Pilot Outcome Results of Culturally Adapted Evidence-Based Substance Use Disorder Treatment with a Southwest Tribe

INTRODUCTION:

Although American Indians/Alaska Natives (AI/ANs) have exhibited high rates of alcohol and drug use disorders, there is a paucity of substance use disorder treatment outcome research. In addition, there exists controversy about whether evidence-based treatments (EBTs) are culturally appropriate given they were derived mainly by and for non-Hispanic White populations and do not explicitly include aspects of AI/AN culture and worldview.

METHODS:

In this pilot study, we collaboratively culturally adapted two EBTs, Motivational Interviewing and Community Reinforcement Approach (MICRA), and evaluated substance use and psychological outcomes at 4- and 8-months post baseline assessment. In preparation for a larger randomized clinical trial (RCT), eight tribal members (75% male) participated in this pilot treatment study. Measures included substance use, urine screens, self-efficacy, psychological distress, and hopelessness. All participants completed follow-up assessments at 4- and 8-months. Due to small sample size, effect sizes were calculated to evaluate outcomes pre- and post-treatment.

RESULTS:

Despite high rates of abstinence at baseline, percent days abstinent (PDA) increased at the 8-month time point for the most commonly used substances (alcohol, Hedges's g = 0.59, and marijuana, g = 0.60) and for all substances combined (excluding tobacco, g = 0.56). Improvements in psychological distress (g = -0.66) and 5 of the 7 Addiction Severity Index domains (range of g = -0.42 to -0.98) also emerged.

CONCLUSIONS:

Results suggest that culturally adapted EBTs yield significant improvements in alcohol use, psychological distress, and legal problems among AI/ANs. Future research using RCT methodology is needed to examine efficacy and effectiveness.

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By:  Venner KL1, Greenfield BL2, Hagler KJ1, Simmons J3, Lupee D4, Homer E4, Yamutewa Y4, Smith JE3.

• 1University of New Mexico, Department of Psychology, 1 University of New Mexico, MSC 03 2220, Albuquerque, NM 87131; Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale Blvd. SE, Albuquerque, NM 87106.
• 2University of Minnesota, Duluth, 1049 University Dr, Duluth, MN 55812.
• 3University of New Mexico, Department of Psychology, 1 University of New Mexico, MSC 03 2220, Albuquerque, NM 87131.
• 4Anonymous Tribal Agency. 
• Addict Behav Rep. 2016 Jun 1;3:21-27.

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Psychiatric Disorders Are Overlooked in Patients with Drug Abuse

INTRODUCTION:

Psychiatric disease is overlooked in drug users. Patients with both drug abuse and a psychiatric disease - dual diagnosis - suffer decreased compliance to treatment and decreased life expectancy compared with single-diagnosis patients. Identifying the patients among either drug addicts or mentally ill patients is difficult.

METHODS:

All drug addicts autopsied at the Department of Forensic Medicine, University of Copenhagen, Denmark, in the years 1992, 2002 and 2012 were included. The group was divided into two subpopulations of possible dual diagnosis patients either according to police reports stating mental illness or to psychotropics found in the toxicology screening after autopsy.

RESULTS:

We found a rise in possible mental illness in both subpopulations in the study period. Drug addicts with psychotropics in the blood at the time of death increased from 3.1% in 1992 to 48.1% in 2012, and this group was significantly younger at the time of death than those without psychotropics in the blood.

CONCLUSIONS:

Suspected dual diagnosis patients have increased in number. They die earlier than their drug addict counterparts. Methadone remains the leading cause of death in all subpopulations. Possible causes are misuse of treatment and/or illegally bought methadone, wrongly assigned cause of death due to unknown tolerance and/or polydrug toxicity in combination with psychotropic medicine.

Full PDF article at:   http://goo.gl/G7u3m5

By:  Kruckow L1, Linnet K, Banner J.

• 1line.kruckow@sund.ku.dk. 

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Parental Criminal Justice Involvement and Children's Involvement with Child Protective Services: Do Adult Drug Treatment Courts Prevent Child Maltreatment?

