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.

Automated pupillometry may be helpful in opioid agonist therapy dosing for opioid use disorder

1. In this study, automated pupillometry demonstrated a significant change in mean pupil size detected withing 15 minutes of opiate agonist therapy dosing amongst patients treated for opioid use disorder.

2. This study also found that there may be a threshold change in pupil size that may indicate good withdrawal symptom control.

Evidence Rating Level: 3 (Average)

Many patients with opioid use disorder (OUD) find it difficult to manage due to withdrawal symptoms; thus, the dosage of opioid agonist therapy (OAT) needed to control withdrawal symptoms is an important question. Current protocols use the validated Clinical Opiate Withdrawal Scale (COWS), which includes a measurement of pupil size that has low precision and high interobserver variability. More precise measures of pupil size and reactivity could help eliminate this high interobserver variability. As such, this pilot study examined whether automated pupillometry may be more accurate in helping quantify opioid withdrawal amongst patients receiving OAT

This pilot study included patients aged 18-50 with OUD who were admitted to Boston Medical Center, Boston, Massachusetts, United States of America and received recommendations on OAT from the inpatient Addiction Consult Service between March and December 2018. Urine toxicology screening was performed to confirm opioid use. Participants were included if they consented to the pupillometry measurements, which were performed with the NeurOptics NPi-200 (n=27). Measured variables included pupil sizes (in light and dark illumination), latency of the pupillary light response, and percent constriction at varying timepoints pre-and post-OAT.

The analyses demonstrated a small but significant change in pupil size within 15 minutes of OAT administration when measured by the automated pupillometer, which persisted at later timepoints. Additionally, patients with well-controlled withdrawal symptoms had a significantly greater change in pupil size 60 minutes after OAT dosing compared to patients with high (therefore worse) COWS scores. This indicated there may be a threshold change in pupil size that corresponds with good symptom control. However, this pilot study was limited due to its small sample size which did not allow for sub-group analyses. Despite these limitations, this study demonstrated the potential viability of automated pupillometry in OAT dosing as a quantitative measure of withdrawal symptoms.

COVID-19 shutdown may have decreased gambling rates in Australia

1. In this study, many individuals in Australia decreased their gambling activity when there were venue-based gambling restrictions due to COVID-19.

2. However, some individuals who engaged in moderate-risk gambling were more likely to report increased gambling frequency.

Evidence Rating Level: 3 (Average)

Due to COVID-19 restrictions, many gambling venues were ordered to close to reduce spread of the virus. In Australia, in-person gambling still accounts for the majority of the country’s gambling, despite increases in online gambling over the past several years. Thus, the COVID-19 restrictions led to an unexpected decrease in access to gambling. Thus far, the influence of these restrictions on gambling patterns have not been explored, which this study sought to address.

This study administered an online survey to Australian adult participants (18+ years old) who had gambled at least once in the last 12 months to ask participants about their gambling habits (n = 769 respondents). A convenience sample was obtained by posting notices on various websites and through email. Participants were excluded if they returned incomplete responses to any questions. Measured variables included gambling frequency, gambling expenditure, and psychological distress (measured through the K6 screening tool).

From the analyses, participants reported a significant median reduction in gambling during the shutdown period, which was expected given lack of access. Interestingly, rates of online gambling did not increase for most individuals, indicating some moderation of behavior. However, approximately 14% of participants reported an increased rate of gambling. Additionally, psychological distress was not associated with amount of gambling. This study did have several limitations, such as its small sample size and its use of a convenience sample. Despite these limitations, this study furthered our understanding of gambling patterns during COVID-19.

Logistical barriers may impact access to contraceptive use amongst females with opioid use disorder

1. Females with opioid use disorder have many logistical barriers to accessing contraceptives, including homelessness and lack of transportation.

2. This study found accessing contraceptives at syringe exchange programs may be one avenue to provide contraceptive care in this population. 

Evidence Rating Level: 3 (Average)

Compared to the general United States population, women who have opioid use disorder (OUD) are far more likely to have unintended pregnancies. Almost 90% of pregnancies of women with OUD are unintended. Prior research has suggested that these individuals are much less likely to use contraceptive methods, such as condoms. However, prior research has not explored the reasons for such disparities in contraceptive methods.

This study used a sample recruited from a volunteer-run non-profit syringe exchange program (SEP) in Santa Ana, California, United States of America between March and December 2019. Participants were included if they were aged 18-45, used injection drugs, spoke English or Spanish, and did not intend to become pregnant (n=14). Interviews were conducted with the participants. This qualitative study assessed outcomes related to patient experiences with contraception, past experiences with health care providers, and ability to obtain contraceptives.

From the interviews, most participants noted that contraception was not a main priority during periods of substance abuse. Participants also noted logistical barriers, including homelessness, lack of transportation, and lack of insurance as a financial barrier to contraception. Several participants additionally believed they could not become pregnant while using substances due to the lack of menstrual periods. Participants did note that they would probably use contraceptives if they were more readily accessible and incorporated as another service at syringe exchange programs. This study did have several limitations, notably its small sample size, homelessness as a potential confounding variable, and social desirability bias. Despite these limitations, this study furthered our understanding of barriers to contraceptive use in this population.

Image: PD 

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