, while using established administration instructions and timelines, did not assess whether the patient would've screened positive at other time points in the past-year. As a result, our analysis may underestimate the rates of affective disorders compared to other studies ( 3 , 45 ).…”

Section: Discussionmentioning

confidence: 70%

Comorbid Affective and Substance Use Disorders of Medicaid/Medicare Beneficiaries at an Opioid Treatment Program Serving Small Urban and Rural Communities

et al. 2022

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ObjectivesIdentify rates and correlates of comorbid affective and substance use disorders among an understudied population, Medicaid/Medicare beneficiaries receiving care at an opioid treatment program serving patients from small urban and rural areas. Examine whether past-year non-medical opioid use status differentiates comorbidity status.MethodsA cross-sectional, venue-based design was used to recruit a convenience sample of patients treated with methadone for opioid use disorder. Measures were assessed across three domains: (1) demographic characteristics, (2) opioid use characteristics, and (3) comorbid disorders. Brief validated screeners categorized probable comorbid disorders. Bivariate analyses examined correlates of comorbid disorders and determined variable selection for multivariable analyses.ResultsIn this sample (N = 210; mean age = 38.5 years; female = 62.2%; Non-Hispanic White race/ethnicity = 86.1%), comorbid disorders were common. Rates were as follows: current anxiety (48.1%), depression (41.1%), and PTSD (33.7%), and past-year stimulant (27.6%), marijuana (19.0%), alcohol (14.9%), and sedative (7.6%). In bivariate analyses, past-year non-medical opioid use and a greater accumulation of opioid use consequences were associated with most disorders. When including demographic and opioid use characteristics in multivariable analyses, past-year non-medical opioid use was associated with anxiety, PTSD, stimulant use disorder, and sedative use disorder.ConclusionsFew studies have investigated comorbid disorders among this understudied population. This analysis highlights a high burden, especially for affective disorders. Our findings demonstrate that routine, ongoing assessment of non-medical opioid use may be a promising and feasible strategy to detect patients needing integrated care. Future research should investigate whether changes to assessment protocols at opioid treatment programs in small urban and rural settings facilitate care coordination.

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Section: Discussionmentioning

confidence: 70%

Comorbid Affective and Substance Use Disorders of Medicaid/Medicare Beneficiaries at an Opioid Treatment Program Serving Small Urban and Rural Communities

et al. 2022

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“…Such dysregulated functioning of the LC‐NA system lasts long after a user has stopped consuming opioids suggesting that such alterations are a risk factor not only for the initiation and maintenance of opioid use but also for relapse 17,18 . Further, the brainstem noradrenergic systems seem to be implicated in the development of anxiety and depression, 35 which are also two of the most recurrent affective symptoms described in OUD 36 and chronic stress 37 . Withdrawal symptoms associated with OUD can increase anxiety and trigger the onset of panic attacks.…”

Section: Shared Neurobiological and Cognitive Facets Of Oud And Atvnsmentioning

confidence: 99%

Regaining control over opioid use? The potential application of auricular transcutaneous vagus nerve stimulation to improve opioid treatment in China

Colzato,

Elmers,

et al. 2023

Addiction Biology

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Opioid use disorder (OUD) is a critical problem in China and is accompanied by depression and deficits in cognitive control. In China, the most successful intervention for OUD is the community drug rehabilitation where methadone maintenance treatment (MMT) plays a key role. Even though methadone for the treatment of OUD can be helpful, it can cause severe somatic side‐effects, which limit its effectivity. Even worse, it can have detrimental effects on cognitive control, which is crucial to regain control over drug intake. Here, we consider the potential use of auricular transcutaneous vagus nerve stimulation (atVNS) as an addition to MMT for opioid withdrawal treatment. Compared to other non‐invasive brain stimulation methods, atVNS also targets the locus coeruleus (LC) important for noradrenaline (NA) synthesis. NA is an essential neurotransmitter impacted in opioid withdrawal and also critically involved in cognitive control processes. Its ADD‐ON to MMT might be a useful mean to improve mood and enhance cognitive control processes impacted in OUD. We discuss the translational advantages of atVNS in China such as the cultural acceptance of the modality of treatment similar to electroacupuncture. Additionally, the wearability of the ear electrode and at‐home self‐administration without intense medical supervision makes of atVNS a useful tool to enhance clinical and cognitive outcomes especially in everyday life situation. We discuss how atVNS can be integrated in tele‐medical health approaches allowing that innovative treatments can widely be disseminated and continued even in situations of restricted medical access.

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“…Understanding the complex nature of healthcare engagement for PWID is essential to improve health outcomes and decrease the cost burden on health systems, particularly accounting for cooccurring mental health diagnoses (Tormohlen et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Understanding healthcare engagement for people who inject drugs

Heidari,

Winiker,

Dangerfield

et al. 2023

Research in Nursing & Health

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People who inject drugs (PWID) are at an increased risk of multimorbid mental health and chronic diseases, which are frequently underdiagnosed and under‐treated due to systemic barriers and ongoing substance use. Healthcare engagement is essential to address these conditions and prevent excess morbidity and mortality. The goal of this study was to understand how PWID engage in care for their chronic health conditions and substance use treatment given the known historic and pervasive barriers. We conducted 24 semistructured qualitative interviews informed by the Behavioral Model for Vulnerable Populations between July–September 2019. Participants were sampled across a range of comorbidities, including co‐occurring mental health disorders. Thematic analysis was conducted to explore experiences of healthcare engagement for multimorbid chronic diseases, mental health, and treatment for substance use disorder. Mean age for participants was 58 years; 63% reported male sex and 83% reported Black race. Interviews yielded themes regarding healthcare access and wraparound services, positive patient–provider relationships, service integration for substance use treatment and mental health, healthcare needs alignment, medication of opioid use disorder stigma, and acceptance of healthcare. Taken together, participants described how these themes enabled healthcare engagement. Engagement in care is crucial to support health and recovery. Clinical implications include the importance of strengthening patient–provider relationships, encouraging integration of medical and mental health services, and counseling on substance use treatment options in a non‐ stigmatizing manner. Additionally, policy to reimburse wrap‐around support for substance use recovery can improve care engagement and outcomes related to chronic diseases, mental health, and substance use among PWID.No Patient or Public Contribution: While we acknowledge and thank ALIVE participants for their time for data collection and sharing their perspectives, no ALIVE participants, other people who use drugs, and service users were involved in data collection, analysis or interpretation of data, or in preparation of the manuscript.

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Co-Occurring Opioid Use and Depressive Disorders: Patient Characteristics and Co-Occurring Health Conditions

Cited by 17 publications

References 35 publications

Comorbid Affective and Substance Use Disorders of Medicaid/Medicare Beneficiaries at an Opioid Treatment Program Serving Small Urban and Rural Communities

Comorbid Affective and Substance Use Disorders of Medicaid/Medicare Beneficiaries at an Opioid Treatment Program Serving Small Urban and Rural Communities

Regaining control over opioid use? The potential application of auricular transcutaneous vagus nerve stimulation to improve opioid treatment in China

Understanding healthcare engagement for people who inject drugs

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