BACKGROUND:

In light of evidence showing reduced criminal recidivism and cost savings, adult drug treatment courts have grown in popularity. However, the potential spillover benefits to family members are understudied.

OBJECTIVES:

To examine: (1) the overlap between parents who were convicted of a substance-related offense and their children's involvement with child protective services (CPS); and (2) whether parental participation in an adult drug treatment court program reduces children's risk for CPS involvement.

METHODS:

Administrative data from North Carolina courts, birth records, and social services were linked at the child level. First, children of parents convicted of a substance-related offense were matched to (a) children of parents convicted of a nonsubstance-related offense and (b) those not convicted of any offense. Second, we compared children of parents who completed a DTC program with children of parents who were referred but did not enroll, who enrolled for <90 days but did not complete, and who enrolled for 90+ days but did not complete. Multivariate logistic regression was used to model group differences in the odds of being reported to CPS in the 1 to 3 years following parental criminal conviction or, alternatively, being referred to a DTC program.

RESULTS:

Children of parents convicted of a substance-related offense were at greater risk of CPS involvement than children whose parents were not convicted of any charge, but DTC participation did not mitigate this risk. Conclusion/Importance: The role of specialty courts as a strategy for reducing children's risk of maltreatment should be further explored.

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By:  Gifford EJ1, Eldred LM2, Sloan FA2, Evans KE1.

• 1 Center for Child and Family Policy , Duke University , Durham , North Carolina , USA.
• 2 Department of Economics , Duke University , Durham , North Carolina , USA.
• Subst Use Misuse. 2016 Jan 20:1-14 

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Shifting Sands: Cocaine's New Routes into Europe

More at:  http://goo.gl/MymgS7

 

Risk Factors of Prescription Opioid Overdose among Colorado Medicaid Beneficiaries

Highlights

• This article presents the risk factors of opioid overdose among the Colorado Medicaid population.
• Six factors were associated with opioid overdose including mean morphine dose equivalent (>50 mg/day), methadone use, drug/alcohol abuse, psychiatric illness, benzodiazepine use, and the number of different pharmacies used by the beneficiary.
• States and communities should ensure the availability of at-home intra-nasal naloxone for overdose rescue based on the presence of risk factors.

This study aims to determine risk factors of opioid overdose among the Colorado Medicaid population. A retrospective nested case-control study was undertaken. Medicaid beneficiaries who had a medical claim(s) for an emergency department visit or a hospitalization associated with an opioid overdose from July 2009 to June 2014 were defined as cases. Controls were selected using a nearest neighbor matching without replacement. The matched controls were selected based on age, gender, and opioid prescription. One case was matched with three controls. Multivariate conditional logistic regression was used to compare risk factors. 

A total of 816 cases with 2,448 controls were included. Six factors were associated with opioid overdose: mean morphine dose equivalent (>50 mg/day), methadone use (switching opioid to methadone vs. no methadone use), drug/alcohol abuse, other psychiatric illness, benzodiazepine use, and the number of pharmacies utilized by the beneficiary (≥4 pharmacies vs. 1 pharmacy). 

In conclusion, several factors are associated with opioid overdose. States and communities should ensure the availability of at-home intra-nasal naloxone for overdose rescue based on the presence of risk factors.

PERSPECTIVES:

This article presents the risk factors of opioid overdose among Colorado Medicaid population. Based on study findings, Colorado Medicaid is currently working with physicians, hospitals, and other health-system stakeholders to continue develop policies to identify and assist this subset of our population. One such policy will be to provide intranasal naloxone for overdose rescue.

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By:   Dilokthornsakul P1, Moore G2, Campbell JD2, Lodge R3, Traugott C3, Zerzan J3, Allen R4, Page RL 2nd2.

• 1Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences (http://www.ucdenver.edu/academics/colleges/pharmacy/Pages/SchoolofPharmacy.aspx), University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand. Electronic address: piyamethd@gmail.com.
• 2Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
• 3Department of Health Care Policy and Financing, State of Colorado.
• 4Peak Statistical Services, Evergreen, CO, USA.
• J Pain. 2015 Dec 22. pii: S1526-5900(15)00985-2. doi: 10.1016/j.jpain.2015.12.006.
• 
  
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Arsonists and Violent Offenders Compared: Two Peas in a Pod?

