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.
1. This quantitative study found that transgender Veterans Health Administration (VA) patients were more likely to use certain drugs than cisgender VA patients.
2. Opioid and sedative use disorder did not differ significantly between transgender and cisgender VA patients.
Evidence Rating Level: 1 (Excellent)
Drug use disorders in the United States (US) are a major problem, especially among vulnerable groups. One example of a vulnerable group is transgender people, defined as people whose genders are different from those assigned at birth. Few studies compare substance use disorder prevalence rates between transgender and cisgender patients, and most of these studies have been small. As the largest national provider of substance use treatment, the US Veterans Health Administration (VA) provides a large dataset to study this important question.
This retrospective quantitative study was a secondary analysis of electronic health record data from the VA Corporate Data Warehouse, which is a parent study examining patterns of alcohol use among transgender versus cisgender VA outpatients from October 1st, 2009 to July 31st,2017. Patients were included if they had a documented alcohol use disorder (n=8,872,793). Patients were excluded if they did not answer all study questions. The measured outcome variables were the documented drug use disorder diagnoses.
Amongst 8,872,793 included patients, 8619 were transgender. From the analyses, the research demonstrated that transgender VA patients were more likely to have amphetamine, cocaine, and cannabis use disorders compared to cisgender patients, but were equally likely to have opioid and sedative use disorders. Furthermore, there was no significant association
with having a mental health condition. This study did have its limitations including possible misclassification of certain transgender patients as well as not distinguishing between men and women. Despite these limitations, this study furthered our understanding of struggles and barriers transgender people may face in regards to substance use disorders.
Nicotine e-cigarettes may help young adults stop smoking
1. This quantitative study found that nicotine e-cigarettes may be an effective tobacco cessation strategy.
2. However, dual use of e-cigarettes and regular cigarettes may lead to heavier use of both over time.
Evidence Rating Level: 2 (Good)
E-cigarette use in the United States has been rapidly increasing, especially among adults aged 18-25. One commonly cited reason for using e-cigarettes is as a cessation strategy to stop smoking. Prior studies have provided conflicted results on whether this strategy is effective. Furthermore, few studies have focused exclusively on young adults, who are the most common users.
This quantitative study comes from the Smoking Tobacco and Drinking (STAND) study, which was a randomized smoking cessation trial conducted over Facebook by the University of California San Francisco. Participants were included in the data if they were aged 18-25, smoked 4+ days/ week and reported heavy drinking in the past month (N=179). Participants were excluded if they did not complete all subsequent surveys. In the study, participants received daily posts for 90 days and weekly live counselling for 12 weeks. They then completed surveys at baseline, 3, 6, and 12 months regarding their past-month e-cigarette use. The measured outcome variables were abstinence rates and number of cigarettes used per week.
Results indicated over 70% of participants reported dual use of e-cigarette and cigarette smoking. Neither past month tetrahydrocannabinol or nicotine e-cigarette use were associated with smoking cessation or reduction. Amongst participants attempting to quit, use of nicotine e-cigarettes as a cessation strategy was correlated to higher odds of self-reported abstinence. However, dual use of e-cigarettes and regular cigarettes had lower odds of abstinence and may have actually led to increased use of both products. This study was limited in its reliance on self-reported data. Nonetheless, this study furthered our understanding of young adults’ use of e-cigarettes.
1. In this study, a majority of patients with alcohol withdrawal syndrome (AWS) had documented prior alcohol use disorder (AUD) or previous AWS.
2. Factors such as male sex, single relationship status, and homelessness, were associated with increased probability of inpatient AWS.
Evidence Rating Level: 3 (Average)
Excessive alcohol use is a major problem in the United States (US), with approximately 15-20% of patients in general hospitals having an alcohol-related condition. Among this population, one dangerous manifestation is alcohol withdrawal syndrome (AWS), which can lead to brain damage and many other complications. Early treatment for AWS is recommended, but it is unclear how to risk-stratify hospitalized patients, and few studies have examined this.
This retrospective cohort study used electronic health record (EHR) data of veterans receiving Veterans Health Administration care who were hospitalized in 2013. Participants were included in the data if they were admitted for at least 24 hours in acute or intensive care (n=209,151). Participant with multiple admissions were only included once, and participants were excluded if they did not have documented alcohol screening, were transferred from another hospital, did not speak English, or had severe AWS on presentation. Measured variables included demographic and health characteristics, as well as prior-year history of AUD or AWS.
From the adjusted and unadjusted logistic regression models, the study showed that prior AUD or prior AWS were strong independent predictors of inpatient AWS. Several factors were also found to increase the likelihood of AWS, including being single, male, homeless, or having a diagnosis of cirrhosis. Interestingly, psychiatric conditions were not associated with increased likelihood of AWS. This study was limited in that it excluded almost 60% of the initial study population, due to common problems such as inability to speak English. Nonetheless, this study furthered our understanding of those who experience severe AWS.
Image: PD
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