Arsonists are considered a type of violent offender by some and a distinct group of offenders by others. Assuming the latter could be beneficial to offer tailor-made psychotherapeutic treatment to these offenders. 

The present study investigated whether arsonists (n = 55) and violent offenders (n = 41) are differentiable regarding several demographic and personal characteristics, and criminal career. 

Results indicated that arsonists were significantly more often diagnosed with a Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis II disorder, and more socially isolated and lacking coping skills. 

Violent offenders, on the other hand, demonstrated more drug abuse/dependence, a younger age at the first manifestation of antisocial behavior, a more extensive criminal history and higher percentage of recidivism. 

In light of these results, it is conceivable that arsonists could benefit from a slightly different treatment approach, for example, with more attention to relational and emotion regulation skills.

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By:   Wilpert J¹, van Horn J², Eisenberg M².

¹De Forensische Zorgspecialisten [The Forensic Care Specialists], Utrecht, The Netherlands jwilpert@dfzs.nl.

²De Forensische Zorgspecialisten [The Forensic Care Specialists], Utrecht, The Netherlands. 

Int J Offender Ther Comp Criminol. 2015 Dec 31. pii: 0306624X15619165.

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Environmental Clustering of Drug Abuse in Households & Communities: Multi-Level Modeling of a National Swedish Sample

Both epidemiological and genetically informative studies indicate that shared environmental influences contribute to resemblance in siblings for drug abuse (DA). To what degree do these influences arise from living in the same household versus residing in the same community?

We performed a cross-classified multi-level logistic regression on all individuals born in Sweden 1975-1990 (N = 1558,654). We assessed the proportion of the total population variation in DA that was due to household versus community effects controlling for genetic resemblance. DA was assessed from medical, criminal and pharmacy records.

Expressed as an intraclass correlation (ICC), the combined household/community effects accounted for ~8 % of the total population variation in DA. The variance attributed to the community was greater than that seen for household (4.5 versus 3.4 %). In males, the variance components were slightly larger and nearly equal at the community (5.3 %) and household level (5.1 %). In females, household effects (4.8 %) were stronger than those arising from the community (3.2 %).

In the total population and among males, community effects on DA were somewhat more potent than household effects. However, in females, household effects on DA were stronger than community effects. In Sweden, shared environmental effects for DA arise both at the household and at the community level. Community effects on DA are more potent in males than in females.

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By:   Kendler KS1, Ohlsson H, Sundquist K, Sundquist J.

• 1Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Box 980126, Richmond, VA, 23298-0126, USA, kendler@vcu.edu. 

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Exposure to Peer Deviance During Childhood & Risk for Drug Abuse: A Swedish National Co-Relative Control Study

Peer deviance (PD) is associated with risk for drug abuse (DA). Is this association causal?

DA was recorded in official records. PD was defined as the percentage of peers residing in small communities with future DA registrations. We examined offspring in families whose community PD changed when the offspring was 0-15 years of age and then examined families where cousins or siblings differed in their years of exposure to low or high PD communities.

The duration of exposure to PD was strongly associated with future DA. Co-relative analyses for families whose exposure to PD declined suggested that the PD-DA association was largely non-causal. Within full-sibling pairs in such families, the length of exposure to low PD environments was unrelated to risk for DA. By contrast, co-relative analyses in families where exposure to PD increased over time indicated that the PD-DA association was largely causal. In such families, siblings who differed in the duration of their exposure to high PD differed in their risk for subsequent DA. These results were replicated in families whose PD changed because they moved or because of changes in the community in which they resided.

Within families whose social environment is improving over time, the association between PD exposure and offspring DA outcomes is not causal but is due to familial confounding. Within families whose social environment is deteriorating, the PD-DA association seems to be largely causal. Our measure of PD may also reflect broader aspects of the community environment beyond peers.

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By:  Kendler KS1, Ohlsson H2, Mezuk B1, Sundquist K2, Sundquist J2.

• 1Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University,Richmond,VA,USA.
• 2Center for Primary Health Care Research,Lund University,Malmö,Sweden. 

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Mucociliary Dysfunction in HIV & Smoked Substance Abuse

Impaired mucociliary clearance (MCC) is a hallmark of acquired chronic airway diseases like chronic bronchitis associated with chronic obstructive pulmonary disease (COPD) and asthma. This manifests as microbial colonization of the lung consequently leading to recurrent respiratory infections. 

People living with HIV demonstrate increased incidence of these chronic airway diseases. Bacterial pneumonia continues to be an important comorbidity in people living with HIV even though anti-retroviral therapy has succeeded in restoring CD4+ cell counts. People living with HIV demonstrate increased microbial colonization of the lower airways. The microbial flora is similar to that observed in diseases like cystic fibrosis and COPD suggesting that mucociliary dysfunction could be a contributing factor to the increased incidence of chronic airway diseases in people living with HIV. 

The three principal components of the MCC apparatus are, a mucus layer, ciliary beating, and a periciliary airway surface liquid (ASL) layer that facilitates ciliary beating. Cystic fibrosis transmembrane conductance regulator (CFTR) plays a pivotal role in regulating the periciliary ASL. HIV proteins can suppress all the components of the MCC apparatus by increasing mucus secretion and suppressing CFTR function. This can decrease ASL height leading to suppressed ciliary beating. The effects of HIV on MCC are exacerbated when combined with other aggravating factors like smoking or inhaled substance abuse, which by themselves can suppress one or more components of the MCC system. 

This review discusses the pathophysiological mechanisms that lead to MCC suppression in people living with HIV who also smoke tobacco or abuse illicit drugs.

Below:  (A) HIV Tat induces expression of TGF-β1 mRNA with a concomitant decrease in CFTR mRNA levels. NHBE ALI cultures re-differentiated at the air liquid interface were treated with recombinant Clade B Tat (10 nM: *p < 0.05) apically and basolaterally. Total RNA was isolated and TGF-β1 and CFTR mRNA levels were quantitated by qRT-PCR. HIV Tat induces almost a 1.7-fold increase in TGF-β1 mRNA expression. This translates to a significant decrease in CFTR mRNA levels. Data are mean ± SE of three experiments from three different lungs. (B) Nationwide trends in Cigarette smoking and drug abuse in general population compared with people living with HIV. While the trend in addiction is similar between the two, the proportion of people living with HIV who smoke cigarettes or abuse street drugs is significantly than that observed in the general population. Cigarette smoking is the most prevalent addiction [62.5% smokers (Benard et al., 2007; Lifson et al., 2010; Lifson and Lando, 2012) compared to 17.8% nationwide], followed by Marijuana [29% (Woolridge et al., 2005) compared to 7.5% nationwide], Cocaine [22.5% (Hinkin et al.,2004) compared to 0.6% nationwide] and methamphetamine [11% (Mitchell et al., 2006) compared to 0.2% nationwide]. The data for substance abuse in the general population is obtained from http://www.drugabuse.gov/national-survey-drug-use-health.

Below:  Schematic model of HIV and substance abuse induced Mucociliary dysfunction. HIV Tat and Cigarette smoke can inhibit CFTR biogenesis and function. HIV Tat increases TGF-β1 mRNA levels with a corresponding decrease in CFTR mRNA. Cigarette smoke can suppress CFTR biogenesis by TGF-β1 signaling or directly inhibit CFTR function by trapping surface CFTR in aggregosomes. Cigarette smoke, marijuana and cocaine can also inhibit the Ciliary component of MCC by decreasing CBF or ciliostasis (by cocaine). Marijuana smoking can lead to a loss of ciliated cells in the airway epithelium. The effects of these drugs on the ciliary component can synergize with the effects of HIV Tat mediated suppression of CFTR leading to a pronounced suppression of MCC. A combination of HIV gp120, Cigarette smoke and/or Marijuana can also promote mucus hypersecretion in the milieu where CFTR function is already attenuated by Tat and cigarette smoke leading to Dysregulation of all the principal components of the MCC system. Dysregulation of one or more components of the MCC system will lead to mucus impaction and microbial colonization. Pharmaceutical drugs that increase intracellular cAMP by either activating cyclase or inhibiting phosphodiesterase when used in combination with CFTR potentiators like Ivacaftor can restore one or more components of the MCC and repair the mucociliary dysfunction.

Full article at:  http://goo.gl/q4vIqB

By: Srinivasan Chinnapaiyan and Hoshang J. Unwalla^*

Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA

Edited by: Pankaj Seth, National Brain Research Centre, India

Reviewed by: Hidekatsu Iha, Oita University, Japan; Yoshitaka Sato, Nagoya University Graduate School of Medicine, Japan

*Correspondence: Hoshang J. Unwalla, Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, AHC-1 #421, Miami, FL 33199, USA ; Email: ude.uif@allawnuh

  

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Substance Abuse & Batterer Programs in California, US: Factors Associated with Treatment Outcomes

The association between substance abuse and intimate partner violence is quite robust. A promising area to improve treatment for the dual problems of substance abuse and violence perpetration is the identification of client characteristics and organisational and program factors as predictors of health outcomes. 

Therefore, we examined associations of client, organisational and program factors with outcomes in community health settings. Directors of 241 substance use disorder programs (SUDPs) and 235 batterer intervention programs (BIPs) reported outcomes of program completion and substance use and violence perpetration rates at discharge; data collection and processing were completed in 2012. SUDPs having more female, non-white, younger, uneducated, unemployed and lower income clients reported lower completion rates. 

In SUDPs, private, for-profit programs reported higher completion rates than public or private, non-profit programs. SUDPs with lower proportions of their budgets from government sources, and higher proportions from client fees, reported better outcomes. Larger SUDPs had poorer program completion and higher substance use rates. Completion rates in SUDPs were higher when clients could obtain substance- and violence-related help at one location, and programs integrated violence-prevention contracting into care. In BIPs, few client, organisational and programme factors were associated with outcomes, but the significant factors associated with programme completion were consistent with those for SUDPs. 

Publicly owned and larger programs, and SUDPs lacking staff to integrate violence-related treatment, may be at risk of poorer client outcomes, but could learn from programmes that perform well to yield better outcomes.

Below:  Determinants and outcomes of SUDP and BIP linkages. SUDP, substance use disorder programme; BIP, batterer intervention programme; SES, socioeconomic status.

Full article at: http://goo.gl/yACbQg

By: Timko C1, Valenstein H2, Stuart GL3, Moos RH1.

• 1Center for Innovation to Implementation, Department of Veterans Affairs Health Care System and Stanford University Medical Center, Palo Alto, California, USA.
• 2Department of Psychology, University of Washington, Seattle, Washington, USA.
• 3Department of Psychology, University of Tennessee-Knoxville, Knoxville, Tennessee, USA.

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Experiences of Violence & Association with Decreased Drug Abstinence among Women in Cape Town, South Africa

Drug abuse is a contributing factor in women's HIV risk in low-income communities in Cape Town, South Africa. This study assessed whether experiencing violence is associated with reduced drug abstinence among adult women (n = 603) participating in a randomized field trial for an HIV prevention study in Cape Town. 

In relation to drug abstinence at 12-month follow-up, multivariable regression models were used to assess

1. baseline partner and non-partner victimization, and 
2. victimization at 12-month follow-up among participants reporting baseline victimization. 

Baseline partner and non-partner victimization were associated with a reduced likelihood of drug abstinence at follow-up. Among participants who reported victimization at baseline, those no longer reporting victimization at follow-up did not differ significantly in drug abstinence compared with those who reported victimization at follow-up. 

The study findings highlight the lasting impact of victimization on women's drug use outcomes, persisting regardless of whether violence was no longer reported at follow-up. Overall, the findings support the need for the primary prevention of violence to address the cycle of violence, drug use, and HIV among women in this setting.

Via:  http://ht.ly/SS83Z Purchase full article at: http://goo.gl/m5f8Wb

By:  Reed E1, Myers B, Novak SP, Browne FA, Wechsberg WM.

1Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, Mail code 0507, La Jolla, CA, 92093, USA

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Can’t Buy My Love: A Typology of Female Sex Workers’ Commercial Relationships in the Mexico–U.S. Border Region

Female sex workers (FSWs) experience elevated risk for HIV and sexually transmitted infections (STIs) through unprotected sex with male clients, yet the complexity of these commercial relationships remains understudied. From 2010 to 2011, we explored FSWs’ conceptualizations of various client types and related risk behavior patterns using semistructured interviews with 46 FSWs in Tijuana and Ciudad Juarez, Mexico, where FSWs’ HIV/STI prevalence is increasing. 

Our grounded theory analysis identified four types of commercial relationships: 

1. nonregular clients, 
2. regular clients and friends, 
3. clients who “fell in love” with FSWs, 
4. and long-term financial providers who often originated from the United States. 

As commercial relationships developed, clients’ social and emotional connections to FSWs increased, rendering condom negotiation and maintaining professional boundaries more difficult. Drug abuse and poverty also influenced behaviors, particularly in Ciudad Juárez, where lucrative U.S. clients were increasingly scarce. While struggling to cultivate dependable relationships in a setting marked by historical sex tourism from a wealthier country, some FSWs ceased negotiating condom use. 

We discuss the need for HIV/STI research and prevention interventions to recognize the complexity within FSWs’ commercial relationships and how behaviors (e.g., condom use) evolve as relationships develop through processes that are influenced by local sociopolitical contexts and binational income inequality.

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By: Angela M. Robertson, Jennifer L. Syvertsen, Hortensia Amaro, Gustavo Martinez, M. Gudelia Rangel, Thomas L. Patterson, and Steffanie A. Strathdee
Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507

Women, Drug Dependency and Consequences: A Study from a Developing Country (Iran)

Below:  Percentage of extramarital sexual relations in all substance dependent women based on marital status

Below:  Percentage of condom usage in sexual relations in three groups

Below:  Type of abused drugs based on having or not having an extramarital sexual relation

Introduction. Addiction in women can expose them to malnutrition, high blood pressure, cancer, and some other dangerous diseases like hepatitis, AIDS, or other sexual transmitted diseases. The aim of this study was to assess illegal sexual relations in three groups of women. 

Methods. This is a cross-sectional study that was done on 236 girls and young women aged 16–25 years in 2012 in three groups: vulnerable women who have substance dependency (crimes that had made women incarcerated were considered as vulnerability in this study), invulnerable women who have substance dependency (substance dependent women without a history of incarceration), and a control group (women with no history of substance dependency or being in prison).

Results. 43.8% of vulnerable women who have substance dependency had extramarital sexual relations; this percentage was 55.8% in invulnerable women who have substance dependency and 1.4% in the control group. Crystal and methamphetamine abuse was higher in addicts who had extramarital sexual relations and alcohol abuse was correlated with unsafe sexual intercourse (r = 0.36, P = 0.001). There was a statistically significant difference in extramarital sexual relation based on marital status (P < 0.001). 

Conclusions. Poverty, drug dependency, divorce, and alcohol consumption make women prone to other high risk behaviors that need more attention.

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Fuelling the Epidemics: Challenges Facing HIV, Hepatitis C and Opioid Treatment Services Programmes for PWID in Eastern Ukraine

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The Canary in the Coal Mine Tweets: Social Media Reveals Public Perceptions of Non-Medical Use of Opioids

Below:  Conceptual Framework for Categorizing Twitter Messages Containing Personal Experiences and General Perceptions

Below:  Author of Twitter Messages (individuals, organizations, news outlets, other (user name contained search terms, foreign languages, references to non-opioids)

We reviewed 540 messages, of which 375 (69%) messages were related to opioid behaviors. Of these, 316 (84%) originated from individual user accounts; 125 messages expressed personal experience with opioids. The majority of personal messages referenced using opioids to obtain a “high”, use for sleep, or other non-intended use (87,70%). General attitudes regarding opioid use included positive sentiment (52, 27%), comments on others peoples opioid use (57, 30%), and messages containing public health information or links (48, 25%).

In a sample of social media messages mentioning opioid medications, the most common theme amongst English users related to various forms of opioid misuse. Social media can provide insights into the types of misuse of opioids that might aid public health efforts to reduce non-medical opioid use.

Read more at:   http://goo.gl/ngfokf  HT @UCSF